Skip to main content

Effective October 29, 2023
TIHP’s new toll-free and TTY numbers for prospective and enrolled members and providers will be 833-471-8447 (TTY: 833-414-8447).

MEMBER & PROVIDER ALERT: New Information Regarding TIHP’s Medicare Advantage Special Needs Business - Read More

Jimmo vs. Sebelius Training

In 2013 a settlement agreement was reached in the case of Jimmo vs. Sebelius class action lawsuit involving skilled care for the skilled nursing facility (SNF), home health (HH), inpatient rehabilitation facility (IRF), and outpatient therapy (OPT) benefits.  The intent of the settlement agreement is to clarify Medicare’s longstanding policy that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration and to ensure that claims are correctly adjudicated in accordance with existing.

On February 2, 2017, a federal judge ordered the Secretary of the U.S. Department of Health and Human Services (DHHS) to execute that it will provide specific forms of Corrective Action Plan education regarding the Jimmo v. Sebelius settlement.

To ensure that services are provided and coverage determinations are adjudicated appropriately in accordance with existing Medicare policy, all Medicare providers are required to review the attached training.

Jimmo vs. Sebelius FAQs (pdf)

Jimmo vs. Sebelius Training (pdf)

Thank you for your partnership with Texas Independence Health Plan.


Texas Independence Health Plan is a HMO-SNP with a Medicare contract. Enrollment in Texas Independence Health Plan depends on contract renewal. H5015_TIHPWEB_2023