As the coronavirus pandemic continues, nursing facilities are being asked, or told, to admit or readmit residents who had or may have COVID-19. Hospitals need beds for acutely ill residents and need to discharge patients that they determine can be safely discharged to other settings.  How do we keep as many people as safe as … Read more

Legislative Changes On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act, H.R. 748 which is the third COVID-related bill to pass Congress in recent weeks. As noted on the Center for Medicare Advocacy’s COVID-19 webpage highlighting such legislation, Medicare-related provisions of this bill include: Significant expansion … Read more

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) released a bulletin (https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf) on March 28, 2020 reiterating that discrimination on the basis of race, color, national origin, disability, age, sex, and exercise of conscience and religion in HHS-funded programs is prohibited. The bulletin stated: “The Office for … Read more

As the need for health care increases in the face of COVID-19, access to Medicaid will become more crucial. Below is list of recent resources for assistance accessing Medicaid. Medicaid.gov: Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Disaster Medicaid.gov: State Resource Disaster Response Toolkit Kaiser Family Foundation tracker: Medicaid Emergency Authority Tracker: … Read more

The current coronavirus (COVID-19) crisis has led to a number of changes in Medicare policy, including coverage for tests, treatments, nursing home stays, telehealth, and Medicare Advantage and Part D plan obligations.  Congress is currently working on passing a third bill related to the crisis, and is starting to plan for a fourth. The Center … Read more

On March 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued new guidance directing state survey agencies to conduct health inspections only if they relate to complaints and facility-reported incidents (FRIs) triaged at the immediate jeopardy level. These facilities will simultaneously have a streamlined infection control review. Additionally, the guidance indicates that federal … Read more

On March 13, 2020, President Trump proclaimed the COVID-19 pandemic a national emergency. As a result, the U.S. Department of Health and Human Services (HHS) now has the authority under Section 1135 of the Social Security Act to waive or modify certain requirements of public health programs, including Medicare. The Centers for Medicare & Medicaid … Read more

As the nation and the world brace for our collective struggle with the novel coronavirus named COVID-19, things are changing rapidly as society adjusts to our new “normal.” Congress continues to explore legislative solutions, including for affected workers. The Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS), … Read more

Because of the uncertainty brought about by COVID-19, we are altering plans for our 2020 National Voices of Medicare Summit and Sen. Jay Rockefeller Lecture. There will be a Virtual Summit program on April 30, 2020. We are grateful to this year’s Sen. Jay Rockefeller lecturer, Wendell Potter, and the many other experts who have agreed to … Read more

On March 13, 2020, the Centers for Medicare & Medicaid Services (CMS) issued guidance to nursing homes on COVID-19 (coronavirus). CMS is directing nursing homes to restrict all visitors and non-essential health care workers from entering facilities, except in end-of-life and other compassionate care situations. While COVID-19 presents significant danger to vulnerable nursing home residents, … Read more

A Statement from the Center for Medicare Advocacy and the Long Term Care Community Coalition March 19, 2020—At least twenty-six residents at Life Care Centers at Kirkland have died of the coronavirus and many more residents and staff at the Washington State nursing facility are showing signs of the illness. Why have these medically fragile … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more

In these very unpredictable times, it’s hard to be certain of things – but one thing to count on is the Center for Medicare Advocacy. We remain open and fully operational – although most of our staff will soon be working remotely. Our phones, email, and online contact forms are available. Our website remains a … Read more

Medicare Advantage Open Enrollment Period (MA-OEP) Effective 2019, for the first 3 months of the calendar year there is a continuous open enrollment and disenrollment period relating to Medicare Advantage (MA) plans called the Medicare Advantage Open Enrollment Period, or MA-OEP. This opportunity is only available to individuals who are enrolled in an MA plan … Read more

This week, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule. The final rule requires daily state-CMS exchange of data to identify who is enrolled in Medicare, and which party is liable for paying each beneficiary’s Parts A and B premiums. The final rule also requires daily state … Read more

Coronavirus legislation signed by the President on March 5, 2020, would allow Medicare to expand the use of telemedicine in outbreak areas, potentially reducing infection risks. The Centers for Disease Control (CDC) has encouraged people who feel sick to first talk to doctors remotely to avoid filling waiting rooms. The bill gives the Health and … Read more

Policy makers often promote the concept of “choice” as a key pillar of health care and insurance, including within the Medicare program. The importance and availability of “choice” becomes less clear, however, the closer one examines what choice actually means with respect to health insurance coverage – including in the Medicare program. Wendell Potter’s New … Read more

On March 2, 2020, the U.S. Supreme Court agreed to hear the case that seeks to strike down the entire Affordable Care Act as unconstitutional. The case (California v. Texas) was brought by Texas and several other states and is supported by the Trump administration. The Center is pleased that the Court granted review of … Read more

Our colleagues at the Long term Care Community Coalition have prepared a Fact Sheet for nursing home residents justifiably concerned with the spread of Coronavirus. The Fact Sheet lays out key concerns for resident safety, tips for residents, families and the public, and some key differences for residents in nursing homes vs. those in assisted … Read more

New Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care The Centers for Medicare & Medicaid Services (CMS) — the federal agency responsible for administering the Medicare program — has begun implementing new Medicare payment models for both home health and skilled nursing facility care. These payment models create a … Read more

Joint Statement from the Long Term Care Community Coalition and the Center for Medicare Advocacy Feb. 28, 2020 – LeadingAge, a trade association for non-profit nursing homes, has released a report on nursing home closures and trends between June 2015 and June 2019. The report finds that more than 550 nursing homes—approximately four percent of … Read more

MA Limitations, Favoritism, and Quality & Access Issues – New York Times A recent article in the New York Times highlights a number of concerns about the Medicare Advantage (MA) program, many of which have been raised by the Center for Medicare Advocacy.  The concerns include the growing imbalance between MA and traditional Medicare, the … Read more

The Commonwealth Fund recently released a report, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care. The Report found significant coverage gains nationwide as a result of the Affordable Care Act (ACA), with historic reductions in racial disparities in coverage and access. Some key findings from the report: … Read more

Background.  On January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) began implementing a new Medicare payment system—“Patient Driven Groupings Model” (PDGM)—for home health services. Under PDGM, home health agencies have a new set of financial incentives to consider when admitting and continuing care for Medicare beneficiaries. Unfortunately, those financial incentives are harmful … Read more

The nursing home industry instinctively responds to the closures of nursing facilities by claiming that Medicaid rates are too low and must be increased.[1] A legislatively-mandated Massachusetts task force on nursing facilities has a different response. Describing declining occupancy in nursing facilities, multiple facilities having both chronically low quality and low occupancy, and the dramatic … Read more

A recent blogpost by Administrator Seema Verma of the Centers for Medicare & Medicaid Services (CMS) announces CMS’s plan to “combine and standardize” the eight Compare websites into a Medicare Compare website.[1] At the same time, an unidentified spokeswoman wrote to McKnight’s Long-Term Care News, an on-line trade publication, that “‘CMS is interested in evaluating … Read more

The Center for Medicare Advocacy and the Medicare Rights Center joined to release a statement this week on the Trump 2021 budget’s harmful policy and payment changes that could create barriers to care for people with Medicare. The statement also highlighted the budget’s $1 trillion in cuts to Medicaid and the ACA’s premium tax credits, … Read more

The National Voices of Medicare Summit and Senator Jay Rockefeller Lecture Whither Medicare – From Promise to Privatization April 30, 2020, 8:30 AM – 3:30 PM Kaiser Family Foundation, 1330 G St NW, Washington, DC 20005 Early-Bird Single Seat: $225 (Prior to 2/29/2020. $250 thereafter) Against the increasing privatization of Medicare, voter focus on health care, … Read more

The Center for Medicare Advocacy (“Center”) and California Health Advocates (“CHA”) submitted joint comments in opposition to a proposed Social Security Administration (SSA) rule to increase the frequency of continuing disability reviews (CDRs) (see Notice of Proposed Rulemaking on Rules Regarding the Frequency and Notice of Continuing Disability Reviews, 84 Fed. Reg. 36588 (November 18, … Read more

Earlier this week, President Trump delivered the annual State of the Union speech (see the transcript here). Here we provide a summary of some of the false and misleading statements concerning health care, along with the facts. Statement 1: “I have also made an ironclad pledge to American families: We will always protect patients with … Read more

Addressing the problem of Medicare’s lack of meaningful oral health coverage has long been a focus of the Center for Medicare Advocacy.  Over the decades, the Center has assisted beneficiaries who require access to medically necessary oral health care, challenged Medicare’s restrictive coverage policy in litigation, and worked with broad coalitions to expand Medicare oral … Read more

On January 30, 2020 The Centers for Medicare & Medicaid Services (CMS) issued new guidance, through a State Medicaid Director Letter, which encourages states to voluntarily adopt caps on their federal Medicaid funds under a Medicaid section 1115 demonstration waiver. This “block granting” of Medicaid would fundamentally change Medicaid programs by allowing states to limit … Read more

The Center for Medicare Advocacy has long advocated for leveling the playing field between Medicare Advantage (MA) and traditional Medicare. Over the last several years, however, legislative and regulatory policy changes have continued to tip the scales in favor of MA over traditional Medicare. Such efforts include the as-yet-unimplemented Executive Order issued by President Trump … Read more

In the first “national-level assessment of how nursing homes self-report major injury fall rates, which are used by CMS for quality measurement and public reporting,” researchers “found substantial underreporting on the specific Minimum Data Set (MDS) item (J1900C) used by NHC [Nursing Home Compare].”  Prachi Sanghav, Shengyuan Pan, Daryl Caudry, “Assessment of nursing home reporting … Read more

The new Medicare reimbursement system for skilled nursing facilities (SNFs) – the Patient-Driven Payment Model (PDPM) – fundamentally changes the financial incentives for facilities. With PDPM, Medicare now pays lower rates for residents needing therapy and higher rates for residents needing complex nursing care. Responding to these financial incentives, SNFs laid off therapists across the … Read more

One of the ongoing problems that Medicare beneficiaries face is so-called “outpatient” hospital observation status. When a hospital classifies a patient as an outpatient, rather than as an inpatient, the result is that the patient is ineligible for Medicare Part A coverage of the post-hospital stay in a skilled nursing facility (SNF) (because the Medicare … Read more

On January 27, 2020, the U.S. Supreme Court in 5-4 vote allowed the Trump administration’s “public charge” immigration rule to go into effect while litigation over the policy continues in the lower courts. The Center joins many partner organizations in opposing the rule as it will irreparably harm older adults, people with disabilities and their … Read more

For the past few years, a coalition of beneficiary advocates, disease organizations, industry groups,  oral health and medical health professionals has been advocating for medically necessary oral health care to be covered by Medicare, as authorized under current law.  The Coalition recently launched a web-based platform for members of the public to express their support … Read more

January 2020 Download this Case Study I. Background – The Jimmo Settlement In 2013, a U.S. District Court approved the settlement agreement in Jimmo v. Sebelius,[1] requiring the Centers for Medicare & Medicaid Services (CMS) to confirm that Medicare coverage of home health, skilled nursing facility (SNF), and outpatient therapy services is determined by a … Read more

On January 21, 2020, the Chairmen and Ranking Members of the House Ways & Means, Energy & Commerce, and Education & Labor Committees sent a letter to the Secretaries of Health and Human Services (HHS) and Department of Labor (DOL) asking the “agencies to address the confusion and financial risks that often confront Americans who … Read more

Starting January 1, 2020 Medicare Part B began covering a new Opioid Treatment Program (OTP) benefit. The Centers for Medicare & Medicaid Services (CMS) pay OTPs through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B. Under the new OTP benefit, Medicare covers: U.S. Food and … Read more

A study of beneficiaries in traditional Medicare who were hospitalized between January 1, 2011 and September 30, 2015 with certain primary diagnoses (stroke, hip or femur fracture without joint replacement, chronic obstructive pulmonary disease, congestive heart failure, or pneumonia) finds that beneficiaries in rural communities fared differently than those from urban areas. Beneficiaries from rural … Read more

On January 21, 2020, the Supreme Court declined to grant expedited review of the lawsuit that seeks to strike down the entire Affordable Care Act (ACA). Texas and several other states are pursuing the case (now called California v. Texas) with the support of the Trump administration. Even though an expedited schedule was denied, the … Read more

The Center has joined other organizations that advocate for older adults in filing amicus briefs in several lawsuits challenging the Department of Homeland Security’s “public charge” rule. The regulation, finalized last year, represents a drastic change in how applicants for lawful permanent residency (green cards) will be evaluated, and it will have a particularly negative … Read more

On January 15, 2020, the Center for Medicare Advocacy joined AARP and Justice in Aging in filing an amicus brief that urges the U.S. Supreme Court to grant immediate review of the health care repeal lawsuit, Texas v. U.S. The case, which seeks to dismantle the entire Affordable Care Act (ACA), is being pursued by … Read more

The Annual Coordinated Election Period (ACEP) – the period during which individuals with Medicare can make coverage elections for the following year – ended on December 7, 2019.  As discussed in previous CMA Alerts, there were a number of factors impacting the 2019 ACEP that made enrollment decisions even more challenging this past fall. Complicating … Read more

On January 15, 2020, Steve Gleason was awarded a Congressional Gold Medal, the highest civilian honor bestowed by Congress. Mr. Gleason was honored for his work on behalf of individuals with ALS and other debilitating conditions, including through his organization Team Gleason. Center for Medicare Advocacy Executive Director Judy Stein and Associate Director Kathy Holt, … Read more

Mr. G, a retired professional, is a Medicare beneficiary in his 80s with advanced Parkinson’s disease who experienced a bad fall at home. He was hospitalized and then went to a skilled nursing facility for rehabilitation. Mr. G has always had original Medicare along with a stand-alone Part D plan and a Medicare supplemental (“Medigap”) … Read more

On January 2, 2020, the Center for Medicare Advocacy and the Long Term Community Care Coalition issued a joint statement condemning proposed legislation that would weaken nurse aide training requirements. The two bills would weaken current law. Each would allow for a shorter period of prohibition of facility-conducted nurse aide training programs, and for lifting … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more