Medicare settlement could offer additional benefits
Officials have agreed to relax Medicare's coverage requirements of skilled nursing and in-home health care. Historically, Medicare only allowed coverage for those services when a beneficiary showed signs of potential improvement. Under the recent settlement of the Jimmo v. Sebelius lawsuit, Medicare will change its coverage criterion to one under which the beneficiary must only demonstrate the need for skilled care, regardless of recovery prognosis.
The lawsuit was filed by Glenda Jimmo in January 2011. Jimmo is a 76-year-old Bristol, Vt., resident, who is blind and uses a wheelchair. She requires regular skilled nursing visits to manage chronic conditions and wound care. Medicare previously did not allow coverage for these services. Under the new standards, Jimmo will likely obtain the benefits she requires to manage her care.
The settlement ends a legal battle between Medicare and the Center for Medicare Advocacy. Its founder, Judith Stein, estimates that the number of people who will be impacted immediately is in the "tens of thousands." People who filed a Medicare claim on or after Jan. 18, 2011, but were turned down may now file an appeal to have their cases reviewed. Instructions on filing appeals are available the Center for Medicare Advocacy.