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Author Archives: mshepard

Support Traditional Medicare by Leveling the Playing Field with Medicare Advantage Administration’s “Public Charge” Rule Would Result in Millions Losing Access to Health Care and Other Necessary Services Center Submits Comments Opposing Proposed Changes to Nondiscrimination Rule Center Submits Comments on the “Patients over Paperwork” Initiative CMA Webinar Schedule for 2019-2020 Support Traditional Medicare by … Read more

The Center has previously written about how legislative and regulatory policy changes are tipping the scales in favor of Medicare Advantage (MA) over traditional Medicare. For example, coverage expansions such as the ability to provide new supplemental benefits have been advanced in MA but not in traditional Medicare. In recent years, this has been exacerbated … Read more

On August 14, 2019, the Department of Homeland Security (DHS) posted a final rule to the Federal Register that amends DHS regulations regarding how an application for legal immigration into this country will be assessed, expanding the government’s ability to deny entry based on the possible future use of services like Medicaid. The “Public Charge” … Read more

On August 13, 2019 the Center for Medicare Advocacy submitted comments on the Centers for Medicare & Medicaid Services’ (“CMS”) Notice of Proposed Rulemaking on Nondiscrimination in Health and Health Education Programs or Activities. The Center expressed strong opposition to the NPRM provisions that seek to eliminate and limit the Health Care Rights Law’s protections … Read more

On August 12, 2019 the Center for Medicare Advocacy submitted comments on the Centers for Medicare & Medicaid Services’ (“CMS”) request for information (“RFI”) regarding reducing administrative burden through the Patients over Paperwork initiative. The RFI sought information on how CMS could simplify and reduce paperwork burdens, including methods to modify and streamline reporting and … Read more

August 13, 2019 VIA ELECTRONIC SUBMISSION Secretary Alex Azar U.S. Department of Health and Human Services Herbert H. Humphrey Building, Room 509F 200 Independence Avenue SW Washington, DC 20201 RE: Docket ID HHS-OCR-2019-0007, RIN 0945-AA11, Nondiscrimination in Health and Health Education Programs or Activities Dear Secretary Azar: The Center for Medicare Advocacy (“Center”) appreciates the … Read more

August 12, 2019 SUBMITTED ELECTRONICALLY VIA www.regulations.gov Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Re:       CMS-6082-NC; Request for Information: Reducing Administrative Burden to Put Patients over Paperwork Dear Administrator Verma: The Center for Medicare Advocacy (“Center”) appreciates the opportunity to comment on … Read more

CMS Administrator Acknowledges that Prior Inpatient Hospital Rules Do Not Make Sense Government Watchdog Report Outlines Problems with Current Medicare Plan Finder As New Version Awaits Debut Short-term Health Plans: Goldmines for Insurance Companies, Junk for Enrollees Annual Surveys at Nursing Facilities Are Essential To Protect Residents CMA Webinar Schedule for 2019-2020 CMS Administrator Acknowledges … Read more

In late July 2019, the General Accounting Office (GAO) issued a report entitled “Medicare Plan Finder: Usability Problems and Incomplete Information Create Challenges for Beneficiaries Comparing Coverage Options” (GAO-19-627). In short, according to the Report, “[t]he Medicare Plan Finder (MPF) website—a primary resource for comparing Medicare coverage options—is difficult for beneficiaries to use and provides … Read more

For decades, the nursing home industry has proposed relaxing the requirement for annual surveys at nursing facilities.[1]  Industry representatives argue that surveyors should excuse “good” facilities from annual surveys and focus their attention on poorly-performing facilities. The argument’s superficial appeal fails with scrutiny. First, how would we identify “good” facilities? As the Government Accountability Office … Read more

A Modern Healthcare article about the National Association of Insurance Commissioners’ 2018 Accident and Health Policy Report, reports that short-term health plans, greatly encouraged by the current administration, offer little coverage for enrollees. The article reports that the average amount spent per dollar of premium paid by the five insurers bringing in the most premiums … Read more

Medicare requires beneficiaries to have a three-day inpatient hospital stay in order to qualify for skilled nursing facility (SNF) care. Unfortunately, too many beneficiaries continue to be classified as hospital outpatients on observation status, thereby eliminating their ability to receive Medicare-covered SNF care. In a recent Tweet, Centers for Medicare & Medicaid Services (CMS) Administrator … Read more

Skilled Nursing Facility Updates Wednesday, September 18, 2019 3:00 PM – 4:00 PM EDT Presenters: Center for Medicare Advocacy Senior Policy Attorney Toby Edelman, Policy Attorney Dara Valanejad, and guest. Medicare for People with Paralysis – Sponsored by the Christopher & Dana Reeve Foundation Wednesday, October 2, 2019 3:00 PM – 4:30 PM EDT Presenters: … Read more

CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good for Residents Federal Reports Find Incidents of Nursing Home Resident Abuse Are on the Rise but also Underreported Self-Help Resources for Improvement Standard Denials – August, 2019 CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good … Read more

                      Joint statement from the Center for Medicare Advocacy and the Long Term Care Community Coalition. On July 23, 2019, the U.S. Government Accountability Office (GAO) published a report on nursing home resident abuse, Improved Oversight Needed to Better Protect Residents from Abuse. The GAO … Read more

Although the revised Requirements of Participation published in October 2016[1] have not yet been fully implemented, the Centers for Medicare & Medicaid Services (CMS) published proposed rules on July 18, 2019 to revise them and also to make changes in survey and enforcement rules.[2]  CMS contends that its proposals are intended to “promote efficiency and … Read more

Medicare coverage of skilled nursing and/or therapy services depends on a beneficiary’s need for the skilled care, not on the individual’s potential for improvement. The Settlement Agreement in Jimmo v. Sebelius, approved by a federal district court in 2013, required the Centers for Medicare & Medicaid Services (CMS) to confirm that coverage of skilled nursing … Read more

Part D Legislation Markup Today: Improve Beneficiary Appeals CMS Releases Special Focus Facility Candidate List But Transparency Issues Remain Senate Finance Committee Holds Hearing on Nursing Home Issues Private Medicare Advantage Plans Overbill Medicare Part D Legislation Markup Today: Improve Beneficiary Appeals On Tuesday, July 23, the Senate Finance Committee released draft drug pricing legislation, … Read more

This week the CT Mirror published a Kaiser Health News article about overpayments to private Medicare plans. The article, originally titled “Insurers Running Medicare Advantage Plans Overbill Taxpayers By Billions As Feds Struggle To Stop It” underscores the need for improved oversight and enforcement of Medicare Advantage plans. According to the Kaiser Health News article, … Read more

On July 23, 2019, the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,”[1] following its March 6 hearing “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes.”[2]  The Center for Medicare Advocacy is pleased that the July 23 hearing included a national advocate … Read more

PROMOTING ELDER JUSTICE: A CALL FOR REFORM HEARING BEFORE THE U.S. SENATE COMMITTEE ON FINANCE July 23, 2019 Statement of Toby S. Edelman Senior Policy Attorney Center for Medicare Advocacy 1025 Connecticut Avenue, N.W., Suite 709 Washington, DC  20036 I am a Senior Policy Attorney in the Washington, D.C. office of the Center for Medicare … Read more

                      Background. Every month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing homes with an extremely poor record of resident care for inclusion in the Special Focus Facility (SFF) program for enhanced oversight. Due to limited resources, CMS currently caps the SFF program … Read more

On Tuesday, July 23, the Senate Finance Committee released draft drug pricing legislation, the Prescription Drug Pricing Reduction Act (PDPRA) of 2019. This sweeping bill would make a number of changes aimed at addressing the high and rising costs of prescription drug prices. However, the legislation currently does not contain important changes to the Medicare … Read more

Updates on the BENES Act and Part D Legislation Guest Speaker: Lindsey Copeland, Medicare Rights Center Overview of the Administration’s Rollback of Nursing Home Protections (Dara Valanejad) Update on Observation Status (Toby Edelman) Framing as a Surprise Billing Issue Litigation Update (Ali Bers) 5th Circuit Case Challenging ACA CMA Litigation General Medicare Q&A (David Lipschutz) … Read more

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. UPDATES on the BENES Act and PART D LEGISLATION Guest Speaker:  Lindsey Copeland from the Medicare Rights Center Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) Medicare Rights Center one-pager – https://www.medicarerights.org/pdf/2019-benes-act-factsheet-long.pdf Medicare Watch article, The BENES Act Advances in the House – https://blog.medicarerights.org/benes-act-advances-in-the-house/ Medicare Watch article, MedPAC Calls for Improvements in Medicare … 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

More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients CMS finalizes Rollback of Pre-Dispute Arbitration Protections Study Finds Home and Community-Based Services Access Disparities More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients Many Medicare hospital patients classified as observation status “outpatients” currently forego necessary skilled nursing … Read more

An article in the July 2019 issue of Health Affairs, “A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles,” relayed findings from a national study on home and community-based services (HCBS) use and outcomes among dual-eligible beneficiaries. The study found that the racial/ethnic disparities in access to high-quality institutional long-term … Read more

Many Medicare hospital patients classified as observation status “outpatients” currently forego necessary skilled nursing facility (SNF) care and head home to continue care through Medicare’s home health care benefit. This is because they lack a 3-day inpatient hospital stay, which is required for Medicare coverage of most beneficiaries’ post-acute care in a SNF.[1] Beginning January … Read more

                      In 2016, the Obama Administration promulgated regulations prohibiting pre-dispute arbitration agreements between nursing homes residents (or their representative) and facilities. On July 18, 2019, the Trump Administration published a Final Rule rolling back certain features of the 2016 resident protection. Most notably, the Final … Read more

Observation Status and Surprise Medical Bills Government Watchdog Agency Issues Report Highlighting “Significant Vulnerabilities” in Medicare’s Hospice Benefit Observation Status and Surprise Medical Bills The Center for Medicare Advocacy frequently hears from Medicare beneficiaries and their families about patients who receive treatment, tests, and services for multiple days while they are in a hospital bed … Read more

Following up on earlier work analyzing the Medicare hospice benefit, the Department of Health and Human Services (DHSS) Office of Inspector General (OIG) issued two reports this week “which found that from 2012 through 2016, the majority of U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they … Read more

The Center for Medicare Advocacy frequently hears from Medicare beneficiaries and their families about patients who receive treatment, tests, and services for multiple days while they are in a hospital bed but who are called “outpatients.” If these patients need post-hospital care in a skilled nursing facility (SNF), Medicare Part A will not pay for … Read more

Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now Nursing Home “Quality Measures” Do Not Reflect Quality of Nursing Home Care New Oral Health Advocacy Collaborative Begins Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now Oral argument in Texas v United States, the lawsuit … 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

The federal website for information about nursing homes, Nursing Home Compare,[1] reports information for each Medicare-certified and Medicaid-certified nursing facility in three categories – health inspections, staffing, and quality measures – as well as an overall score that combines the three domains. The health inspections domain reflects the findings of standard (annual) and complaint surveys … Read more

Oral argument in Texas v United States, the lawsuit seeking to dismantle the Affordable Care Act, will be held Tuesday July 9, 2019. At stake in this case is the health care of millions of Americans. The case will affect the entire health care system and every aspect of the Affordable Care Act, not just the much-discussed … Read more

Center for Medicare Advocacy Urges No Changes to Federal Poverty Measures without Knowing the Impact Ways & Means Committee Marks Up BENES Act and Other Medicare-Related Provisions Latest Issue – Elder Justice Newsletter In Case You Missed It – New Jimmo Improvement Standard Issue Brief Center for Medicare Advocacy Urges No Changes to Federal Poverty … Read more

In 2013, a federal district court approved a settlement agreement in Jimmo v. Sebelius, No. 5:11-CV-17 (D. VT). The Jimmo Settlement confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or therapy), not on the individual’s potential for improvement. The Jimmo Settlement and court decisions pertain to all … Read more

On June 21, 2019, the Center submitted comments to the Office of Management and Budget (OMB) on a proposal to change the method for calculating the annual adjustment of income measures such as the Official Poverty Measure (OPM). We strongly urged OMB not to make the proposed change without conducting extensive research and analysis on the … Read more

On June 25, 2019, the Center sent a letter to the House Ways and Means Committee, to thank the Committee for its work addressing important beneficiary-related issues in the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019, legislation that will assist individuals in making Medicare decisions as well as support low-income beneficiaries. In particular, … Read more

June 25, 2019 The Honorable Richard Neal, Chairman The Honorable Kevin Brady, Ranking Member House Ways and Means Committee Washington, DC 20515 Dear Chairman Neal, Ranking Member Brady: The Center for Medicare Advocacy (Center) applauds the committee for its work addressing important beneficiary-related issues in the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more

June 21, 2019 Nancy Potok Chief Statistician Office of Management and Budget 9257 New Executive Office Building 725 17th St. NW, Washington, DC 20006 Submitted via www.regulations.gov Re: Directive No. 14 Consumer Inflation Measures Produced by Federal Statistical Agencies (OMB–2019–0002) Dear Dr. Potok: The Center for Medicare Advocacy (Center) is pleased to provide comments to the Office … Read more

New Medicare Home Health Fact Sheet Special Report – “Graduates” From the Special Focus Facility Program Provide Poor Care Center for Medicare Advocacy Submits Joint Comments on Proposed Revisions to the Definition Of Group Therapy In Skilled Nursing Facilities New Medicare Home Health Fact Sheet One of the core considerations of the Center for Medicare … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies about 88 nursing facilities – generally one to two facilities per state – that are among the most poorly performing facilities in the country.[1] These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious problems” than other facilities, … Read more

One of the core considerations of the Center for Medicare Advocacy’s Medicare Platform is to reduce ongoing barriers to care. Home health is one area in particular where the Center has seen a disturbing increase in access issues. Advocates, policy-makers and CMS must all work to ensure access to home health coverage and care is … Read more

On April 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking that would revise the definition of group physical, speech and occupational therapy to allow six residents, rather than four, to participate in a group therapy session. If finalized, the rule would place even more nursing home residents … Read more

June 18, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1718-P P.O. Box 8016 Baltimore, MD 21244-8016 Re: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2020 Submitted electronically to: http://www.regulations.gov. … Read more