COVID-19 Updates – 3/26/2020 Federal Court Orders Appeal Rights on “Observation Status” Issue for Certain Medicare Hospital Patients CMS Temporarily Waives Medicare Access Barriers for Skilled Nursing Facility Care New Guidance On Nursing Home Health Inspections Severely Limits Oversight and Enforcement for a Three-Week Period Free Webinar: Medicare & Health Care Updates Register for the … Read more

COVID-19 and Medicare – Where We Stand Today (3/19/2020) The Coronavirus and Nursing Home Residents Restrictions on Family Caregivers Raise Concerns about Unmet Care Needs In Nursing Homes Elder Justice Newsletter – New Issue Available Now Register Now – Upcoming CMA Events Register for the VIRTUAL  National Voices of Medicare Summit and Senator Jay Rockefeller Lecture … Read more

Reminder: Medicare Advantage Enrollment Period Ends this Month; Ongoing Opportunity for Special Enrollment Period COVID-19 May Impact Medicare Coverage CMS Publishes Final Rule on Data Exchange Register Now – Upcoming CMA Events Update on the 7th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture Free Webinar: New Medicare Payment Systems – Obstacles … Read more

Articles Highlight Medicare Advantage Concerns) Report: Affordable Care Act Narrowed Disparities in Health Care Access Register Now – Upcoming CMA Events 7th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture: Only 9 Days Left for Early-Bird Rates  Free Webinar: New Medicare Payment Systems – Obstacles to Accessing Covered Care Articles Highlight Medicare … Read more

Medicare Coverage of Home Health Care Has Not Changed Under the New Payment System (PDGM) Massachusetts Task Force Calls for Closure of Low-Performing, Low Occupancy Nursing Facilities Register Now – Upcoming CMA Events 7th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture  Free Webinar: Medicare Home Health Updates in Light of the … Read more

Changes Coming to CMS Websites for Consumers Joint Statement on President’s Budget Register Now – Upcoming CMA Events 7th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture  Free Webinar: Medicare Home Health Coverage Free Webinar: Medicare Home Health Updates in Light of the New Medicare Payment Model Changes Coming to CMS Websites … Read more

Wendell Potter is a former health insurance company executive who became that industry’s worst nightmare. Time Magazine called Wendell “the ideal whistleblower.” Bill Moyers called him a straight shooter. Michael Moore called him “the Daniel Ellsberg of corporate America.” Wendell walked away from his job at Cigna, the big health insurance corporation, in 2008 after … Read more

Fact-Checking the State of the Union Speech Regarding Health Care Medicare Oral Health Care Update Administration Encourages States to Block Grant Medicaid Center Submits Comments Opposing Social Security Administration Proposal to Increase Frequency of Disability Benefit Reviews  Free Webinar: Medicare Home Health Coverage Fact-Checking the State of the Union Speech Regarding Health Care Earlier this … Read more

Supreme Court Allows Harmful “Public Charge” Immigration Rule to Continue – For Now Accountable Care Organizations and Observation Status Medicare SNF Payment Model Creates Changes in Care and Admissions – What about Facility Assessments? Study Finds Nursing Home Compare Data about Patient Falls with Major Injuries Underreported and “Highly Inaccurate”  Support Medically Necessary Oral Health Care … Read more

House Committees Work to Address Problems Coordinating COBRA and Medicare Enrollment Center Opposes Harmful “Public Charge” Rule Update on ACA-Repeal Lawsuit Study Finds Differences In Post-Hospital Care Settings and Mortality Rates for Medicare Patients In Rural And Urban Areas New Opioid Treatment Program Benefit in Part B  Call for Workshop Proposals for the 2020 National … Read more

CMS Continues to Downplay Medicare Plan Finder Problems and Availability of Special Enrollment Period Medicare Advantage Marketing Matters: Case Study Center for Medicare Advocacy Supports Supreme Court Review of ACA-Repeal Lawsuit ALS Activist Steve Gleason Receives Congressional Gold Medal  CMS Continues to Downplay Medicare Plan Finder Problems and Availability of Special Enrollment Period The Annual … Read more

Nursing Facilities and Medicare Advantage: If You Can’t Beat ’Em, Join ’Em . . . But What About the Medicare Beneficiaries? Free Webinar – Medicare Patient Driven Payment Model: What Does It Mean for Skilled Nursing Facility Residents? Elder Justice Newsletter – Our Latest Edition Reminder – Joint Statement on Nursing Home Aide Training  Nursing … Read more

Center for Medicare Advocacy Wishes All the Best to Rep. John Lewis  Center for Medicare Advocacy Submits Comments Center for Medicare Advocacy Wishes All the Best to Rep. John Lewis On December 29, 2019 Representative John Lewis (D-GA, 05) announced that he will be undergoing treatment for stage IV pancreatic cancer. In a press release, … Read more

Recent Polling Shows Strong Support Among Voters for Medicare Oral Health Benefit  Best Wishes from All of Us at the Center for Medicare Advocacy Recent Polling Shows Strong Support Among Voters for Medicare Oral Health Benefit The Center for Medicare Advocacy is pleased to share the results of new polling conducted by Morning Consult, which found … Read more

Government Watchdog Agency Once Again Finds Wasteful Medicare Advantage Overpayment Skilled Nursing Facilities Lay off Therapists, Change Therapy Services – What Can Residents & Therapists Do? Government Watchdog Agency Once Again Finds Wasteful Medicare Advantage Overpayment The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) recently released a report … Read more

Patients Need Therapy – Medicare Payment Systems Create Barriers Caution: Hospital “Outpatient” Rule Negates Statutory Inpatient Coverage for In-Hospital Dental Care Fairness in Nursing Home Arbitration Act Provides Important Protections Center for Medicare Advocacy Submits Statement to Ways & Means Hearing on “Caring for Aging Americans” Patients Need Therapy – Medicare Payment Systems Create Barriers … Read more

CMA Alert – November 27, 2019

Time for Medicare Enrollment – Time to Talk Turkey! Reminder – You CAN Leave the Nursing Home for the Holidays Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care Thank You! Time for Medicare Enrollment – Time to Talk Turkey! Medicare Fall Open Enrollment continues through December 7 — so you still … Read more

(The views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy.) I. ENROLLMENT PERIOD UPDATES Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – ends on December 7th.  As discussed … Read more

Agenda Enrollment Period Updates (David Lipschutz) Including Medicare Plan Finder, referrals to SHIPs H.R. 3 – Prescription Drug Bill with Medicare Improvements (Kata Kertesz & David Lipschutz) Prescription Drug Changes Medicare Improvements, including adding oral health, hearing vision coverage Update on Skilled Nursing Facilities (Toby Edelman) Including new payment model in effect since 10/1/19 (Patient … Read more

We appreciate your interest in our efforts to keep Medicare strong, advocate for the people who rely on Medicare, and provide important information. As someone who is invested in our activities, we write today hoping you will help us spread the word about the need to protect and improve the Medicare program now, regardless of … Read more

Medicare is Being Privatized. Where is the Outcry? Medicare Advantage Plans Impede Access to Care: Case Study #1 Support for Medicare Oral Health Benefits 2020 Medicare Cost-Sharing Rates Released Medicare is Being Privatized. Where is the Outcry? For years, the Center for Medicare Advocacy has warned of wasteful overspending on private Medicare Advantage (MA) plans, … Read more

Medicare Enrollment Problems Persist Medicare’s New Skilled Nursing Facility Payment System Alters Access to Care Poorly Performing Skilled Nursing Facilities: What Happens to Them? Latest Edition – Elder Justice: What “No Harm” Really Means for Residents  Medicare Enrollment Problems Persist Problems with Medicare Plan Finder Persist As reported by SHIPs across the country and some … Read more

Potential Impacts of New Medicare Payment Models On Skilled Nursing Facility and Home Health Care  CMS Extends “Equitable Relief” from Part B Late Enrollment Penalties for People Moving from ACA Marketplace Plans to Medicare Free Webinar: Coordination of Benefits – What Pays When? Potential Impacts of New Medicare Payment Models On Skilled Nursing Facility and … Read more

Medicare Enrollment and Medicare Advantage Updates CMS Administrator Seema Verma Testifies on Health Care Sabotage Before House Subcommittee Center Attorneys Participate in Oral Health Convening and Advocacy Day Nursing Home Compare’s Abuse Icon is Now Live Center for Medicare Advocacy Submits Comments Supporting Modification to ABN Instructions FREE WEBINAR: Register now for Coordination of Benefits … Read more

October 21, 2019 VIA ELECTRONIC SUBMISSION Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-9115-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 RE: CMS-R-131-Advance Beneficiary Notice of Noncoverage (ABN) Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid … Read more

Center for Medicare Advocacy Board President Judith Feder Testifies at Drug Pricing Hearing  Administration’s “Public Charge” Rule [Temporarily?] Blocked Drug Company Sued Over Kickbacks for Off-Label Marketing of Psychotropic Drug for Nursing Home Residents to Pay Over $115 Million Joint Issue Alert on Medicare Payment and Skilled Therapy Services in Nursing Homes Free Webinar: Medicare … Read more

October 16, 2019 Frank Pallone Chairman Energy and Commerce Committee United States House of Representatives Washington, DC 20515 Greg Walden Ranking Member Energy and Commerce Committee United States House of Representatives Washington, DC 20515         Re: Support for H.R. 3 and Reinvestment of Savings in Medicare Program Dear Chairman Pallone and Ranking … 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

Center for Medicare Advocacy Analysis of President’s Medicare Advantage Executive Order: Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries  Nursing Home Residents and Therapy Under The New Medicare Reimbursement System Important Update to Nursing Home Compare Will Enable Public to Identify Facilities with a History of Abuse Medicare’s Annual Election Period Starts Next Week … Read more

Connecticut Congressional Delegation Concerned about Medicare Advantage Network Provider Terminations in the State House Companion to Part D Extra Help Bill Introduced The Patient Driven Payment Model is Here – What Does It Mean for Residents? Connecticut Congressional Delegation Concerned about Medicare Advantage Network Provider Terminations in the State As noted in a press release … Read more

Medicare Plan Finder Pending Additional Updates; Concerns Remain Speaker Pelosi Unveils Bill Authorizing Negotiation of Drug Prices and Capping Out-of-Pocket Costs California Attorney General Calls on CMS to Withdraw Proposed Revisions to Nursing Home Requirements of Participation House of Representatives Passes Bill Prohibiting Pre-Dispute Arbitration Agreements Center for Medicare Advocacy Senior Policy Attorney Toby S. … Read more

Senator Brown Leads Charge for Better Oversight of Medicare Advantage Plans Health Care Sabotage Takes its Toll Center for Medicare Advocacy Submits Comments Opposing the Administration’s Proposed Roll Back of Nursing Home Standards Rule Allowing Pre-Dispute Arbitration Agreements in Nursing Homes Takes Effect FREE WEBINAR: Register Now for Medicare for People with Paralysis  Senator Brown Leads … Read more

September 15, 2019 Administrator Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-3347-P P.O. Box 8010 Baltimore, MD 21244-1850 Re: CMS-3374-P; Federal Register, Vol. 84, No. 138 (July 18, 2019) Submitted electronically: www.regulations.gov Dear Administrator Verma: The Center for Medicare Advocacy and the Long Term Care Community Coalition … Read more

Medicare & You 2020 – Better Than Draft, But Room for Improvement More People Went Without Health Insurance in United States in 2018 Administrator Verma’s Tweet Sparks Support for Addressing Observation Status Proposed Home Health Rules – Payment Shouldn’t Impede Access Register Now – Free Webinar, September 18 – Skilled Nursing Facility Updates Medicare & … Read more

September 9, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1711-P P.O. Box 8013 Baltimore, Maryland  21244-8013 Submitted electronically to: http://www.regulations.gov Re:  CMS-1711-P; Federal Register, Volume 84, No. 138 (July 18, 2019) The Center for Medicare Advocacy (the Center) provides these comments about CMS-1711-P and the impact of the … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. 1. UPCOMING ANNUAL COORDINATED ELECTION PERIOD (ACEP) Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – will start … Read more

― AGENDA― Upcoming Annual Coordinated Election Period (ACEP) (David Lipschutz) Policy Changes for 2020 Updated Medicare Plan Finder Updates to Marketing Guidelines Nursing Home Updates (Dara Valanejad) Proposed Changes to Requirements of Participation Arbitration Changes Update on Home Health (Judith Stein) Proposed Rule Jimmo Update/Concerns (Judith Stein) Litigation Update (Ali Bers) Update on Alexander v. … Read more

Medicare Platform: Objective Information and Consumer Protections Face Challenges As Home Care Needs Increase, Access Issues Must Be Addressed Nursing Home Deregulation Continues, Despite Substantial Risk to Residents Medicare Platform: Objective Information and Consumer Protections Face Challenges At the beginning of the current session of Congress, the Center for Medicare Advocacy laid out a Medicare … Read more

Advocates Issue Joint Letter Raising Alarms about New Medicare Plan Finder and Revisions to MA and Part D Marketing Guidelines CMS Proposed Medicare Home Health Rules Raise Concerns for Access to Care – Comments due September 9, 2019 Stop Drugging Nursing Home Residents Without their Written Consent Advocates Issue Joint Letter Raising Alarms about New … Read more

August 27, 2019 Seema Verma Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington DC 20201 Dear Administrator Verma: The undersigned organizations are committed to ensuring that all people with Medicare have unfettered access to the accurate and impartial information they need to make optimal choices … Read more

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