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From 1986 all the way through 2009, the Center handles tens of thousands of cases, and sees a continuing increase in the number of denials for conditions that are not improving, are chronic, are stable, or are receiving "maintenance" services.
Judith Stein, executive director of the Center for Medicare Advocacy, litigates Fox v. Bowen, a case that successfully argues against the use of an illegal standard requiring that patients in Connecticut nursing facilities show "improvement" for Medicare coverage.
From 2009 into 2010, the Center undertakes serious conversations with the Centers for Medicare & Medicaid Services (CMS) to try to reach a resolution to these unfair denials. After exhaustive discussion, the Center realizes that every individual case can’t be appealed, and that the systemic problem won’t be solved with individual case work. The Center must proceed with litigation.
The Center for Medicare Advocacy, long aware of the illegal and unfair practice that it coins the "Improvement Standard" realizes, as cases, including Glenda Jimmo’s, continue to arise, that legal action is needed to stop the practice of denying beneficiaries Medicare because they aren't improving. The Center for Medicare Advocacy and co-counsel Vermont Legal Aid file a federal lawsuit and Motion for Certification of a Nationwide Class. The suit is filed against Kathleen Sebelius, Secretary of Health and Human Services, on behalf of six beneficiary plaintiffs and seven national organization plaintiffs harmed by the improvement standard. The case is filed in the United States District Court in Rutland, Vermont.
In early May, the parties submit briefs to the court regarding the certification of the nationwide class Motion.
In early June of 2011, the government files a motion to dismiss the case, arguing that the court lacked jurisdiction over the plaintiffs’ claims and that the plaintiffs had failed to state a claim for which relief could be granted. On October 25th, the court largely denies the motion to dismiss Jimmo v. Sebelius, allowing the Center to move forward with the legal proceedings in its fight against the Improvement Standard. The legal battle for the rights of thousands of Medicare beneficiaries continues.
With Jimmo v. Sebelius heading towards a trial in spring 2012, the government’s legal team and the Center begin negotiations to develop a settlement agreement. The Center for Medicare Advocacy's Gill Deford, Director of Litigation and Judith Stein, Executive Director help ensure that negotiations are fair and just for beneficiaries.
The parties inform the court that they have come to a basic agreement on the Settlement, meeting the court-imposed July 20th deadline.
The proposed Jimmo v. Sebelius settlement agreement is filed in the Federal District Court of Vermont, marking a landmark step towards ending this imposed barrier to Medicare and health care. Chief Justice Christina Reiss now must decide whether the agreement is fair.
A front page feature article on The New York Times, “Settlement Eases Rules for Some Medicare Patients” by Robert Pear brings national attention to the proposed settlement and its implications for beneficiaries and their families.
