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

A Word from the Executive Director News You Can Use CMS Backs Off on Leveling the Playing Field for Traditional Medicare and Private Plans After announcing that Medicare Advantage payment rates would be reduced in an effort to bring in line with payments in traditional Medicare, CMS actually raised rates for MA plans. Private Medicare … Read more

1.  LITIGATION UPDATES Jimmo v. Sebelius (Improvement Standard) No. 11-cv-17 (D.Vt. filed 1/18/11).  As reported during previous Alliance calls, the Settlement in Jimmo was approved on January 24, 2013 during a scheduled fairness hearing.  As previously discussed, CMS has issued revisions to its Medicare Benefit Policy Manual to ensure that Medicare coverage is available for skilled … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Litigation Update   (Gill Deford) Jimmo – Improvement standard Bagnall (Observation) Other litigation Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Ali Bers) Overview Claims Eligible for Review Deadlines and Request Form Due Process and Medicare Appeals Denial rate of beneficiary appeals at lower levels of review (Gill … Read more

You should receive a receipt for your Membership Fee by email shortly.  If you do not, please contact Scott Perkins at sperkins@medicareadvocacy.org. We will talk to you at our next "Ask the Expert" call!

A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community A Message from the Executive Director Since I wrote you last month, the Center for Medicare Advocacy hosted our 1st Annual National Voices of Medicare Summit in Washington, DC.  This all-day conference brought together advocates, policy-makers, economists, and scholars … Read more

Editor’s Note: Last month, readers liked the larger text, but requested better contrasting font color. So, once again, please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community A Message from the Executive Director You may have heard that the health care … Read more

Editor’s Note: We received some feedback that our text was a bit small, so we are bumping it up for this edition. Please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community – Watch us on NBC! A Message from the Executive … Read more

A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community A Message from the Executive Director Welcome to the first issue of the CMA Community News and to the Center for Medicare Advocacy community.  We are grateful for your interest in the Center and for your active support of … Read more

Enforcement Newsletter (Electronic, delivered via email) Delivered right to your inbox, this detailed monthly mailing on nursing home enforcement issues describies the latest developments in nursing home enforcement activities. This incredible resource is only $250.00 for an annual subscription. Purchase Now Read a sample.

Centers for Medicare & Medicaid Services Department of Health & Human Services Attention: CMS-4159-P P.O. Box 8013 Baltimore, MD 21244-8013 March 7, 2014 Submitted Electronically: http://regulations.gov Re: CMS-4159-P To Whom It May Concern: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments on the Notice of … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Gill Deford) Overview Claims Eligible for Review Deadlines and Request Form Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Medicare “Doc Fix” (Physician payment, or “SGR”): Where are we now? Extenders: QI program and therapy cap exceptions … Read more

1. PRESENTATION:  RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. Sebelius provides that Medicare beneficiaries who were previously denied Medicare coverage may have claims re-reviewed under the revised manual provisions.  The … Read more

Thank you for registering for the Center for Medicare Advocacy's 2017 National Voices of Medicare Summit And Senator Jay Rockefeller Lecture. You should have received your receipt by email. Please check your SPAM filters if you have not. Reminders will be sent as the date event approaches, and updates will be sent if speakers or topics … Read more

Be a Sponsor Event Sponsor:  $25,000 Registration for 10 attendees* Co-branding: company  logo on screen with Center for Medicare Advocacy Before event starts During opening presentations During closing presentations Full page recognition in program Logo included on website and in all electronic marketing (after date of sponsorship commitment) Logo on signage during the event Listing in … Read more

1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement.  The Jimmo case ended a longstanding practice denying Medicare coverage to people who had “plateaued,” or were “chronic,” or “stable,” or “not … Read more

Monday, December 16, 2013 – 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 until the Q&A portion of … Read more

Thank you for your donation to the Center for Medicare Advocacy. 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. We will keep you informed about current issues in Medicare and quality … Read more

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 until the Q&A portion of the Agenda. _______________________________________________________________________________________________ Welcome and Housekeeping  (David Lipschutz, … Read more

1. PRESENTATION:  MEDICARE ANNUAL ELECTION PERIOD & THE MARKETPLACES Medicare Annual Coordinated Election Period (ACEP) – 10/15/13 – 12/7/13  During the Annual Coordinated Election Period (ACEP) people with Medicare can change their choice of health coverage (whether they receive that coverage through a private Medicare Advantage plan or traditional Medicare), and add, drop or change Medicare … Read more

1.  PRESENTATION:  UPDATE ON HOSPITAL OBSERVATION STATUS  Observation status is getting a lot of attention from Congress, the media, and researchers.  The bipartisan federal legislation, the Improving Access to Medicare Coverage Act of 2013, has gotten more cosponsors daily.  As of August 6, the House bill, H.R. 1179, introduced by Congressman Joseph Courtney (D, CT), … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, August 12, 2013 – 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

1.  PRESENTATION  CMS Issues New Hospital Discharge Planning Guidance  On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning.  Medicare discharge planning is a Condition of Participation for hospitals. CMS has stated in … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Presentation:  New Hospital Discharge Planning Guidance – Overview  (Alfred Chiplin) Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Proposals to Fix Medicare Physician Payment (SGR) Medicare Trustees’ Report​ Dual Eligible State Demonstrations Update (Andrea Callow) Litigation Update   (Gill Deford and Ali Bers) Jimmo – Improvement standard Bagnall (Observation) … Read more

I HAVE MEDICARE…. and I need help paying for my medical expenses, including my Medicare premiums, coinsurance and drug costs. How can my state’s health care marketplace (a.k.a. exchange) help me? ►  What programs are available in the marketplace to help pay for Medicare? Medicare Savings Programs (MSP) and Medicaid are insurance affordability programs that can … Read more

UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON WAYS & MEANS, SUBCOMMITTEE ON HEALTH HEARING ON "THE PRESIDENT'S AND OTHER BIPARTISAN PROPOSALS TO REFORM MEDICARE" WRITTEN TESTIMONY SUBMITTED JOINTLY BY CALIFORNIA HEALTH ADVOCATES, CENTER FOR MEDICARE ADVOCACY, AND MEDICARE RIGHTS CENTER May 21, 2013 Introduction Mr. Chairman and Members of the Committee: California Health Advocates, the … Read more

April 26, 2013 Dear Friends, I want to share just one of the many stories that continue to inspire the Center for Medicare Advocacy’s work.  I hope Mrs. Cole’s story moves you to help the Center, so that we can help others like her. In January’s bitter cold, Mrs. Cole*, a frail 85-year-old woman, was … Read more

In January’s bitter cold, Mrs. Cole, a frail 85-year-old woman, was blown over by a strong gust of wind.  She cracked her head open when she hit the sidewalk, and lay bleeding, unable to get up and in need of immediate medical attention.  Fortunately, a Good Samaritan called 911 and she was taken by ambulance … Read more

And Proposals for the Future of Medicare 1.  PRESENTATIONS MEDICARE’S ADMINISTRATIVE REVIEW PROCESS – ONGOING DUE PROCESS CONCERNS & POSSIBLE SOLUTIONS During our October 2012 Alliance call, we discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to find that: 1) the success rate for beneficiaries at the initial … Read more