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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 At the center of the lawsuit is the Affordable Care Act’s (ACA) individual mandate penalty, which was repealed by Congress in last year’s tax bill.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 (MShepard@MedicareAdvocacy.org, 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

In their April 2, 2018 letter to CMS Administrator Seema, Republican leaders of the House Energy and Commerce Committee express serious concern about “recent media reports describing horrific instances of abuse, neglect, and patient harm allegedly occurring at SNFs and NFs across the country.”[1]  They focus particular attention on Dr. Jack Michel, an owner of … Read more

In 1997 Congress specifically recognized that Medicare home care was not a short term, acute care benefit and addressed payment methodologies under Parts A and B to meet the costs of longer-term home care. The Balanced Budget Act of 1997, signed into law on August 5, 1997, made some major changes to the Medicare Act.One … Read more

On April 26, 2018, the Center for Medicare Advocacy provided comments to the Centers for Medicare & Medicaid Services (CMS) in response to an April 12, 2018  Request for Input on the 2019 Medicare Communications and Marketing Guidelines (MMG).  Unlike previous opportunities to provide comment, CMS did not offer draft language for revisions to the … Read more

Each May our nation takes time to celebrate the lives and contributions of older Americans. Older Americans belong to the greatest generations who fought wars for our freedom, marched for civil rights, and created a more equitable society for their children and grandchildren. The theme for this year’s Older Americans Month is Engage at Every … Read more

This week, the Center working with other advocacy organizations, submitted comments for the Administration’s proposed rule on Short-Term Limited Duration Insurance. This refers to the “fake insurance” or “junk plans” that we have been highlighting for the last few months. Our Comments come on the heels of the Notice of Benefit and Payment Parameters for … Read more

Oral Health America (OHA) recently published the fourth volume in a series of reports titled A State of Decay, surveying the state of oral health for older Americans.  The first volume in the series focused on the cost of services and financial reimbursement rates as the primary barrier to accessing oral healthcare.  Since then, the … Read more

On April 20, 2018, Alison Kodjak of NPR published the story of trying to navigate her own Mother’s “Outpatient” Observation Status and follow-up care.  After four nights in the hospital, all coded as observation, Alison’s Mother, Catherine Fitzgerald, was discharged, still unable to walk, and in need of follow-up care at a skilled nursing facility, … Read more

On April 18, 2018, Senators Chris Murphy (D-CT) and Jeff Merkley (D-OR) introduced the “Choose Medicare Act.”  The Act would create a new Medicare plan, “Medicare Part E,” which would allow virtually all Americans to choose the traditional Medicare program in addition to now-available private insurance options. Medicare Part E would be available on the … Read more

Last week the United States Department of Health and Human Services issued the Notice of Benefit and Payment Parameters for 2019 final rule. This final rule is another assault on the Affordable Care Act (ACA) and its benefit and coverage protections. The Center for Medicare Advocacy, working with other advocacy partners, submitted comments and signed-on … Read more

On April 6, 2018 the Center for Medicare Advocacy and Florida Health Justice Project filed a lawsuit in U.S. District Court for the Southern District of Florida on behalf of a 49-year-old beneficiary seeking Medicare coverage for his “off-label” (non-FDA-approved) use of a critically needed medication (Dobson v. Azar, 4:18-cv-10038-JLK).  The beneficiary’s Medicare Part D … Read more

Nurse Staffing in Nursing Homes: CMS Transition to Payroll-Based Journal Staffing Data on Nursing Home Compare Will Provide Better Information for the Public Beginning in April 2018, the Centers for Medicare & Medicaid Services (CMS) will begin using Payroll-Based Journal (PBJ) staffing data to determine each facility’s staff rating on Nursing Home Compare. All facilities … Read more

As early as today, the House of Representatives plans to vote on a Balanced Budget Amendment (BBA) to the Constitution that would prohibit federal spending from exceeding federal revenues.  (For a history of such efforts to “make deficits unconstitutional” see, .e.g, this Vox article.)  In a letter to Congress, the Center for Medicare Advocacy joined … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare home health beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” The Fact Sheet emphasizes language from the Jimmo Settlement Agreement, wherein the Centers for Medicare & Medicaid … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare nursing home beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” The Fact Sheet emphasizes language from the Jimmo Settlement Agreement, wherein the Centers for Medicare & Medicaid … Read more

This week CMS released the Final Enrollment Report for the 2018 Health Insurance Exchanges. The report showed that in spite of attempts by the Administration to undermine the Affordable Care Act (ACA) and sabotage our health care system, nearly 11.8 million people “selected or were automatically re-enrolled in an Exchange plan…” Bizarrely, the Administration seems … Read more

A young man who suffered a traumatic brain injury (TBI) following a fall in 2008 was receiving outpatient physical therapy three times a week.  While his therapy was originally covered by his Medicare Advantage (MA) plan, the plan denied further coverage of his therapy, contending that the recovery period for TBI had passed and that … 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 residents. … Read more

On March 22, 2018, the Center for Medicare Advocacy held its fifth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened advocates and leading experts to reflect on challenges and attacks on the Affordable Care Act, Medicaid and Medicare, and to explore … Read more

Jimmo v. Sebelius, No. 11-cv-17 (D. VT), is a nationwide class-action lawsuit brought on behalf of Medicare beneficiaries who received care in skilled nursing facilities, home health care, and outpatient therapy and who were denied Medicare coverage on the basis that they were not improving or did not demonstrate a potential for improvement (known as … Read more

On March 23, 2018, the president signed the fiscal year (FY) 2018 appropriations “Omnibus Bill” into law. The Bill provides funding for services and supports on which older people and people with disabilities rely. Fortunately, many misguided proposals that would have significantly reduced funding for these critical programs were rejected. Older people, people with disabilities … Read more

Politico reported this week that due to (1) Congress not taking measures to stabilize the Affordable Care Act (ACA) Marketplace, (2) the repeal of the individual mandate and the (3) “wild card” Administration proposals to allow short-term plans, insurers are preparing for double-digit rate increases. For months, we’ve been highlighting the harmful impact of expanding … Read more

Revelations have shed light on an opioid crises in the United States that remained largely hidden until recently. These drugs have affected the lives of children and adults nationwide. Unfortunately, the inappropriate use of medication – legally or illegally – is not limited to opioids in its multigenerational reach. As the New York Times reports … Read more

Today marks the eighth anniversary of the Affordable Care Act (ACA), the most significant piece of healthcare legislation since Medicare was enacted in 1965. Like Medicare, the ACA provides security, peace of mind and comprehensive coverage for millions of Americans every day. The ACA has moved us closer to realizing that fair access to quality … Read more

Part C of the Medicare program, also known as Medicare Advantage (MA), is an option available to Medicare beneficiaries who wish to receive their benefits through private insurance companies, primarily HMOs.  In 2017, more than 19 million Medicare beneficiaries (33%) were enrolled in MA plans.  MA enrollment is projected to continue to grow, rising to … Read more

Inpatient rehabilitation hospitals (IRHs, also known as Inpatient Rehab Facilities/IRFs) provide intensive rehabilitation services to patients on an inpatient basis.[1]  Over time, a myth developed – based on a discredited CMS Policy – that patients are appropriate for Medicare-covered IRH care only if they can participate in at least three hours a day of rehabilitative … Read more

This is the eighth 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