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Room for Improvement & Room for None: Jimmo Ruling Directs Medicare Agency to Improve Its Educational Campaign Regarding the “Maintenance Coverage Standard”

As reported by the Center for Medicare Advocacy, “in an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, who oversees the ‘Improvement Standard’ case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she had approved in January 2013.” ...

After the 2013 agreement was established, Michael Benvenuto, one of the lead attorneys from Vermont Legal Aid, stated that “[t]his settlement should send the message that denying Medicare coverage for a chronic condition is wrong.”  Similarly, even as the original settlement was being proposed, the New York Times wrote an editorial extolling the humanity of the rule change.  Together, these notions epitomize an ideal of human dignity that skilled care should be provided to the elderly or disabled, even when their condition may not improve.

Health Care Providers Say They're 'Cautiously Optimistic' About All-Payer Plan

A number of health care providers say they are "cautiously optimistic" that the implementation of a new payment system known as “all-payer" will help reduce costs and allow them to provide a higher quality of service. ,,,

Julia Shaw is a policy analyst in [Vermont Legal Aid's] Office of the Vermont Health Care Advocate. She says things definitely need to change.

"The cost of our health care system is growing too rapidly,” says Shaw. “And I think this is a promising way to address that and really start to bend that curve." ...

And Julia Shaw of the Health Care Advocate's office wants the “all-payer” system to include consumer protections to ensure that patients get appropriate care.

"In this kind of model, where providers are paid basically for treating a population, there are some financial incentives to provide less care," Shaw explains. "So really what the model needs is checks and balances to ensure that patients get the care that they need."

Read our white paper: Consumer Principles for Vermont's All-Payer Model

Driver restoration is a road to opportunity

In this op-ed piece, Vermont Legal Aid attorney Christopher Curtis writes:

A year and a half ago, more than 1,000 Vermonters turned out on a chilly March day in Burlington to get square with the law, pay their traffic fines at reduced rates and get back on the road safely, legally, and affordably. A bright tapestry of Vermonters from all walks of life waited patiently for a second chance to reinstate their driver’s licenses. People came from five counties – one all the way from West Virginia – for a “Driver Restoration Day” project initiated by Chittenden County State Attorney T.J. Donovan. ...

The scope of the license suspension problem is staggering. According to the Department of Motor Vehicles, about 60,000 Vermonters have suspended licenses. More than half of those are simply for failure to pay a fine. Most of those are low-income Vermonters who simply cannot afford to pay and then find themselves in a downward spiral of new tickets and fines following the original infraction. ...

The new law is not a free pass. All drivers remain obligated to pay fines and are subject to a “points system” for infractions. So, repeat offenders are still subject to suspension for failure to comply with our traffic laws. But, flexibility in the system will put low-income drivers on more equal footing with others to be able to simply pay their fines and move on with their lives.

Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage

... Though never part of Medicare regulations, the improvement standard was written into the C.M.S. manuals that providers and claims administrators relied on. “It was a policy they followed for 30 years,” Mr. Deford said.

The lawsuit brought by the Center for Medicare Advocacy and Vermont Legal Aid in 2011 became known as the Jimmo case, after Glenda Jimmo, an elderly Vermont plaintiff. A settlement reached in 2013 required C.M.S. to rewrite its manuals and to begin an educational campaign to publicize the change. ...

By early this year, however, the Center for Medicare Advocacy was hearing from many sources that despite the settlement, providers and the contractors reviewing Medicare claims were still denying coverage when beneficiaries didn’t demonstrate improvement.

The Centers for Medicare and Medicaid Services showed no inclination to take further steps, so the plaintiffs’ lawyers went back to court, seeking enforcement of the agreement. The federal judge in Vermont who oversees the settlement ruled in August that C.M.S. didn’t have to further revise its manuals, but did have to mount a better educational campaign.

By early next month, it has to explain how it plans to do that. A C.M.S. spokeswoman said the agency had reviewed the court’s order, but would make no other comment.

40,000 Vermonters could pay old traffic fines at reduced rates

Thousands of Vermonters have the opportunity to pay off old traffic tickets at a reduced rate. The driver restoration program, which runs until Nov. 30, is part of an effort to help people whose licenses were suspended because of unpaid traffic fines to get back on the road.

Vermonters with outstanding traffic tickets from before July 1, 2012 will be able to pay them off for $30 per ticket by applying by mail or email to the Vermont Judicial Bureau. ...

Christopher Curtis, an attorney with Vermont Legal Aid, hailed the program as “a huge step in the right direction” that will allow thousands of people to get back on the roads.

“Vermonters with old tickets who were locked in a poverty trap of expensive tickets they couldn’t afford have an opportunity to start over, pay a fraction of the old tickets and move on with their lives,” Curtis said.

“That said, this is not a free pass,” Curtis said. “Going forward it’s critical that Vermonters know they do have to pay their traffic fines and maintain their insurance — for those who cannot afford the standard fine they can ask for a repayment plan over time, or they can ask the court to consider their income in setting the fine amount. Not paying is not an option.”

Regulators to decide on $2.4 billion in proposed hospital revenue

Vermont’s health care regulators will decide in the next several weeks whether to lower the prices that hospitals charge for services starting Oct. 1.

The hospital system as a whole, which includes 14 hospitals of various sizes and management structures, has proposed to take in $2.4 billion from patients in the upcoming fiscal year, a 5 percent increase over what was budgeted for in the current fiscal year.

The proposed increase in revenue from patient care is higher than the 3.4 percent target the Green Mountain Care Board requested from hospitals going into the hospital budget process, and may be the result of more people needing health care services. ...

Julia Shaw, who works for Vermont Legal Aid’s Office of the Health Care Advocate, said the board should determine what has been causing hospitals to take in excess revenue, and then develop a process for how to address each hospital’s overage.

Shaw said the board should not allow hospitals to “bake in” their revenue overages into their baseline budgets each year. “We hope that the board doesn’t undercut its process by allowing huge revenue increases without determining what’s driving them,” she said.

Shaw said this is the first year since the Green Mountain Care Board started regulating hospital budgets that the Office of the Health Care Advocate has participated in the process. She said there have been “bumps in the road” that she hopes get smoothed out over time.

Reduced traffic fine program to begin

Thousands of Vermonters will have the chance to get their driver’s licenses back starting Thursday. The driver restoration program will let people with unpaid fines for old traffic tickets apply for reduced fines of $30 per ticket. Once the reduced fines are paid, they can have license suspensions for nonpayment lifted.

The program runs Sept. 1 through Nov. 30. Judgment must have been entered on the tickets prior to July 1, 2012. The Vermont Judicial Bureau and DMV estimate that about 40,000 Vermonters are eligible. ...

Chris Curtis, an attorney with Vermont Legal Aid, called the program a “good first step,” but said it was also important that the state make sure low-income Vermonters with multiple traffic tickets know there are programs that allow them to pay the fines in installments to avoid losing their licenses for nonpayment.

“It’s a victory for Vermonters who were getting caught up in a poverty trap of getting a ticket, not being able to pay the fine and having fines pile up,” he said.

Lead investor makes case to regulators to buy Burlington Labs

A former IDX executive told health care regulators he’s ready to save an embattled drug testing company within a month but will walk away if they wait more than a month to issue a permit for the deal. ...

Jim Crook Jr. has been leading an investor group, with minority partnership from the University of Vermont Health Network, to acquire Burlington Labs, which collects and processes urine samples to check for opiates. It operates locations across Vermont and two in other states.

He made his case before the Green Mountain Care Board on Wednesday, seeking to use an emergency process to apply for a permit, called a certificate of need, to acquire the company, which Crook says is in danger of going under. The board approved the request for an emergency process unanimously in a voice vote after taking public comment. ...

At the hearing, Crook faced questions from reporters and health care advocates from Vermont Legal Aid about the alleged fraud. Gobeille, who generally intervenes during the public comment period at board meetings, answered many of the questions himself. ...

“The point is today’s matter is whether there should be an emergency (certificate of need),” Gobeille said. “We are not diving into what the AG is doing or what the issue is with Burlington Labs.”

State Touts Improved IT, Customer Service At Vermont Health Connect

A couple weeks ago, administration officials delivered their final monthly report on Vermont Health Connect to the Legislature. The document strikes a triumphant tone. Vermont’s insurance exchange, the report says, is succeeding at long last.

Trinka Kerris the chief health advocate for Vermont. She oversees Vermont Legal Aid's Office of the Health Care Advocate, an independent office that works to resolve consumer complaints about Vermont Health Connect, other insurers, state programs, hospitals and providers. ...

“It’s only good when you compare it to what it used to be like,” Kerr says. “We still get calls from people who are really upset, really frustrated, really angry about problems that they’ve been trying to resolve for months.”

Just because Vermont Health Connect is better today than it was six months or a year ago, Kerr says, doesn’t mean it’s as good as it should be. The Legislature commissioned an independent review of Vermont Health Connect due at the end of the year.

“I guess I’d like to see the results of the study that’s being done to determine whether it is really worth sticking with the system,” Kerr says.

Federal Court Orders CMS To Fix Improvement Standard Education Effort

A federal district court agreed with beneficiary advocates that CMS hasn't done enough to implement a three-and-a-half-year old settlement agreement to halt a widespread, unofficial policy of cutting off Medicare coverage for certain services when beneficiaries stop improving. The court ordered the agency to provide more education about Medicare coverage of services for beneficiaries that may not be improving The Center for Medicare Advocacy and Vermont Legal Aid alleged the improvement standard was illegal, and CMS and the beneficiary advocates...

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