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Author Archives: mshepard

Testimony of Judith A. Stein Executive Director, Center for Medicare Advocacy, Inc. United States House of Representatives Energy & Commerce, Subcommittee on Health "Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans If They Like Them" March 13, 2014 I. Introduction Chairman Pitts, Ranking Member Pallone, and distinguished members of the Subcommittee on Health, thank you … Read more

The quarterly Enforcement newsletter describes the latest developments in nursing home enforcement activities. Read a sample. Enforcement Newsletter – PRINT version Purchase a one-year subscription to this detailed monthly mailing on nursing home enforcement issues describing the latest developments in nursing home enforcement activities. $300.00 Purchase Now Enforcement Newsletter – ELECTRONIC version Purchase a one-year subscription to this … Read more

Although most nursing facilities nationwide do not have sufficient staff to provide necessary care to their residents, an analysis by the Center for Medicare Advocacy (Center) finds that the federal enforcement system cites very few facilities with staffing deficiencies and often does not impose any financial penalties, even when it finds that facilities do not … Read more

This week, President Obama unveiled his Fiscal Year 2015 Budget.[1] With respect to Medicare, it is very similar to last year’s proposed budget, both good and bad. One significant improvement over last year's budget is that it no longer seeks to alter the way the federal government measures inflation for purposes of paying Social Security benefits … Read more

Inspector General's Report Underscores Need for Better Staffing and Better Enforcement of Quality Standards March 5, 2014 – The Health and Human Services Office of Inspector General (OIG) recently reported that 32% of Medicare beneficiaries who went to skilled nursing facilities (SNFs) and spent an average of 15.5 days in the SNF in August 2011 experienced … Read more

On February 21, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2015 Call Letter to Medicare Advantage (MA) and Part D plan sponsors, which includes a proposed rate for MA payment for 2015.[1]  Much anticipated, the draft Call Letter, which will be finalized in April, was preceded by an aggressive advertising … Read more

February 24, 2014 – The Affordable Care Act (ACA) is reining in overpayments to private Medicare Advantage (MA) plans by bringing MA payments closer to what traditional Medicare spends on a given beneficiary. The insurance industry and some legislators suggest that these overpayment reductions are harmful "cuts" to Medicare. This is not true. "Private Medicare … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Gill Deford) Overview Claims Eligible for Review Deadlines and Request Form Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Medicare “Doc Fix” (Physician payment, or “SGR”): Where are we now? Extenders: QI program and therapy cap exceptions … Read more

1. PRESENTATION:  RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. Sebelius provides that Medicare beneficiaries who were previously denied Medicare coverage may have claims re-reviewed under the revised manual provisions.  The … Read more

 No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will allow Maine to cut back the eligibility standards in the QMB, SLMB, and QI programs  for disabled Mainers, beginning March … Read more