In order to manage costs, Medicare Advantage (MA) plans are able to restrict their enrollees to a contracted network of health care providers that is “sufficient to provide access to covered services to meet the needs of the population served.”* Some … [Read more...] about Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
Article
Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
An examination of 2019 Medicare cost reports finds that nursing facilities spent more of their revenue on administration, capital, other, and profits (34%) than on nursing (27%). “United States’ Nursing Home Finances: Spending, Profitability, and … [Read more...] about Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing
In “A Look at Nursing Facility Characteristics Between 2015 and 2023,” KFF reports that between 2015 and 2023, the hours of nursing care provided to residents in nursing facilities declined by 9% (from 4.13 hours per resident day (HPRD) in 2015 to … [Read more...] about KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing
Center for Medicare Advocacy Submits Comment on Proposed 2025 Medicare Advantage and Part D Rule
On January 5, 2024, the Center submitted comments to a proposed rule for Medicare Advantage (MA) and Part D issued by the Centers for Medicare & Medicaid Services (CMS) titled: Medicare Program; Contract Year 2025 Policy and Technical Changes to … [Read more...] about Center for Medicare Advocacy Submits Comment on Proposed 2025 Medicare Advantage and Part D Rule
Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options
Building on several recent studies that have found massive overpayments to Medicare Advantage (MA) plans, the Center for Medicare Advocacy released a report outlining how policymakers can look to utilize cost savings by reining in overpayments to … [Read more...] about Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options
Know Jimmo | It’s about the Care
Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Services can be skilled and covered when:CMS revised Medicare policy manuals, guidelines, instructions to reflect these … [Read more...] about Know Jimmo | It’s about the Care
Know Jimmo | No Improvement Needed
The Jimmo Settlement, approved by the federal district court in 2013, confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement; and that Medicare covers skilled care to … [Read more...] about Know Jimmo | No Improvement Needed
New Medicare Drug Provisions Now in Effect – Including Out-of-Pocket Changes
The Inflation Reduction Act of 2022 (IRA), signed into law by President Biden on August 16, 2022, has already provided cost-savings for Medicare beneficiaries through provisions that took effect last year in 2023, including a monthly cap of $35 for … [Read more...] about New Medicare Drug Provisions Now in Effect – Including Out-of-Pocket Changes
Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through March 31st
People who began 2024 enrolled in a Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D prescription drug plan during the first 3 months of the … [Read more...] about Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through March 31st
A Poster Child for Meaningful, Corporate-Wide Enforcement of Nursing Facilities
Late on the afternoon of December 15, 2023, Northview Village Nursing Home, the largest nursing facility in St. Louis, Missouri, abruptly closed, moving all 170 remaining residents overnight to 14 other nursing facilities in Missouri and Illinois … [Read more...] about A Poster Child for Meaningful, Corporate-Wide Enforcement of Nursing Facilities