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Medicare & Oral Health Updates (Wey-Wey Kwok and Kata Kertesz) Medically Necessary Coverage Adding a Comprehensive Benefit to Medicare Policy Updates Durable Medical Equipment (Kathy Holt) Nursing Facilities (Toby Edelman and Dara Valanejad) Prescription Drugs (David Lipschutz) Health Reform (David Lipschutz) Medicare for All Hearing, other updates Litigation Update (Ali Bers) General Medicare Q&A/Wrap Up … Read more

1. MEDICARE & ORAL HEALTH UPDATES Medically Necessary Coverage The Center for Medicare Advocacy has long advocated for coverage of medically necessary oral health care, which is currently supported by the Medicare statue, but is, unfortunately, significantly limited in practice due to CMS policy. Denying Medicare coverage to people for medically essential care, simply because … Read more

The Center for Medicare Advocacy is pleased to share a new opportunity for advocates working to add a comprehensive oral health benefit to Medicare. The Oral Health Progress Equity Network (OPEN), a national network of individuals and organizations that believe oral health is essential to overall health and wellbeing, is organizing across the country to ensure that … Read more

Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Kaiser Family Foundation recently released an issue brief, Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries that examines the state of oral health for Medicare beneficiaries, including use of dental services and out-of-pocket spending. Medicare currently does not cover routine dental care, and … Read more

This week Center for Medicare Advocacy Policy Attorney Kata Kertesz presented a webinar together with Justice in Aging regarding Medicare Basics for OPEN, the Oral Health Progress and Equity Network. OPEN is a national network of individuals and organizations that believe oral health is essential to overall health and wellbeing.  OPEN is organizing across the … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations for Medicare, now and in the future, is the need to expand and Improve Medicare for all current and future beneficiaries, not just those in private Medicare plans. One of the key issues faced by beneficiaries … Read more

One of the Center for Medicare Advocacy’s top priorities is to expand Medicare coverage to include oral and dental care for all beneficiaries. We have also long advocated for coverage of medically necessary oral health care, which is currently supported by the Medicare statue but is significantly limited in practice due to Medicare policy. In the … Read more

The following is the Center for Medicare Advocacy’s legal analysis and does not represent the federal Medicare agency’s (CMS') position or interpretation of its dental coverage policy. Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history, Centers for Medicare and Medicaid Services (CMS) policy, and precedent established … Read more

Note: The memo below is the slightly edited version used by the coaltion of by a coalition of organizations seeking to expand Medicare coverage for medically necessary dental therapies. Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history, Centers for Medicare and Medicaid Services (CMS) policy, and … Read more

We need your help getting Members of Congress to sign on to letters asking CMS to provide Medicare coverage for medically necessary dental care, as authorized by law. Right now there is an opportunity to encourage your delegation to sign on to these letters. Call (202) 224-3121 to be connected with your Senators and Representative. … Read more

FOR IMMEDIATE RELEASE Contact: Matthew Shepard (mshepard@medicareadvocacy.org) 202-293-5760 July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written … Read more

CMA Alert – Center Comments on “Junk Plans;” Report Examines Oral Health; Observation Status in the News

The Sabotage of Health Care Continues – Center Comments on "Junk Plans" State of Decay: Report Examines Oral Health for Older Americans NPR Observation Status Story: How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars The Sabotage of Health Care Continues – Center Comments on "Junk Plans" p>This week, the Center working with other … Read more

Oral Health America (OHA) recently published the fourth volume in a series of reports titled A State of Decay, surveying the state of oral health for older Americans.  The first volume in the series focused on the cost of services and financial reimbursement rates as the primary barrier to accessing oral healthcare.  Since then, the … Read more

A recent Washington Post article, “The Painful Truth About Teeth: You Can Work Full Time But not have the Money to Fix Your Teeth – Visible Reminders of the Divide Between Rich and Poor” outlines the devastating impacts of the lack of adequate oral health care in the country. As Congress considers drastic cuts to … Read more

Medicare Oral Health News: District Court in Lodge Cautions Against Strict Application of Same Time/Same Dentist Rule

Henry Lodge was diagnosed with life-threatening head and neck squamous cell cancer in 1996.  His treatment involved radical dissection of his neck, implantation of radioactive seeds in the base of his tongue, and 30 days of direct beam radiation.  The surgery and the scarring from radiation permanently impaired his ability to speak and swallow, and … Read more

Justice in Aging, one of the Center's longtime partners, recently released an issue brief, Oral Health in California: What About Older Adults? The Issue Brief includes a summary of the state of oral health for older adults in California. It cites disparities in oral health based on income level, education and race. The Brief also outlines the … Read more

As part of the Center for Medicare Advocacy’s commitment to improving oral health for older people and people with disabilities, Center attorneys recently attended a DentaQuest convening in Cambridge, Massachusetts aimed at unifying partners in this common mission. The convening focused on leadership strategies, shared network goals and collaborative work in social justice.  The Center’s … Read more

“Dental care has been the most frustrating part of being a senior, and has the most to do with maintaining health in general.” – Michael Allen, California “This is a very important issue, the ability to eat is vital to a person[‘s] health, at age 71 I needed new dentures and I had no coverage, … Read more

Oral Health America recently released a report, A State of Decay, a state-by-state ranking of healthcare delivery and public health factors that affect the oral health of older adults. Some of the Report’s Findings 76% or 38 states earned a Composite Score of Fair (22%) or Poor (54%); Ten states received a Composite Score of … Read more

On May 5, 2016 Center for Medicare Advocacy executive director Judith Stein and Senior Attorney Wey-Wey Kwok, the Dental Lifeline Network, the Medicare Rights Center, and former CMS (then HCFA) administrator Bruce Vladeck, met with CMS officials to discuss coverage of medically necessary oral health care. The group’s primary goal was to advance Medicare coverage … Read more

Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history and, in some instances, even CMS policy.  For this purpose, “medically necessary oral health care” refers to treatment deemed necessary by a physician when a patient’s medical condition or treatment is or will likely be complicated by an … Read more

MEDICARE’S COVERAGE OF ORAL HEALTH   Current Centers for Medicare & Medicaid Services (CMS) policy[1] broadly bars Medicare coverage for practically all dental services.  The Center for Medicare Advocacy firmly believes that CMS has the legal authority under the Medicare statute to cover medically necessary oral health care – that is, treatment deemed necessary by … Read more

​Welcome and Housekeeping  (David Lipschutz, Moderator)  Medicare’s Coverage of Oral Health (Wey-Wey Kwok)  Medically necessary oral health care Goal: add a comprehensive oral health benefit to Medicare Administrative Update    Proposed Rules Part B Drug Demonstration (David Lipschutz) Hospital Payment Rule and the NOTICE Act (Toby Edelman) Concerns about notice to be given to those … Read more

Sign our petition to remind CMS that Medicare should cover medically necessary oral health care. Medicare was created to help older people and people with disabilities.  It should not deny clinically essential or life-saving treatments simply because those treatments occur within the mouth. The Medicare statute does not prohibit coverage for non-routine dental or oral procedures … Read more

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Are Dental Services Covered Under Medicare? Increasing the Possibility of Coverage Additional Resources Why We Need Medicare Coverage of Dental Services – Beneficiary Comments Community Statement on Oral Health Articles and Updates Legal Memorandum: Statutory Authority Exists for Medicare to Cover Medically Necessary Oral Health Care The following is the Center for Medicare Advocacy’s legal analysis and … Read more

By Judith Stein, Executive Director, Center for Medicare Advocacy When Medicare was enacted in 1965, over half of people over 65 had no health insurance. The fact that Medicare provided affordable, basic health insurance was a huge boon for older Americans and their families. (People with disabilities were added to the program in 1972.)  However, … Read more

The landmark Affordable Care Act (ACA) included an anti-discrimination provision – the Health Care Rights Law – otherwise known as Section 1557.  This provision prohibits discrimination by certain health programs or facilities on the basis of race, color, national origin, sex, age or disability. Unfortunately, the Trump Administration recently released a proposed rule (not yet … Read more

The Problem Mrs. B contacted the Center for Medicare Advocacy seeking assistance with Medicare home health coverage. She lives with her husband who has advanced Parkinson’s disease. He receives physical therapy and speech language pathology through a Medicare-certified home health agency, but the agency told Mr. and Mrs. B they are “over Medicare’s income limit … Read more

WHAT IS NEEDED TO QUALIFY FOR  MEDICARE HOME HEALTH COVERAGE? The patient must be homebound. (This does not mean the patient can never leave home. For example, patients can leave home occasionally, go to adult day care, religious services, medical appointments, special occasions); The patient must require skilled nursing on an intermittent basis (from once … Read more

Center Comments on Harmful Proposed Home Health Rule Health Care Sabotage Continues: New Pre-Existing Conditions Legislation Not What It Seems; GAO Critical of HHS ACA Enrollment Actions Re-Review of Some Home Health Denials Now Available Center Comments on Harmful Proposed Home Health Rule The Center for Medicare Advocacy (the Center) submitted comments to the Centers … Read more

New Legislation Dealing with Pre-existing Conditions is Not What it Seems Last week Sen. Thom Tillis (R-NC) and others introduced the Ensuring Coverage for Patients with Pre-Existing Conditions Act. This bill would amend the Health Insurance Portability and Accountability Act to supposedly guarantee the availability of health coverage. The sponsors of the legislation claim that … Read more

Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans Home Health Highlight: People Can Leave Home and Still Receive Medicare-Covered Home Care CMS Tries Again: Another New Skilled Nursing Facility Medicare Reimbursement System Proposed – If Implemented, Would Gut Therapy Health Care Sabotage: More on Short-Term Limited-Duration “Junk” Plans _ Free Webinar Series Next Webinar: … Read more

CMA Alert – Home Health Care Barriers; Overuse of Antipsychotic Drugs; More

Barriers to Home Care Created by CMS Payment, Quality Measurement, and Fraud Investigation Systems Elder Justice Alert: Human Rights Watch Publishes In-Depth Report on Antipsychotic Drug Use in U.S. Nursing Homes Consumer Statement on New Federal Landmark Study on “Critical Incidents” in Assisted Living Barriers to Home Care Created by CMS Payment, Quality Measurement, and … Read more

CMA Alert – SNF Enforcement Halted; Know Your Medicare Appeals; Ultimate Health Care Sabotage; More

This Week In Health Care Sabotage New Fact Sheet – Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights CMS Halts Enforcement, as Requested by the Nursing Home Industry This Week In Health Care Sabotage Medicare Enrollment Periods Medicare Open Enrollment Ends Tomorrow, December 7. There is only one day left … Read more

CMA Alert – Changes to Help QMBs; Home Health Updates; ACA Sabotage

CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed CMS Reissues Improved Medicare Home Health Booklet Dispelling a Myth: Medicare Home Health Coverage is NOT a Short Term, Post-Acute Care Benefit The ACA Sabotage Continues CMS Changes Will Help Ensure Low Income Beneficiaries Are Not Illegally Billed The Centers for Medicare and … Read more

September 25, 2017 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1672-P P.O. Box 8016 Baltimore, Maryland  21244-8016 Submitted electronically to: http://www.regulations.gov Re:      Federal Register Volume 82 No. 144 Medicare and Medicaid Programs: CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology … Read more

As Medicare’s Anniversary Approaches, the Fight for Health Care Continues Beware of a New Social Security Scam As Medicare’s Anniversary Approaches, the Fight for Health Care Continues On July 30, Medicare will turn 52 years old.  As we honor this program that provides stable coverage to over 57 million older adults and individuals with disabilities, … Read more

I. HEALTH REFORM: UPDATE Overview On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill then moved on the Senate, and was reintroduced, with some minor changes, as the Better Care Reconciliation Act of 2017 (BCRA). Both AHCA and BCRA would cause substantial … Read more

Congress is on recess, but we can’t be – the health care repeal debate continues!  In their home states and through tough, ongoing negotiations, Senators are making up their minds about the future of the ACA, Medicaid, and Medicare.  This CMA Alert provides updated “Myths & Facts” about the most recent potential changes to the … Read more

This is Part Four of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

May 25, 2017 – WASHINGTON, DC. – Health care coverage through the Affordable Care Act (ACA), Medicare and Medicaid is under assault. The Congressional Budget Office finally released its estimate regarding the devastating impact of the AHCA bill that passed the House earlier this month. Now a select group of Senators is considering its own … Read more

Statement from the Center for Medicare Advocacy and Executive Director Judith Stein: Health Care is Under Assault – CBO Score for AHCA, Trump Budget and ACA Sabotage

May 25, 2017 – WASHINGTON, DC. – Health care coverage through the Affordable Care Act (ACA), Medicare and Medicaid is under assault. The Congressional Budget Office finally released its estimate regarding the devastating impact of the AHCA bill that passed the House earlier this month. Now a select group of Senators is considering its own … Read more

HEALTH REFORM: HOUSE PASSES AMERICAN HEALTH CARE ACT (AHCA) On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill will now be taken up by the Senate. American Health Care Act (AHCA): Impact on the Affordable Care Act, Medicare and Medicaid The … Read more

LITIGATION UPDATE Barrows v. Price (formerly Bagnall v. Sebelius, Barrows v. Burwell), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a proposed class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more

On November 3, 2015, the Centers for Medicare & Medicaid Services (CMS), published in the Federal Register (80 Fed. Reg. 68126), proposed revisions to requirements for discharge planning for hospitals, CAHs, and HHAs. The proposed rule is also available at http://www.gpo.gov/fdsys/pkg/FR-2015-11-03/pdf/2015-27840.pdf.  Comments on the proposed rule must be submitted to CMS by 5 p.m. on … Read more

September 1, 2015 SUBMITTED ELECTRONICALLY http://www.regulations.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201 Re: CMS-1625-P Dear Acting Administrator Slavitt: The Center for Medicare Advocacy (the Center) is pleased to provide comments on the Centers for Medicare & Medicaid Services … 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

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

On July 11, 2014, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the 2015 calendar year.  Among these proposed rules, CMS adds four additions to covered telehealth services: psychoanalysis and psychotherapy (including family psychotherapy with and without the patient present), prolonged outpatient services such as evaluation and management, and annual … Read more