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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

CMA Alert – Proposed Payment Rules Will Worsen Home Care Crisis; CMS Clarifies “3-Hour Rule;” Still Time to Register for Next Week’s Summit

Proposed CMS Payment Rules Will Worsen the Home Care Crisis CMS Clarifies 3-Hour “Rule” Should Not Preclude Medicare-Covered Inpatient Rehabilitation Hospital Care Register Now – One Week Left Until the National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture in Washington, DC Proposed CMS Payment Rules Will Worsen the Home Care Crisis This is … Read more

CMA Alert – Center Comments on MA & Part D; Bill to Reduce Medicare Drug Costs; More

Center for Medicare Advocacy Submits Comments to CMS’ Draft 2019 Call Letter for Medicare Advantage and Part D This Week in Healthcare Sabotage: Administration Wants Older People to Pay More Bill to Control Medicare Prescription Drug Costs Introduced  JAMA Calls for Release of Medicare Advantage Data – A Full Review of MA is Long Overdue … Read more

Via Electronic Submission: Regulations.gov March 6, 2018 U.S. Department of Labor 200 Constitution Avenue, NW Washington, DC 20210 RE: Definition of “Employer” under Section 3(5) of ERISA – Association Health Plans (RIN 1210-AB85) The Center for Medicare Advocacy (Center) is pleased to provide comments in response to the proposed rule, Definition of “Employer” under Section … Read more

March 5, 2018 Via Electronic Submission to www.regulations.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Blvd. Baltimore, Maryland 21244 Re: Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies, and 2019 … Read more

CMA Alert – Bill Jeopardizes Civil Rights of People with Disabilities; More

House Passes Bill Jeopardizing Civil Rights of Individuals with Disabilities Medicare Home Health Highlight Latest Nursing Home Rights Issue Alert This Week in Healthcare Sabotage House Passes Bill Jeopardizing Civil Rights of Individuals with Disabilities 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture This year's Summit will focus on health care … Read more

CMA Alert – Therapy Caps Repealed; New Toolkit; Gleason Act Passes. More

Congress Repeals Medicare Outpatient Therapy Caps, Strengthening the Jimmo Settlement Agreement New Toolkit! Medicare Home Health Coverage & Jimmo v. Sebelius Congratulations, Team Gleason, on the Passage of the Steve Gleason Enduring Voices Act Health Care Sabotage Continues Congress Repeals Medicare Outpatient Therapy Caps, Strengthening the Jimmo Settlement Agreement 5th Annual National Voices of Medicare Summit & … Read more

Jimmo v. Sebelius, No. 11-cv-17 (D. VT), is a nationwide class-action lawsuit brought on behalf of Medicare beneficiaries who received care in skilled nursing facilities, home health care, and outpatient therapy and who were denied Medicare coverage on the basis that they were not improving or did not demonstrate a potential for improvement (known as … Read more

Khelan is a seasoned political strategist and campaign director with 18 years of experience in elections, voter education, political intelligence, grassroots organizing, advocacy, congressional and legislative relations, external outreach, coalition building, and legislative analysis. For nearly sixteen years, Khelan has been a part of AARP’s advocacy efforts. Most recently, he worked on the Association’s health … Read more

CMA Alert – Home Health Care Barriers; Overuse of Antipsychotic Drugs; More

Barriers to Home Care Created by CMS Payment, Quality Measurement, and Fraud Investigation Systems Elder Justice Alert: Human Rights Watch Publishes In-Depth Report on Antipsychotic Drug Use in U.S. Nursing Homes Consumer Statement on New Federal Landmark Study on “Critical Incidents” in Assisted Living Barriers to Home Care Created by CMS Payment, Quality Measurement, and … Read more

Kate McEvoy is the Director of the Division of Health Services at the Department of Social Services, and is responsible for administration of medical, behavioral health, pharmacy, dental and transportation benefits for over 785,000 Medicaid and CHIP beneficiaries.  Related, she oversees health policy aspects of Connecticut Medicaid's implementation of the Affordable Care Act, Administrative Services … Read more

CMA Alert – SOTU Address; Therapy Caps; More

State of the Union Speech Touches on Health Care Issues Outpatient Therapy Caps: What Now? Observation Status Update Webinar Now Available Nursing Home Resident’s Rights Newsletter – January Edition Kaiser Family Foundation Issues Report on Medicare Beneficiaries’ Out-of-Pocket Spending Center for Medicare Advocacy Comments on HHS Request for Information State of the Union Speech Touches … Read more

January 25, 2018 Via Electronic Submission: CompetitionRFI@hhs,gov U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation 200 Independence Avenue S.W. Washington, DC 20201 Re: Promoting Healthcare Choice and Competition Across the United States The Center for Medicare Advocacy (Center) is pleased to provide the Office of the Assistant … Read more

CMA Alert – Don’t Forget Medicare Beneficiaries In Spending Debates; Skilled Nursing Facility Updates

Remember People with Medicare in Renewed Spending Bill Debates Skilled Nursing Facility Roundup Medicare Advantage Enrollees Have Fewer SNF Options than Traditional Medicare Beneficiaries CMS to Propose Revising the Nursing Home Requirements of Participation Lawsuit Challenging Chronic SNF Understaffing Settled for $72 Million Remember People with Medicare in Renewed Spending Bill Debates  Don't Miss It! … Read more

Ilene Stein is currently Assistant Legislative Director and formerly the Associate Director of Health Policy for the Service Employees International Union (SEIU),  a union of 2 million workers, including one million workers in the healthcare industry.  At SEIU, she works on a range of issues but primarily focuses on healthcare workforce and policy advocacy. Previously, … Read more

MEDICARE APPEALS Expedited v. Standard Appeals – Not Knowing the Difference Can Cost You Your Appeal Rights Here’s the Issue Expedited Medicare appeals and standard Medicare appeals are designed to address different things and there are situations where a Medicare beneficiary must pursue both types of appeals. Expedited Appeals – Address whether the provider’s termination … Read more

January 16, 2018 Via Electronic Submission to www.regulations.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-4182-P P.O. Box 8013 Baltimore, MD 21244-8013 Re: CMS-4182-P – Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2019 Dear Administrator … Read more

Center Executive Director Judith Stein with the 2017 Sen. Jay Rockefeller Lecturer, Sen. Sherrod Brown of Ohio. Don't Miss It! The Center for Medicare Advocacy’s 5th annual National Voices of Medicare Summit & Senator Jay Rockefeller Lecture will connect leading experts and advocates to discuss best practices, challenges and successes in efforts to improve access … Read more

ARE YOU ENROLLED IN MEDICARE? DID YOU GET A NOTICE FROM DSS SAYING YOU ARE LOSING YOUR MEDICARE SAVINGS PROGRAM BENEFITS (QMB, SLMB, ALMB) IN JANUARY 2018 DUE TO THE BUDGET CUT? ______________ If so, you should know this is happening because of a drastic cut that was included in the state budget that was … Read more

November 27, 2017 Submitted Electronically to www.regulations.gov Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue SW Washington, D.C. 20201 Attn:   CMS-9930-P             NPRM Notice of Benefit and Payment Parameters for 2019 Thank you for the opportunity to comment on the proposed HHS … Read more

November 20, 2017 Via Electronic Submission CMMI_NewDirection@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 Innovation Center New Direction Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for … Read more

November 22, 2017 Division of Nursing Homes Survey and Certification Group Center for Medicare & Medicaid Services 7500 Security Blvd. Baltimore, MD 21244 Re: Revised Policies regarding the Immediate Imposition of Federal Remedies-FOR ACTION (S&C: 18-01-NH) Submitted electronically: dnh_triageteam@cms.hhs.gov. Dear David, Karen, Evan, Lisa, and CMS colleagues,    The Center for Medicare Advocacy (Center) is … Read more

ENROLLMENT IN MEDICARE CMS Steering to Medicare Advantage? The Medicare Annual Coordinated Election Period (ACEP), from October 15th through December 7th, allows Medicare beneficiaries to make certain changes to their Medicare coverage, effective the following January 1st.  Official Center for Medicare & Medicaid Services (CMS) Medicare Open Enrollment materials for 2018 tip the scales to … Read more

Below is a joint statement from Judith Stein, executive director, Center for Medicare Advocacy, and Joe Baker, president, Medicare Rights Center, regarding the Tax Cuts and Jobs Act. As organizations that share a commitment to promoting access to affordable, high-quality health care for older adults, people with disabilities, and their families, we have significant concerns with … Read more

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Sabotage of ACA Must Stop Action Needed The U.S. Department of Health and Human Services (HHS) recently released its draft FY 2018- 2022 Strategic Plan. While one of HHS’ stated objectives is to “Improve American’s access to health care and expand choices of care and service options,” we are instead seeing a systematic effort to … Read more