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Author Archives: mshepard

Ben Belton

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Ben Belton, Former Senior Advisor to the Acting Commissioner, Social Security Administration, is the first recipient of the the Alfred J. Chiplin, Jr., Social Justice & Advocacy Award. Ben most recently served in the administration of President Barack Obama as a Senior Advisor to the Acting Commissioner of the Social Security Administration (SSA). In that role, he oversaw … Read more

CMA Alert, October 18, 2017 – Nursing Home Rights Roundup; ACA Stabilization; More

This Week in ACA Sabotage Bipartisan Agreement on ACA Stabilization Package Nursing Home Rights Roundup CMS Signals End of Campaign to Reduce Unnecessary Use of Antipsychotic Drugs In Nursing Homes; Claim of Success is Grossly Overstated OIG Report about Nursing Home Complaints Leaves Questions Unanswered Congressional Letter Asks for Revision and Delay of Nursing Home … Read more

October 13, 2017 – WASHINGTON, DC Like others who care about the well-being and health care of all Americans, the Center for Medicare Advocacy is dismayed by the Trump Administration’s actions to undermine the Affordable Care Act (ACA). Following a pattern of sabotaging the ACA – including reducing the ACA enrollment period and gutting funding … Read more

CMA Alert – Open Enrollment Tips; ACA Sabotage; More

Medicare Annual Enrollment Period Begins October 15: Look Before You Leap This Week in ACA Sabotage  Breast Cancer Awareness Month International Day of Older Persons Medicare Annual Enrollment Period Begins October 15: Look Before You Leap Free Webinar Series Next Webinar: Social Security Disability Insurance (SSDI) Part 1 – History/Myths/Who is Served October 18, 2017 … Read more

CMA Alert – Changes to Help QMBs; Home Health Updates; ACA Sabotage

CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed CMS Reissues Improved Medicare Home Health Booklet Dispelling a Myth: Medicare Home Health Coverage is NOT a Short Term, Post-Acute Care Benefit The ACA Sabotage Continues CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed The Centers for Medicare and … Read more

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Sabotage of ACA Must Stop Action Needed The U.S. Department of Health and Human Services (HHS) recently released its draft FY 2018- 2022 Strategic Plan. While one of HHS’ stated objectives is to “Improve American’s access to health care and expand choices of care and service options,” we are instead seeing a systematic effort to … Read more

Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries We Called It: Continued Sabotage of the ACA “Equitable Relief” Ends this Week – Sign Up for Medicare Part B Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries In July, CMS proposed new payment, case-mix adjustment and quality reporting rules that will make it harder … Read more

Statement from Center for Medicare Advocacy on Latest ACA Repeal Effort 

Yesterday, in a significant victory for millions of Americans, Senate leadership cancelled plans for a vote on the latest effort to repeal the Affordable Care Act (ACA).  The Graham-Cassidy bill, if passed, would have led to millions of people becoming uninsured, gutted Medicaid, and eroded crucial consumer protections. The bill faced overwhelming opposition from virtually … Read more

Senate Holds Single Hearing on Bill to Strip Coverage from Millions – Act Now

Graham-Cassidy is Still A Threat Senate Holds Single Hearing on Bill to Strip Health Coverage from Millions Action Still Needed! Today the Senate Finance Committee is holding the only Senate "hearing" on the Graham-Cassidy bill. The bill would, among other things, cause tens of millions of people to become uninsured, eliminate the ACA’s expansion of Medicaid, … 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

World Alzheimer’s Day 2017 – September 21

The Center for Medicare Advocacy joins Alzheimer’s organizations, caregivers, people with Alzheimer’s and their families, on World Alzheimer’s Day, to raise awareness about this devastating disease. Alzheimer’s is the most common form of dementia.  It devastates families and communities, and is one of the costliest chronic conditions to manage. According to the Alzheimer’s Association, there … Read more

CMA Alert – Graham Cassidy is Just Worse; SNF Disaster Requirements; More

Graham-Cassidy: It’s Just Worse Center for Medicare Advocacy and Medicare Rights Center Send Joint Letter to Congress Opposing Graham-Cassidy Center Submits Statement On SNF Requirements for Senate Aging Committee Hearing Graham-Cassidy: It’s Just Worse Despite an enormous public outcry that eventually doomed this summer’s attempt at repealing the Affordable Care Act and decimating Medicaid, legislators … Read more

Despite an enormous public outcry that eventually doomed this summer’s attempt at repealing the Affordable Care Act and decimating Medicaid, legislators seem to be lining up behind yet another bad bill. In fact, the Graham-Cassidy bill is even worse than earlier rejected bills. The Graham Cassidy bill[1]: Permits states to waive rules on premium ratings … Read more

The U.S. Senate Special Committee on Aging held a hearing on "Disaster Preparedness and Response: The Special Needs of Older Americans" today. The hearing came on the heels of Hurricanes Harvey and Irma, which resulted in the deaths of at least nine nursing home residents in Florida. Chairman Collins began the hearing by acknowledging the … Read more

United States Senate Special Committee on Aging Hearing September 20, 2017 Statement Submitted by the Center for Medicare Advocacy The Center for Medicare Advocacy (Center) thanks the Senate Special Committee on Aging for holding the September 20th hearing examining “policies and procedures for sheltering in place, evacuating, and relocating our most vulnerable citizens before disaster … Read more

Leading Medicare Advocates Voice Opposition to Graham-Cassidy Bill

—Letter Urges Senators to Oppose Block Grants and Medicaid Per-Capita Caps— Washington, DC – The Medicare Rights Center and the Center for Medicare Advocacy sent a letter to Senate leadership today in opposition to the recently unveiled “Graham-Cassidy” bill. The letter voices both organizations’ deep concerns that the Graham-Cassidy bill, like its predecessors, would take … Read more

URGENT:  ACA Repeal Effort Renewed Through Graham-Cassidy Bill. This is Not a Drill – Action Needed!

Just when we thought Congress was moving on from failed efforts to “repeal and replace” the Affordable Care Act (ACA), momentum is quietly building to try again, through yet another legislative effort – the Graham-Cassidy bill.  We need to stop this bill in its tracks. While some Senators are engaging in positive, bipartisan talks to … Read more

Today the United States Senate is a study in contrasts: on the same day that one Senator introduces a bill seeking universal health insurance coverage, another pair of Senators introduce yet another bill to gut the Affordable Care Act and roll back insurance coverage for millions. At one end of the spectrum, Senator Bernie Sanders … Read more

Abbey, Duane. “Inpatient Versus Outpatient: The Real Issue.” RAC Monitor. 06 March 2014. http://www.racmonitor.com/rac-enews/1618-inpatient-versus-outpatient-the-real-issue.html (site visited September 21, 2016). The author writes that there aren’t any well-established guidelines for Recovery Audit Contractors (RACs) when they review observation-related Medicare appeals. When there are disagreements, RACs can be directed to specific criteria. Unfortunately, Medicare RACs lack such … Read more

Medicare Hospital Outpatient & Observation Status Toolkit

Supported by             The John A. Hartford Foundation   Patients may find themselves in the hospital, receiving medical services, tests, and treatment, sometimes for many days, but learn they are considered outpatients, in Observation Status, not admitted inpatients. This is understandably confusing for patients and families – and difficult for … Read more

I. JIMMO IMPLEMENTATION UPDATE Background – Jimmo Settlement The settlement in Jimmo v. Sebelius, No. 5:11-cv-17 (D. Vt.) was approved on January 24, 2013.  CMS issued revisions to its Medicare Benefit Policy Manual to clarify that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings.  CMS also implemented … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Jimmo Implementation Update (Judy Stein, Ali Bers)  Corrective Action Plan Completed New CMS webpage: https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html Jimmo Webinar – September 27 at 3pm EDT.  Register at: https://register.gotowebinar.com/register/4716521538610996739 Update on Home Health Access Initiative Project (Kathy Holt)  Proposed rule re: payment (comments due 9/25) Joint Webinar with National Association for Home … Read more

CMA Alert – Congress Returns, Still Threatening Health Care; ACA Sabotage; More

Congress is Back – And Health Care Remains Under Threat Administration Continues Sabotage of ACA Center for Medicare Advocacy Welcomes Dara Valanejad Congress is Back – And Health Care Remains Under Threat As Congress returns from the August recess, members face a full agenda of issues they must tackle ranging from the federal budget, to … Read more

– Organizations team up to protect and strengthen the health coverage and financial security of older adults and people with disabilities – New York, NY – The Medicare Rights Center and the Center for Medicare Advocacy are proud to announce a new partnership to protect access to quality health coverage for older Americans, made possible … Read more

CMA Alert –  OIG Warns of Abuse in SNFs; Ted Kennedy, Jr. Joins CMA Advisory Board; “Jimmo” Corrective Action Plan

HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Connecticut State Senator Ted Kennedy, Jr. Joins Center for Medicare Advocacy Advisory Board Jimmo Corrective Action Plan Completed HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Last week, the HHS Office of Inspector General (OIG) issued an Early Alert, warning of … Read more

Jimmo Corrective Action Plan Completed CMS Adds Resources Regarding Medicare Coverage To Help People Who Need Skilled Maintenance Nursing or Therapy As ordered by the federal judge in Jimmo v. Sebelius, the Centers for Medicare and Medicaid Services (CMS) published a new webpage containing important information about the Jimmo Settlement on its CMS.gov website. The … Read more

CMA Alert – Joint Replacement Model Undermines Care;  OTC Hearing Aids Legislation Passed; More

Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point Over-the-Counter (OTC) Hearing Aid Act Signed into Law Severe Harm if ACA Cost-Sharing Payments End Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point On a Friday this past March, “Ms. T”, … Read more

Statement by Center for Medicare Advocacy Executive Director Judith Stein

The Center for Medicare Advocacy stands with the peaceful protestors of Charlottesville.  For more than thirty years, the mission of the Center has been to ensure fair access to Medicare and health care for all.  FAIR.  FOR ALL.  We cannot, therefore, separate ourselves from the greater fight for fairness, for justice, for all.  And we … Read more

CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More

Former CMS Administrator Comments on Medicare Advantage Overpayments Proposed Home Health Rules – Payments Drive Delivery of Care, Harming Beneficiaries Observation Status Harms Low-Income Medicare Beneficiaries Poll: Americans Favor Making the ACA Work Former CMS Administrator Comments on Medicare Advantage Overpayments In Austin Frakt’s August 7, 2017 The Upshot blog in the New York Times … Read more

CMA Alert – SNF Update: Comments on Reimbursement; Civil Money Penalties Weakened

Center for Medicare Advocacy Submits Comments on CMS’s Proposed Redesign of Medicare Reimbursement for Skilled Nursing Facilities  As Sought By Nursing Home Industry, CMS Changes Guidance to Reduce Civil Money Penalties for Nursing Facility Deficiencies Center for Medicare Advocacy Submits Comments on CMS’s Proposed Redesign of Medicare Reimbursement for Skilled Nursing Facilities  In an Advance … Read more

August 9, 2017 Thomas E. Price Secretary Department of Health and Human Services Seema Verma Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1686-ANPRM.  Advance Notice of Proposed Rulemaking with Comment.  Medicare Program; Prospective Payment System … Read more

Sean Cavanaugh was the Deputy Administrator and Director of the Center for Medicare at the Centers for Medicare & Medicaid Services. He was responsible for overseeing the regulation and payment of Medicare fee-for service providers, privately-administered Medicare health plans, and the Medicare prescription drug program. Medicare provides health coverage for over 57 million older and … Read more

CMA Alert – Home Health Care Crisis; SSDI Anniversary

The Home Care Crisis: An Elder Justice Issue (Part 5 of a Ten-Part Series) Happy 61st Anniversary SSDI The Home Care Crisis: An Elder Justice Issue This is Part Five 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 … Read more

This is Part Five 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

Decision in Alexander v. Price Means Medicare Patients Could Gain Right to Appeal Placement on “Observation Status” and Avoid Large Medical Bills Eighty-four-year-old Nancy Niemi of North Carolina was hospitalized for 39 days earlier this year after her doctor sent her to the emergency room. It took weeks to stabilize her blood pressure and she … Read more

For Immediate Release July 28, 2017 Contact: Matthew Shepard, 860-456-7790 MShepard@MedicareAdvocacy.org Washington, DC – Early this morning the Senate failed to pass the latest attempt to dismantle the Affordable Care Act (ACA). The following is a statement from Judith Stein, Executive Director and founder of the Center for Medicare Advocacy: The failure of the Senate to pass the … Read more

As Medicare’s Anniversary Approaches, the Fight for Health Care Continues Beware of a New Social Security Scam As Medicare’s Anniversary Approaches, the Fight for Health Care Continues On July 30, Medicare will turn 52 years old.  As we honor this program that provides stable coverage to over 57 million older adults and individuals with disabilities, … Read more

 

For Immediate Release July 25, 2017 Contact: Matthew Shepard, 860-456-7790 MShepard@MedicareAdvocacy.org Washington, DC – Today the Senate narrowly passed a key procedural vote to open debate on one or more health care reform bills that will be voted on in the coming days. While it is still unclear what mystery bill(s) the Senate will actually vote on, … Read more

Featuring Guest Presenter Carol Regan, Community Catalyst Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: Update (Carol Regan, Community Catalyst, and David Lipschutz)  Overview of Senate Debate Impact on Older Adults, Medicare (David Lipschutz) Impact on Medicaid, Dual Eligibles (Carol Regan) Litigation Update   (Ali Bers) Jimmo (Improvement standard) Barrows (formerly Bagnall) (Observation) Sherman (Lower level … Read more

CMA Alert – Senate Health Bill, Again; Medicare Trustees Report; HH CoPs; More

Here We Go Again: Senate Health Repeal Bill Released Today, Vote Planned for Next Week Medicare Trustees Project Increase in Solvency Delay of New Medicare Home Health Conditions of Participation Advocacy News from the Capitol Here We Go Again: Senate Health Repeal Bill Released Today, Vote Planned for Next Week After backing off of plans … 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

Making permanent the law that provides access to Speech Generating Devices for Medicare beneficiaries The Bill was introduced in the Senate (S.1132) and House (H.R.2465) in May 2017. In the House, H.R. 2465 was referred to the Energy and Commerce Committee and the Ways and Means Committee. On May 19th, the Bill was referred by … Read more

Congress is on recess, but we can’t be – the health care repeal debate continues!  In their home states and through tough, ongoing negotiations, Senators are making up their minds about the future of the ACA, Medicaid, and Medicare.  This CMA Alert provides updated “Myths & Facts” about the most recent potential changes to the … Read more

Congress Leaves for the July 4th Recess, Health Care Repeal Remains a Threat – Continue to Make Your Voice Heard

We got a reprieve this week when Senate Majority Leader Mitch McConnell delayed a planned vote on the Better Care Reconciliation Act of 2017 (BCRA).  Like the bill that passed in the House, BCRA would repeal the Affordable Care Act, decimate Medicaid, and weaken Medicare. The battle over health repeal is not over. Sen. McConnell … Read more

Senator Collins Is Right to Oppose the Senate’s Version of Trumpcare By Judith Stein The Senate has released the previously secret details of its healthcare legislation – and they are not good. The Better Care Reconciliation Act (BCRA) of 2017 hurts our nation’s healthcare system as a whole and our most vulnerable citizens in particular. … Read more

Health Care Repeal Vote Postponed But the Fight is Not Over

Yesterday, Senate leadership announced that a vote on the Senate health care bill – the Better Care Reconciliation Act (BCRA) – would be postponed until after the July 4 recess.  In the coming weeks, Leader McConnell will try to wrangle together enough votes to pass the BCRA by offering relatively small “fixes” to placate various … Read more

Health Care Repeal Vote Postponed – But Keep the Pressure On

Senate leadership today announced that a vote on the Senate health care repeal bill would be postponed until after the July 4 recess. While this shows that the efforts of all those who have called and written to tell the truth about this awful legislation are working, it is not the end. We saw this happen in the … Read more

Real People Will be Harmed by House & Senate Health Repeal Bills

The House passed its bill, the American Health Care Act (AHCA), in May. Last week, the Senate unveiled its ACA repeal bill, called the Better Care Reconciliation Act of 2017 (BCRA). The Senate plans to vote on the bill this week. Although there are some minor differences between AHCA and BCRA, as noted by the Center on … Read more

Senate Releases Draft of Bill to Undermine Health Coverage: Stop the “Better Care Reconciliation Act”

The wait is finally over. Senate Republicans have released a "discussion draft" of their health care bill, The Better Care Reconciliation Act of 2017. This language is the culmination of secret drafting by a few Republican Senators, and it is as harmful to millions of Americans and as mean as we expected. Said Center for Medicare Advocacy … Read more