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

Welcome and Housekeeping  (David Lipschutz, Moderator)  Oral Health Update (Wey-Wey Kwok)   Proposed Rule on Durable Medical Equipment  (Kathy Holt) Home Health Update (Kathy Holt) Executive Order re: Administrative Law Judges (ALJs) (David Lipschutz) See Center’s statement at: https://www.medicareadvocacy.org/administrative-law-judges-and-objective-medicare-appeals-jeopardized-by-recent-executive-order/ ACA Sabotage Update (Ben Belton) Litigation Update  (Wey-Wey Kwok) Alexander (formerly Barrows/Bagnall) (Hospital Observation Status) Other Updates General … Read more

June , 2018 Mr. Alex M. Azar. II Secretary, Department of Health and Human Services Seema Verma 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 Re: CMS-1696-P.  Notice of Proposed Rulemaking with Comment.  Medicare Program; Prospective Payment … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Recent Policy Changes Relating to Medicare Advantage  (David Lipschutz) New Medicare Advantage “Flexibilities” Impact on Beneficiary Choice/Decision-Making Forthcoming CMA Report Proposed Skilled Nursing Facility (SNF) Rule  (Toby Edelman) Overview of Proposed Rule – Skilled Nursing Facility Prospective Payment System (SNF PPS) (CMS-1696-P) See:  https://www.gpo.gov/fdsys/pkg/FR-2018-05-08/pdf/2018-09015.pdf     Comments due June 26 … Read more

         Welcome and Housekeeping  (David Lipschutz, Moderator)           Federal Update (David Lipschutz) o   Federal Budget & Omnibus Bill          Tipping the Scales Towards Medicare Advantage (David Lipschutz)    Overview    Recent Legislative and Regulatory changes favoring MA    CMS steering during 2017 Annual Coordinated Election Period (ACEP)          Provisions of the Budget Act of 2018 … Read more

RECENT POLICY CHANGES RELATING TO MEDICARE ADVANTAGE The first few months of 2018 have seen a number of changes in law, regulations and sub-regulatory guidance that impact the Medicare program, particularly Part C, known as Medicare Advantage (MA), and Part D, the prescription drug benefit.  The section below highlights some, but not all, of these … Read more

FEDERAL UPDATE Federal Budget & Omnibus Bill On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law.  While the Budget Act included a number of permanent provisions, including those discussed below, it only extended spending on the federal budget through another short-term continuing resolution (CR), which expires March 23rd.  The remainder … Read more

March 5, 2018 Via Electronic Submission to www.regulations.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Blvd. Baltimore, Maryland 21244 Re: Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies, and 2019 … Read more

CMA Alert – SOTU Address; Therapy Caps; More

State of the Union Speech Touches on Health Care Issues Outpatient Therapy Caps: What Now? Observation Status Update Webinar Now Available Nursing Home Resident’s Rights Newsletter – January Edition Kaiser Family Foundation Issues Report on Medicare Beneficiaries’ Out-of-Pocket Spending Center for Medicare Advocacy Comments on HHS Request for Information State of the Union Speech Touches … Read more

MEDICARE APPEALS Expedited v. Standard Appeals – Not Knowing the Difference Can Cost You Your Appeal Rights Here’s the Issue Expedited Medicare appeals and standard Medicare appeals are designed to address different things and there are situations where a Medicare beneficiary must pursue both types of appeals. Expedited Appeals – Address whether the provider’s termination … Read more

In difficult times, we need your help to be the voice for those people who have nobody to speak for them. We are currently in need of the following stories: Durable Medical Equipment (DME) Access Problems Home Health Care Access Problems "Improvement Standard" Denials "Observation Status" Problems Stories About the Value of Medicare, Medicaid and … Read more

CMA Alert – SNF Enforcement Halted; Know Your Medicare Appeals; Ultimate Health Care Sabotage; More

This Week In Health Care Sabotage New Fact Sheet – Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights CMS Halts Enforcement, as Requested by the Nursing Home Industry This Week In Health Care Sabotage Medicare Enrollment Periods Medicare Open Enrollment Ends Tomorrow, December 7. There is only one day left … Read more

In October of 2016, the Obama Administration issued a Final Rule regarding the Requirements of Participation (RoP) for nursing homes. The Final Rule was issued, in part, because the regulations had “not been comprehensively reviewed and updated since 1991.”[1] Under the Final Rule, the revisions to the RoP were to be implemented over three phases: … Read more

November 22, 2017 Division of Nursing Homes Survey and Certification Group Center for Medicare & Medicaid Services 7500 Security Blvd. Baltimore, MD 21244 Re: Revised Policies regarding the Immediate Imposition of Federal Remedies-FOR ACTION (S&C: 18-01-NH) Submitted electronically: dnh_triageteam@cms.hhs.gov. Dear David, Karen, Evan, Lisa, and CMS colleagues,    The Center for Medicare Advocacy (Center) is … Read more

Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay 2018 Medicare Cost Sharing REMINDER: Medicare Enrollment Continues through December 7th Tax Bill Facing Vote in the Senate Next Week – Time to Talk Turkey! Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay Late November begins a time for … Read more

ENROLLMENT IN MEDICARE CMS Steering to Medicare Advantage? The Medicare Annual Coordinated Election Period (ACEP), from October 15th through December 7th, allows Medicare beneficiaries to make certain changes to their Medicare coverage, effective the following January 1st.  Official Center for Medicare & Medicaid Services (CMS) Medicare Open Enrollment materials for 2018 tip the scales to … 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

September 11, 2017 Administrator Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1676-P P.O. Box 8016, Baltimore, MD 21244-8013. Re: CMS-1676 Submitted electronically: http://www.regulations.gov Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) comments on the 2018 … Read more

I. JIMMO IMPLEMENTATION UPDATE Background – Jimmo Settlement The settlement in Jimmo v. Sebelius, No. 5:11-cv-17 (D. Vt.) was approved on January 24, 2013.  CMS issued revisions to its Medicare Benefit Policy Manual to clarify that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings.  CMS also implemented … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Jimmo Implementation Update (Judy Stein, Ali Bers)  Corrective Action Plan Completed New CMS webpage: https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html Jimmo Webinar – September 27 at 3pm EDT.  Register at: https://register.gotowebinar.com/register/4716521538610996739 Update on Home Health Access Initiative Project (Kathy Holt)  Proposed rule re: payment (comments due 9/25) Joint Webinar with National Association for Home … Read more

August 9, 2017 Thomas E. Price Secretary Department of Health and Human Services Seema Verma 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 Re: CMS-1686-ANPRM.  Advance Notice of Proposed Rulemaking with Comment.  Medicare Program; Prospective Payment System … Read more

August 7, 2017 Thomas E. Price Secretary Department of Health and Human Services Seema Verma 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 Re: Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements … Read more

As Medicare’s Anniversary Approaches, the Fight for Health Care Continues Beware of a New Social Security Scam As Medicare’s Anniversary Approaches, the Fight for Health Care Continues On July 30, Medicare will turn 52 years old.  As we honor this program that provides stable coverage to over 57 million older adults and individuals with disabilities, … Read more

Featuring Guest Presenter Carol Regan, Community Catalyst Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: Update (Carol Regan, Community Catalyst, and David Lipschutz)  Overview of Senate Debate Impact on Older Adults, Medicare (David Lipschutz) Impact on Medicaid, Dual Eligibles (Carol Regan) Litigation Update   (Ali Bers) Jimmo (Improvement standard) Barrows (formerly Bagnall) (Observation) Sherman (Lower level … Read more

July 12, 2017 Thomas E. Price Secretary Department of Health and Human Services Seema Verma 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 Re: Request for information: Reducing Regulatory Burdens Imposed by the Patient Protection and Affordable … Read more

I. HEALTH REFORM: UPDATE Overview On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill then moved on the Senate, and was reintroduced, with some minor changes, as the Better Care Reconciliation Act of 2017 (BCRA). Both AHCA and BCRA would cause substantial … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: House Passes American Health Care Act (AHCA) (David Lipschutz)  What’s in AHCA Impact on Affordable Care Act, Medicaid and Medicare Next up: the Senate Update on Home Health Access Initiative Project (Kathy Holt)  Speech Generating Devices (SGDs) (Kathy Holt) Steve Gleason Act            Observation Status (Toby Edelman) Medicare … Read more

HEALTH REFORM: HOUSE PASSES AMERICAN HEALTH CARE ACT (AHCA) On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213.  The bill will now be taken up by the Senate. American Health Care Act (AHCA): Impact on the Affordable Care Act, Medicare and Medicaid 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

Beginning no later than March 8, 2017, hospitals are required to give written and oral notice to Medicare patients when they are placed in “outpatient” observation status for 24 hours and are not formally admitted as inpatients.[1] The written notice is called the Medicare Outpatient Observation Notice (MOON).[2] Although hospitals can provide all the care … Read more

February 17, 2017 – WASHINGTON – Yesterday, the Senate Finance Committee held a confirmation hearing for Seema Verma, President Trump's nominee for Administrator of the Centers for Medicare & Medicaid Services. Ms. Verma is currently president, CEO and founder of SVC, Inc., a national health policy consulting company. “While short on specifics, it was clear … Read more