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Author Archives: mshepard

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Barrows (formerly Bagnall) (Observation) Sherman (Lower level Medicare appeals) Other updates The Fight to Protect the ACA, Medicare and Medicaid – Updates (David Lipschutz)  House proposal: American Health Care Act (AHCA Impact on Affordable Care Act, Medicaid and Medicare Other health reform … Read more

The proposed Affordable Care Act (ACA) repeal legislation, the American Health Care Act, would cause 24 million people to lose coverage by 2026 and cut Medicaid by $880 billion over the next ten years, according to the Congressional Budget Office (CBO), a non-partisan, independent group of budget economists and analysts used to score the financial … Read more

14 million people will become uninsured in 2018 if the proposed Affordable Care Act repeal legislation becomes law according to yesterday’s Congressional Budget Office (CBO) Report, (3/13/2017). The American Health Care Act proposal, which has passed two key committees in the House of Representatives, would cause 24 million people to lose coverage by 2026 and … Read more

Congress is now considering the AHCA, the Bill to repeal the Affordable Care Act.  The proposed repeal legislation would lead to extreme cuts in Medicaid.  Thus, it is essential to underscore the role Medicaid plays for millions of Medicare beneficiaries. Kaiser Family Foundation recently released a report, Medicaid’s Role for Medicare Beneficiaries, which details the … 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

March 7, 2017, Washington, DC – Last night House Republicans presented a bill to repeal the Affordable Care Act (ACA) and cut Medicaid payments to states.  While the new bill, “America Health Care Act” (AHCA) lacks either an estimate of how many people will lose their health insurance coverage as a result of the bill … Read more

March 3, 2017 VIA ELECTRONIC SUBMISSION AdvanceNotice2018@cms.hhs.gov Cynthia G. Tudor, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244 Re:  Advance Notice of Methodological Changes for Calendar Year 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2018 Call Letter Dear … Read more

— Advocates Oppose Medicaid Block Grants and Per Capita Caps — March 3, 2017 Contact: Center for Medicare Advocacy – Matthew Shepard: 860-456-7790, mshepard@medicareadvocacy.org Justice in Aging – Vanessa Barrington: 510-256-1200, vbarrington@justiceinaging.org Medicare Rights Center – Mitchell Clark: 212-204-6286, mclark@medicarerights.org Washington, DC — Today, the Center for Medicare Advocacy, Justice in Aging, the Medicare Rights … Read more

Beginning no later than March 8, 2017, hospitals are required to give written and oral notice to Medicare patients when they are placed in “outpatient” observation status for 24 hours and are not formally admitted as inpatients.[1] The written notice is called the Medicare Outpatient Observation Notice (MOON).[2] Although hospitals can provide all the care … Read more

Health Savings Accounts (HSAs) Defined Health Savings Accounts (HSAs) are savings accounts that allow consumers to put money aside to pay for certain “qualified health expenses” on a tax-free basis. HSAs are used in tandem with high deductible health plans (HDHPs), which are health insurance plans that require high deductibles to be paid prior to … Read more

Last night, President Trump, in a speech to Congress, discussed health care but offered no new insight into his Administration’s plans concerning the Affordable Care Act, Medicaid and Medicare.  A day after noting that “nobody knew health care could be so complicated”, the President stated "[t]onight, I am also calling on this Congress to repeal … Read more

On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage.  The government will use the statement as part of its Corrective Action Plan, which was ordered by the … Read more

Many Americans are greatly concerned that repeal of the Affordable Care Act (ACA) will once again leave people with pre-existing conditions without health insurance. The ACA replacement proposal released by Speaker Ryan on February 16 would move coverage from the general ACA marketplace to specific High Risk Insurance Pools. These High Risk Pools would separate … Read more

According to a recent report from Vox, Congressional plans to repeal key provisions of the Affordable Care Act (ACA) will have devastating consequences for thousands of Americans each year. Vox’s Julia Belluz cites evidence to estimate that 24,000 Americans would die annually if Congress repeals vital provisions of the ACA without simultaneously enacting an appropriate … Read more

Replace – verb – 1. To place again; to restore to a former place, position, condition, or the like. Retrench – verb – 1. Reduce amount of, cut down; economize Regress – noun –  2. Movement backward to a previous and especially worse or more primitive state or condition February 21, 2017 – Washington, DC … Read more

February 17, 2017 – WASHINGTON – Yesterday, the Senate Finance Committee held a confirmation hearing for Seema Verma, President Trump's nominee for Administrator of the Centers for Medicare & Medicaid Services. Ms. Verma is currently president, CEO and founder of SVC, Inc., a national health policy consulting company. “While short on specifics, it was clear … Read more

Beginning no later than March 8, 2017, and as required by the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act),[1] hospitals and critical access hospitals (CAHs) are required to give patients both oral and written notice when they are outpatients and not admitted as inpatients.[2]  Hospitals must use the written notice … Read more

The Administration and the Republican Congress threaten to repeal the Affordable Care Act (ACA), and have suggested various ideas about what a replacement to ACA would include. To better understand these proposals we’ve compiled a list of ACA replacement materials available from colleagues and partnering organizations. Though there is no consensus about what an ACA … Read more

For Immediate Release Contact: Liz Posner lposner@douglasgould.com 646-214-0514 February 9, 2017 – WASHINGTON – Today, the Senate voted by a narrow margin of 52 – 47 to confirm Rep. Tom Price as Secretary of Health and Human Services. In light of Sec. Price’s previous statements threatening Medicare, Medicaid, and the Affordable Care Act, the Center … Read more

For Immediate Release Contact: Matthew Shepard mshepard@medicareadvocacy.org 860-456-7790 Feb. 9, 2017 – In a decision released on February 8, 2017, a federal judge allowed Medicare hospital patients seeking a right to appeal their placement on “outpatient observation status” to proceed with their lawsuit. The Barrows case, now called Alexander v. Cochran, is a proposed nationwide … Read more

CMS recently finalized significant changes affecting Medicare appeals, particularly at the Administrative Law Judge (ALJ) level of review.  These changes apply to appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as … Read more

In a decision released February 2, 2017, the federal judge overseeing the Settlement Agreement in the Medicare “Improvement Standard” case (Jimmo v. Burwell) ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan to remedy the Department’s noncompliance with the Settlement.  In August, 2016, Chief Judge Christina Reiss, of the … Read more

On January 24, 2017 the Task Force on America’s Health and Retirement Security, chaired by Marilyn Moon, Ph.D. and led by Principal Investigator Peter Arno, Ph.D., released a new study showing the dramatic negative impact of raising Medicare’s eligibility age to 67 – assessing results on uninsured rates if the ACA stays in place and, what we … Read more

If Medicaid becomes a block grant program, nearly one million nursing home residents who rely on Medicaid could immediately lose coverage for their nursing home care.  In addition, all of the federal standards that govern nursing home care today could be in jeopardy.  The United States does not have a comprehensive program to pay for … Read more

On January 23, 2017, Senators Susan Collins (R- ME) and Bill Cassidy (R- LA) introduced the Patient Freedom Act of 2017 (S. 191) billed as a “comprehensive replacement plan for Obamacare.” [1] According to a summary of the bill outlined on Sen. Collins’ website, it “repeals burdensome federal mandates” but “keeps essential consumer protections.”  The … Read more

 

“My name is JC and I live [in Speaker Paul Ryan’s Congressional District] in Wisconsin with my husband and two college-aged children.  I would like to tell you why the Affordable Care Act has been key to my husband’s recent success starting up his own business.  My husband had been employed as Vice President of … Read more

Today U.S. Rep. Tom Price (R – Ga.) faced a hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee to determine his qualification to become Secretary of Health and Human Services.  Next week, on January 24th, he will face an additional hearing before the Senate Finance Committee, which will vote on his nomination. … Read more

On January 13, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a State Informational Bulletin encouraging states to adopt strategies to improve dual eligible beneficiaries’ access to Durable Medical Equipment (DME). The Bulletin addresses a serious and persistent obstacle to obtaining DME faced by people dually eligible for Medicare and Medicaid in many states … Read more

January 18, 2017 – WASHINGTON – Today U.S. Rep. Tom Price (R – Ga.) faced a hearing before the Senate Health, Education, Labor and Pensions Committee to determine his qualification to become Secretary of Health and Human Services. Medicare experts from the Center for Medicare Advocacy (CMA) have the following analysis of his statements. Rep. … 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

January 13, 2017 – WASHINGTON – On January 18, 2017 U.S. Rep. Tom Price (R – Ga.) will face a hearing before the Senate Health, Education, Labor and Pensions Committee to determine his qualification to become Secretary of Health and Human Services. Details are pending regarding an additional hearing before the Senate Finance Committee. Medicare … Read more

FOR IMMEDIATE RELEASE January 13, 2017 Contact Center for Medicare Advocacy – Matthew Shepard: 860-456-7790, mshepard@MedicareAdvocacy.org Justice in Aging – Vanessa Barrington: 510-256-1200, vbarrington@justiceinaging.org Medicare Rights Center – Mitchell Clark: 212-204-6286, mclark@medicarerights.org On January 13, 2017, the Center for Medicare Advocacy, Justice in Aging, Medicare Rights Center and 65 other organizations that represent older people … Read more

“Medicare saved my life. Without this program, I would be dead. I'm not exaggerating; it's no hyperbole when I say Medicare saved my life. I have a life threatening illness and if I had no access to doctors or medicines, I wouldn't be here. A few years ago, I had been prescribed Bactrim, which caused … Read more

Protect our Health Care – Join National Call-In Day Today to #ProtectOurCare! Congress will soon vote on measures that will significantly affect access to health care for tens of millions of people insured through the Affordable Care Act (ACA), Medicare, and Medicaid. A vote that affects one of these programs will affect access to care … 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

HHS Inspector General: Observation Status is a Growing Problem for Patients In a new report, Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy,[1] the HHS Inspector General documents and confirms what Medicare beneficiaries and their advocates have seen: long outpatient stays in hospitals are increasing. How hospitals bill the Medicare program – Part A for inpatient … Read more

On December 13, 2016, President Obama signed into law the 21st Century Cures Act (Public Law No: 114-255, also known as “Cures”, H.R. 34[1]).  The bill, which passed with overwhelming bipartisan support, addresses a wide range of issues, including medical research, the drug approval process, and, added in the final days leading up to passage, … Read more

1.The Problem The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care. These problems have been escalating in 2016. Care provided often falls short of care that is covered under the law and ordered by … Read more

As we approach a new year, a new Administration and a new session of Congress, the catastrophic risks to health care coverage include threats to repeal the Affordable Care Act – without an agreed-upon replacement, turning Medicaid into a block grant or per capita cap program, and further privatizing Medicare. Several recently-issued/updated reports underscore some … Read more

Effective August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires acute care hospitals to provide oral and written notification to patients who are classified as outpatients or observation status patients for more than 24 hours.  Notice of non-inpatient status must be provided within 36 hours.  On August … Read more

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 others in Congress also want to further privatize Medicare … Read more

Center for Medicare Advocacy Executive Director Judith Stein was featured in the New York Times "Room for Debate" this week defending the traditional Medicare program against efforts to privatize and weaken it. Under Speaker Paul Ryan’s plan, individuals would be given a set amount to help pay premiums for insurance on the open market. This … Read more

Medicare is not in crisis. It is on solid financial footing, and, in fact, is stronger than was predicted before the enactment of the Affordable Care Act. Medicare Part A is mostly paid for with payroll taxes which go into a trust fund. Prior to the enactment of the ACA, the Part A trust fund … Read more

Nominations Of Rep. Tom Price To Head The Department Of Health & Human Services And Seema Verma To Head The Centers For Medicare & Medicaid Services Threaten Medicare and Medicare Beneficiaries November 29, 2016 – Despite statements during the campaign that he would protect Medicare, the President-Elect is indicating otherwise with his selections of Rep. … Read more

The visionaries who designed, launched and supported Medicare to help all American families. The Medicare program for its invaluable contribution to desegregating American hospitals. The Medicare program for helping to keep older Americans out of poverty. The Medicare program, for insuring people with disabilities, who, like older Americans, were left behind by private insurance. The … Read more

November 23, 2016 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by Chanukah, Christmas, and New Years. Nursing home residents often want to participate in these gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and … Read more

  Happy Thanksgiving! Giving Thanks Today and every day the Center for Medicare is grateful for our partners and supporters who help us open doors to health care for the 55 million people who rely on Medicare.  We are grateful to earlier generations who designed and launched Medicare to help all American families.  Sadly, our … Read more

Speaker Paul Ryan is already in the news saying that because of “Obamacare” Medicare is “going broke” (Fox News, 11/13/2016). As a consequence, he says, he intends to bring back his plan to privatize Medicare and change it into a voucher system. Under his plan, individuals would be given a set amount to help pay premiums … Read more