In 2013 a settlement agreement was reached in the case of Jimmo vs. Sebelius class action lawsuit involving skilled care for the skilled nursing facility (SNF), home health (HH), inpatient rehabilitation facility (IRF), and outpatient therapy (OPT) benefits.  The intent of the settlement agreement is to clarify Medicare’s longstanding policy that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration and to ensure that claims are correctly adjudicated in accordance with existing Medicare policy.

On February 2, 2017, a federal judge ordered the Secretary of the U.S. Department of Health and Human Services (DHHS) to execute that it will provide specific forms of Corrective Action Plan education regarding the Jimmo v. Sebelius settlement.

To ensure that services are provided and coverage determinations are adjudicated appropriately in accordance with existing Medicare policy, all Medicare providers are required to review the attached training.

Jimmo vs. Sebelius FAQs (pdf)

Jimmo vs. Sebelius Training (pdf)

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