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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.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

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Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator