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Author Archives: mshepard

Medicare home health coverage can mean the difference between an individual staying home or becoming a nursing home resident.  While the Medicare skilled nursing facility benefit is very limited, for beneficiaries who meet the coverage criteria, the home care benefit can be an ongoing Godsend. For people who can’t readily leave home without a major … Read more

We thank you for joining us to celebrate Judith Stein's joining the ranks of the Medicare-eligible, as well as 50 years of Medicare itself. Remember, if you wish to contribute any notes, pictures or thoughts to Judy, to include in her Memory Book of this day, please mail them to: Center for Medicare Advocacy 1025 … Read more

Last week’s Alert discussed the Centers for Medicare & Medicaid Services’ (CMS’s) National Partnership to Improve Dementia Care and the Government Accountability Office’s (GAO) recent report on antipsychotic drugs.[1]  The CMS Partnership and the GAO reported different numbers of nursing home residents receiving antipsychotic drugs.  Some of the differences appear to reflect the different databases … Read more

Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in … Read more

In order to prescribe medications for their Part D patients, a new federal rule requires physicians, including psychiatrists and other prescribers of Part D drugs, to be enrolled in Medicare in an approved status, or to formally opt out of Medicare.  The original start date for this rule was June 1, 2015 but the actual … Read more

March 6, 2015 VIA ELECTRONIC SUBMISSION AdvanceNotice2016@cms.hhs.gov Centers for Medicare & Medicaid Services Department of Health and Human Services P.O. Box 8016 Baltimore, MD 21244-8016 Re:  Advance Notice of Methodological Changes for Calendar Year 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter To Whom It … Read more

Many people outside the Medicare and health care world don’t know that in 1989 Medicare was briefly, dramatically altered.  The “Medicare Catastrophic Coverage Act,” (MCCA) was the most significant revision to Medicare since its inception.  The law increased the amount of coverage available in all care settings, established limits to beneficiary cost-sharing, and added new benefits. … Read more

By Congresswoman Rosa DeLauro, CT-3 "Along with Medicaid, Social Security and now the Affordable Care Act, Medicare is a bedrock part of the American social insurance system. Its enactment was a turning point in our history that has helped ensure the elderly do not have to go without basic health care. Before Medicare, only half … Read more

We are continuously amazed at the courage and empathy of our clients.  The plaintiffs in Jimmo v. Sebelius, a class action lawsuit, filed by the Center for Medicare Advocacy in 2011 and settled in 2013, are remarkable examples of this. The Jimmo Settlement opens doors to Medicare coverage for people with long-term and chronic conditions throughout the country.  … Read more

In September 2014, the Centers for Medicare & Medicaid Services (CMS)[1] reported that the National Partnership to Improve Dementia Care had reduced the use of antipsychotic drugs with nursing home residents by 15.1%, “exceeding” the Partnership’s 15% drug reduction goal for long-stay residents.  That claim of success was overstated.  When CMS originally announced the initial … Read more