Skilled maintenance services include outpatient physical therapy, occupational therapy, speech therapy, and long term home health care under Part B. Until recently, Medicare improperly denied payment for those services for some patients.
In 2012, a national class action lawsuit challenged Medicare’s use of an improper “improvement standard” to deny coverage to people who may not improve, but whose conditions may deteriorate without skilled maintenance services. The Vermont District Court approved the settlement of the case, Jimmo v. Sebelius, No. 5:11-cv-00017 (D.Vt.) on January 24, 2013.
Under the terms of the settlement agreement, the agency that administers Medicare (CMS) will revise its coverage standards to remove any reference to this improper standard and provide that Medicare coverage is available for the maintenance of chronic conditions. Attorneys from Vermont Legal Aid’s Medicare Advocacy Project served as co-counsel on the case with the Center for Medicare Advocacy.