If you are a member of a Medicare or Medicare Advantage plan, access to maintenance therapy and home health care skilled services is improved for those with chronic conditions.

As a result of a recent settlement, Jimmo vs. Sebelius, Medicare must pay for maintenance therapy when the patient requires skilled therapy and medical record documentation demonstrates the need for it. Coverage of skilled nursing and skilled therapy services ?...does not turn on the presence or absence of a beneficiary?s potential for improvement, but rather on the beneficiary?s need for skilled care.?

Services can be skilled and covered when:


  1. Needed to maintain, prevent, or slow decline or deterioration; or
  2. Skilled professional is needed to ensure services are safe and effective.


However, you may still face a challenge in convincing your therapist or doctor that 'plateauing' or not improving are no longer the standards for Medicare reimbursement. The best resource for learning about Jimmo and how to appeal to get the care you need, or be reimbursed for care that was declined is on the website of the Center for Medicare Advisory web site.

A collaboration with several organizations, including the Christopher & Dana Reeve Foundation, has created the
Jimmo Implementation Council for this purpose:

Advancing Access to Medicare and Necessary Care for
People with Long-Term Conditions and Injuries


Find more info on the Reeve Foundation on how you can access the therapy or home health services you need. They have a team of information specialists been trained specifically in the Jimmo v. Sebelius decision and are ready to assist you to navigate the process of gaining access to more care if your therapy was denied on this illegal ?improvement standard.?

Help your therapist or doctor out with these guidelines for Medicare Maintenance Therapy Documentation.