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Harmful Changes to Lower Limb Prostheses Coverage Too Much Reliance on “Improvement” in the Proposed Home Health Value-Based Purchasing (HHVBP) Model Proposed Revisions to the 2-Midnight Rule Won’t Make Any Significant Change 1. Harmful Changes to Lower Limb Prostheses Coverage The Center recently called for the elimination of a proposed local coverage determination (LCD) that … Read more

August 31, 2015 Stacey Brennan, M.D. DME MAC Medical Director National Government Services 8115 Knue Road Indianapolis, Indiana  46250 Submitted Electronically to: DMAC_DRAFT_LCD_Comments@anthem.com Re: Proposed Draft LCD on Lower Limb Prostheses (DL33787) Dear Dr. Brennan: The Center for Medicare Advocacy (Center) appreciates the opportunity to provide the following comments regarding the proposed draft LCD on … Read more

The Center for Medicare Advocacy is concerned that Medicare beneficiaries are being denied Medicare coverage for skilled services that are specifically listed as covered by Medicare in federal regulations. Medicare covers various skilled therapies (physical, speech–language pathology and occupational) and skilled nursing services, including observation and assessment, management and evaluation of a care plan, or … Read more

A recent Centers for Medicare & Medicaid Services (CMS) report, Access to Care Issues Among Qualified Medicare Beneficiaries (QMB), revealed several access to care problems for low-income Medicare beneficiaries enrolled in the QMB program. The report analyzed two studies focused on access to care for low-income beneficiaries. The first study utilized qualitative interviews with beneficiaries … Read more

Hospitals often classify hospitalized Medicare patients as outpatients, even though their hospital care may be indistinguishable from the care they would receive if they were formally admitted as inpatients.  This issue – called Observation Status – has been a serious problem for Medicare beneficiaries for many years,[1] chiefly because patients who do not have at … Read more

9 Facts About Social Security, a recent blog post by Jason Furman, Chairman of the Council of Economic Advisers, and Jeff Zients, Director of the National Economic Council, identifies nine important accomplishments for our aging society and for persons with disabilities. Social Security forms the foundation for retirement security through universal, guaranteed benefits. Social Security … Read more

This photo of the signing of the Social Security Act was sent to us by a friend of the Center whose father received it, signed, from President Roosevelt’s son. When President Franklin Roosevelt signed the Social Security Act into law on August 14, 1935, older people and their families entered a new era of financial … Read more

The Center for Medicare Advocacy received an e-mail inquiry from an individual requesting assistance advocating for her sister, Mrs. B.  Mrs. B is a Medicare beneficiary enrolled in a Medicare Advantage plan and in need of home health services.  The questions raised demonstrate several important issues that often arise with both the home health benefit … Read more

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter. Cognitive Behavioral Therapy (CBT) as psychotherapy via telemental health is covered by Medicare for certain eligible … Read more

An increasing number of patients in hospitals are not formally admitted as inpatients, but as “outpatients” on “observation status.”  Although they receive whatever medical and nursing care, diagnostic tests, medications, and food they need, their status as “outpatients” means that they do not satisfy the three-day inpatient hospital prerequisite for Medicare coverage of post-acute care … Read more

Over the past week, problems with Medicare coverage of Speech Generating Devices (SGDs) have been favorably addressed through both final Administrative and Congressional action. Prior to these actions, Medicare only covered SGDs to generate face-to-face speech, excluding other forms of communication such as by email, phone or text.  Medicare had also changed the payment category … Read more

As a retired speech/language pathologist I have intimate knowledge of the benefits and need to increase eligibility for services.In my professional capacity, I would often evaluate a dementia or Alzeheimer patient who was experiencing severe difficulty eating and swallowing, which is common as these diseases progress.Many would cough or choke during a meal, thus their … Read more

The 50th anniversary of Medicare has given us an opportunity to reflect on all it has accomplished to advance the health and well-being of families throughout the country. It also reminds us what could have been better – and what could still be improved. We are thankful for the vision and fortitude of President Johnson … Read more

A.P., Washington State I have a pre-existing condition (Epilepsy) and if it wasn't for Medicare, I don't think I could afford the medications needed to control it. __________ L.F., Colorado Medicare has helped me in so many ways! It helped to pay for my pacemaker, plus doctor visits, medicine etc Us older folks that are on … Read more

While the Medicare Act covers physical, speech, and occupational therapies in various community-based and facility settings, coverage is often denied or inappropriately limited.  Most often, this is because the individual requires therapy to maintain her condition, or slow deterioration. When an individual is not going to improve, providers too often decline to provide therapy or … Read more

By T.P., PhD, a Medicare Beneficiary from Ohio I would like to express my view that it would be cheaper and more efficient for all to have drug coverage as part of Medicare itself and not as a separate plan handled by private insurance companies. In addition, if the government can negotiate drug prices for … Read more

By Max Richtman, President & CEO National Committee to Preserve Social Security and Medicare As we celebrate Medicare’s 50th anniversary, it’s important to remember that one of Medicare’s most important hallmarks is the program’s long and successful history of adapting to the changing demographic and health security needs of America’s seniors.  Ten thousand Americans turn … Read more

When a Medicare beneficiary lives in an area that has been declared an emergency or disaster by the President, a Governor, or the Secretary of Health and Human Services, the usual Medicare rules for coverage and related concerns may be changed in order to assist those in need.  Below you will find specific information, if … Read more

Medicare Trustees Report – Medicare Part A Solvency Remains Stable On July 22, 2015, the Medicare and Social Security Trustees issued the 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Good News: In short, the projected solvency of the Part … Read more

By D.C., California Last October I awoke early one morning with a severe pain radiating from my abdomen to my back. I had never had a pain quite like this before. I had recently moved, and my new primary care physician was not available. I had had a gastroenterology evaluation for acid reflux (negative) a … Read more

By Lisa Hall, Appeals Administrator, Center for Medicare Advocacy   After beginning to work for Medicare beneficiaries, I was amazed to realize that Medicare, which is a federal health care insurance that we are all entitled to and count on being there for us one day, spends so much time, money and energy trying to … Read more

By L.S., a Medicare Beneficiary from New York Medicare has kept my family from being homeless. My husband had three different kinds of cancer, with surgery and radiation. He had three necessary replacements – hip and both knees and he had to have back surgery. Medicare took care of all the bills. There is absolutely no … Read more

One of the most fundamental rights set out in the Constitution is the right to due process of law when government action harms an individual. “Due process” means both notice and an opportunity to be heard. In other words, individuals are entitled to be informed about a government action, as well as their right to … Read more

No. 3:15-cv-00390-JBA (D.Conn.), filed March 17, 2015 Issue: Whether extraordinary dental care should be covered because the exclusion for coverage of dental care should be limited to routine dental care. Relief Sought: Reversal of the Secretary’s decision denying coverage to the plaintiff and enjoining the Secretary from relying on a regulation that does not define … Read more

By C.G., California My younger sister who has now passed became very ill at the age of 12 years old with kidney disease. She eventually had both of her kidneys removed, and Medicare was there for the long haul. She also came down with a severe case of Rheumatoid Arthritis, and Lupus. My sister still … Read more

One of Medicare’s key strengths, compared with most other types of health insurance, is that its benefits are “defined.” The Medicare law, regulations and rules set out the minimum scope of benefits that the program must cover and outlines the out-of-pocket costs for which beneficiaries are responsible. For example, as long as certain requirements are met, … Read more

On Tuesday, July 14, 2015, at a news conference on adding Medicare coverage of hearing aids, Rep. Debbie Dingell (D-MI) discussed H.R. 1653, the “Medicare Hearing Aid Coverage Act of 2015,” the first bill she introduced as a member of Congress, which would allow Medicare to provide coverage for hearing aids. She was joined by … Read more

On July 13, 2015, the Centers for Medicare & Medicaid Services (CMS) posted proposed regulations to revise the Requirements of Participation for nursing homes (called Skilled Nursing Facilities under Medicare and Nursing Facilities under Medicaid).  The proposed rules were published in the Federal Register on July 16,[1] with a 60-day comment period.  The public announcement … Read more

July 16, 2015 WASHINGTON, DC – Steve Gleason, former NFL standout athlete for the New Orleans Saints, has redefined what it means to be a hero. Diagnosed with ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease) in 2011, Steve’s mind is unaffected by the disease, but he can no longer move any part of his … Read more

By Jenny Gore Dwyer, Washington State In 2005 my husband was diagnosed with ALS. ALS is also known as Lou Gehrig's disease…or "the Ice Bucket Challenge" disease…remember last August when everyone was dumping ice over their heads? That was for ALS. ALS is a horrible disease where the nerve cells that tell the muscles to … Read more

By V.W., a Medicare Beneficiary from Colorado I am a 77 year old woman. I only used Medicare back in the earlier part of this decade, in 2002 and 2005, when I had accidents that required surgery to repair broken bones. The “out of pocket” costs for those surgeries were in the $10,000+ range each. Thanks … Read more

Once a decade, the White House convenes experts, seniors, legislators and advocates to examine issue facing older Americans and plan for the future. This year’s White House Conference on Aging was held on Monday, July 13, 2015.  The Center’s Executive Director, Judith Stein was honored to attend. The day focused on the power of our … Read more

By an Anonymous Beneficiary from Iowa   In the last year I lost both of my parents.  They were 92 and 94 years old when they passed away.  They had been married for 69 years and died within less than 10 months of each other. In the last decade of their lives, due to their … Read more

Many healthcare institutions are required to provide discharge planning for their Medicare patients as part of their “Conditions of Participation” in the Medicare program.  Under the Medicare program, discharge planning services are required for hospital inpatients, long-term care hospital and rehabilitation inpatients, skilled nursing facility residents, patients in swing-beds, and hospice patients.  Discharge planning services … Read more

In the annual update to Medicare reimbursement of acute care hospitals for outpatient care (July 8, 2015)[1] the Centers for Medicare & Medicaid Services (CMS) includes proposed revisions to the “Two-Midnight Rule” and its enforcement. If the proposed changes lead to an increased number of patients being formally admitted as inpatients (rather than, as now, … Read more

Effective July 1, 2015, Virginia has become the fifth state to enact legislation requiring hospitals to inform patients when they are in Observation or other outpatient status, and the consequences of not being admitted as inpatients.  Senate Bill 750[1] requires hospitals to provide oral and written notice to patients who are receiving “onsite services” (including … Read more

Former residents at 12 nursing facilities owned by Golden Living in Arkansas (or their special administrators, guardians, or attorneys-in-fact) filed a lawsuit challenging the facilities’ chronic understaffing between December 2006 and July 1, 2009.  Plaintiffs moved for class certification on three claims – breach of the facilities’ standard admission agreement, violation of the Arkansas Long-Term … Read more

By P. B., a Medicare Beneficiary from Colorado I would not have been able to have a career, care for others at work, care for my mother after my career or be able to NOT be a dependent at retirement time. All this is because of a prescription that is allowed because I have Medicare. I … Read more

Most people think Medicare is a government program. That’s only partly true. While Congress created Medicare, and continues to develop Medicare coverage and appeal rules, decisions to pay claims are actually made by private companies. The government does not make those decisions. This was one of the compromises made in order to pass Medicare in … Read more

By Marilyn Moon, Institute Fellow, American Institutes for Research (Center for Medicare Advocacy Luminary) Medicare is a successful program that is extremely popular with its beneficiaries who rank it higher than others do their private insurance plans.  And polls always show that people are willing to pay more for Medicare.  So why do politicians persist in … Read more

By Mary Ashkar, Senior Attorney, Center for Medicare Advocacy Prior to becoming eligible for Medicare, many Americans who have health insurance through employment are enrolled in some type of managed care plan. Health Maintenance Organizations (HMOs) are one of the most common types of managed care plans.  Generally, individuals enrolled in HMOs are restricted to … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries With support from the John A. Hartford Foundation the Center for Medicare Advocacy has created a multi-disciplinary Jimmo Implementation Council. The Center convened the first meeting of the Council on June 23, 2015 at the US Capitol in Washington, DC.[1] The … Read more

Medicare has helped my husband to go to the hospital, Dr. Visits, Prescriptions. It has given my husband a fighting chance to LIVE. Thank God for Medicare.    By L.W., the Spouse of a Medicare Beneficiary from Florida

Our country has a patchwork of different types of health insurance coverage, including individual insurance policies, employer-based insurance coverage plans available through the new Affordable Care Act, Medicaid, and Medicare – the country’s flagship insurance program. While some people go without health insurance altogether, others have different types of coverage over the course of their … Read more

"If it were not for Medicare I could not possibly afford the health care that I get." – R.B, A Medicare Beneficiary from New Mexico

Medicare is not just an acute care benefit.  It covers skilled maintenance nursing and therapy; in some cases it covers long-term home care. Also, importantly, Medicare covers many preventive services, which, when utilized, can help limit the need for more costly future care. Most Medicare beneficiaries know about the "Welcome to Medicare" physical, but Medicare covers … Read more

1. Comments to Senate Finance Committee Chronic Care Workgroup On June 22, 2015, the Center for Medicare Advocacy submitted comments to the Senate Finance Committee Chronic Care Workgroup in response to the Committee’s May 22, 2015 request for comments on reforming care for individuals with chronic conditions. The Committee identified three overarching goals to guide … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has created a council of beneficiary advocates, providers, policy-makers and other partners to discuss, analyze and advance the implementation of the Jimmo v. Sebelius "Improvement Standard" Settlement. The Center convened the first meeting of the multi-disciplinary Council on June 23, 2015 at … Read more

By Howard Back, a Medicare Beneficiary from California Medicare funding for hospice services is a wonderful thing. But there is a missing element in the system: there is no timely way a hospice patient can appeal failure of a hospice to provide a drug, or piece of equipment or other service that the patient’s physician … Read more

By LGBT Aging Advocacy (Connecticut) and CT TransAdvocacy Coalition A substantial number of physicians serving Medicare participants do not know the sexual orientation or gender identification of the LGBT elders they care for, although this can be a critical factor for their patients’ health and health care. This is particularly important to keep in mind as the current … Read more