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Medicare “Improvement Standard” Case (Jimmo v. Burwell) Receives Court Ordered Corrective Action Plan

February 7, 2017

In a decision released February 2, 2017, the federal judge overseeing the settlement agreement in the Medicare “Improvement Standard” case (Jimmo v. Burwell – formerly Sebelius)) ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan (CAP) to remedy the Department’s noncompliance with the settlement. The National Multiple Sclerosis Society has remained an organizational  plaintiff in the case since the original class action was filed in 2011.  In August, 2016, Chief Judge Christina Reiss (District of Vermont), held that the Secretary had not accurately implemented the Jimmo Settlement’s required educational campaign. The Judge ruled that the Secretary failed to explain that a consideration of the need for skilled care, not the potential for improvement, should govern Medicare coverage determinations – for skilled nursing facility, home health, and outpatient therapy. Medicare covers skilled nursing and rehabilitation therapy to maintain, limit the decline, and improve the patient’s condition. Following up on her August decision, the Judge has ruled on the content of a CAP.

The Judge ruled that the CAP will include a new CMS webpage dedicated to Jimmo, a published Corrective Statement disavowing the improvement standard, a posting of Frequently Asked Questions (FAQs), and new training for contractors making coverage decisions.  In addition, and significantly, the Court largely adopted the corrective statement drafted by plaintiffs, and ordered the Secretary to conduct a new national call to explain the correct policy.

 “Rehabilitation therapy is essential for people with multiple sclerosis to maintain the flexibility, strength, and independence they need to avoid falls or other injuries, and to live their best lives,” said Cyndi Zagieboylo, President and CEO of the National Multiple Sclerosis Society. “More and better education about Medicare coverage of these benefits will help ensure that those affected by MS are never again told they cannot get the rehabilitation therapy they need as prescribed by their physician.”

The Secretary is required to certify compliance with the order by September 4, 2017. Learn more about the National MS Society’s involvement with the case and the full statement from the Center for Medicare Advocacy

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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