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Court motion in Jimmo case urges education

Medical providers and contractors continue to illegally deny Medicare coverage and care based on an “improvement standard” that has been eliminated, according to a March 1 press release by the Center for Medicare Advocacy.

On that date, CMA and Vermont Legal Aid filed a court motion for resolution of noncompliance with the settlement agreement in the landmark case, Jimmo v. Sebelius.

NASW is a member of the Jimmo Implementation Council, convened by the CMA with support from the John A. Hartford Foundation.

The council works to educate key players and the public about the settlement, which invalidates the false but pervasive perception that Medicare beneficiaries must show improvement in order to obtain skilled nursing and therapies (occupational therapy, physical therapy, and speech-language pathology) in home health care, skilled nursing facilities, and outpatient therapies — and, to a lesser extent, in inpatient rehabilitation hospitals.

“Three years after the Jimmo settlement we are still hearing daily about providers who never heard of the case and patients who can’t get necessary care based on an improvement standard,” Judith Stein, co-counsel for the plaintiffs and executive director of the CMA, said in the press release.

By filing the motion, CMA and Vermont Legal Aid are asking the court to order the Centers for Medicare & Medicaid Services to step up its educational efforts related to Jimmo.

“For over two years, we have tried repeatedly to get Medicare to take additional steps to make sure that providers and contractors knew that the days of using an Improvement Standard test have ended but the agency would not do anything,” Gill Deford, director of litigation for CMA and lead counsel for the plaintiffs, stated in the press release.

A representative from CMS said the agency would not comment on ongoing litigation.

At press time, a hearing in the case was set for May 26.

In the meantime, NASW and other members of the Jimmo Implementation Council will continue to spread the word about the Jimmo settlement and its implications, said Chris Herman, senior practice associate at NASW.

“The Jimmo Implementation Council is a valuable resource for social workers, other professionals, beneficiaries — as well as to Medicare provider organizations, contractors, and adjudicators — who seek clear, accurate information on the Jimmo settlement,” Herman said.

To read the press release, visit: medicareadvocacy.org/jimmo-motion-for-resolution-of-non-compliance.

For more about the Jimmo Implementation Council and settlement agreement, visit: medicareadvocacy.org/jimmo-implementation-council.

From the June 2016 NASW News.

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