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On October 17, 2019, the House Ways & Means Committee held a hearing entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-of-Pocket Costs, and Improving Medicare Benefits.”  The hearing focused on H.R. 3, the Lower Drug Costs Now Act (discussed in a previous Alert), as well as current gaps in Medicare … Read more

On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled … Read more

Background When the Centers for Medicare & Medicaid Services (CMS) launched a national campaign to reduce the off-label prescribing of antipsychotic drugs for nursing home residents in 2012, Avanir Pharmaceuticals directed its sales force to talk to nursing facilities about using Nuedexta as a substitute for antipsychotic drugs. The Food and Drug Administration had approved … Read more

Last week federal judges in several states issued temporary injunctions against the Trump administration’s “public charge” rule, preventing it from taking effect. The rule was set to take effect this week. The “Public Charge” final rule, which was posted on August 14, 2019 to the Federal Register, amended Department of Homeland Security (DHS) regulations regarding how an … Read more

October 16, 2019 Richard Neal Chairman Ways and Means Committee United States House of Representatives Washington, DC 20515 Kevin Brady Ranking Member Ways and Means Committee United States House of Representatives Washington, DC 20515         Re: Support for H.R. 3 and Reinvestment of Savings in Medicare Program Dear Chairman Neal and Ranking … Read more

The Annual Coordinated Election Period (ACEP), between October 15th and December 7th, is the time period during which Medicare beneficiaries can make coverage elections effective January 1st (this period is often referred to as the Open Enrollment period). As discussed in previous Alerts here and here, advocates have been concerned about a number of factors … Read more

Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO).[1] Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are … Read more

The Long Term Care Community Coalition is hosting a webinar on Medicare’s new payment system for skilled nursing facilities, Patient-Driven Payment Model (PDPM) on Tuesday, October 15, 2019, at 1:00 p.m.  The Center for Medicare Advocacy’s Senior Policy Attorney Toby S. Edelman will discuss how the new system works and what it means for residents. … Read more

The Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Part A reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM), on October 1, 2019.[1] Therapists immediately began reporting that nursing homes and therapy companies were laying them off and demanding that they change their therapy practices, shifting residents from … Read more

Joint alert from the Center for Medicare Advocacy and the Long Term Care Community Coalition. New Icon On October 7, 2019, the Centers for Medicare & Medicaid Services (CMS) announced changes to Nursing Home Compare that make it easier for residents and families to identify facilities with a history of resident abuse, neglect, or exploitation. … Read more

The Patient Driven Payment Model is Here What Does It Mean For Residents? On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) began implementing a new payment system for Medicare-covered nursing home care. The payment system is called the “Patient Driven Payment Model” (PDPM). PDPM creates a new set of financial incentives … Read more

This week Rep. Brad Schneider (D-IL) introduced a House companion to the Senate Medicare Extra Rx HELP Act (S. 691, H.R. 4583) introduced by Sen. Bob Casey (D-PA) in March 2019.  The bill would expand Part D Low Income Subsidy/ Extra Help by eliminating the asset test, streamlining program administration, and providing full benefits to those living on the … Read more

As noted in a press release issued by Rep. Rosa DeLauro’s office, on September 30, 2019, members of Connecticut’s congressional delegation sent a letter to the President of Anthem Blue Cross Blue Shield to “express our concern regarding the recently announced provider terminations from Anthem Blue Cross and Blue Shield’s (Anthem) Medicare Advantage (MA) network … Read more

​​​​​Free Webinar – Register Now: Medicare for People with Paralysis As part of our 2019-2020 webinar series, the Center for Medicare Advocacy is honored to partner with the Christopher and Dana Reeve Foundation to present Medicare for People with Paralysis.  Understanding Medicare is important to those who currently qualify for health coverage through Medicare, or … Read more

As discussed in a recent CMA Alert, the Center or Medicare Advocacy joined Medicare Rights Center, Justice in Aging and National Council on Aging in writing to the Administrator of the Centers for Medicare & Medicaid Services (CMS) to express concerns about the roll-out of the updated Medicare Plan Finder (MPF), publicly released on August … Read more

On September 19, 2019, Representative Frank Pallone, Jr., Chairman of the U.S. House Committee on Energy & Commerce, introduced the Lower Drug Costs Now Act (H.R. 3). As noted in The New York Times, the bill addresses the problem of skyrocketing prescription drugs costs. In a press release, Speaker Nancy Pelosi stated that “[t]he soaring … Read more

In his September 16, 2019 comments on the Administration’s proposed revisions to the nursing facility Requirements of Participation, California State Attorney General Xavier Becerra writes that the proposed rule violates the 1987 federal Nursing Home Reform Law, the Social Security Act, the Affordable Care Act, and the Administrative Procedures Act. Beccera describes the proposed changes … Read more

On September 20, 2019, the U.S. House of Representatives passed the Forced Arbitration Injustice Repeal (FAIR) Act. The FAIR Act prohibits pre-dispute arbitration agreements in consumer, employment, antitrust, and civil rights cases. The Act also prohibits any agreements or practices that interfere with an individual’s right to participate in joint, class, or collective action. Representative … Read more

Center for Medicare Advocacy Senior Policy Attorney Toby. S. Edelman has been selected to receive the   Janet Wells Public Policy Leadership Award from the National Consumer Voice for Quality Long-Term Care, the national non-profit long-term care advocacy organization. The Public Policy Leadership Award honors the tremendous contributions of an individual or organization to national long-term … Read more

Senator Sherrod Brown (D-OH) recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, urging the Administration “to be better stewards of taxpayer dollars and conduct sufficient oversight of Medicare Advantage plans, to ensure they are appropriately managing the health care needs of older Americans and people with disabilities” … Read more

Last week the New York Times reported even that while the number of Americans living in poverty has declined, the number of people without insurance has actually gone up. This is the first increase in the ranks of the uninsured since the Affordable Care Act (ACA) was enacted. The New York Times reported that “experts … Read more

On September 15, 2019, the Center for Medicare Advocacy (the Center) and the Long Term Care Community Coalition (LTCCC) submitted comments opposing the Trump Administration’s proposed rule to revise the nursing home Requirements of Participation. The proposed rule is the latest example of the Administration’s efforts to deregulate the nursing home industry. Among the changes, … Read more

As of September 16, 2019, nursing homes nationwide can begin asking residents (or their representatives) to sign a pre-dispute arbitration agreement. The Trump Administration reversed a previous prohibition on such agreements in a July 2019 final rule. Although there is ongoing legal action to overturn the Administration’s rule, implementation has not been delayed for the … Read more

The Centers for Medicare & Medicaid Services (CMS) recently posted the Medicare & You 2020 handbook on their website. The Center for Medicare Advocacy (the Center) reviewed the new handbook with an eye toward assessing the balance of information provided about traditional Medicare vs. Medicare Advantage (MA), and the accuracy of information regarding coverage. In … Read more

On September 10, 2019 the Census Bureau released the annual national-level income, poverty and health insurance statistics for 2018 in two reports, Income and Poverty in the United States: 2018 and Health Insurance Coverage in the United States: 2018. According to the reports, “the rate and number of people without health insurance increased from 7.9%, … Read more

On August 4, CMS Administrator Seema Verma tweeted that beneficiaries wanting Medicare to pay for their stay at a skilled nursing facility (SNF) should make sure they are first admitted to the hospital for at least three days.[1] Writing, “Govt doesn’t always make sense,” she concludes, “We’re listening to feedback.” Posted feedback supports addressing the … Read more

The Center for Medicare Advocacy (the Center), submitted comments this week regarding the 2020 proposed rules for Medicare home health care. The Center is pleased CMS plans to allow therapist assistants to perform maintenance therapy (therapist assistants are currently allowed to perform improvement therapy), recognizing equal coverage for beneficiaries who need safe and effective therapy … Read more

At the beginning of the current session of Congress, the Center for Medicare Advocacy laid out a Medicare Platform for the New Congress to guide improvements to Medicare and possible expansion of the Medicare-covered population. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve … Read more

According to a recent New York Times Article, “Home health care is the fastest growing major job category in the country, one of the most emotionally and personally demanding, and one of the worst paid.” Families – and state governments – are struggling with a growing demand for long-term services and supports (LTSS) such as … Read more

September 2019 Background Under the Trump Administration, the Centers for Medicare & Medicaid Services (CMS) has been advancing efforts to deregulate the nursing home industry by rolling back the rights and protections of nursing home residents. These efforts include reducing accountability for substandard care, such as by shifting the default financial penalty for the most … Read more

Background. Nursing homes administer antipsychotic drugs to approximately 20 percent of residents nationwide. Sadly, and too often, nursing homes use these drugs as a way of chemically restraining residents exhibiting the behavioral symptoms of dementia, despite the Food and Drug Administration’s (FDA) “black box” warning against using antipsychotic drugs on elderly patients with dementia. The … Read more

The Center for Medicare Advocacy is concerned that proposed home health rules will further steer home health agencies away from providing care for beneficiaries who need it the most and toward beneficiaries with short-term post-acute care needs.[1] Beginning in 2020, payments to home health agencies under the new model will provide higher payments for individuals … Read more

On August 27, 2019, the same day that the Centers for Medicare and Medicaid Services (CMS) debuted the updated Medicare Plan Finder (MPF) tool, four beneficiary advocacy organizations – the Center for Medicare Advocacy, Justice in Aging, Medicare Rights Center, and the National Council on Aging – sent a joint letter to CMS raising concerns … Read more

A new entry in the Health Affairs Blog, “Evaluating Medicare Programs Against Saving Taxpayer Dollars,” compares Medicare’s two payment programs that are paving the way to “value-based” care: the Medicare Shared Savings Program (MSSP) and Medicare Advantage (MA) program. They are both growing rapidly, the authors note, and, together, they comprise over half of Medicare … Read more

The Centers for Medicare & Medicaid Services (CMS) recently issued a notice of proposed rulemaking to roll back several nursing home standards of care. The Long Term Care Community Coalition (LTCCC) hosted a webinar on August 20, 2019, to help consumers understand the impact of these proposed changes. Dara Valanejad, a Policy Attorney at both … Read more

The Centers for Medicare & Medicaid Services (CMS) launched a “Patients over Paperwork” initiative in 2017 “to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience.”[1] Unfortunately, most of CMS’s efforts under this initiative focus on reducing so-called provider “burden” instead of improving beneficiary … Read more

Since 2011 the Center for Medicare Advocacy has been pursuing a nationwide class action lawsuit seeking an appeal for Medicare beneficiaries who are classified as hospital outpatients in observation status. (Alexander v. Azar, 3:11-cv-1703, U.S. District Court, Connecticut.) Co-counsels in the case are Wilson, Sonsini, Goodrich & Rosati and Justice in Aging. The Alexander trial … 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

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

                      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

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