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Feds refuse to stop Medicare's persistent use of 'improvement standard' despite court settlement

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Two years ago, a settlement agreement ended Medicare’s use of the “improvement standard.”  At least it was supposed to.  But, despite the agreement some beneficiaries continue to be denied coverage and federal officials are refusing to take any further action to ensure that providers are aware of the change.

Under the long standing improvement standard, Medicare patients had to show a likelihood of improvement in order to receive coverage of skilled care and therapy services.  The settlement requires Medicare to cover skilled care as long as the beneficiary needs it even if the care only maintains the current condition or slow further deterioration.

Because providers and Medicare judges continue to be unaware of the change, beneficiaries are still being denied.  If you have been denied Medicare coverage due to the “improvement standard,” you are encouraged to appeal the decision.  The Center for Medicare Advocacy’s site, you can find additional information and self-help material.

To read more about the Jimmo v Sebelius case, in the order of their occurrence click on the stories below.

Medicare settlement is approved

New Medicare Manuals reflect end of Improvement Standard

Medicare beneficiaries still being denied for ‘not improving’

Jimmo denied Medicare coverage despite settlement bearing her name, finally receives coverage

Know your rights.  People with chronic care needs such as those dealing with Alzheimer’s diabetes and stroke can and should be able to continue to receive therapy and care as part of their treatment.  In addition, they shouldn’t have to worry about being billed for that care inappropriately.

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