On January 29, 2015, a federal judge ruled that Medicare beneficiaries who filed suit about the lengthy and illegal delays in Administrative Law Judge appeals may proceed with the case. The Center for Medicare Advocacy, which represents the plaintiffs, brought the case (Lessler et al. v. Burwell, 3:14-CV-1230, D. Conn.) to help fix a broken … Read more

Civil Money Penalties for nursing facilities have historically been too low to provide meaningful incentive for most facilities to comply with federal standards of care implemented to ensure patient safety and well-being.  The new Civil Money Penalty Analytic Tool from the Centers for Medicare & Medicaid Services (CMS) does not solve this problem. Background Every … Read more

Although inadequate staffing is a claim in many negligence and wrongful death lawsuits against nursing facilities, some litigation addresses insufficient staffing directly as the sole issue.  Two cases are discussed here: the New Mexico Attorney General’s recently-filed lawsuit against the twelfth largest nursing home company in the country, Preferred Care, alleging that the company provided … Read more

At its January 16, 2015 public meeting, the Medicare Payment Advisory Commission (MedPAC), the government agency that advises Congress on Medicare payment policy, addressed observation status as part of its discussion of hospital short stay policy issues.[1]  MedPAC Commissioners preliminarily, but unanimously, voted to move forward on a recommendation to count time in observation status … Read more

Medicare patients considered hospital outpatients on Observation Status may be helped by a decision issued on January 22, 2015 by a federal appeals court.  A three-judge panel of the U.S. Court of Appeals for the Second Circuit decided that Medicare patients who are placed on “Observation Status” in hospitals may have an interest, protected by … Read more

In early 2000, Edward, who was then 60 years old, applied for Social Security Disability.  Despite having suffered from bipolar disorder for nearly 40 years, Edward had earned a PhD, but was not able to hold a job.  While the Social Security Disability was economically important, becoming eligible for Medicare allowed him to access what … Read more

Bios and photos will be added as they are received. Jonathan Blum Jonathan (Jon) Blum is the Executive Vice President for Medical Affairs at CareFirst BlueCross BlueShield, which provides health care coverage in Maryland, the District of Columbia and Northern Virginia.  Jon has responsibility for overseeing CareFirst’s nationally recognized Patient-Centered Medical Home program.  He also … Read more

As part of our recognition of Medicare’s first 50 years, this week begins our Medicare Matters: 50 Insights for Medicare’s 50th Anniversary.  Be part of the CMA Community Truth Squad: help us spread the word – on Twitter, Facebook – in conversations!  The future of a comprehensive Medicare program may depend on it. Insight 2: … Read more

Inadequate nurse staffing is the most significant predictor of poor care in nursing facilities.  Despite the fact that understaffing is a pervasive and nationwide problem,[1] understaffing is rarely cited by state survey agencies.[2]  One reason for the lack of deficiencies and enforcement actions is that the federal standard for nurse staffing is vague.  Aside from … Read more

2015 marks the 50th anniversary of Medicare. Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families. 2015 also ushers in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These … Read more