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We need your help getting Members of Congress to sign on to letters asking CMS to provide Medicare coverage for medically necessary dental care, as authorized by law. Right now there is an opportunity to encourage your delegation to sign on to these letters. Call (202) 224-3121 to be connected with your Senators and Representative. … Read more

Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history and, in some instances, even CMS policy.  For this purpose, “medically necessary oral health care” refers to treatment deemed necessary by a physician when a patient’s medical condition or treatment is or will likely be complicated by an … Read more

FOR IMMEDIATE RELEASE Contact: Matthew Shepard (mshepard@medicareadvocacy.org) 202-293-5760 July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written … Read more

Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans Home Health Highlight: People Can Leave Home and Still Receive Medicare-Covered Home Care CMS Tries Again: Another New Skilled Nursing Facility Medicare Reimbursement System Proposed – If Implemented, Would Gut Therapy Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans _ Free Webinar Series Next Webinar: … Read more

CMA Alert – Home Health Care Barriers; Overuse of Antipsychotic Drugs; More

Barriers to Home Care Created by CMS Payment, Quality Measurement, and Fraud Investigation Systems Elder Justice Alert: Human Rights Watch Publishes In-Depth Report on Antipsychotic Drug Use in U.S. Nursing Homes Consumer Statement on New Federal Landmark Study on “Critical Incidents” in Assisted Living Barriers to Home Care Created by CMS Payment, Quality Measurement, and … Read more

September 25, 2017 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1672-P P.O. Box 8016 Baltimore, Maryland  21244-8016 Submitted electronically to: http://www.regulations.gov Re:      Federal Register Volume 82 No. 144 Medicare and Medicaid Programs: CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology … Read more

I. HEALTH REFORM: UPDATE Overview On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill then moved on the Senate, and was reintroduced, with some minor changes, as the Better Care Reconciliation Act of 2017 (BCRA). Both AHCA and BCRA would cause substantial … Read more

This is Part Four of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

May 25, 2017 – WASHINGTON, DC. – Health care coverage through the Affordable Care Act (ACA), Medicare and Medicaid is under assault. The Congressional Budget Office finally released its estimate regarding the devastating impact of the AHCA bill that passed the House earlier this month. Now a select group of Senators is considering its own … Read more

Statement from the Center for Medicare Advocacy and Executive Director Judith Stein: Health Care is Under Assault – CBO Score for AHCA, Trump Budget and ACA Sabotage

May 25, 2017 – WASHINGTON, DC. – Health care coverage through the Affordable Care Act (ACA), Medicare and Medicaid is under assault. The Congressional Budget Office finally released its estimate regarding the devastating impact of the AHCA bill that passed the House earlier this month. Now a select group of Senators is considering its own … Read more

Medicare Oral Health News: District Court in Lodge Cautions Against Strict Application of Same Time/Same Dentist Rule

Henry Lodge was diagnosed with life-threatening head and neck squamous cell cancer in 1996.  His treatment involved radical dissection of his neck, implantation of radioactive seeds in the base of his tongue, and 30 days of direct beam radiation.  The surgery and the scarring from radiation permanently impaired his ability to speak and swallow, and … Read more

HEALTH REFORM: HOUSE PASSES AMERICAN HEALTH CARE ACT (AHCA) On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill will now be taken up by the Senate. American Health Care Act (AHCA): Impact on the Affordable Care Act, Medicare and Medicaid The … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

LITIGATION UPDATE Barrows v. Price (formerly Bagnall v. Sebelius, Barrows v. Burwell), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a proposed class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more

As part of the Center for Medicare Advocacy’s commitment to improving oral health for older people and people with disabilities, Center attorneys recently attended a DentaQuest convening in Cambridge, Massachusetts aimed at unifying partners in this common mission. The convening focused on leadership strategies, shared network goals and collaborative work in social justice.  The Center’s … Read more

“Dental care has been the most frustrating part of being a senior, and has the most to do with maintaining health in general.” – Michael Allen, California “This is a very important issue, the ability to eat is vital to a person[‘s] health, at age 71 I needed new dentures and I had no coverage, … Read more

On May 5, 2016 Center for Medicare Advocacy executive director Judith Stein and Senior Attorney Wey-Wey Kwok, the Dental Lifeline Network, the Medicare Rights Center, and former CMS (then HCFA) administrator Bruce Vladeck, met with CMS officials to discuss coverage of medically necessary oral health care. The group’s primary goal was to advance Medicare coverage … Read more

MEDICARE’S COVERAGE OF ORAL HEALTH   Current Centers for Medicare & Medicaid Services (CMS) policy[1] broadly bars Medicare coverage for practically all dental services.  The Center for Medicare Advocacy firmly believes that CMS has the legal authority under the Medicare statute to cover medically necessary oral health care – that is, treatment deemed necessary by … Read more

​Welcome and Housekeeping  (David Lipschutz, Moderator)  Medicare’s Coverage of Oral Health (Wey-Wey Kwok)  Medically necessary oral health care Goal: add a comprehensive oral health benefit to Medicare Administrative Update    Proposed Rules Part B Drug Demonstration (David Lipschutz) Hospital Payment Rule and the NOTICE Act (Toby Edelman) Concerns about notice to be given to those … Read more

Sign our petition to remind CMS that Medicare should cover medically necessary oral health care. Medicare was created to help older people and people with disabilities.  It should not deny clinically essential or life-saving treatments simply because those treatments occur within the mouth. The Medicare statute does not prohibit coverage for non-routine dental or oral procedures … Read more

Dental/Oral Health

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Are Dental Services Covered Under Medicare? Increasing the Possibility of Coverage Additional Resources Why We Need Medicare Coverage of Dental Services – Beneficiary Comments Articles and Updates Medically Necessary Oral Health Care Is Coverable Under Current Medicare Law While Medicare coverage of dental services does not include routine services, as discussed below, coverage for medically necessary dental and … Read more

September 1, 2015 SUBMITTED ELECTRONICALLY http://www.regulations.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201 Re: CMS-1625-P Dear Acting Administrator Slavitt: The Center for Medicare Advocacy (the Center) is pleased to provide comments on the Centers for Medicare & Medicaid Services … Read more

The Center for Medicare Advocacy received an e-mail inquiry from an individual requesting assistance advocating for her sister, Mrs. B.  Mrs. B is a Medicare beneficiary enrolled in a Medicare Advantage plan and in need of home health services.  The questions raised demonstrate several important issues that often arise with both the home health benefit … Read more

1. Comments to Senate Finance Committee Chronic Care Workgroup On June 22, 2015, the Center for Medicare Advocacy submitted comments to the Senate Finance Committee Chronic Care Workgroup in response to the Committee’s May 22, 2015 request for comments on reforming care for individuals with chronic conditions. The Committee identified three overarching goals to guide … Read more

Introduction Checklist for Home Health Appeals Quick Screen: Should My Home Health Care Be Covered By Medicare? Home Health Appeal Details Additional Information The “Improvement Standard” Myth and Home Health Care Glossary of Terms Federal Regulations – Home Health Coverage Federal Regulations – Expedited Appeals Centers for Medicare & Medicaid Services (CMS) Home Health Manual Provisions … Read more

  FAQs Contacts Watch our 2014 Webinar on Billing and Documentation FTP Instructions & Login 2018 Supporting Materials (156 pg .pdf) Face-to-Face PowerPoint (22 pg .pdf) Frequently Asked Questions Q. Will the Medicare claim extend back earlier than May 1, 2017 or later than October 31, 2017? A. It is possible that the first episode will begin … Read more

National Medicare Advocates Alliance ISSUE BRIEF #15                                                                                          FEBRUARY, 2012 __________________________________________________________________ EXTENDER … Read more

On June 24, 2011, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA), released amendments to a set of interim final rules regarding claims and appeals review processes that were originally published in July 2010.[1] The rules and amendments implement requirements … Read more

What does Medicare cover for an inpatient psychiatric hospital stay?  Are outpatient psychiatric services covered by Medicare? How much will Medicare pay for mental health and substance use services, and what out-of-pocket costs will beneficiaries be responsible for? Is there information from Medicare,gov on mental health and substance abuse services? For further information, follow one … Read more

November 20, 2017 Via Electronic Submission CMMI_NewDirection@cms.hhs.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, DC 20201 RE: Request for Information on Innovation Center New Direction Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for … Read more

September 11, 2017 Administrator Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1676-P P.O. Box 8016, Baltimore, MD 21244-8013. Re: CMS-1676 Submitted electronically: http://www.regulations.gov Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments on the 2018 … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Fight to Protect the ACA, Medicare and Medicaid – Updates (David Lipschutz and Kata Kertesz)  Affordable Care Act (ACA) Congressional action Advocacy/coalition action Outlook for Medicare and Medicaid Observation Status (David Lipschutz) Recent HHS OIG Report confirms that long outpatient stays in hospitals increasing Update on NOTICE Act … Read more

THE FIGHT TO PROTECT THE ACA, MEDICARE AND MEDICAID The President-Elect and Republican leaders in Congress have promised to repeal, and at some point, “replace” the Affordable Care Act.  They also plan to gut the Medicaid program by imposing block granting or per-capita caps.  Speaker Ryan, Trump’s nominee for HHS Secretary Rep. Price, and many … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Election’s Potential Impact on Medicare (David Lipschutz)  Affordable Care Act Medicare Structural Changes Including premium support/vouchers New Nursing Home Requirements of Participation (Toby Edelman) Overview of final rule Positive changes Prohibition against facilities’ use of mandatory pre-dispute arbitration agreements and ensuing litigation What’s missing Including staffing requirements Review: … Read more

MOVING FORWARD WITH HOPE It’s no surprise that the election has left many of us worried and disoriented.  But we’ll regroup. We may not understand where we’ve landed, but we’ll acclimate and march forward – with hope. We hope the new administration will realize how today’s families are balancing – often barely – all the … Read more

National Medicare Advocates Alliance Issue Brief #41, September 2016 LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Court order for additional education issued August 18, 2016 Exley (formerly Lessler) (ALJ Delay Case) Settlement approved August 1, 2016 Sherman (Lower level Medicare appeals) Defendant’s motion to dismiss denied, class certification granted August 8, 2016 Bremby (Per se skilled services) Coverage … Read more

PROPOSED RULE TO REVISE MEDICARE ADMINISTRATIVE APPEALS PROCESS As discussed during previous Alliance calls, there is a significant backlog of cases at the third and fourth levels of the Medicare administrative appeals process, the administrative law judge (ALJ) stage administered by the Office of Medicare Hearings and Appeals (OMHA), and the Medicare Appeals Council (Council) … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, July 11th, 2016 – 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 9874704 NOTE: We ask people calling from the same location to gather around one telephone. This frees up lines and holds down costs. Please ensure your line is on MUTE for the duration of the call … Read more

On April 1, 2016, the Center for Medicare Advocacy held its third annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. The event brought together leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health care for older people and people with … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) CMA and Vermont Legal Aid have filed a Motion for Resolution of Non-Compliance with the Settlement Agreement Exley (formerly Lessler) (ALJ Delay Case) Settlement preliminarily approved Barrows (formerly Bagnall) (Observation) Discovery on protected property interest issue; summary judgment briefing Other cases Hull … Read more

LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius) (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because their care … Read more

On April 1, 2016, the Center for Medicare Advocacy held its third annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. The event brought together leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health care for older people and people with disabilities. The … Read more

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The Center for Medicare Advocacy is Celebrating 30 years  of advancing fair access to Medicare and quality health care. Please help us meet our goal of $80,000 for the Medicare Advocacy Fund by June 30 to ensure a strong start to our next 30 years! My mother's unprecedented progress continues to be evidence of how … Read more

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Since 1986, the Center for Medicare Advocacy has been a passionate educator and advocate, working to ensure access to Medicare and quality health care. In difficult times, we need your help to be the voice for those people who have nobody to speak for them. Current Actions Other Actions Other Ways to Get Involved File … Read more

Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights Study Finds Link Between Registered Nurse Hours and Antipsychotic Drug Use Webinar: Skilled Nursing Facilities Update Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights The involuntary transfer and discharge of nursing home residents … Read more

Human Rights Watch (HRW) published a devastating report in February 2018, which found that over 179,000 nursing home residents were being administered off-label antipsychotic drugs every week.[1] Antipsychotic drugs are indicated to treat specific clinical conditions, such as schizophrenia, and not the behavioral symptoms of dementia. Nevertheless, the HRW report noted that most of the … Read more

MEDICARE HOT TOPICS[1] ORAL HEALTH UPDATE On July 19, 2018 the Center issued the following press release: July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. … Read more

Center for Medicare Advocacy Discusses Nursing Home Resident Protections with CMS Administrator Seema Verma Did CMS’s Partnership to Improve Dementia Care Reduce the Inappropriate Prescribing of Antipsychotic Drugs for Nursing Home Residents as Much as CMS Claims? Two Recent Studies Say No Health Care Sabotage: Another Attempt at ACA Repeal Free Webinar: Enhancing the Promise … Read more