Alzheimer’s Association and United Cerebral Palsy Join Court Fight Against Illegal Medicare Coverage Rule

Filed in federal district court in Burlington, Vermont on January 18 of this year, the original complaint has now been amended to include the Alzheimer's Association and United Cerebral Palsy.  Jimmo v. Sebelius, No. 5:11-CV-17 (D.Vt.).  Also joining the lawsuit is a sixth individual beneficiary, Rosalie McGill of Erie, Pennsylvania, who, despite her doctor's directives and opinion "that more therapy would be helpful," has been repeatedly denied Medicare coverage for physical, occupational, and speech therapy. Through the lawsuit, the Alzheimer's Association and United Cerebral Palsy are now working with the National Committee to Preserve Social Security and Medicare, the National Multiple Sclerosis Society, the Parkinson's Action Network, the Paralyzed Veterans of America, and the American Academy of Physical Medicine and Rehabilitation to eliminate the Improvement Standard.

The total of thirteen plaintiffs seek to represent a nationwide class of Medicare beneficiaries who have been or are being harmed by application of the Improvement Standard, "a rule of thumb" that is not supported by the Medicare statute or regulations.  Federal judges have repeatedly rejected the Improvement Standard in previous cases, but the Secretary of Health and Human Services, who oversees Medicare and is the defendant in the case, continues to apply the Standard to other beneficiaries.

The plaintiffs are represented by the Center for Medicare Advocacy, Inc., a Connecticut- and Washington-based non-partisan public interest law firm, and by the Medicare Advocacy Project of Vermont Legal Aid, which represents Medicare beneficiaries in Vermont.  Judith Stein, the Executive Director of the Center for Medicare Advocacy, applauded the decision by the Alzheimer's Association and United Cerebral Palsy to join the case: "The decision of these two important organizations to get involved in this action should signal to the government that Medicare beneficiaries and their allies around the country are determined to end the Improvement Standard once and for all."

The case has been assigned to Chief District Judge Christina Reiss, who ruled favorably last fall for an individual Medicare beneficiary who disputed application of the Improvement Standard in her case.  The government has until March 21, 2011 to respond to the amended complaint and to file its opposition to the plaintiffs' motion for class certification.