CMA Health Policy Blog

Challenge to Medicare: Don’t Require People to Get Better to Get Coverage and Care

January 24, 2011 at 5:03 pm Judith Stein Leave a comment

On January 18th, the Center for Medicare Advocacy, with co-counsel Vermont Legal Aid, filed a national class action law suit in federal district court to eliminate Medicare’s long-standing practice of denying coverage and access to care for people who are not going to improve, or improve sufficiently, or improve quickly enough.

This inappropriate “Improvement Standard” keeps people with long-term and chronic conditions from obtaining medically necessary health care and therapeutic services such as nursing, physical, occupational, and speech therapy. That is what happened to the lead plaintinff, Glenda Jimmo.

Ms. Jimmo, a 71-year-old resident of Vermont, was denied Medicare coverage for home health nursing and aide services on the grounds that she was stable despite the fact that she had diabetes, peripheral vascular disease, on-going circulatory problems, skin lesions, and is legally blind and has a below-the-knee amputation.

The lawsuit, Jimmo vs. Sebelius, No. 5:11-cv-17 (D. Vt.), was filed in Vermont federal court on behalf of five individual Medicare beneficiaries from Vermont, Connecticut, Rhode Island, and Maine, and five organizations, National Multiple Sclerosis Society, Parkinson’s Action Network, Paralyzed Veterans of America, National Committee to Preserve Social Security and Medicare, and American Academy of Physical Medicine and Rehabilitation. The federal government has 60 days to file it’s Answer to the lawsuit.

Improvement is NOT a legal standard upon which to determine eligibility for Medicare coverage. The Center for Medicare Advocacy hopes the Jimmo case will eliminate this harmful policy and practice once and for all.

Entry filed under: Improvement, Medicare.