National Medicare Advocates Alliance Issue brief #18 1.  PRESENTATIONS ADMINISTRATIVE REVIEW PROCESS:  LITTLE SUCCESS, LONG DELAYS Based upon the Center’s extensive experience with the Medicare administrative appeals process, we are continuing to find that: 1) the success rate for beneficiaries at the initial levels of appeal is generally very low; and 2) once appeals get … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, October 15, 2012 – 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. _______________________________________________________________________________________________ Update on Medicare Appeals and Complaints − AGENDA − (Materials will be sent prior to … Read more

  NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, August 13, 2012 – 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. _______________________________________________________________________________________________ − AGENDA − (Materials will be sent prior to the call) … Read more

1. MEDICARE AND ACA MESSAGING: FIGHTING FICTION WITH FACT As pundits and politicians continue to discuss the deficit, misinformation and confusion about Medicare abound.  Fiction seems to flourish more than fact. Particularly since the passage of the Affordable care Act (ACA), we are hearing a lot of misinformation about the law and its impact on … Read more

HOSPITALIZATION AND REHOSPITALIZATION OF NURSING HOME RESIDENTS 1.  Concerns about hospitalization and rehospitalization of nursing home residents •         Effects on patients (hospital-acquired infections, delirium, increased use of antipsychotic drugs and physical restraints, increased morbidity and mortality) •         High costs associated with hospitalization 2.  Three distinct issues (some overlap) are involved: •         Reducing hospitalization from the community, … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL AGENDA Monday, June 11, 2012– 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 1050263# NOTE: We ask people calling from the same location to gather around one telephone. This frees up lines and holds down costs. _______________________________________________________________________________________________   Welcome and Housekeeping  (Alfred J. Chiplin, CMA, Moderator)   Presentation: … Read more

No. 09-cv-16 (D.Vt.), filed January 22, 2009   Issue: Whether the Secretary's policy of terminating Medicare coverage for a home health patient on the ground that her condition is stable or is not improving violates the Medicare statute and regulations.   Relief Sought: Declaratory and permanent injunctive relief prohibiting application of the "improvement" standard, with an award of … Read more

Save Medicare

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Mr. Blake* is an 86-year old grandfather who fell and was taken to the emergency room with a broken back and internal bleeding.  After being treated for eight days, the hospital still denies that he is an inpatient. Instead, they claim Mr. Blake is simply an "outpatient under observation status." Because he is not considered … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, April 9, 2012– 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 1050263# NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. ______________________________________________ Welcome and Housekeeping  (David Lipschutz, CMA, Moderator) Presentation: Challenging Notices of … Read more

For several years, reducing rehospitalizations of Medicare beneficiaries has been a key public policy goal, the intent of which is to improve quality of care for beneficiaries and reduce costs for the Medicare program.[1]  Studies have shown that rehospitalizations are common and expensive.  In 2006, for example, nearly one-quarter of nursing home residents (23.5%) were … Read more

National Medicare Advocates Alliance ISSUE BRIEF #15                                                                                          FEBRUARY, 2012 __________________________________________________________________ EXTENDER … Read more

Monday, February 13, 2012– 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 1050263# NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. AGENDA Welcome and Housekeeping  (David Lipschutz, Policy Attorney, Center for Medicare Advocacy, Moderator)   Legislative Update  (David Lipschutz, CMA) … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, December 12, 2011– 2:00 P.M., Eastern Time Call-in Number: 1(888)206-2266 Pass Code: 1050263# NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. _____________________________________________________   Welcome and Housekeeping  (David Lipschutz, CMA, Moderator) Extender Bill  (re: QI, therapy caps, physician … Read more

I. LEGISLATIVE UPDATE Failure of the Super-Committee On November 21, 2011, members of the Joint Select Committee on Deficit Reduction ("Super-Committee") announced that they had failed to put together a legislative package to cut the deficit by approximately $1.2 trillion, as outlined by the Budget Control Act of 2011.  Without further Congressional action, automatic cuts … Read more

For Immediate Release                                             Contacts: Judith Stein and Gill Deford November 3, 2011                                                                          (860)456-7790 Center for Medicare Advocacy Seeks … Read more

Hospitalists are defined as physicians who are based full-time in acute care hospitals and who provide care to hospitalized patients.  The past decade has witnessed a rapid growth in hospitals' use of hospitalists, who have been shown to lead to reduced lengths of inpatient hospital stays.  A new study, however, finds that decreased inpatient costs … Read more

The Centers for Medicare & Medicaid Services (CMS) recently announced several new initiatives focused on improving care for people who are eligible for both Medicare and Medicaid (dual eligibles). Two initiatives relate to providing fully integrated services to dual eligibles, through both capitation and fee-for-service structures.  A third initiative addresses preventing unnecessary hospitalizations of nursing home … Read more

Archived Articles

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Click on any of the links below to view older articles by topic.  Topics with no link have no current archived articles. Acute Hospital Antipsychotic Drugs Chronic Conditions Discharge Planning Home Health Hospice Hospital Improvement Standard and Jimmo v. Sebelius Lesbian, Gay Bisexual and Transgender (LGBT) Seniors Medicare Advantage Medicare Basics Medicare Coverage & Appeals Medicare … Read more

Improving Access to Medicare Coverage Act of 2011 Section by Section Summary Sen. John F. Kerry & Sen. Olympia Snowe Section 1:  Short Title—"Improving Access to Medicare Coverage Act of 2011". Section 2:  Counting a Period of Receipt of Outpatient Observation Services in a Hospital towards the 3-Day Inpatient Hospital Requirement for Coverage of Skilled … Read more

The National medicare Advocates Alliance is an initiative to assist public interest advocates throughout the country with Medicare cases and issues, supported by the John A. Hartford Foundation. Older agendas are in .pdf form Call Agendas February 14, 2011 – "Observation Status" December 13, 2010 – "A Potpourri of Part B Issues" October 18, 2010 – … Read more

Nursing home residents are frequently hospitalized.  Residents who have recently been admitted from the hospital are frequently rehospitalized.[1]  Many of these hospitalizations, which "can cause discomfort for residents, anxiety for their loved ones, morbidity due to iatrogenic events, and excess healthcare costs,"[2] are considered avoidable.  The 2010 National Healthcare Quality Report found that residents' hospitalization … Read more

Articles by Topic

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Please use the links below to navigate to a list of articles by topic. Acute Hospital Care Antipsychotic Drugs Chronic Conditions Connecticut Consumers Coverage for People with Disabilities Discharge Planning Health Care Reform – The Affordable Care Act (ACA) Home Health Care The Improvement Standard Medicare Advantage Medicare Reform Medicare Summary Medicare Coverage Appeals Medicare Coverage … Read more

Medicare Savings Programs in Connecticut (Including Eligibility/Income Limit Updates) What is CONNMAP? What is Medicaid? Homecare in CT Articles and Updates Note: CT Residents Only Can Contact the Center for Medicare Advocacy Toll-free at 1-800-262-4414 Medicare Savings Programs in Connecticut If you have Medicare, Social Security deducts money from your check each month to pay … 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

Medicare Reform

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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 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 … Read more

Discharge Planning

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Rights and Procedures for Medicare Beneficiaries in Various Care Settings What does “Discharge Planning” plan for? What is the hospital supposed to do to prepare me for discharge? How do I get notified? How can I argue being discharged? For other information, follow one of the links below or scroll down the page. General Guidelines … Read more

My summer at the Center for Medicare Advocacy gave me great insight into the policy side of healthcare law. Last summer, I worked directly with low-income clients to secure public benefits, including health coverage through Medicare and Medicaid. Having understood the importance of policy on an individual level, my internship at the Center let me … Read more

Chronic Conditions

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Are people with certain conditions, such as Multiple Sclerosis, Alzheimer’s Disease and other chronic conditions able to obtain Medicare coverage? Does Medicare cover maintenance therapy when my condition is not going to improve? Is the restoration potential of a patient relevant in Medicare coverage? What are some examples of services that Medicare covers for chronic … Read more

Hospital

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When does Medicare cover acute hospital care? How many days of coverage am I entitled to under the Medicare hospital benefit? Is there a deductible for a hospital stay? If so, how much is it? My mother is being told she will be discharged from the hospital in two days; what are my rights? What … Read more

Glossary of Terms

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  The letters at the top of the glossary chart will act as alphabetical links. To search for a specific word or phrase on this page, use the Ctrl+F keys on your keyboard, and enter the word you are looking for. If you do not find the term you are searching for, please feel free … Read more

Donate to the Center

The Center for Medicare Advocacy is Celebrating 30 years  of advancing fair access to Medicare and quality health care. Please help us meet our goal of $80,000 for the Medicare Advocacy Fund by June 30 to ensure a strong start to our next 30 years! My mother's unprecedented progress continues to be evidence of how … Read more

Take Action

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Take Action

Since 1986, the Center for Medicare Advocacy has been a passionate educator and advocate, working to ensure access to Medicare and quality health care. In difficult times, we need your help to be the voice for those people who have nobody to speak for them. Current Actions Other Actions Other Ways to Get Involved File … Read more

Info by Topic

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Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are entitled. In addition, individuals receiving railroad retirement benefits and individuals suffering from end stage renal disease are eligible to receive Medicare benefits. Medicare can be confusing, even for people who … Read more

About Us

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Mission Statement The Center for Medicare Advocacy’s mission is to advance access to comprehensive Medicare coverage and quality health care for older people and people with disabilities by providing exceptional legal analysis, education, and advocacy. About the Center for Medicare Advocacy The Center for Medicare Advocacy, established in 1986, is a national nonprofit, nonpartisan law … Read more

Health care reform does not cut Medicare benefits. In fact, health care reform expands Medicare coverage, by eliminating cost-sharing for preventive services, adding a yearly wellness visit, limiting some cost-sharing in private Medicare plans, and closing the Part D "Donut Hole." It also improves the solvency of the Medicare program itself. Reform does, however, change … Read more

July 14, 2010 For Immediate Release Contact: Toby Edelman (202) 293-5760 tedelman@medicareadvocacy.org In its first set of regulations implementing the nursing home provisions of the new Health Care Reform law, the Centers for Medicare & Medicaid Services has done a commendable job,” said Toby S. Edelman, Senior Policy Attorney with the Center for Medicare Advocacy.  … Read more

On March 10, 2010 NCCCNHR, The National Consumer Voice for Quality Long-Term Care, along with the Center for Medicare Advocacy hosted a web seminar on overcoming barriers to skilled nursing care, presented by Center Senior Policy Attorney Toby S. Edelman. Recorded copies are still available! Medicare pays for more residents in nursing homes than ever … Read more

People with chronic conditions and long-term illnesses are too often denied Medicare coverage on the grounds that they will not improve, need “maintenance services only,” have “plateaued” or are “chronic and stable”. Taken together, these reasons are referred to here as the Medicare “Improvement Standard.” Because Medicare is often the sole or primary insurance for … Read more

No. 3:04CV1988JCH (D. Conn.), filed Nov. 23, 2004 Last Updated: September 22, 2009 Issue: Whether the Secretary's policy of not counting time in an emergency room or in "observation status" towards the three-day qualifying hospital stay for purposes of establishing the right to subsequent skilled nursing facility coverage violates the Medicare statute and guarantees of equal … Read more

In July,1998 revisions were made to the federal regulations which made significant changes to the Medicare skilled nursing facility level-of-care requirements. The revisions created a lack of clarity about what constitutes skilled nursing and, therefore, about a beneficiary's ability to receive Medicare coverage for skilled nursing facility care. This confusion was resolved, one year later, … Read more

Payment System Prior to July, 1998: Retrospective and Cost-Based Until July, 1998, nursing homes used to be reimbursed for care provided to Medicare Part A-covered residents residing in Medicare-certified beds through a retrospective cost-based system. The rate received by a nursing home for a Medicare covered resident was based on three components: Routine costs: These … Read more