The ruling of a recent court settlement helps Medicare beneficiaries in need of physical therapy coverage through skilled care. In Jimmo vs. Sebelius, the Center for Medicare Advocacy (CMA) claimed that contractors were denying Medicare claims for skilled care based on improvement standards used by therapists. The improvement standard requires that a patient must show “potential for rehabilitation”. At the point a patient stops showing reasonable improvement, Medicare stops paying.
CMA argued that some Medicare beneficiaries require skilled care to prevent or slow further deterioration of a medical condition. The Centers for Medicare & Medicaid Services denied the establishment of an improvement standard in order for skilled care to be covered.
The Jimmo settlement agreement doesn’t offer additional Medicare benefits. Instead, it clarifies the use of skilled services required to prevent or slow further deterioration caused by a medical condition. As a result, Medicare coverage can no longer be denied due to the lack of potential for improvement or restoration.