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Author Archives: mshepard

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

The National Association of Insurance Commissioners Recognizes Maintenance Therapy, Bolstering the Jimmo Settlement Agreement Inadequate Personal Care at Home Increases Overall Medicare Costs The New York Times Reports On HUD-Backed Nursing Homes Center for Medicare Advocacy Submits Comments to House Ways & Means and Energy & Commerce Committees on Draft Part D Legislation The National … Read more

Nursing home financial arrangements are important issues of public policy. Failures by state and federal governments to ensure nursing home financial accountability and integrity have an increasingly devastating impact on nursing home residents and their families across the country. According to a recent report by The New York Times, the U.S. Department of Housing and … Read more

On May 23, 2019, Ways & Means Committee Chairman Richard E. Neal (D-MA) and Energy & Commerce Committee Chairman Frank Pallone, Jr. (D-NJ), along with Ranking Members Kevin Brady (R-TX) and Greg Walden (R-OR) announced a solicitation for comments on draft legislation to reform the Medicare Part D program that would establish an out-of-pocket cap … Read more

Medicare home health coverage plays a vital role in supporting the health, safety, and well-being of adults in need of community-based care. Unfortunately, the Center for Medicare Advocacy (the Center) regularly hears from Medicare beneficiaries and their families about their inability to access care, or the appropriate amount of care, despite meeting the necessary coverage … Read more

The National Association of Insurance Commissioners (NAIC) is a standard-setting and regulatory support organization governed by chief insurance regulators from across the country. NAIC’s website indicates that organizational members and its resources, “form the national system of state-based insurance regulation in the U.S.” One such resource is NAIC’s Glossary of Health Insurance and Medical Terms, … Read more

June 6, 2019 Via Electronic Submission to PartDImprovements@mail.house.gov The Honorable Richard Neal                             The Honorable Frank Pallone Chairman                                                    … Read more

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. This program is a federally mandated initiative to address persistent problems through enhanced oversight. Over an 18 to 24-month period, CMS expects SFFs to significantly … Read more

More Health Care Sabotage: “Censorship” of the Affordable Care Act Nursing Home Study Finds Discharges Linked to Medicare Copayments Senators Release Secret List of Poor Quality Nursing Homes Center for Medicare Advocacy Submits Comments to CMS about Direct Contracting, Geographic-Based Model Center Comments on Proposed Rule Regarding Medicare/Medicaid Interoperability More Health Care Sabotage: “Censorship” of … Read more

On June 3, 2019, The Center submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding interoperability in Medicare and Medicaid programs. In the comments, the Center expressed support for the Administration’s commitment to improving patient access to health information. However, we raised concerns about patient privacy created by increased data … Read more

The Affordable Care Act created the Centers for Medicare & Medicaid Innovations (CMMI), which is tasked with testing demonstration programs aimed at delivery system reform. As discussed in a previous Weekly Alert in May 2018, among the models being developed is a suite of “Direct Contracting Model Options” described on the CMMI website.  According to … Read more

At present, only 88 nursing facilities nationwide (0.6% of the nation’s total number of facilities) are identified as Special Focus Facilities (SFFs). The Centers for Medicare & Medicaid Services (CMS) describes SFFs as having “more problems” than other facilities, “more serious problems” than other facilities, and “[a] pattern of serious problems that has persisted over … Read more

    Background. Medicare beneficiaries are entitled to a maximum of 100 days of skilled nursing facility (SNF) care in a benefit period when they meet specific coverage criteria. However, Medicare Part A only covers the full cost of a beneficiary’s skilled care during the first 20 days of a nursing home stay. Starting on … Read more

A recent report by the Sunlight Foundation’s Web Integrity Project shows that the Administration removed 85 pages of information about the Affordable Care Act (ACA). According to the report, the removed information concerned “a wide range of information about programs offered, and rights guaranteed, under the ACA, and how the law affects coverage for a … Read more

May 30, 2019 Via Electronic Submission to DPC@cms.hhs.gov    Adam Boehler Director, Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services 200 Independence Ave, SW Washington, DC 20201 Re: Request for Information on Direct Contracting—Geographic Population-Based Payment Model Option Dear Director Boehler: The Center for Medicare Advocacy (Center) is pleased to provide … Read more

Trump Administration Proposes to Gut Health Care Rights, Particularly Targeting LGBTQ People Nursing Home Compare Inaccurately Reports Civil Money Penalties Imposed Against Nursing Facilities Nursing Homes, Medicaid Rates, and Campaign Contributions Trump Administration Proposes to Gut Health Care Rights, Particularly Targeting LGBTQ People The landmark Affordable Care Act (ACA) included an anti-discrimination provision – the … Read more

As part of its investigative series on nursing home care in Florida, Naples Daily News (part of the USA Today Network) reports that the new Medicaid reimbursement system for Florida’s nursing homes, scheduled for full implementation in 2023, will increase reimbursement for some of the state’s most poorly performing facilities by millions of dollars while … 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

Public information about enforcement actions imposed and upheld against nursing facilities is inaccurate and limited, or missing. The Center for Medicare Advocacy (the Center) analyzed whether the federal website Nursing Home Compare to determine if it accurately reports civil money penalties (CMPs) that were imposed against nursing facilities and upheld by Administrative Law Judges (ALJs).  … Read more

Congressional Hearing on Surprise Medical Bills; Center for Medicare Advocacy Submits Statement on Observation Status Report Highlights Overpayments to Medicare Advantage Plans and Raises Important Policy Considerations Webinar: Where Does the Money Go? Insights and Consumer Perspectives on Nursing Home Profits and Losses Elder Justice Newsletter – New Issue Available Now Congressional Hearing on Surprise Medical … 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

On May 21, 2019, the Long Term Care Community Coalition (LTCCC) hosted a webinar on nursing home profits and losses. Dara Valanejad, a Policy Attorney with both the Center for Medicare Advocacy and LTCCC, participated in the webinar. Mr. Valanejad presented findings from the Medicare Payment Advisory Commission’s March 2019 report to Congress, discussed how … Read more

The Kaiser Family Foundation (KFF) recently released a report entitled “Do People Who Sign Up for Medicare Advantage Plans Have Lower Medicare Spending?” (May 2019). As summarized in the report, “Even after risk adjustment, the results indicate that beneficiaries who choose Medicare Advantage have lower Medicare spending – before they enroll in Medicare Advantage plans … Read more

“Protecting Patients from Surprise Medical Bills” – a hearing held on May 21 by the House Ways and Means’ Subcommittee on Health – considered the bills for health care services that patients get after they received care from health care providers who were not in the patients’ health insurance network.[1] Typically, patients receive these bills … Read more

On May 9, 2019, the Center for Medicare Advocacy held its sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The theme of the day was Health Care as a Human Right: Medicare’s Role in Making it a Reality. The Summit convened advocates, leading experts, and policy-makers to discuss … Read more

The Center for Medicare Advocacy mourns the sudden and awful loss of Robert Pear. Robert was an extraordinary reporter – dogged, determined, prepared. He knew more, asked more, and honored his sources. He wrote beautifully, with integrity and intelligence. No bravado.  We will miss his voice. 

Last year, New Jersey-based Skyline Healthcare abandoned more than 100 nursing facilities nationwide, forcing multiple states to seek receiverships in court in order to protect residents and make sure they received food, medications, and care.[1] States had allowed Skyline to take over the facilities, many from the nursing home chain Golden Living, even as Skyline’s … Read more

With more and more patients quickly discharged from acute care hospitals to skilled nursing facilities (SNFs), SNF residents are more clinically complex than ever. Despite the fact that residents have greater health care needs, federal standards for professional staffing at SNFs have not changed in more than 30 years. The consequences are dire. The Inspector … 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

(Due) 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: … Read more

Special Update Issue Brief: Medicare Coverage of Dental Services One of the core considerations of the Center for Medicare Advocacy’s Medicare Platform is to expand Medicare coverage to include oral health and dental care for all beneficiaries. We have also long advocated for coverage of medically necessary oral health care, which we think is currently supported … Read more

One of the core considerations of the Center for Medicare Advocacy’s Medicare Platform is to expand Medicare coverage to include oral health and dental care for all beneficiaries. We have also long advocated for coverage of medically necessary oral health care, which we think is currently supported by the Medicare statue but is, unfortunately, significantly limited … Read more

A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Medicare Coverage for Genetic Tests: Know the Facts A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing … Read more

Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing public awareness of the importance of access to health coverage and accompanying patient protections. Recognition of the important role of the ACA and Medicare, and growing support for Medicaid, have combined to shape public support for expanding health coverage, instead … Read more

Medicare typically covers genetic tests only when a beneficiary has signs or symptoms that can be further clarified by diagnostic testing. Medicare also covers some genetic tests that assess an individual’s ability to metabolize certain drugs. The only screening test Medicare will cover (once every three years) is to determine if a beneficiary has colorectal … Read more

The Problem Mr. Jones tripped and fell on his driveway, fracturing his cheek and jaw, tearing the musculature, and crushing several teeth.  He was stabilized in the emergency room on the day of the accident, but in the days that followed he required assessments and procedures to repair damage and restore function to his face … Read more

Medicare Trustees Issue 2019 Report: Medicare is Not Going Broke Article Raises Concerns about Medicare Advantage and Calls Attention to Limited Medigap Access CMS Proposed Rule to Redefine Group Therapy in Skilled Nursing Facilities: Concern for Resident Care CMS Expands List of DMEPOS Subject to Prior Authorization as a Condition of Payment Only a few … Read more

Earlier this week, the Medicare Trustees issued their 2019 annual report, which offers projections concerning the fiscal health of the Medicare and Social Security programs.  The Medicare Trustees estimate that the Part A Hospital Trust Fund will be depleted by 2026, unchanged from last year’s projection. As noted in the Report, income to the Part … Read more

A recent Bloomberg News article highlighted an important issue for Medicare beneficiaries: limited access to Medigap plans. The Center for Medicare Advocacy has long advocated for improved access to Medigap plans for all Medicare beneficiaries. Medigap plans are private plans that provide supplemental health insurance for beneficiaries in Traditional Medicare to assist with out-of-pocket medical … Read more

On April 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking (NPRM) on fiscal year 2020 payment and policy changes for Medicare-certified skilled nursing facilities. Most notably, the proposed rule projects an $887 million increase in aggregate payments to SNFs and revises the definition of group therapy to … Read more

CMS has announced updates to its list of items of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) that will require prior authorization as a condition of payment. These new items will join 33 types of power wheelchairs that currently require prior authorization, bringing the list of DMEPOS that will require prior authorization to 45 … Read more

The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations Latest Issue: Elder Justice: What “No Harm” Really Means … Read more

The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018.[1] As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available … Read more

Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care … Read more

                      GAO Findings. Federal law requires state survey agencies to investigate allegations of resident abuse and neglect stemming from complaints and facility-reported incidents. About three-quarters of all abuse violations nationwide stem from these investigations. Unfortunately, a recently published management report by the U.S. Government Accountability … 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