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With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare providers, contractors, and adjudicators apply the correct legal standard to Medicare coverage and payment determinations – as required by the Jimmo v. Sebelius Settlement Agreement. The Jimmo Settlement means that Medicare coverage and … Read more

As reported widely, including in The New York Times,[1] the Trump Administration spent this Medicare Annual Enrollment Period steering beneficiaries towards private Medicare Advantage (MA) plans. While CMS contests this conclusion, Administrator Verma stated they are “unleashing and strengthening” Medicare Advantage[2] and HHS Secretary Azar says he sees Medicare Advantage as the future of Medicare: … Read more

Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories In Her Own Words: A Beneficiary's Take On Medicare Advantage Steering Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories The Medicare … Read more

We have previously written about new guidance from the Administration that will make it easier for states to both ignore Affordable Care Act (ACA) coverage and consumer protection rules, and weaken the ACA Marketplace. Last week, the Centers for Medicare & Medicaid Services (CMS) issued waiver concepts about how states can implement the new guidance. … Read more

Dear CMA, I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services. I have become increasingly troubled by the targeted ads to seniors on TV … Read more

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the … Read more

The Medicare Annual Coordinated Election Period (ACEP), ends this week – December 7, 2018.  As we near the end of the ACEP, consumer advocates remain concerned that the information put out by the Medicare program regarding coverage options is incomplete and continues to promote certain options over others. There’s still time to decide which Medicare … Read more

As we approach the final week of the Medicare Annual Coordinated Election Period (ACEP), individuals continue to make decisions about how they want to access their Medicare benefits in 2019.  Consumer advocates are concerned, however, that the information put out by the Medicare program about coverage options is incomplete and continues to promote one option … Read more

The November 2018 New England Journal of Medicine features a article by KFF’s Tricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation (KFF) that “examine[s] the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality. They also highlight areas where more evidence … Read more

There is not much time left to obtain health insurance from the Affordable Care Act (ACA) Marketplace during this year's Open Enrollment period. Consumers who need coverage should visit www.healthcare.gov to shop, compare and find a plan that meets their needs. Consumers should act quickly.  Not only has this year’s Open Enrollment period been shortened … Read more

State Attorneys General are successfully litigating issues of key importance to nursing home residents, including insufficient nurse staffing levels and inappropriate transfers or discharges of residents. This Alert discusses two cases: the Pennsylvania Attorney General’s challenge to inadequate staffing levels by a national chain and the Maryland Attorney General’s challenge to a state chain’s transfer … Read more

The Jeffrey P. Ossen Foundation and the Center for Medicare Advocacy have joined forces to advance access to Medicare and necessary home and community-based care. The two organizations are partnering to provide education and advocacy throughout the greater Windham area to help providers, discharge planners, and families understand and access Medicare-covered home health and community-based … Read more

On September 20, 2018, CMS issued a notice of proposed rulemaking (NPRM) to revise the emergency preparedness program requirements. Most notably, the proposed rule would allow nursing homes to review their emergency preparedness programs and to train staff to carry out those plans every two years rather than annually. The HHS Office of the Inspector … Read more

Concerned that Medicare beneficiaries could reject proper consideration of Medigap supplement plans because of undefined and significantly high costs listed in an “Estimated Annual Cost” column for Medigaps in the Medicare.gov CMS Plan Finder tool, the Center for Medicare Advocacy (the Center) requested CMS define costs that are included in the “Estimated Annual Cost” column. … Read more

As families across the country prepare to gather with loved ones for the Thanksgiving holiday, lawmakers in Washington are preparing for the post-election ‘lame duck’ session, which could bring opportunities to protect and strengthen Medicare. This and every Thanksgiving, we are thankful for Medicare. Tell your lawmakers why you are too, and ask them to … Read more

As part of a project supported by the Ossen Family Foundation, Center for Medicare Advocacy staff recently called the 16 home health agencies that, according to Medicare’s Home Health Compare tool, serve the two counties near our CT office. Home health agencies were asked about their ability to provide care to a beneficiary with a chronic … Read more

Mrs. R contacted the Center for Medicare Advocacy about her husband, who has ALS, and was told his home health physical therapy was about to be terminated. While receiving physical therapy, Mr. R had reduced pain, allowing him to decrease pain medications, improved bowel function, and increased ability to clear airway secretions. Nonetheless, home health agency … Read more

For years the Center for Medicare Advocacy and other stakeholders have advocated for Medicare coverage for home health aides without the current prerequisites that the individual be homebound and require skilled nursing or therapy. Unfortunately, the ability to get Medicare-covered home health aide care has greatly declined in recent years, even when individuals meet the … 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 Medicare home health care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for home health care and emphasizes language from … Read more

Since 2017 the Center for Medicare Advocacy has been writing and disseminating a ten-part Home Health Issue Brief Series examining the growing crisis in access to Medicare-covered home health care, and outlining the Center’s work to address the issue. This Home Health Issue Brief includes all ten prior Briefs in one document. We hope this … Read more

November 15, 2018 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends … Read more

As results from this week’s mid-term elections continue to come in, it is clear that the Democrats will control the House of Representatives and Republicans will retain control of the Senate in the 116th Congress that starts in January.  According to polling conducted before and during the election, health care was the top issue for … Read more

Legislation to Reduce Rehospitalizations Fails to Answer Questions About Resident Protections The Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2018 (H.R. 6502) would allow certain medical groups to provide telehealth and on-site first responder services to nursing home residents in an attempt to reduce rehospitalizations. Although the goal of reducing unnecessary and inappropriate rehospitalizations is … Read more

Despite the Jimmo case’s confirmation that Medicare coverage of a stay in a skilled nursing facility (SNF) is appropriate to maintain a resident’s functional status, when the nursing or therapy services must be provided by a professional nurse or therapist, SNFs and managed care plans frequently continue to deny medically necessary coverage.  Expedited appeals to … Read more

Today is one of the most consequential elections of our lifetime. Millions of voters will head to the polls and decide on the kind of future we want for our country. Ballots cast today will decide issues of economic fairness, equality under the law and whether our government is truly “of the people, by the … Read more

Today is the first day of Open Enrollment for the Affordable Care Act (ACA) Marketplace. Consumers who need coverage should visit www.healthcare.gov to shop around and find an ACA plan that meets their needs. Unfortunately, due to actions taken by the Administration to undermine the Marketplace, there is not as much assistance available to help … Read more

On October 11, 2018, the Department of Health and Human Services published final rules updating civil money penalty (CMP) amounts for civil penalties assessed on or after October 11, 2018 for violations of various HHS programs occurring on or after November 2, 2015.  83 Fed. Reg. 51369 (Oct. 11, 2018) (“Annual Civil Monetary Penalties Inflation … Read more

New Medicare payment rules for home health agencies serving Medicare beneficiaries will likely further reduce access to care for people with longer term and chronic conditions. Medicare will pay agencies significantly more for services provided to beneficiaries within the first 30 days following inpatient institutional care (hospital or skilled nursing facility), than for those who … Read more

With the mid-term elections just days away, the President unveiled a minimal drug proposal in yet another effort to suggest minor changes at a politically opportune time. This is a distraction from the fact that the Administration is not “strengthening” Medicare as claimed, but fragmenting it and putting it on a path to privatization. Don’t fall for the … Read more

Earlier this week the National Committee shared a list of “Campaign Codewords” to watch out for this election season.  Here’s what some of the phrases they highlighted (and one of our own) will really mean when you hear them.   When You Hear…   It REALLY Means… Reform/Save → Privatize it! Raise the Retirement Age … Read more

This week the Administration issued new guidance that will make it easier for states to ignore Affordable Care Act (ACA) rules and weaken the ACA Marketplace. The new guidance concerns state innovation waivers which would allow states to expand inadequate coverage such as short-term plans and Association Health Plans. As Politico reports, “Many health insurance … 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 skilled nursing facility care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for SNF care and emphasizes language from the Jimmo Settlement … Read more

The mid-term elections are just 14 days away. Medicare Matters A recent Kaiser Health poll shows that health care is the top issue for voters in this election. The poll finds that for 7 in 10 voters, health care is a “very important” factor in determining their vote. Unfortunately, the poll shows that only about 17% … Read more

Last week the Centers for Medicare & Medicaid Services released the Medicare premium, deductible and co-pay amounts for 2019.  Below are the 2019 cost-sharing amounts. Part A Premium (For those not automatically enrolled) 0-29 qualifying quarters of employment: $437.00 30-39 quarters: $240.00 Inpatient Hospital Deductible, Per Spell of Illness: $1,364.00 Co-pay, Days 1 – 60: … Read more

The Department of Health and Human Services (DHHS) Office of Inspector General (OIG) recently issued a report entitled “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials” (OEI-09-16-00410) (see summary and full report). Among the report’s findings are that when beneficiaries and providers appealed preauthorization and payment denials, MA plans … Read more

This is Part Ten of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … 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 home health care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for home health care and emphasizes language from the … Read more

The mid-term elections are 20 days away. To help keep Medicare in the forefront of candidates’ and voters’ minds, our SaveMedicareNow project is focusing on issues relevant to the promise and future of the Medicare program.  Last week, we focused on the importance of Medicare to young people.  This week, we focus on the growing … Read more

Providing Medicare Beneficiaries with Complete, Objective Information to Help Them Make the Best Enrollment Decision The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare have partnered to develop an education and outreach project to support Medicare beneficiaries and those who assist them enroll and re-enroll in Medicare. The Medicare … Read more

Yesterday, USA Today published an Op-Ed by President Trump entitled “Democrats [sic] 'Medicare for All' plan will demolish promises to seniors.” In addition to the inflammatory rhetoric throughout the piece (which includes language reminiscent of the “Red Scare” fears used to oppose passage of Medicare in the 1960s), it is filled with false and misleading statements about the … Read more

As midterm elections near, young Americans will be in the spotlight. Young Americans have been integral to a number of surprising primary victories across the country. And, for the first time, they will surpass Baby Boomers as the largest generation of Americans eligible to vote.[1] Medicare is often at the forefront of national discourse. However, … Read more

Overview The Annual Coordinated Election Period (ACEP), from October 15 through December 7, 2018, is the time period during which Medicare beneficiaries can enroll in, switch, or disenroll from Medicare Advantage (MA, or Part C) plans and Part D prescription drug plans.  Elections made during this time period will be effective January 1, 2019.  Information … Read more

The Center for Medicare Advocacy recently completed a survey of Jimmo v. Sebelius stakeholders to analyze the effectiveness of the Centers for Medicare & Medicaid Services’ education efforts regarding the Jimmo Settlement, which clarified that Medicare must cover skilled maintenance care in the home health, skilled nursing facility and outpatient therapy settings. Unfortunately, the results … Read more

In order to qualify for Medicare Part A coverage of a post-hospital stay in a skilled nursing facility, the traditional Medicare program requires that the beneficiary first be hospitalized as an inpatient for three consecutive days, not counting the day of discharge.  This requirement has been in place since the Medicare program was enacted more … Read more

In September 2007, The New York Times published a lengthy investigative article about private equity’s purchase of nursing facilities – “At Many Nursing Homes, More Profits, Less Nursing.”[1]  The Times reported that private equity firms purchased facilities and divided ownership into multiple companies, insulating themselves from private litigation and meaningful regulatory enforcement.  Meanwhile, the firms … Read more

Starting this week, consumers may purchase short-term, limited-duration insurance policies that will provide coverage for up to one year.  It is important to remember that these skimpy plans were never intended to be used as long-term comprehensive health insurance. At best, they should be a stopgap for consumers who experience a temporary break in coverage. … Read more

In the weeks leading up to the mid-term elections, the Center for Medicare Advocacy will work to ensure Medicare gains momentum as a top issue for voters and candidates. During an audio news conference announcing the SaveMedicareNow initiative, led by the Center, key experts discussed policy and structural changes that threaten the Medicare program. Presenters … Read more

The Administration is at it again. Last weekend, the Department of Homeland Security released the text of a proposed rule that would create hardships for certain immigrants seeking permanent residency (green cards) in the U.S. This “public charge” proposed rule would also place additional barriers in the way of immigrants seeking to enter the country. … Read more

The Center for Medicare Advocacy is pleased to announce the additions of Julia Evans-Starr and Charles P. Sabatino to our Board of Directors. Julia Evans-Starr, MSW, Senior Fellow at the Center for the Advancement of Well-Being at George Mason University, is a leading authority on issues affecting the growing and diverse population of older adults. Her … Read more

The involuntary transfer and discharge of nursing home residents is the top complaint received by nursing home ombudsman programs nationwide.  In December 2017, the Centers for Medicare & Medicaid Services (CMS) announced an initiative “to examine and mitigate facility-initiated discharges that violate federal regulations.”[1]  While recognizing the seriousness of involuntary transfer and discharge for residents … Read more