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In January, Vermont Legal Aid and the Center for Medicare Advocacy settled a case on behalf of Medicare beneficiaries in the six New England states and New York who had had been denied coverage of home health services for not being “homebound.” The settlement in Ryan v. Price, 5:14-cv-269 (D. Vt.), calls for re-review of such denials for people who had previously been found to be homebound in an earlier appeal. The agency will review the claims under the proper legal standard that was in effect at the time, which gave “great weight” to a previous determination that the person was homebound. In other words, if a beneficiary had previously been found to be homebound in an appeal, and then was denied in a subsequent appeal for not being homebound, the second claim may be eligible for re-review and is more likely to be approved. If there have been no changes that affect the beneficiary’s ability to leave the home, and all other criteria for home health services are met, the second claim will ordinarily be paid.

Eligible class members must identify themselves and their eligible claims to the Medicare agency (CMS) by completing and submitting the “Ryan Re-Review Form,” along with any supporting documentation, no later than August 1, 2019.

The form provides information to assist in determining whether the beneficiary’s claims qualify for re-review under the settlement (for example, the home health services have to have been received on or before August 2, 2015, and denied on or after January 1, 2010). The re-review form and other important information about the settlement are published on CMS’s website here. Please contact Vermont Legal Aid or the Center for Medicare Advocacy with questions about the settlement.

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