Booklet entitled "Medicare & You"
Health Insurance Print

Medicare Fixes Reimbursement for Home Health Services

Call it a win for those 65 and older.  A court has ordered CMS (the Centers for Medicare & Medicaid Services) to clarify that Medicare is required to pay for skilled nursing care and rehabilitation services if the patient needs such services in order to maintain function or to prevent a slow decline or deterioration.

The case dates back to 2011 and is referred to as Jimmo versus Burwell. You might have heard of it as the Jimmo settlement. There was a misunderstanding from the settlement that a patient must improve in order for Medicare to reimburse them for the cost of care.  Its intention may have been to require quality care in order for medical facilities to be paid, but the practicality is that not all patients can improve even with quality care.  

WHAT DOES THIS MEAN TO ME?  First, if your Medicare coverage was denied because the improvement requirement was applied (incorrectly) then you might be able to appeal and be reimbursed. Contact your Medicare health plan (either Medicare Part A or Medicare Advantage) to begin that process.   And second, skilled nursing services and therapy services will be available to you or your family member even if your health has no prospects of improving.