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Author Archives: mshepard

The Administration on Aging defines a subcategory of elder abuse – “physical abuse” – as “inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.”[1] Administering antipsychotic drugs to more than a quarter of a million nursing home residents meets the definition of elder abuse and, left … Read more

A report from the National Academies of Sciences, Engineering, and Medicine (about which the Center for Medicare Advocacy has commented) was recently highlighted by ABC News. The Report, Hearing Health Care for Adults: Priorities for Improving Access and Affordability, rightly names hearing loss as a public health priority and social health responsibility. Even mild hearing … Read more

In a recent Boston Globe piece, former CMS Administrator Donald M. Berwick, MD called for expanded access to dental care, which he characterized as a critical aspect of health care that is out of reach for many. People with low incomes, people with disabilities, and older Americans all have difficulty accessing routine, preventive, and medically … Read more

The Patient Access and Medicare Protection Act (PAMPA), enacted on December 28, 2015, delayed application of competitive bid program (CBP) adjusted payment rates for accessories furnished in connection with complex rehabilitation technology (CRT) power group 3 wheelchairs. PAMPA also included a provision requiring the General Accounting Office (GAO) to study Medicare utilization and expenditures for … Read more

A recent post by health economist Uwe Reinhardt in the Journal of the American Medical Association Forum discusses the fact that despite all the support Medicare Advantage (MA) plans have received, the vast majority of Medicare beneficiaries still prefer Traditional Medicare. 30% of Medicare recipients now receive their coverage through MA plans. This is largely because … Read more

“The June 2, 2016 report from the National Academies of Sciences, Engineering, and Medicine rightly named hearing loss as a public health priority and social health responsibility. The Report’s findings demonstrate the urgent need to update Medicare coverage to reflect the serious health issues that stem from hearing loss. “Hearing loss affects nearly 30 million Americans, … Read more

As previously reported, a court preliminarily approved settlement in the case of Exley v. Burwell, 3:14-cv-1230 (JAM) (D. Conn.), in March of this year. Since then the government requested and the plaintiffs agreed to a revision in the proposed settlement. Because of this revision, the parties are posting notice to the class again and the … Read more

October 21, 2016 – Update on Seamless Conversion: CMS is revisiting the seamless conversion enrollment policy and is temporarily suspending its acceptance of any new seamless enrollment proposals. Read more… Ms. M., a Medicare beneficiary living in the Southwest, turned 65 in October 2015 and became eligible for Medicare on October 1st. On September 30th she signed … Read more

This week CMS released, for the first time, a public use file for the Medicare Current Beneficiary Survey (MCBS).  The “MCBS 2013 Access to Care Public Use File” (MCBS PUF) provides the first publicly available MCBS file for people interested in the health, health care use, access to, and satisfaction with care for Medicare beneficiaries.  … Read more

By Cynthia Ronzio, Public Health Consultant The British Medical Journal (BMJ) recently published a highly controversial and alarming study that claims that medical errors are the third leading cause of death in the US.[1]  The authors used crude statistics (for example, they do not describe their method of extrapolation nor is there mention of weights, … Read more

Oral Health America recently released a report, A State of Decay, a state-by-state ranking of healthcare delivery and public health factors that affect the oral health of older adults. Some of the Report’s Findings 76% or 38 states earned a Composite Score of Fair (22%) or Poor (54%); Ten states received a Composite Score of … Read more

The controversial issue of Observation Status continues.[1]  The latest news is that the Centers for Medicare & Medicaid Services (CMS) told Quality Improvement Organizations (QIOs) on May 4 that they should temporarily pause their reviews of hospitals’ compliance with the two-midnight rule.  The pause was reported by Livanta, one of the two QIOs nationwide (the … Read more

The Medicare Advocacy Project of Greater Boston Legal Services recently received a favorable decision from the U.S. District Court in Massachusetts for “off-label” coverage of the drug Dronabinol.  This is a welcome development given how difficult it has been to obtain coverage for medications that prescribing doctors agree are necessary, but that are not FDA-approved … Read more

American Heart Association/American Stroke Association Recommends That Patients Who Have Strokes Receive Rehabilitation at Inpatient Rehabilitation Hospitals, not Skilled Nursing Facilities For the first time, the American Heart Association/American Stroke Association has issued a Scientific Statement and guidelines strongly recommending that, “whenever possible,” “stroke patients be treated at an in-patient rehabilitation hospital (now often referred to … Read more

On May 5, 2016 Center for Medicare Advocacy executive director Judith Stein and Senior Attorney Wey-Wey Kwok, the Dental Lifeline Network, the Medicare Rights Center, and former CMS (then HCFA) administrator Bruce Vladeck, met with CMS officials to discuss coverage of medically necessary oral health care. The group’s primary goal was to advance Medicare coverage … Read more

This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments.  The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling … Read more

As discussed in previous Alerts, on March 11, 2016 CMS published a proposed rule aimed at reforming how Medicare pays for drugs covered under Part B. CMS states that its main objective is to ensure that physicians are prescribing the most effective prescription drugs in order to improve patient treatment and to rein in drug spending. … Read more

May 9, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–1670–P Mail Stop C4–26–05 7500 Security Boulevard Baltimore, MD 21244–1850 Submitted electronically to:    http://regulations.gov Re:      CMS–1670–P   To Whom It May Concern: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & … Read more

Medicare coverage for medically necessary dental and oral health care is supported by the Medicare statute, its legislative history, and even CMS policy.  For this purpose, “medically necessary oral health care” refers to treatment deemed necessary by a physician when a patient’s medical condition is or will likely be complicated by an untreated oral health … Read more

MEDICARE’S COVERAGE OF ORAL HEALTH   Current Centers for Medicare & Medicaid Services (CMS) policy[1] broadly bars Medicare coverage for practically all dental services.  The Center for Medicare Advocacy firmly believes that CMS has the legal authority under the Medicare statute to cover medically necessary oral health care – that is, treatment deemed necessary by … Read more

The Centers for Medicare & Medicaid Services (CMS) has recently issued a host of Medicare-related proposed rules that are currently open for comment, including the following: MACRA (Physician Payment) On April 27, 2016, CMS released a proposed rule outlining new physician payment systems created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The … Read more

​Welcome and Housekeeping  (David Lipschutz, Moderator)  Medicare’s Coverage of Oral Health (Wey-Wey Kwok)  Medically necessary oral health care Goal: add a comprehensive oral health benefit to Medicare Administrative Update    Proposed Rules Part B Drug Demonstration (David Lipschutz) Hospital Payment Rule and the NOTICE Act (Toby Edelman) Concerns about notice to be given to those … Read more

1. Are you with (Pick one): Created with Highcharts 4.1.1SHIP: 27.88%SHIP: 27.88%SHIP: 27.88%SMP: 43.27%SMP: 43.27%SMP: 43.27%Both SHIP and SMP: 28.85%Both SHIP and SMP: 28.85%Both SHIP and SMP: 28.85%SHIPPercent: 27.88%Count: 29         SHIP 27.88%   29 SMP 43.27%   45 Both SHIP and SMP 28.85%   30   Total Responses 104   Skipped … Read more

In proposed rules updating Medicare reimbursement to acute care hospitals,[1] the Centers for Medicare & Medicaid Services (CMS) announces how it intends to implement the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act).[2]  Effective August 6, 2016, the NOTICE Act requires that hospitals provide written and oral notice, within 36 hours, … Read more

Reports that 20% or more of unplanned hospital readmissions are avoidable has led to considerable interest in policymakers in reducing readmissions.[1]  Actively reducing hospital readmissions is seen as a route to lower Medicare spending and improved patient care. The Affordable Care Act (ACA) established a penalty program for preventable readmissions.  Under the Hospital Readmissions Reduction … Read more

CT Sen. Ted Kennedy, Jr. presents Center for Medicare Advocacy Executive Director Judith Stein with a citation at the Center's 30th anniversary party. On Wednesday, April 13, 2016 the Center for Medicare Advocacy held a reception at the Connecticut State Capitol to celebrate 30 years working for fair access to Medicare and health care.  The … Read more

The single factor most critical to high quality of care and quality of life for nursing home residents is the staff who provide residents with care.  Most direct care in nursing facilities is provided by nurse aides, primarily women of color, who are poorly paid and often poorly treated.  In a sobering new report, Raise … Read more

As part of the Center’s ongoing project on approaches to improve nurse staffing levels in nursing facilities, this week we are posting a paper on “Increasing Reimbursement.”  This approach increases reimbursement to nursing facilities on the assumption and expectation that nursing facilities will use some of the increased reimbursement to increase their staffing levels.  This … Read more

Introduction One approach to improving nurse staffing levels is increasing reimbursement to nursing facilities, on the assumption and expectation that nursing facilities will use some of the increased reimbursement to increase their staffing.  This approach – at the federal level with Medicare and at the state level with Medicaid, in both Florida and California – … Read more

On April 1, 2016, the Center for Medicare Advocacy held its third annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. The event brought together leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health care for older people and people with … Read more

As discussed in our March 2, 2016 CMA Alert, the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register in February 2016 announcing its effort to seek approval from the Office of Management and Budget (OMB) to “collect information” pursuant to a demonstration project to identify, investigate and prosecute fraud … Read more

April 5, 2016 Centers for Medicare & Medicaid Services Office of Strategic Operations and Regulatory Affairs Division of Regulations Development 7500 Security Blvd. Baltimore, MD 21244-1850 Delivered Electronically through www.regulations.gov Re: Medicare Prior Authorization of Home Health Services Demonstration (CMS-10599) To Whom It May Concern: The Center for Medicare Advocacy (the Center) appreciates the opportunity … Read more

The Older Americans Act Reauthorization Act of 2015 is tremendously important for the protection of older people and people living with disabilities.  The Reauthorization Act Bill passed the House with an amendment on March 21, 2016.  The Senate Bill, S. 192, is entitled "An Act to Reauthorize the Older Americans Act of 1965.”  The short … Read more

A comparison of the long-term care industry in California, Ontario (Canada), England, and Norway evaluates the extent to which ownership of nursing facilities has shifted from the public sector to private for-profit and not-for-profit companies, and how this shift affects the transparency of information and accountability for public reimbursement.[1] While privatization has been a recent … Read more

Medicare Part B covers drugs that are usually not self-administered, such as many intravenous medications and chemotherapy drugs. Medicare Part D, on the other hand, generally covers self-administered outpatient prescription drugs.  On March 11, 2016, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register aimed at reforming how Medicare … Read more

On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) released a memorandum entitled “Suspension of Policy Providing for Automatic Reduction of Star Ratings for Contracts Operating Under Intermediate Sanction.” Through this memo, CMS has suspended its policy of lowering the star ratings of Medicare Advantage plans that are under sanction for violations … Read more

Since its implementation in 1965, Medicare has excluded coverage for hearing aids and related audiology services despite the large numbers of older Americans that have hearing loss. It is increasingly well-documented, however, that untreated hearing loss often leads to a variety of serious health problems and injuries. This means the cost of not treating audiology … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) CMA and Vermont Legal Aid have filed a Motion for Resolution of Non-Compliance with the Settlement Agreement Exley (formerly Lessler) (ALJ Delay Case) Settlement preliminarily approved Barrows (formerly Bagnall) (Observation) Discovery on protected property interest issue; summary judgment briefing Other cases Hull … Read more

Sign our petition to remind CMS that Medicare should cover medically necessary oral health care. Medicare was created to help older people and people with disabilities.  It should not deny clinically essential or life-saving treatments simply because those treatments occur within the mouth. The Medicare statute does not prohibit coverage for non-routine dental or oral procedures … Read more

1. Comments to CMS re: 2017 Draft Call Letter for Medicare Parts C and D Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that will apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the … Read more

LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius) (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). 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 and nursing home stays because their care … Read more

March 4, 2016 The Honorable Ron Wyden Ranking Member, Committee on Finance United States Senate Washington, D.C. 20510 The Honorable Charles Grassley Senior Member, Committee on Finance United States Senate Washington, D.C. 20510 Submitted electronically to: Report_Feedback@finance.senate.gov Re: Comments on Prescription Drug Pricing Reform Dear Ranking Member Wyden and Senior Member Grassley: The Center for Medicare … Read more

March 4, 2016 VIA ELECTRONIC SUBMISSION AdvanceNotice2017@cms.hhs.gov Andrew Slavitt, Acting Administrator 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 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call … Read more

1. CMS Proposes Medicare Home Health Prior Authorization Demonstration On February 5, 2016, the Centers for Medicare & Medicaid Services (CMS) published a two-page Paperwork Reduction Act notice in the Federal Register announcing their effort to seek approval from the Office of Management and Budget (OMB) to “collect information” relating to a demonstration project.  Pursuant … Read more

Beneficiaries Across the Country Still Denied Needed Coverage Due to Illegal Use of Improvement Standard March 1, 2016 – Today, Plaintiffs’ counsel, the Center for Medicare Advocacy and Vermont Legal Aid, filed a Motion for Resolution of Non-Compliance with the Settlement Agreement in the landmark case, Jimmo v. Sebelius. The filing comes after three years … Read more

March 2016 Update: CMS is now delaying enforcement of the Part D Prescriber Enrollment Requirements until February 1, 2017. Nevertheless, prescribers of Part D drugs should submit their Medicare enrollment applications or opt-out affidavits to their Part B Medicare Administrative Contractors (MACs) by January 1, 2016, or earlier, to ensure that MACs have sufficient time … Read more

On October 5, 2015, the Centers for Medicare and Medicaid Services (CMS) announced final rules concerning its requirements for Meaningful Use Stage 3 of its health records initiative. These measures have the potential to reduce health disparities among elder lesbian, gay, bisexual, and transgender (transgendered) (LGBT) patients.  The final rules require providers to have the … Read more

Thank you very much for taking the time to reply to our invitation.  If you included a donation, we thank you for that as well, and your receipt should arrive by email shortly. Detailed directions and parking information will be sent to all attendees by email prior to the Celebration. And please do share your memories, … Read more

The 2016 Medicare Part A and B General Enrollment Period runs from January 1 through March 31, 2016. As detailed below, this enrollment period is especially important for many individuals who are not eligible for premium-free Medicare Part A. Most people do not pay a premium for Medicare Part A because they have sufficient work history. … Read more

On February 9, 2016, President Obama unveiled his Fiscal Year 2017 Budget.[1]  With respect to Medicare, this year’s proposed budget is very similar to last year’s, both good and bad, with some notable exceptions.  While not a comprehensive analysis of all of the Medicare-related provisions, the Center for Medicare Advocacy provides these comments about the … Read more