Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2017

Medicare Advantage: Important Information about Jimmo Settlement


In keeping with a requirement from the Centers for Medicare & Medicaid Services (CMS), Harvard Pilgrim offers the following reminder to our Medicare Advantage providers regarding the settlement of the 2013 Jimmo v. Sebelius class action lawsuit.

This settlement addressed the delivery and coverage of services to Medicare beneficiaries in skilled nursing facility, home health, and outpatient therapy settings. It clarified that Medicare beneficiaries in need of reasonable and necessary skilled care to maintain function or to prevent or slow further deterioration cannot be denied coverage based on the absence of potential improvement.
 
The Jimmo settlement may reflect a change in practice for those providers who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.
 
CMS has developed a website to provide additional details on the Jimmo settlement, and requires that all Medicare providers review these resources to ensure that services are provided in accordance with existing Medicare policy. If you provide care for Harvard Pilgrim’s Medicare Advantage members, please review the materials on CMS’ Jimmo settlement website.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Harvard Pilgrim’s New “Estimate My Cost” Transparency Tool

Medicare Advantage: Important Information about Jimmo Settlement

Medicare Advantage Policy Updates for 2018

New Products and Benefits for 2018

CLINICIAN CORNER

Prior Authorization for Hip, Knee, and Shoulder Surgeries

Updates to Cholecystectomy Medical Review Criteria

Synagis for Upcoming RSV Season

Therapeutic Yoga for Chronic Pain and Other Conditions

P&T Committee Updates

Specialty Pharmacy Program Updates

ADHD Diagnosis and Follow-up Care

OFFICE ASSISTANT

Reporting Modifier 50 for Bilateral Procedures

2018 CPT and HCPCS codes

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator