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WHAT IS NEEDED TO QUALIFY FOR  MEDICARE HOME HEALTH COVERAGE? The patient must be homebound. (This does not mean the patient can never leave home. For example, patients can leave home occasionally, go to adult day care, religious services, medical appointments, special occasions); The patient must require skilled nursing on an intermittent basis (from once … Read more

¿QUÉ SE NECESITA PARA CALIFICAR PARA COBERTURA DE SALUD DOMICILIARIA DE MEDICARE? El paciente debe ser confinado. (Esto no significa que el paciente nunca puede salir de su hogar. Por ejemplo, los pacientes pueden salir del hogar ocasionalmente, ir a la guardería para adultos, servicios religiosos, citas médicas, ocasiones especiales); El paciente debe requerir enfermería … Read more

As part of a project supported by the Ossen Family Foundation, Center for Medicare Advocacy staff recently called the 16 home health agencies that, according to Medicare’s Home Health Compare tool, serve the two counties near our CT office. Home health agencies were asked about their ability to provide care to a beneficiary with a chronic … Read more

Mrs. R contacted the Center for Medicare Advocacy about her husband, who has ALS, and was told his home health physical therapy was about to be terminated. While receiving physical therapy, Mr. R had reduced pain, allowing him to decrease pain medications, improved bowel function, and increased ability to clear airway secretions. Nonetheless, home health agency … Read more

For years the Center for Medicare Advocacy and other stakeholders have advocated for Medicare coverage for home health aides without the current prerequisites that the individual be homebound and require skilled nursing or therapy. Unfortunately, the ability to get Medicare-covered home health aide care has greatly declined in recent years, even when individuals meet the … Read more

Since 2017 the Center for Medicare Advocacy has been writing and disseminating a ten-part Home Health Issue Brief Series examining the growing crisis in access to Medicare-covered home health care, and outlining the Center’s work to address the issue. This Home Health Issue Brief includes all ten prior Briefs in one document. We hope this … Read more

This is Part Ten of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for home health care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for home health care and emphasizes language from the … Read more

The Center for Medicare Advocacy (the Center) submitted comments to the Centers for Medicare and Medicaid Services (CMS) about the devastating impact a proposed rule will have on access to Medicare home health care for vulnerable older and disabled people. The proposed rule purports “to better align payment with patient care needs and better ensure … Read more

In January, Vermont Legal Aid and the Center for Medicare Advocacy settled a case on behalf of Medicare beneficiaries in the six New England states and New York who had had been denied coverage of home health services for not being “homebound.” The settlement in Ryan v. Price, 5:14-cv-269 (D. Vt.), calls for re-review of … Read more

This is part nine of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

In the proposed rule, published in the Federal Register on July 12, 2018[1], CMS confirms that a patient’s condition does not need to improve for home health care to be covered by Medicare. CMS also acknowledges the following: There have been reports of difficulty accessing coverable home health care, especially when the patient’s condition is … Read more

The announcement on July 2, 2018, that CMS seeks to “modernize” Medicare home health care is filled with patient-oriented rhetoric, but will actually further gut the Medicare home health benefit – which is already being implemented in a way that doesn't work for many patients who are most in need. New payment policies, such as … Read more

In April 2017, the Centers for Medicare and Medicaid Services (CMS) abandoned a multi-state Medicare Pre-Claim Review Demonstration Model that had so many flaws it never made it out of the initial implementation state, Illinois. The latest proposed model promises to improve on the past model and boasts of greater flexibility and choice for providers … Read more

The Center for Medicare Advocacy hears from Medicare beneficiaries throughout the country who are living with serious illnesses and injuries without the home care they need – and that should be covered by Medicare. There are many reasons for these access problems. Patients are told they don’t meet the qualifying criteria because they aren’t “homebound,” … Read more

In 1997 Congress specifically recognized that Medicare home care was not a short term, acute care benefit and addressed payment methodologies under Parts A and B to meet the costs of longer-term home care. The Balanced Budget Act of 1997, signed into law on August 5, 1997, made some major changes to the Medicare Act.One … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare home health beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” The Fact Sheet emphasizes language from the Jimmo Settlement Agreement, wherein the Centers for Medicare & Medicaid … Read more

This is the eighth of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

Home health access problems have ebbed and flowed over the years, depending on the reigning payment mechanisms, systemic pressures, and misinformation about Medicare home health coverage.  Regrettably, as we’ve been reporting, access issues are on the upswing.  This is the second of several Practice Tips to help maximize Medicare-covered home care under the law. Family … Read more

Home health access problems have ebbed and flowed over the years, depending on the reigning payment mechanisms, systemic pressures, and misinformation about Medicare home health coverage.  Regrettably, as we’ve been reporting, it seems access issue are on the upswing.  Here is the first of several Practice Tips to help maximize Medicare-covered home care under the … Read more

Toolkit: Medicare Home Health Coverage & <i>Jimmo v. Sebelius</i>

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

____ Team Gleason and the Center for Medicare Advocacy are pleased to announce a new initiative to help people living with ALS understand the Medicare home health benefit and maximize access to coverage and care. The Home Health Initiative will provide the following: 1.  Three Educational Webinars:  Webinar #1: An Overview of Medicare for People Living … Read more

This is Part Seven of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

Medicare Home Health Access Problems Continue

As we have reported, the Center for Medicare Advocacy has been hearing from people unable to access Medicare-covered home health care, or the appropriate amount of care, despite meeting Medicare coverage criteria.  In particular, people living with long-term and debilitating conditions find themselves facing significant access problems. In a January 17 NPR article, Susan Jaffe … Read more

Beneficiary Protections Expanded in Revised Home Health Conditions of Participation

This is Part Six of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

Alert – Spotlight on Medicare Home Health Care; Tax Cuts Set Stage for Medicare/Medicaid Cuts; ACA News

Medicare Home Health Coverage is Not a Short-Term, Acute Care Benefit ─ Congress Acted in 1980 to Provide for Longer-Term Coverage Final Home Health Rules and Interpretive Guidance: Proposed Payment Model Rescinded Advocates Oppose House Tax Cuts Bill that Would Set the Stage for Deep Cuts to Medicare & Other Programs This Week in Sabotage … Read more

CMA Alert – It’s Enrollment Season; CMS Reissues HH Booklet; “Homebound” Case Settlement; More

It's Health Care Enrollment Season NEW! CMS Again Reissues Improved Medicare Home Health Booklet THIS Week In ACA Sabotage… Happy Anniversary SSI Medicare "Homebound" Class Action Settled – Fairness Hearing Set for January 11, 2018 It's Health Care Enrollment Season Free Webinar Series Next Webinar: Social Security Disability Insurance (SSDI) Part 2 – Overview of Benefits for … Read more

CMA Alert – Changes to Help QMBs; Home Health Updates; ACA Sabotage

CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed CMS Reissues Improved Medicare Home Health Booklet Dispelling a Myth: Medicare Home Health Coverage is NOT a Short Term, Post-Acute Care Benefit The ACA Sabotage Continues CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed The Centers for Medicare and … Read more

Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries We Called It: Continued Sabotage of the ACA “Equitable Relief” Ends this Week – Sign Up for Medicare Part B Proposed Home Health Rules Harm the Most Vulnerable Beneficiaries In July, CMS proposed new payment, case-mix adjustment and quality reporting rules that will make it harder … Read more

September 25, 2017 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1672-P P.O. Box 8016 Baltimore, Maryland  21244-8016 Submitted electronically to: http://www.regulations.gov Re:      Federal Register Volume 82 No. 144 Medicare and Medicaid Programs: CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology … Read more

CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More

Former CMS Administrator Comments on Medicare Advantage Overpayments Proposed Home Health Rules – Payments Drive Delivery of Care, Harming Beneficiaries Observation Status Harms Low-Income Medicare Beneficiaries Poll: Americans Favor Making the ACA Work Former CMS Administrator Comments on Medicare Advantage Overpayments In Austin Frakt’s August 7, 2017 The Upshot blog in the New York Times … Read more

This is Part Five of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

CMA Alert – Senate Health Bill, Again; Medicare Trustees Report; HH CoPs; More

Here We Go Again: Senate Health Repeal Bill Released Today, Vote Planned for Next Week Medicare Trustees Project Increase in Solvency Delay of New Medicare Home Health Conditions of Participation Advocacy News from the Capitol Here We Go Again: Senate Health Repeal Bill Released Today, Vote Planned for Next Week After backing off of plans … Read more

This is Part Four of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

This is Part Three of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care, and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the Center … Read more

A ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care, and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series, and submit Medicare home health stories to the Center at http://www.medicareadvocacy.org/submit-your-home-health-access-story/. Download the complete Brief … Read more

This is Part Two of a Ten-Part CMA Issue Brief Series to examine, and inform work to resolve, the growing crisis in access to Medicare home health coverage and necessary care.  We invite you to follow this Series and provide Medicare home health stories at http://www.medicareadvocacy.org/submit-your-home-health-access-story/. CMA Issue Brief Series: Medicare Home Health Care Crisis … Read more

From the Centers for Medicare & Medicaid Services (CMS): Many minorities experience a disproportionate burden of preventable disease, including diabetes, heart disease, kidney failure, and obesity. Providers should talk to patients about the importance of preventive care and recommend appropriate Medicare-covered preventive services. For More Information: Medicare Preventive Services Educational Tool Mapping Medicare Disparities Tool … Read more

Today the Center for Medicare Advocacy launches a Ten-Part Series to examine and continue work to resolve the growing crisis in access to Medicare home health coverage and necessary care. We invite you to follow this Series and provide Medicare home health stories at http://www.medicareadvocacy.org/submit-your-home-health-access-story/ Medicare Home Health Crisis Series Overview – The Crisis in … Read more

1.The Problem The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care. These problems have been escalating in 2016. Care provided often falls short of care that is covered under the law and ordered by … Read more

As a condition of payment for Medicare home health benefits, a physician must certify that a patient is confined to the home, needs skilled services, receiving the services under a plan of care established and periodically reviewed by a physician, and under the care of the physician.[1]  The Affordable Care Act (ACA) added a requirement … Read more

Can we talk about fraud? It exists. It’s not good for Medicare. Efforts to eliminate its damage to the program are necessary.  But CMS’ war on fraud seems to be indiscriminate, full of tactical errors and collateral damage. Rather than carefully targeting the perpetrators of fraud, a wide net is cast, resulting in legitimate claims … Read more

As we have reported, the Center has been hearing more and more about people who meet Medicare criteria but cannot obtain, or retain, necessary home health care ordered by their physicians. In particular, people living with long-term and debilitating conditions such as ALS, MS, paralysis and Parkinson’s disease find themselves without necessary home care. For … Read more

As part of the Center's Home Health Access Initiative, we are collecting stories from beneficiaries and caregivers who have had difficulty obtaining necessary home health care as ordered by their doctor. Please share your story below! &amp;amp;amp;lt;a data-cke-saved-href=&amp;amp;amp;quot;http://www.eSurveysPro.com/Survey.aspx?id=b17a6403-cedd-4ee9-ba6d-9aa0f453ad2a&amp;amp;amp;quot; href=&amp;amp;amp;quot;http://www.eSurveysPro.com/Survey.aspx?id=b17a6403-cedd-4ee9-ba6d-9aa0f453ad2a&amp;amp;amp;quot; target=_blank&amp;amp;amp;gt;Click here to take the survey now&amp;amp;amp;lt;/a&amp;amp;amp;gt;. The survey was created with eSurveysPro.com &amp;amp;amp;lt;a data-cke-saved-href=&amp;amp;amp;quot;http://www.eSurveysPro.com&amp;amp;amp;quot; href=&amp;amp;amp;quot;http://www.eSurveysPro.com&amp;amp;amp;quot; … Read more

The Center for Medicare Advocacy has been hearing from people who meet Medicare coverage criteria but are unable to access Medicare-covered home health care, or the appropriate amount of care.   In particular, people living with long-term and debilitating conditions find themselves facing significant access problems. For example, patients have been told Medicare will only … Read more

The Center for Medicare Advocacy has been hearing about people who clearly meet Medicare criteria but are unable to access home health care ordered by their physicians. In particular, people living with long-term and debilitating conditions find themselves without necessary home care. For example, they have been told Medicare will only cover 1 to 5 … Read more

April 5, 2016 Centers for Medicare & Medicaid Services Office of Strategic Operations and Regulatory Affairs Division of Regulations Development 7500 Security Blvd. Baltimore, MD 21244-1850 Delivered Electronically through www.regulations.gov Re: Medicare Prior Authorization of Home Health Services Demonstration (CMS-10599) To Whom It May Concern: The Center for Medicare Advocacy (the Center) appreciates the opportunity … Read more

1. CMS Proposes Medicare Home Health Prior Authorization Demonstration On February 5, 2016, the Centers for Medicare & Medicaid Services (CMS) published a two-page Paperwork Reduction Act notice in the Federal Register announcing their effort to seek approval from the Office of Management and Budget (OMB) to “collect information” relating to a demonstration project.  Pursuant … Read more

September 1, 2015 SUBMITTED ELECTRONICALLY http://www.regulations.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201 Re: CMS-1625-P Dear Acting Administrator Slavitt: The Center for Medicare Advocacy (the Center) is pleased to provide comments on the Centers for Medicare & Medicaid Services … 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