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The Center for Medicare Advocacy has heard that some Medicare beneficiaries believe that new federal rules authorize Medicare to pay for their nursing home care if they are inpatients in a hospital for two midnights.  This belief is NOT CORRECT.  New rules published by the Centers for Medicare & Medicaid Services (CMS) in August 2013, … Read more

As policymakers consider proposals to slash successful community programs including Medicare and Medicaid, older Americans and their families continue to face barriers to necessary health care, including access to dental coverage and services. A new report from Oral Health America highlights this growing dental crisis for older Americans. According to the report, lack of affordable … Read more

Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at Survey and Certification deficiency citations for antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives.  First, it analyzes all of the approximately 300 antipsychotic drug deficiencies that were cited by seven states over a two-year period, … Read more

Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives.  First, it analyzes the antipsychotic drug deficiencies that were cited in seven states in calendar years 2010 and 2011 (Part One).  Second, in this Part, it reports … Read more

The misuse of antipsychotic drug is a pervasive problem in American nursing facilities.  Misuse causes physical and psychological harm and death to residents and costs many hundreds of millions of dollars annually,[1] both for the drugs themselves and in efforts to reverse the poor resident outcomes that are the common consequence of their misuse.  Examining … Read more

No. 09-1706 (C.D.Cal.), filed September 8, 2009.  Appeal filed January 28, 2011 (No. 11-55175, 9th Cir.) Issue: Whether the absence of an administrative appeals process for the denial of services by a hospice violates the Medicare statute and the Due Process Clause. Relief Sought: Declaratory and injunctive relief requiring an administrative appeals process. Updated: October 22, … Read more

Beware of Scammers Trying to Sell Marketplace Plans to People with Medicare The Health Insurance Marketplace, created by the Affordable Care Act (ACA), opened for business on October 1, 2013.  Uninsured people can shop for and purchase health insurance on the Marketplace. They can also apply for public programs on the Marketplace like Medicaid and … Read more

During the Annual Coordinated Election Period, which runs from October 15th through December 7th, people with Medicare can change their choice of health coverage (whether they receive that coverage through a private Medicare Advantage plan or traditional Medicare), and add, drop or change Medicare Part D drug coverage. For more information and to get help … Read more

Legislation was introduced on October 4th that could lead to a cap on the home health services available to a Medicare beneficiary.  In the midst of a government shutdown, Representatives Matheson (D-Utah) and Guthrie (R-Kentucky) introduced the "Medicare Home Health Fraud Reduction Act" (H.R. 3245).  This bill would establish maximum annual reimbursements to Medicare home … Read more

For 2014, United Healthcare (UHC) is cutting 2,250 doctors from its Connecticut Medicare Advantage (MA) network. UHC is also closing one of its MA plans in New Haven County that serves 2,900 people and taking similar actions in other states.  Medicare Advantage enrollees who visit a doctor, hospital, specialist, or health center outside of UHC’s … Read more