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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.

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  • Welcome and Housekeeping  (David Lipschutz, CMA, Moderator)
  • Presentation: Challenging Notices of Involuntary Discharge (Veronica E. Williams, Estate and Elder Law Attorney, and Alfred J. Chiplin, Senior Policy Attorney, CMA)
    • Clients are being discharged involuntarily and often without adequate notice or planning by hospitals, nursing facilities and home health agencies. Some are encountering the imposition of emergency guardianships even when competent and engaged family members are present. Challenging such discharges is essential, including working with hospitals and other entities toward more appropriate discharge and discharge planning practices.  Receiving adequate notice (orally and in writing) of a proposed discharge from any care setting is critical to advocacy on behalf of Medicare beneficiaries who are faced with a discharge, particularly if the client feels that the discharge is inappropriate for any reason.  Similarly, good discharge planning on the part of patients, their families, and their healthcare providers paves the way to successful transitions from one care setting to anther and should go hand in hand. 
  • Current Issues: Have You Run Into This …?
    • New Face to Face Requirements for Home Health under Medicare
      • Are your clients being denied access to Medicare’s home health benefit for lack of recent face to face encounter with a physician?
      • The Center is aware of problems accessing the home health care benefit where the face to face requirement, which is a payment issue, has not been met.  Problems are emerging because of CMS’ interpretation of documentation requirements and home health agencies’ inability or unwillingness to comply with the face to face documentation requirements outlined in 42 CFR §424.22(a)(1)(v)
    • Medicare Denials of Skilled Nursing Facility (SNF) stays because a patient who was not Medicare eligible during the prior 3-day hospital stay becomes Medicare eligible during post-hospital SNF stay
      • The Medicare statute does not require that a patient be Medicare eligible during the qualifying 3-day hospital for Medicare to cover the subsequent SNF stay. Such a restrictive requirement, however, is found in the regulations (42 CFR §409.30(a))
      • Please let us know if you have clients affected by this issue
  • Legislative Update  (David Lipschutz, CMA)
    • House Republican Budget (Ryan Plan)
  • Litigation Update   (Gill Deford, CMA)
    • Affordable Care Act challenges in Supreme Court
    • Jimmo (Improvement)
    • Bagnall (Observation) [Ali Bers, CMA]
    • Other litigation
    • Inpatient Rehabilitation Hospitals and the Three-Hour Rule (of Thumb)
  • General Medicare Q&A* (Moderator)
  • Wrap-up  (Moderator)
  • Issue Briefs on Center’s Website
  • Searchable Database
  • Next Call

REMINDER: The Center for Medicare Advocacy’s on-line Medicare Decision database and other information are available at:

  • https://www.medicareadvocacy.org/ALJDecisions/ALJSearch.asp.
  • https://www.medicareadvocacy.org/Projects/AdvocatesAlliance/AdvocatesAlliance.IssueBriefs.htm. 

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