Medicare Approves and Ms. Jimmo Gets Benefits….Finally

Who amongst us has not heard of the Jimmo case?  You know that case—where Vermont Legal Aid and the Center for Medicare Advocacy (full disclosure-I’m on their board), sued CMS over the improvement standard (which isn’t a requirement for Medicare).  Well, the plaintiffs were victororiou and CMS amended the manuals…. more details and a host of articles about the Jimmo settlement and what it means for clients is available on the CMA website.

But did you ever think about outcome for the plaintiff, Ms. Jimmo?  Guess what, she didn’t get benefits as part of the settlement…in fact, she had to apply again with CMS for her benefits, and she has finally prevailed!

Susan Jaffe reported in  Disabled Vt. Senior Wins Medicare Coverage After 2nd Lawsuit that CMS has finally awarded Ms. Jimmo benefits. The story explains that after the first lawsuit, she applied for benefits and was denied. Thus starts round two.  Denied in April, she sues in June and now it is the end of October, 2014.  Ms. Jimmo “argued [in her second suit that] Medicare should have paid for the nursing care and other skilled services she received at her home during 2007. On Wednesday, [October 29, 2014] Medicare officials agreed, invalidating an April ruling that she was not entitled to coverage because her condition had stabilized and she was not improving.”

Although CMS officials didn’t comment for the story, the article contains this “Medicare officials agreed Wednesday that the Medicare Appeals Council’s denial “shall have no remaining force or effect.”  Medicare will now pay Jimmo’s home health agency nearly $12,000, as well as her attorney fees.”  My favorite part of the story (other than the ending) is this from Judy Stein, executive director of the CMA:

“This should give hope to other people who are going through the Medicare appeals process,” said Judith Stein, executive director of the Center for Medicare Advocacy, which filed the original class action lawsuit with Vermont Legal Aid and negotiated both settlements.  “It’s helpful to know that people will get a fair shot for an appeal because if Mrs. Jimmo couldn’t, who could?”

Good news for today!