Jimmo v. Sebelius
Posted in Uncategorized
No. 11-cv-17 (D.Vt.), filed January 18, 2011
Issue: Whether the "Improvement Standard", which operates as a rule of thumb to terminate or deny Medicare coverage to beneficiaries who are not improving, violates substantive and procedural requirements of the Medicare statute, the Administrative Procedure Act, and the Freedom of Information Act, and the Due Process Clause of the Fifth Amendment.
Relief sought: Declaratory and injunctive relief prohibiting the continued application of the Improvement Standard and review of the cases of class members and beneficiary plaintiffs to determine whether a prior denial of coverage based on the Improvement Standard should be revised.
Updated: January 6, 2012
Status: The complaint, with five beneficiary plaintiffs and five national organization plaintiffs, was filed along with a motion for certification of a nationwide class on January 18, 2011. On March 3, plaintiffs filed an amended complaint that added two more organization plaintiffs and one beneficiary plaintiff. The parties completed briefing of the class motion in early May 2011, but the court has neither ruled nor scheduled oral argument.
Instead of answering the amended complaint, the government filed a motion to dismiss. It contended both that the court lacked jurisdiction over the plaintiffs’ claims (for a variety of reasons) and that the plaintiffs had failed to state a claim for which relief could be granted. Oral argument on the motion to dismiss was held on July 14, 2011. On October 25, 2011, the court largely denied the motion to dismiss. 2011 WL 5104355. The judge did dismiss one beneficiary plaintiff for failing to satisfy the "presentment" requirement of 42 U.S.C. §405(g) and one organizational plaintiff for lack of standing, but she rejected most of the Secretary's arguments regarding exhaustion of administrative remedies and standing. She determined that the court had jurisdiction over the other organizational plaintiffs under the mandamus statute. The judge also held that plaintiffs had stated a claim, thus denying the motion to dismiss for failure to state a claim. The court has not yet ruled on the class motion.
The Secretary filed the Answer to the Amended Complaint on November 8, 2011. The case now proceeds to the discovery phase.
