Friday, August 25, 2017 CMS Publishes More Clarification on Jimmo Settlement and 'Improvement Standard' Myth The US Centers for Medicare and Medicaid Services (CMS) is making it clearer than ever that the so-called "improvement standard"—the idea that Medicare coverage can only be extended if that care will actually improve the patient's condition—is a fallacy. The new clarity on the validity of skilled maintenance is part of the agency's efforts to comply with a federal court finding that CMS had made "virtually no efforts" to educate stakeholders on the 2013 Jimmo v Sebelius settlement. CMS now offers a webpage exclusively devoted to the Jimmo settlement, which established that the improvement standard was a myth (for its part, CMS maintains that it never explicitly supported that standard, even though it was commonly used by contractors as a reason to deny payment). The agency's low-key efforts to educate contractors in the wake of the Jimmo settlement prompted Medicare beneficiary advocates to go back to the courts to compel CMS to do more, arguing that the improvement standard still was being applied by many contractors. APTA was a supporter of those efforts. In February, a federal court agreed with the patient advocates and ordered CMS to take "corrective action" that included publishing a new webpage on Jimmo that would contain, among other elements, a clear disavowal of the improvement standard and a list of frequently asked questions about the settlement. The judge gave CMS until September 4 to make it happen. CMS complied. Its new webpage states that skilled therapy services are covered by Medicare when an assessment reveals that "the specialized judgment, knowledge, and skills of a qualified therapist … are necessary for the performance of a safe and effective maintenance program " intended to "maintain the patient's current condition or to prevent or slow further deterioration." "The Jimmo settlement agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve," CMS states on the webpage. "The Jimmo settlement agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide." APTA offers a webpage on skilled maintenance that includes links to a podcast series, a recorded webinar, and several pages of frequently asked questions.