October 21, 2019 VIA ELECTRONIC SUBMISSION Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-9115-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 RE: CMS-R-131-Advance Beneficiary Notice of Noncoverage (ABN) Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid … Read more

November 27, 2017 Submitted Electronically to www.regulations.gov Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue SW Washington, D.C. 20201 Attn:   CMS-9930-P             NPRM Notice of Benefit and Payment Parameters for 2019 Thank you for the opportunity to comment on the proposed HHS … Read more

Beginning no later than March 8, 2017, and as required by the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act),[1] hospitals and critical access hospitals (CAHs) are required to give patients both oral and written notice when they are outpatients and not admitted as inpatients.[2]  Hospitals must use the written notice … Read more

Effective August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires acute care hospitals to provide oral and written notification to patients who are classified as outpatients or observation status patients for more than 24 hours.  Notice of non-inpatient status must be provided within 36 hours.  On August … Read more

An August 7, 2016 New York Times article once again highlighted the problem of hospital Observation Status, including issues with the NOTICE Act, which is supposed to help Medicare beneficiaries understand their status. The article, New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage, featured a Center For Medicare Advocacy client's story. In the piece, Center Executive Director Judith … Read more

Beginning August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires hospitals to provide written and oral notice, within 36 hours, to patients who are in observation or other outpatient status for more than 24 hours.  The notice must explain the reason that the patient is an outpatient … Read more

June 16, 2016 Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1655-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and … Read more

In proposed rules updating Medicare reimbursement to acute care hospitals,[1] the Centers for Medicare & Medicaid Services (CMS) announces how it intends to implement the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act).[2]  Effective August 6, 2016, the NOTICE Act requires that hospitals provide written and oral notice, within 36 hours, … Read more

As part of the Center’s ongoing project on approaches to improve nurse staffing levels in nursing facilities, this week we are posting a paper on “Increasing Reimbursement.”  This approach increases reimbursement to nursing facilities on the assumption and expectation that nursing facilities will use some of the increased reimbursement to increase their staffing levels.  This … Read more

January 4, 2016 Centers for Medicare & Medicaid Services Comments on NOTICE Act Submitted electronically: NOTICE_Act@cms.hhs.gov The Center for Medicare Advocacy (Center) is a national, private, non-profit law organization, founded in 1986, that provides education, analysis, advocacy, and legal assistance to help people nationwide, primarily older people and people with disabilities, to obtain necessary health … Read more

December 21, 2015 Acting Administrator Andy Slavitt Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-8016 RE: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017 [CMS–9937–P] Submitted electronically via www.regulations.gov Dear Acting Administrator Slavitt: The Center for Medicare Advocacy … Read more

Submitted electronically at http://www.regulations.gov December 15, 2015 CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention: CMS-10003/0938-0829, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850 Re:      Comments on CMS-10003 Notice of Denial of Medical Coverage (or Payment) To Whom It May Concern: The Center for Medicare Advocacy (the Center) greatly appreciates … Read more

The Centers for Medicare & Medicaid Services (CMS) hosted a Tele Town Hall on December 21, 2015 to solicit comments on the Notice of Observation Treatment and Implications for Care Eligibility (NOTICE) Act, Public Law 114-42.  Beginning in August 2016, the NOTICE Act requires hospitals to inform patients who are hospitalized for more than 24 … 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

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

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

August 16, 2012 On June 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal No.R2480CP, which updates its instructions on the issuance of the Advance Beneficiary Notice (ABN), Form CMS-R-131.[1]  The changes are effective on September 4, 2012.[2]  The new transmittal is part of an ongoing effort by CMS to provide additional … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, April 9, 2012– 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 1050263# NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. ______________________________________________ Welcome and Housekeeping  (David Lipschutz, CMA, Moderator) Presentation: Challenging Notices of … Read more

On March 7, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the redesign of the Medicare Summary Notice (MSN), the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits.  The Medicare Summary Notice (MSN) generally sets out what Medicare has or hasn't covered, provides information about a beneficiary's payment … Read more

Medicare's limitation on liability (LOL) protections[1] apply when a provider believes that an otherwise covered Medicare item or service will be denied because the item or service is not reasonable and necessary[2] or is for custodial care.[3] In order to shift liability to the beneficiary, a provider is required to notify a beneficiary in advance … Read more

Effective January 1, 2012, Medicare Part D plan enrollees who are unable to obtain a prescription drug at the pharmacy are now, in most instances, entitled to a written notice explaining how they can contact their Part D plan in order to initiate an appeal.  On February 2, 2012, CMS announced that the final model … Read more

The Center is concerned about the use of MSNs that do not reveal to beneficiaries that their service was denied based on a National Coverage Determination.  Such an MSN will instead provide a misleading explanation, such as "Medicare does not cover this service," or "information provided does not support the need for this service." If … Read more

On April 4, 2011, the Center for Medicare Advocacy (the Center) filed comments on a proposal by the Centers for Medicare & Medicaid Services (CMS) to establish a new condition of Medicare participation (CoP) for certain Medicare service providers.  These providers would be required to give Medicare beneficiaries notice of the right to seek review … Read more

The Center is concerned about the use of MSNs that do not reveal to beneficiaries that their service was denied based on a National Coverage Determination.  Such an MSN will instead provide a misleading explanation, such as "Medicare does not cover this service," or "information provided does not support the need for this service." If … Read more

Starting July 1, 2007, hospitals participating in the traditional or Medicare Advantage Medicare program must provide beneficiaries with a new notice of discharge and appeal rights, as discussed in last week’s Weekly Alert. This Weekly Alert describes the new notice as well as beneficiary rights to question and appeal hospital discharge decisions and to receive … Read more

The Health Care Financing Administration (HCFA) has made revisions to its Important Message from Medicare notice which all beneficiaries receive upon admission to the hospital and again at the time that the hospital establishes a discharge date. There are two forms of the notice, with essentially the same text: one for fee-for-service beneficiaries and one … Read more

As the nation and the world brace for our collective struggle with the novel coronavirus named COVID-19, things are changing rapidly as society adjusts to our new “normal.” Congress continues to explore legislative solutions, including for affected workers. The Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS), … Read more

COVID-19 and Medicare – Where We Stand Today (3/19/2020) The Coronavirus and Nursing Home Residents Restrictions on Family Caregivers Raise Concerns about Unmet Care Needs In Nursing Homes Elder Justice Newsletter – New Issue Available Now Register Now – Upcoming CMA Events Register for the VIRTUAL  National Voices of Medicare Summit and Senator Jay Rockefeller Lecture … Read more

On March 13, 2020, the Centers for Medicare & Medicaid Services (CMS) issued guidance to nursing homes on COVID-19 (coronavirus). CMS is directing nursing homes to restrict all visitors and non-essential health care workers from entering facilities, except in end-of-life and other compassionate care situations. While COVID-19 presents significant danger to vulnerable nursing home residents, … Read more

Fact-Checking the State of the Union Speech Regarding Health Care Medicare Oral Health Care Update Administration Encourages States to Block Grant Medicaid Center Submits Comments Opposing Social Security Administration Proposal to Increase Frequency of Disability Benefit Reviews  Free Webinar: Medicare Home Health Coverage Fact-Checking the State of the Union Speech Regarding Health Care Earlier this … Read more

The Center for Medicare Advocacy (“Center”) and California Health Advocates (“CHA”) submitted joint comments in opposition to a proposed Social Security Administration (SSA) rule to increase the frequency of continuing disability reviews (CDRs) (see Notice of Proposed Rulemaking on Rules Regarding the Frequency and Notice of Continuing Disability Reviews, 84 Fed. Reg. 36588 (November 18, … Read more

CMS Continues to Downplay Medicare Plan Finder Problems and Availability of Special Enrollment Period Medicare Advantage Marketing Matters: Case Study Center for Medicare Advocacy Supports Supreme Court Review of ACA-Repeal Lawsuit ALS Activist Steve Gleason Receives Congressional Gold Medal  CMS Continues to Downplay Medicare Plan Finder Problems and Availability of Special Enrollment Period The Annual … Read more

The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – ended on December 7, 2019.  As discussed in previous CMA Alerts, there were a number of factors impacting the 2019 ACEP that made enrollment decisions even more challenging this past fall. Complicating … Read more

Center for Medicare Advocacy Wishes All the Best to Rep. John Lewis  Center for Medicare Advocacy Submits Comments Center for Medicare Advocacy Wishes All the Best to Rep. John Lewis On December 29, 2019 Representative John Lewis (D-GA, 05) announced that he will be undergoing treatment for stage IV pancreatic cancer. In a press release, … Read more

The Center for Medicare Advocacy submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) public comment period regarding Tennessee’s section 1115 waiver application. Regrettably the Tennessee waiver proposal seeks to transform the State’s Medicaid program (TennCare) into a block grant. The Center expressed opposition to this proposal, as it would fundamentally … Read more

What does Medicare cover? When does Medicare cover skilled nursing facility care? Can a patient who is receiving non-skilled “custodial” services receive Medicare coverage in a SNF? What are examples of skilled services in a SNF? Are there any tools for comparing nursing facilities? For further information, follow one of the links below or scroll … Read more

CMA Alert – November 27, 2019

Time for Medicare Enrollment – Time to Talk Turkey! Reminder – You CAN Leave the Nursing Home for the Holidays Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care Thank You! Time for Medicare Enrollment – Time to Talk Turkey! Medicare Fall Open Enrollment continues through December 7 — so you still … Read more

Time for Medicare Enrollment – Time to Talk Turkey!

From the Center for Medicare Advocacy and the Medicare Rights Center: Medicare Fall Open Enrollment continues through December 7 — so you still have time to make certain changes to your coverage, including switching prescription drug plans or between traditional (sometimes called Original) Medicare and Medicare Advantage (MA). As friends and families around the country … Read more

November, 2019 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can … Read more

(The views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy.) I. ENROLLMENT PERIOD UPDATES Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – ends on December 7th.  As discussed … Read more

Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay Two Weeks Left in Medicare Enrollment Period Medicare Advantage Plans Impede Access to Care: Case Study #2 Issue Alert – Medicare Benefit Periods Under PDPM Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay Late November begins a time for … Read more

Medicare is Being Privatized. Where is the Outcry? Medicare Advantage Plans Impede Access to Care: Case Study #1 Support for Medicare Oral Health Benefits 2020 Medicare Cost-Sharing Rates Released Medicare is Being Privatized. Where is the Outcry? For years, the Center for Medicare Advocacy has warned of wasteful overspending on private Medicare Advantage (MA) plans, … Read more

For years, the Center for Medicare Advocacy has warned of wasteful overspending on private Medicare Advantage (MA) plans, the limitations on access to physicians and health care provided by MA, and the difficulties in obtaining the same coverage from the plans as is available in real Medicare. (See Case Study below.) Despite these efforts, Medicare … Read more

Medicare Enrollment and Medicare Advantage Updates CMS Administrator Seema Verma Testifies on Health Care Sabotage Before House Subcommittee Center Attorneys Participate in Oral Health Convening and Advocacy Day Nursing Home Compare’s Abuse Icon is Now Live Center for Medicare Advocacy Submits Comments Supporting Modification to ABN Instructions FREE WEBINAR: Register now for Coordination of Benefits … Read more

On October 21, 2019, The Center for Medicare Advocacy submitted comments in support of a Centers for Medicare & Medicaid Services (CMS) proposal to modify the instructions to the Advance Beneficiary Notice of Noncoverage (ABN). The change would make it clear that providers may not bill dually eligible beneficiaries before their claim has gone through … Read more

On October 22, the Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare launched the second annual Medicare Fully Informed Project, with a variety of unbiased, accurate, up-to-date, and comprehensive information about the full range of Medicare coverage options. The Medicare Fully Informed Project includes an array of tools to … Read more

Background The United States District Court for the District of Vermont approved a settlement agreement in Jimmo v. Sebelius[1] on January 23, 2013. The Jimmo Settlement required the Centers for Medicare & Medicaid Services (CMS) to confirm that Medicare coverage of skilled nursing facility, home health, and outpatient therapy services must be determined on the … Read more

Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO).[1] Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are … Read more

September 15, 2019 Administrator Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-3347-P P.O. Box 8010 Baltimore, MD 21244-1850 Re: CMS-3374-P; Federal Register, Vol. 84, No. 138 (July 18, 2019) Submitted electronically: www.regulations.gov Dear Administrator Verma: The Center for Medicare Advocacy and the Long Term Care Community Coalition … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. 1. UPCOMING ANNUAL COORDINATED ELECTION PERIOD (ACEP) Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – will start … Read more