Whither the “Improvement Standard”? Coverage for Severe Brain Injury after<i>Jimmo v. Sebelius</i>

Fins, Joseph J.; Wright, Margaret H.; Kraft, Claudia; Rogers, Alix; Romani, Marina B.; Godwin, Samantha; Ulrich, Michael R.

doi:10.1177/1073110516644209

Cited by 17 publications

(10 citation statements)

References 38 publications

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“…Given that this system does not rely on overt responses, it can be done independent of behavioural responses and therefore is not confounded by ‘motor-mind disconnection’. It is imperative that patients in minimally conscious or locked-in states receive the stimulation and rehabilitation necessary to maximize their odds of improvement ( Giacino 2004 ; Fins et al 2016 ; Illman and Crawford 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation

Fleck-Prediger

Hajra

Liu

et al. 2018

Neuroscience of Consciousness

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Survivors of severe brain injury may remain in a decreased state of conscious awareness for an extended period of time. Clinical scales are used to describe levels of consciousness but rely on behavioural responses, precipitating misdiagnosis. We have previously utilized event-related potentials (ERPs) to circumvent reliance on behavioural responses. However, practical implementation barriers limit the clinical utility of ERP assessment at point-of-care (POC). To address this challenge, we developed the Halifax Consciousness Scanner (HCS)—a rapid, semi-automated electroencephalography system. The current study evaluated: (i) HCS feasibility in sub-acute, POC settings nationwide; (ii) ERP P300 responses in patients with acquired brain injury versus healthy controls; and (iii) correlations within and between clinical measures and P300 latencies. We assessed 28 patients with severe, chronic impairments from brain injuries and contrasted the results with healthy control data (n = 100). Correlational analyses examined relationships between P300 latencies and the commonly used clinical scales. P300 latencies were significantly delayed in patients compared to healthy controls (P < 0.05). Clinical assessment scores were significantly inter-correlated and correlated significantly with P300 latencies (P < 0.05). In sub-acute and chronic care settings, the HCS provided a physiological measure of neurocognitive processing at POC for patients with severe acquired brain injury, including those with disorders of consciousness.

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Section: Discussionmentioning

confidence: 99%

Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation

Fleck-Prediger

Hajra

Liu

et al. 2018

Neuroscience of Consciousness

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“…69 But the challenge is not just one of access to care. 70 Instead it is a question of rights, of fundamental equality, necessitated by new scientific insights, to borrow Justice Kennedy's formulation.…”

Section: Recovery Resilience and Rightsmentioning

confidence: 99%

Disorders of Consciousness, Past, Present, and Future

Fins¹

2019

Camb Q Healthc Ethics

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Abstract:This paper, presented as the 2019 Cambridge Quarterly Neuroethics Network Charcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classification of disorders of consciousness—epitomized by the minimally conscious state, cognitive motor dissociation, and the recently described chronic vegetative state—the author argues that there is a counter-narrative to the one linking these conditions to the right to die. Instead, there is a more nuanced schema distinguishing futility from utility, informed by technical advances now able to identify covert consciousness contemplated by Jennett and Plum. Their prescience foreshadows recent developments in the disorders of consciousness literature yielding a layered legacy with implications for society’s normative and legal obligations to these patients.

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“…Pa. 2010) (agreeing with the plaintiff's argument that the Secretary of HHS failed to apply the correct legal standard and did not consider plaintiff's potential need for a rehabilitative maintenance program: "Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities."). 3 See Jimmo v. Sebelius, 2011 WL 5104355 (D. Vt. 2011); Fins et al 2016 (noting that the Jimmo settlement "gives hope that coverage standards will be based on individualized assessment and the needs and conditions of specific patients" and concluding with policy recommendations designed to realize the aspirations of the Jimmo plaintiffs in the context of patients in the minimally conscious state in need of skilled care). 4 See Jimmo v. Burwell, No.…”

Section: A Skilled Care Hypotheticalmentioning

confidence: 99%

Disparities in Private Health Insurance Coverage of Skilled Care

Tovino

2017

Laws

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This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care). As background, prior scholars writing in this area have focused on Medicare coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard). By and large, these scholars have applauded the settlement agreement approved on 24 January 2013, by the U.S. District Court for the District of Vermont in Jimmo v. Sebelius (Jimmo), as well as related motions, rulings, orders, government fact sheets, and Medicare program manual statements clarifying that Medicare covers skilled care that is necessary to prevent or slow a beneficiary's deterioration or to maintain a beneficiary at his or her maximum practicable level of function even though no further improvement in the beneficiary's condition is expected. Scholars who have focused on beneficiaries who have suffered severe brain injuries, in particular, have framed public insurance coverage of skilled brain rehabilitation as an important civil, disability, and educational right. Given that approximately two-thirds of Americans with health insurance are covered by private health insurance and that many private health plans continue to require their insureds to demonstrate improvement within a short period of time to obtain coverage of skilled care, scholarship assessing private health insurance coverage of skilled care is important but noticeably absent from the literature. This article responds to this gap by highlighting state benchmark plans' and other private health plans' continued use of the Improvement Standard in skilled care coverage decisions and identifying possible legal approaches for removing the Improvement Standard in private health insurance. This article also calls for scholars in health law, disability law, and insurance law, among other doctrinal areas, to evaluate the ethics and values associated with the continued use of the Improvement Standard in private health insurance.Keywords: skilled care; Medicare; private health insurance; stigma; improvement; maintenance This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care). As background, prior scholars writing in this area have focused on Medicare 1 coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard). 2 By and large, these scholars have applauded the settlement ag...

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Whither the “Improvement Standard”? Coverage for Severe Brain Injury afterJimmo v. Sebelius

Cited by 17 publications

References 38 publications

Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation

Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation

Disorders of Consciousness, Past, Present, and Future

Disparities in Private Health Insurance Coverage of Skilled Care

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