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Author Archives: mshepard

Examining Bipartisan Medicare Policies that Improve Care for Patients with Chronic Conditions May 16, 2017 Hearing before the Senate Committee on Finance Statement for the Record Center for Medicare Advocacy 1025 Connecticut Avenue, N.W., Suite 709 Washington, DC  20036 The Center for Medicare Advocacy, founded in 1986, is a national, non-partisan education and advocacy organization … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: House Passes American Health Care Act (AHCA) (David Lipschutz)  What’s in AHCA Impact on Affordable Care Act, Medicaid and Medicare Next up: the Senate Update on Home Health Access Initiative Project (Kathy Holt)  Speech Generating Devices (SGDs) (Kathy Holt) Steve Gleason Act            Observation Status (Toby Edelman) Medicare … Read more

(The Center received this story in May, 2017) “I suffer from the motor form of an autoimmune disorder called chronic inflammatory Demyelinating Polyneuropathy (CIDP).  The treatment for this involves bi-monthly six-hour infusions of IVIG (Gammaguard). In April 2010 after approximately two years of infusions, I was informed by my insurance company, Anthem BCBS, that I … 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

For Immediate Release Contact: Matthew Shepard, 860-456-7790 mshepard@medicareadvocacy.org May 4, 2017 WASHINGTON, DC — “By four votes, the House of Representatives passed the American Health Care Act (AHCA) today, a bill that guts the Affordable Care Act (ACA), decimates Medicaid, and undermines Medicare,” stated Judith Stein, founder and executive director of the Center for Medicare … Read more

AHCA Vote Today – Act Now! #ProtectOurCare and #RejectRepeal

Even amended, AHCA is a bad Bill. AHCA still guts protections for people with pre-existing conditions. Funds provided through the latest last-ditch amendment would cover only a fraction of the people with pre-existing conditions who would face discrimination by insurers. It would still leave 15 million people with pre-existing conditions with no added protection from … Read more

This is Part Two of a Ten-Part CMA Issue Brief Series to examine, and inform work to resolve, the growing crisis in access to Medicare home health coverage and necessary care.  We invite you to follow this Series and provide Medicare home health stories at http://www.medicareadvocacy.org/submit-your-home-health-access-story/. CMA Issue Brief Series: Medicare Home Health Care Crisis … Read more

Latest Health Care Repeal Tactic? How About $8 Billion?  Act Now!

Facing another failure to repeal the Affordable Care Act, and replace it with a bill that leaves at least 24 million people without coverage, AHCA proponents are desperate enough to throw a lot of money around. They are now trying to reach a last-minute deal to win “moderate” Republican votes by spending an additional $8 … Read more

It’s Back – You Asked for Better and They Made it Worse! Call Today!

#ProtectOurCare and #RejectRepeal The latest effort to revive the so-called American Health Care Act and repeal the Affordable Care Act is worse than the first.  Americans want quality, affordable health coverage and care for everyone – including older people and people with pre-exisiting conditions. They are committed to the Affordable Care Act, Medicaid and Medicare. … Read more

From the Centers for Medicare & Medicaid Services (CMS): Many minorities experience a disproportionate burden of preventable disease, including diabetes, heart disease, kidney failure, and obesity. Providers should talk to patients about the importance of preventive care and recommend appropriate Medicare-covered preventive services. For More Information: Medicare Preventive Services Educational Tool Mapping Medicare Disparities Tool … Read more

As noted in a previous Alert, the Center for Medicare & Medicaid Services (CMS) recently finalized their 2018 Call Letter.  In the same document, CMS issued a Request for Information regarding ideas for “regulatory, sub-regulatory, policy, practice and procedural changes to better accomplish” the goals of “using transparency, flexibility, program simplification and innovation to transform … Read more

April 24, 2017 VIA ELECTRONIC SUBMISSION PartCDcomments@cms.hhs.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244 Re:                  2017 Transformation Ideas – Response to Request for Information re: Medicare Advantage and Part D Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide … Read more

Today the Center for Medicare Advocacy launches a Ten-Part Series to examine and continue work to resolve the growing crisis in access to Medicare home health coverage and necessary care. We invite you to follow this Series and provide Medicare home health stories at http://www.medicareadvocacy.org/submit-your-home-health-access-story/ Medicare Home Health Crisis Series Overview – The Crisis in … Read more

Last month in Connecticut, United Healthcare (UHC) set off a panic among its Medicare Advantage (MA) enrollees by sending out letters indicating that they would no longer be affiliated with Hartford HealthCare HHC), one of Connecticut’s largest provider networks. These MA enrollees often received multiple letters – one for each of their HHC providers. One … Read more

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2018 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, … 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

For decades, Alfred J. Chiplin, Jr. (Chip) has been a beloved and admired leader in the elder law, disability and health care rights communities. To honor Chip’s long-term advocacy and commitment to civility and justice for all members of society, the Center for Medicare Advocacy has established an award in his honor. The Alfred J. … Read more

Mandating specific levels of direct care nursing staff would seem to be a straightforward method to improve staffing in nursing facilities.  If more nursing staff are needed, why not simply require facilities to employ more nurses?  The strategy is far more complex, however, than it at first appears.  This paper reviews which states have tried … Read more

This project has produced a series of short papers evaluating various state approaches to improving nurse staffing levels at nursing facilities.  The papers have addressed state-mandated nurse staffing levels, wage pass-throughs, increasing reimbursement, and public and private (non-tort) litigation.  This paper, in contrast, considers whether regulatory changes at the federal level, while not specifically directed … Read more

On October 4, 2016, the Centers for Medicare & Medicaid Services (CMS) published revised Requirements of Participation (RoP) for skilled nursing facilities (Medicare) and nursing facilities (Medicaid).[1]  Although the substantive standards for nurse staffing are unchanged, CMS’s reorganization of the RoPs included moving the nurse staffing requirements to a different section[2] and moving standards for … 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

March 24, 2017 – WASHINGTON, DC — Today the House of Representatives is scheduled to vote on the American Health Care Act (AHCA), a bill that would gut the Affordable Care Act (ACA), dramatically cut Medicaid payments to states, and undermine Medicare. In an attempt to secure additional votes, the bill keeps getting worse for … Read more

Tomorrow, March 23, 2017, the 7th anniversary of the Affordable Care Act (ACA), the House of Representatives is scheduled to vote on a bill that would gut the ACA, dramatically cut Medicaid payments to states, and undermine Medicare. If passed in the House, the Senate could vote on the bill as early as next week. … Read more

Facts should be key to participating in the debate about the Affordable Care Act (ACA) and its future. To help separate what is true from what is often stated, we offer the following Myths and Facts. ACA Myths ACA Facts Affordability The ACA makes it too hard for middle-income Americans to purchase insurance in the … Read more

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