On February 13, 2017 the United States District Court for the District of Vermont approved a stipulated corrective statement disavowing the erroneous, but common, “improvement standard” that Medicare decision makers had been relying upon in denying benefits for patients during their first 100 days of skilled nursing institutionalization. The corrective statement re-affirmed that Medicare MUST pay benefits to skilled nursing patients who were being “maintained” or were on a “slow decline”.
The initial settlement of Jimmo v. Sebelius and entry of the settlement agreement occurred on January 24, 2013. Now, four years later after an egregious and extended term of non-compliance by Medicare providers adjudicators and contractors, the statement approved by the Jimmo Court explicitly re-affirms that skilled nursing services are covered by Medicare during the first 100 days of an initialization where necessary to maintain the patient’s current condition or prevent or slow further deterioration if the beneficiary needs skilled care for the services to be safely and effectively provided.
This issue has been a common point of confusion and angst among those receiving not only this benefit, but skilled therapy as well under a nearly identical standard.
This corrective statement certainly represents a step in the right direction for those in need of Medicare to assist within the first 100 days of a long term care institutionalization and will be followed by a corrective action plan that must be fully implemented by September 4, 2017. Meanwhile,share this post to join us in spreading the word to banish the previous, but common, misconception that there must be a documented improvement noted to trigger Medicare coverage during the patient’s first hundred days!
To learn more about issues involving how to pay for skilled nursing care, Elderlaw, Estate Planning and Asset Protection, call us in Syracuse or the Central New York area at (315) 422-6666!
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