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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

Connecticut Passes Observation Notice Law On June 12, 2014, Connecticut Governor Dannel P. Malloy signed into law a requirement that, starting October 1, 2014, Connecticut hospitals give oral and written notice to patients placed on observation status for 24 hours or more.  Similar laws already exist in New York and Maryland.  Specifically, Connecticut's law requires: … Read more

Research suggests that medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by Medicare Part D plans. In March, to prevent this from happening, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for … Read more