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On June 4, 2018, the House of Representatives Democratic Caucus Seniors Task Force held a briefing on “Protecting Seniors by Improving – Not Eroding – Nursing Home Quality Standards.” The Center for Medicare Advocacy, led by Senior Policy Attorney Toby Edelman, presented on the enforcement of the nursing home standards, as well as the current … Read more

CMA Alert – Bill Jeopardizes Civil Rights of People with Disabilities; More

House Passes Bill Jeopardizing Civil Rights of Individuals with Disabilities Medicare Home Health Highlight Latest Nursing Home Rights Issue Alert This Week in Healthcare Sabotage House Passes Bill Jeopardizing Civil Rights of Individuals with Disabilities 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture This year's Summit will focus on health care … Read more

The Long Term Care Community Coalition (LTCCC), in partnership with the Center for Medicare Advocacy, publishes monthly Issue Alerts on the rights of nursing home residents. These Issue Alerts focus on specific standards of care that nursing homes must follow as a requirement of participating in Medicare and Medicaid. The goal of this project is … Read more

New LTCCC Issue Alert: Nursing Home Staffing Requirements

The Long Term Care Community Coalition (LTCCC), in partnership with the Center for Medicare Advocacy, publishes monthly issue alerts on the rights of nursing home residents. These issue alerts focus on specific standards of care that nursing homes must follow as a requirement of participating in Medicare and Medicaid. The goal of this project is … Read more

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident Protections Tax Cut Bill Just Got Worse.  Health Care at Risk. Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 … Read more

CMA Alert, October 18, 2017 – Nursing Home Rights Roundup; ACA Stabilization; More

This Week in ACA Sabotage Bipartisan Agreement on ACA Stabilization Package Nursing Home Rights Roundup CMS Signals End of Campaign to Reduce Unnecessary Use of Antipsychotic Drugs In Nursing Homes; Claim of Success is Grossly Overstated OIG Report about Nursing Home Complaints Leaves Questions Unanswered Congressional Letter Asks for Revision and Delay of Nursing Home … Read more

CMA Alert –  OIG Warns of Abuse in SNFs; Ted Kennedy, Jr. Joins CMA Advisory Board; “Jimmo” Corrective Action Plan

HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Connecticut State Senator Ted Kennedy, Jr. Joins Center for Medicare Advocacy Advisory Board Jimmo Corrective Action Plan Completed HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Last week, the HHS Office of Inspector General (OIG) issued an Early Alert, warning of … Read more

As noted in a previous Alert, the Center for Medicare & Medicaid Services (CMS) recently finalized their 2018 Call Letter.  In the same document, CMS issued a Request for Information regarding ideas for “regulatory, sub-regulatory, policy, practice and procedural changes to better accomplish” the goals of “using transparency, flexibility, program simplification and innovation to transform … Read more

April 24, 2017 VIA ELECTRONIC SUBMISSION PartCDcomments@cms.hhs.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244 Re:                  2017 Transformation Ideas – Response to Request for Information re: Medicare Advantage and Part D Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide … Read more

Mandating specific levels of direct care nursing staff would seem to be a straightforward method to improve staffing in nursing facilities.  If more nursing staff are needed, why not simply require facilities to employ more nurses?  The strategy is far more complex, however, than it at first appears.  This paper reviews which states have tried … Read more

March 3, 2017 VIA ELECTRONIC SUBMISSION AdvanceNotice2018@cms.hhs.gov Cynthia G. Tudor, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244 Re:  Advance Notice of Methodological Changes for Calendar Year 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2018 Call Letter Dear … Read more

January 13, 2017 – WASHINGTON – On January 18, 2017 U.S. Rep. Tom Price (R – Ga.) will face a hearing before the Senate Health, Education, Labor and Pensions Committee to determine his qualification to become Secretary of Health and Human Services. Details are pending regarding an additional hearing before the Senate Finance Committee. Medicare … Read more

MOVING FORWARD WITH HOPE It’s no surprise that the election has left many of us worried and disoriented.  But we’ll regroup. We may not understand where we’ve landed, but we’ll acclimate and march forward – with hope. We hope the new administration will realize how today’s families are balancing – often barely – all the … Read more

For Immediate Release Contact: Toby S. Edelman, Senior Policy Attorney TEdelman@MedicareAdvocacy.org, (202) 293-5760 The Centers for Medicare & Medicaid Services has just released a comprehensive revision of federal nursing facility regulations.   The regulations and explanatory material (over 700 pages total) are available here.  The positives for nursing facility residents include expanded training requirements, and a … Read more

Under the federal Nursing Home Reform Law, the Centers for Medicare & Medicaid Services (CMS) has authority and the “responsibility”[1] to impose Civil Money Penalties (CMPs) and other enforcement actions at nursing homes that are found to violate federal standards of care (which are called Requirements of Participation).[2]  For the first time in more than … Read more

On February 9, 2016, President Obama unveiled his Fiscal Year 2017 Budget.[1]  With respect to Medicare, this year’s proposed budget is very similar to last year’s, both good and bad, with some notable exceptions.  While not a comprehensive analysis of all of the Medicare-related provisions, the Center for Medicare Advocacy provides these comments about the … Read more

Together with other beneficiary advocacy groups, the Center for Medicare Advocacy responded to several requests for comment from the Centers for Medicare & Medicaid Services (CMS) in December.  Below, we include summaries of these comments on: Integrated Denial Notice Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017 [CMS–9937–P] … 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

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

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

On March 11, 2015, the Diane Rehm program on National Public Radio hosted a discussion of the revisions to the Centers for Medicare & Medicaid Services’s (CMS’s) Five Star Quality Rating System for nursing homes.[1] Patrick Conway, CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality began the show by describing the changes.  … Read more

Two-Thirds of Nursing Facilities Nationwide Will See Decline In their Quality Measures; One-Third of Facilities Will See Decline in Their Overall Score As promised in October 2014,[1] the Centers for Medicare & Medicaid Services (CMS) has made significant changes to Nursing Home Compare, effective February 20, 2015.  The changes recalibrate the Quality Measures (QMs), add … Read more

The Centers for Medicare & Medicaid Services (CMS) announced plans to expand its focused surveys on resident assessments and nurse staffing for nursing facilities nationwide (but not in all facilities), beginning in early fiscal year 2015.  Expanded surveys should lead to more accurate reporting of quality measures and staffing data on the federal website Nursing … Read more

The federal nursing home website, Nursing Home Compare, is about to undergo major changes that should significantly improve the accuracy of information about nursing homes that is provided to the public.  The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014), signed by President Obama on October 6, 2014, supports one of … Read more

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

In its most recent report on nursing home payments and quality, February 2013, the Office of Inspector General (OIG), Department of Health and Human Services (HHS) reports that many skilled nursing facilities (SNFs) failed to provide adequate care planning and discharge planning to residents and provided "egregious" care to some residents, yet were paid by … Read more

HOSPITALIZATION AND REHOSPITALIZATION OF NURSING HOME RESIDENTS 1.  Concerns about hospitalization and rehospitalization of nursing home residents •         Effects on patients (hospital-acquired infections, delirium, increased use of antipsychotic drugs and physical restraints, increased morbidity and mortality) •         High costs associated with hospitalization 2.  Three distinct issues (some overlap) are involved: •         Reducing hospitalization from the community, … Read more

One of the many decisions individuals and families face when they need long-term care is choosing a facility.  A key factor that should be considered is whether to choose a for-profit corporate facility or a non-profit facility. Federal and state policymakers also need to consider the implications of ownership information as they design and implement … Read more

For several years, reducing rehospitalizations of Medicare beneficiaries has been a key public policy goal, the intent of which is to improve quality of care for beneficiaries and reduce costs for the Medicare program.[1]  Studies have shown that rehospitalizations are common and expensive.  In 2006, for example, nearly one-quarter of nursing home residents (23.5%) were … Read more

For many years, advocates for nursing home residents have argued that when residents are denied good care, the costs of trying to treat and correct avoidable conditions and bad resident outcomes are high.  Advocates refer to this phenomenon as "the high cost of poor care."  Others identify the phenomenon as "the business case for quality."  … Read more

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Click on any of the links below to view older articles by topic.  Topics with no link have no current archived articles. Acute Hospital Antipsychotic Drugs Chronic Conditions Discharge Planning Home Health Hospice Hospital Improvement Standard and Jimmo v. Sebelius Lesbian, Gay Bisexual and Transgender (LGBT) Seniors Medicare Advantage Medicare Basics Medicare Coverage & Appeals Medicare … Read more

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Please use the links below to navigate to a list of articles by topic. Acute Hospital Care Antipsychotic Drugs Chronic Conditions Connecticut Consumers Coverage for People with Disabilities Discharge Planning Health Care Reform – The Affordable Care Act (ACA) Home Health Care The Improvement Standard Medicare Advantage Medicare Reform Medicare Summary Medicare Coverage Appeals Medicare Coverage … Read more

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Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are entitled. In addition, individuals receiving railroad retirement benefits and individuals suffering from end stage renal disease are eligible to receive Medicare benefits. Medicare can be confusing, even for people who … Read more

Introduction The three-year old, and still ongoing, investigation and criminal prosecution of former staff members of a California skilled nursing facility for improper use of antipsychotic drugs on residents raises issues that go far beyond the gruesome facts of the case; issues that remain current today. This Alert discusses that case, research and Federal Drug … Read more

FORCE THE NURSING HOME REFORM LAW INSTEAD OF WEAKENING THE CONTROLLED SUBSTANCES ACT   March 24, 2010 For Immediate Release                                                               Contact: Toby S. Edelman (202) 293-5760, ext.104 Tedelman@medicareadvocacy.org   The Center for Medicare Advocacy is troubled by the Senate Special Committee on Aging's March 24 hearing, "The War on Drugs Meets the War … Read more

In recognition of Older Americans' Mental Health Week (May 24-30, 2009), this Weekly Alert reviews the mental health services that are available under the Medicare Program. [1] Advocates seek improved access to mental health services, an expansion in the scope of services covered, and an increase in the types of providers whose services are covered. … Read more

Toby S. Edelman has been representing older people in long-term care facilities since 1977. As a Senior Policy Attorney with the Center for Medicare Advocacy since January 2000, Ms. Edelman provides training, research, policy analysis, consultation, and litigation support relating to nursing homes and other long-term care facilities.  Under two grants from the Commonwealth Fund, she … Read more

#MedicarePlatform – Improve and Expand Medicare: Long-Term Services and Supports (LTSS) Center Submits Comments on Proposed Medicare Prescription Drug Rule Congressional Hearings Explore Rising Prescription Drug Costs Medicare’s New “What’s Covered” App Adds to Outreach but More Work Is Needed #MedicarePlatform – Improve and Expand Medicare: Long-Term Services and Supports (LTSS) Recently, the Center for … Read more

The Center for Medicare Advocacy recently submitted comments to a Notice of Proposed Rulemaking issued by the Centers for Medicare & Medicaid Services (CMS) entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses” (CMS-4180-P).  The Center’s comments are available at: https://www.medicareadvocacy.org/center-comments-on-modernizing-part-d-and-medicare-advantage/.   Currently, Part D prescription drug plans (PDPs) … Read more

Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News This Week in Healthcare Sabotage: Double Digit Rate Hikes Expected and Proposed “Conscience” Rules Elder Justice Alert: New York Times Publishes Article on Drug Use Among Older Adults Highlights from FY18 “Omnibus” Appropriations Bill: Some Good, Some Not-So-Good News Webinar Rescheduled! Home Health Updates … Read more

Revelations have shed light on an opioid crises in the United States that remained largely hidden until recently. These drugs have affected the lives of children and adults nationwide. Unfortunately, the inappropriate use of medication – legally or illegally – is not limited to opioids in its multigenerational reach. As the New York Times reports … Read more

CMA Alert – The Fight Continues; Home Health Access Issues; World Elder Abuse Awareness Day

1. Medicare Home Health Crisis – Misleading and Inaccurate CMS Medicare Home Health Publications 2. Senate Plans to Vote to Gut Health Care Next Week – Act Now to Stop These Cuts! 3. World Elder Abuse Awareness Day Misleading and Inaccurate CMS Medicare Home Health Publications This is Part Four of a ten-part CMA Issue … Read more

Last week, Center for Medicare Advocacy Chiplin Senior Fellow Ben Belton participated in a 2017 World Elder Abuse Awareness Day (WEAAD) commemoration at the United Nations (UN) in New York. This year’s WEAAD theme, “Understand and End Financial Abuse of Older People: A Human Rights Issue” highlighted the need to protect older people from the … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

On March 30, 2017, the Center for Medicare Advocacy held its fourth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The Summit convened leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health … Read more

While the Center for MEdicare Advocacy continues to press for systemic improvements to the Medicare program, both big and small, there has been some good news for beneficiaries in the health care arena.  As calendar year 2014 draws to a close, the Center highlights positive changes in Medicare and health care that occurred this year, … Read more

I. LEGISLATIVE UPDATE Failure of the Super-Committee On November 21, 2011, members of the Joint Select Committee on Deficit Reduction ("Super-Committee") announced that they had failed to put together a legislative package to cut the deficit by approximately $1.2 trillion, as outlined by the Budget Control Act of 2011.  Without further Congressional action, automatic cuts … Read more