Most Read <i>CMA Alerts</i> (Plus, Webinars) of 2019

As 2019 winds down, we took a look back at the CMA Alerts you were most interested in over the last twelve months. News about skilled nursing facilities featured highly, as did Medicare payment changes. Interest in Medicare coverage of oral health remains high, and of course, you continued to follow the ongoing issues of … Read more

 WAYS & MEANS COMMITTEE HEARING “CARING FOR AGING AMERICANS” November 14, 2019 STATEMENT FOR THE RECORD Statement of Toby S. Edelman Senior Policy Attorney Center for Medicare Advocacy 1025 Connecticut Avenue, N.W., Suite 709 Washington, DC  20036 (202) 293-5760 The Center for Medicare Advocacy (Center) is a national, private, non-profit law organization, founded in 1986, … Read more

What does Medicare cover? When does Medicare cover skilled nursing facility care? Can a patient who is receiving non-skilled “custodial” services receive Medicare coverage in a SNF? What are examples of skilled services in a SNF? Are there any tools for comparing nursing facilities? For further information, follow one of the links below or scroll … Read more

(The views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy.) I. ENROLLMENT PERIOD UPDATES Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – ends on December 7th.  As discussed … Read more

Agenda Enrollment Period Updates (David Lipschutz) Including Medicare Plan Finder, referrals to SHIPs H.R. 3 – Prescription Drug Bill with Medicare Improvements (Kata Kertesz & David Lipschutz) Prescription Drug Changes Medicare Improvements, including adding oral health, hearing vision coverage Update on Skilled Nursing Facilities (Toby Edelman) Including new payment model in effect since 10/1/19 (Patient … Read more

We appreciate your interest in our efforts to keep Medicare strong, advocate for the people who rely on Medicare, and provide important information. As someone who is invested in our activities, we write today hoping you will help us spread the word about the need to protect and improve the Medicare program now, regardless of … Read more

Potential Impacts of New Medicare Payment Models On Skilled Nursing Facility and Home Health Care  CMS Extends “Equitable Relief” from Part B Late Enrollment Penalties for People Moving from ACA Marketplace Plans to Medicare Free Webinar: Coordination of Benefits – What Pays When? Potential Impacts of New Medicare Payment Models On Skilled Nursing Facility and … Read more

The Centers for Medicare & Medicaid Services will be implementing revised payment systems for both skilled nursing facility care (effective October 2019) and home health care (effective January 2020). The Center for Medicare Advocacy has written at length and submitted comments on both the home health and skilled nursing facility payment models. Unfortunately, implementing these … Read more

Center for Medicare Advocacy Board President Judith Feder Testifies at Drug Pricing Hearing  Administration’s “Public Charge” Rule [Temporarily?] Blocked Drug Company Sued Over Kickbacks for Off-Label Marketing of Psychotropic Drug for Nursing Home Residents to Pay Over $115 Million Joint Issue Alert on Medicare Payment and Skilled Therapy Services in Nursing Homes Free Webinar: Medicare … Read more

On October 17, 2019, the House Ways & Means Committee held a hearing entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-of-Pocket Costs, and Improving Medicare Benefits.”  The hearing focused on H.R. 3, the Lower Drug Costs Now Act (discussed in a previous Alert), as well as current gaps in Medicare … Read more

Center for Medicare Advocacy Analysis of President’s Medicare Advantage Executive Order: Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries  Nursing Home Residents and Therapy Under The New Medicare Reimbursement System Important Update to Nursing Home Compare Will Enable Public to Identify Facilities with a History of Abuse Medicare’s Annual Election Period Starts Next Week … Read more

The Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Part A reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM), on October 1, 2019.[1] Therapists immediately began reporting that nursing homes and therapy companies were laying them off and demanding that they change their therapy practices, shifting residents from … Read more

Infographics

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Medicare Infographic – A visual timeline of the Medicare program from the Center for Medicare Advocacy. Observation-Status Infographic – The Center for Medicare Advocacy’s 3-Part Infographic explaining Observation Status and the problems it causes for Medicare beneficiaries. Medicare Home Health Coverage Infographic – The Road to Medicare Covered Home Health Care Home Health Infographic (SPANISH) – El … Read more

The Centers for Medicare & Medicaid Services (CMS) recently posted the Medicare & You 2020 handbook on their website. The Center for Medicare Advocacy (the Center) reviewed the new handbook with an eye toward assessing the balance of information provided about traditional Medicare vs. Medicare Advantage (MA), and the accuracy of information regarding coverage. In … Read more

The Center for Medicare Advocacy (the Center), submitted comments this week regarding the 2020 proposed rules for Medicare home health care. The Center is pleased CMS plans to allow therapist assistants to perform maintenance therapy (therapist assistants are currently allowed to perform improvement therapy), recognizing equal coverage for beneficiaries who need safe and effective therapy … Read more

Medicare & You 2020 – Better Than Draft, But Room for Improvement More People Went Without Health Insurance in United States in 2018 Administrator Verma’s Tweet Sparks Support for Addressing Observation Status Proposed Home Health Rules – Payment Shouldn’t Impede Access Register Now – Free Webinar, September 18 – Skilled Nursing Facility Updates Medicare & … Read more

September 9, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1711-P P.O. Box 8013 Baltimore, Maryland  21244-8013 Submitted electronically to: http://www.regulations.gov Re:  CMS-1711-P; Federal Register, Volume 84, No. 138 (July 18, 2019) The Center for Medicare Advocacy (the Center) provides these comments about CMS-1711-P and the impact of the … Read more

Disclaimer: the views expressed in this Issue Brief and during the Alliance call are solely those of the Center for Medicare Advocacy. 1. UPCOMING ANNUAL COORDINATED ELECTION PERIOD (ACEP) Overview The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – will start … Read more

― AGENDA― Upcoming Annual Coordinated Election Period (ACEP) (David Lipschutz) Policy Changes for 2020 Updated Medicare Plan Finder Updates to Marketing Guidelines Nursing Home Updates (Dara Valanejad) Proposed Changes to Requirements of Participation Arbitration Changes Update on Home Health (Judith Stein) Proposed Rule Jimmo Update/Concerns (Judith Stein) Litigation Update (Ali Bers) Update on Alexander v. … Read more

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