As part of the annual update to inpatient hospital reimbursement under the Medicare program, the Centers for Medicare & Medicaid Services (CMS) is again considering observation status.  This time CMS is proposing "a time-based presumption of medical necessity for hospital inpatient services based on the beneficiary's length of stay."  78 Fed. Reg. 27486, 47644 … Read more →

Spring is often a time for gatherings with family and friends – weddings, graduations, Mothers’ Day. Nursing home residents often want to participate in these gatherings but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. This is not true. The Medicare Benefit Policy Manual … Read more →

In the midst of ongoing budget discussions, policymakers are considering a wide array of approaches for cutting spending and saving federal dollars. The Center for Medicare Advocacy recently wrote of ways to strengthen the Medicare program while achieving significant savings.[1] Included in our analysis was a proposal that would save taxpayers billions of dollars: reinstating … Read more →

This article is part of a NAELA Journal symposium edition that focuses on "The Future of Elder Law and Special Needs Planning." This article will provide an overview of the policy debate that led to the creation of the Medicare program.  It will identify key cost and quality problems facing the program and review solutions … Read more →

$30,000 – that’s Mrs. Kauffman’s nursing home bill for care she received following a three-day hospitalization. Although she was in the hospital for three full days, Mrs. Kauffman was never admitted as an inpatient. Instead, she was classified as an outpatient on "observation status."  Because Medicare coverage for nursing home care is only available after … Read more →

Recently, a bipartisan group of Senators unveiled a plan to overhaul our nation's immigration system, a key portion of which aims to provide a pathway to citizenship for the 11 million undocumented immigrants living in the United States, including older immigrants. Access to affordable health care is a serious issue for lawfully present and undocumented … Read more →

The role of private managed care in Medicare and Medicaid has been growing at a rapid pace in recent years. The Center for Medicare Advocacy has written widely on the dangers of turning these successful community health care programs over to profit-driven private insurers.  Despite the efforts of the Center and other advocacy groups, however, … Read more →

In its most recent report on nursing home payments and quality, February 2013, the Office of Inspector General (OIG), Department of Health and Human Services (HHS) reports that many skilled nursing facilities (SNFs) failed to provide adequate care planning and discharge planning to residents and provided "egregious" care to some residents, yet were paid by … Read more →

No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will allow Maine to cut back the eligibility standards in the QMB, SLMB, and QI programs  for disabled Mainers, beginning March … Read more →

No. 3:08-CV-1148 (AHN) (D. Conn.), filed July 31, 2008 Issue: Whether the use of a "stability" test to terminate home health coverage on the ground that the patient no longer needs skilled nursing care violates the Medicare statute and regulations. Relief Sought: Declaratory judgment, and temporary and permanent injunctive relief on behalf of an individual … Read more →