RSS

The New York Times reported on July 11, 2016 that a noninvasive alternative to dental fillings that could save money, while preventing future decay, has gained increased traction among dentists. The liquid – Silver Diamine Fluoride, or S.D.F. – can be brushed on certain types of cavities, removing the need for a drill or injection. … Read more

On June 30, 2016 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule about the difficulties of dually eligible people (individuals eligible for both Medicare and Medicaid) to obtain Durable Medical Equipment (DME). The proposed rule seeks information about the problem, as well as potential solutions. The proposed rule is primarily focused … Read more

In 2012, the Centers for Medicare & Medicaid Services (CMS) announced expansion of Medicare’s Value-Based Purchasing (VBP) Program for acute care hospitals.  Beginning in Fiscal Year 2015, and as mandated by Congress in the Affordable Care Act,[1] CMS would incorporate a new measure for “Medicare Spending Per Beneficiary.”  CMS suggested this efficiency measure would reward … Read more

In the last 18 months, the Center for Medicare Advocacy, and other advocates around the country, have received many, many calls from older and disabled beneficiaries who can no longer obtain coverage for the Lidocaine Patch 5% from their Part D plans. Many have been using the Patch for at least a decade and are … Read more

As part of the Center for Medicare Advocacy’s commitment to improving oral health for older people and people with disabilities, Center attorneys recently attended a DentaQuest convening in Cambridge, Massachusetts aimed at unifying partners in this common mission. The convening focused on leadership strategies, shared network goals and collaborative work in social justice.  The Center’s … Read more

The Center for Medicare Advocacy submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) concerning the proposed rule on the Medicare Program Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule (CMS–5571–P), two elements proposed in the Medicare Access and CHIP Reauthorization Act of … Read more

Today, June 22, 2016, the Medicare and Social Security Trustees issued the 2016 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. In short, according to the report, the Part A trust fund depletion date is 2028, down 2 years from 2030 as … Read more

On June 9, 2016, the Government Accountability Office (GAO) publicly released a report (dated May 2016) titled “Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process”.[1]   Among other things, the report analyzes the increased number of appeals in the system and the resulting backlog at the third level (Administrative Law Judge, or ALJ) and fourth level … Read more

The Center for Medicare Advocacy submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) concerning its proposed rule titled “Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements” (81 Fed. Reg. 25498), which was published on April 28, 2016.[1]  The Center’s comments focused on … Read more

The Center for Medicare Advocacy’s comments on the Medicare prospective payment system for skilled nursing facilities (SNFs),[1] submitted June 20, 2016, support the recommendation of the Medicare Payment Advisory Commission (MedPAC) not to increase reimbursement to SNFs for FY 2017.  MedPAC reports that SNFs have enjoyed Medicare margins exceeding 10% for 15 consecutive years. With … Read more

Last week, the Senate Appropriations Committee approved a bill that would eliminate federal funding for State Health Insurance Assistance Programs (SHIPs).  Since 1992, the SHIP network has provided critical information upon which people with Medicare rely to make informed decisions about their coverage options and enrollment decisions. As roughly 10,000 people a day become eligible … Read more

The Administration on Aging defines a subcategory of elder abuse – “physical abuse” – as “inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.”[1] Administering antipsychotic drugs to more than a quarter of a million nursing home residents meets the definition of elder abuse and, left … Read more

A report from the National Academies of Sciences, Engineering, and Medicine (about which the Center for Medicare Advocacy has commented) was recently highlighted by ABC News. The Report, Hearing Health Care for Adults: Priorities for Improving Access and Affordability, rightly names hearing loss as a public health priority and social health responsibility. Even mild hearing … Read more

In a recent Boston Globe piece, former CMS Administrator Donald M. Berwick, MD called for expanded access to dental care, which he characterized as a critical aspect of health care that is out of reach for many. People with low incomes, people with disabilities, and older Americans all have difficulty accessing routine, preventive, and medically … Read more

The Patient Access and Medicare Protection Act (PAMPA), enacted on December 28, 2015, delayed application of competitive bid program (CBP) adjusted payment rates for accessories furnished in connection with complex rehabilitation technology (CRT) power group 3 wheelchairs. PAMPA also included a provision requiring the General Accounting Office (GAO) to study Medicare utilization and expenditures for … Read more

A recent post by health economist Uwe Reinhardt in the Journal of the American Medical Association Forum discusses the fact that despite all the support Medicare Advantage (MA) plans have received, the vast majority of Medicare beneficiaries still prefer Traditional Medicare. 30% of Medicare recipients now receive their coverage through MA plans. This is largely because … Read more

As previously reported, a court preliminarily approved settlement in the case of Exley v. Burwell, 3:14-cv-1230 (JAM) (D. Conn.), in March of this year. Since then the government requested and the plaintiffs agreed to a revision in the proposed settlement. Because of this revision, the parties are posting notice to the class again and the … Read more

October 21, 2016 – Update on Seamless Conversion: CMS is revisiting the seamless conversion enrollment policy and is temporarily suspending its acceptance of any new seamless enrollment proposals. Read more… Ms. M., a Medicare beneficiary living in the Southwest, turned 65 in October 2015 and became eligible for Medicare on October 1st. On September 30th she signed … Read more

This week CMS released, for the first time, a public use file for the Medicare Current Beneficiary Survey (MCBS).  The “MCBS 2013 Access to Care Public Use File” (MCBS PUF) provides the first publicly available MCBS file for people interested in the health, health care use, access to, and satisfaction with care for Medicare beneficiaries.  … Read more

By Cynthia Ronzio, Public Health Consultant The British Medical Journal (BMJ) recently published a highly controversial and alarming study that claims that medical errors are the third leading cause of death in the US.[1]  The authors used crude statistics (for example, they do not describe their method of extrapolation nor is there mention of weights, … Read more

Oral Health America recently released a report, A State of Decay, a state-by-state ranking of healthcare delivery and public health factors that affect the oral health of older adults. Some of the Report’s Findings 76% or 38 states earned a Composite Score of Fair (22%) or Poor (54%); Ten states received a Composite Score of … Read more

The controversial issue of Observation Status continues.[1]  The latest news is that the Centers for Medicare & Medicaid Services (CMS) told Quality Improvement Organizations (QIOs) on May 4 that they should temporarily pause their reviews of hospitals’ compliance with the two-midnight rule.  The pause was reported by Livanta, one of the two QIOs nationwide (the … Read more

The Medicare Advocacy Project of Greater Boston Legal Services recently received a favorable decision from the U.S. District Court in Massachusetts for “off-label” coverage of the drug Dronabinol.  This is a welcome development given how difficult it has been to obtain coverage for medications that prescribing doctors agree are necessary, but that are not FDA-approved … Read more

American Heart Association/American Stroke Association Recommends That Patients Who Have Strokes Receive Rehabilitation at Inpatient Rehabilitation Hospitals, not Skilled Nursing Facilities For the first time, the American Heart Association/American Stroke Association has issued a Scientific Statement and guidelines strongly recommending that, “whenever possible,” “stroke patients be treated at an in-patient rehabilitation hospital (now often referred to … Read more

On May 5, 2016 Center for Medicare Advocacy executive director Judith Stein and Senior Attorney Wey-Wey Kwok, the Dental Lifeline Network, the Medicare Rights Center, and former CMS (then HCFA) administrator Bruce Vladeck, met with CMS officials to discuss coverage of medically necessary oral health care. The group’s primary goal was to advance Medicare coverage … Read more

This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments.  The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling … Read more

As discussed in previous Alerts, on March 11, 2016 CMS published a proposed rule aimed at reforming how Medicare pays for drugs covered under Part B. CMS states that its main objective is to ensure that physicians are prescribing the most effective prescription drugs in order to improve patient treatment and to rein in drug spending. … Read more

The Centers for Medicare & Medicaid Services (CMS) has recently issued a host of Medicare-related proposed rules that are currently open for comment, including the following: MACRA (Physician Payment) On April 27, 2016, CMS released a proposed rule outlining new physician payment systems created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The … Read more

In proposed rules updating Medicare reimbursement to acute care hospitals,[1] the Centers for Medicare & Medicaid Services (CMS) announces how it intends to implement the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act).[2]  Effective August 6, 2016, the NOTICE Act requires that hospitals provide written and oral notice, within 36 hours, … Read more

Reports that 20% or more of unplanned hospital readmissions are avoidable has led to considerable interest in policymakers in reducing readmissions.[1]  Actively reducing hospital readmissions is seen as a route to lower Medicare spending and improved patient care. The Affordable Care Act (ACA) established a penalty program for preventable readmissions.  Under the Hospital Readmissions Reduction … Read more

The single factor most critical to high quality of care and quality of life for nursing home residents is the staff who provide residents with care.  Most direct care in nursing facilities is provided by nurse aides, primarily women of color, who are poorly paid and often poorly treated.  In a sobering new report, Raise … Read more

As part of the Center’s ongoing project on approaches to improve nurse staffing levels in nursing facilities, this week we are posting a paper on “Increasing Reimbursement.”  This approach increases reimbursement to nursing facilities on the assumption and expectation that nursing facilities will use some of the increased reimbursement to increase their staffing levels.  This … Read more

As discussed in our March 2, 2016 CMA Alert, the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register in February 2016 announcing its effort to seek approval from the Office of Management and Budget (OMB) to “collect information” pursuant to a demonstration project to identify, investigate and prosecute fraud … Read more

The Older Americans Act Reauthorization Act of 2015 is tremendously important for the protection of older people and people living with disabilities.  The Reauthorization Act Bill passed the House with an amendment on March 21, 2016.  The Senate Bill, S. 192, is entitled "An Act to Reauthorize the Older Americans Act of 1965.”  The short … Read more

A comparison of the long-term care industry in California, Ontario (Canada), England, and Norway evaluates the extent to which ownership of nursing facilities has shifted from the public sector to private for-profit and not-for-profit companies, and how this shift affects the transparency of information and accountability for public reimbursement.[1] While privatization has been a recent … Read more

Medicare Part B covers drugs that are usually not self-administered, such as many intravenous medications and chemotherapy drugs. Medicare Part D, on the other hand, generally covers self-administered outpatient prescription drugs.  On March 11, 2016, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register aimed at reforming how Medicare … Read more

On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) released a memorandum entitled “Suspension of Policy Providing for Automatic Reduction of Star Ratings for Contracts Operating Under Intermediate Sanction.” Through this memo, CMS has suspended its policy of lowering the star ratings of Medicare Advantage plans that are under sanction for violations … Read more

Since its implementation in 1965, Medicare has excluded coverage for hearing aids and related audiology services despite the large numbers of older Americans that have hearing loss. It is increasingly well-documented, however, that untreated hearing loss often leads to a variety of serious health problems and injuries. This means the cost of not treating audiology … Read more

1. Comments to CMS re: 2017 Draft Call Letter for Medicare Parts C and D Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that will apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the … 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

March 2016 Update: CMS is now delaying enforcement of the Part D Prescriber Enrollment Requirements until February 1, 2017. Nevertheless, prescribers of Part D drugs should submit their Medicare enrollment applications or opt-out affidavits to their Part B Medicare Administrative Contractors (MACs) by January 1, 2016, or earlier, to ensure that MACs have sufficient time … Read more

On October 5, 2015, the Centers for Medicare and Medicaid Services (CMS) announced final rules concerning its requirements for Meaningful Use Stage 3 of its health records initiative. These measures have the potential to reduce health disparities among elder lesbian, gay, bisexual, and transgender (transgendered) (LGBT) patients.  The final rules require providers to have the … Read more

The 2016 Medicare Part A and B General Enrollment Period runs from January 1 through March 31, 2016. As detailed below, this enrollment period is especially important for many individuals who are not eligible for premium-free Medicare Part A. Most people do not pay a premium for Medicare Part A because they have sufficient work history. … Read more

On February 9, 2016, President Obama unveiled his Fiscal Year 2017 Budget.[1]  With respect to Medicare, this year’s proposed budget is very similar to last year’s, both good and bad, with some notable exceptions.  While not a comprehensive analysis of all of the Medicare-related provisions, the Center for Medicare Advocacy provides these comments about the … Read more

On January 4, 2016, The Centers for Medicare and Medicaid Services (CMS) awarded the administration of the Jurisdiction B Durable Medicare Equipment Administrative Contractor (DME MAC) serving Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin to CGS Administrators, LLC (CGS)—an organization that is headquartered in Nashville, Tennessee. This jurisdiction was previously contracted to National Government … Read more

The Centers for Medicare & Medicaid Services (CMS) has posted new materials for unions and employers to help employees with decisions about Medicare.  The materials are available at https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/Publications-to-share-with-employees.html.  Topics include: Medicare decisions for someone nearing age 65 Deciding whether to enroll in Medicare Part A or Part B when you turn 65 Deciding whether to enroll … Read more

In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document.  The Policy Options Document was issued as part of a process begun in May 2015 to develop legislation to address challenges facing Medicare beneficiaries with chronic conditions.   According to a press release issued by the Committee, the Options … Read more

A December 2015 Health Affairs study of freestanding Skilled Nursing Facilities (SNFs) from 2001 thru 2011 found that registered nurses (RNs) were less likely to work at nursing homes with high concentrations of racial and ethnic minorities.[1] This study reports on significant health disparities for racial and ethnic minority SNF residents. In the Health Affairs … Read more

Low income racial and ethnic minority beneficiaries are adversely affected by prescription drug pricing, a problem that has a negative impact on overall Medicare program costs.  A 2011 International Journal of Health Services study estimates that the economic costs of health disparities due to race for African Americans, Asian Americans, and Latinos from 2003 thru … Read more

Be a Resource for National Healthcare Decisions Day on April 16. There are numerous ways to participate at no cost, and the goal is simple: "To inspire, educate & empower the public & providers about the importance of advance care planning."  The easiset thing you can do is draw attention to your existing resources about advance care planning … Read more