Posted on 25 October 2012
By Mark Miller
Glenda Jimmo has had a challenging life. Blind since the age of 19, the 76-year-old Bristol, Vermont, resident is confined to a wheelchair due to disabling conditions that include a below-the-knee amputation stemming from her diabetes.
“But it’s been an interesting, full life,” she says. “I have four children.”
Now, she’s lent her name to a landmark class action lawsuit. Its settlement, announced this week, is expected to transform the way that Medicare covers long-term care.
Jimmo requires regular skilled nursing services in her home for wound care and management of her condition. Medicare has not been paying for those services, because the program’s policy was to cover skilled nursing care only when patients had a demonstrated medical potential to improve. That left patients like Jimmo, who need care to maintain their current health status, to fend for themselves.
Under the settlement of the lawsuit, Jimmo v. Sebelius, the U.S. Department of Health and Human Services has agreed to relax Medicare’s requirements for coverage of skilled nursing and therapy services in institutional or home care settings.
The key criterion for coverage will be a demonstrated need for skilled care – regardless of whether there is a recovery prognosis. That means patients already enrolled in Medicare Part A (hospitalization) who need care to maintain their current condition but aren’t likely to improve will qualify for Medicare’s standard benefits.
Learn more in my column today at Reuters Money.