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 was settled on October 29, 2014 that will result in paying Ms. Jimmo’s Medicare claim in full and completely vacating the decision of the Medicare Appeals Council that denied coverage due to lack of improvement.
Ms. Jimmo’s individual federal case was necessary because she was again denied coverage earlier this year by the Medicare Appeals Council, the last step in the Medicare administrative appeals system. "The resolution of this federal case completely vacates the Appeals Council denial for her skilled maintenance home care," says Judith Stein, Executive Director of the Center for Medicare Advocacy and an attorney who brought the Jimmo v. Sebelius class action lawsuit. "The maintenance home care she received will now be paid in full. And coverage for similar skilled maintenance care may also be available."
Ms. Jimmo, an elderly, disabled resident of Vermont is currently receiving therapy in a nursing home, but expects to be discharged soon. When asked about how winning this case will help her, Ms. Jimmo said, "When I get home, that home care will let me stay out of the nursing home and let me get to see my own doctor."
Ms. Jimmo's attorney, Michael Benvenuto, Director of the Vermont Legal Aid Medicare Advocacy Program reiterated the importance of the settlement. "This settlement should send the message that denying Medicare coverage for a chronic condition is wrong," he said.
A copy of the Settlement is available at https://www.medicareadvocacy.org/wp-content/uploads/2014/10/Jimmo-II-Settlement-FINAL.pdf.