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1.  PRESENTATIONS UPDATE ON JIMMO: THE IMPROVEMENT STANDARD CASE In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of … Read more

Review the Center for Medicare Advocacy’s Self-Help packets for Medicare appeals of nursing home, home health and outpatient therapy cases, available on our website at www.medicareadvocacy.org. Note: if you are a Medicare beneficiary or a person representing a Medicare beneficiary requesting an ALJ hearing (a family member, friend, attorney, etc.), the envelope and all correspondence … Read more

The Medicare Advantage Disenrollment Period (MADP) lasts from January 1st through February 14th of each year.  During the MADP, a beneficiary can switch from an MA plan to traditional Medicare. The new MADP also provides an opportunity to enroll in a Part D drug plan for those who have not already done so. When disenrolling … Read more

Two recent cases – one in Georgia and the other in Pennsylvania – enforce nursing home quality of care standards through actions by United States Attorneys.   In neither case had the regulatory agencies cited deficiencies for the significant care problems at the three facilities in question.   In addition, two of the three facilities have high … Read more

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A new study out this month in the Annals of Family Medicine highlights the reality facing many people with health insurance and Medicare and their families: high out-of-pocket costs and cost-sharing.  These costs have a considerable effect on their household budgets and decisions about their care.[1] The study explored the social, medical, financial, and legal … Read more

According to an analysis by the Center for Medicare Advocacy (the Center) few sanctions are imposed for the poor care provided by nursing facilities identified by the Federal Government as among those providing the poorest quality of care and quality of life to residents – Special Focus Facilities (SFFs).  The Center's analysis documents an enforcement … Read more

In the past few weeks, the media spotlight on the country's fiscal issues has led to a flurry of attacks on Medicare.[1] Pundits and some policymakers decry Medicare spending as "the largest driver of the federal debt" and argue that the program on which millions of American families rely is unsustainable and must be radically … Read more

This week, the U.S. House of Representatives voted to approve legislation passed by the Senate to address  the "fiscal cliff"- the concurrent expiration of tax cuts and the beginning of automatic spending cuts (the Sequester) set to take place on January 1st. The deal, also known as the American Taxpayer Relief Act  (the Relief Act)[1], … Read more

Under the Affordable Care Act, states will be eligible for greatly increased federal-match payments beginning in 2014 if they expand their Medicaid programs to cover adults with incomes up to 133% of the Federal Poverty Level (FPL).  In a letter dated December 10, 2012, Secretary of Health and Human Services (HHS) Kathleen Sebelius said that … Read more