October 23, 2012; Source: Los Angeles Times
A lawsuit challenging the government’s denial of Medicare coverage to patients whose condition is not improving looks as if it is due to be settled. According to the settlement, Medicare would not deny skilled nursing care and various forms of therapy for beneficiaries, regardless of their prognosis. Under what is currently known as the “improvement standard,” a person with a range of diseases or conditions may be denied coverage for physical therapy that might “keep them stable or prevent declines in their health,” as the Los Angeles Times puts it. The improvement standard is not part of the law but was written into the Medicare benefit manual. The manual will be rewritten.
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If the settlement is approved as expected, the case will be considered a nonprofit collaborative success. Plaintiffs were represented by the Center for Medicare Advocacy (with Vermont Legal Aid as co-counsel) and included the National Committee to Preserve Social Security and Medicare, the National Multiple Sclerosis Society, Parkinson’s Action Network, Paralyzed Veterans of America, and the American Academy of Physical Medicine and Rehabilitation. It is not clear how many will benefit from the settlement because many of those affected were dissuaded from applying but advocates believe tens or even hundreds of thousands of Medicare beneficiaries had been denied this kind of care over the years.
Lead plaintiff Glenda Jimmo, 76, was “denied coverage for skilled nursing services in her home because she was deemed unlikely to improve,” the Times reports. Jimmo, blind since age 19, is in a wheelchair due to an amputation. –Ruth McCambridge