Happy Thanksgiving! Giving Thanks Today and every day the Center for Medicare is grateful for our partners and supporters who help us open doors to health care for the 55 million people who rely on Medicare.  We are grateful to earlier generations who designed and launched Medicare to help all American families.  Sadly, our … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Election’s Potential Impact on Medicare (David Lipschutz)  Affordable Care Act Medicare Structural Changes Including premium support/vouchers New Nursing Home Requirements of Participation (Toby Edelman) Overview of final rule Positive changes Prohibition against facilities’ use of mandatory pre-dispute arbitration agreements and ensuing litigation What’s missing Including staffing requirements Review: … Read more

MOVING FORWARD WITH HOPE It’s no surprise that the election has left many of us worried and disoriented.  But we’ll regroup. We may not understand where we’ve landed, but we’ll acclimate and march forward – with hope. We hope the new administration will realize how today’s families are balancing – often barely – all the … Read more

No. 3:15-cv-1468-JAM, filed October 9, 2015 Issue: Whether the extremely high denial rates (98% and higher) at the redetermination and reconsideration stages of administrative review for home health care claims violate the Medicare statute and the Due Process Clause.  Relief sought: Declaratory and injunctive relief requiring the Secretary to correct the existing system of lower … Read more

No. 3:15-cv-01397 (DJS), filed September 22, 2015 Issue: Whether the Secretary violated the Medicare statute and the Due Process Clause by not recognizing that Vitamin B-12 injections represent a per se skilled nursing service and therefore the service should have been covered, and, in general, by failing to recognize the right to coverage for per se … Read more

No. 5:14-cv-269 (D.Vt.), filed Dec. 19, 2014 Issue: Whether the failure of the Secretary to apply the “prior favorable homebound decision” rule, which accords “great weight” to previous administrative decisions establishing homebound status, violates the Medicare regulations, as implemented by the Medicare Program Integrity Manual, and the Due Process Clause. Relief Sought: Declaratory and injunctive … Read more

No. 3:14-cv-01230 (D.Conn.), filed August 26, 2014 Issue: Whether the consistent failure of administrative law judges (ALJs) to issue decisions within 90 days of the request for ALJ review (with an average delay now approaching 500 days) violates the Medicare statute and the Due Process Clause. Relief sought: Declaratory and injunctive relief prohibiting the Secretary from … Read more

No. 11-cv-17 (D.Vt.), filed January 18, 2011 Issue: Whether the "Improvement Standard", which operates as a rule of thumb to terminate or deny Medicare coverage to beneficiaries who are not improving, violates substantive and procedural requirements of the Medicare statute, the Administrative Procedure Act, and the Freedom of Information Act, and the Due Process Clause of … Read more

No. 09-cv-134-TUC-DCB (D.Ariz.), filed March 10, 2009.  Appeal filed June 30, 2011 (No. 11-16606, 9th Cir.). Issue: Whether the Secretary's aggressive methods for attempting to collect payments under his Medicare Secondary Payer (MSP) program, directed at beneficiaries and their attorneys, violates the Medicare statute and the Due Process Clause. Relief sought: Declaratory and injunctive relief … Read more

No. 14-801 (D.Conn.), filed June 4, 2014 Issue: Whether the Secretary of Health & Human Services’ denial rate of about 98% at the lowest two levels of appeal in Medicare’s system of administrative review (redetermination and reconsideration) violates the Medicare statute and the Due Process Clause. Relief sought: Declaratory and injunctive relief for a Connecticut … Read more

No. 11-1703 (D.Conn.), filed November 3, 2011 Issue: Whether the Secretary's policy of allowing hospitalized Medicare beneficiaries to be placed in "observation status," rather than formally admitting them, deprives them of their Part A coverage in violation of the Medicare statute, the Administrative Procedure Act, the Freedom of Information Act, and the Due Process Clause. … Read more

 

As part of the Center’s Home Health Access Initiative, we are collecting stories from beneficiaries and caregivers who have had difficulty obtaining necessary home health care as ordered by their doctor. Please share your story below! Click here to take the survey now.

National Medicare Advocates Alliance Issue Brief #41, September 2016 LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Court order for additional education issued August 18, 2016 Exley (formerly Lessler) (ALJ Delay Case) Settlement approved August 1, 2016 Sherman (Lower level Medicare appeals) Defendant’s motion to dismiss denied, class certification granted August 8, 2016 Bremby (Per se skilled services) Coverage … Read more

Thank you for taking the time to complete our survey. Your response will help us determine how to best meet the unique needs of Medicare beneficiaries under age 65 who need assistance with Medicare enrollment and other issues.

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August 29, 2016 Office of Medicare Hearings and Appeals Department of Health & Human Services Attention: HHS-2015-49 5201 Leesberg Pike, Suite 1300 Falls Church, VA 22041  Submitted electronically to: www.regulations.gov Re: HHS-2015-49 To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) … Read more

August 26, 2016 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1648-P P.O. Box 8016 Baltimore, Maryland  21244-8016 Submitted electronically to: http://www.regulations.gov Re:      Federal Register Volume 81 No. 128 Medicare and Medicaid Programs: CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home … Read more

The Honorable Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services 7500 Security Blvd. Baltimore, MD 21244 August 19, 2016 Submitted electronically: http://www.regulations.gov Re: CMS–1651–P; Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable … Read more

August 23, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–1651-P P.O. Box 8010 Baltimore, MD 21244–8010 Submitted electronically to:  www.regulations.gov           Re:      CMS-1651-P To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments … Read more

August 5, 2016 Mr. Laurence Wilson Director Chronic Conditions Policy Group Center for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD  21244 Laurence.wilson@cms.hhs.gov  Ms. Jeanette Kranacs Acting Deputy Director Chronic Conditions Policy Group Center for Medicare Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD  21244 Jeanette.kranacas@cms.hhs.gov Dear Mr. Wilson and Ms. … Read more

PROPOSED RULE TO REVISE MEDICARE ADMINISTRATIVE APPEALS PROCESS As discussed during previous Alliance calls, there is a significant backlog of cases at the third and fourth levels of the Medicare administrative appeals process, the administrative law judge (ALJ) stage administered by the Office of Medicare Hearings and Appeals (OMHA), and the Medicare Appeals Council (Council) … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, July 11th, 2016 – 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 9874704 NOTE: We ask people calling from the same location to gather around one telephone. This frees up lines and holds down costs. Please ensure your line is on MUTE for the duration of the call … Read more

June 16, 2016 Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1655-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and … Read more

Medicare Access Project for People Living With ALS Medicare Overview – With an Emphasis on the Home Health Care Benefit Frequently Asked Questions and Answers General Home Health Questions "Homebound" Questions Specific Coverage Questions Can they be using a walker instead of crutches in homebound example? Yes, the homebound definition generally is intended to provide … Read more

June 27, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–5571–P P.O. Box 8013 Baltimore, MD 21244–8013 Submitted electronically to: www.regulations.gov             Re:  CMS–5517–P To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & … Read more

June 20, 2016 Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Re: CMS-1655-P, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Proposed Rule for FY2017, SNF Value-Based Purchasing Program, … Read more

June 20, 2016 Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–1652–P P.O. Box 8010 Baltimore, MD 21244-8010 Re: CMS–1652–P Dear Mr. Slavitt: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments on its proposal “Medicare … Read more

May 9, 2016 Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS–1670–P Mail Stop C4–26–05 7500 Security Boulevard Baltimore, MD 21244–1850 Submitted electronically to:    http://regulations.gov Re:      CMS–1670–P   To Whom It May Concern: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & … Read more

Medicare coverage for medically necessary oral health care is supported by the Medicare statute, its legislative history and, in some instances, even CMS policy.  For this purpose, “medically necessary oral health care” refers to treatment deemed necessary by a physician when a patient’s medical condition or treatment is or will likely be complicated by an … Read more

MEDICARE’S COVERAGE OF ORAL HEALTH   Current Centers for Medicare & Medicaid Services (CMS) policy[1] broadly bars Medicare coverage for practically all dental services.  The Center for Medicare Advocacy firmly believes that CMS has the legal authority under the Medicare statute to cover medically necessary oral health care – that is, treatment deemed necessary by … Read more

​Welcome and Housekeeping  (David Lipschutz, Moderator)  Medicare’s Coverage of Oral Health (Wey-Wey Kwok)  Medically necessary oral health care Goal: add a comprehensive oral health benefit to Medicare Administrative Update    Proposed Rules Part B Drug Demonstration (David Lipschutz) Hospital Payment Rule and the NOTICE Act (Toby Edelman) Concerns about notice to be given to those … Read more

Introduction One approach to improving nurse staffing levels is increasing reimbursement to nursing facilities, on the assumption and expectation that nursing facilities will use some of the increased reimbursement to increase their staffing.  This approach – at the federal level with Medicare and at the state level with Medicaid, in both Florida and California – … Read more

April 5, 2016 Centers for Medicare & Medicaid Services Office of Strategic Operations and Regulatory Affairs Division of Regulations Development 7500 Security Blvd. Baltimore, MD 21244-1850 Delivered Electronically through www.regulations.gov Re: Medicare Prior Authorization of Home Health Services Demonstration (CMS-10599) To Whom It May Concern: The Center for Medicare Advocacy (the Center) appreciates the opportunity … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) CMA and Vermont Legal Aid have filed a Motion for Resolution of Non-Compliance with the Settlement Agreement Exley (formerly Lessler) (ALJ Delay Case) Settlement preliminarily approved Barrows (formerly Bagnall) (Observation) Discovery on protected property interest issue; summary judgment briefing Other cases Hull … Read more

Sign our petition to remind CMS that Medicare should cover medically necessary oral health care. Medicare was created to help older people and people with disabilities.  It should not deny clinically essential or life-saving treatments simply because those treatments occur within the mouth. The Medicare statute does not prohibit coverage for non-routine dental or oral procedures … Read more

LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius) (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because their care … Read more

March 4, 2016 The Honorable Ron Wyden Ranking Member, Committee on Finance United States Senate Washington, D.C. 20510 The Honorable Charles Grassley Senior Member, Committee on Finance United States Senate Washington, D.C. 20510 Submitted electronically to: Report_Feedback@finance.senate.gov Re: Comments on Prescription Drug Pricing Reform Dear Ranking Member Wyden and Senior Member Grassley: The Center for Medicare … Read more

March 4, 2016 VIA ELECTRONIC SUBMISSION AdvanceNotice2017@cms.hhs.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services P.O. Box 8016 Baltimore, MD 21244-8016 Re: Advance Notice of Methodological Changes for Calendar Year 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call … Read more

Thank you very much for taking the time to reply to our invitation.  If you included a donation, we thank you for that as well, and your receipt should arrive by email shortly. Detailed directions and parking information will be sent to all attendees by email prior to the Celebration. And please do share your memories, … Read more

January 29, 2016 The Honorable Orrin Hatch                                       The Honorable Ron Wyden Chair, Committee on Finance                                    Ranking Member, Committee on Finance United States Senate                                               United States Senate Washington, D.C. 20510                                           Washington, D.C. 20510 The Honorable Johnny Isakson                                 The Honorable Mark Warner United States Senate                                               United States Senate Washington, D.C. 20510                                           Washington, DC 20510 Submitted electronically to: chronic_care@finance.senate.gov Re: Comments … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update (David Lipschutz) Senate Finance Committee Releases Document for Comment Bipartisan Chronic Care Working Group Policy Options Document (December 2015) Overview Comments due January 26, 2016 Medicare Appeals Bill Introduced in Senate Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S.2368) Overview Administrative … Read more

LEGISLATIVE UPDATE Senate Finance Committee Releases Document for Comment   In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document.  The following is an excerpt from a 12/18/15 Press Release by Senate Finance Committee announcing the document’s release: (available at: http://www.finance.senate.gov/release/hatch-wyden-isakson-warner-release-chronic-care-options-paper): The “Finance Committee Chronic Care Working Group, … Read more

January 4, 2016 Centers for Medicare & Medicaid Services Comments on NOTICE Act Submitted electronically: NOTICE_Act@cms.hhs.gov The Center for Medicare Advocacy (Center) is a national, private, non-profit law organization, founded in 1986, that provides education, analysis, advocacy, and legal assistance to help people nationwide, primarily older people and people with disabilities, to obtain necessary health … Read more

(New York Times) To the Editor: Today’s story, The Hidden Financial Incentives Behind Your Shorter Hospital Stay, describes how hospital stays classified under “Observation Status” are skewing admission and readmission data. As Dr. Jha states in the article, Observation Status is driven by incentives for the hospital.  This is an ever-increasing phenomena in which Medicare … Read more

December 23, 2015 Filing code for submitting comments: CMS-3317-P.  Dear Sir or Madam: Comments on the Proposed Discharge Planning Rule as put forth by the Centers for Medicare & Medicaid Services (CMS) The Center for Medicare Advocacy (the Center) is pleased to comment on the November 3, 2015, proposed revisions to the discharge planning regulations … Read more

December 21, 2015 Acting Administrator Andy Slavitt Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-8016 RE: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017 [CMS–9937–P] Submitted electronically via www.regulations.gov Dear Acting Administrator Slavitt: The Center for Medicare Advocacy … Read more

Submitted electronically via MMCOcapsmodel@cms.hhs.gov December 21, 2015 Tim Engelhardt, Director Medicare-Medicaid Coordination Office Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: Medicare-Medicaid Plan Quality Ratings Strategy Dear Director Engelhardt, The Center for Medicare Advocacy (Center) greatly appreciates the opportunity to provide comments on the Medicare-Medicaid Plan Quality Ratings Strategy. The … Read more

Submitted electronically at http://www.regulations.gov December 15, 2015 CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention: CMS-10003/0938-0829, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850 Re:      Comments on CMS-10003 Notice of Denial of Medical Coverage (or Payment) To Whom It May Concern: The Center for Medicare Advocacy (the Center) greatly appreciates … Read more