Home Health & Hospice Week

A recent court decision is changing the "improvement standard" for home health, outpatient therapy services and skilled nursing facilities. On Jan. 24, the U.S. District Court for the District of Vermont gave a final approval on a settlement with HHS in the class-action lawsuit Jimmo v. Sebelius.

Under the settlement, HHS has agreed to clarify that Medicare covers home health, therapy services and SNFs regardless of whether the beneficiary’s condition is expected to improve -- known as the "improvement standard," reports Leading Age.

Back in January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed the lawsuit on behalf of four individuals and five health organizations, Leading Age says. The final settlement could spark re-review of Medicare claims prior to Jan. 18, 2011 involving denials for beneficiaries seeking SNF or home health services. The lawsuit alleges that the improvement standard violates Medicare law.

Although HHS denied any wrongdoing or that the improvement standard even existed, under the settlement the department agreed to clarify in the Medicare Benefit Policy Manual that there is no requirement for improvement. Specifically, CMS will re-write certain parts of the Manual to include rules to "maintain the patient’s current condition or prevent or slow further deterioration" for skilled nursing and home health services, Leading Age explains. CMS will also launch an educational campaign for providers, contractors, Medicare Advantage plans, administrative law judges and Quality Improvement Organizations.