As your local resource for health insurance information, our Health Insurance Counseling & Advocacy Program (HICAP) strives to ensure residents of Santa Clara County are well-informed on Medicare issues.
Two years ago a significant yet little known step was taken toward dispelling the myth that Medicare will not cover skilled services to maintain an individual’s condition.
In some situations, individuals have been told that services would not continue without noted improvements. Some doctors, skilled nursing facilities, and therapy providers continue to make this statement, citing an assumption that Medicare does not provide coverage unless someone shows signs of improvement.
On January 24, 2013, the Jimmo vs. Sebelius settlement was approved, requiring the Centers for Medicare & Medicaid Services (CMS) to undertake an educational campaign to inform providers, Medicare contractors, and adjudicators that they should not limit Medicare coverage to only those beneficiaries showing improvement.
If you or someone you know has Medicare, be aware that skilled “maintenance” nursing or therapy may be received to maintain a person’s condition or slow their decline.
We recommend that you talk to the provider or skilled nursing facility about the criteria that must be met, and ask about the proper documentation to facilitate the approval of this type of “maintenance” coverage.
For more information about your Medicare options, call the Health Insurance Counselors of HICAP at (408) 350-3200, option 2, or e-mail Sourcewise at: email@example.com.