A federal district court orders the federal government to implement a corrective action plan to comply with the settlement in Jimmo v. Sebelius that ended Medicare's "improvement standard." Jimmo v. Burwell (U.S. Dist. Ct., D. Vt., No. 5:11-cv-17, Feb. 1, 2017).
Six Medicare beneficiaries and seven national organizations filed a class action lawsuit against the federal government, arguing that home health care agencies and nursing homes routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. The federal government agreed to settle the lawsuit and to revise the relevant portions of the Medicare manual to reflect that a patient does not need to be improving in order to continue receiving skilled care, as well as to conduct a nationwide education campaign.
Three years after the settlement, the Center for Medicare Advocacy continued to get reports that Medicare was denying coverage to patients who were not improving. It filed a motion in federal court for resolution of non-compliance, asking the court to order the federal government to carry out additional educational activities. The court agreed that some of the information in the education campaign was not correct. The parties attempted to negotiate a corrective action plan, but they were unable to agree, so they submitted the plans to the court.
The U.S. District Court for the District of Vermont approves the federal government's plan for corrective action that involves creating a website devoted to Jimmo, issuing additional statements, and holding additional trainings. The court rejects the Center for Medicare Advocacy's request to participate in the additional trainings. The court orders the federal government to complete the corrective action by September 4, 2017.
For the full text of this decision, go to: https://cases.justia.com/federal/district-courts/vermont/vtdce/5:2011cv00017/19913/115/0.pdf?ts=1486138986
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