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

On Wednesday, April 13, 2016 the Center for Medicare Advocacy held a reception at the Connecticut State Capitol to celebrate 30 years working for fair access to Medicare and health care.  The gathering included Center staff and alumni, representatives from both the state and federal government, other advocates, and provider organizations. CT Sen. Ted Kennedy, … Read more

Medicare and Health Care for People living with ALS Established in 1985, the ALS Association is the only national non-profit organization fighting Lou Gehrig’s Disease on every front.  By leading the way in global research, providing assistance for people with ALS through a nationwide network of chapters, coordinating multidisciplinary care through certified clinical care centers, and … Read more

MEDICARE’S COVERAGE OF ORAL HEALTH   Current Centers for Medicare & Medicaid Services (CMS) policy[1] broadly bars Medicare coverage for practically all dental services.  The Center for Medicare Advocacy firmly believes that CMS has the legal authority under the Medicare statute to cover medically necessary oral health care – that is, treatment deemed necessary by … Read more

The Centers for Medicare & Medicaid Services (CMS) has recently issued a host of Medicare-related proposed rules that are currently open for comment, including the following: MACRA (Physician Payment) On April 27, 2016, CMS released a proposed rule outlining new physician payment systems created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The … Read more

​Welcome and Housekeeping  (David Lipschutz, Moderator)  Medicare’s Coverage of Oral Health (Wey-Wey Kwok)  Medically necessary oral health care Goal: add a comprehensive oral health benefit to Medicare Administrative Update    Proposed Rules Part B Drug Demonstration (David Lipschutz) Hospital Payment Rule and the NOTICE Act (Toby Edelman) Concerns about notice to be given to those … Read more

Reports that 20% or more of unplanned hospital readmissions are avoidable has led to considerable interest in policymakers in reducing readmissions.[1]  Actively reducing hospital readmissions is seen as a route to lower Medicare spending and improved patient care. The Affordable Care Act (ACA) established a penalty program for preventable readmissions.  Under the Hospital Readmissions Reduction … Read more

CT Sen. Ted Kennedy, Jr. presents Center for Medicare Advocacy Executive Director Judith Stein with a citation at the Center's 30th anniversary party. On Wednesday, April 13, 2016 the Center for Medicare Advocacy held a reception at the Connecticut State Capitol to celebrate 30 years working for fair access to Medicare and health care.  The … Read more

On April 1, 2016, the Center for Medicare Advocacy held its third annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. The event brought together leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health care for older people and people with … Read more

CMA Webinars

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CMA Webinars

Current issues in Medicare & health care, and your questions answered live. Our Next Webinar: Medicare Home Health Updates in Light of the New Medicare Payment Model Wednesday, February 26, 2020 3:00 PM – 4:00 PM EST 2019-2020 Schedule Team Gleason/CMA Webinars & Town Halls Previously Recorded Webinars Administration for Community Living Webinar Series 2019-2020 … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) CMA and Vermont Legal Aid have filed a Motion for Resolution of Non-Compliance with the Settlement Agreement Exley (formerly Lessler) (ALJ Delay Case) Settlement preliminarily approved Barrows (formerly Bagnall) (Observation) Discovery on protected property interest issue; summary judgment briefing Other cases Hull … Read more

LITIGATION UPDATE Barrows v. Burwell (formerly Bagnall v. Sebelius) (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). 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 and nursing home stays because their care … Read more

Beneficiaries Across the Country Still Denied Needed Coverage Due to Illegal Use of Improvement Standard March 1, 2016 – Today, Plaintiffs’ counsel, the Center for Medicare Advocacy and Vermont Legal Aid, filed a Motion for Resolution of Non-Compliance with the Settlement Agreement in the landmark case, Jimmo v. Sebelius. The filing comes after three years … 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

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update (David Lipschutz) Senate Finance Committee Releases Document for Comment Bipartisan Chronic Care Working Group Policy Options Document (December 2015) Overview Comments due January 26, 2016 Medicare Appeals Bill Introduced in Senate Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S.2368) Overview Administrative … Read more

LEGISLATIVE UPDATE Senate Finance Committee Releases Document for Comment   In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document.  The following is an excerpt from a 12/18/15 Press Release by Senate Finance Committee announcing the document’s release: (available at: http://www.finance.senate.gov/release/hatch-wyden-isakson-warner-release-chronic-care-options-paper): The “Finance Committee Chronic Care Working Group, … Read more

January 4, 2016 Centers for Medicare & Medicaid Services Comments on NOTICE Act Submitted electronically: NOTICE_Act@cms.hhs.gov The Center for Medicare Advocacy (Center) is a national, private, non-profit law organization, founded in 1986, that provides education, analysis, advocacy, and legal assistance to help people nationwide, primarily older people and people with disabilities, to obtain necessary health … Read more

(New York Times) To the Editor: Today’s story, The Hidden Financial Incentives Behind Your Shorter Hospital Stay, describes how hospital stays classified under “Observation Status” are skewing admission and readmission data. As Dr. Jha states in the article, Observation Status is driven by incentives for the hospital.  This is an ever-increasing phenomena in which Medicare … 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

December 23, 2015 Filing code for submitting comments: CMS-3317-P.  Dear Sir or Madam: Comments on the Proposed Discharge Planning Rule as put forth by the Centers for Medicare & Medicaid Services (CMS) The Center for Medicare Advocacy (the Center) is pleased to comment on the November 3, 2015, proposed revisions to the discharge planning regulations … 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

The Senate Finance Committee recently passed the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368).  The Act, intended to improve the Medicare audit and appeals process, would not, in fact, improve the appeals process for beneficiaries and leaves key beneficiary concerns unaddressed. The Bill does not address the … Read more

The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released a statement on October 30, 2015 that advises hospitals that it will not administratively sanction them if they discount or waive charges for an outpatient’s self-administered drugs. Thus, hospitals now have the option, and a greater incentive, not … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update: Congress Mitigates Increases in 2016 Part B Premium and Deductible (David Lipschutz) Bipartisan Budget Act of 2015 – Overview 2016 Part B premiums increases for some, and deductible increases for all, mitigated “Loan” is to be repaid by Medicare beneficiaries over time Underlying cause(s) of increase in … Read more

Medicare beneficiaries often need care in a Medicare- participating skilled nursing facility (SNF) after an inpatient hospitalization.  For these patients, hospitals are responsible for identifying skilled nursing facilities within the geographic region that can meet the patient’s medical needs.  Until such a placement is found, the beneficiary will not be responsible for her hospital stay.  … Read more

  Tell us your story about Medicare, Medicaid, or the ACA!   Longtime Center Client Rosalie Berkowitz on the importance of being able to stay in her home (A StoryCorps portrait) Edith Masterman: Fighting to Keep Medicare Services Center for Medicare Advocacy client Lee Barrows testifies on "Observation Status" Senator Jay Rockefeller on long-term care … Read more

LEGISLATIVE UPDATE: CONGRESS MITIGATES INCREASES IN 2016 PART B PREMIUM AND DEDUCTIBLE Bipartisan Budget Act of 2015 – Overview On Monday November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015.  This wide-ranging budget agreement includes provisions that averted a pending government default by raising the nation’s debt ceiling, and prevents … Read more

Today, the U.S. House of Representatives passed the Bipartisan Budget Act of 2015.  Broadly speaking, this agreement avoids a pending government default by raising the nation’s debt ceiling, and prevents relief from budgetary “sequester” spending limits that have constrained social service programs.  The bill also provides temporary stability to the Social Security Disability Insurance fund. … Read more

Harmful Changes to Lower Limb Prostheses Coverage Too Much Reliance on “Improvement” in the Proposed Home Health Value-Based Purchasing (HHVBP) Model Proposed Revisions to the 2-Midnight Rule Won’t Make Any Significant Change 1. Harmful Changes to Lower Limb Prostheses Coverage The Center recently called for the elimination of a proposed local coverage determination (LCD) that … Read more

ADMINISTRATIVE UPDATE 1. Proposed Requirements of Participation for Nursing Facilities On July 16, 2015, the Centers for Medicare & Medicaid Services (CMS) published proposed rules to revise the nursing home Requirements of Participation (RoPs) – the federal rules that govern the standards of care that facilities must meet in order to participate in the Medicare … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Administrative Update    Proposed Requirements of Participation for Nursing Facilities (Toby Edelman) Overview of Proposed Rule – 80 Fed. Reg. 41267 (July 16, 2015) Center’s Draft Comments (now due October 14, 2015) Update on 2016 Part B Premiums and Deductibles (David Lipschutz) Medicare Trustees Report and next steps Access … Read more

CMS-1633-P, Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. … Read more

The Center for Medicare Advocacy is concerned that Medicare beneficiaries are being denied Medicare coverage for skilled services that are specifically listed as covered by Medicare in federal regulations. Medicare covers various skilled therapies (physical, speech–language pathology and occupational) and skilled nursing services, including observation and assessment, management and evaluation of a care plan, or … Read more

The Center for Medicare Advocacy received an e-mail inquiry from an individual requesting assistance advocating for her sister, Mrs. B.  Mrs. B is a Medicare beneficiary enrolled in a Medicare Advantage plan and in need of home health services.  The questions raised demonstrate several important issues that often arise with both the home health benefit … Read more

On April 1, 2016, the Center for Medicare Advocacy held its third annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture. The event brought together leading experts and advocates to discuss best practices, challenges, and successes in efforts to improve and expand fair access to health care for older people and people with disabilities. The … Read more

June 22, 2015 The Honorable Orrin Hatch                                        The Honorable Ron Wyden Chair, Committee on Finance                                     Ranking Member, Committee on … 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

A federal judge in Connecticut has certified a nationwide class of beneficiaries who are challenging the Medicare program’s failure to render decisions at the administrative law judge (ALJ) level within the 90 days required by law.  Earlier in the year, the judge had denied the government’s motion to dismiss in the case, Lessler v. Burwell … Read more

As we’ve previously reported, on April 28, 2015 the Senate Finance Committee held a hearing about the tremendous backlog of cases piled up at the Office of Medicare Hearings and Appeals (OMHA), the office that oversees Administrative Law Judges (ALJs), the third level of appeal in Medicare’s administrative appeals system.[1]  The Finance Committee hearing also … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative Update    Senate Finance Committee Addresses Medicare Appeals System (David Lipschutz & Judith Stein) Hearing on April 28, 2015 re: Audits and Appeals Audit and Appeal Fairness, Integrity and Reforms in Medicare Act of 2015 (AFIRM) marked up on June 3, 2015 Ways & Means Committee Mark-up June … Read more

LEGISLATIVE UPDATE 1.Senate Finance Committee Addresses Medicare Appeals System On previous Alliance calls, we have discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to find that: The success rates for beneficiaries at the initial levels of Medicare appeal are dismal; and The average wait for a decision at … Read more