LEGISLATIVE/BUDGET UPDATE 1.Medicare Physician Payment (SGR) In an effort to address the perennial issue of payment for Medicare physicians — the fundamentally flawed reimbursement system known as the sustainable growth rate or SGR – the House of Representatives overwhelmingly passed a “doc fix” package on March 26, 2015 that would repeal and replace the SGR.  … Read more

Reflections on the 2nd Annual National Voices of Medicare Summit A Look Back at the Summit from the Attendees' View 2015 Program and Speakers    Register Now for 2016!  Reflections on the 2nd Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture On March 20, 2015, the Center for Medicare Advocacy, held its second … Read more

Today, March 26, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2).  While the Center for Medicare Advocacy believes it’s in the best interest of Medicare beneficiaries to find a permanent solution to the broken physician payment formula called the “Sustainable Growth Rate” (SGR), this Bill is not … Read more

 “Beneficiaries Would Pay Too Much, With Too Little in Return” March 24, 2015 – The Center for Medicare Advocacy believes it is in the best interest of Medicare beneficiaries and their doctors to find a permanent solution to the broken physician payment formula called the “Sustainable Growth Rate” (SGR). “Unfortunately, the SGR replacement package from … Read more

Many people outside the Medicare and health care world don’t know that in 1989 Medicare was briefly, dramatically altered.  The “Medicare Catastrophic Coverage Act,” (MCCA) was the most significant revision to Medicare since its inception.  The law increased the amount of coverage available in all care settings, established limits to beneficiary cost-sharing, and added new benefits. … Read more

Centers for Medicare & Medicaid Services Submitted electronically, http://www.regulations.gov Re: CMS-1461-P Dear CMS Colleagues: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid Services (CMS) with comments on the Notice of Proposed Rule Making (NPRM) CMS-1461-P published in the Federal Register on December 8, 2014 (79 Fed. Reg. … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Litigation Update   (Ali Bers) Discussion of two recent litigation victories: Bagnall (Observation) – On 1/22/15, the 2nd Circuit Court of Appeals reversed the trial court’s dismissal of the complaint and remanded the case to district court to proceed on due process claims Lessler (ALJ Delay Case) – On 1/29/15, … Read more

LITIGATION UPDATE Recent Litigation Victories 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 the National Senior Citizens Law Center filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more

Ben Belton Ben F. Belton is the Senior Advisor to the Acting Commissioner, Social Security Administration, Office of Intergovernmental and External Affairs.  Prior to this he served as an HHS Constituency Liaison to constituency groups and national and local community leaders. Working very closely with the White House Office of Public Engagement and across Federal … Read more

As part of our recognition of Medicare’s first 50 years, this week begins our Medicare Matters: 50 Insights for Medicare’s 50th Anniversary. Help us spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it. Medicare Was Key to Integrating Hospitals Medicare Reduced Poverty Medicare Saves Lives Medicare’s Future … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Legislative Update: The Year Ahead: Overview (David Lipschutz) Legislative landscape in a new Congress Medicare physician payment (Sustainable Growth Rate, or SGR) – action required by end of March 2015 Debt and deficit reform proposals Draft Legislation Hospitals Improvements for Payment (HIP) Act of 2014 (Toby Edelman) On November … Read more

LEGISLATIVE UPDATE The Year Ahead 1. Legislative & Budget Landscape in a New Congress In the 114th Congress staring in January 2015, Republicans will control both the House of Representatives and the Senate.  What will this mean for health care policy generally and Medicare specifically?  Here are a few different takes: American Enterprise Institute (AEI) briefing … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Legislative Update: The IMPACT Act of 2014 (David Lipschutz) Overview  – signed into law by President Obama on October 6, 2014, the Improving Medicare Post-Acute Care for Medicare Beneficiaries Act of 2014 (IMPACT Act, H.R. 4994) requires reporting of standardized data by post-acute care (PAC) providers across different PAC … Read more

1.  LEGISLATIVE UPDATE: THE IMPACT ACT OF 2014 On October 6, 2014, President Obama signed into law the “Improving Medicare Post-Acute Care Transformation Act of 2014” or IMPACT Act.  The bill resulted from a bipartisan, bicameral effort by the House Ways & Means and Senate Finance Committees to address various issues relating to care Medicare … Read more

A Message from the Executive Director Dear Community Members: We have been busy at the Center this summer- even with the lovely long, warm days. Our advocacy has been focusing on enhancing access to health services and medical equipment for people with long-term and chronic conditions. In August we launched an Action Campaign to alert … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Changes to Medicare’s Quality Improvement Organizations (QIOs) (Alfred Chiplin and Terry Berthelot) Overview of QIO restructuring to separate the beneficiary complaint review functions from the quality improvement functions Recent Revision to Hospice and Part D Guidance- (David Lipschutz and Terry Berthelot)  CMS recently revised guidance that had served as … Read more

1.  CHANGES TO MEDICARE’S QUALITY IMPROVEMENT ORGANIZATIONS (QIOs)     CMS has restructured its Quality Improvement Organization (QIO) Program to separate the beneficiary complaint review functions from the quality improvement functions. The change information described below is response to many years of urging CMS to separate the review of beneficiary complaints function of QIOs from … Read more

Under a 2008 decision of the Second Circuit Court of Appeals, the Secretary of HHS has authority under the Medicare statute to include a hospital patient’s time in observation as part of inpatient time in the hospital for purposes of determining whether the patient qualifies for Part A coverage of a subsequent stay in a … Read more

The federal Nursing Home Reform law requires nursing facilities to have "sufficient" staff to meet their residents' needs.[1]  Sufficient nursing staff is universally recognized as a key requirement for making high quality of care possible and available for residents.  To determine whether nursing facilities are in compliance with nurse staffing (and other) federal standards of … Read more

Few would dispute that nursing facilities must employ a sufficient number of professional nurses and well-trained, well-supervised, and well-compensated paraprofessional nursing staff in order to be able to provide high quality care and quality of life to residents.  The question is how to achieve this universally-acknowledged standard. Federal law sets out few requirements for nurse … Read more

1.  MEDICARE’S COVERAGE OF CAPPED RENTAL ITEMS DURING PART A INSTITUTIONAL STAYS: LOSING ACCESS TO SPEECH GENERATING DEVICES (SGDs) CMS Changes Its Coverage of Speech Generating Devices Through a new interpretation of longstanding rules, CMS is currently leading an outright attack on coverage for Speech Generating Devices (SGDs).  SGDs are typically tablet-like units that allow … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Medicare’s Coverage of Capped Rental Items During Part A Institutional Stays: Losing Access to Speech Generating Devices (SGDs) (Alfred Chiplin) Overview of Medicare coverage guidelines re: capped rental durable medical equipment (DME) when a person requires Medicare Part A institutional care (hospital, long term care or skilled nursing facility, … Read more

A Word from the Executive Director As you will see in this issue, Center staffers have been busy this month testifying before Congress and meeting with lawmakers and policy leaders to educate them about issues affecting access to health care for older people and people with disabilities. This CMA Community News highlights just a few … Read more

The Department of Health and Human Services' Inspector General recently reported that nearly one third-of nursing home residents suffered an adverse event or other harm during a stay in a Medicare-participating nursing home in August 2011, and that most of the adverse events or other harm were preventable and the result of problems in staffing.[1] … Read more

A Word from the Executive Director News You Can Use CMS Backs Off on Leveling the Playing Field for Traditional Medicare and Private Plans After announcing that Medicare Advantage payment rates would be reduced in an effort to bring in line with payments in traditional Medicare, CMS actually raised rates for MA plans. Private Medicare … Read more

Alone we can do so little; together we can do so much. − Helen Keller Join the Center for Medicare Advocacy as a CMA Community Member and be one of the voices of Medicare and health care heard in Washington, DC – and throughout the country! For only $25 a year, you can be part … Read more

1.  LITIGATION UPDATES Jimmo v. Sebelius (Improvement Standard) No. 11-cv-17 (D.Vt. filed 1/18/11).  As reported during previous Alliance calls, the Settlement in Jimmo was approved on January 24, 2013 during a scheduled fairness hearing.  As previously discussed, CMS has issued revisions to its Medicare Benefit Policy Manual to ensure that Medicare coverage is available for skilled … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Litigation Update   (Gill Deford) Jimmo – Improvement standard Bagnall (Observation) Other litigation Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Ali Bers) Overview Claims Eligible for Review Deadlines and Request Form Due Process and Medicare Appeals Denial rate of beneficiary appeals at lower levels of review (Gill … Read more

You should receive a receipt for your Membership Fee by email shortly.  If you do not, please contact Scott Perkins at sperkins@medicareadvocacy.org. We will talk to you at our next "Ask the Expert" call!

On Tuesday, April 1st, President Obama signed into law the "Protecting Access to Medicare Act of 2014" (H.R. 4302).[1] This bill is a one year short-term "fix" or "patch" to pending Medicare physician payment cuts under the current physician payment formula called the "sustainable growth rate" or "SGR".  Passed by voice vote in the House … Read more

On March 21, 2014, the Center for Medicare Advocacy, Inc., held its first annual national Voices of Medicare Summit and Sen. Jay Rockefeller Lecture. The event brought together advocates, thought leaders, researchers, policy makers and others for a day of reflection and collaboration. The theme of "Voices of Medicare" came to life in the stories … Read more

Editor’s Note: Last month, readers liked the larger text, but requested better contrasting font color. So, once again, please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community A Message from the Executive Director You may have heard that the health care … Read more

Editor’s Note: We received some feedback that our text was a bit small, so we are bumping it up for this edition. Please let us know what you think. A Message from the Executive Director News You Can Use Legislative Watch CMA In the Community – Watch us on NBC! A Message from the Executive … Read more

1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement.  The Jimmo case ended a longstanding practice denying Medicare coverage to people who had “plateaued,” or were “chronic,” or “stable,” or “not … Read more

Monday, December 16, 2013 – 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 until the Q&A portion of … Read more

The Center for Medicare Advocacy has heard that some Medicare beneficiaries believe that new federal rules authorize Medicare to pay for their nursing home care if they are inpatients in a hospital for two midnights.  This belief is NOT CORRECT.  New rules published by the Centers for Medicare & Medicaid Services (CMS) in August 2013, … Read more

Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at Survey and Certification deficiency citations for antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives.  First, it analyzes all of the approximately 300 antipsychotic drug deficiencies that were cited by seven states over a two-year period, … Read more

Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives.  First, it analyzes the antipsychotic drug deficiencies that were cited in seven states in calendar years 2010 and 2011 (Part One).  Second, in this Part, it reports … Read more

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 until the Q&A portion of the Agenda. _______________________________________________________________________________________________ Welcome and Housekeeping  (David Lipschutz, … Read more

1. PRESENTATION:  MEDICARE ANNUAL ELECTION PERIOD & THE MARKETPLACES Medicare Annual Coordinated Election Period (ACEP) – 10/15/13 – 12/7/13  During the Annual Coordinated Election Period (ACEP) people with Medicare can change their choice of health coverage (whether they receive that coverage through a private Medicare Advantage plan or traditional Medicare), and add, drop or change Medicare … Read more

August 19, 2013 Senate Finance Committee House of Representatives, Committee on Ways and Means United States Congress Submitted electronically to: postacutecarereform@finance.senate.gov and postacutecarereform@mail.house.gov Re: Comments on Post Acute Care (PAC) Reform Proposals Dear Committee Members: The undersigned organizations, the Center for Medicare Advocacy, the National Senior Citizens Law Center, the National Committee to Preserve Social Security and Medicare, … Read more

PROGRAM INTEGRITY: OVERSIGHT OF RECOVERY AUDIT CONTRACTORS United States Senate Committee on Finance Hearing June 25, 2013 Statement Submitted by the Center for Medicare Advocacy, Inc. The Senate Finance Committee’s June 25 hearing on the Recovery Audit Contractors (RACs) program highlights the high financial costs that the RAC program has imposed on acute care hospitals … Read more

1.  PRESENTATION  CMS Issues New Hospital Discharge Planning Guidance  On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning.  Medicare discharge planning is a Condition of Participation for hospitals. CMS has stated in … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Presentation:  New Hospital Discharge Planning Guidance – Overview  (Alfred Chiplin) Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Proposals to Fix Medicare Physician Payment (SGR) Medicare Trustees’ Report​ Dual Eligible State Demonstrations Update (Andrea Callow) Litigation Update   (Gill Deford and Ali Bers) Jimmo – Improvement standard Bagnall (Observation) … Read more

General Question: Are professional therapy services available under Medicare only for patients who are improving or who are expected to improve? Answer: No. The Jimmo Settlement confirms that services by a physical therapist, occupational therapist, and speech and language pathologist are covered by Medicare, Parts A and B, and by Medicare Advantage Plans in skilled … Read more

On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning.[1]  Medicare discharge planning is a Condition of Participation for hospitals, including psychiatric hospitals.[2] Medicare-participating hospitals must make their discharge planning process available to … Read more

Yesterday, President Obama unveiled his Fiscal Year 2014 Budget.[1]   It contains significant changes to the Medicare program – including some that would strengthen the program's fiscal stability, and some that would weaken the program and shift costs to beneficiaries.  On the one hand, it offers serious improvements to strengthen Medicare's financial footing: proposals that allow … Read more

And Proposals for the Future of Medicare   Welcome and Housekeeping  (David Lipschutz, Moderator)  Presentation:  Medicare’s Administrative Review Process – Ongoing Due Process Concerns & Possible Solutions  (Margaret Murphy and Gill Deford) ​Reports from the Field: What are your experiences? Presentation: Proposals to Redesign Medicare’s Benefit Structure – (David Lipschutz) Legislative Update:  The Federal Budget and … Read more

And Proposals for the Future of Medicare 1.  PRESENTATIONS MEDICARE’S ADMINISTRATIVE REVIEW PROCESS – ONGOING DUE PROCESS CONCERNS & POSSIBLE SOLUTIONS During our October 2012 Alliance call, we discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to find that: 1) the success rate for beneficiaries at the initial … Read more

1.  PRESENTATIONS UPDATE ON JIMMO:  SETTLEMENT APPROVED In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of thumb to … Read more