Archive for January, 2013

Judge Approves Settlement in Jimmo vs. Sebelius After Court Hearing

The Center for Medicare Advocacy, along with its co-counsel Vermont Legal Aid are pleased that the Settlement Agreement in the Medicare Improvement Standard case, Jimmo v. Sebelius, was approved January 24, 2013 at the conclusion of a scheduled fairness hearing, marking a critical step forward for thousands of beneficiaries nationwide.

The plaintiffs joined with the named defendant, Secretary of Health and Human Services Kathleen Sebelius, in asking the federal judge to approve the settlement of the case. With only one written comment received, and no class members appearing at the fairness hearing to question the settlement, Chief Judge Christina Reiss granted the motion to approve the Settlement Agreement on the record, while retaining jurisdiction to enforce the agreement in the future, as requested by the parties.

“We are not surprised but are very pleased that the judge ruled the settlement is fair, reasonable and adequate,” said Gill Deford, Litigation Director of the Center for Medicare Advocacy. “This moment is a culmination of two years of hard work, in conjunction with partners and advocates, to ensure that those who need health services covered under the Medicare law are not denied based on an illegal, outdated rule of thumb.”

With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings.  CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.

“It is important to note that the Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now – while CMS works on policy revisions and its education campaign,” said Judith Stein, Executive Director, Center for Medicare Advocacy. “We’ve been hearing from beneficiaries who are still being denied Medicare coverage based on an Improvement Standard. Coverage should be available now for people who need skilled maintenance care and meet any other qualifying Medicare criteria. This is the law of the land – agreed to by the federal government and approved by the federal judge. We encourage people to appeal should they be denied Medicare for skilled maintenance nursing or therapy because they are not improving.”

For people needing assistance with appeals, the Center for Medicare Advocacy has self-help materials available on its website, www.medicareadvocacy.org.  This information can help individuals understand proper coverage rules and learn how to contest Medicare denials for outpatient, home health, or skilled nursing facility care.

“It is exciting to know that by this time next year, Medicare policies will clearly state that coverage for skilled maintenance nursing and therapy is available, and that a beneficiary’s access to coverage does not depend on the potential for improvement, but rather on the need for skilled care,” continued Stein.

To speak with a representative of the Center for Medicare Advocacy, please contact Lauren Weybrew at lweybrew@douglasgould.com or 914-833-7093. Learn more about the Center for Medicare Advocacy at www.medicareadvocacy.org

January 24, 2013 at 9:55 pm 2 comments

Medicare and … the Military?

I read David Brooks’ New York Times editorial yesterday with dismay. It seems Medicare is not only to blame for the federal deficit, but also for Sen. Hagel’s nomination and the end of America’s military might. I have been representing Medicare beneficiaries and studying Medicare since 1977. Even I was surprised by these positions.

The determination to slash Medicare seems never ending. One hardly knows where to begin responding. But we need to try, before it’s too late. Before the next deficit cutting activities get underway, we need to set the record straight.

The basic, public Medicare program was a cost-effective success. Medicare brought access to health care to older people who were refused private health insurance. It dramatically decreased poverty among older people. Unnecessary payments to private Medicare plans, unrestricted payments for prescription drugs and policies aimed at privatizing Medicare increased the program’s costs exponentially. These expensive provisions should be the targets for those whose true goal is to reduce the deficit. If the will exists, there is a way to reduce costs while preserving Medicare’s promise.
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Watch this short video from the Kaiser Family Foundation: http://www.kff.org/medicare/medicare-timeline2.cfm. It will remind you why Medicare matters.

January 9, 2013 at 9:29 pm Leave a comment


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