A group of disability groups and individual Medicare beneficiaries who either are, or represent people, going blind from macular degeneration, sued the US Department of Health and Human Services on Tuesday, seeking to force the agency to set up a process for beneficiaries to appeal the agency’s coverage decisions.
The plaintiffs wanted to challenge Medicare’s decision to deny coverage of ocular photodynamic therapy with the drug Visudyne, but said they could not because the agency has not set up an appeals process, despite being ordered to do so by Congress.
As part of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Medicare was supposed to establish a way for Medicare beneficiaries to challenge coverage decisions by October 1, 2001.
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