Excellent Medicare Litigation Settlement

Dear Parkinson's Community,

As you may recall from earlier emails, in early 2011 the Parkinson's Action Network (PAN) joined with the Center for Medicare Advocacy in a class action lawsuit against the U.S. Department of Health and Human Services.  The lawsuit challenges the Center for Medicare and Medicaid Service's (CMS) policy that denies Medicare coverage to those who are unable to show that they are improving from certain skilled care services, including therapy.  Needless to say, this policy is blatantly absurd for those with degenerative diseases, like Parkinson's, where services such as therapy may be exactly what is needed to help slow degeneration.  PAN was joined in this lawsuit by a small number of individual plaintiffs and national organizations, including the Alzheimer's Association, the National Multiple Sclerosis Society, and United Cerebral Palsy.  The full name of the case is Jimmo v. Sebelius, No. 11-cv-17 (D.Vt.).  There was an excellent article in the NY Times about the case and the settlement today.

I am extremely happy to tell you that, thanks to the outstanding advocacy work of the Center for Medicare Advocacy that took the lead in arguing this case, there has been a very favorable settlement filed with the federal court.  The bottom line is that CMS has agreed to change the policy.  Specifically, CMS has agreed to:  

  • revise its policy manual to state that coverage decisions for benefits such as skilled nursing facility, home health, and outpatient therapy, and for inpatient rehabilitation facilities, cannot be based on a beneficiary's potential for improvement, but are to be based on the beneficiary's need for the care;
  • conduct a nationwide education campaign with providers, contractors, and adjudicators to inform them of the changed policy; and
  • allow class members who received a non-appealable denial of these important skilled care services within the period of the lawsuit to have their claims re-reviewed.

We have every reason to believe that the court will accept the settlement agreement and that the policy changes will be implemented soon.  

In these complicated times, it is important that PAN's advocacy efforts have a balance between the public policy challenges of current services, particularly Medicare and Social Security, and those involving biomedical research and the efforts to find better treatments and a cure.  PAN's involvement in this case is a good example of the value of keeping that balance.

Thank you for all of your support of PAN.





Amy Comstock Rick