- Trump Administration Works to Undermine the Affordable Care Act – Yet Again
- Court Denies All Government Motions in Class Action Seeking Appeal Right for Medicare Beneficiaries on “Observation Status”
- Observation Status: Physicians Challenge the Inspector General
- Study Finds Home Health Lowers Costs and Readmission Rates Compared to Hospital Care
- Medicare Advocates: Trump Budget Would Impede Access to Care
- Elder Justice “No Harm” Newsletter – Issue 11
- Webinar – April 10, 3:00 PM – Medicare & health Care Hot Topics – Register Now
6th Annual National Voices of Medicare Summit &
Rep. John Lewis will deliver this year’s Sen. Jay Rockefeller Lecture
Also joining us: Sen. Jay Rockefeller; Rep. Rosa DeLauro; Judy Feder of Georgetown University; Tricia Neuman, Senior VP, Kaiser Family Foundation; Henry Claypool, Technology Policy Consultant at AAPD and Former Director of the HHS Office on Disability; Cathy Hurwit, Former Chief of Staff for Rep. Jan Schakowsky; film writer Anna Reid-Jhirad, Ben Belton, AARP Global Partner Engagement Director; and a direct-care worker from SEIU._______________
May 9, 2019
Kaiser Family Foundation
— Statement from the Center for Medicare Advocacy and the Medicare Rights Center —
Washington, DC – This week, the Department of Justice took a new, more extreme position in a federal case challenging the constitutionality of the Affordable Care Act (ACA), agreeing with a federal district court in Texas that the entire law should be invalidated.
Now under appeal in the Fifth Circuit, the Texas court’s December ruling – which is now the Trump Administration’s official stance – represents a serious threat to the rule of law, access to health care, and, potentially, to our health care system.
Previously, the Justice Department argued that some parts of the health law, but not all of it, should be struck down. At the center of the lawsuit, filed in 2018 by 20 Republican state attorneys general and governors as well as two individuals, is the ACA’s individual mandate and penalty for failure to be insured. Congress repealed this provision in the 2017 tax bill; an act the lawsuit claims should render the ACA null and void. Unfortunately, the district court in Texas agreed with this flawed analysis, although it has been denounced by legal scholars across the ideological spectrum.
If the Justice Department is successful and the entire law is eliminated, the results would be catastrophic. As many as 20 million Americans would lose health coverage in 2019 alone, and millions more would find their coverage at risk – including an estimated 133 million Americans under 65 with pre-existing conditions who rely on the ACA’s coverage and consumer protections. Older adults would be disproportionately impacted, as the likelihood of having a pre-existing condition increases with age: up to 84% of those ages 55 to 64 – 31 million individuals – have a pre-existing condition for which they could be denied coverage or charged an unaffordable rate absent the ACA’s important protections. This same group would also once again face an “age tax” that could put high quality coverage out of reach, and the ACA’s Medicare reforms that make the program more sustainable and its coverage more affordable would also be erased, including those that improve beneficiary access to preventive services and prescription drugs.
Instead of sabotaging access to health care, the federal government should be working to ensure more Americans have high quality and affordable coverage, as intended by several bills recently introduced in the House of Representatives. We call on the Trump Administration to stop undermining the Affordable Care Act, and we applaud those in Congress who are working to protect and strengthen it.
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In a decision issued on March 27, 2019, a federal judge denied multiple attempts by the federal government to halt a lawsuit by Medicare patients seeking a right to appeal their placement on “outpatient observation status” in hospitals.
- Read More at: https://www.medicareadvocacy.org/court-denies-all-government-motions-in-class-action-seeking-appeal-right-for-medicare-beneficiaries-on-observation-status/
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A group of physicians has challenged a recent audit report from the Inspector General for the Department of Health & Human Services that concluded that between 2013 and 2015 Medicare incorrectly paid $84.2 million for skilled nursing facility (SNF) stays for beneficiaries who had not had a prior three-day qualifying inpatient hospital stay. Like the Centers for Medicare & Medicaid Services (CMS), the physicians reject the Inspector General’s recommendations to impose new requirements on hospitals and SNFs to provide additional notices to patients of their outpatient observation status. They base their objections on multiple grounds.
First, the three physicians describe the changes in hospitalization and medical care since Medicare was enacted more than 50 years ago. In 1965, when observation status did not exist, the average hospital length of stay for people over age 65 was 14.2 days; today, the average length of stay is 5.1 days, reduced in large part, they contend, because of changes in medical treatment.
Second, the physicians describe the confusion between the three-day inpatient stay required for Medicare coverage of post-hospital SNF care, and the “two-midnight rule,” established by CMS in 2013 to determine patient status in the hospital. They point to the large percentage of hospital outpatients who are eventually admitted to inpatient status as well as to the Inspector General’s earlier finding that, in 2014, more than 600,000 hospital stays were three nights or longer, but did not include three inpatient days.
The physicians describe the “significant resources” used by hospitals to make decisions about inpatient/outpatient status. More than 40% of job postings for hospital case manager positions are related to patient status. An earlier study found that three hospitals employed an average of 5.1 full-time staff per hospital “just to manage the audit and appeals process related to billing status.”
Adding more paperwork, as the Inspector General proposes, would increase costs but not improve health care.
The physicians recommend synchronizing the two- and three-midnight rules and supporting the Improving Access to Medicare Coverage Act of 2019 – federal legislation that would count all midnights in the hospital toward meeting the statutory inpatient requirement.
The Center for Medicare Advocacy agrees with their analysis and with their recommendation to enact federal legislation.
 HHS Office of Inspector General, CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met, A-05-16-00043 (Feb. 2019), https://oig.hhs.gov/oas/reports/region5/51600043.asp. The report was discussed at CMS, “Inspector General Report: Medicare Overpaid Skilled Nursing Facilities When Patients Did Not Have Qualifying Inpatient Hospital Stays” (CMA Alert, Feb. 28, 2019), https://www.medicareadvocacy.org/improve-and-expand-medicare-end-the-use-of-outpatient-observation-status-a-billing-issue-that-restricts-needed-care/.
2] Ann M. Sheehy, Charles F.S. Locke, Bradley Flansbaum, “What The Inspector General Gets Wrong About Reforming Observation Hospital Care,” HealthAffairs blog (Mar. 25, 2019), https://www.healthaffairs.org/do/10.1377/hblog20190320.244258/full/.
3] 42 C.F.R. §412.3; CMA, “Observation Status: New Final Rules from CMS Do Not Help Medicare Beneficiaries” (CMA Alert, Aug. 29, 2013), https://www.medicareadvocacy.org/observation-status-new-final-rules-from-cms-do-not-help-medicare-beneficiaries/.
 H.R. 1682, S. 753.
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A recently published study in The American Journal of Accountable Care finds that home health care may result in lower costs and a lower hospital readmission rate for Medicare beneficiaries after emergency room visits. The study, “Improved Cost and Utilization Among Medicare Beneficiaries Dispositioned From the ED to Receive Home Health Care Compared With Inpatient Hospitalization,” notes that total 90-day costs were lower for beneficiaries receiving home health care after an emergency room visit when compared to beneficiaries treated at the hospital ($13,012 and $20,325, respectively). Furthermore, the study finds that beneficiaries receiving home health care had lower readmission rates (23.7%) compared to beneficiaries receiving hospital care (33%).
As part of our Medicare Platform, the Center for Medicare Advocacy (the Center) has long been working to ensure beneficiaries with longer-term, chronic, and/or debilitating conditions have full access to skilled nursing, therapy and related care needed to maintain their conditions or slow decline. The Center’s advocacy efforts include pushing back against bias toward institutional admissions for home care patients, which makes it harder for beneficiaries who avoid hospitalizations to obtain and retain home health care.
- To learn more about Medicare’s home health benefit, visit https://www.medicareadvocacy.org/medicare-info/home-health-care/.
- To read the Center’s ten-part Issue Brief Series: Medicare Home Care Crisis, visit https://www.medicareadvocacy.org/cma-issue-brief-series-medicare-home-health-care-crisis/.
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The Center for Medicare Advocacy and the Medicare Rights Center joined to submit a letter to the New York Times refuting their recently published editorial regarding Medicare “reform.”
- See https://www.nytimes.com/2019/03/28/opinion/letters/medicare-trump-budget.html (the letter will also run in tomorrow’s print edition.)
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Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means to nursing home residents. Our latest issue has real stories from nursing homes in New York, Kansas, Michigan, and Florida. Some examples of “no harm” deficiencies featured in this issue include a resident receiving an unnecessary drug and a resident being inappropriately touched.
- Read the latest Issue at: https://www.medicareadvocacy.org/newsletter-elder-justice-what-no-harm-really-means-for-residents/
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Medicare & Health Care Hot Topics
Wed, Apr 10, 2019 3:00 PM – 4:00 PM EDT
This presentation will examine several current issues facing Medicare beneficiaries. Topics include: ongoing barriers to care, including home health and observation status issues, Medicare outreach and education, transitions from other coverage to Medicare, prescription drug proposals, and various issues impacting low-income beneficiaries, including Dual-Eligible Special Needs Plans (D-SNPs) and improper billing of Qualified Medicare Beneficiaries (QMBs).
David Lipschutz, Associate Director/Senior Policy Attorney, Center for Medicare Advocacy
Lindsey Copeland, Federal Policy Director, Medicare Rights Center
Jennifer Goldberg, Deputy Director, Justice in Aging
Register now at:
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