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Since the Balanced Budget Act of 1997, outpatient therapy under Medicare Part B has been subject to dollar limits, or caps.[1]  During most of these 20 years, an “exceptions” process has allowed beneficiaries and providers to seek coverage above the caps.  The exceptions process expired December 31, 2017.  Although legislation to repeal the therapy caps … 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, how prevalent "no harm" deficiencies are, … Read more

The Kaiser Family Foundation (KFF) just released a report entitled “Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future” (January 2018).  As noted in the report, “[w]ith half of all Medicare beneficiaries living on annual per capita income of less than $26,200, out-of-pocket health care costs can … Read more

In anticipation of last night’s State of the Union address, the Center issued a guide entitled “How to Listen to Tonight’s State of the Union Address” that included some suggestions for how to listen to, and translate, key statements related to health care that may be in the speech.  Sometimes policymakers, including presidents, speak in … Read more

How to Listen to Tonight’s State of the Union Address 

Sometimes policymakers, including presidents, speak in code – they say one thing, but mean something else. Here are some suggestions for how to listen to, and translate, key statements related to health care that may be in the State of the Union Address.  For example, if you hear the following phrases, consider the following translations: … Read more

A lawsuit by former residents at 12 Arkansas nursing facilities owned by Golden Living alleged that the facilities were chronically understaffed between December 2006 and July 2009, in violation of the facilities’ admission agreement, the Arkansas Long-Term Care Residents’ Rights Act, and the Arkansas Deceptive Trade Practices Act.[1]  The case was settled in 2017 for … Read more

In October 2017, CMS announced its new “Patients over Paperwork” initiative.[1] The objective of the initiative is to adhere to the Trump Administration’s Executive Order (EO 13771), which tasked agencies with cutting regulations.[2] Specifically, the purported intent of the initiative is to put patients first by reducing the so-called “burdens” on the health care industry. … Read more

“Medicare Advantage Enrollees More Likely to Enter Lower-Quality Nursing Homes Compared to Fee-For-Service Enrollees,” a report recently published by Health Affairs, examines the quality of skilled nursing facilities (SNFs) used by Medicare Advantage (MA) enrollees and traditional Medicare beneficiaries. As the title indicates, the authors of the report found that traditional Medicare beneficiaries “tended to … Read more

Following the reopening of the federal government on January 23, 2018, the Center for Medicare Advocacy and the Medicare Rights Center issued a joint statement highlighting how Congress has so far failed to address several issues critical to people with Medicare. Specifically, our organizations urged lawmakers to act on the harmful Medicare outpatient therapy caps, … Read more

Health Care Sabotage Continues

Throughout 2017 we called on the Administration to stop undermining the Affordable Care Act (ACA) and protect the care of millions of consumers in need of quality coverage. We highlighted the Administration’s actions cutting the ACA enrollment period in half; slashing funding for enrollment assistance, refusing to participate in enrollment events; shutting down www.healthcare.gov during … Read more

Reminder: Objections to Home Health Appeals Settlement Due February 5, 2018

As previously announced, the Center has reached a tentative agreement with CMS in Sherman v. Hargan. The Sherman case challenged the quality of lower-level Medicare home health appeals.  The settlement was preliminarily approved, and any objections from class members must be received by February 5, 2018.  A fairness hearing on the settlement will be held in New Haven, … Read more

Medicare Home Health Access Problems Continue

As we have reported, the Center for Medicare Advocacy has been hearing from people unable to access Medicare-covered home health care, or the appropriate amount of care, despite meeting Medicare coverage criteria.  In particular, people living with long-term and debilitating conditions find themselves facing significant access problems. In a January 17 NPR article, Susan Jaffe … Read more

Center for Medicare Advocacy Submits Comments to Proposed Rule re: Medicare Advantage and Part D

On November 28, 2017, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule entitled Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program  (82 FR 56336). On January 16, 2018, Center attorneys submitted comments to … Read more

Josephine Kalipeni is the Director of Policy and Partnerships at Caring Across Generations. Ms. Kalipeni’s expertise includes asset-based grassroots and faith organizing, public speaking, and policy development for issues-based campaigns in health, education, and international affairs, with a focus on racial and economic equity. She initially worked in family case management and social work, assisting … Read more

Remembering Martin Luther King in 2018

On Monday, January 15, we will pause to reflect on the incredible legacy of Dr. Martin Luther King Jr. In a time such as ours, when faith in institutions is shaken, new generations feel the sting of bigotry and common decency often seems passé, Dr. King’s dream has never been more relevant. Dr. King had … Read more

2018 CT Medicare Savings Programs

If you have Medicare, Social Security deducts money from your check each month to pay for your Medicare Part B premium.  If you qualify for one of Connecticut’s three Medicare Savings Programs (MSP), the State of Connecticut will pay this monthly Part B premium on your behalf.  Your Social Security check will then increase each month. In … Read more

New LTCCC Issue Alert: Nursing Home Staffing Requirements

The Long Term Care Community Coalition (LTCCC), in partnership with the Center for Medicare Advocacy, publishes monthly issue alerts on the rights of nursing home residents. These issue alerts focus on specific standards of care that nursing homes must follow as a requirement of participating in Medicare and Medicaid. The goal of this project is … Read more

CMA Alert – Home Health News; More SNF Enforcement News

Beneficiary Protections Expanded in Revised Home Health Conditions of Participation Nursing Home Residents Are At Risk Elder Justice: What “No Harm” Really Means for Residents, December Issue Available Now Beneficiary Protections Expanded in Revised Home Health Conditions of Participation Don't Miss It! 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture This … Read more

Beneficiary Protections Expanded in Revised Home Health Conditions of Participation

This is Part Six 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

Are Nursing Home Residents at Risk? New York Times and Los Angeles Times Report on SNF Deregulation Special Issue Alert: Enforcement in Kansas Are Nursing Home Residents at Risk? The New York Times and Los Angeles Times Report on SNF Deregulation Don't Miss It! 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller … Read more

CMA Alert – Tax Cuts will Hurt, Not Help; Sherman Fairness Hearing Set; “Homebound” Settlement Objections Due; More

Words Matter. Tax Cuts Will Hurt, Not Help America Final Week in Health Care Sabotage – 2017 ACA Open Enrollment Over in Most States Social Isolation Among Older Medicare Beneficiaries Reminder: Objections to "Homebound" Settlement Due December 28, 2017 Settlement on Lower-Level Home Health Appeals Preliminarily Approved – Fairness Hearing Set for February 26, 2018 … Read more

CMA Alert – SNF Enforcement Halted; Know Your Medicare Appeals; Ultimate Health Care Sabotage; More

This Week In Health Care Sabotage New Fact Sheet – Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights CMS Halts Enforcement, as Requested by the Nursing Home Industry This Week In Health Care Sabotage Medicare Enrollment Periods Medicare Open Enrollment Ends Tomorrow, December 7. There is only one day left … Read more

In October of 2016, the Obama Administration issued a Final Rule regarding the Requirements of Participation (RoP) for nursing homes. The Final Rule was issued, in part, because the regulations had “not been comprehensively reviewed and updated since 1991.”[1] Under the Final Rule, the revisions to the RoP were to be implemented over three phases: … Read more

The Plan: Pass a Devastating Tax Bill, Balloon the Deficit, then Gut the Social Programs We Rely On Jimmo Update: Court Orders CMS to Modify Special Jimmo Webpage ACA and Medicare Enrollment Periods End Soon Changes to Notice of Qualified Medicare Beneficiary (QMB) Status The Plan: Pass a Devastating Tax Bill, Balloon the Deficit, then … Read more

Reports indicate that state surveyors cite nursing home deficiencies at a “no harm” scope and severity level 95 percent of the time. Unfortunately, this has a profound impact on a nursing home resident’s quality of care and quality of life. CMS data provide clear evidence that residents are actually being harmed by such deficiencies, despite the … Read more

Help Stop the Devastating Tax Bills. Call Congress Now!

When most of the country was asleep this Saturday, the Senate passed its version of a so-called tax “reform” bill. The senate bill undermines the Affordable Care Act and provides massive tax cuts for large corporations and wealthy people. It would explode the federal deficit, setting the stage for an immediate Medicare cut and future … Read more

Nursing Home Enforcement: Center Submits Comments on CMS’s Draft Guidance Regarding the Immediate Imposition of Remedies Comments Submitted on Center for Medicare and Medicaid Innovation (CMMI) Center Submits Comments on HHS Notice of Benefit and Payment Parameters for 2019 Nursing Home Enforcement: Center Submits Comments on CMS’s Draft Guidance Regarding the Immediate Imposition of Remedies … Read more

Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay 2018 Medicare Cost Sharing REMINDER: Medicare Enrollment Continues through December 7th Tax Bill Facing Vote in the Senate Next Week – Time to Talk Turkey! Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay Late November begins a time for … Read more

November 21, 2017 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends … Read more

As families around the country prepare to gather with loved ones for the Thanksgiving holiday, the House passed a tax bill that would threaten the health and economic security of many low-income and middle-class families. This Thanksgiving, talk turkey about taxes! It’s not too late to protect our health care and our families. Here's what … Read more

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident Protections Tax Cut Bill Just Got Worse.  Health Care at Risk. Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 … Read more

  FOR IMMEDIATE RELEASE November 15, 2017 Contact: Center for Medicare Advocacy – Matt Shepard: 860-456-7790, mshepard@MedicareAdvocacy.org Medicare Rights Center – Mitchell Clark: 212-204-6286, mclark@medicarerights.org Tax Cut Bill Just Got Worse.  Health Care at Risk. As the House and Senate rush to make changes to their versions of the bill, it keeps getting worse and worse, … Read more

Alert – Spotlight on Medicare Home Health Care; Tax Cuts Set Stage for Medicare/Medicaid Cuts; ACA News

Medicare Home Health Coverage is Not a Short-Term, Acute Care Benefit ─ Congress Acted in 1980 to Provide for Longer-Term Coverage Final Home Health Rules and Interpretive Guidance: Proposed Payment Model Rescinded Advocates Oppose House Tax Cuts Bill that Would Set the Stage for Deep Cuts to Medicare & Other Programs This Week in Sabotage … Read more

CMA Alert – It’s Enrollment Season; CMS Reissues HH Booklet; “Homebound” Case Settlement; More

It's Health Care Enrollment Season NEW! CMS Again Reissues Improved Medicare Home Health Booklet THIS Week In ACA Sabotage… Happy Anniversary SSI Medicare "Homebound" Class Action Settled – Fairness Hearing Set for January 11, 2018 It's Health Care Enrollment Season Free Webinar Series Next Webinar: Social Security Disability Insurance (SSDI) Part 2 – Overview of Benefits for … Read more

Federal Judge Fails to Protect Affordable Care Act Subsidies

October 26, 2017 – At least for now, a federal court failed to protect the Affordable Care Act subsidies ended by the president’s executive order.   The Judge denied a request from 18 states and Washington, DC to stop the administration from scrapping the cost-sharing reduction subsidies that are paid to insurance companies to help … Read more

CMA Alert – Remember You CAN Choose Original Medicare; Equitable Relief; This Week’s Sabotage News

You Can Choose Original Medicare: CMS Over-Emphasizes Private Medicare Advantage Plans in Open Enrollment Roll-Out CMS Extends Equitable Relief  CMA Joins 30 Organizations in Amicus Brief in Support of Court Challenge to Trump ACA Sabotage And THIS Week in ACA Sabotage… Auto-Enrollment… And No Time to Switch More Repeal Disguised as Reform You Can Choose Original … Read more

CMA Alert, October 18, 2017 – Nursing Home Rights Roundup; ACA Stabilization; More

This Week in ACA Sabotage Bipartisan Agreement on ACA Stabilization Package Nursing Home Rights Roundup CMS Signals End of Campaign to Reduce Unnecessary Use of Antipsychotic Drugs In Nursing Homes; Claim of Success is Grossly Overstated OIG Report about Nursing Home Complaints Leaves Questions Unanswered Congressional Letter Asks for Revision and Delay of Nursing Home … Read more

CMA Alert – Open Enrollment Tips; ACA Sabotage; More

Medicare Annual Enrollment Period Begins October 15: Look Before You Leap This Week in ACA Sabotage  Breast Cancer Awareness Month International Day of Older Persons Medicare Annual Enrollment Period Begins October 15: Look Before You Leap Free Webinar Series Next Webinar: Social Security Disability Insurance (SSDI) Part 1 – History/Myths/Who is Served October 18, 2017 … Read more

CMA Alert – Changes to Help QMBs; Home Health Updates; ACA Sabotage

CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed CMS Reissues Improved Medicare Home Health Booklet Dispelling a Myth: Medicare Home Health Coverage is NOT a Short Term, Post-Acute Care Benefit The ACA Sabotage Continues CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed The Centers for Medicare and … Read more

Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries We Called It: Continued Sabotage of the ACA “Equitable Relief” Ends this Week – Sign Up for Medicare Part B Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries In July, CMS proposed new payment, case-mix adjustment and quality reporting rules that will make it harder … Read more

World Alzheimer’s Day 2017 – September 21

The Center for Medicare Advocacy joins Alzheimer’s organizations, caregivers, people with Alzheimer’s and their families, on World Alzheimer’s Day, to raise awareness about this devastating disease. Alzheimer’s is the most common form of dementia.  It devastates families and communities, and is one of the costliest chronic conditions to manage. According to the Alzheimer’s Association, there … Read more

Despite an enormous public outcry that eventually doomed this summer’s attempt at repealing the Affordable Care Act and decimating Medicaid, legislators seem to be lining up behind yet another bad bill. In fact, the Graham-Cassidy bill is even worse than earlier rejected bills. The Graham Cassidy bill[1]: Permits states to waive rules on premium ratings … Read more

The U.S. Senate Special Committee on Aging held a hearing on "Disaster Preparedness and Response: The Special Needs of Older Americans" today. The hearing came on the heels of Hurricanes Harvey and Irma, which resulted in the deaths of at least nine nursing home residents in Florida. Chairman Collins began the hearing by acknowledging the … Read more

URGENT:  ACA Repeal Effort Renewed Through Graham-Cassidy Bill. This is Not a Drill – Action Needed!

Just when we thought Congress was moving on from failed efforts to “repeal and replace” the Affordable Care Act (ACA), momentum is quietly building to try again, through yet another legislative effort – the Graham-Cassidy bill.  We need to stop this bill in its tracks. While some Senators are engaging in positive, bipartisan talks to … Read more

Today the United States Senate is a study in contrasts: on the same day that one Senator introduces a bill seeking universal health insurance coverage, another pair of Senators introduce yet another bill to gut the Affordable Care Act and roll back insurance coverage for millions. At one end of the spectrum, Senator Bernie Sanders … Read more

Abbey, Duane. “Inpatient Versus Outpatient: The Real Issue.” RAC Monitor. 06 March 2014. http://www.racmonitor.com/rac-enews/1618-inpatient-versus-outpatient-the-real-issue.html (site visited September 21, 2016). The author writes that there aren’t any well-established guidelines for Recovery Audit Contractors (RACs) when they review observation-related Medicare appeals. When there are disagreements, RACs can be directed to specific criteria. Unfortunately, Medicare RACs lack such … Read more

CMA Alert – Congress Returns, Still Threatening Health Care; ACA Sabotage; More

Congress is Back – And Health Care Remains Under Threat Administration Continues Sabotage of ACA Center for Medicare Advocacy Welcomes Dara Valanejad Congress is Back – And Health Care Remains Under Threat As Congress returns from the August recess, members face a full agenda of issues they must tackle ranging from the federal budget, to … Read more

CMA Alert –  OIG Warns of Abuse in SNFs; Ted Kennedy, Jr. Joins CMA Advisory Board; “Jimmo” Corrective Action Plan

HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Connecticut State Senator Ted Kennedy, Jr. Joins Center for Medicare Advocacy Advisory Board Jimmo Corrective Action Plan Completed HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Last week, the HHS Office of Inspector General (OIG) issued an Early Alert, warning of … Read more

CMA Alert – Joint Replacement Model Undermines Care;  OTC Hearing Aids Legislation Passed; More

Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point Over-the-Counter (OTC) Hearing Aid Act Signed into Law Severe Harm if ACA Cost-Sharing Payments End Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point On a Friday this past March, “Ms. T”, … Read more

CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More

Former CMS Administrator Comments on Medicare Advantage Overpayments Proposed Home Health Rules – Payments Drive Delivery of Care, Harming Beneficiaries Observation Status Harms Low-Income Medicare Beneficiaries Poll: Americans Favor Making the ACA Work Former CMS Administrator Comments on Medicare Advantage Overpayments In Austin Frakt’s August 7, 2017 The Upshot blog in the New York Times … Read more