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As previously announced, the Center has reached a tentative agreement with CMS in Sherman v. Hargan. The Sherman case challenged the quality of lower-level Medicare home health appeals.  The settlement was preliminarily approved, and any objections from class members must be received by February 5, 2018.  A fairness hearing on the settlement will be held in New Haven, Connecticut on February 26, 2018. The Notice to Class Members, with instructions on submitting objections, and a copy of the proposed Settlement Agreement can be found here.

The proposed settlement applies to all Medicare beneficiaries whose appeals for coverage of home health services have been, or will be, denied at the first two levels of review and who received an initial determination or notice of termination of coverage for those services dated on or after January 1, 2012. Under the agreement, the Medicare agency will transmit four memoranda containing important principles for deciding home health appeals to the Medicare contractors that handle those decisions at the first and second levels of review.

The Center for Medicare Advocacy, as class counsel, believes that the principles expressed in the transmittals are key to fair decision-making and will reinforce compliance with beneficiaries’ due process protections in the administrative appeal system.

A. Bers, January 17, 2018

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