Jimmo plaintiffs complain in court that CMS still using 'improvement standard,' despite landmark settlement

CMS has "refused" to clear up confusion that remains among providers following the Jimmo settlement, Stein says
CMS has "refused" to clear up confusion that remains among providers following the Jimmo settlement, Stein says

Plaintiffs' counsel in Jimmo v. Sebelius was back in court Tuesday to file a motion that would force the Centers for Medicare & Medicaid Services to adhere to the settlement of the landmark lawsuit.

The case involved Medicare beneficiary Glenda Jimmo, who was denied coverage for treatment of her chronic, diabetes-related conditions because she was “unlikely to improve”.

The settlement for the class-action lawsuit, reached in 2012, required CMS to update its policies and complete an education campaign to ensure that beneficiaries who need maintenance care for conditions that aren't improving can't be denied Medicare coverage under an “improvement standard.”

Despite the settlement, CMS has continued to deny coverage and care based on the improvement standard, according to the Center for Medicare Advocacy.

“Three years after the Jimmo Settlement we are still hearing daily about providers who never heard of the case and patients who can't get necessary care based on an improvement standard,” said Judith Stein, executive director of the Center for Medicare Advocacy, in a news release. “CMS could help, but has refused to provide any more education or written information.”

The plaintiffs' counsel is asking the court for “relief that CMS has refused to provide,” said Gill Deford, director of litigation for the Center for Medicare Advocacy. The plaintiffs' motion for resolution of non-compliance would require CMS to end use of the improvement standard and fulfill the “failed” campaign to educate providers and Medicare decision-makers on the settlements' policies.

CMS updated its Medicare Benefit Policy manual in 2013 to reflect the Jimmo settlement.