November 2, 2017
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, contained in one of the agency’s manuals, was intended to prevent beneficiaries from having to repeatedly prove that they were homebound.
The lawsuit was brought by Vermont Legal Aid and the Center for Medicare Advocacy because the agency was not following the Prior Favorable Homebound provision, which has since been rescinded.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.