As discussed in a recent CMA Alert (Feb. 22, 2024), the Centers for Medicare & Medicaid Services (CMS) has issued proposed Medicare Advantage (MA) and Part D payment rates for 2025, comments to which are due March 1, 2024. MA plans are … [Read more...] about Medicare Advantage Plans Under Scrutiny by Department of Justice and Office of Inspector General
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Know Jimmo | CMS Reminder to MA Plans
In a February 2024 memo, the Centers for Medicare & Medicaid Services reminded Medicare Advantage organizations that the Jimmo Settlement...clarified that the Medicare program covers skilled nursing care and skilled therapy services under … [Read more...] about Know Jimmo | CMS Reminder to MA Plans
Know Jimmo | Skilled Nursing Facility Policy
Medicare Benefit Policy Manual, Chapter 8 – Skilled Nursing Facility ServicesSection 30Coverage of nursing care and/or therapy to perform a maintenance program does not turn on the presence or absence of a patient’s potential for improvement … [Read more...] about Know Jimmo | Skilled Nursing Facility Policy
Medicare Advantage Proposed Payment for 2025 and Other Updates
The Centers for Medicare & Medicaid Services (CMS) has issued proposed Medicare Advantage (MA) and Part D payment rates for 2025. As discussed below, the insurance industry is already trying to pressure the agency to increase their payment in … [Read more...] about Medicare Advantage Proposed Payment for 2025 and Other Updates
CMS Must Strengthen Federal Criteria for Certifying Nursing Homes for Medicare and Medicaid Reimbursement
One of the best predictors of quality is past performance. If an operator provides poor care in its facilities, it is likely to provide poor care in any additional facilities that it may purchase or operate. As a result, one of the most effective … [Read more...] about CMS Must Strengthen Federal Criteria for Certifying Nursing Homes for Medicare and Medicaid Reimbursement
Simplified Access to Medicare Savings Programs
The Centers for Medicare & Medicaid Services (CMS) recently released updated instructions for states on eligibility and enrollment processes for the Medicare Savings Programs (MSPs). The guidance provides states with instructions to implement … [Read more...] about Simplified Access to Medicare Savings Programs
When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
Skilled Nursing Facility (SNF) care can be covered by Medicare if it meets the following criteria:Note: Medicare Advantage plans often do not require a prior hospital stay to qualify for SNF coverage.Note: “Daily” is defined as seven … [Read more...] about When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
The 11th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture
Connect with Your CMA Community!11th Annual National Voices of Medicare Summit& Senator Jay Rockefeller Lecture– Pathways to Change –April 24, 2024In-person at KFF’s Barbara Jordan Conference CenterIn Washington, DC and via Live … [Read more...] about The 11th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture
Know Jimmo | New CMS Implementation Activity!
CMS Joins the Center for Medicare Advocacy to Advance Access to Medicare-Covered Skilled Care to Maintain One’s Condition or Slow DeclineIn 2011, the Center for Medicare Advocacy and Vermont Legal Aid brought the Jimmo v. Sebelius class … [Read more...] about Know Jimmo | New CMS Implementation Activity!
New Report Breaks Down Medicare Beneficiaries by Income & Assets
A KFF issue brief released this week outlines income, assets, and other financial data points of Medicare beneficiaries. The issue brief, “Income and Assets of Medicare Beneficiaries in 2023,” breaks down beneficiary income and assets data down by … [Read more...] about New Report Breaks Down Medicare Beneficiaries by Income & Assets