Today the U.S. House of Representatives passed H.R. 3, The Elijah Cummings Lower Drug Costs Now Act, by a vote of 230 to 192. This bill, if enacted into law, would lead to a significant reduction in prescription drug costs. The resulting savings would be reinvested into a critical expansion of Medicare benefits (vision, hearing, … Read more

A unified Medicare payment system that pays all institutional post-acute care providers the same rates, regardless of setting, runs counter to repeated analysis showing that all post-acute providers are not the same, even when they treat patients with similar conditions. It also ignores the significant changes that Medicare made in its new reimbursement system for … Read more

Medicare generally does not cover dental care (see 42 U.S.C. § 1395y(a)(12)).  Under the law, however, if dental treatment must be performed in a hospital, either because of a patient’s underlying condition or the severity of the dental procedure, Medicare Part A covers the costs of the inpatient hospitalization, even if the procedure itself is … Read more

On December 5, 2019, Representatives Linda Sánchez (D-CA) and Jan Schakowsky (D-IL) introduced the Fairness in Nursing Home Arbitration Act (H.R. 5326). The legislation prohibits long-term care facilities from requiring or requesting residents (or their representatives) to sign pre-dispute arbitration agreements. Pre-dispute arbitration agreements, which require victims to give up their right to settle disputes … Read more

The House Ways and Means Committee held a hearing on November 14, 2019 entitled “Caring for Aging Americans.” In a Statement submitted for the record, the Center for Medicare Advocacy expressed concerns about the Patient-Driven Payment Model (PDPM), the new Medicare reimbursement system for skilled nursing facilities that went into effect on October 1, 2019. … Read more

Concerns about nursing home quality have increased over the last several years. For instance, a June 2019 report by the Government Accountability Office (GAO) found that the number of cited abuse violations more than doubled between 2013 and 2017. GAO-led stakeholder meetings identified insufficient staffing, staff training, and staff screening as risk factors. On November … Read more

The Center for Medicare Advocacy (the Center) has developed information, materials, and educational webinars to promote informed choice by beneficiaries. As the Center has written, information about Medicare coverage options produced by the Medicare agency is no longer neutral; instead it now actively promotes private Medicare Advantage (MA) enrollment, and paints MA plans in the … Read more

The Medicare Annual Coordinated Election Period (ACEP) is the period during which individuals review their Medicare coverage for the next year and consider their options. At this time, beneficiaries can return to or continue in Traditional Medicare, or can make changes to their Medicare Advantage (MA) or Part D prescription drug plan (PDP). The Period … Read more

Per a December 5, 2019 press release from Speaker Pelosi’s office, the House of Representatives will vote next week on H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act. The Act, which the Center for Medicare Advocacy has supported since its inception, would lower Medicare prescription drug costs and, importantly, reinvest the savings … Read more

Adding a Dental Benefit to Medicare Part B One of the Center for Medicare Advocacy’s top priorities is to expand Medicare coverage to include oral and dental care for all beneficiaries. The addition of a comprehensive dental/oral health benefit would go a long way to improve the overall health and well-being of older persons and … Read more

On November 20, the Center for Medicare Advocacy, with support from the John A. Hartford Foundation, convened an online gathering of members of the Jimmo Implementation Council and other stakeholders in the effort to remove barriers to care for people with longer-term, chronic, and debilitating conditions. The Council first met in 2015 in Washington, DC … Read more

Time for Medicare Enrollment – Time to Talk Turkey!

From the Center for Medicare Advocacy and the Medicare Rights Center: Medicare Fall Open Enrollment continues through December 7 — so you still have time to make certain changes to your coverage, including switching prescription drug plans or between traditional (sometimes called Original) Medicare and Medicare Advantage (MA). As friends and families around the country … Read more

November, 2019 Late November begins a time for gatherings with family and friends – Thanksgiving, soon followed by the December holidays. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can … Read more

The current Medicare enrollment period ends on December 7, 2019. As reported yesterday in the Minneapolis Star Tribune, while some Medicare Plan Finder (MFP) problems previously identified have been fixed, there are still significant outstanding issues.  As noted in the article, “[i]n some cases, the federal website has been showing wrong information about drug formularies, … Read more

Medicare’s annual open enrollment period (October 15 – December 7), is time for beneficiaries to take stock of their Medicare options for the upcoming calendar year – whether to choose traditional (real) Medicare or a private insurance Medicare Advantage (MA) plan. The Center for Medicare Advocacy (the Center) has developed information, materials, and educational webinars … Read more

Benefit Periods. Medicare covers up to a maximum of 100 days of skilled nursing facility (SNF/nursing home) care in each benefit period. A benefit period begins on the first day that a nursing home resident receives services and ends when the resident has not received inpatient hospital or nursing home services for at least 60 … Read more

On November 8, 2019, the Centers for Medicare & Medicaid Services (CMS) released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Each year, Medicare premiums, deductibles, and copayment rates are adjusted according to the Social Security Act. For 2020, the cost-sharing amounts for both Medicare Part A … Read more

The Center for Medicare Advocacy is pleased that oral health in Medicare is gaining attention and focus, as evidenced by the number of Congressional bills introduced this year that would add dental benefits to the Medicare program. Among them are the Medicare Dental Benefit Act of 2019 (S.22/H.R. 2951), the Medicare and Medicaid Dental, Vision, … Read more

Medicare’s annual open enrollment period (October 15 – December 7), is time for beneficiaries to take stock of their Medicare options for the upcoming calendar year – whether to choose  traditional (real) Medicare or a private insurance Medicare Advantage (MA) plan. The Center for Medicare Advocacy (the Center) has developed information, materials, and educational webinars … Read more

For years, the Center for Medicare Advocacy has warned of wasteful overspending on private Medicare Advantage (MA) plans, the limitations on access to physicians and health care provided by MA, and the difficulties in obtaining the same coverage from the plans as is available in real Medicare. (See Case Study below.) Despite these efforts, Medicare … Read more

Problems with Medicare Plan Finder Persist As reported by SHIPs across the country and some of our partner organizations, problems with the new Medicare Plan Finder (MPF) persist during the current Medicare Annual Election Period, which lasts through December 7, 2019. These problems include: inaccurate information about covered drugs and costs, non-formulary drugs, dosage options, … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies 88 nursing facilities nationwide that are among the most poorly performing facilities in the country. CMS calls these facilities, generally two per state, Special Focus Facilities (SFFs). SFFs have a special icon on the federal website Nursing Home Compare that identifies their SFF status. At present, … Read more

Medicare’s new reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM),[1] changed reimbursement rules and the financial incentives for SNFs, effective October 1, 2019. Just one month since implementation, some of the problems that were predicted as a result of PDPM[2] are already being seen. The former reimbursement system, Resource Utilization Groups … Read more

CMS will continue offering “Equitable Relief” to Medicare beneficiaries who are confused about the transition from an ACA Health Insurance Exchange (Marketplace) plan to Medicare. Under Equitable Relief, people who are eligible for Medicare and have Marketplace coverage can apply to enroll in Medicare Part B without penalty. Those who have already transitioned to Medicare … Read more

The Centers for Medicare & Medicaid Services will be implementing revised payment systems for both skilled nursing facility care (effective October 2019) and home health care (effective January 2020). The Center for Medicare Advocacy has written at length and submitted comments on both the home health and skilled nursing facility payment models. Unfortunately, implementing these … Read more

Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an “Improvement Standard,” which was firmly rejected by the court-approved settlement in Jimmo v. Sebelius. In order … Read more

On October 21, 2019, The Center for Medicare Advocacy submitted comments in support of a Centers for Medicare & Medicaid Services (CMS) proposal to modify the instructions to the Advance Beneficiary Notice of Noncoverage (ABN). The change would make it clear that providers may not bill dually eligible beneficiaries before their claim has gone through … Read more

As part of the Center for Medicare Advocacy’s continued commitment to improving oral health for older adults and people with disabilities, and expanding Part B to include a comprehensive oral health benefit, Center attorneys are participating in oral health partnership meetings this week. The OPEN (Oral Health Progress & Equity Network, a national network of … Read more

Over the last several years, the Center for Medicare Advocacy (the Center) has written at length about the Trump Administration’s detrimental changes to the Affordable Care Act (ACA), Medicare, Medicaid, and other vital health care programs. On October 23, 2019, the House Committee on Energy & Commerce, Subcommittee on Oversight and Investigations, held a hearing … Read more

On October 23, 2019, the Centers for Medicare & Medicaid Services (CMS) began use of a new “abuse icon” on Nursing Home Compare. Consumers using the website will now be alerted when a nursing home has been cited for an abuse violation in the past year or over each of the past two years, depending … Read more

On October 22, the Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare launched the second annual Medicare Fully Informed Project, with a variety of unbiased, accurate, up-to-date, and comprehensive information about the full range of Medicare coverage options. The Medicare Fully Informed Project includes an array of tools to … Read more

On October 17, 2019, the House Ways & Means Committee held a hearing entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-of-Pocket Costs, and Improving Medicare Benefits.”  The hearing focused on H.R. 3, the Lower Drug Costs Now Act (discussed in a previous Alert), as well as current gaps in Medicare … Read more

On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled … Read more

Background When the Centers for Medicare & Medicaid Services (CMS) launched a national campaign to reduce the off-label prescribing of antipsychotic drugs for nursing home residents in 2012, Avanir Pharmaceuticals directed its sales force to talk to nursing facilities about using Nuedexta as a substitute for antipsychotic drugs. The Food and Drug Administration had approved … Read more

Last week federal judges in several states issued temporary injunctions against the Trump administration’s “public charge” rule, preventing it from taking effect. The rule was set to take effect this week. The “Public Charge” final rule, which was posted on August 14, 2019 to the Federal Register, amended Department of Homeland Security (DHS) regulations regarding how an … Read more

The Annual Coordinated Election Period (ACEP), between October 15th and December 7th, is the time period during which Medicare beneficiaries can make coverage elections effective January 1st (this period is often referred to as the Open Enrollment period). As discussed in previous Alerts here and here, advocates have been concerned about a number of factors … Read more

Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO).[1] Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are … Read more

The Long Term Care Community Coalition is hosting a webinar on Medicare’s new payment system for skilled nursing facilities, Patient-Driven Payment Model (PDPM) on Tuesday, October 15, 2019, at 1:00 p.m.  The Center for Medicare Advocacy’s Senior Policy Attorney Toby S. Edelman will discuss how the new system works and what it means for residents. … Read more

The Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Part A reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM), on October 1, 2019.[1] Therapists immediately began reporting that nursing homes and therapy companies were laying them off and demanding that they change their therapy practices, shifting residents from … Read more

Joint alert from the Center for Medicare Advocacy and the Long Term Care Community Coalition. New Icon On October 7, 2019, the Centers for Medicare & Medicaid Services (CMS) announced changes to Nursing Home Compare that make it easier for residents and families to identify facilities with a history of resident abuse, neglect, or exploitation. … Read more

The Patient Driven Payment Model is Here What Does It Mean For Residents? On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) began implementing a new payment system for Medicare-covered nursing home care. The payment system is called the “Patient Driven Payment Model” (PDPM). PDPM creates a new set of financial incentives … Read more

This week Rep. Brad Schneider (D-IL) introduced a House companion to the Senate Medicare Extra Rx HELP Act (S. 691, H.R. 4583) introduced by Sen. Bob Casey (D-PA) in March 2019.  The bill would expand Part D Low Income Subsidy/ Extra Help by eliminating the asset test, streamlining program administration, and providing full benefits to those living on the … Read more

As noted in a press release issued by Rep. Rosa DeLauro’s office, on September 30, 2019, members of Connecticut’s congressional delegation sent a letter to the President of Anthem Blue Cross Blue Shield to “express our concern regarding the recently announced provider terminations from Anthem Blue Cross and Blue Shield’s (Anthem) Medicare Advantage (MA) network … Read more

​​​​​Free Webinar – Register Now: Medicare for People with Paralysis As part of our 2019-2020 webinar series, the Center for Medicare Advocacy is honored to partner with the Christopher and Dana Reeve Foundation to present Medicare for People with Paralysis.  Understanding Medicare is important to those who currently qualify for health coverage through Medicare, or … Read more

As discussed in a recent CMA Alert, the Center or Medicare Advocacy joined Medicare Rights Center, Justice in Aging and National Council on Aging in writing to the Administrator of the Centers for Medicare & Medicaid Services (CMS) to express concerns about the roll-out of the updated Medicare Plan Finder (MPF), publicly released on August … Read more

On September 19, 2019, Representative Frank Pallone, Jr., Chairman of the U.S. House Committee on Energy & Commerce, introduced the Lower Drug Costs Now Act (H.R. 3). As noted in The New York Times, the bill addresses the problem of skyrocketing prescription drugs costs. In a press release, Speaker Nancy Pelosi stated that “[t]he soaring … Read more

In his September 16, 2019 comments on the Administration’s proposed revisions to the nursing facility Requirements of Participation, California State Attorney General Xavier Becerra writes that the proposed rule violates the 1987 federal Nursing Home Reform Law, the Social Security Act, the Affordable Care Act, and the Administrative Procedures Act. Beccera describes the proposed changes … Read more

On September 20, 2019, the U.S. House of Representatives passed the Forced Arbitration Injustice Repeal (FAIR) Act. The FAIR Act prohibits pre-dispute arbitration agreements in consumer, employment, antitrust, and civil rights cases. The Act also prohibits any agreements or practices that interfere with an individual’s right to participate in joint, class, or collective action. Representative … Read more

Center for Medicare Advocacy Senior Policy Attorney Toby. S. Edelman has been selected to receive the   Janet Wells Public Policy Leadership Award from the National Consumer Voice for Quality Long-Term Care, the national non-profit long-term care advocacy organization. The Public Policy Leadership Award honors the tremendous contributions of an individual or organization to national long-term … Read more

Senator Sherrod Brown (D-OH) recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, urging the Administration “to be better stewards of taxpayer dollars and conduct sufficient oversight of Medicare Advantage plans, to ensure they are appropriately managing the health care needs of older Americans and people with disabilities” … Read more