Watch Out for Inappropriate Denials of Home Health Coverage for “Lack of Improvement”

Be alert for inappropriate denials of Medicare home health coverage based on lack of improvement or on “stability” – particularly for individuals with chronic conditions. The Jimmo vs. Sebelius settlement requires Medicare coverage determinations to be based on individuals’ need for skilled care, not on their potential for improvement or on their stability. Skilled nursing, or physical, occupational, or speech therapy may be required to maintain a person’s condition or to prevent or slow deterioration.

Here is an example of a case won by our partners at Center for Medicare Advocacy.

For more information on Jimmo and the “Improvement Standard,” see the webpages of the Center for Medicare Advocacy and CMS.