Last week, the Secretary of Health and Human Services was reported as claiming, in remarks to the American Legislative Exchange Council, that the Affordable Care Act (ACA) has caused 28 million Americans to be uninsured. In light of this statement, we highlight the many ways the ACA has actually expanded access to insurance coverage and … Read more

Elder Justice: What "No Harm" Really Means for Residents is a monthly newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a "no harm” deficiency is and what it means to nursing … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies some of the most poorly performing nursing facilities in the country as Special Focus Facilities (SFFs).  In this Second Report on SFFs, the Center for Medicare Advocacy looks at one of four categories of SFFs – those that “have not improved” – and how they game … Read more

Last week, the U.S. Department of Health and Human Services (HHS) released the final rule expanding the use of Short-Term Limited-Duration Insurance. For months, we have been highlighting how these “Junk Plans” would adversely impact both the Affordable Care Act (ACA) Marketplace and consumers with complex care needs. Short-term insurance is meant to be a … Read more

Last week, the Office of Inspector General (“OIG”) published a report[1] of its study on the growth in hospice utilization and reimbursement since 2005.  The Report summarizes key vulnerabilities in the Medicare hospice program affecting quality of care and program integrity, and presents recommendations to the Department of Health and Human Services for protecting beneficiaries … Read more

The Center for Medicare Advocacy wanted to determine whether nursing facilities that had one-star in their health survey ratings on Nursing Home Compare were able to boost their overall ratings from one star to two stars through the designation of five stars in the self-reported quality measure domain.  The finding – that many facilities in … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for nursing home care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for care at a skilled nursing facility and emphasizes … Read more

Charlene Harrington, professor emerita at the University of California San Francisco, and Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman have written an analysis of the class action lawsuit against twelve Golden Living nursing facilities in Arkansas for insufficient nurse staffing. The case was settled for $72 million in 2017.[1]  In “Failure to … Read more

Last week, the Center for Medicare and Medicaid Services (CMS) issued a notice that beneficiaries in Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island and Vermont will begin receiving new Medicare cards. The agency also announced the completion of the mailing to beneficiaries who live in Alaska, American Samoa, California, Guam, Hawaii, … Read more

The Center for Medicare Advocacy issues this Special Report to shine a light on nursing homes throughout the country that have been identified as providing the poorest quality care to residents – while facing limited, if any, enforcement action as a consequence. Known as Special Focus Facilities, (SFFs), these facilities are identified by the Centers … Read more

The Office of the Inspector General for the Department of Health and Human Services released a report recently regarding Part D coverage of prescription drugs used by people dually eligible for Medicare and Medicaid. The June report, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2018, found that most Part D plan … Read more

This week, the Kaiser Family Foundation released a poll showing that 56% of Americans believe that the Administration is “trying to make the ACA fail.” The polling also shows that by nearly seven to one, people think this is a negative thing. Over the last few months, we’ve highlighted negative actions taken by the Administration … Read more

Kaiser Family Foundation Report A report recently issued by the Kaiser Family Foundation, “Medigap Enrollment and Consumer Protections Vary Across States” (July 2018), “provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, [the] brief examines implications for older adults … Read more

An emerging issue of concern for advocates is nursing facilities’ increased marketing of “in-house” managed care plans – specifically, Institutional Special Needs Plans, or I-SNPs – to their residents.[1]  These Medicare Advantage plans are limited to beneficiaries who require, or are expected to need, institutional long-term care for 90 days or more. A recent article … Read more

In a previous CMA Alert we highlighted a statement reportedly made by CMS Administrator Seema Verma that she took “exception to those out there who have made claims that we have tried to sabotage the health care of the American people, particularly when it comes to the health-care exchanges…” We listed actions taken prior to … Read more

The Social Security Administration (SSA) has released revisions to the Program Operations Manual System (POMS) regarding how to process Part A enrollments that are conditional to a state’s determination of a beneficiary as a Qualified Medicare Beneficiary (QMB).  The update is intended to address inconsistencies and confusion in SSA field offices and includes important clarifications, … Read more

In the proposed rule, published in the Federal Register on July 12, 2018[1], CMS confirms that a patient’s condition does not need to improve for home health care to be covered by Medicare. CMS also acknowledges the following: There have been reports of difficulty accessing coverable home health care, especially when the patient’s condition is … Read more

On July 10, 2018, the President signed an Executive Order undermining the impartial hiring of Administrative law Judges (ALJs). The order states that “conditions of good administration make necessary an exception to the competitive hiring rules and examinations for the position of ALJ.”  What this really means is that ALJs will now be hired directly … Read more

Researchers studying patients with hip fractures found that patients with Medicare Advantage (MA) plans have shorter stays in skilled nursing facilities (SNFs) and receive less rehabilitation than patients in traditional Medicare, but are, nevertheless, less likely to be readmitted to an acute care hospital within 30 days or to become long-term care residents.[1]  These findings … Read more

Last year, we highlighted how the Administration cut funding for Affordable Care Act (ACA) outreach and enrollment assistance. They are at it again. This week it was reported that the Administration is slashing even more funding for organizations called “navigators” that assist people who need health insurance. The Washington Post reports that for the upcoming … Read more

The Medicare-Medicaid Coordination Office’s Integrated Resource Center (ICRC) of the Center for Medicare & Medicaid Services recently released an issue brief addressing the challenges of access to durable medical equipment (DME) for dually eligible beneficiaries. The brief, Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches, … Read more

The announcement on July 2, 2018, that CMS seeks to “modernize” Medicare home health care is filled with patient-oriented rhetoric, but will actually further gut the Medicare home health benefit – which is already being implemented in a way that doesn't work for many patients who are most in need. New payment policies, such as … Read more

This week, the Centers for Medicare and Medicaid Services (CMS) released their reports on the performance of the exchanges and individual health insurance market. These reports include the Early 2018 Effectuated Enrollment Snapshot, Exchange Trends Report and the Trends in Subsidized and Unsubsidized Enrollment. In the press release for these reports, CMS makes a few … Read more

The Centers for Medicare & Medicaid Services (CMS) has ended its campaign to reduce the inappropriate use of antipsychotic drugs for long-stay residents in nursing facilities (formally called the National Partnership to Improve Dementia Care in Nursing Homes) for facilities that reduced their antipsychotic drug usage by 34% by the end of 2016 (from 23.9% … Read more

Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services (CMS), invited the Center for Medicare Advocacy and other advocacy organizations to meet with her on June 25, 2018. The Administrator asked our organizations to provide one to two recommendations for the Requirements of Participation that would reduce burdens on nursing facilities. However, … Read more

Last week, the Health Policy Consensus Group released a plan to repeal the Affordable Care Act (ACA). It is reported that this group, led by longtime ACA critic, former Senator Rick Santorum, has been working with Senate Republicans and the White House on this “new” plan. Make no mistake; as we noted in a joint … Read more

Ranking Committee Members Echo Advocates’ Complaints to CMS about Draft 2019 Medicare & You As discussed in a previous CMA Alert, the Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the … Read more

As required by the Affordable Care Act, the Medicare Hospital Readmissions Reduction Program (HRRP) reduces Medicare payment rates, by up to 3%, to hospitals that readmit patients with certain specified conditions within 30 days.[1]  The financial penalty is applied only when the patient’s initial hospital stay and subsequent hospital stay are both identified as inpatient.  … Read more

The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017, which outlined proposed changes to Chapter 7 of the State Operations Manual (SOM), and invited public comment. As the Center for Medicare Advocacy noted in a previous alert, the proposed changes sought to reverse surveyor guidance issued … Read more

The Center for Medicare Advocacy was pleased to have participated in the World Elder Abuse Awareness Day observance at the United Nations (UN) in New York. The theme for this year’s observance was “Moving from Awareness to Action through a Human Rights based approach. In attendance were NGOs, representatives from the UN Focal Point on … Read more

This week the Department of Labor issued the final rule for Association Health Plans. The release of this rule is yet another action taken by the Administration to undermine the Affordable Care Act (ACA). Expanding these Association Health Plans will make it easier for certain small employers to offer plans don’t provide ACA coverage protections. … Read more

In April 2017, the Centers for Medicare and Medicaid Services (CMS) abandoned a multi-state Medicare Pre-Claim Review Demonstration Model that had so many flaws it never made it out of the initial implementation state, Illinois. The latest proposed model promises to improve on the past model and boasts of greater flexibility and choice for providers … Read more

In a previous Alert, we highlighted a lawsuit against the federal government by State Attorney’s General in twenty states led by Texas. At the center of the lawsuit is the Affordable Care Act’s (ACA) individual mandate penalty, which was repealed by Congress in last year’s tax bill. The lawsuit claims that the ACA is null … Read more

Since January 2017 the health and safety of nursing home residents has become increasingly imperiled. Nursing home lobbyists have urged the Centers for Medicare & Medicaid Services (CMS) to eliminate or delay regulations and dramatically reduce enforcement of violations. Unfortunately, CMS has shown a disturbing willingness to follow these lobbyists’ recommendations. For example, under regulations … Read more

On May 8, 2018, the Centers for Medicare & Medicaid Services (CMS) proposed a new Medicare Part A reimbursement system for skilled nursing facilities, called Patient-Driven Payment Model (PDPM).[1]  The Center for Medicare Advocacy issued an Alert on the proposed rules (“CMS Tries Again: Another New Skilled Nursing Facility Medicare Reimbursement System Proposed – If … Read more

A message from the Center for Medicare Advocacy and the Long Term Care Community Coalition: June 15th is World Elder Abuse Awareness Day. According to the Administration for Community Living (ACL), about five million – one in ten – older adults are abused, neglected, or exploited every year. Elder abuse can take many forms and may … Read more

On June 4, 2018, the House of Representatives Democratic Caucus Seniors Task Force held a briefing on “Protecting Seniors by Improving – Not Eroding – Nursing Home Quality Standards.” The Center for Medicare Advocacy, led by Senior Policy Attorney Toby Edelman, presented on the enforcement of the nursing home standards, as well as the current … Read more

Thirty-one new items of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) will join two existing items of DMEPOS on the Center for Medicare and Medicaid Services (CMS) Master List of Items Frequently Subject to Unnecessary Utilization, requiring prior authorization as a condition of payment. All these 33 DMEPOS items are types of power wheelchairs. … Read more

Robert Pear wrote last week in the New York Times (“Trump Plan to Lower Drug Prices Could Increase Costs for Some Patients”) that the President’s plan to “inject more competition into the market” and switch coverage of some expensive drugs from Medicare Part B Medicare Part D could significantly increase out-of-pocket costs for some of … Read more

June 6, 2018 Contact: Matt Shepard (, 860-456-7790) The Medicare trustees estimate the Part A Trust Fund will be insolvent in 2026, three years sooner than last year’s projection. The good news is this is about nine years later than it would have been without the Affordable Care Act.  The bad news is the projection reflects … Read more

This week, Politico reported the President as saying "I have my two Alexes [Azar and Acosta]… coming out with plans that are phenomenal plans, phenomenal plans,” and that “They’ll be out over the next four weeks [and] it's going to cover a tremendous amount of territory." The report goes on to say that “Trump specifically … Read more

The Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft 2019 Medicare & You Handbook, and urged CMS to rectify the errors prior to dissemination.  As stated in a joint … Read more

As discussed in a previous CMA Alert, the Centers for Medicare & Medicaid Services (CMS) recently issued a Request for Information on a proposal relating to “direct provider contracting” or “DPC” which, according to CMS, “would allow providers to take further accountability for the cost and quality of a designated population in order to drive … Read more

Last week, it was reported that the failed Graham-Cassidy repeal and replace bill may be making another appearance in some form. In its original form, the bill was defeated as it sparked a huge public outcry and the mobilization of advocates around the country. The public saw it for what it was – a bad … Read more

In recent months, the buying and selling of nursing facilities and the transfers of licenses to new managers have raised questions about who the new owners/managers/lessees are and whether there are sufficient state and federal laws, regulations, and practices in place, meaningfully implemented and enforced, to protect residents. The issue came vividly into public consciousness … Read more

Proposed changes to nursing facility payment under consideration by CMS would reduce financial incentives to provide therapy, and would do so with such force – providing higher reimbursement to skilled nursing facilities (SNFs) that provide residents fewer types of therapy over a shorter period of time, or no therapy at all – that it would … Read more

In a New York Times article this week, Robert Pear reported on a study done by the chief actuary of the Center for Medicare & Medicaid Services, which shows the devastating impact of expanding access to short-term, limited-duration plans, as proposed by the Trump Administration. According to the Times, the study finds that as many … Read more

The Center for Medicare Advocacy hears from Medicare beneficiaries throughout the country who are living with serious illnesses and injuries without the home care they need – and that should be covered by Medicare. There are many reasons for these access problems. Patients are told they don’t meet the qualifying criteria because they aren’t “homebound,” … Read more

The Affordable Care Act created the Centers for Medicare & Medicaid Innovations (CMMI), which is tasked with testing demonstration programs aimed at delivery system reform. According to a press release describing feedback to a Request for Information (RFI) on “new directions” for CMMI, the Centers for Medicare & Medicaid Services (CMS) has been engaged in … Read more

In a recent speech to the World Health Care Congress, CMS Administrator Seema Verma reportedly said “I take exception to those out there who have made claims that we have tried to sabotage the health care of the American people, particularly when it comes to the health-care exchanges. Obamacare was failing long before Donald Trump … Read more