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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

The U.S. Senate Committee on Finance held a hearing on nursing home resident abuse and neglect on March 6, 2019. The Senate Finance Committee did not invite a single consumer advocate to testify before the Committee, although a nursing home industry representative did participate in the hearing. As a result, the Center for Medicare Advocacy … 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

The Long Term Care Community Coalition (LTCCC), a non-profit consumer advocacy organization headquartered in New York, has published a report examining the federal requirements and key practices for addressing nursing home resident abuse, neglect, and crime. The report, Addressing Abuse, Neglect, and Suspicion of a Crime Against Nursing Home Residents, is free and available on … Read more

Nursing homes can be penalized through the imposition of a civil money penalty (CMP) for either the number of days that the facility has not been in compliance with a federal requirement (per-day) or for each instance of noncompliance (per-instance). Responding to requests from the nursing home industry, the Trump Administration rolled back previous guidelines … Read more

Washington, DC ─ The President’s annual budget request is a statement of values. It is incredibly troubling then, that President Trump’s budget blueprint for FY 2020, submitted this week, again prioritizes deep cuts to programs on which older adults and people with disabilities rely, including Medicare, Medicaid, and the Affordable Care Act. The President’s FY 2020 … Read more

The son of a hospitalized patient recently called the Center for Medicare Advocacy. His father was ready for discharge. Physicians at both the hospital and the inpatient rehabilitation hospital (IRH) agreed that the patient would benefit from IRH services. However, the patient’s Medicare Advantage (MA) plan refused to authorize IRH care.  The plan instead said … Read more

Medicare requires a three-day inpatient hospital stay in order to qualify for care at a skilled nursing facility. Sadly, and all too often however, beneficiaries are classified as hospital outpatients on observation status. While outpatients on observation status and inpatients may receive the same care and services, for the same number of days or weeks, … Read more

(The Content below is taken from the Centers for Medicare & medicaid Services: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html) Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Certain drugs can be infused in the home, but the nature of the home setting presents different challenges than [other settings]. The components … Read more

On March 6, 2019, the U.S. Senate Committee on Finance held a hearing entitled “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes.” The hearing consisted of two panels of witnesses. The first panel included Patricia Blank (daughter of a nursing home neglect victim), Maya Fischer (daughter of a nursing home rape victim), … Read more

Recent OMHA statistics show that beneficiaries[1] currently wait an average of 60 days[2] to obtain an Administrative Law Judge (ALJ) hearing and receive a decision. In contrast, non-beneficiaries (providers, suppliers, state Medicaid agencies, and others) wait an average of 1,303 days (over 3.5 years) to obtain an ALJ decision.[3] The much shorter average wait time … Read more

On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of its draft 2020 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that want to participate in Medicare in the following calendar year. In collaboration with several … Read more

On March 6, 2019, the House Committee on Education and Labor voted in favor of the Raise the Wage Act of 2019 (H.R. 582). The bill would raise the federal minimum wage to $15 an hour over five years, after which the minimum wage will be indexed to median wages. The bill is now headed … Read more

To the Editor: “Nursing Homes Are Closing Across Rural America, Scattering Residents” (Mar. 4, 2019) describes the closure of Mobridge, South Dakota’s sole nursing home and the transfer of residents to distant communities.  It suggests that low Medicaid payments were the cause of the closure.  Unfortunately, the Times story leaves out an important part of … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to end ongoing barriers to care. One of the most common barriers about which the Center receives inquiries is the continued overuse … Read more

The Settlement Agreement in Jimmo v. Sebelius, No. 5:11-CV-17 (D. VT), was approved by a federal district court in January 2013. The Centers for Medicare & Medicaid Services (CMS) was required to confirm that Medicare coverage is determined by a beneficiary’s need for skilled care and is not based on a beneficiary’s potential for improvement. … Read more

As we have reported in the past, the ability to get Medicare-covered home health aide care has greatly declined in recent years. This is true even when individuals meet the law’s homebound and skilled care requirements – and thus qualify for coverage. Sadly, and incorrectly, Medicare beneficiaries are often told the only aide care they … 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

The Center for Medicare Advocacy is pleased to announce that Cathy Hurwit has joined our Advisory Board. Ms. Hurwit recently retired as Chief of Staff to Representative Jan Schakowsky (D-IL), where she also had responsibility for universal health care, senior and labor issues. Prior to joining Rep. Schakowsky’s staff in January 1999, she was a … Read more

The Administration for Community Living (ACL) recently released their annual summary of minority aging statistics, the 2017 Minority Aging Statistical Profiles and Profile of Older Americans. The summaries provide statistics on older adults within the African American, American Indian and Alaska Native, Asian American, and Hispanic American populations. The summaries are compiled primarily with data … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more

The Office of Medicare Hearings and Appeals (OMHA) is the agency that administers the Administrative Law Judge (ALJ) hearing program for Medicare Parts A, B, C and D appeals. OMHA has a Case Processing Manual that sets out day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives. Importantly … Read more

In cooperation with states, the Centers for Medicare & Medicaid Services (CMS) regularly identifies a subset of nursing facilities, generally one to two facilities per state, that are among the most poorly performing facilities in the country. These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more

While the President’s State of the Union Address was short on substance concerning health care, he did mention a desire to work with Congress to “lower the cost of health care and prescription drugs.” While the President focused on “global freeloading” there is one common sense solution that would make drugs more affordable for individuals, … Read more

Medicare Savings Programs (MSP) offer assistance with meeting the costs of Medicare premiums and deductibles. The MSPs include the Qualified Medicare Beneficiary program (QMB), Specified Low-Income Medicare Beneficiary program (SLMB), and Qualified Individual program (QI).  All of these help Medicare beneficiaries of modest means pay all or some of Medicare’s cost sharing amounts (ie. premiums, … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more

The Center for Medicare Advocacy recently submitted comments to a Notice of Proposed Rulemaking issued by the Centers for Medicare & Medicaid Services (CMS) entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses” (CMS-4180-P).  The Center’s comments are available at: https://www.medicareadvocacy.org/center-comments-on-modernizing-part-d-and-medicare-advantage/.   Currently, Part D prescription drug plans (PDPs) … Read more

On January 29, 2019, the Senate and House held separate hearings on prescription drug prices. The Senate Finance Committee’s hearing, Drug Pricing in America: A Prescription for Change, Part 1, explored the rising cost of prescription drugs and potential solutions to the ongoing crisis. In his opening testimony, Ranking Member Ron Wyden stated that “[m]ore … Read more

The Centers for Medicare & Medicaid Services (CMS) has released a free mobile app for iOS and Android users. The app, “What’s Covered,” is designed to provide Medicare beneficiaries and their families with a general overview of covered services, coverage requirements, costs, and additional information. While the app is geared towards beneficiaries in traditional Medicare, … Read more

We are only a few weeks into 2019 and the Administration is already busy sabotaging the Affordable Care Act (ACA). Last week, the Centers for Medicare & Medicaid Services (CMS) issued the 2020 Notice of Benefit and Payment Parameters rule. In one part of the rule, CMS seeks input on ending an ACA process called “silver … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more