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Author Archives: mshepard

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

Effective September 6, 2016, and as required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (§701 of the Bipartisan Budget Act of 2015, Pub. L. 114-74),[1] the Centers for Medicare & Medicaid Services (CMS) published interim final rules updating, to account for inflation, civil money penalties (CMPs) that are imposed for … Read more

Pursuant to the settlement agreement in Exley v. Burwell, a class action brought by the Center to address delays in appeals at the Administrative Law Judge (ALJ ) level, the Office of Medicare Hearings and Appeals (OMHA) has established a new help line to troubleshoot beneficiary appeals.  In a September 1, 2016 announcement, OMHA introduced … Read more

When: Thursday, September 15, 2016 2 – 3 p.m. EST Costly mistakes and service disruptions are common for people under 65 transitioning onto or off of Medicare from Marketplace plans, Medicaid, or other insurance. Join Justice in Aging’s Directing Attorney Georgia Burke and the Center for Medicare Advocacy’s Associate Director Kathleen Holt to explore common … Read more

Thank you for taking the time to complete our survey. Your response will help us determine how to best meet the unique needs of Medicare beneficiaries under age 65 who need assistance with Medicare enrollment and other issues.

Prescription Drug Pricing An excellent and well-timed (given #Epi-gate) article appeared in this week’s Journal of the American Medical Association discussing the reason drug costs are so high in the U.S. According to the article, the major cause is the “granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a … Read more

The Center recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the following proposed rules. Appeals Since 1986, the Center has represented thousands of Medicare beneficiaries seeking coverage of health care and services through the Medicare administrative appeals process.  As discussed in previous CMA Alerts, the Center has advocated for our … Read more

August 29, 2016 Office of Medicare Hearings and Appeals Department of Health & Human Services Attention: HHS-2015-49 5201 Leesberg Pike, Suite 1300 Falls Church, VA 22041  Submitted electronically to: www.regulations.gov Re: HHS-2015-49 To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) … Read more

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August 26, 2016 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1648-P P.O. Box 8016 Baltimore, Maryland  21244-8016 Submitted electronically to: http://www.regulations.gov Re:      Federal Register Volume 81 No. 128 Medicare and Medicaid Programs: CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home … Read more

The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, is launching the Transdisciplinary Collaborative Centers (TCC) for Health Disparities Research on Chronic Disease Prevention program. This program responds to the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, under-served … Read more

The Center for Medicare Advocacy has been hearing about people who clearly meet Medicare criteria but are unable to access home health care ordered by their physicians. In particular, people living with long-term and debilitating conditions find themselves without necessary home care. For example, they have been told Medicare will only cover 1 to 5 … Read more

In an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, the judge in Jimmo v. Burwell – the “Improvement Standard case” – ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she approved in January 2013. The Order requires CMS to remedy … Read more

On Friday August 19, 2016, the Center for Medicare Advocacy submitted comments in response to a June 30 request from the Centers for Medicare & Medicaid Services (CMS) for information regarding Durable Medical Equipment (DME) access issues faced by individuals who are dually eligible for Medicare and Medicaid.[1] The letter, signed by almost 80 organizations, … Read more

The Honorable Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services 7500 Security Blvd. Baltimore, MD 21244 August 19, 2016 Submitted electronically: http://www.regulations.gov Re: CMS–1651–P; Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable … Read more

August 23, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–1651-P P.O. Box 8010 Baltimore, MD 21244–8010 Submitted electronically to:  www.regulations.gov           Re:      CMS-1651-P To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments … Read more

For Immediate Release Contact: Matthew Shepard, mshepard@medicareadvocacy.org or 860-456-7790. Aug. 18, 2016. Burlington, Vt.  In an Opinion and Order filed late yesterday and released this morning, Chief Judge Christina Reiss, who oversees the “Improvement Standard” case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), … Read more

Under the federal Nursing Home Reform Law, the Centers for Medicare & Medicaid Services (CMS) has authority and the “responsibility”[1] to impose Civil Money Penalties (CMPs) and other enforcement actions at nursing homes that are found to violate federal standards of care (which are called Requirements of Participation).[2]  For the first time in more than … Read more

On August 8, a federal judge in Connecticut largely denied the government’s motion to dismiss and granted plaintiff’s motion for certification of a nationwide class. Sherman v. Burwell, No. 3:15-cv-1468 (JAM) (D. Conn.). The case challenges the fact that, for the last several years, decisions at the earliest two levels of appeal in the Medicare administrative process … Read more

The Center for Medicare Advocacy was pleased to attend, exhibit and present at this year's national SHIP and SMP conference. Pursuant to a Target Population Grant from the Administration for Community Living (ACL), the Center is working to enhance outreach and education for younger Medicare beneficiaries.  At the conference, we discussed progress and next-steps in … Read more

Justice in Aging, one of the Center's longtime partners, recently released an issue brief, Oral Health in California: What About Older Adults? The Issue Brief includes a summary of the state of oral health for older adults in California. It cites disparities in oral health based on income level, education and race. The Brief also outlines the … Read more

An August 7, 2016 New York Times article once again highlighted the problem of hospital Observation Status, including issues with the NOTICE Act, which is supposed to help Medicare beneficiaries understand their status. The article, New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage, featured a Center For Medicare Advocacy client's story. In the piece, Center Executive Director Judith … Read more

For Immediate Release Contact: Matthew Shepard, Communications Director MShepard@MedicareAdvocacy.org, (860) 456-7790 August 9, 2016 – Although required by law to issue decisions within 90 days of receiving a request for Administrative Law Judge (ALJ) review, Medicare’s Office of Hearings and Appeals (OMHA) was consistently taking a year or more to complete the task.  Last week, however, … Read more

Beginning August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires hospitals to provide written and oral notice, within 36 hours, to patients who are in observation or other outpatient status for more than 24 hours.  The notice must explain the reason that the patient is an outpatient … Read more

On August 1, 2016, Judge Jeffrey Meyer of U.S. District Court in Connecticut granted final approval to a settlement agreement that will ensure timely decisions for Medicare beneficiaries who appeal denials of coverage to Administrative Law Judges (ALJs). The nationwide class action, Exley v. Burwell, 3:14-CV-1230, was brought by six individuals who waited longer than … Read more

The Centers for Medicare & Medicaid Services (CMS) recently released research drawn from the 2013-14 National Health Interview Survey highlighting health disparities between LGBT and other older people (age 65 or older). The National Health Interview Survey is a wide-ranging survey conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics … Read more

Jul 19, 2016 by Gretchen Jacobson and Tricia Neuman This Issue Brief, available at http://kff.org/medicare/issue-brief/turning-medicare-into-a-premium-support-system-frequently-asked-questions/, is an excellent breakdown of what a "Premium Support" structure – also referred to as "Defined Contributions" or "Vouchers"  – would mean for Medicare and Medicare beneficiaries. Topics addressed include: What is premium support? How could a premium support system for Medicare affect beneficiaries’ premiums … Read more

Hospice care is holistic care for the dying.  Medicare coverage of hospice care is available for beneficiaries who have been certified as terminally ill, for services that are “reasonable and necessary for the palliation or management of the terminal illness as well as related conditions.”  Prior to receiving Medicare coverage for hospice care, beneficiaries must … Read more

In order for Medicare Part A to pay for a patient’s stay in a skilled nursing facility (SNF), the patient must first have spent at least three consecutive days as an inpatient in an acute care hospital.[1]  For many Medicare beneficiaries, Part A SNF coverage is denied because the hospital classifies the stay as Outpatient … Read more

Platform Side-by-Side Suggested Medicare/Healthcare Priorities Language Originally Submitted to Platform Committee The two major American political parties have released their 2016 party platforms in anticipation of their respective party conventions and the upcoming general election. Given the importance of health care in this upcoming election, the Center for Medicare Advocacy has done an initial analysis … Read more

If properly utilized, Electronic Health Records (EHR) could increase the quality of care for Medicare’s beneficiaries and lower program costs. EHRs provide the possibility of easy transfer of information between providers, and better patient access to important information. This can mean that clinicians are apprised of changes in health status, with access to information regarding … Read more

For Immediate Release Contact: Matthew Shepard, Communications Director MShepard@MedicareAdvocacy.org, (860) 456-7790 July 14, 2016 – The Center for Medicare Advocacy (CMA) is thrilled to be partnering with The John A. Hartford Foundation to improve care for older adults with long-term and chronic conditions. With the Foundation’s generous two-year grant, CMA will be able to focus … Read more

As reported this week in The Hill, President Obama is calling on Congress to add a “public option” to the Affordable Care Act (ACA) to improve his signature health law.  “Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers,” Obama writes in the Journal of … Read more

The New York Times reported on July 11, 2016 that a noninvasive alternative to dental fillings that could save money, while preventing future decay, has gained increased traction among dentists. The liquid – Silver Diamine Fluoride, or S.D.F. – can be brushed on certain types of cavities, removing the need for a drill or injection. … 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

June 16, 2016 Andrew M. Slavitt Acting 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-1655-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and … Read more

On June 30, 2016 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule about the difficulties of dually eligible people (individuals eligible for both Medicare and Medicaid) to obtain Durable Medical Equipment (DME). The proposed rule seeks information about the problem, as well as potential solutions. The proposed rule is primarily focused … Read more

In 2012, the Centers for Medicare & Medicaid Services (CMS) announced expansion of Medicare’s Value-Based Purchasing (VBP) Program for acute care hospitals.  Beginning in Fiscal Year 2015, and as mandated by Congress in the Affordable Care Act,[1] CMS would incorporate a new measure for “Medicare Spending Per Beneficiary.”  CMS suggested this efficiency measure would reward … Read more

In the last 18 months, the Center for Medicare Advocacy, and other advocates around the country, have received many, many calls from older and disabled beneficiaries who can no longer obtain coverage for the Lidocaine Patch 5% from their Part D plans. Many have been using the Patch for at least a decade and are … 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

The Center for Medicare Advocacy submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) concerning the proposed rule on the Medicare Program Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule (CMS–5571–P), two elements proposed in the Medicare Access and CHIP Reauthorization Act of … Read more

Medicare Access Project for People Living With ALS Medicare Overview – With an Emphasis on the Home Health Care Benefit Frequently Asked Questions and Answers General Home Health Questions "Homebound" Questions Specific Coverage Questions Can they be using a walker instead of crutches in homebound example? Yes, the homebound definition generally is intended to provide … Read more

June 27, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–5571–P P.O. Box 8013 Baltimore, MD 21244–8013 Submitted electronically to: www.regulations.gov             Re:  CMS–5517–P To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & … 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

Action is needed for the 30 million Americans affected by hearing loss Access a recording of the briefing at: https://cc.readytalk.com/registration/#/?meeting=sfxfevabid3j&campaign=cslq7e4xvr5g June 23, 2016 – WASHINGTON – In a noon-time briefing, health and advocacy experts urged policymakers to update Medicare to cover hearing services. Hearing loss affects nearly 30 million Americans, but only 1 in 5 … Read more

Today, June 22, 2016, the Medicare and Social Security Trustees issued the 2016 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. In short, according to the report, the Part A trust fund depletion date is 2028, down 2 years from 2030 as … Read more

On June 9, 2016, the Government Accountability Office (GAO) publicly released a report (dated May 2016) titled “Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process”.[1]   Among other things, the report analyzes the increased number of appeals in the system and the resulting backlog at the third level (Administrative Law Judge, or ALJ) and fourth level … Read more

The Center for Medicare Advocacy submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) concerning its proposed rule titled “Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements” (81 Fed. Reg. 25498), which was published on April 28, 2016.[1]  The Center’s comments focused on … Read more