CMA Alert – Medicare Home Health Coverage Does Not Require Improvement; AHCA Undermines Medicare

Medicare Coverage for Home Care Is Based On a Need For Skilled Care – Improvement Is Not Required The American Health Care Act undermines Medicare This is Part Three 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 … Read more

This is Part Three 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 Center … Read more

CMA Alert – Budget Response: Abandoning Older Adults and People with Disabilities

Yesterday, May 23rd, the Trump Administration released its proposed FY2018 federal budget.  The budget, entitled “A New Foundation for American Greatness,” would have a wide-ranging and devastating impact on the nation’s safety net programs.  It is not a foundation for a caring society. As noted by the New York Times, it “would cut deeply into … Read more

Legislation would make the Steve Gleason Act of 2015, which increased access to speech generating devices for people with degenerative diseases, permanent. On May 16, 2017, Representatives John Larson (D-CT), Cathy McMorris Rodgers (R-WA), and Senators Bill Cassidy (R-LA) and Amy Klobuchar (D-MN) introduced the Steve Gleason Enduring Voices Act, which builds upon the successes … Read more

A recent Washington Post article, “The Painful Truth About Teeth: You Can Work Full Time But not have the Money to Fix Your Teeth – Visible Reminders of the Divide Between Rich and Poor” outlines the devastating impacts of the lack of adequate oral health care in the country. As Congress considers drastic cuts to … 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 fewer types of therapy to residents over a shorter period of time or no therapy at all – that it … Read more

The American Health Care Act (AHCA), passed by the House by 4 votes on May 4, 2017, has now moved to the Senate for consideration.  Early next week, the Congressional Budget Office (CBO) is expected to issue a report on the most recent amended version of ACHA that passed the House, including whether anticipated impacts … Read more

Medicare Oral Health News: District Court in Lodge Cautions Against Strict Application of Same Time/Same Dentist Rule

Henry Lodge was diagnosed with life-threatening head and neck squamous cell cancer in 1996.  His treatment involved radical dissection of his neck, implantation of radioactive seeds in the base of his tongue, and 30 days of direct beam radiation.  The surgery and the scarring from radiation permanently impaired his ability to speak and swallow, and … Read more

This is Part Two of a Ten-Part CMA Issue Brief Series to examine, and inform work to resolve, the growing crisis in access to Medicare home health coverage and necessary care.  We invite you to follow this Series and provide Medicare home health stories at CMA Issue Brief Series: Medicare Home Health Care Crisis … Read more

Latest Health Care Repeal Tactic? How About $8 Billion?  Act Now!

Facing another failure to repeal the Affordable Care Act, and replace it with a bill that leaves at least 24 million people without coverage, AHCA proponents are desperate enough to throw a lot of money around. They are now trying to reach a last-minute deal to win “moderate” Republican votes by spending an additional $8 … Read more

From the Centers for Medicare & Medicaid Services (CMS): Many minorities experience a disproportionate burden of preventable disease, including diabetes, heart disease, kidney failure, and obesity. Providers should talk to patients about the importance of preventive care and recommend appropriate Medicare-covered preventive services. For More Information: Medicare Preventive Services Educational Tool Mapping Medicare Disparities Tool … Read more

As noted in a previous Alert, the Center for Medicare & Medicaid Services (CMS) recently finalized their 2018 Call Letter.  In the same document, CMS issued a Request for Information regarding ideas for “regulatory, sub-regulatory, policy, practice and procedural changes to better accomplish” the goals of “using transparency, flexibility, program simplification and innovation to transform … Read more

Today the Center for Medicare Advocacy launches a Ten-Part Series to examine and continue work to resolve the growing crisis in access to Medicare home health coverage and necessary care. We invite you to follow this Series and provide Medicare home health stories at Medicare Home Health Crisis Series Overview – The Crisis in … Read more

Last month in Connecticut, United Healthcare (UHC) set off a panic among its Medicare Advantage (MA) enrollees by sending out letters indicating that they would no longer be affiliated with Hartford HealthCare HHC), one of Connecticut’s largest provider networks. These MA enrollees often received multiple letters – one for each of their HHC providers. One … Read more

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2018 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

Tomorrow, March 23, 2017, the 7th anniversary of the Affordable Care Act (ACA), the House of Representatives is scheduled to vote on a bill that would gut the ACA, dramatically cut Medicaid payments to states, and undermine Medicare. If passed in the House, the Senate could vote on the bill as early as next week. … Read more

Facts should be key to participating in the debate about the Affordable Care Act (ACA) and its future. To help separate what is true from what is often stated, we offer the following Myths and Facts. ACA Myths ACA Facts Affordability The ACA makes it too hard for middle-income Americans to purchase insurance in the … Read more

The proposed Affordable Care Act (ACA) repeal legislation, the American Health Care Act, would cause 24 million people to lose coverage by 2026 and cut Medicaid by $880 billion over the next ten years, according to the Congressional Budget Office (CBO), a non-partisan, independent group of budget economists and analysts used to score the financial … Read more

Congress is now considering the AHCA, the Bill to repeal the Affordable Care Act.  The proposed repeal legislation would lead to extreme cuts in Medicaid.  Thus, it is essential to underscore the role Medicaid plays for millions of Medicare beneficiaries. Kaiser Family Foundation recently released a report, Medicaid’s Role for Medicare Beneficiaries, which details the … Read more

March 7, 2017, Washington, DC – Last night House Republicans presented a bill to repeal the Affordable Care Act (ACA) and cut Medicaid payments to states.  While the new bill, “America Health Care Act” (AHCA) lacks either an estimate of how many people will lose their health insurance coverage as a result of the bill … Read more

Beginning no later than March 8, 2017, hospitals are required to give written and oral notice to Medicare patients when they are placed in “outpatient” observation status for 24 hours and are not formally admitted as inpatients.[1] The written notice is called the Medicare Outpatient Observation Notice (MOON).[2] Although hospitals can provide all the care … Read more

Health Savings Accounts (HSAs) Defined Health Savings Accounts (HSAs) are savings accounts that allow consumers to put money aside to pay for certain “qualified health expenses” on a tax-free basis. HSAs are used in tandem with high deductible health plans (HDHPs), which are health insurance plans that require high deductibles to be paid prior to … Read more

Last night, President Trump, in a speech to Congress, discussed health care but offered no new insight into his Administration’s plans concerning the Affordable Care Act, Medicaid and Medicare.  A day after noting that “nobody knew health care could be so complicated”, the President stated "[t]onight, I am also calling on this Congress to repeal … Read more

Many Americans are greatly concerned that repeal of the Affordable Care Act (ACA) will once again leave people with pre-existing conditions without health insurance. The ACA replacement proposal released by Speaker Ryan on February 16 would move coverage from the general ACA marketplace to specific High Risk Insurance Pools. These High Risk Pools would separate … Read more

According to a recent report from Vox, Congressional plans to repeal key provisions of the Affordable Care Act (ACA) will have devastating consequences for thousands of Americans each year. Vox’s Julia Belluz cites evidence to estimate that 24,000 Americans would die annually if Congress repeals vital provisions of the ACA without simultaneously enacting an appropriate … Read more

Beginning no later than March 8, 2017, and as required by the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act),[1] hospitals and critical access hospitals (CAHs) are required to give patients both oral and written notice when they are outpatients and not admitted as inpatients.[2]  Hospitals must use the written notice … Read more

The Administration and the Republican Congress threaten to repeal the Affordable Care Act (ACA), and have suggested various ideas about what a replacement to ACA would include. To better understand these proposals we’ve compiled a list of ACA replacement materials available from colleagues and partnering organizations. Though there is no consensus about what an ACA … Read more

CMS recently finalized significant changes affecting Medicare appeals, particularly at the Administrative Law Judge (ALJ) level of review.  These changes apply to appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as … Read more

On January 24, 2017 the Task Force on America’s Health and Retirement Security, chaired by Marilyn Moon, Ph.D. and led by Principal Investigator Peter Arno, Ph.D., released a new study showing the dramatic negative impact of raising Medicare’s eligibility age to 67 – assessing results on uninsured rates if the ACA stays in place and, what we … Read more

If Medicaid becomes a block grant program, nearly one million nursing home residents who rely on Medicaid could immediately lose coverage for their nursing home care.  In addition, all of the federal standards that govern nursing home care today could be in jeopardy.  The United States does not have a comprehensive program to pay for … Read more

On January 23, 2017, Senators Susan Collins (R- ME) and Bill Cassidy (R- LA) introduced the Patient Freedom Act of 2017 (S. 191) billed as a “comprehensive replacement plan for Obamacare.” [1] According to a summary of the bill outlined on Sen. Collins’ website, it “repeals burdensome federal mandates” but “keeps essential consumer protections.”  The … Read more

“My name is JC and I live [in Speaker Paul Ryan’s Congressional District] in Wisconsin with my husband and two college-aged children.  I would like to tell you why the Affordable Care Act has been key to my husband’s recent success starting up his own business.  My husband had been employed as Vice President of … Read more

Today U.S. Rep. Tom Price (R – Ga.) faced a hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee to determine his qualification to become Secretary of Health and Human Services.  Next week, on January 24th, he will face an additional hearing before the Senate Finance Committee, which will vote on his nomination. … Read more

On January 13, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a State Informational Bulletin encouraging states to adopt strategies to improve dual eligible beneficiaries’ access to Durable Medical Equipment (DME). The Bulletin addresses a serious and persistent obstacle to obtaining DME faced by people dually eligible for Medicare and Medicaid in many states … Read more

“Medicare saved my life. Without this program, I would be dead. I'm not exaggerating; it's no hyperbole when I say Medicare saved my life. I have a life threatening illness and if I had no access to doctors or medicines, I wouldn't be here. A few years ago, I had been prescribed Bactrim, which caused … Read more

Protect our Health Care – Join National Call-In Day Today to #ProtectOurCare! Congress will soon vote on measures that will significantly affect access to health care for tens of millions of people insured through the Affordable Care Act (ACA), Medicare, and Medicaid. A vote that affects one of these programs will affect access to care … Read more

HHS Inspector General: Observation Status is a Growing Problem for Patients In a new report, Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy,[1] the HHS Inspector General documents and confirms what Medicare beneficiaries and their advocates have seen: long outpatient stays in hospitals are increasing. How hospitals bill the Medicare program – Part A for inpatient … Read more

On December 13, 2016, President Obama signed into law the 21st Century Cures Act (Public Law No: 114-255, also known as “Cures”, H.R. 34[1]).  The bill, which passed with overwhelming bipartisan support, addresses a wide range of issues, including medical research, the drug approval process, and, added in the final days leading up to passage, … Read more

1.The Problem The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care. These problems have been escalating in 2016. Care provided often falls short of care that is covered under the law and ordered by … Read more

As we approach a new year, a new Administration and a new session of Congress, the catastrophic risks to health care coverage include threats to repeal the Affordable Care Act – without an agreed-upon replacement, turning Medicaid into a block grant or per capita cap program, and further privatizing Medicare. Several recently-issued/updated reports underscore some … Read more

Effective August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires acute care hospitals to provide oral and written notification to patients who are classified as outpatients or observation status patients for more than 24 hours.  Notice of non-inpatient status must be provided within 36 hours.  On August … Read more

The President-Elect and Republican leaders in Congress have promised to repeal, and at some point, “replace” the Affordable Care Act.  They also plan to gut the Medicaid program by imposing block granting or per-capita caps.  Speaker Ryan, Trump’s nominee for HHS Secretary Rep. Price, and many others in Congress also want to further privatize Medicare … Read more

Center for Medicare Advocacy Executive Director Judith Stein was featured in the New York Times "Room for Debate" this week defending the traditional Medicare program against efforts to privatize and weaken it. Under Speaker Paul Ryan’s plan, individuals would be given a set amount to help pay premiums for insurance on the open market. This … Read more

Medicare is not in crisis. It is on solid financial footing, and, in fact, is stronger than was predicted before the enactment of the Affordable Care Act. Medicare Part A is mostly paid for with payroll taxes which go into a trust fund. Prior to the enactment of the ACA, the Part A trust fund … Read more

The visionaries who designed, launched and supported Medicare to help all American families. The Medicare program for its invaluable contribution to desegregating American hospitals. The Medicare program for helping to keep older Americans out of poverty. The Medicare program, for insuring people with disabilities, who, like older Americans, were left behind by private insurance. The … Read more

Speaker Paul Ryan is already in the news saying that because of “Obamacare” Medicare is “going broke” (Fox News, 11/13/2016). As a consequence, he says, he intends to bring back his plan to privatize Medicare and change it into a voucher system. Under his plan, individuals would be given a set amount to help pay premiums … Read more

Advancing Excellence in America’s Nursing Homes, a voluntary program promoted as an effort to improve quality of care in nursing homes, has ended after a decade.  Unfortunately, the Centers for Medicare & Medicaid Services (CMS) will continue the website (“New name, new logo, same GREAT website!”[1]), which it has funded since 2006, in a new … Read more

Part A Monthly Premium (For those not automatically enrolled) 0-29 qualifying quarters of employment: $413.00 30-39 quarters: $227.00 Inpatient Hospital Deductible, Per Spell of Illness: $1316.00 Co-pay, Days 1 – 60: $0 Co-pay, Days 61 – 90: $329.00/day Co-pay, Lifetime Reserve Days: $658.00/day Skilled Nursing Facility Co-pay, Days 1 – 20: $0 Co-pay, Days 21 – 100: … Read more