RSS

On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage.  The government will use the statement as part of its Corrective Action Plan, which was ordered by the … Read more

In a decision released February 2, 2017, the federal judge overseeing the Settlement Agreement in the Medicare “Improvement Standard” case (Jimmo v. Burwell) ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan to remedy the Department’s noncompliance with the Settlement.  In August, 2016, Chief Judge Christina Reiss, of the … Read more

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 … Read more

In an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, the judge in Jimmo v. Burwell – the “Improvement Standard case” – ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she approved in January 2013. The Order requires CMS to remedy … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) CMA and Vermont Legal Aid have filed a Motion for Resolution of Non-Compliance with the Settlement Agreement Exley (formerly Lessler) (ALJ Delay Case) Settlement preliminarily approved Barrows (formerly Bagnall) (Observation) Discovery on protected property interest issue; summary judgment briefing Other cases Hull … Read more

LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius) (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because their care … Read more

In an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, who oversees the “Improvement Standard” case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she had approved in January 2013.  The Order requires CMS … Read more

Beneficiaries Across the Country Still Denied Needed Coverage Due to Illegal Use of Improvement Standard March 1, 2016 – Today, Plaintiffs’ counsel, the Center for Medicare Advocacy and Vermont Legal Aid, filed a Motion for Resolution of Non-Compliance with the Settlement Agreement in the landmark case, Jimmo v. Sebelius. The filing comes after three years … Read more

Thank you to everyone who took the time to complete our recent Jimmo Implementation Council survey. We are writing to provide a summary of the results and the status of our efforts. In summary, there is enthusiasm for staying in touch and continuing to work together to advance implementation of the Jimmo Settlement.  96% of … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries With support from the John A. Hartford Foundation the Center for Medicare Advocacy has created a multi-disciplinary Jimmo Implementation Council. The Center convened the first meeting of the Council on June 23, 2015 at the US Capitol in Washington, DC.[1] The … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries                                                                                      … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has created a council of beneficiary advocates, providers, policy-makers and other partners to discuss, analyze and advance the implementation of the Jimmo v. Sebelius "Improvement Standard" Settlement. The Center convened the first meeting of the multi-disciplinary Council on June 23, 2015 at … Read more

Thank you for your interest in the Jimmo Implemenation Council. We look forward to your insight as we move forward with Implementation of the Jimmo v. Sebelius settlement. Stay tuned for updates and further activities. More information on the Improvement Standard and Jimmo v. Sebelius.

No. 5:14-cv-128 (D.Vt.), filed June 23, 2014 Issue: Whether the denial of coverage for named plaintiff Glenda Jimmo by the Medicare Appeals Council on re-review of her claim under the revised manual provisions pursuant to the Jimmo settlement agreement was correct. Relief Sought: Reversal of the Secretary’s decision denying coverage and granting the claim for … Read more

Twenty-one months after winning a national class action lawsuit that sought to overturn Medicare's practice of denying skilled maintenance care to patients who did not meet an "improvement standard," plaintiff Glenda Jimmo is finally receiving Medicare coverage for skilled home health maintenance care benefits she was denied in 2007. A federal court case in Vermont … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Gill Deford) Overview Claims Eligible for Review Deadlines and Request Form Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Medicare “Doc Fix” (Physician payment, or “SGR”): Where are we now? Extenders: QI program and therapy cap exceptions … Read more

1. PRESENTATION:  RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. Sebelius provides that Medicare beneficiaries who were previously denied Medicare coverage may have claims re-reviewed under the revised manual provisions.  The … Read more

If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years.  Please read carefully. In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … Read more

As of December 6, 2013, Centers for Medicare & Medicaid Services (CMS) Policy manuals have been updated to reflect the settlement in Jimmo vs. Sebelius, No.11-cv-17 (D.VT, January 24, 2013).  The manuals now make it clear that improvement is not necessary for coverage of skilled nursing and therapy services. For example, the home health section … Read more

1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement.  The Jimmo case ended a longstanding practice denying Medicare coverage to people who had “plateaued,” or were “chronic,” or “stable,” or “not … Read more

Monday, December 16, 2013 – 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 9874704 NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. Please ensure your line is on MUTE for the duration of the call until the Q&A portion of … Read more

  Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius, No. 11-cv-17 (D.VT), filed January 18, 2011.  A proposed settlement agreement was filed in federal District Court on October 16, 2012.  When the judge approves … Read more

(print stories only) Mrs. Jimmo Lead plaintiff in the Improvement Standard case, Glenda Jimmo of Bristol, Vermont is blind and has had her right leg amputated due to complications from diabetes. She requires a wheelchair, and receives multiple home health care visits per week for various treatments for her complex condition. However, Medicare denied coverage … Read more

FREQUENTLY ASKED QUESTIONS ABOUT JIMMO SETTLEMENT What Does the Jimmo Settlement Agreement Mean? A: The Jimmo agreement settles once and for all that Medicare coverage is available for skilled services to maintian an individual’s condition.  Under the maintenance coverage standard articulated in the Jimmo Settlement, the determining issue regarding Medicare coverage is whether the skilled services of a health care professional are needed, not whether … Read more

1.  PRESENTATIONS UPDATE ON JIMMO:  SETTLEMENT APPROVED In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of thumb to … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  The Road Forward on Jimmo: Post-Approval Update on the Improvement Standard Litigation – Jimmo v. Sebelius  (Judith Stein) Presentation: Update on Medicare Secondary Payor (MSP): CMS to Establish a New Website For Medicare Secondary Payer Claims Information (Alfred Chiplin) Legislative Update:  The Federal Budget and Medicare (David Lipschutz) … Read more

1.  PRESENTATIONS UPDATE ON JIMMO: THE IMPROVEMENT STANDARD CASE In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of … Read more

Based on an article by Judith A. Stein, Executive Director, Center for Medicare Advocacy, Copyright © 2013 Bloomberg BNA (2/2013). Mrs. “P” was 68 years old and living with Amyotrophic Lateral Sclerosis (ALS, commonly known as Lou Gehrig's disease) when she contacted the Center for Medicare Advocacy. She needed a wheelchair, was unable to stand … Read more

Completion of legal process for beneficiaries with long-term and chronic conditions  January 24, 2013 – Mansfield, Conn. – 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 today at the conclusion of a scheduled fairness … Read more

Over 50 Million Americans Rely on Medicare.     We've got their backs.   Will you have ours?     For over 26 years, The Center for Medicare Advocacy has been a tireless advocate for Medicare beneficiaries — both for individuals and entire classes.  The Center has also fought to preserve our nation's Medicare program which, since … Read more

Medicare: Just the Facts! Misinformation about Medicare and the Affordable Care Act is widespread and increasing as the election nears.  Below, we try to dispel misinformation and base discussions on a factual foundation.  Spread the word. Help set the record straight! The Fact Here's Why The Affordable Care Act does NOT cut Medicare for beneficiaries. … Read more

Updated Improvement Standard and Jimmo News from CMS

CMS Issues Fact Sheet Outlining Jimmo v. Sebelius Settlement.  See Details Below – Fact Sheet; CMS.gov Jimmo Search result; CMS Cover Letter to Medicare Advantage Organizations, Medicare Advantage-Prescription Drug, Section 1876 Cost Organizations, and PACE Plans.  For more on the Improvement Standard and Jimmo v. Sebelius, see our full Improvement Standard page.

Federal Court Approves CMS Corrective Statement to Enforce Jimmo Settlement On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage.  The government will use the statement as part … Read more

This is Part Four of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

CMA Alert – Medicare Home Health Coverage Does Not Require Improvement; AHCA Undermines Medicare

Medicare Coverage for Home Care Is Based On a Need For Skilled Care – Improvement Is Not Required The American Health Care Act undermines Medicare This is Part Three of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care, and outlining the Center for … Read more

This is Part Three of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care, and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the Center … Read more

CMA Alert – Budget Response: Abandoning Older Adults and People with Disabilities

Yesterday, May 23rd, the Trump Administration released its proposed FY2018 federal budget.  The budget, entitled “A New Foundation for American Greatness,” would have a wide-ranging and devastating impact on the nation’s safety net programs.  It is not a foundation for a caring society. As noted by the New York Times, it “would cut deeply into … Read more

UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON WAYS & MEANS, SUBCOMMITTEE ON HEALTH HEARING ON "THE CURRENT STATUS OF THE MEDICARE PROGRAM, PAYMENT SYSTEMS, AND EXTENDERS” WRITTEN TESTIMONY SUBMITTED BY CENTER FOR MEDICARE ADVOCACY May 18, 2017 Introduction The Center for Medicare Advocacy, founded in 1986, is a national, non-partisan education and advocacy organization that … Read more

Proposed changes to nursing facility payment under consideration by CMS would reduce financial incentives to provide therapy, and would do so with such force – providing higher reimbursement to skilled nursing facilities (SNFs) that provide fewer types of therapy to residents over a shorter period of time or no therapy at all – that it … Read more

CMA Alert – May 17, 2017

  1. Senate Must Reject Health Bill Passed by the House 2. CMS Considers New Medicare Reimbursement System for Skilled Nursing Facilities: If Implemented, Would Gut Therapy 3. Steve Gleason Enduring Voices Act Introduced 4. Oral Health Update – "The Painful Truth About Teeth" (Washington Post)     Senate Must Reject Health Bill Passed by … Read more

Examining Bipartisan Medicare Policies that Improve Care for Patients with Chronic Conditions May 16, 2017 Hearing before the Senate Committee on Finance Statement for the Record Center for Medicare Advocacy 1025 Connecticut Avenue, N.W., Suite 709 Washington, DC  20036 The Center for Medicare Advocacy, founded in 1986, is a national, non-partisan education and advocacy organization … Read more

HEALTH REFORM: HOUSE PASSES AMERICAN HEALTH CARE ACT (AHCA) On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill will now be taken up by the Senate. American Health Care Act (AHCA): Impact on the Affordable Care Act, Medicare and Medicaid The … Read more

This is Part Two of a Ten-Part CMA Issue Brief Series to examine, and inform work to resolve, the growing crisis in access to Medicare home health coverage and necessary care.  We invite you to follow this Series and provide Medicare home health stories at http://www.medicareadvocacy.org/submit-your-home-health-access-story/. CMA Issue Brief Series: Medicare Home Health Care Crisis … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

LITIGATION UPDATE Barrows v. Price (formerly Bagnall v. Sebelius, Barrows v. Burwell), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a proposed class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more

THE FIGHT TO PROTECT THE ACA, MEDICARE AND MEDICAID The President-Elect and Republican leaders in Congress have promised to repeal, and at some point, “replace” the Affordable Care Act.  They also plan to gut the Medicaid program by imposing block granting or per-capita caps.  Speaker Ryan, Trump’s nominee for HHS Secretary Rep. Price, and many … Read more

1.The Problem The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care. These problems have been escalating in 2016. Care provided often falls short of care that is covered under the law and ordered by … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

  Happy Thanksgiving! Giving Thanks Today and every day the Center for Medicare is grateful for our partners and supporters who help us open doors to health care for the 55 million people who rely on Medicare.  We are grateful to earlier generations who designed and launched Medicare to help all American families.  Sadly, our … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Election’s Potential Impact on Medicare (David Lipschutz)  Affordable Care Act Medicare Structural Changes Including premium support/vouchers New Nursing Home Requirements of Participation (Toby Edelman) Overview of final rule Positive changes Prohibition against facilities’ use of mandatory pre-dispute arbitration agreements and ensuing litigation What’s missing Including staffing requirements Review: … Read more