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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

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

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

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

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

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

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

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 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

The Center seeks an attorney to practice in the Connecticut office. The attorney will be a member of the team that leads the organization’s high volume administrative law practice and individual legal advocacy. Among other things, the attorney will be expected to perform the following duties: Maintain and manage a large case load of Medicare … Read more

The Center seeks a paralegal for its Connecticut office.  The paralegal will be a member of the team that leads the organization’s high volume administrative law practice and individual advocacy.  Among other things, the paralegal will be expected to perform the following duties under the supervision of an attorney: Become familiar with the Medicare program … Read more

The Trump Administration solicited ideas for cutting nursing home standards of care[1] and has announced plans to publish new Requirements of Participation in order to reduce the burden on nursing facilities.[2] In October 2016, the Obama Administration revised these Requirements, which establish the standards of care for nursing facilities that receive public reimbursement from the … Read more

The facts are in: The ever-increasing use of observation status deprives many Medicare beneficiaries of care and coverage in skilled nursing facilities (SNFs).  In 2018, research by Avalere Health confirmed that the use of SNFs by beneficiaries in the traditional Medicare program declined each year between 2009 and 2016. Avalere identified the cause as “fewer … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare beneficiaries and their families respond to unfair Medicare denials for care at inpatient rehabilitation hospitals/facilities (IRH/F). The Fact Sheet outlines the coverage criteria for IRH/Fs and emphasizes language from the Jimmo Settlement Agreement. … Read more

Many nursing homes have closed in recent months throughout the country.  The nursing home industry instinctively claims that the cause is Medicaid rates that are low,[1] too low even to cover nursing home costs (See our joint letter, below). The New York Times’ recent article about the closure of a rural South Dakota nursing facility … Read more

Court Strikes Blow For Health Care Last week, a federal district court judge put a stop to another effort by the Administration to sabotage the Affordable Care Act (ACA). The judge’s ruling halts an attempt by the Department of Labor to expand Association Health Plans and weaken the ACA. In past Alerts, we have highlighted … 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

On November 28, 2019 – three years after the revised federal nursing home rules were issued – “Phase 3” requirements will go into effect. These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. This presentation will examine the Compliance and … Read more

The Center for Medicare Advocacy and the Medicare Rights Center joined to submit a letter to the New York Times refuting their recently published editorial regarding Medicare “reform.” See https://www.nytimes.com/2019/03/28/opinion/letters/medicare-trump-budget.html (the letter will also run in tomorrow’s print edition.)

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 to nursing home … Read more

A recently published study in The American Journal of Accountable Care finds that home health care may result in lower costs and a lower hospital readmission rate for Medicare beneficiaries after emergency room visits. The study, “Improved Cost and Utilization Among Medicare Beneficiaries Dispositioned From the ED to Receive Home Health Care Compared With Inpatient … Read more

A group of physicians has challenged a recent audit report from the Inspector General for the Department of Health & Human Services[1] that concluded that between 2013 and 2015 Medicare incorrectly paid $84.2 million for skilled nursing facility (SNF) stays for beneficiaries who had not had a prior three-day qualifying inpatient hospital stay.[2] Like the … Read more

— Statement from the Medicare Rights Center and Center for Medicare Advocacy — Washington, DC – This week, the Department of Justice took a new, more extreme position in a federal case challenging the constitutionality of the Affordable Care Act (ACA), agreeing with a federal district court in Texas that the entire law should be … Read more

re: “Not all Medicare Cuts Are bad” (https://www.nytimes.com/2019/03/25/opinion/trump-medicare-cuts.html?smid=tw-nytopinion&smtyp=cur) To the Editor: Our organizations agree that conserving Medicare resources to preserve the program for generations to come is an important goal. But we cannot support a budget that impedes access to care — and the President’s budget would do just that. Among the problematic Medicare provisions are … Read more