On January 24, 2013, a federal judge approved a settlement agreement in the Jimmo vs. Sebelius case that NASL had reported on in mid-December, officially ending a decades-long CMS practice of denying skilled care to beneficiaries if a condition fails to continuously improve. The class action lawsuit challenged CMS on its so-called Medicare "Improvement" standard. In approving the settlement, the courts have sided with the plaintiffs’ advocates at the Center for Medicare Advocacy and Vermont Legal Aid who filed the suit and who argued that Medicare should cover “skilled maintenance services in the home health, nursing home and outpatient settings” for beneficiaries with chronic conditions even if their underlying conditions will not improve.

CMS must now revise the Medicare Benefit Policy Manual and other guidelines and policies that may infer the need for a beneficiary who is receiving therapy services to show "improvement" for Medicare to cover those services. This process may take 6 months or longer. Afterwards CMS will move forward on a six-month education campaign. Following both the policy update and education campaign, all beneficiaries with claims denied based on the improvement standard after January 2011 will have their claims reassessed. The settlement agreement also requires that CMS conduct a National Provider Call “for the sole purpose of communicating the policy clarifications, as well as a National Call for contractors, agency personnel and the different levels of the Medicare appeals system. In the meantime, the advocates’ site underscores the fact that the “Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now – while CMS works on policy revisions and its education campaign.”