Home Health & Hospice Week

Medicare didn’t live up to its responsibilities, federal judge says.

Although the Jimmo vs. Sebelius ruling in 2014 made clear that Medicare could not impose a so-called improvement standard for Medicare eligibility, the Centers for Medicare & Medicaid Services still has a lot of work to do to comply with the decision. So said a Vermont federal court judge in a new ruling in the case issued Feb. 1.

Recap: The 2014 settlement agreement in the Jimmo case required the Department of Health and Human Services to clarify that no improvement standard existed for Medicare (see Eli’s HCW, Vol. 22, No. 6). In a new motion filed last March, “plaintiffs argued that the Secretary did not adequately disavow the Improvement Standard or disseminate the Maintenance Coverage Standard and that the Secretary’s Educational Campaign was so confusing and inadequate that little had changed as a result of the Jimmo settlement,” the new ruling notes. “Plaintiffs asked the court to require HHS ‘to carry out additional educational activities to address the inaccuracies and inadequacies of the original [Educational] Campaign,’” the latest ruling notes. In August 2016, the federal court found that HHS “failed to fulfill the letter and spirit of the Settlement Agreement” and “at least some of the information provided by the Secretary in the Educational Campaign was inaccurate, nonresponsive, and failed to reflect the maintenance coverage standard.”

Then plaintiffs and HHS/CMS tried to hammer out a corrective action plan to address the failure, but couldn’t agree on terms. So, both sides submitted their plans to the court. In the latest decision, Judge Christina Reiss finalizes the corrective action plan steps, which include CMS issuing a statement largely drafted by the plaintiff (see box, p. 55); establishing a Jimmo website; “disavowal” of the improvement standard on the website and in other communication materials; letters to Medicare Administrative Contractors and Medicare Advantage plans making clear the policy; Frequently Asked Questions posted on the website; educational materials on the topic; and instructions to MACs and MA plans to conduct training on the topic.