Victory in Medicare Lawsuit

Many times a year, MS Activists around the country contact their legislators to urge support of policies and funding that will benefit people living with multiple sclerosis (MS). Today, the Society is pleased to announce that another type of activism—judicial action—has resulted in a settlement that will help ensure that people with MS get the home health care, skilled nursing home stays and outpatient therapy they need. Just two years ago, the Society joined as an original plaintiff in a class action lawsuit that challenged the Centers for Medicare and Medicaid Services’ (CMS) inappropriate and illegal practice of denying Medicare coverage to those who are unable to show that they are improving from certain skilled care services, including therapy. This practice has been particularly impactful for people with chronic, degenerative diseases such as MS for which services such as therapy may be exactly what is needed to help slow deterioration. As a result of the lawsuit, the government has agreed to take corrective action so that it will not happen in the future. The government will revise relevant portions of its Medicare Benefit Policy Manual and engage in a nationwide Educational Campaign about the corrected maintenance coverage standards. Members of class will also be entitled to a re-review of their denied claim within the next year. We at the National MS Society are very pleased with the progress which has been made in this case. Medicare beneficiaries living with MS and other chronic illnesses will now definitively be able to receive important needed health care services that prevent decline and maximize independence. To learn more about this important settlement and about one of its inspirational plaintiffs who lives with MS, click here. The Society recognizes the work of the Center for Medicare Advocacy, Inc. which has coordinated the legal proceedings for plaintiffs in this case and acted as lead counsel. The other national organizations that entered the case as plaintiffs are: Parkinson’s Action Network, the Alzheimer’s Association, Paralyzed Veterans of America, United Cerebral Palsy and the National Committee to Preserve Social Security and Medicare.