Medicare "Homebound" Class Action Settled - Fairness Hearing Set for January 11, 2018
On October 27, 2017, a federal
court preliminarily approved a settlement agreement in Ryan v. Hargan,
5:14-cv-269-gwc (D. Vt.). The case involves the Medicare agency’s failure to
apply a policy that was helpful to beneficiaries seeking coverage of home health
nursing or therapy services. One requirement for coverage of home health
services is that the beneficiary be “confined to the home” (i.e. homebound).
The policy in question directed that when a beneficiary had previously
been found to be homebound in a Medicare appeal, that conclusion should be
given “great weight” in any subsequent appeal for home health services,
provided there had not been a significant change in the beneficiary’s
condition. This “Prior Favorable Homebound” provision, which was contained in
one of the agency’s manuals, was intended to prevent beneficiaries from having
to repeatedly prove that they were homebound. Vermont Legal Aid and the Center
for Medicare Advocacy brought the lawsuit because the Medicare agency was not
following the Prior Favorable Homebound provision, which has since been
rescinded.
The proposed settlement applies
to Medicare beneficiaries in the northeast United States whose appeals for
coverage of home health services were denied between January 1, 2010 and March
5, 2015 on the basis of not being homebound, and who had previously received a
favorable appeal decision determining that they were homebound. More details on
the class definition can be found in the notice to class members. The agreement
will allow class members to have their eligible claims for home health services
reviewed under the Prior Favorable Homebound provision.
A Fairness Hearing on the
settlement will be held in Rutland, Vermont on January 11, 2018. The proposed
settlement agreement and notice to the class, with information on filing
objections in advance of the Fairness Hearing, are below.
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