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

House Committees Work to Address Problems Coordinating COBRA and Medicare Enrollment

On January 21, 2020, the Chairmen and Ranking Members of the House Ways & Means, Energy & Commerce, and Education & Labor Committees sent a letter to the Secretaries of Health and Human Services (HHS) and Department of Labor (DOL) asking the “agencies to address the confusion and financial risks that often confront Americans who are Medicare-eligible and receive coverage under a group health plan subject to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).”  See the press release issued by the Energy & Commerce Committee here.

Due to the complex rules surrounding Medicare secondary payment, coordination of benefits, and Part B enrollment, coupled with a lack of adequate information provided to former employees who choose to take COBRA coverage when they are eligible (or near eligibility) for Medicare, such individuals often face “unexpected penalties and unnecessary out-of-pocket expenses” (see, e.g., Alerts the Center wrote in November 2015 about problems arising surrounding the interaction between COBRA and Medicare: parts I, II and III).

The Committees called on the federal agencies to “develop a strategy that effectively addresses the issue and to produce informative and clear communications for affected Americans.” The Center for Medicare Advocacy strongly supports this effort.

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Center Opposes Harmful “Public Charge” Rule

The Center has joined other organizations that advocate for older adults in filing amicus briefs in several lawsuits challenging the Department of Homeland Security’s “public charge” rule. The regulation, finalized last year, represents a drastic change in how applicants for lawful permanent residency (green cards) will be evaluated, and it will have a particularly negative impact on older immigrants, including those who are dually eligible for Medicare and Medicaid. Under the rule, use of programs that are often vital to the livelihood of older adults, such as Medicaid, SNAP (food stamps), or housing benefits, could jeopardize the pathway to a green card. The rule would also make being over 62, or having a treatable medical condition, “negative factors” in the public charge determination, and it would impose an arbitrary and unprecedented income test.

While the public charge rule does not involve Medicare itself, the use of Medicaid-funded benefits such as Medicare Savings Programs, which provide critical assistance with premiums and cost-sharing for lower-income Medicare beneficiaries, could weigh against a green card applicant. As the amicus briefs state, the rule “shoves aside existing law and erects new – and often insurmountable – barriers to entry into the United States for older immigrants.”

So far, the public charge rule has remained blocked from implementation by the courts, however the Trump administration has requested that the Supreme Court allow the rule to go into effect while the litigation continues. For more information, check the website of the Protecting Immigrant Families partnership.

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Update on ACA-Repeal Lawsuit

On January 21, 2020, the Supreme Court declined to grant expedited review of the lawsuit that seeks to strike down the entire Affordable Care Act (ACA). Texas and several other states are pursuing the case (now called California v. Texas) with the support of the Trump administration. Even though an expedited schedule was denied, the Court may still grant review, as California and the other states defending the ACA have requested. The Center joined AARP and Justice in Aging in filing an amicus brief in support of Supreme Court review. We remain hopeful that the Supreme Court will take up the case and reverse the clearly erroneous decision of the Fifth Circuit, which leaves the entire ACA at risk of being nullified. The Court should not let this dangerous uncertainty about the fate of the ACA continue.

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Study Finds Differences In Post-Hospital Care Settings and Mortality Rates for Medicare Patients In Rural And Urban Areas

A study of beneficiaries in traditional Medicare who were hospitalized between January 1, 2011 and September 30, 2015 with certain primary diagnoses (stroke, hip or femur fracture without joint replacement, chronic obstructive pulmonary disease, congestive heart failure, or pneumonia) finds that beneficiaries in rural communities fared differently than those from urban areas. Beneficiaries from rural areas were:

  • More likely to be discharged to a skilled nursing facility or to home, without services;
  • Less likely to be discharged to home health care or an inpatient rehabilitation hospital;
  • Less likely to be readmitted to the hospital within 30 days after discharge or within 90 days after discharge; and
  • More likely to die within 30 days of hospital discharge, within 90 days of hospital discharge, or within 180 days of hospital discharge.

For more information about these findings, including possible explanations: see Cyrus M. Kosar, Lacey Loomer, Nasim B. Ferdows, Amal N. Trivedi, Orestis A. Panagiotou, Momotazur Rahman, “Assessment of Rural-Urban Differences in Postacute Care Utilization and Outcomes Among Older US Adults,” JAMA Network Open. 2020;3(1):e1918738 (Jan. 8, 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2756259. (Full PDF available.)

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New Opioid Treatment Program Benefit in Part B

Starting January 1, 2020 Medicare Part B began covering a new Opioid Treatment Program (OTP) benefit. The Centers for Medicare & Medicaid Services (CMS) pay OTPs through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B.

Under the new OTP benefit, Medicare covers:

  • U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
  • Dispensing and administration of MAT medications (if applicable)
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments

All states must also cover OTP in their Medicaid programs effective October 2020 subject to an exception process as defined by the Secretary. For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who previously got OTP services through Medicaid, starting January 1, 2020, Medicare became the primary payer for OTP services. OTP providers need to enroll as a Medicare provider in order to bill Medicare. CMS recently issued a memo emphasizing the importance of ensuring continuity of care for dually eligible enrollees currently obtaining treatment from an OTP provider through Medicaid.

More information is available at: https://www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center

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Call for Workshop Proposals for the 2020 National Aging and Law Conference

Please share your expertise at the 2020 National Aging and Law Conference (NALC) October 22-23rd at the Hilton Crystal City, in Arlington, Virginia.

Once again, this year the ABA Commission on Law and Aging is hosting NALC. The majority of the agenda is developed with proposals from speakers like you.

The agenda will feature a balance of programs on retirement income security, guardianship reform, capacity and decision making, elder abuse, Medicare/Medicaid, long term care, consumer law, and legal service delivery. 

Proposals are due by February 23rd. Details and the proposal forms can be found at https://www.americanbar.org/content/dam/aba/administrative/law_aging/2020-nalc-rfp.docx 

Please contact David.Godfrey@Americanbar.org with any questions, or if you need help obtaining the workshop proposal form.


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