HEARING - U.S. Senate Special Committee on Aging

147
13,114 New Developments l4 2.87
1I 36,0301 Blanche Fox. Representative of the Estate of Walter Fox, et al. v. Bowen.
U.S. District Court. District of Connecticut. Civ. Nu. 11-78-541 (JAC). Jan. 13, 1987
Medicare: Entitlement to Physical Therapy Services
Medicare Part A coverage-Extended care service-Skilled physical theray-Sufficiency
of coverage.-Inasmuch as it was previously determined that the Secretary of H HS and his
agents acted illegally by arbitrarily denying Medicare skilled nursing facility benefits to patients
receiving daily physical therapy treatment between October 1978 and April 1986 the Secretary
must grant retroactive and prospective relief to the class of beneficiaries involved. Therefore, the
Secretary must give written notice to all living members of the beneficiary class of their right to
request that their claims for Medicare skilled nursing facility benefits be redetermined. In addition
to a personalized notice by first class mail, the Secretary must publish a generalized notice to the
*benituuy-clss in five newspapers r ether publictions having general diatribtioqn within the
State of Connecticut. at least two of which must be publications whose target audience is the elderly.
Further, the Secretary must provide written notice to all providers and intermediaries of the
judgment of the court, and a special master is appointed to assist in administering and evaluating
the relief herein ornered.
See 1325.
For a related matter between these Lame parties; see 19g862 Transfer Binde rl 35.374.
[Text of Judgment] i. Retroactive Relief To The PlaintiffCass
The court hereby enters the following judg- A. The defendant will give written notice to
ment to effectuate the Memorandum of Deci- all living members of the plaintiff class of their
sion and Order entered in this case on April 23, right to request that their claims for Medicare
1986. skilled nursing facility benefits he rcdetermined.
The precise method of notification (including,
but not limited tu separate notice, or notice
' SWI exptr- Wo opinion coIcerning Wcodstoetks due procc"
auneent Wetleae it to the diserit -nart to cun ite
that ire in the tistl infncy
1 36,030 C1987, Commerce Clearing House. Inc.