In 2013, a federal district court approved a settlement agreement in a landmark case named Jimmo v. Sebelius. The Jimmo Settlement confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or therapy), not on the individual’s potential for improvement. The Jimmo Settlement and court decisions pertain to Medicare beneficiaries throughout the country. It applies regardless of whether an individual is in traditional Medicare or a Medicare Advantage plan.
The Settlement required the government to conduct an “Educational Campaign” to inform Medicare providers and decision-makers about the Jimmo “clarification” that Medicare-covered skilled services include care that improves, maintains, or slows decline of a patient’s condition. Medicare coverage should not be denied solely because an individual has an underlying condition that won’t get better, such as MS, ALS, Parkinson’s disease, or paralysis.
For more information about the Jimmo Settlement, please visit the following link: https://www.medicareadvocacy.org/medicare-info/improvement-standard/.
To discuss your NJ Medicare matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org. Please ask us about our video conferencing consultations if you are unable to come to our office.
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Elder Care Attorney