Settlement signed for the “Improvement Standard” – Now what? - December 4, 2012

In October, we reported on the proposed settlement in the case of Jimmo v. Sebelius that was filed in Federal District Court in Vermont on Oct. 16, 2012 and was waiting the court's approval.  This case centers on the "Improvement Standard" in Medicare that requires that an individual show improvement in his or her condition or functional status in order to qualify for Medicare coverage of therapy services.  The plaintiff in this case alleged that this standard wrongfully denies Medicare coverage to patients suffering from chronic conditions and who are in need of Skilled Nursing Facility (SNF) care and Home Health (HH) care, as well as Outpatient Therapy (OPT).  For a complete initial analysis by LeadingAge NY, please click here.

On Nov. 20, Chief Judge Christina Reiss of the District of Vermont signed an order preliminarily approving the settlement agreement.  By Dec. 10, 2012, notice of the settlement will be posted on the websites of numerous organizations, including the seven national organizations that served as plaintiffs in the case, which will alert advocates and beneficiaries to the terms of the settlement.  The court will hold a Fairness Hearing on Jan. 24, 2013 "to determine whether the settlement agreement is fair, reasonable and adequate," after which it is hoped that the judge will issue an order permanently approving the settlement agreement.

In short, it is not clear the impact it will have and how immediate it will be. 

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871