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On July 11, 2014, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the 2015 calendar year.  Among these proposed rules, CMS adds four additions to covered telehealth services: psychoanalysis and psychotherapy (including family psychotherapy with and without the patient present), prolonged outpatient services such as evaluation and management, and annual … Read more

Medicare Advantage (MA) plans are increasingly dropping doctors and other health care providers from their contracted networks, often in the middle of a plan year, when most plan enrollees are not permitted to change plans.  MA enrollees often get little advance warning, and some lose access to doctors they have seen for a long time, … Read more

A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at … Read more

Quick Summary When Medicare beneficiaries elect the hospice benefit, they waive Medicare coverage for all care and services related to the terminal illness that are not on the hospice plan of care and provided through the hospice provider.  This means that when a terminally ill beneficiary elects hospice, all of the medications needed to control … Read more

Medicare beneficiaries often need care in a skilled nursing facility after an inpatient hospitalization.  For these patients, hospitals are responsible for identifying skilled nursing facilities within the geographic region that can meet their medical needs.  Until such a placement is found, the beneficiary will not be responsible for her hospital stay.  However, once a placement … Read more

Separating Beneficiary Complaint Review Functions from Quality Improvement Functions On May 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the first phase of its restructuring of the QIO functions.  In the first phase, CMS has contracted with Livanta LLC (for geographic areas 1 and 5), located in Annapolis Junction, Maryland, and KePRO … Read more

The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation and oversight of the DMEPOS program.[1]  Since the rollout of the DMEPOS competitive bidding program (CBP) in July, 2008, there has been confusion over what constitutes delivery and set-up of specific DMEPOS items.[2]  In some instances, beneficiaries have experienced delays in obtaining … Read more

To: Medicare Beneficiary Advocates From: Mario D. Ramsey, CMA Health Policy Fellow Subject: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS.  Beneficiary Advocates Disagree. Date: July 8, 2014 Advocates' Concerns about the DMEPOS Reports Advocates are concerned that some suppliers are not delivering and setting-up necessary items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).[1] … Read more

The Supreme Court decision in Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al. (5-4 decision), 573 U.S. ___ (2014) is ominous. Not only is the decision, and its interpretation of the Religious Freedom Restoration Act (RFFA) a blow to a woman's access to preventive and contraceptive care, its … Read more

June 26, 2014 Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was enacted by Congress as a cost and fraud protection measure.  From its inception, there have been questions about the program's complexity and fairness, and whether it would hinder beneficiary access to necessary DMEPOS items and services.  Background information about … Read more