Jimmo 'victory' not as good as first appeared?

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James M. Berklan Editor, McKnight’s Long-Term Care News
James M. Berklan Editor, McKnight’s Long-Term Care News

Long-term care providers and consumer advocates were able to celebrate a rare common victory over federal regulators in mid-August. 

The U.S. District Court in Vermont ordered the Centers for Medicare & Medicaid Services to propose a better educational campaign concerning the 2013 Jimmo case settlement.

(This historic 2013 deal set conditions for allowing Medicare coverage of rehab services for certain beneficiaries, whether or not they were functionally improving. Three years later, advocates say settlement terms still are not being followed.)

The provider-consumer victory may be muted. It's yet to be seen just how much effort the administration will put into any new outreach and education. If history is any indicator, it won't be much.

At press time, it also was not known whether CMS would appeal the decision or meet the deadline to comply with the court's order — which is merely for submitting a plan of improvement. It had 45 days from the August 17 ruling to do so. 

CMS could be simply angling for further court dates. After all, the U.S. District Court kindly ruled that the numerous manual changes CMS made were good enough to satisfy part of the settlement, never mind they didn't address the most vital issues, as patient advocates complain.

When the feds signed onto the settlement three years ago, they clearly had more favorable terms written into it than opponents first believed. The original settlement called only for a “good faith” effort to notify plaintiff's attorneys and make other basic publicity efforts about any educational outreach. The District Court agreed that low bar had been cleared, even though, as plaintiffs point out, thousands of providers remain unaware.

CMS has been begrudging in the way it has stabbed at disseminating information, so it's no wonder patient advocates and providers are frustrated. The CMS administrator repeatedly has refused to entertain more coverage questions, and some of the little information CMS has given providers and consumers has been labeled “inaccurate” and “non-responsive.”

The new ruling at least keeps the provider-consumer team in the game, and allows it to continue holding CMS's feet to the fire.

That, ironically, is a position that enables the team to maintain, if not necessarily improve, its leverage in the matter. 

Fitting terms for something involving the Jimmo case.