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The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation and oversight of the DMEPOS program.[1]  Since the rollout of the DMEPOS competitive bidding program (CBP) in July, 2008, there has been confusion over what constitutes delivery and set-up of specific DMEPOS items.[2]  In some instances, beneficiaries have experienced delays in obtaining … Read more

To: Medicare Beneficiary Advocates From: Mario D. Ramsey, CMA Health Policy Fellow Subject: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS.  Beneficiary Advocates Disagree. Date: July 8, 2014 Advocates' Concerns about the DMEPOS Reports Advocates are concerned that some suppliers are not delivering and setting-up necessary items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).[1] … Read more

The Supreme Court decision in Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al. (5-4 decision), 573 U.S. ___ (2014) is ominous. Not only is the decision, and its interpretation of the Religious Freedom Restoration Act (RFFA) a blow to a woman's access to preventive and contraceptive care, its … Read more

Federal law sets out few specific requirements for nurse staffing.  These requirements have not been revised since they were established by the 1987 Nursing Home Reform Law[1] and became effective on October 1, 1990.  Nursing Home Reform Law and Regulations Numbers of staff: The Reform Law requires that facilities employ a registered nurse (RN) for … Read more

The federal Nursing Home Reform law requires nursing facilities to have "sufficient" staff to meet their residents' needs.[1]  Sufficient nursing staff is universally recognized as a key requirement for making high quality of care possible and available for residents.  To determine whether nursing facilities are in compliance with nurse staffing (and other) federal standards of … Read more

June 26, 2014 Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was enacted by Congress as a cost and fraud protection measure.  From its inception, there have been questions about the program's complexity and fairness, and whether it would hinder beneficiary access to necessary DMEPOS items and services.  Background information about … Read more

Connecticut Passes Observation Notice Law On June 12, 2014, Connecticut Governor Dannel P. Malloy signed into law a requirement that, starting October 1, 2014, Connecticut hospitals give oral and written notice to patients placed on observation status for 24 hours or more.  Similar laws already exist in New York and Maryland.  Specifically, Connecticut's law requires: … Read more

Research suggests that medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by Medicare Part D plans. In March, to prevent this from happening, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for … Read more

June 12, 2014 Quality Assessment and Performance Improvement (QAPI) In Nursing Homes: Diverting CMS Attention from Enforcement In the past few years, the Centers for Medicare & Medicaid Services (CMS) has focused considerable attention on Quality Assessment and Performance Improvement (QAPI) in nursing homes.  This focus, we fear, is diverting the agency's resources from enforcing … Read more

Technology can help the most vulnerable among us live with more capabilities than we would have considered possible, even a few short years ago.  Rather than encourage technological advances that promote independence and safety, however, the Centers for Medicare & Medicaid Services (CMS) is reducing access to technology in an ill-conceived effort to control short-term … Read more