182 journal of law, medicine & ethics Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medi- cal Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third- year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philoso- phy and her J.D. from Georgetown University. Michael R. Ulrich, J.D., M.P.H., is a Senior Research Scholar in Law and Senior Fellow in Health Law at Yale Law School. He received his J.D. from University of Maryland Carey School of Law (Baltimore, MD) and his M.P.H. from the Harvard T.H. Chan School of Public Health (Cambridge, MA). O ver the past decade, neuroscience has fur- ther reined the categorization of disorders of consciousness, severe brain injuries ranging from coma to the vegetative and minimally conscious states. 1 Improved bedside assessment and neuroimag- ing methods have created new opportunities to iden- tify consciousness in patients formerly thought to be vegetative or unconscious, while emerging drugs and technologies have demonstrated that some of these minimally conscious patients may be amenable to emerging treatments. 2 Yet, patients in the minimally conscious state (MCS) are frequently burdened by coverage denials for services, which often leave them without diagnosis, treatment, or rehabilitation appro- priate to their condition. This could soon change. A recent settlement in Jimmo v. Sebelius 3 between plaintifs and the Center for Medicare and Medicaid Services (CMS) could dra- matically alter how care is provided to patients with chronic conditions like MCS. One aspect of the court- supervised negotiated settlement were revisions to the Medicare Policy Manual, which has the potential to widely inluence care determinations across the coun- try for both government funded entitlement programs as well as private payers that typically look to the Man- ual for guidance. The plaintifs in Jimmo, a consortium representing patients with chronic conditions such as Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, cere- bral palsy, and paralysis, asserted that local coverage determinations (LCDs) about Medicare coverage were being based on an “improvement standard,” where beneits are denied to patients who are not expected to improve, or have failed to demonstrate progress despite receipt of some treatments. 4 They maintained that this was in contradistinction to applicable law. Whither the “Improvement Standard”? Coverage for Severe Brain Injury after Jimmo v. Sebelius Joseph J. Fins, Megan S. Wright, Claudia Kraft, Alix Rogers, Marina B. Romani, Samantha Godwin, and Michael R. Ulrich The Journal of Law, Medicine & Ethics, 44 (2016): 182-193. © 2016 The Author(s) DOI: 10.1177/1073110516644209