Marcella Myer was sitting on her bed in the nursing home when I visited her Wednesday. She looked exactly as she looked when I saw her in September. In fact, she was sitting in the same bed. Nothing had changed.

How could that be?

Marcella is 53. (That has changed. She had a birthday in November.) She is in the Woodland Manor Nursing Center in Arnold, which seems like a nice nursing home. But even a nice nursing home is not a great place for a 53-year-old woman. Truth is, it’s more appropriate for her mother.

That would be Delorse Knehans, who is 85 and lives down the hall.

Marcella has always lived with her mother. She never married. After graduating from Lutheran High School South, she got a job at a gas station and then worked as an aide in nursing homes. Finally, she got a job in the warehouse at Famous-Barr, which, of course, became Macy’s. She lost that job in 2008. She told me she just couldn’t keep up anymore.

Something was wrong. Her niece, Lisa Volner, had noticed a slurring of her speech. Her gait was increasingly unsteady. She went to a doctor who said she had a form of cerebral palsy.

By this time, she was also having problems keeping up at home. She and her mother were renting a second-story condo, and taking care of her mother just got to be too much. So in the summer of 2008, Delorse moved into the nursing home.

Marcella applied for disability. She was turned down. She had a hearing on that denial last March. By that time, she had suffered a series of strokes. She walked with a cane. She could hardly talk.

Attorney Jeffrey Swaney was at the Social Security office with another client when Marcella’s case was called.

“I knew it was an appeal, and I remember thinking, ‘How could this woman have been denied?’ You could see that she was profoundly disabled,” he told me in September when I first wrote about this case.

At any rate, he ended up with the case. A new hearing was scheduled for August.

But in July of last year, on Delorse’s birthday, Marcella and Lisa decided to take Delorse out to dinner. They stopped at a grocery store to buy flowers. Marcella fell. She ended up in the hospital.

After a few days, the hospital decided she should go to a nursing home to recuperate. She went to Woodland Manor to be with her mother.

In August, the administrative law judge said there was not enough information upon which to base a decision. Lisa gathered doctors’ reports and gave them to Swaney. He gave them to the judge.

When I visited in September, everybody seemed confident that a decision would be rendered soon.

I had no question what the decision would be. Marcella could hardly talk. She could hardly walk.

But in November, she was ordered to go to an office on Brentwood Boulevard for a psychological evaluation. The psychologist noted that the medical records indicated “a history of cerebral palsy, spastic paraparesis, and degenerative arthritis with lumbar stenosis, gait disorder/ataxia, stroke, hypertension” and various other maladies.

That’s not enough?

By the way, the psych evaluation said Marcella functions within the “borderline range” of intelligence and has verbal comprehension in the “low average” range.

“Her knowledge of current events was adequate as evidenced by her ability to name the current President and Mayor, but not the Governor.”

The governor? Who can name the governor? We haven’t seen or heard from him in two years. And what does that have to do with disability, anyway?

Obviously, the administrative judge is in no rush to make a decision.

Perhaps you’re thinking that because these decisions are retroactive, time is not of the essence.

But when Marcella went into the hospital and then the nursing home, she put all her furniture – a lifetime’s worth of stuff – in storage. She has gone through her savings. She has maxed out her credit card. Lisa has helped as much as she can. But the storage unit was locked for lack of payments. If it’s not paid by the middle of next month, the contents will be sold at auction.

Furthermore, if Marcella’s disability claim is approved, she is eligible for Medicare. She needs it.

Perhaps most importantly, a nursing home is not an appropriate place for a 53-year-old woman. Michelle Pannier, the director of Social Service at Woodland Manor Nursing Center, told me that she is hopeful of helping Marcella get into some kind of assisted-living arrangement.

Before I left, I went back to say goodbye to Marcella. She was sitting on the bed.

NOTE: Marcella was later approved for Social Security Disabilty benefits.

It’s unclear what changes the contractor might make and whether it will follow last month’s decision in Haro v. Sebelius, but its temporary suspension of  “rights and responsibilities” letters and demand letters has caused problems for plaintiffs. One attorney notes that an insurance company refused to send a settlement check without Medicare’s demand letter.

After a federal judge in Arizona held that the Centers for Medicare and Medicaid Services (CMS) had overstepped its authority regarding Medicare reimbursement claims in Haro v.Sebelius last month, the Medicare Secondary PayerRecovery Contractor (MSPRC) temporarily stopped issuing “rights and responsibilities” letters and demand letters. It has finished reviewing the rights and responsibilities letter and resumed issuing them on June 10, but it is still reviewing the demand letter.

In the meantime, “there are thousands of injury cases across the country being held hostage” because they don’t have final demand letters, said Jay Vaughn, a trial lawyer in Florence, Kentucky. He noted that he recently settled a case with an insurance company, but it refused to send the settlement check without Medicare’s demand letter.

The suspension also delays conditional payment letters, because MSPRC sends them out 65 days after rights and responsibilities letters. This delay “will affect plaintiff attorneys’ ability to evaluate cases, evaluate settlement for clients, and meaningfully participate in settlement discussions,” said Caitlin Palacios, a Washington, D.C., lawyer.

In Haro, the court enjoined CMS from demanding payment of a Medicare Secondary Payer (MSP) reimbursement claim and threatening collection actions before an appeal or waiver request could be resolved. It also said the agency may not demand that attorneys withhold liability proceeds from their clients while a disputed MSP reimbursement claim is pending. (2011 WL 2040219 (D. Ariz. May 9, 2011).)

The plaintiffs included beneficiaries and an attorney representing beneficiaries. Judge David Bury wrote that “the secretary’s application of the 60-day reimbursement requirement to support immediate collection activities against beneficiaries when the reimbursement claim is in dispute is neither rational nor consistent with the statutory scheme providing for waiver and appeal rights.”

The lawyer plaintiff had argued that requiring him to pay incorrect reimbursement claims would create a conflict of interest because doing so would go against his client’s best interests. The court held that no statutory authority supports a direct action against lawyers and that CMS cannot hold them financially responsible for MSP reimbursement if they do not turn their clients’ awards over to Medicare.

The court also certified a class of “persons who are or will be subject to MSP recovery, and from whom defendant has demanded or will demand payment of MSP claims before there have been determinations of the correct amounts through the waiver or appeal process.”

It’s unclear what changes MSPRC might make and whether it will follow Haro, lawyers say.

“The changes should be good for clients and their attorneys who wish to seek waivers and compromises,” Palacios said. “Previously, the demand for payment of disputed funds up front under threat of collection actions–even before the waiver or appeal had been considered–had a chilling effect on those considering seeking waivers and compromises.”

Vaughn said he hopes that any changes will streamline the process. “The Medicare reimbursement process has caused a lot of frustration and confusion among the practicing bar–attorneys on both sides–and insurance companies,” he said. “It shouldn’t be that hard.”

Phoenix lawyer Frank Verderame said Medicare may try to go through Congress to get around the Haro injunction. Meanwhile, he noted, the uncertainty in the MSP process is “creating a hardship for elderly and disabled clients.”

“It’s a chronic problem that’s not going to go away,” he said.