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9 Facts About Social Security, a recent blog post by Jason Furman, Chairman of the Council of Economic Advisers, and Jeff Zients, Director of the National Economic Council, identifies nine important accomplishments for our aging society and for persons with disabilities. Social Security forms the foundation for retirement security through universal, guaranteed benefits. Social Security … Read more

This photo of the signing of the Social Security Act was sent to us by a friend of the Center whose father received it, signed, from President Roosevelt’s son. When President Franklin Roosevelt signed the Social Security Act into law on August 14, 1935, older people and their families entered a new era of financial … 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

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter. Cognitive Behavioral Therapy (CBT) as psychotherapy via telemental health is covered by Medicare for certain eligible … Read more

An increasing number of patients in hospitals are not formally admitted as inpatients, but as “outpatients” on “observation status.”  Although they receive whatever medical and nursing care, diagnostic tests, medications, and food they need, their status as “outpatients” means that they do not satisfy the three-day inpatient hospital prerequisite for Medicare coverage of post-acute care … Read more

Over the past week, problems with Medicare coverage of Speech Generating Devices (SGDs) have been favorably addressed through both final Administrative and Congressional action. Prior to these actions, Medicare only covered SGDs to generate face-to-face speech, excluding other forms of communication such as by email, phone or text.  Medicare had also changed the payment category … Read more

The 50th anniversary of Medicare has given us an opportunity to reflect on all it has accomplished to advance the health and well-being of families throughout the country. It also reminds us what could have been better – and what could still be improved. We are thankful for the vision and fortitude of President Johnson … Read more

Medicare Trustees Report – Medicare Part A Solvency Remains Stable On July 22, 2015, the Medicare and Social Security Trustees issued the 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Good News: In short, the projected solvency of the Part … Read more

On Tuesday, July 14, 2015, at a news conference on adding Medicare coverage of hearing aids, Rep. Debbie Dingell (D-MI) discussed H.R. 1653, the “Medicare Hearing Aid Coverage Act of 2015,” the first bill she introduced as a member of Congress, which would allow Medicare to provide coverage for hearing aids. She was joined by … Read more

On July 13, 2015, the Centers for Medicare & Medicaid Services (CMS) posted proposed regulations to revise the Requirements of Participation for nursing homes (called Skilled Nursing Facilities under Medicare and Nursing Facilities under Medicaid).  The proposed rules were published in the Federal Register on July 16,[1] with a 60-day comment period.  The public announcement … Read more

July 16, 2015 WASHINGTON, DC – Steve Gleason, former NFL standout athlete for the New Orleans Saints, has redefined what it means to be a hero. Diagnosed with ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease) in 2011, Steve’s mind is unaffected by the disease, but he can no longer move any part of his … Read more

In the annual update to Medicare reimbursement of acute care hospitals for outpatient care (July 8, 2015)[1] the Centers for Medicare & Medicaid Services (CMS) includes proposed revisions to the “Two-Midnight Rule” and its enforcement. If the proposed changes lead to an increased number of patients being formally admitted as inpatients (rather than, as now, … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries With support from the John A. Hartford Foundation the Center for Medicare Advocacy has created a multi-disciplinary Jimmo Implementation Council. The Center convened the first meeting of the Council on June 23, 2015 at the US Capitol in Washington, DC.[1] The … Read more

1. Comments to Senate Finance Committee Chronic Care Workgroup On June 22, 2015, the Center for Medicare Advocacy submitted comments to the Senate Finance Committee Chronic Care Workgroup in response to the Committee’s May 22, 2015 request for comments on reforming care for individuals with chronic conditions. The Committee identified three overarching goals to guide … Read more

In September 2006, the nursing home industry announced a voluntary quality improvement campaign – Advancing Excellence in America’s Nursing Homes.[1]  The campaign, now in its ninth year and third phase, describes its mission: “to make nursing homes better places to live, work, and visit.”[2]  The Center for Medicare Advocacy (Center) was skeptical about the campaign … Read more

Part B of Medicare will generally cover up to 80% of emergent and non-emergent ambulance transports when medically necessary and when transport by any other means could endanger your health.  There are also origin/destination requirements; Medicare will typically only cover transports to the nearest appropriate medical facility that can provide the level of care necessary … Read more

Fast-food workers have been demonstrating for a higher minimum wage and recently, various corporations have increased the wages of their lowest-paid workers.  Has the movement come to the health care industry? On May 22, 2015, the country’s largest Roman Catholic health system, St. Louis-based Ascension Health, announced that it would pay workers at least $11 … Read more

As we’ve previously reported, on April 28, 2015 the Senate Finance Committee held a hearing about the tremendous backlog of cases piled up at the Office of Medicare Hearings and Appeals (OMHA), the office that oversees Administrative Law Judges (ALJs), the third level of appeal in Medicare’s administrative appeals system.[1]  The Finance Committee hearing also … Read more

Government contractors administering Medicare benefits are routinely denying coverage to cancer patients for claims involving the surgical removal of decayed and infected teeth caused by an aggressive course of radiation treatment to the head and neck.[1] The decayed and infected teeth, when left untreated, place these cancer patients at increased risk for infection, thereby decreasing … Read more

This CMA Alert highlights a recent individual ALJ decision that sets out an important but often unrecognized beneficiary right to a written notice when he or she is about to use hospital “Lifetime Reserve Days.”  A hospital’s failure to provide appropriate notice in this context can lead to the waiver of a beneficiary’s liability for … Read more

The traditional Medicare program pays individual health care providers for the specific services and care they provide to beneficiaries and guarantees that patients have “freedom of choice”[1] to select their Medicare providers.  A current focus of Congress and policymakers is changing Medicare payment policy to pay, instead, for episodes of care for beneficiaries.  One issue … Read more

The Medicare appeals system is not working. The success rate at the first two levels of appeal is staggeringly low for beneficiaries. It can take years to get an ALJ hearing decision – the third level of appeal, and the first real opportunity to get a coverage denial reversed. As we’ve previously reported, the Senate … Read more

On April 28, 2015, the Senate Finance Committee held a hearing entitled “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.”[1] As noted by Chairman Hatch in his opening statement, Medicare’s hiring of contractors to conduct audits of claims submitted to Medicare “has led to a seemingly insurmountable increase in appeals, with … Read more

Beneficiaries who seek Medicare coverage for expanded types and features of Speech Generating Devices (SGDs) have reason to be optimistic.  Electronic devices that meet the definition of a Speech Generating Device will be coverable.  This could include a tablet, computer, or smart phone. On April 29, 2015 the Centers for Medicare and Medicaid Services (CMS) … Read more

Observation Status – hospital patients’ classification as outpatients, which makes them ineligible for Medicare Part A coverage of their subsequent stay in a skilled nursing facility (SNF) when they do not have “inpatient” status for at least three consecutive midnights – is an ongoing issue that the Center for Medicare Advocacy has discussed many times.[1]  … Read more

On April 14, 2015, the Senate overwhelmingly (92 to 8) passed H.R. 2 – the Medicare and CHIP Reauthorization Act (MACRA) – which repeals and replaces the flawed Medicare physician reimbursement system known as the sustainable growth rate or SGR.  The House of Representatives passed its own bill, H.R. 2 (392 to 37), on March … Read more

In the spirit of aiding the discussion concerning the budget and the SGR “Doc Fix,” we raise many of the myths surrounding Medicare and answer them with facts. Congress is working to repeal and replace the Sustainable Growth Rate (SGR) — also known as the “Doc Fix.”  The House version of the SGR bill asked too … Read more

Every year, the Centers for Medicare and Medicaid Services (CMS) issues payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in draft form, subject … Read more

Reflections on the 2nd Annual National Voices of Medicare Summit A Look Back at the Summit from the Attendees' View 2015 Program and Speakers    Register Now for 2016!  Reflections on the 2nd Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture On March 20, 2015, the Center for Medicare Advocacy, held its second … Read more

The Kaiser Family Foundation (KFF) has published a report entitled “Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations.” The report is authored by Center Senior Policy Attorney David Lipschutz, former Center Policy Attorney Andrea Callow (now at Families USA) and Karen Pollitz, MaryBeth Musumeci … Read more

For the last several years, the Center has been trying to address the problem of Observation Status in the hospital, which can affect both what Medicare beneficiaries pay for hospital stays, and their coverage of subsequent care in a nursing facility.  For the last several sessions of Congress, bills have been introduced to try to … Read more

Today, March 26, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2).  While the Center for Medicare Advocacy believes it’s in the best interest of Medicare beneficiaries to find a permanent solution to the broken physician payment formula called the “Sustainable Growth Rate” (SGR), this Bill is not … Read more

Today the Senate releases its budget, which like the companion House budget released yesterday, appears to have significant cuts to the Medicare program.  Yet again, yesterday’s House budget includes a proposal to create a “premium support” – or voucher – option for future Medicare beneficiaries, starting in 2024. Medicare vouchers would convert much of Medicare … Read more

Unless Congress takes action by March 31, 2015, doctors who treat Medicare patients will see a 21% payment cut due to the current physician payment formula called the "sustainable growth rate" or "SGR."  Lawmakers have deferred the cuts prescribed by this 1997 reimbursement formula 17 times. These “patches” have been temporary because Congress has not … Read more

On March 11, 2015, the Diane Rehm program on National Public Radio hosted a discussion of the revisions to the Centers for Medicare & Medicaid Services’s (CMS’s) Five Star Quality Rating System for nursing homes.[1] Patrick Conway, CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality began the show by describing the changes.  … Read more

Last week’s Alert discussed the Centers for Medicare & Medicaid Services’ (CMS’s) National Partnership to Improve Dementia Care and the Government Accountability Office’s (GAO) recent report on antipsychotic drugs.[1]  The CMS Partnership and the GAO reported different numbers of nursing home residents receiving antipsychotic drugs.  Some of the differences appear to reflect the different databases … Read more

Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in … Read more

In September 2014, the Centers for Medicare & Medicaid Services (CMS)[1] reported that the National Partnership to Improve Dementia Care had reduced the use of antipsychotic drugs with nursing home residents by 15.1%, “exceeding” the Partnership’s 15% drug reduction goal for long-stay residents.  That claim of success was overstated.  When CMS originally announced the initial … Read more

Two-Thirds of Nursing Facilities Nationwide Will See Decline In their Quality Measures; One-Third of Facilities Will See Decline in Their Overall Score As promised in October 2014,[1] the Centers for Medicare & Medicaid Services (CMS) has made significant changes to Nursing Home Compare, effective February 20, 2015.  The changes recalibrate the Quality Measures (QMs), add … Read more

On February 12, 2015, the Centers for Medicare and Medicaid Services (CMS) published final rules entitled “Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” [CMS-4159-F2], otherwise known as the final 2016 rules for Medicare Parts C and D.[1] Applicable to the 2016 plan … Read more

As originally enacted, the Affordable Care Act (ACA) required each state to expand Medicaid eligibility to 138 % of the Federal Poverty Level.  However, the 2012 U.S. Supreme Court’s decision National Federation of Independent Business v. Sebelius, changed that.  The National Federation decision gives states the option to accept federal funds, reject the funds altogether and … Read more

On Monday, February 2nd, President Obama unveiled his Fiscal Year 2016 Budget.[1]  For an overview of the budget’s Medicare-related provisions, including both projected costs and savings to the Medicare program, see the Kaiser Family Foundation’s summary.[2] With respect to Medicare, this year’s proposed budget is very similar to last year’s, both good and bad, with … Read more

(Steve Gleason, on living with ALS and utilizing a speech generating device.) The Steve Gleason Act of 2015, recently introduced in the House and the Senate, is a good first step toward ensuring continuous Medicare coverage for individuals who qualify for Durable Medical Equipment (DME) serving as speech generating devices (SGD) and for accessories that … Read more

Civil Money Penalties for nursing facilities have historically been too low to provide meaningful incentive for most facilities to comply with federal standards of care implemented to ensure patient safety and well-being.  The new Civil Money Penalty Analytic Tool from the Centers for Medicare & Medicaid Services (CMS) does not solve this problem. Background Every … Read more

At its January 16, 2015 public meeting, the Medicare Payment Advisory Commission (MedPAC), the government agency that advises Congress on Medicare payment policy, addressed observation status as part of its discussion of hospital short stay policy issues.[1]  MedPAC Commissioners preliminarily, but unanimously, voted to move forward on a recommendation to count time in observation status … Read more

Medicare patients considered hospital outpatients on Observation Status may be helped by a decision issued on January 22, 2015 by a federal appeals court.  A three-judge panel of the U.S. Court of Appeals for the Second Circuit decided that Medicare patients who are placed on “Observation Status” in hospitals may have an interest, protected by … Read more

By Connie Cherba, Iowa In early 2000, Edward, who was then 60 years old, applied for Social Security Disability.  Despite having suffered from bipolar disorder for nearly 40 years, Edward had earned a PhD, but was not able to hold a job.  While the Social Security Disability was economically important, becoming eligible for Medicare allowed … Read more

Medicare has not only provided access to care for people who could not get private insurance, it has also significantly reduced poverty.  As Nancy-Ann Min DeParle, former administrator of HCFA (Now CMS) stated in the preface to A Profile of Medicare in 1998: Few programs in the history of the United States have brought as … Read more

Inadequate nurse staffing is the most significant predictor of poor care in nursing facilities.  Despite the fact that understaffing is a pervasive and nationwide problem,[1] understaffing is rarely cited by state survey agencies.[2]  One reason for the lack of deficiencies and enforcement actions is that the federal standard for nurse staffing is vague.  Aside from … Read more

Most people know Medicare as one of the most successful social programs in our country’s history for its impact on the health of our older citizens and those with disabilities. But did you know that the Medicare program was key to integrating hospitals? The Civil Rights Act of 1964, stated that “No person in the … Read more