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Alexander v. Azar Trial Update – Seeking an Appeal of Outpatient Observation Status CMS Could Truly Put “Patients over Paperwork” By Fully Implementing the Jimmo Settlement Comparing Spending on Medicare Advantage vs. Accountable Care Organizations (ACOs) Recorded Webinar: Proposed Changes to Nursing Home Standards Alexander v. Azar Trial Update – Seeking an Appeal of Outpatient Observation Status … Read more

Support Traditional Medicare by Leveling the Playing Field with Medicare Advantage Administration’s “Public Charge” Rule Would Result in Millions Losing Access to Health Care and Other Necessary Services Center Submits Comments Opposing Proposed Changes to Nondiscrimination Rule Center Submits Comments on the “Patients over Paperwork” Initiative CMA Webinar Schedule for 2019-2020 Support Traditional Medicare by … Read more

August 13, 2019 VIA ELECTRONIC SUBMISSION Secretary Alex Azar U.S. Department of Health and Human Services Herbert H. Humphrey Building, Room 509F 200 Independence Avenue SW Washington, DC 20201 RE: Docket ID HHS-OCR-2019-0007, RIN 0945-AA11, Nondiscrimination in Health and Health Education Programs or Activities Dear Secretary Azar: The Center for Medicare Advocacy (“Center”) appreciates the … Read more

August 12, 2019 SUBMITTED ELECTRONICALLY VIA www.regulations.gov Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Re:       CMS-6082-NC; Request for Information: Reducing Administrative Burden to Put Patients over Paperwork Dear Administrator Verma: The Center for Medicare Advocacy (“Center”) appreciates the opportunity to comment on … Read more

CMS Administrator Acknowledges that Prior Inpatient Hospital Rules Do Not Make Sense Government Watchdog Report Outlines Problems with Current Medicare Plan Finder As New Version Awaits Debut Short-term Health Plans: Goldmines for Insurance Companies, Junk for Enrollees Annual Surveys at Nursing Facilities Are Essential To Protect Residents CMA Webinar Schedule for 2019-2020 CMS Administrator Acknowledges … Read more

CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good for Residents Federal Reports Find Incidents of Nursing Home Resident Abuse Are on the Rise but also Underreported Self-Help Resources for Improvement Standard Denials – August, 2019 CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good … Read more

Part D Legislation Markup Today: Improve Beneficiary Appeals CMS Releases Special Focus Facility Candidate List But Transparency Issues Remain Senate Finance Committee Holds Hearing on Nursing Home Issues Private Medicare Advantage Plans Overbill Medicare Part D Legislation Markup Today: Improve Beneficiary Appeals On Tuesday, July 23, the Senate Finance Committee released draft drug pricing legislation, … Read more

Updates on the BENES Act and Part D Legislation Guest Speaker: Lindsey Copeland, Medicare Rights Center Overview of the Administration’s Rollback of Nursing Home Protections (Dara Valanejad) Update on Observation Status (Toby Edelman) Framing as a Surprise Billing Issue Litigation Update (Ali Bers) 5th Circuit Case Challenging ACA CMA Litigation General Medicare Q&A (David Lipschutz) … Read more

1. UPDATES on the BENES Act and PART D LEGISLATION Guest Speaker:  Lindsey Copeland from the Medicare Rights Center Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) Medicare Rights Center one-pager – https://www.medicarerights.org/pdf/2019-benes-act-factsheet-long.pdf Medicare Watch article, The BENES Act Advances in the House – https://blog.medicarerights.org/benes-act-advances-in-the-house/ Medicare Watch article, MedPAC Calls for Improvements in Medicare … Read more

1. MEDICARE & ORAL HEALTH UPDATES Medically Necessary Coverage The Center for Medicare Advocacy has long advocated for coverage of medically necessary oral health care, which is currently supported by the Medicare statue, but is, unfortunately, significantly limited in practice due to CMS policy. Denying Medicare coverage to people for medically essential care, simply because … Read more

More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients CMS finalizes Rollback of Pre-Dispute Arbitration Protections Study Finds Home and Community-Based Services Access Disparities More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients Many Medicare hospital patients classified as observation status “outpatients” currently forego necessary skilled nursing … Read more

Observation Status and Surprise Medical Bills Government Watchdog Agency Issues Report Highlighting “Significant Vulnerabilities” in Medicare’s Hospice Benefit Observation Status and Surprise Medical Bills The Center for Medicare Advocacy frequently hears from Medicare beneficiaries and their families about patients who receive treatment, tests, and services for multiple days while they are in a hospital bed … Read more

Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now Nursing Home “Quality Measures” Do Not Reflect Quality of Nursing Home Care New Oral Health Advocacy Collaborative Begins Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now Oral argument in Texas v United States, the lawsuit … Read more

Center for Medicare Advocacy Urges No Changes to Federal Poverty Measures without Knowing the Impact Ways & Means Committee Marks Up BENES Act and Other Medicare-Related Provisions Latest Issue – Elder Justice Newsletter In Case You Missed It – New Jimmo Improvement Standard Issue Brief Center for Medicare Advocacy Urges No Changes to Federal Poverty … Read more

June 25, 2019 The Honorable Richard Neal, Chairman The Honorable Kevin Brady, Ranking Member House Ways and Means Committee Washington, DC 20515 Dear Chairman Neal, Ranking Member Brady: The Center for Medicare Advocacy (Center) applauds the committee for its work addressing important beneficiary-related issues in the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of … Read more

June 21, 2019 Nancy Potok Chief Statistician Office of Management and Budget 9257 New Executive Office Building 725 17th St. NW, Washington, DC 20006 Submitted via www.regulations.gov Re: Directive No. 14 Consumer Inflation Measures Produced by Federal Statistical Agencies (OMB–2019–0002) Dear Dr. Potok: The Center for Medicare Advocacy (Center) is pleased to provide comments to the Office … Read more

New Medicare Home Health Fact Sheet Special Report – “Graduates” From the Special Focus Facility Program Provide Poor Care Center for Medicare Advocacy Submits Joint Comments on Proposed Revisions to the Definition Of Group Therapy In Skilled Nursing Facilities New Medicare Home Health Fact Sheet One of the core considerations of the Center for Medicare … Read more

June 18, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1718-P P.O. Box 8016 Baltimore, MD 21244-8016 Re: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2020 Submitted electronically to: http://www.regulations.gov. … Read more

The National Association of Insurance Commissioners Recognizes Maintenance Therapy, Bolstering the Jimmo Settlement Agreement Inadequate Personal Care at Home Increases Overall Medicare Costs The New York Times Reports On HUD-Backed Nursing Homes Center for Medicare Advocacy Submits Comments to House Ways & Means and Energy & Commerce Committees on Draft Part D Legislation The National … Read more

June 6, 2019 Via Electronic Submission to PartDImprovements@mail.house.gov The Honorable Richard Neal                             The Honorable Frank Pallone Chairman                                                    … Read more

More Health Care Sabotage: “Censorship” of the Affordable Care Act Nursing Home Study Finds Discharges Linked to Medicare Copayments Senators Release Secret List of Poor Quality Nursing Homes Center for Medicare Advocacy Submits Comments to CMS about Direct Contracting, Geographic-Based Model Center Comments on Proposed Rule Regarding Medicare/Medicaid Interoperability More Health Care Sabotage: “Censorship” of … Read more

May 30, 2019 Via Electronic Submission to DPC@cms.hhs.gov    Adam Boehler Director, Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services 200 Independence Ave, SW Washington, DC 20201 Re: Request for Information on Direct Contracting—Geographic Population-Based Payment Model Option Dear Director Boehler: The Center for Medicare Advocacy (Center) is pleased to provide … Read more

Trump Administration Proposes to Gut Health Care Rights, Particularly Targeting LGBTQ People Nursing Home Compare Inaccurately Reports Civil Money Penalties Imposed Against Nursing Facilities Nursing Homes, Medicaid Rates, and Campaign Contributions Trump Administration Proposes to Gut Health Care Rights, Particularly Targeting LGBTQ People The landmark Affordable Care Act (ACA) included an anti-discrimination provision – the … Read more

On May 9, 2019, the Center for Medicare Advocacy held its sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The theme of the day was Health Care as a Human Right: Medicare’s Role in Making it a Reality. The Summit convened advocates, leading experts, and policy-makers to discuss … Read more

(Due) June 18, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1718-P P.O. Box 8016 Baltimore, MD 21244-8016 Re: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2020 Submitted electronically to: … Read more

Special Update Issue Brief: Medicare Coverage of Dental Services 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 … Read more

A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Medicare Coverage for Genetic Tests: Know the Facts A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing … Read more

Medicare Trustees Issue 2019 Report: Medicare is Not Going Broke Article Raises Concerns about Medicare Advantage and Calls Attention to Limited Medigap Access CMS Proposed Rule to Redefine Group Therapy in Skilled Nursing Facilities: Concern for Resident Care CMS Expands List of DMEPOS Subject to Prior Authorization as a Condition of Payment Only a few … Read more

The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations Latest Issue: Elder Justice: What “No Harm” Really Means … Read more

Comments to Medicare Marketing Guidelines (MMG) Submitted by Center for Medicare Advocacy April 4, 2019 The following comments were submitted to CMS online via 2020 MCMG feedback tool: https://cmsgov.wufoo.com/forms/cy2020-mcmg-feedback-tool/.  Submitted by David Lipschutz, Senior Policy Attorney, Center for Medicare Advocacy – dlipschutz@medicareadvocacy.org ——————————————————————————– Section: Miscellaneous Communicating About New MA Benefit Flexibilities.  We are disappointed that … Read more

Observation Status Deprives Medicare Beneficiaries of their Skilled Nursing Facility Benefit. Period. Nursing Home Requirements of Participation: Will the Administration Overturn 2016 Rules for Infection Control? New Fact Sheet Available – Medicare Inpatient Rehabilitation Hospital/Facility Coverage In Light of Jimmo v. Sebelius Join Us! 6th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller … Read more

Nursing Home Roundup: What's Causing Nursing Home Closures; Joint Letter; Free Webinar on Phase 3 Nursing Home Regulations Health Care Sabotage News: Court Strikes Blow for Health Care; Advocacy Groups File Amicus Brief in Texas ACA Case Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Webinar – April 10, 3:00 PM – Medicare … Read more

Trump Administration Works to Undermine the Affordable Care Act – Yet Again Court Denies All Government Motions in Class Action Seeking Appeal Right for Medicare Beneficiaries on “Observation Status” Observation Status: Physicians Challenge the Inspector General Study Finds Home Health Lowers Costs and Readmission Rates Compared to Hospital Care Medicare Advocates: Trump Budget Would Impede … Read more

Average Nursing Home Fine Drops Significantly After Administration Rolls Back Civil Money Penalties Nursing Home Resident Advocates, Not Invited to Testify, Submit Statement for the Record LTCCC Publishes Report on Nursing Home Resident Abuse, Neglect, and Crime Oral Health Highlight Join Us! 6th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture Rep. … Read more

NOT FORGOTTEN: PROTECTING AMERICANS FROM ABUSE AND NEGLECT IN NURSING HOMES Hearing held March 6, 2019 Statement for the record submitted by:  Tony Chicotel, Staff Attorney; Michael Connors, Long Term Care Advocate; Janet Wells, Public Policy Consultant California Advocates for Nursing Home Reform 650 Harrison Street, #2 San Francisco, CA  94107 www.canhr.org Toby Edelman, Senior … Read more

Medicare Education & Outreach (David Lipschutz) Information from the February 8, 2019 meeting of CMS’ National Medicare Education Program (NMEP) Medicare Advantage Steering Redesign of Medicare Plan Finder Senate Finance Committee Hearing on Nursing Facilities (Toby Edelman and Dara Valanejad) “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019: https://www.finance.senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-neglect-in-nursing-homes … Read more

1. MEDICARE EDUCATION & OUTREACH At a February 8, 2019 meeting of the Center for Medicare & Medicaid Services’ (CMS) National Medicare Education Program (NMEP), the agency released information about the 2018 Annual Coordinated Election Period (ACEP), sometimes referred to as “Open Enrollment” or “OP.” (Note: this is a downloadable “zip” file containing several items. … Read more

Joint Statement by Center for Medicare Advocacy and Medicare Rights Center: President’s Budget Targets Key Health Care Programs Members of Congress Reintroduce Legislation to Fix Outpatient Observation Status Medicare Advantage Case Spotlight Spanish Language Home Health Outreach Materials Available Join Us! 6th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture Early-Bird Registration … Read more

United States Senate Committee on Finance “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019 Statement submitted by: Long Term Care Community Coalition, Center for Medicare Advocacy, National Consumer Voice for Quality Long-Term Care, Justice in Aging, California Advocates for Nursing Home Reform, and National Academy of Elder Law Attorneys … Read more

March 1, 2019 Via Electronic Submission to www.regulations.gov (CMS-2018-0154)   Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Blvd. Baltimore, Maryland 21244 Re: Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies, … Read more

Improve and Expand Medicare: End the Use of Outpatient Observation Status – A Billing Issue that Restricts Needed Care Jimmo Implementation Update: Where is CMS? 2019 National Aging and Law Conference Speaker Proposals Still Accepted through Tomorrow Improve and Expand Medicare: End the Use of Outpatient Observation Status – A Billing Issue that Restricts Needed … Read more

6th Annual National Voices of Medicare Summit Welcomes Congressman John Lewis as the 2019 Sen. Jay Rockefeller Lecturer – Register Now Home Health Aide Coverage Continues to Shrink: Attention Must Be Paid Case Spotlight: A Medicare Beneficiary in Need of Home Health Aides  Cathy Hurwit Joins Center for Medicare Advocacy Advisory Board The Administration for Community Living … Read more

6th Annual National Voices of Medicare Summit Welcomes Congressman John Lewis as the 2019 Sen. Jay Rockefeller Lecturer – Register Now Improve and Expand Medicare: CMS Should Provide Objective Information About Medicare Options Practice Tip: Office of Medicare Hearings and Appeals Manual Can Be a Useful Tool  There’s Nothing Special About How CMS Treats Special Focus Nursing … Read more

Improve and Expand Medicare: Create Parity Between Medicare Advantage and Traditional Medicare 2019 Federal Poverty Levels Released: New Income Limits for Medicare Savings Programs State of the Union: Want More Affordable Prescription Drugs? Start with Medicare.  Home Health Outreach Materials Available Improve and Expand Medicare: Create Parity Between Medicare Advantage and Traditional Medicare Recently, the … Read more

#MedicarePlatform – Improve and Expand Medicare: Long-Term Services and Supports (LTSS) Center Submits Comments on Proposed Medicare Prescription Drug Rule Congressional Hearings Explore Rising Prescription Drug Costs Medicare’s New “What’s Covered” App Adds to Outreach but More Work Is Needed #MedicarePlatform – Improve and Expand Medicare: Long-Term Services and Supports (LTSS) Recently, the Center for … Read more

January 25, 2018 Submitted via www.regulations.gov Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-4180-P Re: CMS-4180-P: Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses The Center for Medicare Advocacy (Center) submits the following comments in response to the Centers for Medicare & Medicaid … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. ACCESS TO CARE    Home Health Between April 2017 and October 2018, the Center completed the “CMA Issue Brief Series: Medicare Home Health Crisis” – a ten-part series examining the growing crisis in … Read more

Access to Care ​​Home Health (Kathy Holt) Durable Medical Equipment (DME) (Kathy Holt) Observation Status (Judy Stein) Nursing Home Issues (Dara Valanejad)   Leveling the Playing Field – Traditional Medicare and Medicare Advantage (David Lipschutz) Policy Changes and CMS Efforts Favoring MA Law, regulations and policy CMS materials Medicare Fully Informed Project  Promoting Free Choice … Read more

March 2019 – Medicare Education & Outreach, and Other Issues January 2019 – Medicare Advocacy: Highlights from 2018 and Looking Forward in 2019 November 2018 – Special Presentation – Better Advance Care Legal Counseling – Presented by ABA Commission on Law and Aging Director Charles Sabatino

Improve and Expand Medicare: Add an Out-of-Pocket Cap There's Still Time to Go Back to Traditional Medicare or Change MA Plans Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Updates Healthcare Sabotage Continues Improve and Expand Medicare: Add an Out-of-Pocket Cap Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New … Read more