Advocates Issue Joint Letter Raising Alarms about New Medicare Plan Finder and Revisions to MA and Part D Marketing Guidelines CMS Proposed Medicare Home Health Rules Raise Concerns for Access to Care – Comments due September 9, 2019 Stop Drugging Nursing Home Residents Without their Written Consent Advocates Issue Joint Letter Raising Alarms about New … Read more

The Center for Medicare Advocacy is concerned that proposed home health rules will further steer home health agencies away from providing care for beneficiaries who need it the most and toward beneficiaries with short-term post-acute care needs.[1] Beginning in 2020, payments to home health agencies under the new model will provide higher payments for individuals … Read more

August 27, 2019 Seema Verma Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington DC 20201 Dear Administrator Verma: The undersigned organizations are committed to ensuring that all people with Medicare have unfettered access to the accurate and impartial information they need to make optimal choices … Read more

Alexander v. Azar Trial Update – Seeking an Appeal of Outpatient Observation Status CMS Could Truly Put “Patients over Paperwork” By Fully Implementing the Jimmo Settlement Comparing Spending on Medicare Advantage vs. Accountable Care Organizations (ACOs) Recorded Webinar: Proposed Changes to Nursing Home Standards Alexander v. Azar Trial Update – Seeking an Appeal of Outpatient Observation Status … Read more

CMS Administrator Acknowledges that Prior Inpatient Hospital Rules Do Not Make Sense Government Watchdog Report Outlines Problems with Current Medicare Plan Finder As New Version Awaits Debut Short-term Health Plans: Goldmines for Insurance Companies, Junk for Enrollees Annual Surveys at Nursing Facilities Are Essential To Protect Residents CMA Webinar Schedule for 2019-2020 CMS Administrator Acknowledges … Read more

Medicare requires beneficiaries to have a three-day inpatient hospital stay in order to qualify for skilled nursing facility (SNF) care. Unfortunately, too many beneficiaries continue to be classified as hospital outpatients on observation status, thereby eliminating their ability to receive Medicare-covered SNF care. In a recent Tweet, Centers for Medicare & Medicaid Services (CMS) Administrator … Read more

CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good for Residents Federal Reports Find Incidents of Nursing Home Resident Abuse Are on the Rise but also Underreported Self-Help Resources for Improvement Standard Denials – August, 2019 CMS’s Proposed Changes to Nursing Home Requirements of Participation, Survey and Enforcement: Nothing Good … Read more

Although the revised Requirements of Participation published in October 2016[1] have not yet been fully implemented, the Centers for Medicare & Medicaid Services (CMS) published proposed rules on July 18, 2019 to revise them and also to make changes in survey and enforcement rules.[2]  CMS contends that its proposals are intended to “promote efficiency and … Read more

Updates on the BENES Act and Part D Legislation Guest Speaker: Lindsey Copeland, Medicare Rights Center Overview of the Administration’s Rollback of Nursing Home Protections (Dara Valanejad) Update on Observation Status (Toby Edelman) Framing as a Surprise Billing Issue Litigation Update (Ali Bers) 5th Circuit Case Challenging ACA CMA Litigation General Medicare Q&A (David Lipschutz) … Read more

1. UPDATES on the BENES Act and PART D LEGISLATION Guest Speaker:  Lindsey Copeland from the Medicare Rights Center Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) Medicare Rights Center one-pager – https://www.medicarerights.org/pdf/2019-benes-act-factsheet-long.pdf Medicare Watch article, The BENES Act Advances in the House – https://blog.medicarerights.org/benes-act-advances-in-the-house/ Medicare Watch article, MedPAC Calls for Improvements in Medicare … Read more

1. MEDICARE & ORAL HEALTH UPDATES Medically Necessary Coverage The Center for Medicare Advocacy has long advocated for coverage of medically necessary oral health care, which is currently supported by the Medicare statue, but is, unfortunately, significantly limited in practice due to CMS policy. Denying Medicare coverage to people for medically essential care, simply because … Read more

More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients CMS finalizes Rollback of Pre-Dispute Arbitration Protections Study Finds Home and Community-Based Services Access Disparities More Doors to Medicare Home Health Closing, More Harm for Observation Status Patients Many Medicare hospital patients classified as observation status “outpatients” currently forego necessary skilled nursing … Read more

Observation Status and Surprise Medical Bills Government Watchdog Agency Issues Report Highlighting “Significant Vulnerabilities” in Medicare’s Hospice Benefit Observation Status and Surprise Medical Bills The Center for Medicare Advocacy frequently hears from Medicare beneficiaries and their families about patients who receive treatment, tests, and services for multiple days while they are in a hospital bed … Read more

The National Association of Insurance Commissioners Recognizes Maintenance Therapy, Bolstering the Jimmo Settlement Agreement Inadequate Personal Care at Home Increases Overall Medicare Costs The New York Times Reports On HUD-Backed Nursing Homes Center for Medicare Advocacy Submits Comments to House Ways & Means and Energy & Commerce Committees on Draft Part D Legislation The National … Read more

Medicare home health coverage plays a vital role in supporting the health, safety, and well-being of adults in need of community-based care. Unfortunately, the Center for Medicare Advocacy (the Center) regularly hears from Medicare beneficiaries and their families about their inability to access care, or the appropriate amount of care, despite meeting the necessary coverage … Read more

More Health Care Sabotage: “Censorship” of the Affordable Care Act Nursing Home Study Finds Discharges Linked to Medicare Copayments Senators Release Secret List of Poor Quality Nursing Homes Center for Medicare Advocacy Submits Comments to CMS about Direct Contracting, Geographic-Based Model Center Comments on Proposed Rule Regarding Medicare/Medicaid Interoperability More Health Care Sabotage: “Censorship” of … Read more

At present, only 88 nursing facilities nationwide (0.6% of the nation’s total number of facilities) are identified as Special Focus Facilities (SFFs). The Centers for Medicare & Medicaid Services (CMS) describes SFFs as having “more problems” than other facilities, “more serious problems” than other facilities, and “[a] pattern of serious problems that has persisted over … Read more

Congressional Hearing on Surprise Medical Bills; Center for Medicare Advocacy Submits Statement on Observation Status Report Highlights Overpayments to Medicare Advantage Plans and Raises Important Policy Considerations Webinar: Where Does the Money Go? Insights and Consumer Perspectives on Nursing Home Profits and Losses Elder Justice Newsletter – New Issue Available Now Congressional Hearing on Surprise Medical … Read more

On May 9, 2019, the Center for Medicare Advocacy held its sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The theme of the day was Health Care as a Human Right: Medicare’s Role in Making it a Reality. The Summit convened advocates, leading experts, and policy-makers to discuss … Read more

A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Medicare Coverage for Genetic Tests: Know the Facts A First Step in an Important National Discussion: Congressional Committee Holds Hearing on “Medicare for All” Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing … Read more

Repeated efforts to repeal and undermine the Affordable Care Act (ACA) have led to growing public awareness of the importance of access to health coverage and accompanying patient protections. Recognition of the important role of the ACA and Medicare, and growing support for Medicaid, have combined to shape public support for expanding health coverage, instead … Read more

The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations Latest Issue: Elder Justice: What “No Harm” Really Means … Read more

Observation Status Deprives Medicare Beneficiaries of their Skilled Nursing Facility Benefit. Period. Nursing Home Requirements of Participation: Will the Administration Overturn 2016 Rules for Infection Control? New Fact Sheet Available – Medicare Inpatient Rehabilitation Hospital/Facility Coverage In Light of Jimmo v. Sebelius Join Us! 6th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller … Read more

Nursing Home Roundup: What's Causing Nursing Home Closures; Joint Letter; Free Webinar on Phase 3 Nursing Home Regulations Health Care Sabotage News: Court Strikes Blow for Health Care; Advocacy Groups File Amicus Brief in Texas ACA Case Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Webinar – April 10, 3:00 PM – Medicare … Read more

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 … Read more

Medicare Education & Outreach (David Lipschutz) Information from the February 8, 2019 meeting of CMS’ National Medicare Education Program (NMEP) Medicare Advantage Steering Redesign of Medicare Plan Finder Senate Finance Committee Hearing on Nursing Facilities (Toby Edelman and Dara Valanejad) “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019: https://www.finance.senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-neglect-in-nursing-homes … Read more

1. MEDICARE EDUCATION & OUTREACH At a February 8, 2019 meeting of the Center for Medicare & Medicaid Services’ (CMS) National Medicare Education Program (NMEP), the agency released information about the 2018 Annual Coordinated Election Period (ACEP), sometimes referred to as “Open Enrollment” or “OP.” (Note: this is a downloadable “zip” file containing several items. … Read more

Joint Statement by Center for Medicare Advocacy and Medicare Rights Center: President’s Budget Targets Key Health Care Programs Members of Congress Reintroduce Legislation to Fix Outpatient Observation Status Medicare Advantage Case Spotlight Spanish Language Home Health Outreach Materials Available Join Us! 6th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture Early-Bird Registration … Read more

Improve and Expand Medicare: End the Use of Outpatient Observation Status – A Billing Issue that Restricts Needed Care Jimmo Implementation Update: Where is CMS? 2019 National Aging and Law Conference Speaker Proposals Still Accepted through Tomorrow Improve and Expand Medicare: End the Use of Outpatient Observation Status – A Billing Issue that Restricts Needed … Read more

The <i>National Voices of Medicare Summit<br />and Senator Jay Rockefeller Lecture</i>

Register now for the 2020 National Voices of Medicare Summit And enjoy the 2019 Summary below The Center thanks all who participated in the sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation in Washington, DC. The theme of the day was Health Care as a Human … 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 Centers for Medicare & Medicaid Services (CMS) has released a free mobile app for iOS and Android users. The app, “What’s Covered,” is designed to provide Medicare beneficiaries and their families with a general overview of covered services, coverage requirements, costs, and additional information. While the app is geared towards beneficiaries in traditional Medicare, … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. ACCESS TO CARE    Home Health Between April 2017 and October 2018, the Center completed the “CMA Issue Brief Series: Medicare Home Health Crisis” – a ten-part series examining the growing crisis in … Read more

Access to Care ​​Home Health (Kathy Holt) Durable Medical Equipment (DME) (Kathy Holt) Observation Status (Judy Stein) Nursing Home Issues (Dara Valanejad)   Leveling the Playing Field – Traditional Medicare and Medicare Advantage (David Lipschutz) Policy Changes and CMS Efforts Favoring MA Law, regulations and policy CMS materials Medicare Fully Informed Project  Promoting Free Choice … Read more

Improve Medicare: Correct Medicare Hospital Observation Status Legal Memorandum: Statutory Authority Exists for Medicare to Cover Medically Necessary Oral Health Care Joint Statement on Turmoil in the Nursing Home Industry Improve Medicare: Correct Medicare Hospital Observation Status Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core … Read more

Core Considerations for Medicare for Today & Tomorrow – A Medicare Platform for the New Congress Texas Lawsuit Sabotage of the Affordable Health Care Act Core Considerations for Medicare for Today & Tomorrow – A Medicare Platform for the New Congress The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health … Read more

Core Considerations for Today & Tomorrow The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to: Improve Medicare for current and future beneficiaries. Support the development of … Read more

Important Health Policy Article Published In New England Journal of Medicine: “Medicare Advantage Checkup" ACA Open Enrollment Ends December 15th State Attorneys General Successfully Take on Nursing Home Issues Important Health Policy Article Published In New England Journal of Medicine: “Medicare Advantage Checkup” The November 2018 New England Journal of Medicine features a article by … Read more

The November 2018 New England Journal of Medicine features a article by KFF’s Tricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation (KFF) that “examine[s] the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality. They also highlight areas where more evidence … Read more

Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement Standard” Education Still Not Working Health Care Sabotage: Expanded “Short-Term, Limited-Duration Insurance” is Here Study: Three-Day Hospital Requirement for Post-Hospital Care In a Skilled Nursing Facility Increases Medicare Costs Who Owns Nursing Facilities and Why? Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement … Read more

In order to qualify for Medicare Part A coverage of a post-hospital stay in a skilled nursing facility, the traditional Medicare program requires that the beneficiary first be hospitalized as an inpatient for three consecutive days, not counting the day of discharge.  This requirement has been in place since the Medicare program was enacted more … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. RECENT CHANGES IN LAW, REGULATIONS AND GUIDANCE RELATING TO MEDICARE ADVANTAGE AND PART D CMA Special Report (September 2018): http://www.medicareadvocacy.org/special-report-recent-changes-in-law-regulations-and-guidance-relating-to-medicare-advantage-and-the-prescription-drug-benefit-program/ Overview The first half of 2018 has seen a number of changes in … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Recent Changes in Law, Regulations and Guidance Relating to Medicare Advantage and Part D (David Lipschutz) CMA Special Report (to be released Monday, 9/17) Summary of Changes Discussion Tipping the Scales Towards MA Impact of Recent Changes on Consumer Decision-Making   Informed Choice and the Mid-Term Elections (Ben Belton) Informed … Read more

Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights Study Finds Link Between Registered Nurse Hours and Antipsychotic Drug Use Webinar: Skilled Nursing Facilities Update Report: Transfer and Discharge Deficiencies Cited Since 2017: Surveyors Focus On paperwork, Not Residents’ Rights The involuntary transfer and discharge of nursing home residents … Read more

Human Rights Watch (HRW) published a devastating report in February 2018, which found that over 179,000 nursing home residents were being administered off-label antipsychotic drugs every week.[1] Antipsychotic drugs are indicated to treat specific clinical conditions, such as schizophrenia, and not the behavioral symptoms of dementia. Nevertheless, the HRW report noted that most of the … Read more

More Health Care Sabotage: Inadequate Funding for Navigators Court Ruling May Lead to Even More Overpayments to Medicare Advantage MedPAC Discusses Requiring a Three-Day Hospital Stay for All Post-Acute Care, Threatening Access to Care House Committee Holds Hearing on Nursing Home Quality Issues Proposed DMEPOS Rules: Clarification and Enforcement Needed More Health Care Sabotage: Inadequate … Read more

The Medicare Payment Advisory Commission (MedPAC) held a public meeting on September 6, 2018. Commissioners listened as staff presented on “Aligning Medicare’s statutory and regulatory requirements under a unified payment system for post-acute care.”[1] Specifically, the presentation discussed the need to make level-of-care requirements consistent across post-acute care (PAC) settings under a unified PAC prospective … Read more

August 27, 2018 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1689-P P.O. Box 8013 Baltimore, Maryland  21244-8013 Submitted electronically to: http://www.regulations.gov Re:  CMS-1689-P; Federal Register, Volume 83, No. 134 (July 12, 2018) The Center for Medicare Advocacy (the Center) provides these comments regarding CMS-1689-P and the impact of the … Read more

This is part nine of a ten-part CMA Issue Brief Series examining the growing crisis in access to Medicare home health coverage and necessary care – and outlining the Center for Medicare Advocacy’s work to address these issues. We invite you to follow this Issue Brief Series and submit Medicare home health stories to the … Read more

MEDICARE HOT TOPICS[1] ORAL HEALTH UPDATE On July 19, 2018 the Center issued the following press release: July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. … Read more