Jimmo Settlement Agreement

The Jimmo Settlement Agreement: What It Means for Medicare Beneficiaries

The Jimmo Settlement Agreement is an important legal decision that impacts Medicare beneficiaries across the country. The agreement clarified and expanded access to necessary care for individuals who require skilled services in order to maintain or improve their condition. This article will provide a brief overview of the Jimmo Settlement Agreement and its significance for those who rely on Medicare for their healthcare needs.

What is the Jimmo Settlement Agreement?

The Jimmo Settlement Agreement is the result of a lawsuit that was filed in 2011 by the Center for Medicare Advocacy and Vermont Legal Aid. The lawsuit challenged the Medicare program`s longstanding practice of only covering services that were deemed to be “medically necessary” for the purpose of improving a patient`s condition. The plaintiffs argued that this practice was in violation of federal law, which requires Medicare to provide coverage for services that are necessary to maintain a patient`s condition or prevent a decline in their health.

After several years of negotiations, the parties involved in the lawsuit reached a settlement agreement in 2013. The agreement clarified that Medicare coverage should not be denied solely on the basis of a patient`s potential for improvement. Rather, coverage should be provided for services that are necessary to maintain a patient`s condition or prevent a decline in their health.

What Does the Jimmo Settlement Agreement Mean for Medicare Beneficiaries?

The Jimmo Settlement Agreement is an important victory for Medicare beneficiaries who require skilled services to maintain their health or prevent a decline in their condition. Prior to the settlement, many beneficiaries were denied coverage for vital services such as physical therapy, occupational therapy, and speech-language pathology because they were not expected to improve. Under the terms of the settlement, beneficiaries have greater access to the care they need to maintain their health and independence.

It is important to note that the Jimmo Settlement Agreement does not mandate coverage for any specific service or treatment. Rather, it clarifies the standard for coverage and requires that Medicare contractors follow this standard when making coverage determinations. Beneficiaries who believe they have been wrongly denied coverage under the terms of the settlement can file an appeal with Medicare.

Conclusion

The Jimmo Settlement Agreement is a landmark legal decision that clarifies and expands access to necessary care for Medicare beneficiaries. It provides important protections for individuals who require skilled services to maintain or improve their condition, and ensures that coverage decisions are based on the need for care rather than the potential for improvement. As a result, beneficiaries have greater access to the care they need to live healthy, independent lives.