A tentative settlement reached in October of Jimmo v. Sebelius (a class action lawsuit brought against the federal government) will make Medicare a bigger player in funding LTC.

Under the settlement the U.S. Department of Health and Human Services will relax Medicare’s requirements for enrollees seeking coverage for institutional or in-home skilled nursing and therapy services.  Currently the standard for coverage is to provide services only for patients with the potential to improve.  The new standard will be the provision of services based upon a demonstrated need for skilled care.

The settlement fails to broaden Medicare’s coverage of standard nursing home care beyond the current 100 days of skilled nursing care or rehabilitation if ordered by a physician.  Patients must have already been enrolled in Medicare Part A and have been formally admitted to a hospital for a minimum of three consecutive days.