CMS Fact Sheet on the "Improvement Standard" Settlement Agreement

This two-page summary highlights the case and follow-up actions required of CMS. The case of Jimmo v. Sebelius involved plaintiffs alleging Medicare contractors were inappropriately applying an "Improvement Standard" in coverage for skilled nursing Medicare services (e.g., the Skilled Nursing Facility (SNF), Home Health (HH), and Outpatient Therapy (OPT) benefits). The settlement agreement outlined specific steps for CMS to do which includes, issuing clarifications to existing program guidance and new educational material on this subject.

The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8383, ext. 151