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Health Care Prominent in Mid-Term Elections – How will the New, Divided Congress React? Center for Medicare Advocacy Comments on Proposed Nursing Home Legislation and Rule Jimmo Implementation: Beneficiary Successfully Appeals Denial of Maintenance Therapy Health Care Prominent in Mid-Term Elections – How will the New, Divided Congress React? As results from this week’s mid-term … Read more

ACA Open Enrollment Begins Choosing Between Traditional Medicare and Medicare Advantage Final Medicare Home Health Payment Rule Threatens Access to Care HHS Publishes Final Rules Providing Annual Inflation-Related Increases for Civil Money Penalties in Its Programs. Better Late than Never? ACA Open Enrollment Begins #SaveMedicareNow The #SaveMedicareNow initiative seeks to educate and raise awareness about … Read more

Campaign Codewords from the National Committee to Preserve Social Security and Medicare Health Care Sabotage: Administration Issues New Guidance Making it Easier to Ignore ACA Rules Medicare Enrollment Reminder: Be Fully Informed Checklist for Medicare Nursing Home “Improvement Standard” Denials Campaign Codewords from the National Committee to Preserve Social Security and Medicare Earlier this week … Read more

2019 Medicare Cost-Sharing Announced Government Watchdog Agency Raises Concerns About Medicare Advantage Denials Home Health Issue Brief #10 – Plans to Address and Resolve the Medicare Home Care Crisis New Checklist for Medicare Home Health Care “Improvement Standard” Denials 2019 Medicare Cost-Sharing Announced #SaveMedicareNow The #SaveMedicareNow initiative seeks to educate and raise awareness about current … Read more

President's Medicare Op-Ed is Untrue Enforcement Weakens as Civil Money Penalties Shift From Per Day to Per Instance Elder Justice: What "No Harm" Really Means for Residents Webinar – Medicare Advantage Education & Enrollment Issues – Register Now President's Medicare Op-Ed Is Untrue #SaveMedicareNow The #SaveMedicareNow initiative seeks to educate and raise awareness about current … Read more

Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement Standard” Education Still Not Working Health Care Sabotage: Expanded “Short-Term, Limited-Duration Insurance” is Here Study: Three-Day Hospital Requirement for Post-Hospital Care In a Skilled Nursing Facility Increases Medicare Costs Who Owns Nursing Facilities and Why? Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement … Read more

Center Launches SaveMedicareNow Initiative Ahead of Mid-Term Elections Public Charge Proposed Rule – A Strike on the Health Care and Well-Being of Immigrants and American Families Center for Medicare Advocacy Welcomes New Board Members Center Launches SaveMedicareNow Initiative Ahead of Mid-Term Elections How has Medicare, Medicaid or the Affordable Care Act (ACA) helped you or your … Read more

Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights Study Finds Link Between Registered Nurse Hours and Antipsychotic Drug Use Webinar: Skilled Nursing Facilities Update Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights The involuntary transfer and discharge of nursing home residents … Read more

More Health Care Sabotage: Inadequate Funding for Navigators Court Ruling May Lead to Even More Overpayments to Medicare Advantage MedPAC Discusses Requiring a Three-Day Hospital Stay for All Post-Acute Care, Threatening Access to Care House Committee Holds Hearing on Nursing Home Quality Issues Proposed DMEPOS Rules: Clarification and Enforcement Needed More Health Care Sabotage: Inadequate … Read more

September 10, 2018 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1691-P Mail Stop C4-26-05 7500 Security Boulevard Baltimore, Maryland  21244-1850 Submitted electronically to: http://www.regulations.gov Re:  CMS-1691-P; Federal Register, Volume 83, No. 139 (July 19, 2018) The Center for Medicare Advocacy (the Center) provides these comments regarding CMS-1691-P and the … Read more

Health Care Sabotage: Association Health Plans Are Here New Jimmo Resources from the Center for Medicare Advocacy and The John A. Hartford Foundation Health Care Sabotage: Association Health Plans Are Here Thanks to a final rule issued by the Administration, Association Health Plans (AHPs) will be available starting this month. Expanding AHPs will make it … Read more

Center Comments on Harmful Proposed Home Health Rule Health Care Sabotage Continues: New Pre-Existing Conditions Legislation Not What It Seems; GAO Critical of HHS ACA Enrollment Actions Re-Review of Some Home Health Denials Now Available Center Comments on Harmful Proposed Home Health Rule The Center for Medicare Advocacy (the Center) submitted comments to the Centers … Read more

August 27, 2018 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1689-P P.O. Box 8013 Baltimore, Maryland  21244-8013 Submitted electronically to: http://www.regulations.gov Re:  CMS-1689-P; Federal Register, Volume 83, No. 134 (July 12, 2018) The Center for Medicare Advocacy (the Center) provides these comments regarding CMS-1689-P and the impact of the … Read more

Home Health Issue Brief – Statistical Trends and Published Articles with Studies and Research from 2002-2017 Final Rules for New Medicare Reimbursement System for Skilled Nursing Facilities: Goodbye Therapy The Center for Medicare Advocacy Submits Comments Opposing Kentucky’s Medicaid Work Requirements Home Health Issue Brief – Statistical Trends and Published Articles with Studies and Research from … Read more

August 18, 2018 Via Electronic Submission: Medicaid.gov U.S. Department of Health and Human Services 200 Independence Avenue S.W. Washington, DC 20201 RE: Comments on the Kentucky HEALTH Medicaid Section 1115 waiver The Center for Medicare Advocacy (Center) is pleased to provide comments during the re-opened comment period for the Kentucky HEALTH Medicaid Section 1115 waiver … Read more

Health Care Sabotage – Slandering a Program Which Has Widely Expanded Access and Coverage Joint Statement with Long Term Care Community Coalition – Medical Loss Ratios for Nursing Homes: Protecting Residents and Public Funds Elder Justice: What "No Harm" Really Means for Residents – Latest Issue Released Health Care Sabotage – Slandering a Program Which Has … Read more

We need your help getting Members of Congress to sign on to letters asking CMS to provide Medicare coverage for medically necessary dental care, as authorized by law. Right now there is an opportunity to encourage your delegation to sign on to these letters. Call (202) 224-3121 to be connected with your Senators and Representative. … Read more

Major Health Care Sabotage: HHS Issues Final Rule on Short-Term Limited-Duration Insurance Inspector General Reports Concerns About Medicare Hospice Care New Checklist for Medicare Nursing Home “Improvement Standard” Denials Nursing Facilities’ “Quality Measures” Do Not Reflect Actual Quality of Care Provided to Residents Major Health Care Sabotage: HHS Issues Final Rule on Short-Term Limited-Duration Insurance Last … Read more

Center for Medicare Advocacy Co-Authors Case Study Journal Article on Nurse Staffing Litigation in Arkansas New Medicare Cards:Wave Four Distribution Begins Center for Medicare Advocacy Co-Authors Case Study Journal Article on Nurse Staffing Litigation in Arkansas How has Medicare, Medicaid or the Affordable Care Act (ACA) helped you or your family?  Your stories about the value of … Read more

July 26, 2018 Dual Eligibles and Access to Part D Drugs: Pretty Good News from the OIG Health Care Sabotage: Poll Shows Voters are Watching Dual Eligibles and Access to Part D Drugs: Pretty Good News from the OIG How has Medicare, Medicaid or the Affordable Care Act (ACA) helped you or your family?  Your stories about … Read more

MEDICARE HOT TOPICS[1] ORAL HEALTH UPDATE On July 19, 2018 the Center issued the following press release: July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Oral Health Update (Wey-Wey Kwok)   Proposed Rule on Durable Medical Equipment  (Kathy Holt) Home Health Update (Kathy Holt) Executive Order re: Administrative Law Judges (ALJs) (David Lipschutz) See Center’s statement at: http://www.medicareadvocacy.org/administrative-law-judges-and-objective-medicare-appeals-jeopardized-by-recent-executive-order/ ACA Sabotage Update (Ben Belton) Litigation Update  (Wey-Wey Kwok) Alexander (formerly Barrows/Bagnall) (Hospital Observation Status) Other Updates General … Read more

Medigap News: Disparities in Enrollment Rights; Bill Introduced to Strengthen Medigap Access and Protections Nursing Home “In-House” Managed Care Plans May Harm Residents Now Can We Call it Sabotage? Helpful News for Some Lower Income Medicare Beneficiaries SNF "No Harm" Newsletter – New Issue Now Available Medigap News: Disparities in Enrollment Rights; Bill Introduced to … Read more

Proposed Home Health Rule Affirms Medicare Coverage and Payment for Patients Who Will Not Improve and May Need More Care than the Norm Administrative Law Judges and Objective Medicare Appeals Jeopardized By Recent Executive Order Studies Differ Regarding Traditional Medicare and Medicare Advantage Health Care Sabotage – Navigators Face another Round of Cuts Proposed Home … Read more

CMS Releases Issue Brief on Access Challenges of DME for Duals Medicare Home Health Rules Proposed by CMS to "Improve Access to Solutions" Will Further Reduce Patient Access to Care Health Care Sabotage: Impact of Sabotage on the Exchanges Free Webinar: Enhancing the Promise of Medicare – Oral Health, Audiology, Vision Benefits CMS Releases Issue … Read more

Center for Medicare Advocacy Discusses Nursing Home Resident Protections with CMS Administrator Seema Verma Did CMS’s Partnership to Improve Dementia Care Reduce the Inappropriate Prescribing of Antipsychotic Drugs for Nursing Home Residents as Much as CMS Claims? Two Recent Studies Say No Health Care Sabotage: Another Attempt at ACA Repeal Free Webinar: Enhancing the Promise … Read more

June 11, 2018 Seema Verma Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard, Baltimore, MD  21244 Via Electronic Mail Dear Administrator Verma:  Thank you for the opportunity to meet with you on June 25, 2018 to discuss the Requirements of Participation (RoPs).  In response to your … Read more

Tipping the Scales Toward Medicare Advantage (at the Expense of Medicare) Does Observation Status Undercut Claims that Hospital Readmissions Have Been Reduced? MedPAC Says No, Research Says Yes. Another Week, More Health Care Sabotage CMS Reverses Obama Policy on Nursing Home Quality Enforcement World Elder Abuse Awareness Day at the UN Tipping the Scales Toward … Read more

Home Health Pre-Claim Review Demonstration Model, Take Two Read the Center's Comments on Proposed Reimbursement for Skilled Nursing Facilities Health Care Sabotage: DOJ Won’t Defend ACA Nursing Home Residents at Risk Clarification on DMEPOS Prior Authorization from June 7, 2018 CMA Alert Home Health Pre-Claim Review Demonstration Model, Take Two How has Medicare, Medicaid or … Read more

June , 2018 Mr. Alex M. Azar. II Secretary, Department of Health and Human Services Seema Verma Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1696-P.  Notice of Proposed Rulemaking with Comment.  Medicare Program; Prospective Payment … Read more

Medicare Trustees Report: Stop Overpaying Private Plans & Underfunding Medicare The Right Way to Lower Medicare Prescription Drug Costs Medicare Prior Authorization Requirement for Power Wheelchairs Expanding Nationwide Effective September 1, 2018 Center for Medicare Advocacy Emphasizes Need to Protect Nursing Home Residents at Congressional Briefing Medicare Trustees Report: Stop Overpaying Private Plans & Underfunding … Read more

Advocates Raise Concerns About Inaccuracies and Bias in Draft MEDICARE & YOU Handbook Center for Medicare Advocacy Submits Comments to CMS about Direct Provider Contracting Proposal More Health Care Sabotage May Be Coming Soon if Short-Term Plans are Allowed Advocates Raise Concerns About Inaccuracies and Bias in Draft MEDICARE & YOU Handbook The Center for … Read more

May 25, 2018 Via Electronic Submission DPC@cms.hhs.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, DC 20201 RE: Request for Information on Direct Provider Contracting Models Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for … Read more

New! Medicare Fact Sheet Buying and Selling Nursing Homes: Who’s Looking Out for the Residents? Health Care Sabotage: Graham-Cassidy Redux? New! Medicare Fact Sheet What is Medicare? Why does it Matter? What challenges does it face? Have easy facts and figures at your fingertips with our new Medicare Fact Sheet.  Produced with support from the … Read more

Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans Home Health Highlight: People Can Leave Home and Still Receive Medicare-Covered Home Care CMS Tries Again: Another New Skilled Nursing Facility Medicare Reimbursement System Proposed – If Implemented, Would Gut Therapy Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans _ Free Webinar Series Next Webinar: … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Recent Policy Changes Relating to Medicare Advantage  (David Lipschutz) New Medicare Advantage “Flexibilities” Impact on Beneficiary Choice/Decision-Making Forthcoming CMA Report Proposed Skilled Nursing Facility (SNF) Rule  (Toby Edelman) Overview of Proposed Rule – Skilled Nursing Facility Prospective Payment System (SNF PPS) (CMS-1696-P) See:  https://www.gpo.gov/fdsys/pkg/FR-2018-05-08/pdf/2018-09015.pdf     Comments due June 26 … Read more

         Welcome and Housekeeping  (David Lipschutz, Moderator)           Federal Update (David Lipschutz) o   Federal Budget & Omnibus Bill          Tipping the Scales Towards Medicare Advantage (David Lipschutz)    Overview    Recent Legislative and Regulatory changes favoring MA    CMS steering during 2017 Annual Coordinated Election Period (ACEP)          Provisions of the Budget Act of 2018 … Read more

RECENT POLICY CHANGES RELATING TO MEDICARE ADVANTAGE The first few months of 2018 have seen a number of changes in law, regulations and sub-regulatory guidance that impact the Medicare program, particularly Part C, known as Medicare Advantage (MA), and Part D, the prescription drug benefit.  The section below highlights some, but not all, of these … Read more

CMA Alert – It IS Sabotage; “Direct Provider Contracting” Raises Concerns; SNF “Corporate Integrity Agreements”

If it Looks Like Health Care Sabotage and it Sounds Like Health Care Sabotage… CMS Issues Request for Information on “Direct Provider Contracting:” Beneficiary Advocates Take Note Corporate Integrity Agreements and Nursing Homes If it Looks Like Health Care Sabotage and it Sounds Like Health Care Sabotage… _ In a recent speech to the World … Read more

CMA Alert – Medicare Home Health Coverage is NOT a Short-Term Benefit; Older Americans Month; More

Medicare Home Health Coverage is Not a Short Term Benefit ‒ Congress Reiterated This in the Balanced Budget Act of 1997 (BBA ’97) Older Americans Month 2018 Center for Medicare Advocacy Submits Comments on New CMS Medicare Marketing Medicare Home Health Coverage is Not a Short Term Benefit ‒ Congress Reiterated This in the Balanced … Read more

Submitted by Center for Medicare Advocacy April 26, 2018 The Center provided the following comments to the Centers for Medicare & Medicaid Services (CMS) in response to an April 12, 2018  Request for Input on the 2019 Medicare Communications and Marketing Guidelines. Section: Other – Miscellaneous Concern about Process.  As a consumer organization seeking to … Read more

CMA Alert – Center Comments on “Junk Plans;” Report Examines Oral Health; Observation Status in the News

The Sabotage of Health Care Continues – Center Comments on "Junk Plans" State of Decay: Report Examines Oral Health for Older Americans NPR Observation Status Story: How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars The Sabotage of Health Care Continues – Center Comments on "Junk Plans" p>This week, the Center working with other … Read more

April 23, 2018 Via Electronic Submission: Regulations.gov U.S. Department of Health and Human Services 200 Independence Avenue S.W. Washington, DC 20201 RE: Comments on Short-Term, Limited-Duration Insurance Proposed Rule (CMS-9924-P) The Center for Medicare Advocacy (Center) is pleased to provide comments on the proposed rule on short-term limited-duration insurance. The Center, founded in 1986, is … Read more

CMA Alert – Choose Medicare Act Offers a Step Forward; Health Care Sabotage Slides Back; More

Choose Medicare Act Introduced – Improving Medicare, Moving Toward Universal Coverage The Sabotage of Health Care Continues – Important News The Center for Medicare Advocacy and Florida Health Justice Project Sue to Obtain “Off-label” Part D Prescription Drug Coverage for Beneficiary Choose Medicare Act Introduced – Improving Medicare, Moving Toward Universal Coverage On April 18, … Read more

CMA Alert – Congress Poised to Vote on Harmful Amendment; Home Health Highlight; SNF Updates

Congress Poised to Vote for Harmful Balanced Budget Amendment Home Health Highlight: New Fact Sheet – Medicare Home Health Coverage In Light of Jimmo v. Sebelius  Nursing Home Roundup: Nurse Staffing in Nursing Homes: CMS Transitions to Payroll-Based Journal Staffing Data on Nursing Home Compare Elder Justice Alert: Republican Congressmen Question CMS’s Oversight of Nursing Homes … Read more

CMA Alert – Jimmo “Improvement Standard” News; Elder Justice Newsletter & More

Jimmo "Improvement Standard" News: ALJ Rules Medicare Covers Outpatient therapy to Maintain Function, Indefinitely if Needed New Fact Sheet: Skilled Nursing Facility Coverage and Jimmo v. Sebelius  Elder Justice Newsletter, March 2018 You Guessed it… More Health Care Sabotage Jimmo "Improvement Standard" News: ALJ Rules Medicare Covers Outpatient therapy to Maintain Function, Indefinitely if Needed … Read more

Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News This Week in Healthcare Sabotage: Double Digit Rate Hikes Expected and Proposed “Conscience” Rules Elder Justice Alert: New York Times Publishes Article on Drug Use Among Older Adults Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News Webinar Rescheduled! Home Health Updates … Read more

March 27, 2018 Via Electronic Submission: Regulations.gov U.S. Department of Health and Human Services Office for Civil Rights Attention: Conscience NPRM, RIN 0945-ZA03 Hubert H. Humphrey Building Room 509F 200 Independence Avenue, S.W. Washington, D.C. 20201 RE: Public Comment in Response to the Proposed Regulation, Protecting Statutory Conscience Rights in Health Care RIN 0945-ZA03 The … Read more

FEDERAL UPDATE Federal Budget & Omnibus Bill On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law.  While the Budget Act included a number of permanent provisions, including those discussed below, it only extended spending on the federal budget through another short-term continuing resolution (CR), which expires March 23rd.  The remainder … Read more