As discussed in a recent CMA Alert (Aug. 18, 2022), President Biden signed into law the Inflation Reduction Act (IRA) of 2022 on August 16, 2022. This bill includes historic prescription drug provisions that will soon be of significant benefit to … [Read more...] about Provisions of Recently Passed Medicare Drug Bill in Effect Next Month – January 2023
Weekly Alert
Nursing Home Reform: Where Are We Now? Where Do We Need to Go?
Last month, the White House announced additional steps to implement President Biden’s comprehensive nursing home reform agenda, which he originally announced in February. The White House described why nursing home reform is so needed … [Read more...] about Nursing Home Reform: Where Are We Now? Where Do We Need to Go?
WHO Issues Guidance on Sustaining Telemedicine Beyond the COVID-19 Pandemic
In the nearly three years since the COVID-19 Public Health Emergency (PHE) was enacted, the use of telehealth services by Medicare beneficiaries has increased by over 6,000%. Telehealth’s efficacy has been closely examined as its use has expanded … [Read more...] about WHO Issues Guidance on Sustaining Telemedicine Beyond the COVID-19 Pandemic
Center for Medicare Advocacy Sues, Again, for Coverage of “Off-label” Prescription Drug
On November 18, 2022, the Center for Medicare Advocacy and Murphy Orlando LLC filed suit on behalf of a retired public-school teacher in New Jersey who seeks coverage of her “off-label” (non-FDA-approved) use of a critically needed medication. … [Read more...] about Center for Medicare Advocacy Sues, Again, for Coverage of “Off-label” Prescription Drug
Report | Trained Workers in Nursing Homes, a Requirement Since 1990, Threatened
When the Nursing Home Reform Law was enacted in 1987, half of the states did not require that nurse aides receive any training in how to do their jobs. One of the major changes mandated by the Reform Law was the requirement that every nurse aide be … [Read more...] about Report | Trained Workers in Nursing Homes, a Requirement Since 1990, Threatened
Medicare Annual Enrollment Period Ends December 7th
The Medicare Annual Coordinated Election Period (AEP) – the period during which individuals with Medicare can make coverage choices for the coming year – ends next Wednesday, December 7th. During this time, people can enroll in, switch, or get … [Read more...] about Medicare Annual Enrollment Period Ends December 7th
Reminder: Questions or Comments on Proposed Clarification in Hospital “Observation Status” Case Due November 25
In Alexander v. Becerra, a federal court found that certain beneficiaries must be allowed to appeal to Medicare when their hospitalizations are reclassified from “inpatient” to “outpatient receiving observation services.” The Center for Medicare … [Read more...] about Reminder: Questions or Comments on Proposed Clarification in Hospital “Observation Status” Case Due November 25
Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances
Under Medicare law, Medicare Advantage plans and stand-alone Part D plans (“Plans”) must follow certain rules when enrollees disagree with Plan health care coverage determinations. Under the law, there are two distinct methods for raising issues with … [Read more...] about Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances
Sale of “Ancillary Products” to Fill Gaps in Medicare Advantage Highlight Both Coverage Shortfalls and Need for Stronger Regulation of the MA Marketplace
IntroductionAs discussed in recent CMA publications, including our “Special Report | Recent Articles and Reports Shed Light on Medicare Advantage Issues” (Oct. 31, 2022), and “Senate Report Highlights Widespread Medicare Advantage Marketing … [Read more...] about Sale of “Ancillary Products” to Fill Gaps in Medicare Advantage Highlight Both Coverage Shortfalls and Need for Stronger Regulation of the MA Marketplace
Senate Report Highlights Widespread Medicare Advantage Marketing Misconduct – But the Driving Forces of Misconduct Are Broader
After the Centers for Medicare & Medicaid Services (CMS) reported earlier this year that Medicare beneficiary complaints about Medicare Advantage (MA) marketing more than doubled between 2020 and 2021, the Senate Finance Committee launched an … [Read more...] about Senate Report Highlights Widespread Medicare Advantage Marketing Misconduct – But the Driving Forces of Misconduct Are Broader