Whither the "Improvement Standard"? Coverage for Severe Brain Injury after Jimmo v. Sebelius.

TitleWhither the "Improvement Standard"? Coverage for Severe Brain Injury after Jimmo v. Sebelius.
Publication TypeJournal Article
Year of Publication2016
AuthorsFins, Joseph J., Wright Megan S., Kraft Claudia, Rogers Alix, Romani Marina B., Godwin Samantha, and Ulrich Michael R.
JournalJ Law Med Ethics
Date Published2016 Mar

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an "improvement standard" that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state (MCS), where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions.

Alternate JournalJ Law Med Ethics
PubMed ID27256134

Weill Cornell Medicine Consortium for the Advanced Study of Brain Injury 520 East 70th Street New York, NY