One of the best predictors of quality is past performance. If an operator provides poor care in its facilities, it is likely to provide poor care in any additional facilities that it may purchase or operate. As a result, one of the most effective … [Read more...] about CMS Must Strengthen Federal Criteria for Certifying Nursing Homes for Medicare and Medicaid Reimbursement
Weekly Alert
Simplified Access to Medicare Savings Programs
The Centers for Medicare & Medicaid Services (CMS) recently released updated instructions for states on eligibility and enrollment processes for the Medicare Savings Programs (MSPs). The guidance provides states with instructions to implement … [Read more...] about Simplified Access to Medicare Savings Programs
When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
Skilled Nursing Facility (SNF) care can be covered by Medicare if it meets the following criteria:Note: Medicare Advantage plans often do not require a prior hospital stay to qualify for SNF coverage.Note: “Daily” is defined as seven … [Read more...] about When Should Medicare Coverage Be Available For Skilled Nursing Facility (SNF) Care?
Know Jimmo | New CMS Implementation Activity!
CMS Joins the Center for Medicare Advocacy to Advance Access to Medicare-Covered Skilled Care to Maintain One’s Condition or Slow DeclineIn 2011, the Center for Medicare Advocacy and Vermont Legal Aid brought the Jimmo v. Sebelius class … [Read more...] about Know Jimmo | New CMS Implementation Activity!
New Report Breaks Down Medicare Beneficiaries by Income & Assets
A KFF issue brief released this week outlines income, assets, and other financial data points of Medicare beneficiaries. The issue brief, “Income and Assets of Medicare Beneficiaries in 2023,” breaks down beneficiary income and assets data down by … [Read more...] about New Report Breaks Down Medicare Beneficiaries by Income & Assets
Organizational Sign-On Letter Commenting on Proposed Rule on Observation Status Appeals
The Center for Medicare Advocacy and Justice in Aging invite organizations to sign on to a comment letter responding to CMS’s proposed rule implementing appeal rights for Medicare beneficiaries who are admitted to hospitals as inpatients and … [Read more...] about Organizational Sign-On Letter Commenting on Proposed Rule on Observation Status Appeals
When Should Medicare Coverage be Available for Home Health Care?
Home health care can be covered by Medicare if it meets the following criteria:Medicare Coverable Home Health ServicesIf the triggering conditions described above are met, the beneficiary is eligible for Medicare coverage of home health … [Read more...] about When Should Medicare Coverage be Available for Home Health Care?
Know Jimmo | Home Health Policy
Medicare Benefit Policy Manual, Chapter 7 – Home Health ServicesSection 20.1.2Coverage of skilled nursing or therapy to perform a maintenance program does not turn on the presence or absence of a patient’s potential for improvement from the … [Read more...] about Know Jimmo | Home Health Policy
Medicare Program Proposes to Increase Medicare Advantage Payment for 2025
On January 31, the Centers for Medicare & Medicaid Services (CMS) released an Advance Rate Notice proposing an overall pay increase to MA plans of 3.7% in 2025 (see CMS fact sheet here). According to CMS, “This is over a $16 billion increase in … [Read more...] about Medicare Program Proposes to Increase Medicare Advantage Payment for 2025
When Should Medicare Coverage be Available for Outpatient Therapy?
Physical, speech-language pathology, and occupational therapies can be covered by Medicare Part B if they meet the following criteria:Other Important Points: … [Read more...] about When Should Medicare Coverage be Available for Outpatient Therapy?