Rizzi v. Shalala

No. 5:88CV00360 (TFGD) (D. Conn. Sept. 29, 1994) ; Clearinghouse Number: 45070

Description

Revised Home Health Guidelines Render Medicare Beneficiaries’ Claims Moot

Abstract

The district court has granted defendant HHS’s motion for summary judgment in this action challenging defendant’s policy of denying Medicare coverage for home health care services on the grounds that the patient’s medical condition is classified as "chronic" or "stable." Plaintiffs, Medicare beneficiaries faced with the loss of home health benefits, argued that defendant’s policy violated Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq. After plaintiffs’ complaint was filed, HHS changed its policy in response to the court’s decision in Duggan v. Bowen, 691 F. Supp. 1487 (D.D.C. 1988) (Clearinghouse No. 42,167). The revised policy, articulated in HCFA’s Intermediary Manual and the Home Health Agency Manual, clarifies the standards to be applied in determining whether the skilled care requirement has been met. The revisions emphasize that skilled care findings must be individualized determinations and specify that coverage may be available for the "management and evaluation of a patient care plan." The court found that defendant’s revised home health coverage standards, as well as measures HHS had taken to ensure that the revised coverage guidelines are understood and correctly applied, rendered plaintiffs’ claims moot. Accordingly, the court granted HHS’s motion for summary judgment.

Additional Information

Attorney Information
Charles Hulin, Judith Hulin, Brad Plebani, Center for Medicare Advocacy, P.O. Box 171, South Windham, CT 06266, (203) 456-7790.
Docket Date
1994-09-29 00:00:00+00:00

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