Action Lawsuit Filed
Jimmo v. Sebelius, No.
Seeks to End Illegal Medicare "Improvement Standard"
Complaint filed in
Jimmo v. Sebelius (.pdf), 2/25/11
Press Release, 1/18/11
Conference, 1/18/11 (streaming audio)
Article from the Hill, 1/18/11
Gram, Dave. 2011.
Patients, groups sue Medicare over service cuts,
Associated Press, January 18.
Graham, Judith. 2011.
Medicare's policy on therapy comes under attack,
Chicago Tribune, January 18.
Center for Medicare Advocacy is launching a new advocacy and
education initiative to eliminate the Medicare "Improvement
Standard," which requires that Medicare beneficiaries be able to
improve in order to qualify for coverage. The insistence that people
must be able to get better unfairly restricts access to Medicare
coverage and necessary health care.
Although the Improvement Standard conflicts with the law, it has
become deeply ingrained in the system and ardently followed by those
who provide care and those who make coverage determinations
throughout the health care continuum. Beneficiaries are told
Medicare coverage is not available if their underlying condition
will not improve, if they have "plateaued," are not likely to
improve, or if they need "maintenance care only". As a result it
keeps people with debilitating, chronic conditions from receiving
the care they need. This practice persists although the Medicare Act
does not require improvement as a precondition to coverage for
illness or injury. Further, the federal regulations state that
"restoration is not to be the deciding factor" in making Medicare
Everyday the Improvement Standard blocks access to Medicare and
health care for real people. The people most affected by this
barrier include people with Multiple Sclerosis, Alzheimer's disease,
ALS (Lou Gehrig's disease), spinal cord injuries, diabetes,
Parkinson's disease, hypertension, arthritis, heart disease, and
stroke. Further, the erroneous standard disproportionately affects
people who have low-incomes, as well as African-Americans and
support from The Atlantic Philanthropies, the Center for Medicare
Advocacy will begin a focused, collaborative effort to eliminate the
Improvement Standard in Medicare policy and practice. This effort
will include advocacy with the administration, litigation if needed,
and a multi-faceted education campaign.
Center for Medicare Advocacy, founded in 1986, is staffed by
attorneys, other professional advocates, and a nurse. The Center's
staff assists thousands of individuals in obtaining Medicare
coverage and necessary health care each year. Armed with this
experience, the Center works to obtain systemic change to eliminate
unfair barriers to coverage and care. For decades, the Improvement
Standard has been among the most significant obstacles facing the
Center's clients, as well as the millions of other people with
Medicare who have no legal representation. By removing this
obstacle, we will open doors to needed medical and rehabilitative
care for people with long term conditions and injuries. This is the
goal of the proposed project.
Share a story! If you or someone you know has
had problems obtaining Medicare coverage, necessary health care, or
rehabilitative services because the patient was said to be chronic,
stable, not likely to improve, or in need of "maintenance services
share the story with us today.
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