AAPD Joins Lawsuit Against HHS
FOR IMMEDIATE RELEASE
Contact: Andrew J. Imparato
(202) 457-0046
AAPD JOINS MEDICARE LAWSUIT AGAINST U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES (HHS)
Organizations and Individuals Seek to Enforce Right to Appeal Medicare Ruling on
Treatment for Age-Related Macular Degeneration (AMD)
WASHINGTON, DC, August 6, 2002 - The American Association of People with
Disabilities (AAPD) has joined as a plaintiff in a lawsuit challenging the
failure of the Department of Health and Human Services (HHS) to implement an
appeals process for Medicare National Coverage Determinations (NCDs) as required
by Congress. Other plaintiffs are the American Council of the Blind (ACB) and
the Gray Panthers, along with Medicare beneficiaries Lois Jalbert, Robert
Kennell and Barbara McAuliffe. The lawsuit was filed this morning in federal
court and announced at a press conference at the National Press Club in
Washington, DC.
"This lawsuit is important not only for individuals who have age-related macular
degeneration (AMD), but also for everyone," said Andrew J. Imparato, AAPD
President and CEO of AAPD. "The Centers for Medicare and Medicaid Services must
be held accountable and must implement a process whereby beneficiaries can
challenge national coverage decisions denying medically necessary treatments to
the millions of people who rely on Medicare for health coverage. The failure of
the Administration to provide for this kind of basic due process is an insult to
all Medicare beneficiaries and will not be tolerated."
The national coverage decision challenged in the lawsuit is the March decision
by the Centers for Medicare and Medicaid Services (CMS) to deny Medicare
coverage of ocular photodynamic therapy (OPT) with verteporfin ("Visudyne") --
the only effective treatment for age-related macular degeneration with occult
lesions. In the absence of this treatment elderly Americans with the condition
lose their vision. The decision to deny coverage reversed an October 2001
announcement by HHS Secretary Tommy Thompson that Medicare would pay for the
treatment.
The Medicare, Medicaid and SCHIP Benefits and Improvement Act of 2000 (BIPA)
became law in December 2000 with overwhelming support of Congress and President
Clinton. Section 522 of BIPA created a new right for "any aggrieved party" to
challenge a Medicare National Coverage Decision (NCD). An NCD is a determination
by HHS with respect to whether or not a particular item or service is covered
nationally by Medicare. Under Section 522, once an aggrieved party challenges an
unfavorable NCD the decision "shall be reviewed by the Departmental Appeals
Board of the Department of Health and Human Services." Congress mandated that
Section 522 take effect and apply to any NCD made on or after October 1, 2001.
Nearly a year after the congressionally-imposed deadline for compliance with
BIPA, however, HHS has failed to implement the appeals process. As a result,
beneficiaries continue to be denied their right to appeal. When plaintiffs
Jalbert, Kennell and McAuliffe tried to appeal HHS's decision to not cover
Visudyne therapy, their appeals were sidelined until an appeals process is in
place. Unfortunately, people with AMD cannot afford to wait. The disease, whose
causes are not yet well understood, can progress quickly and result in such
dramatic vision loss that a person can become legally blind soon after an
initial diagnosis.
"We're dealing with a very basic bodily function here" said Charles Crawford,
Executive Director of the American Council of the Blind. "This treatment is
critical. HHS's reversal means that people who can afford to pay for the
treatment out of their own pockets will retain their sight. People who cannot
pay for it will go blind. It's nothing short of an outrage when the agency set
up to provide for health care won't even hear the simple request for
reconsideration of a decision that puts the eyesight of the Medicare eligible
elderly on the chopping block of administrative arrogance."
To compel HHS to implement Section 522 of BIPA, Plaintiffs are suing HHS and
CMS, seeking a writ of mandamus as well as preliminary injunctive relief.
"Congress recognized the need for Medicare beneficiaries to be able to challenge
the policies that affect them," said Grant P. Bagley of Arnold & Porter, Counsel
for the Plaintiffs. "It is time for HHS to implement the process Congress
created. We welcome the opportunity to fight to protect this important
beneficiary right."
The American Association of People with Disabilities (AAPD) is a
national membership organization dedicated to promoting the economic and
political empowerment of all people with disabilities; educating businesses and
the general public about disability issues; and providing membership benefits,
like financial services and product discounts. AAPD was founded in 1995 by a
group of cross-disability leaders to help unite the diverse community of people
with disabilities, including their family, friends and supporters, and to be a
national voice for change in implementing the goals of the Americans with
Disabilities Act: equality of opportunity, full participation, independent
living and economic self-sufficiency.
JUSTICE FOR ALL -- A Service of the American Association of
People with Disabilities
www.aapd-dc.org www.jfanow.org
There's strength in numbers! Be a part of a national coalition of people with
disabilities and join AAPD today.
www.aapd-dc.org
