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

If Medicaid becomes a block grant program, nearly one million nursing home residents who rely on Medicaid could immediately lose coverage for their nursing home care.  In addition, all of the federal standards that govern nursing home care today could be in jeopardy.  The United States does not have a comprehensive program to pay for … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Fight to Protect the ACA, Medicare and Medicaid – Updates (David Lipschutz and Kata Kertesz)  Affordable Care Act (ACA) Congressional action Advocacy/coalition action Outlook for Medicare and Medicaid Observation Status (David Lipschutz) Recent HHS OIG Report confirms that long outpatient stays in hospitals increasing Update on NOTICE Act … Read more

THE FIGHT TO PROTECT THE ACA, MEDICARE AND MEDICAID The President-Elect and Republican leaders in Congress have promised to repeal, and at some point, “replace” the Affordable Care Act.  They also plan to gut the Medicaid program by imposing block granting or per-capita caps.  Speaker Ryan, Trump’s nominee for HHS Secretary Rep. Price, and many … Read more

  Happy Thanksgiving! Giving Thanks Today and every day the Center for Medicare is grateful for our partners and supporters who help us open doors to health care for the 55 million people who rely on Medicare.  We are grateful to earlier generations who designed and launched Medicare to help all American families.  Sadly, our … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Election’s Potential Impact on Medicare (David Lipschutz)  Affordable Care Act Medicare Structural Changes Including premium support/vouchers New Nursing Home Requirements of Participation (Toby Edelman) Overview of final rule Positive changes Prohibition against facilities’ use of mandatory pre-dispute arbitration agreements and ensuing litigation What’s missing Including staffing requirements Review: … 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

No. 11-1703 (D.Conn.), filed November 3, 2011 Issue: Whether the Secretary's policy of allowing hospitalized Medicare beneficiaries to be placed in "observation status," rather than formally admitting them, deprives them of their Part A coverage in violation of the Medicare statute, the Administrative Procedure Act, the Freedom of Information Act, and the Due Process Clause. … Read more

National Medicare Advocates Alliance Issue Brief #41, September 2016 LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Court order for additional education issued August 18, 2016 Exley (formerly Lessler) (ALJ Delay Case) Settlement approved August 1, 2016 Sherman (Lower level Medicare appeals) Defendant’s motion to dismiss denied, class certification granted August 8, 2016 Bremby (Per se skilled services) Coverage … Read more

The Center recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the following proposed rules. Appeals Since 1986, the Center has represented thousands of Medicare beneficiaries seeking coverage of health care and services through the Medicare administrative appeals process.  As discussed in previous CMA Alerts, the Center has advocated for our … Read more

August 29, 2016 Office of Medicare Hearings and Appeals Department of Health & Human Services Attention: HHS-2015-49 5201 Leesberg Pike, Suite 1300 Falls Church, VA 22041  Submitted electronically to: www.regulations.gov Re: HHS-2015-49 To Whom It May Concern: The Center for Medicare Advocacy (the Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) … Read more

Beginning August 6, 2016, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act)[1] requires hospitals to provide written and oral notice, within 36 hours, to patients who are in observation or other outpatient status for more than 24 hours.  The notice must explain the reason that the patient is an outpatient … Read more

In order for Medicare Part A to pay for a patient’s stay in a skilled nursing facility (SNF), the patient must first have spent at least three consecutive days as an inpatient in an acute care hospital.[1]  For many Medicare beneficiaries, Part A SNF coverage is denied because the hospital classifies the stay as Outpatient … Read more

PROPOSED RULE TO REVISE MEDICARE ADMINISTRATIVE APPEALS PROCESS As discussed during previous Alliance calls, there is a significant backlog of cases at the third and fourth levels of the Medicare administrative appeals process, the administrative law judge (ALJ) stage administered by the Office of Medicare Hearings and Appeals (OMHA), and the Medicare Appeals Council (Council) … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, July 11th, 2016 – 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 9874704 NOTE: We ask people calling from the same location to gather around one telephone. This frees up lines and holds down costs. Please ensure your line is on MUTE for the duration of the call … Read more

June 16, 2016 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 Re: CMS-1655-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and … Read more

Medicare Access Project for People Living With ALS Medicare Overview – With an Emphasis on the Home Health Care Benefit Frequently Asked Questions and Answers General Home Health Questions "Homebound" Questions Specific Coverage Questions Can they be using a walker instead of crutches in homebound example? Yes, the homebound definition generally is intended to provide … Read more

On June 9, 2016, the Government Accountability Office (GAO) publicly released a report (dated May 2016) titled “Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process”.[1]   Among other things, the report analyzes the increased number of appeals in the system and the resulting backlog at the third level (Administrative Law Judge, or ALJ) and fourth level … Read more

June 20, 2016 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 Re: CMS-1655-P, Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Proposed Rule for FY2017, SNF Value-Based Purchasing Program, … Read more