Are you a Medicare beneficiary in need of outpatient physical, occupational or speech therapy? Have you been denied services stating that you no longer have made significant improvements to continue your benefits? Many older and disabled Medicare beneficiaries who needed these therapies to maintain their condition or slow down deterioration have been denied services.
On January 24, 2013 the district court approved a settlement in the case of Jimmo v. Sebelius. The Jimo settlement states that Medicare will continue to provide services to those patients that will benefit from them regardless if they have made improvements or not. Up to now Medicare beneficiaries could receive up to 100 days of treatment. Most did not receive this as they were deemed "no longer making improvements". Medicare has denied these allegations. Under the maintenance standard in the settlement Medicare will look at the issues and determine whether the skilled services of a health care professional are needed, not whether the Medicare beneficiary will improve. The Center for Medicare and Medicaid services will update its policy immediately.
The Jimmo settlement established a process of re-review for Medicare beneficiaries who received a denial of care that had become final and non-appeal able after January 18, 2011. If you have been denied services in the past you can contact the Center for Medicare Advocacy which will explain the process to have your claim over turned.