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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

 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 … Read more

A Word from the Executive Director As you will see in this issue, Center staffers have been busy this month testifying before Congress and meeting with lawmakers and policy leaders to educate them about issues affecting access to health care for older people and people with disabilities. This CMA Community News highlights just a few … Read more

1.  LITIGATION UPDATES Jimmo v. Sebelius (Improvement Standard) No. 11-cv-17 (D.Vt. filed 1/18/11).  As reported during previous Alliance calls, the Settlement in Jimmo was approved on January 24, 2013 during a scheduled fairness hearing.  As previously discussed, CMS has issued revisions to its Medicare Benefit Policy Manual to ensure that Medicare coverage is available for skilled … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Litigation Update   (Gill Deford) Jimmo – Improvement standard Bagnall (Observation) Other litigation Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Ali Bers) Overview Claims Eligible for Review Deadlines and Request Form Due Process and Medicare Appeals Denial rate of beneficiary appeals at lower levels of review (Gill … Read more

Please note that if printed in its entirety, this file runs to 50 pages.  Pages 1 – 6 explain the immediate process for appealing denials.  Pages 7 – 50 are an appendix offering background information on Outpatient Therapy, Federal Regulations, and CMS policy. Self-Help Packet Introduction How to Use this Packet Quick Screen for Medicare Coverage … Read more

Editor's Note: We received some feedback that our text was a bit small, so we are bumping it up for this edition. Please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community – Watch us on NBC! A Message from the Executive … Read more

A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community A Message from the Executive Director Welcome to the first issue of the CMA Community News and to the Center for Medicare Advocacy community.  We are grateful for your interest in the Center and for your active support of … 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