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

Thank you for registering for "Medicare's Open Enrollment Period for 2016" The webinar will take place Wednesday, October 14, 2015 at 2:00 pm Eastern. Within the next 72 hours you should receive a confirmation from "GoToWebinar" or mshepard@medicareadvocacy.org which includes your call-in and log-in information. Please note that audio, both hearing and speaking, is guaranteed over … Read more

As part of our recognition of Medicare’s first 50 years, this week begins our Medicare Matters: 50 Insights for Medicare’s 50th Anniversary. Help us spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it. Medicare Was Key to Integrating Hospitals Medicare Reduced Poverty Medicare Saves Lives Medicare’s Future … Read more

A Message from the Executive Director News You Can Use Legislative & Policy Update CMA In the Community A Message from the Executive Director 2015 Marks the 50th Anniversary of Medicare – Help Ensure its Future Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Legislative Update: The Year Ahead: Overview (David Lipschutz) Legislative landscape in a new Congress Medicare physician payment (Sustainable Growth Rate, or SGR) – action required by end of March 2015 Debt and deficit reform proposals Draft Legislation Hospitals Improvements for Payment (HIP) Act of 2014 (Toby Edelman) On November … Read more

LEGISLATIVE UPDATE The Year Ahead 1. Legislative & Budget Landscape in a New Congress In the 114th Congress staring in January 2015, Republicans will control both the House of Representatives and the Senate.  What will this mean for health care policy generally and Medicare specifically?  Here are a few different takes: American Enterprise Institute (AEI) briefing … Read more

No. 5:14-cv-128 (D.Vt.), filed June 23, 2014 Issue: Whether the denial of coverage for named plaintiff Glenda Jimmo by the Medicare Appeals Council on re-review of her claim under the revised manual provisions pursuant to the Jimmo settlement agreement was correct. Relief Sought: Reversal of the Secretary’s decision denying coverage and granting the claim for … Read more

No. 3:08-CV-1148 (AHN) (D.Conn.), filed July 31, 2008 Issue: Whether the use of a "stability" test to terminate home health coverage on the ground that the patient no longer needs skilled nursing care violates the Medicare statute and regulations. Relief Sought: Declaratory judgment, and temporary and permanent injunctive relief on behalf of an individual Medicare … Read more

A Message from the Executive Director Dear CMA Community: It’s autumn here in Connecticut, the leaves have already turned and the trees are becoming bare. Autumn is quickly turning to Fall.  In the Medicare world this means it’s open enrollment season. Through December 7th Medicare beneficiaries can choose how they want to receive their Medicare … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Legislative Update: The IMPACT Act of 2014 (David Lipschutz) Overview  – signed into law by President Obama on October 6, 2014, the Improving Medicare Post-Acute Care for Medicare Beneficiaries Act of 2014 (IMPACT Act, H.R. 4994) requires reporting of standardized data by post-acute care (PAC) providers across different PAC … Read more

1.  LEGISLATIVE UPDATE: THE IMPACT ACT OF 2014 On October 6, 2014, President Obama signed into law the “Improving Medicare Post-Acute Care Transformation Act of 2014” or IMPACT Act.  The bill resulted from a bipartisan, bicameral effort by the House Ways & Means and Senate Finance Committees to address various issues relating to care Medicare … Read more

A Message from the Executive Director Dear Community Members: We have been busy at the Center this summer- even with the lovely long, warm days. Our advocacy has been focusing on enhancing access to health services and medical equipment for people with long-term and chronic conditions. In August we launched an Action Campaign to alert … Read more

Coming into my summer fellowship with the Center, I already knew that the Medicare program was complex. After my summer began, however, I soon realized that there are considerably more moving parts to the Medicare program than I had imagined. Over the course of my ten weeks with the Center, I was fortunate enough to … Read more

My time as a summer Health Policy Fellow at the Center for Medicare Advocacy, Inc.,(the Center) introduced me to the field of health law and provided me the opportunity to write about health related policies and procedures. The attorneys in the Washington, D.C. office view the internships as an opportunity to train the interns in … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Changes to Medicare’s Quality Improvement Organizations (QIOs) (Alfred Chiplin and Terry Berthelot) Overview of QIO restructuring to separate the beneficiary complaint review functions from the quality improvement functions Recent Revision to Hospice and Part D Guidance- (David Lipschutz and Terry Berthelot)  CMS recently revised guidance that had served as … Read more

1.  CHANGES TO MEDICARE’S QUALITY IMPROVEMENT ORGANIZATIONS (QIOs)     CMS has restructured its Quality Improvement Organization (QIO) Program to separate the beneficiary complaint review functions from the quality improvement functions. The change information described below is response to many years of urging CMS to separate the review of beneficiary complaints function of QIOs from … Read more

 No. CV 08-2309-PHX-ROS (D.Ariz.), filed December 18, 2008. Appeal filed March 6, 2012 (No. 12-15478, 9th Cir.). Issue: Whether the Secretary's exclusion of coverage for dental care in extraordinary circumstances where the care is necessary to treat a medical condition violates the Medicare statute and policy provisions, and the Equal Protection Clause. Relief Sought: Declaratory judgment … Read more

1.  MEDICARE’S COVERAGE OF CAPPED RENTAL ITEMS DURING PART A INSTITUTIONAL STAYS: LOSING ACCESS TO SPEECH GENERATING DEVICES (SGDs) CMS Changes Its Coverage of Speech Generating Devices Through a new interpretation of longstanding rules, CMS is currently leading an outright attack on coverage for Speech Generating Devices (SGDs).  SGDs are typically tablet-like units that allow … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Medicare’s Coverage of Capped Rental Items During Part A Institutional Stays: Losing Access to Speech Generating Devices (SGDs) (Alfred Chiplin) Overview of Medicare coverage guidelines re: capped rental durable medical equipment (DME) when a person requires Medicare Part A institutional care (hospital, long term care or skilled nursing facility, … Read more