Medicare ruling approved; quick benefit sought
By Gordon Dritschilo
Staff Writer | January 27,2013
Advocates hope Vermont Medicare patients won’t have to wait a year to reap the benefits of a class-action lawsuit that was settled last week.
Vermont Legal Aid and the Center for Medicare Advocacy settled a class-action lawsuit against the federal government over Medicare coverage of maintenance therapy. When U.S. District Judge Christina Reiss approved the settlement Thursday to cover such treatment, the government said it would set out to revise its relevant policies and prepare a three-month educational campaign for the Medicare system.
“Full implementation will take a year from today,” Michael Benvenuto, director of Vermont Legal Aid’s Medicare Advocacy Project, said Friday. “Because they have agreed this is what Medicare should always have been, we’re going to be pushing that changes should be taking place faster.”
Benvenuto said the case was over Medicare coverage of therapy to maintain a patient’s condition or to prevent deterioration, rather than just treatments aimed at improvements.
“Medicare never wanted to cover people just to maintain their present condition,” he said. “The impact on your grandmother would be if she needs a skilled nurse to come in every two weeks to maintain her position, that should be covered.”
Vermont’s position in the national class-action lawsuit was unusual, Benvenuto said, in that the Vermont Medicaid program often covers such treatment. Providers will be able to get reimbursed more by billing Medicare, he said, and the state will save money with those claims no longer going to Medicaid.
Benvenuto also said the decision would apply to preventive services, reducing overall costs from hospitalization and complications.
The lead plaintiff in the lawsuit was a Vermont woman, Glenda Jimmo of Lincoln. Blind and diabetic, Jimmo was denied Medicare coverage for home health care because her condition was deemed unlikely to improve.