End to Jimmo legal battle between CMS, patient advocates in sight

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A decision in the fight over how federal health officials should educate people about maintenance therapy coverage may be on the horizon, according to a new report.

In August a federal judge ruled that the Department of Health and Human Services fell short in explaining Medicare coverage for maintenance care as mandated by the 2013 settlement of Jimmo v. Sebelius. Last month, both HHS and counsel for plaintiff Glenda Jimmo concluded that they were “unable to agree” on a plan to satisfy the court's August order.

Both sides submitted proposals in mid-January on how to resolve the number of Medicare beneficiaries still unaware of what services are covered.  With the new plans in, the court's decision on how to proceed may arrive within months, NPR and Kaiser Health News reported Monday.

HHS' proposal includes an educational campaign, a “frequently asked questions” website and a statement to clarify that use of the “Improvement Standard” is improper under the Jimmo settlement. A proposal from the plaintiffs takes it a step further, suggesting to draft a statement for HHS that would disavow use of the Improvement Standard.

"The major problem for us is that [HHS does] not want the plaintiff's counsel to have any say or involvement in what they do," Gill DeFord, litigation director at the Center for Medicare Advocacy told NPR. “We think that's exactly the reason the educational campaign was so riddled with inaccuracies in the first place."

Federal authorities have offered just one conference call detailing the changes and opportunities, according to plaintiffs, who also have complained that some information distributed has not only been sparse but incomplete or wrong.