With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced two new Checklists to help Medicare beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” Per the Jimmo Settlement, CMS revised the Medicare Benefit Policy Manual to clearly disavow any notion that residents of a skilled nursing facility must improve in order for their care to be covered by Medicare.

Medicare Home Health Coverage Requirements

The following Checklist provides Medicare beneficiaries and their families with an overview of the home health coverage criteria, providing an emphasis on the Jimmo Settlement. As the Checklist illustrates, beneficiaries who meet the coverage criteria cannot be denied care solely because of an erroneous “Improvement Standard.”

• Download the Home Health Coverage Checklist at: http://www.medicareadvocacy.org/wp-content/uploads/2018/09/Home-Health-Jimmo-Checklist.pdf

Skilled Nursing Facility Expedited Appeals Checklist

The following Checklist provides readers with an overview of the expedited appeals process in traditional Medicare, focusing on the termination of skilled care solely based on an erroneous “Improvement Standard.” The Center hopes this Checklist will help beneficiaries and their families as they appeal improper terminations and denials.

• Download the Expedited Appeals Checklist at: http://www.medicareadvocacy.org/wp-content/uploads/2018/09/Expedited-Appeals-Fact-Sheet.pdf

SNF Coverage Checklist

The Two Checklists above are in addition to our previously published Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for nursing home care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for care at a skilled nursing facility and emphasizes language from the Jimmo Settlement Agreement.  Per the Settlement, the Centers for Medicare & Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clearly disavow any notion that residents of a skilled nursing facility must improve in order for their care to be covered by Medicare.

• Download the SNF Coverage Checklist at: http://www.medicareadvocacy.org/wp-content/uploads/2018/08/Checklist.pdf