RSS

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

All Competitive Bid Program Contracts Ended on December 31, 2018. What Beneficiaries Should Know: Equipment in process under the 13 month capped rental program should continue “business as usual”. While providers who do not accept Medicare assignment cannot charge more than 15% higher than Medicare’s allowed charge. There is no such restriction (no limiting charge) … Read more

Annual Enrollment has ended, but the Medicare Advantage Open Enrollment Period, allowing plan changes or a return to traditional Medicare continues through March 31 – Make sure you are fully informed about the Medicare that is right for you. When? January 1–March 31 What Can I Do? If you’re in a Medicare Advantage Plan (with … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations for Medicare, now and in the future, is the need to expand and Improve Medicare for all current and future beneficiaries, not just those in private Medicare plans. One of the key issues faced by beneficiaries … Read more

The Center for Medicare Advocacy is thrilled to announce that Judy Feder has been elected President of our Board of Directors. Ms. Feder is a professor of public policy and, from 1999 to 2008, served as dean of what is now the McCourt School of Public Policy at Georgetown University. A nationally-recognized leader in health … Read more

States Whose Nursing Facilities Employ Few Registered Nurses Are More Likely To Be Penalized for Readmissions of Their Residents to Hospitals In 2014, as part of the Protecting Access to Medicare Act, Congress created the Skilled Nursing Facility Value-Based Purchasing Program, whose financial incentives are intended to reduce rehospitaliations of nursing home residents.  In December … Read more

The Center for Medicare Advocacy’s comprehensive Medicare Handbook is now available from Wolters Kluwer. The Medicare Handbook is a complete resource for attorneys, advocates, policy experts and health care providers.  It is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by the experts at the Center for Medicare Advocacy, it addresses issues … Read more

The Center for Medicare Advocacy, the Long Term Care Community Coalition, the National Consumer Voice for Quality Long-Term Care, Justice in Aging, and California Advocates for Nursing Home Reform recently submitted a briefing to members of Congress addressing ongoing concerns regarding the health and safety of nursing home residents. The Nursing Home Reform Law requires … 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

On July 10, 2018, the President signed an Executive Order undermining the impartial hiring of Medicare Administrative law Judges (ALJs). The Order states that “conditions of good administration make necessary an exception to the competitive hiring rules and examinations for the position of ALJ.”  What this means is that ALJs will now be hired directly … Read more

The Nursing Home Reform Law (1987) established the federal standards for nurse staffing in nursing facilities: registered nurses eight consecutive hours per day; licensed nurses 24 hours per day; and “sufficient” nursing staff to meet residents’ needs.[1] Most nursing facilities do not have sufficient numbers of nurses to provide the care that residents need.  The … Read more

The Medicare program has excluded coverage for hearing aids and related audiology services since its implementation in 1965, despite documented risks associated with untreated hearing loss and links to other chronic conditions. While the Over-the-Counter Hearing Aid Act of 2017 will soon allow access to hearing aids for mild-to-moderate hearing loss without the services of … Read more

One of the Center for Medicare Advocacy’s top priorities is to expand Medicare coverage to include oral and dental care for all beneficiaries. We have also long advocated for coverage of medically necessary oral health care, which is currently supported by the Medicare statue but is significantly limited in practice due to Medicare policy. In the … 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 reduce ongoing barriers to coverage and care. One of the key issues impeding access to Medicare coverage is the continued, and … Read more

The following is the Center for Medicare Advocacy’s legal analysis and does not represent the federal Medicare agency’s (CMS') position or interpretation of its dental coverage policy. Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history, Centers for Medicare and Medicaid Services (CMS) policy, and precedent established … Read more

January 2019 – The nursing home industry is facing tremendous turmoil because some operators are undertaking risky financial deals in an attempt to squeeze out larger profits from their nursing homes, even when these deals could potentially harm residents. The recent collapse of several nursing home chains around the country also raises serious concerns about … Read more

– Join us for Our Medicare Home Health Webinar · January 23 at 3pm EST– Guest Speaker: Physical Therapist Cindy Krafft, PT, MS Last week, 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, … Read more

Core Considerations for Today & Tomorrow The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to: Improve Medicare for current and future beneficiaries. Support the development of … Read more

The Center for Medicare Advocacy and the Medicare Rights Center recently issued a joint statement on the misguided decision of a federal court in Texas against the Affordable Care Act (ACA). If this decision stands, all of the ACA’s coverage and consumer protections will be null and void. People with pre-existing conditions and those who … Read more

There are only two days left to get covered! Consumers have until December 15th to obtain health insurance through the Affordable Care Act (ACA) Marketplace. Those who need coverage should visit www.healthcare.gov to shop, compare and find a plan that meets their needs. It is important to keep in mind that ACA plans prohibit annual … Read more

Legislation supported by Center for Medicare Advocacy, Patients for Affordable Drugs Now, Families USA, Consumer Reports, and Public Citizen. In a statement released today, U.S. Senators Richard Blumenthal (D-CT), Kamala Harris (D-CA), Jeff Merkley (D-OR), and Amy Klobuchar (D-MN) announced the introduction of the Curbing Unreasonable Rises and Excessively (CURE) High Drug Prices Act “to … Read more

Under longstanding immigration policy, to be considered a “public charge” one must be likely to become primarily dependent on the government to meet basic needs. As it now stands, receiving government-issued financial assistance benefits such as Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI), or long-term care benefits through Medicaid, may cause … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for outpatient therapy based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for outpatient therapy and emphasizes language from the Jimmo Settlement Agreement. Per the Settlement, the … 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 to nursing home … Read more

With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare providers, contractors, and adjudicators apply the correct legal standard to Medicare coverage and payment determinations – as required by the Jimmo v. Sebelius Settlement Agreement. The Jimmo Settlement means that Medicare coverage and … Read more

As reported widely, including in The New York Times,[1] the Trump Administration spent this Medicare Annual Enrollment Period steering beneficiaries towards private Medicare Advantage (MA) plans. While CMS contests this conclusion, Administrator Verma stated they are “unleashing and strengthening” Medicare Advantage[2] and HHS Secretary Azar says he sees Medicare Advantage as the future of Medicare: … Read more

Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories In Her Own Words: A Beneficiary's Take On Medicare Advantage Steering Health Care Sabotage: Administration Doubles Down on States’ Ability to Undermine ACA Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories The Medicare … Read more

We have previously written about new guidance from the Administration that will make it easier for states to both ignore Affordable Care Act (ACA) coverage and consumer protection rules, and weaken the ACA Marketplace. Last week, the Centers for Medicare & Medicaid Services (CMS) issued waiver concepts about how states can implement the new guidance. … Read more

Dear CMA, I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services. I have become increasingly troubled by the targeted ads to seniors on TV … Read more

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the … Read more

The Medicare Annual Coordinated Election Period (ACEP), ends this week – December 7, 2018.  As we near the end of the ACEP, consumer advocates remain concerned that the information put out by the Medicare program regarding coverage options is incomplete and continues to promote certain options over others. There’s still time to decide which Medicare … Read more

As we approach the final week of the Medicare Annual Coordinated Election Period (ACEP), individuals continue to make decisions about how they want to access their Medicare benefits in 2019.  Consumer advocates are concerned, however, that the information put out by the Medicare program about coverage options is incomplete and continues to promote one option … Read more

The November 2018 New England Journal of Medicine features a article by KFF’s Tricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation (KFF) that “examine[s] the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality. They also highlight areas where more evidence … Read more

There is not much time left to obtain health insurance from the Affordable Care Act (ACA) Marketplace during this year's Open Enrollment period. Consumers who need coverage should visit www.healthcare.gov to shop, compare and find a plan that meets their needs. Consumers should act quickly.  Not only has this year’s Open Enrollment period been shortened … Read more

State Attorneys General are successfully litigating issues of key importance to nursing home residents, including insufficient nurse staffing levels and inappropriate transfers or discharges of residents. This Alert discusses two cases: the Pennsylvania Attorney General’s challenge to inadequate staffing levels by a national chain and the Maryland Attorney General’s challenge to a state chain’s transfer … Read more

The Jeffrey P. Ossen Foundation and the Center for Medicare Advocacy have joined forces to advance access to Medicare and necessary home and community-based care. The two organizations are partnering to provide education and advocacy throughout the greater Windham area to help providers, discharge planners, and families understand and access Medicare-covered home health and community-based … Read more

On September 20, 2018, CMS issued a notice of proposed rulemaking (NPRM) to revise the emergency preparedness program requirements. Most notably, the proposed rule would allow nursing homes to review their emergency preparedness programs and to train staff to carry out those plans every two years rather than annually. The HHS Office of the Inspector … Read more

Concerned that Medicare beneficiaries could reject proper consideration of Medigap supplement plans because of undefined and significantly high costs listed in an “Estimated Annual Cost” column for Medigaps in the Medicare.gov CMS Plan Finder tool, the Center for Medicare Advocacy (the Center) requested CMS define costs that are included in the “Estimated Annual Cost” column. … Read more

As families across the country prepare to gather with loved ones for the Thanksgiving holiday, lawmakers in Washington are preparing for the post-election ‘lame duck’ session, which could bring opportunities to protect and strengthen Medicare. This and every Thanksgiving, we are thankful for Medicare. Tell your lawmakers why you are too, and ask them to … Read more