Ryan Settlement

On January 11, 2018, the U.S. District Court for the District of Vermont approved a settlement agreement in the case of Ryan v. Price (Ryan). As part of the Ryan settlement agreement, Medicare will re-review eligible claims for Home Health services that were denied between January 1, 2010 and August 3, 2015 on the basis that the beneficiary class member was not “confined to home” (otherwise referred to as the Medicare “homebound” requirement) when that beneficiary had previously received a determination through the Medicare appeals process that the beneficiary had met the homebound requirement.  

The re-review of certain denied Medicare claims will be done in order to apply the “great weight” review criteria as previously found in §6.2.1 (B) of the Medicare Program Integrity Manual to determine whether the beneficiary meets the homebound requirement under the Medicare home health benefit. A link to this review criteria can be found below under Important Links.

This re-review process is available only to beneficiaries in Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, or Vermont. The settlement agreement lays out additional qualifying criteria for re-review, and the Ryan Re-review Form is intended to assist in determining eligibility. Links to both the settlement agreement and the Ryan Re-review Form are below under Important Links.

Settlement Application Process:

1. Those beneficiaries seeking re-review of an eligible claim must identify themselves and their eligible claim(s) to CMS by completing and submitting the Ryan Re-review Form provided below under Important Links, along with any supporting documentation called for by the form, no later than August 1, 2019.  This form is also available on https://vtlawhelp.org, and medicareadvocacy.org. The form provides information to assist you in determining whether you and your claims qualify for re-review under this settlement agreement.
2. The Ryan Re-review Form and any supporting documentation must be submitted to National Government Services (a CMS contractor) by mail or fax as follows:

3. Upon receipt of the completed form, National Government Services will make reasonable efforts to identify and obtain the relevant prior favorable appellate homebound decision.