CMS has “refused” to clear up confusion that remains among providers following the Jimmo settlement, Stein says

Plaintiffs’ counsel in Jimmo v. Sebelius was back in court Tuesday to file a motion that would force the Centers for Medicare & Medicaid Services to adhere to the settlement of the landmark lawsuit.

The case involved Medicare beneficiary Glenda Jimmo, who was denied coverage for treatment of her chronic, diabetes-related conditions because she was “unlikely to improve”.

The settlement for the class-action lawsuit, reached in 2012, required CMS to update its policies and complete an education campaign to ensure that beneficiaries who need maintenance care for conditions that aren’t improving can’t be denied Medicare coverage under an “improvement standard.”

Despite the settlement, CMS has continued to deny coverage and care based on the improvement standard, according to the Center for Medicare Advocacy.

“Three years after the Jimmo Settlement we are still hearing daily about providers who never heard of the case and patients who can’t get necessary care based on an improvement standard,” said Judith Stein, executive director of the Center for Medicare Advocacy, in a news release. “CMS could help, but has refused to provide any more education or written information.”

The plaintiffs’ counsel is asking the court for “relief that CMS has refused to provide,” said Gill Deford, director of litigation for the Center for Medicare Advocacy. The plaintiffs’ motion for resolution of non-compliance would require CMS to end use of the improvement standard and fulfill the “failed” campaign to educate providers and Medicare decision-makers on the settlements’ policies.

CMS updated its Medicare Benefit Policy manual in 2013 to reflect the Jimmo settlement

Blogger comment:  CMS continues to defraud the Medicare beneficiaries’ coverage based on illegal interpretations.  The Jimmo landmark case and the Fox v Bowen decision in 1986 have been ignored by the Federal Government denying billions of dollars of coverage for rehabilitating elderly Medicare patients.  As a result 3 million seniors have been forced onto Medicaid that has no rehabilitation coverage and relegated to a nursing home till death.  Another example of the Federal Government’s disregard for due process of law with 900,000 appeals hung up because of CMS’ illegal interpretations.

It is truly ironic that CMS and OIG continue to indict the providers for fraud and abuse when they are creating the policies and complexities that invite such an environment just to be able to afford providing care.  Their recent published document on bundled payment for two episodes (knee and hop replacements) of 1,008 pages is the precursor to academic approach to implementing Obama Care.  At this rate we will have 1 million pages of instructions from the professors and bureaucrats telling the workers what to do.  Another example was the proposed legislation to put into law how to assess and treat dementia … fortunately this ridiculous proposal was killed before it came to a vote.  Is this a political problem?  You better believe it.  If we don’t allow the private sector a role in developing policy and procedures we have given into socialized medicine.