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

Now is the time to support the Center's activities to preserve a full and fair Medicare program for today – and tomorrow. Gifts to the Medicare Advocacy Fund support the broad range of programming that has been the Center for Medicare Advocacy's hallmark: from keeping people informed about Medicare laws and regulations, to advocating for equitable … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update: Congress Mitigates Increases in 2016 Part B Premium and Deductible (David Lipschutz) Bipartisan Budget Act of 2015 – Overview 2016 Part B premiums increases for some, and deductible increases for all, mitigated “Loan” is to be repaid by Medicare beneficiaries over time Underlying cause(s) of increase in … Read more

February 2008.  Pain prescription ordered by Emily Back’s physician under her hospice plan of care.  Medicare-certified hospice refuses to furnish the medication.  Howard Back purchases prescription at pharmacy. March 2008.  Emily Back dies. September 2008 – April 2009.  Howard Back makes numerous unsuccessful attempts to appeal the hospice’s denial of the medication and to submit claims … Read more

LEGISLATIVE UPDATE: CONGRESS MITIGATES INCREASES IN 2016 PART B PREMIUM AND DEDUCTIBLE Bipartisan Budget Act of 2015 – Overview On Monday November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015.  This wide-ranging budget agreement includes provisions that averted a pending government default by raising the nation’s debt ceiling, and prevents … Read more

In recognition of her superb work advancing access to long term care and health care with Senator Rockefeller, the Pepper Commission, and (then) Senator Hillary Clinton, the Center for Medicare Advocacy is pleased to honor our 2016 Senator Jay Rockefeller Lecturer: Ms.Tamera Luzzatto Tamera Luzzatto is senior vice president of Government Relations at The Pew Charitable … Read more

October 14, 2015 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 Medicare and Medicaid Programs; Reform of Requirements for long-Term Care Facilities CMS-3260-P Submitted electronically:  http://www.regulations.gov Dear Mr. Slavitt and CMS Colleagues: The … Read more

Proposed LCD DL 33787 unfairly and illegally restricts Medicare coverage for, and discriminates against, Dr. Roger Catlin, an above-knee amputee who wears an elevated vacuum socket, micro-processor knee and energy storing foot. Dr. Catlin breaks all assumptions the proposed LCD makes about his co-morbidities related to his functional potential. He ambulates independently, runs a tractor, … Read more

Your support for Medicare is crucial. If you haven't already, get your friends and family involved too! Send them this link and encourage them to write to their senators now: http://org.salsalabs.com/o/777/p/dia/action3/common/public/?action_KEY=18543. And, if you would like to help us continue to fight for the rights of Medicare beneficiaries, please make a donation today. Thank you.

Thank you to everyone who took the time to complete our recent Jimmo Implementation Council survey. We are writing to provide a summary of the results and the status of our efforts. In summary, there is enthusiasm for staying in touch and continuing to work together to advance implementation of the Jimmo Settlement.  96% of … Read more

September 15, 2015 Submitted electronically Sheila Hanley Director, Policy and Programs Group Center for Medicare & Medicaid Innovation Centers for Medicare & Medicaid Services HealthPlanInnovation@cms.hhs.gov RE: Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model The Center for Medicare Advocacy, Inc., (Center) appreciates the opportunity to provide comments in response to the recently announced Medicare Advantage … Read more

September 8, 2015 Andy Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1631-P P.O. Box 8016 Baltimore, MD 21244-8016 Delivered Electronically through www.regulations.gov Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016  Administrator Slavitt: The … Read more

September 8, 2015 Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Attention: CMS-5516-P 7500 Security Boulevard Baltimore, MD 21244-1850 Delivered Electronically through www.regulations.gov Re: Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services (CMS-5516-P) Administrator Slavitt: … Read more

ADMINISTRATIVE UPDATE 1. Proposed Requirements of Participation for Nursing Facilities On July 16, 2015, the Centers for Medicare & Medicaid Services (CMS) published proposed rules to revise the nursing home Requirements of Participation (RoPs) – the federal rules that govern the standards of care that facilities must meet in order to participate in the Medicare … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Administrative Update    Proposed Requirements of Participation for Nursing Facilities (Toby Edelman) Overview of Proposed Rule – 80 Fed. Reg. 41267 (July 16, 2015) Center’s Draft Comments (now due October 14, 2015) Update on 2016 Part B Premiums and Deductibles (David Lipschutz) Medicare Trustees Report and next steps Access … Read more

September 1, 2015 SUBMITTED ELECTRONICALLY http://www.regulations.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201 Re: CMS-1625-P Dear Acting Administrator Slavitt: The Center for Medicare Advocacy (the Center) is pleased to provide comments on the Centers for Medicare & Medicaid Services … Read more

CMS-1633-P, Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. … Read more

Another Barrier for Jimmo implementation that may not yet have percolated to the top is the Medicare fee schedule rates for rehabilitation services negatively impacting providers willingness to not only risk providing services for fear of denials and recoupments, but also because payment rates may not sufficiently cover expenses with current and pending Medicare fee schedule … Read more

No. 14-1519 (APM) (D.D.C.), filed Sept. 5, 2014 Amicus information: Amici are the Center and the National Health Law Program.  They are supporting the claim of Medicare beneficiaries that they should be covered for a form of testing that would assist in the diagnosis of patients suffering from dementia. Issues: Whether a diagnostic test (PET … Read more

Thank you for honoring Medicare’s 50th Anniversary with your donation to the Center’s Medicare Advocacy Fund. Your gift will help us assist older and disabled people and fight for a full and fair Medicare program. Your generous support is key to our ability to continue this critical work. Check out the Center’s infographic showing how … Read more

June 22, 2015 The Honorable Orrin Hatch                                        The Honorable Ron Wyden Chair, Committee on Finance                                     Ranking Member, Committee on … Read more

CMS-1622-P: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection Submitted electronically, http://www.regulations.gov June 19, 2015 Dear Colleagues:         The Center for Medicare Advocacy (Center) submits the following comments on the proposed rules, 80 Fed. Reg. 22043 … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update    Senate Finance Committee Addresses Medicare Appeals System (David Lipschutz & Judith Stein) Hearing on April 28, 2015 re: Audits and Appeals Audit and Appeal Fairness, Integrity and Reforms in Medicare Act of 2015 (AFIRM) marked up on June 3, 2015 Ways & Means Committee Mark-up June … Read more

LEGISLATIVE UPDATE 1.Senate Finance Committee Addresses Medicare Appeals System On previous Alliance calls, we have discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to find that: The success rates for beneficiaries at the initial levels of Medicare appeal are dismal; and The average wait for a decision at … Read more

Thank you again for taking action today to support the rights of Medicare beneficiaries, and for spreading the word!

New York Times, June 1965 By David Lipschutz, Center for Medicare Advocacy Senior Policy Attorney In the run-up to the passage of a major expansion of health insurance coverage, a prominent and rising political figure urged people to oppose such expansion, and contact their members of Congress to express their opposition: "Write those letters now; … Read more

By Terry Berthelot, JD, MSW Somewhere in our history, it became unacceptable to die. Elizabeth Kubler-Ross described in her seminal work, On Death and Dying, dying patients forced to endure fruitless procedures and then left in their dark hospital rooms, alone, to face the inevitable.  Each death was treated as a failure. Then in the 1970’s, the … Read more

Thank you for your interest in the Jimmo Implemenation Council. We look forward to your insight as we move forward with Implementation of the Jimmo v. Sebelius settlement. Stay tuned for updates and further activities. More information on the Improvement Standard and Jimmo v. Sebelius.

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative/Budget Update    Medicare physician payment (Sustainable Growth Rate, or SGR) (David Lipschutz) House passed SGR bill – review of what is and is not in the bill for beneficiaries Senate takes the bill up now … Dueling Budgets: Overview of House and Senate, Republican and Democratic Budgets and … Read more

LEGISLATIVE/BUDGET UPDATE 1.Medicare Physician Payment (SGR) In an effort to address the perennial issue of payment for Medicare physicians — the fundamentally flawed reimbursement system known as the sustainable growth rate or SGR – the House of Representatives overwhelmingly passed a “doc fix” package on March 26, 2015 that would repeal and replace the SGR.  … Read more

By Kevin Prindiville, Executive Director, Justice in Aging Of the 54 million people with Medicare, a staggering 25% have annual incomes below $14,400.  For these people living in retirement, or coping with a disability in poverty, Medicare coverage offers a lifeline, a chance to get needed health care. That precious red white and blue Medicare card means … Read more

Medicare home health coverage can mean the difference between an individual staying home or becoming a nursing home resident.  While the Medicare skilled nursing facility benefit is very limited, for beneficiaries who meet the coverage criteria, the home care benefit can be an ongoing Godsend. For people who can’t readily leave home without a major … Read more

We thank you for joining us to celebrate Judith Stein's joining the ranks of the Medicare-eligible, as well as 50 years of Medicare itself. Remember, if you wish to contribute any notes, pictures or thoughts to Judy, to include in her Memory Book of this day, please mail them to: Center for Medicare Advocacy 1025 … Read more

March 6, 2015 VIA ELECTRONIC SUBMISSION AdvanceNotice2016@cms.hhs.gov 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 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter To Whom It … Read more

When Medicare was enacted in 1965, it covered only older people – those 65-years old or more. In 1972, Congress added coverage for people with long-term disabilities, recognizing that like older people, they were often unable to obtain health insurance. To limit the cost of covering this new cohort, Congress added a 24-month waiting period before … Read more

Centers for Medicare & Medicaid Services Submitted electronically, http://www.regulations.gov Re: CMS-1461-P Dear CMS Colleagues: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) with comments on the Notice of Proposed Rule Making (NPRM) CMS-1461-P published in the Federal Register on December 8, 2014 (79 Fed. Reg. … Read more

January 20, 2015 The Honorable Fred Upton, Chairman Energy & Commerce Committee United States House of Representatives ​Washington, DC  20515 The Honorable Frank Pallone, Ranking Member Energy & Commerce Committee United States House of Representatives                       ​Washington, DC  20515  The Honorable Joe Pitts, Chairman Energy & Commerce Committee Subcommittee on Health United States House of … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Litigation Update   (Ali Bers) Discussion of two recent litigation victories: Bagnall (Observation) – On 1/22/15, the 2nd Circuit Court of Appeals reversed the trial court’s dismissal of the complaint and remanded the case to district court to proceed on due process claims Lessler (ALJ Delay Case) – On 1/29/15, … Read more

LITIGATION UPDATE Recent Litigation Victories 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 the National Senior Citizens Law Center filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more