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On March 13, 2014, Center for Medicare Advocacy Executive Director and Founder Judith Stein testified before the House Energy & Commerce Committee, Subcommittee on Health, at a hearing entitled "Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans If They Like Them."   That testimony is summarized below. The Center for Medicare Advocacy recognizes … Read more

Although most nursing facilities nationwide do not have sufficient staff to provide necessary care to their residents, an analysis by the Center for Medicare Advocacy (Center) finds that the federal enforcement system cites very few facilities with staffing deficiencies and often does not impose any financial penalties, even when it finds that facilities do not … Read more

This week, President Obama unveiled his Fiscal Year 2015 Budget.[1] With respect to Medicare, it is very similar to last year’s proposed budget, both good and bad. One significant improvement over last year's budget is that it no longer seeks to alter the way the federal government measures inflation for purposes of paying Social Security benefits … Read more

On February 21, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2015 Call Letter to Medicare Advantage (MA) and Part D plan sponsors, which includes a proposed rate for MA payment for 2015.[1]  Much anticipated, the draft Call Letter, which will be finalized in April, was preceded by an aggressive advertising … Read more

 No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will allow Maine to cut back the eligibility standards in the QMB, SLMB, and QI programs  for disabled Mainers, beginning March … Read more

Final rules published in August 2013 by the Centers for Medicare & Medicaid Services (CMS) created time-based rules for determining inpatient status in an acute-care hospital.[1]  Under the rules' two-midnight presumption, a physician should order an inpatient admission if the physician expects that the patient's stay in the acute care hospital will be at least … Read more

On February 18, 2014, CMS’s Financial Services Group announced in an Alert an important change in the reporting threshold for certain liability settlements, judgments awards or other payments required by Section 202 of the Strengthening Medicare and Repaying Tax Payers Act of 2012 (SMART Act). CMS is increasing its current reporting threshold from $300 to $1000. … Read more

More than half a million Medicare beneficiaries rely on the Qualified Individual (QI) program to pay their Part B premium – a critical benefit afforded to older adults and people with disabilities with very low incomes and few assets. Reauthorization for the QI program is attached to the Medicare physician payment formula, known as the … Read more

Programs that help low-income people afford their Medicare, including the Medicare Savings Programs and the Part D Low Income Subsidy (also called LIS or Extra Help) have income and resource eligibility guidelines that change yearly. The Federal poverty level (FPL) guidelines for 2014 were published in the Federal Register on January 22, 2014.[1]  These guidelines … Read more

If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years.  Please read carefully. In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … Read more