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Civil Rights Litigation Clearinghouse
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Case Name Jimmo v. Sebelius PB-VT-0002
Docket / Court 11-cv-17 ( D. Vt. )
State/Territory Vermont
Case Type(s) Public Benefits / Government Services
Attorney Organization NDRN/Protection & Advocacy Organizations
Case Summary
This case concerns the "Improvement Standard," a rule of thumb that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services. As a result, some people are forced into nursing homes or suffer other ... read more >
This case concerns the "Improvement Standard," a rule of thumb that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services. As a result, some people are forced into nursing homes or suffer other adverse medical outcomes. The complaint, with five beneficiary plaintiffs and five national organization plaintiffs, was filed in the U.S. District Court for the District of Vermont, along with a motion for certification of a nationwide class, on January 18, 2011. On March 3, plaintiffs filed an amended complaint that added two more organization plaintiffs and one beneficiary plaintiff. The parties completed briefing of the class motion in early May 2011.

Oral argument on the government's motion to dismiss was held on July 14, 2011. On October 25, 2011, the court largely denied the motion to dismiss. 2011 WL 5104355. After the Secretary filed an Answer on November 8, 2011, discovery was stayed for settlement discussions. On July 20, 2012, the parties reported to the court that they had reached an agreement in principle. In October 2012, the parties filed a settlement agreement, which was approved by the court (Chief Judge Christina C. Reiss) on January 24, 2013. The agreement significantly changes Medicare coverage rules; Medicare will pay for services if they are needed to "maintain the patient's current condition or prevent or slow further deterioration," regardless of whether the patient's condition is expected to improve. The Court will monitor compliance for four years.

In the settlement, the government agreed to pay an unspecified amount for reasonable attorneys' fees and costs to the plaintiffs.

- 10/21/2012
Alex Colbert-Taylor - 06/24/2013


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Issues and Causes of Action
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Issues
Benefit Source
Medicare
Content of Injunction
Goals and Timekeeping
Monitoring
Defendant-type
Hospital/Health Department
General
Deinstitutionalization/decarceration
Funding
Government Services (specify)
Payment for care
Plaintiff Type
Private Plaintiff
Causes of Action None on record
Defendant(s) Department of Health and Human Services
Plaintiff Description Five medicare beneficiaries and 6 advocacy organizations (National Committee to Preserve Social Security and Medicare, National Multiple Sclerosis Society, Parkinson's Action Network, Paralyzed Veterans of America, American Academy of Physical Medicine and Rehabilitation, United Cerebral Palsy)
Indexed Lawyer Organizations NDRN/Protection & Advocacy Organizations
Class action status sought Yes
Class action status granted Yes
Prevailing Party Plaintiff
Public Int. Lawyer Yes
Nature of Relief Injunction / Injunctive-like Settlement
Source of Relief Settlement
Form of Settlement Court Approved Settlement or Consent Decree
Order Duration not on record
Case Closing Year 2013
Case Ongoing No
Docket(s)
5:11-cv-17 (D. Vt.) 01/25/2013
PB-VT-0002-9000.pdf | Detail
PACER [Public Access to Court Electronic Records]
General Documents
Class Action Complaint for Declaratory, Injunctive, and Mandamus Relief 01/13/2011
PB-VT-0002-0006.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Motion for Class Certification and Appointment for Class Counsel 01/18/2011
PB-VT-0002-0003.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Amended Complaint for Declaratory, Injunctive, and Mandamus Relief 03/03/2011
PB-VT-0002-0005.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Opinion and Order Denying in Part and Granting in Part Defendant's Motion to Dismiss for Lack of Subject Matter Jurisdiction and Denying Defendant's Motion to Dismiss for Failure to State a Claim 10/25/2011 (2011 WL 5104355) (D. Vt.)
PB-VT-0002-0002.pdf | WESTLAW | Detail
Document Source: Westlaw
Order Denying Partial Reconsideration of Opinion and Order of October 25, 2011 12/23/2011 (D. Vt.)
PB-VT-0002-0007.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Joint Notice Regarding Settlement Agreement 10/16/2012
PB-VT-0002-0004.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
[Proposed] Settlement Agreement 10/16/2012
PB-VT-0002-0008.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Order Preliminarily Approving Settlement Agreement, Preliminarily Certifying the Class, Approving Class Notice, and Setting Fairness Hearing 11/20/2012 (D. Vt.)
PB-VT-0002-0009.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Order Granting Final Approval of Settlement Agreement and Directing Entry of Final Judgment 01/24/2013 (D. Vt.)
PB-VT-0002-0010.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Judgment in a Civil Case 01/25/2013
PB-VT-0002-0011.pdf | Detail
Document Source: PACER [Public Access to Court Electronic Records]
Judges Reiss, Christina Clair (D. Vt.)
PB-VT-0002-0002 | PB-VT-0002-0007 | PB-VT-0002-0009 | PB-VT-0002-0010 | PB-VT-0002-9000
Monitors/Masters None on record
Plaintiff's Lawyers Benvenuto, Michael Kelly (Vermont)
PB-VT-0002-0003 | PB-VT-0002-0004 | PB-VT-0002-0005 | PB-VT-0002-0008 | PB-VT-0002-9000
Berger, David J. (California)
PB-VT-0002-0004 | PB-VT-0002-0008 | PB-VT-0002-9000
Bers, Alice (Connecticut)
PB-VT-0002-9000
Deford, Gill (Connecticut)
PB-VT-0002-0003 | PB-VT-0002-0004 | PB-VT-0002-0005 | PB-VT-0002-0006 | PB-VT-0002-0008 | PB-VT-0002-9000
Edelman, Toby (District of Columbia)
PB-VT-0002-0003 | PB-VT-0002-0005 | PB-VT-0002-0006 | PB-VT-0002-9000
Gifford, Nancy V. (Vermont)
PB-VT-0002-0003 | PB-VT-0002-0005 | PB-VT-0002-0006 | PB-VT-0002-9000
Green, Devon J. (Vermont)
PB-VT-0002-0003 | PB-VT-0002-9000
Kwok, Wey-Wey (Vermont)
PB-VT-0002-0003 | PB-VT-0002-0005 | PB-VT-0002-0006 | PB-VT-0002-9000
Murphy, Margaret (Connecticut)
PB-VT-0002-0003 | PB-VT-0002-0006 | PB-VT-0002-9000
Reed, Matthew R. (California)
PB-VT-0002-0004 | PB-VT-0002-0008 | PB-VT-0002-9000
Stein, Judith A. (Connecticut)
PB-VT-0002-0003 | PB-VT-0002-0004 | PB-VT-0002-0005 | PB-VT-0002-0006 | PB-VT-0002-0008 | PB-VT-0002-9000
Defendant's Lawyers Bressler, Steven Y. (District of Columbia)
PB-VT-0002-0004 | PB-VT-0002-0008 | PB-VT-0002-9000
Coffin, Tristram J. (District of Columbia)
PB-VT-0002-0004 | PB-VT-0002-0008
Delery, Stuart F. (District of Columbia)
PB-VT-0002-0008
Doyle, Kevin J. (Vermont)
PB-VT-0002-9000
Hoffman, Janice L (District of Columbia)
PB-VT-0002-0008
Lieber, Sheila M. (District of Columbia)
PB-VT-0002-0004 | PB-VT-0002-0008
Lyons, Susan Maxson (District of Columbia)
PB-VT-0002-0008
Moore, Tamra (District of Columbia)
PB-VT-0002-9000
Rivera, William Alvarado (District of Columbia)
PB-VT-0002-0008
Roddy, Kirsten Friedel (District of Columbia)
PB-VT-0002-0008
Schultz, William B (District of Columbia)
PB-VT-0002-0008
Zee, M. Andrew (District of Columbia)
PB-VT-0002-0004 | PB-VT-0002-0008 | PB-VT-0002-9000
Other Lawyers None on record

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