Jimmo v. Sebelius Settlement Agreement.   For about 30 years, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. Medicare contractors have instead used a covert "rule of thumb" known as the “Improvement Standard" to illegally deny coverage to such patients. Once beneficiaries failed to show progress, contractors claimed they could deliver only "custodial care," which Medicare does not cover. This is a great travesty that has affected millions of elders who have been denied services that would have made improvements in their health and welfare. Many thousands have died as a result of a denial of services, and many more had to pay billions of dollars to get the services they should have received as part of their Medicare benefits.   Some basic definitions are in order to understand this post: “Improvement” Standard (also known as restorative or rehabilitative): The patient’s condition has the potential to improve or is improving in response to therapy; maximum improvement is yet to be attained; and, there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time. “Maintenance” Standard: The skills of a therapist are necessary to maintain, prevent, or slow further deterioration of the patient’s functional status, and the services cannot be safely and effectively carried out by the beneficiary personally or with the assistance of non-therapists, including unskilled caregivers. Jimmo and the...