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Another Update on the "Improvement Standard"

In a Feb. 2nd decision, the federal judge overseeing the 2013 settlement of Jimmo v. Sebelius, the Medicare “Improvement Standard” case, has now ordered the Department of Health and Human Services (HHS) to implement a new Corrective Action Plan. The plan was accepted in a decision published Thursday by U.S. District Court Chief Judge Christina Reiss, who wrote that the plan offered up by the health agency "will cure its breach of the Settlement Agreement" and help it better educate providers and beneficiaries about therapy coverage and the so-called "Improvement Standard." This plan should govern Medicare coverage determinations for home care, skilled nursing facilities, and outpatient therapy.

The revised plan follows Reiss' August ruling, which stated that HHS didn't hold up its end of the Jimmo bargain when it came to creating an education campaign on maintenance therapy.

HHS is now required to create a new Centers for Medicare and Medicaid Services (CMS) website solely on the Jimmo settlement, publish a Corrective Statement clarifying the "Improvement Standard," post new Frequently Asked Questions, hold a second national provider call to clarify the 2013 settlement, and provide new training for contractors making coverage decisions.

HHS has 14 days to file an objection to Reiss' decision and must implement its plan by Sept. 4th.

LeadingAge NY will keep members posted on any new developments.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871