Group works to improve Medicare recipients’ access to care

NASW has joined a multidisciplinary group of health care leaders, legal experts and consumer advocates charged with improving access to care for Medicare beneficiaries as a result of the 2013 Jimmo v. Sebelius settlement.

The Jimmo Implementation Council, convened by the Center for Medicare Advocacy with support from the John A. Hartford Foundation, held its inaugural meeting in June on Capitol Hill.

At that meeting, council participants discussed challenges to and recommendations for implementation of the settlement, which invalidates the false but pervasive perception that Medicare beneficiaries must show improvement in order to obtain certain types of skilled care.

Jimmo v. Sebelius was debated in federal court on behalf of a nationwide class of Medicare beneficiaries and seven national organizations representing people with chronic conditions, according to the Center for Medicare Advocacy.

The case challenged the use of various “improvement standards” that improperly deny Medicare coverage for skilled nursing and therapies (occupational therapy, physical therapy, and speech–language pathology) to maintain an individual’s condition or to slow deterioration.

The Jimmo settlement stressed that improvement of the beneficiary is not required to obtain Medicare coverage for such skilled care in skilled nursing facilities, home health care and outpatient therapies — and to a lesser extent in inpatient rehabilitation hospitals.

At the June meeting, the Jimmo Implementation Council discussed the persistent belief that improvement is required, and identified effective methods of countering it.

Chris Herman, an NASW senior practice associate, represented NASW at the meeting.

She said the Jimmo settlement addresses neither the provision of medical social services in skilled nursing facilities, outpatient therapy settings, home health agencies, or inpatient rehabilitation hospitals, nor licensed clinical social workers’ provision of psychotherapy to Medicare beneficiaries.

Yet, the settlement holds great significance for the social work profession.

One of the primary barriers identified by the Jimmo Implementation Council was lack of awareness—among Medicare beneficiaries, health care providers, and Medicare claims reviewers—of the Jimmo settlement and its implications, Herman explained.

“Social workers play a key role in helping Medicare beneficiaries to understand and exercise their rights,” she said. “By helping to implement Jimmo, social workers can facilitate access to occupational therapy, physical therapy, and speech-language pathology services that help beneficiaries either to maintain function or to slow functional decline.”

Herman added that Jimmo-related advocacy can also help to facilitate beneficiaries’ access to skilled nursing services necessary either to prevent deterioration of or to maintain health.

Recommendations to implement the Jimmo settlement discussed at the June meeting include:

  • Develop more in-depth literature and research studies to produce evidence-based materials
  • Provide additional CMS education and outreach
  • Include Jimmo information in the Medicare & You Handbook
  • Add Jimmo information to nursing/therapy school curricula
  • Create online continuing educational opportunities for health care professionals
  • Distribute web-based tool kits to contain replicable documentation, appeals and other communication templates

The CMA noted that council members are committed to working collaboratively to ensure the Jimmo settlement is fully implemented. Prior to Sept. 30, the council plans to assist CMA in developing an in-depth Jimmo Implementation Council work plan.

More information about the Jimmo Implementation Council and settlement can be found on The Center for Medicare Advocacy website.