Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called "improvement standard."
Medicare officials continue to cite an "improvement standard" as a reason for withholding benefits from Glenda Jimmo, whose 2012 legal victory was supposed to end this type of denial, Kaiser Health News reported Monday. The situation shows why both beneficiaries and providers are confused about current policy, and why some nursing homes continue to expect business-as-usual, an expert told McKnight's.
Long-term care providers have been outspoken in their criticism of the Medicare appeals process, which has all but ground to a halt. Now a class-action lawsuit says Medicare beneficiaries also are being harmed by the excessively long delays.
Skilled nursing providers remain confused about Medicare changes related to the Jimmo v. Sebelius legal settlement, and many beneficiaries are not aware that their therapy might now be eligible for coverage, according to prominent long-term care expert Judith Stein. Stein is an attorney and director of the Center for Medicare Advocacy, which along with Vermont Legal Aid filed the Jimmo case.
For those who work with Medicare beneficiaries, Judith Stein is a well-known powerhouse. Since founding the Center for Medicare Advocacy in 1986, she's led numerous major cases involving Medicare denials.
LTC Commission wins praise for recommendations, but some members say the group failed to complete missionSeptember 16, 2013
Long-term care advocates have praised a set of recommendations issued by the Congressional Commission on Long-Term Care, but some commissioners broke ranks, saying the panel did not fulfill its mandate.
The Congressional Long-Term Care Commission is on an "extraordinarily short time frame" that merits an extension, a member told McKnight's in June.
With its report due by the end of September, the Congressional Long-Term Care Commission is setting its sights on what can be accomplished in an "extraordinarily short time-frame," according to member Judith Stein, executive director of the Center for Medicare Advocacy.
House Minority Leader Nancy Pelosi (D-CA) on Thursday named three people to the bipartisan long-term care commission created as part of January's fiscal cliff deal.
Under a proposed settlement, a nationwide class of beneficiaries will be certified, numerous parts of the Medicare Benefit Policy Manual will be rewritten, and the Centers for Medicare & Medicaid Services (CMS) will carry out an educational campaign for providers, Medicare contractors and adjudicators.