In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius. After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services. That is care would no longer be denied due to a Medicare beneficiary's lack of restoration potential.
During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.
Margaret Murphy is the Associate Director of the Center for Medicare Advocacy where she works to develop the Center's legal policy and litigation strategies. Ms. Murphy has been counsel or co- counsel in several of the Center's federal class action suites. She serves on the Steering Committee of the Complex Care Committee of the Connecticut Medicaid Medical Assistance Program Oversight Council. She has also been appointed by the Connecticut probate courts to represent incapacitated adults. She has also taught as an adjunct professor at Quinnipiac University Law School. Prior to joining the Center Ms. Murphy worked for more than 20 years a a trust and estate attorney. She is a member of the Connecticut Bar Association, serves as the Secretary of the Executive Committee of the Elder Law Section and is a member of Swift's Inn in Hartford. Ms. Murphy earned her JD degree from the University of Connecticut School of Law and her BA from Mt. Holyoke College.
The Jimmo Settlement: Its Importance and Implementation to Date: A Conversation With Margaret Murphy (November 10th)