Agenda Enrollment Period Updates (David Lipschutz) Including Medicare Plan Finder, referrals to SHIPs H.R. 3 – Prescription Drug Bill with Medicare Improvements (Kata Kertesz & David Lipschutz) Prescription Drug Changes Medicare Improvements, including adding oral health, hearing vision coverage Update on Skilled Nursing Facilities (Toby Edelman) Including new payment model in effect since 10/1/19 (Patient … Read more

― AGENDA― Upcoming Annual Coordinated Election Period (ACEP) (David Lipschutz) Policy Changes for 2020 Updated Medicare Plan Finder Updates to Marketing Guidelines Nursing Home Updates (Dara Valanejad) Proposed Changes to Requirements of Participation Arbitration Changes Update on Home Health (Judith Stein) Proposed Rule Jimmo Update/Concerns (Judith Stein) Litigation Update (Ali Bers) Update on Alexander v. … Read more

Updates on the BENES Act and Part D Legislation Guest Speaker: Lindsey Copeland, Medicare Rights Center Overview of the Administration’s Rollback of Nursing Home Protections (Dara Valanejad) Update on Observation Status (Toby Edelman) Framing as a Surprise Billing Issue Litigation Update (Ali Bers) 5th Circuit Case Challenging ACA CMA Litigation General Medicare Q&A (David Lipschutz) … Read more

Medicare & Oral Health Updates (Wey-Wey Kwok and Kata Kertesz) Medically Necessary Coverage Adding a Comprehensive Benefit to Medicare Policy Updates Durable Medical Equipment (Kathy Holt) Nursing Facilities (Toby Edelman and Dara Valanejad) Prescription Drugs (David Lipschutz) Health Reform (David Lipschutz) Medicare for All Hearing, other updates Litigation Update (Ali Bers) General Medicare Q&A/Wrap Up … Read more

Medicare Education & Outreach (David Lipschutz) Information from the February 8, 2019 meeting of CMS’ National Medicare Education Program (NMEP) Medicare Advantage Steering Redesign of Medicare Plan Finder Senate Finance Committee Hearing on Nursing Facilities (Toby Edelman and Dara Valanejad) “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019: https://www.finance.senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-neglect-in-nursing-homes … Read more

Access to Care ​​Home Health (Kathy Holt) Durable Medical Equipment (DME) (Kathy Holt) Observation Status (Judy Stein) Nursing Home Issues (Dara Valanejad)   Leveling the Playing Field – Traditional Medicare and Medicare Advantage (David Lipschutz) Policy Changes and CMS Efforts Favoring MA Law, regulations and policy CMS materials Medicare Fully Informed Project  Promoting Free Choice … Read more

Special Presentation – Better Advance Care Legal Counseling – Presented by ABA Commission on Law and Aging Director Charles Sabatino This presentation will discuss the importance of advance care planning, advocates' roles in such planning, and offer a conceptual framework and guidelines to align the practice of advance care planning in legal offices with the realities … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Recent Changes in Law, Regulations and Guidance Relating to Medicare Advantage and Part D (David Lipschutz) CMA Special Report (to be released Monday, 9/17) Summary of Changes Discussion Tipping the Scales Towards MA Impact of Recent Changes on Consumer Decision-Making   Informed Choice and the Mid-Term Elections (Ben Belton) Informed … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Oral Health Update (Wey-Wey Kwok)   Proposed Rule on Durable Medical Equipment  (Kathy Holt) Home Health Update (Kathy Holt) Executive Order re: Administrative Law Judges (ALJs) (David Lipschutz) See Center’s statement at: https://www.medicareadvocacy.org/administrative-law-judges-and-objective-medicare-appeals-jeopardized-by-recent-executive-order/ ACA Sabotage Update (Ben Belton) Litigation Update  (Wey-Wey Kwok) Alexander (formerly Barrows/Bagnall) (Hospital Observation Status) Other Updates General … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Recent Policy Changes Relating to Medicare Advantage  (David Lipschutz) New Medicare Advantage “Flexibilities” Impact on Beneficiary Choice/Decision-Making Forthcoming CMA Report Proposed Skilled Nursing Facility (SNF) Rule  (Toby Edelman) Overview of Proposed Rule – Skilled Nursing Facility Prospective Payment System (SNF PPS) (CMS-1696-P) See:  https://www.gpo.gov/fdsys/pkg/FR-2018-05-08/pdf/2018-09015.pdf     Comments due June 26 … Read more

         Welcome and Housekeeping  (David Lipschutz, Moderator)           Federal Update (David Lipschutz) o   Federal Budget & Omnibus Bill          Tipping the Scales Towards Medicare Advantage (David Lipschutz)    Overview    Recent Legislative and Regulatory changes favoring MA    CMS steering during 2017 Annual Coordinated Election Period (ACEP)          Provisions of the Budget Act of 2018 … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Jimmo Implementation Update (Judy Stein, Ali Bers)  Corrective Action Plan Completed New CMS webpage: https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html Jimmo Webinar – September 27 at 3pm EDT.  Register at: https://register.gotowebinar.com/register/4716521538610996739 Update on Home Health Access Initiative Project (Kathy Holt)  Proposed rule re: payment (comments due 9/25) Joint Webinar with National Association for Home … Read more

Featuring Guest Presenter Carol Regan, Community Catalyst Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: Update (Carol Regan, Community Catalyst, and David Lipschutz)  Overview of Senate Debate Impact on Older Adults, Medicare (David Lipschutz) Impact on Medicaid, Dual Eligibles (Carol Regan) Litigation Update   (Ali Bers) Jimmo (Improvement standard) Barrows (formerly Bagnall) (Observation) Sherman (Lower level … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Health Reform: House Passes American Health Care Act (AHCA) (David Lipschutz)  What’s in AHCA Impact on Affordable Care Act, Medicaid and Medicare Next up: the Senate Update on Home Health Access Initiative Project (Kathy Holt)  Speech Generating Devices (SGDs) (Kathy Holt) Steve Gleason Act            Observation Status (Toby Edelman) Medicare … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Barrows (formerly Bagnall) (Observation) Sherman (Lower level Medicare appeals) Other updates The Fight to Protect the ACA, Medicare and Medicaid – Updates (David Lipschutz)  House proposal: American Health Care Act (AHCA Impact on Affordable Care Act, Medicaid and Medicare Other health reform … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Fight to Protect the ACA, Medicare and Medicaid – Updates (David Lipschutz and Kata Kertesz)  Affordable Care Act (ACA) Congressional action Advocacy/coalition action Outlook for Medicare and Medicaid Observation Status (David Lipschutz) Recent HHS OIG Report confirms that long outpatient stays in hospitals increasing Update on NOTICE Act … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  The Election’s Potential Impact on Medicare (David Lipschutz)  Affordable Care Act Medicare Structural Changes Including premium support/vouchers New Nursing Home Requirements of Participation (Toby Edelman) Overview of final rule Positive changes Prohibition against facilities’ use of mandatory pre-dispute arbitration agreements and ensuing litigation What’s missing Including staffing requirements Review: … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator)  Litigation Update   (Ali Bers) Jimmo (Improvement standard) Court order for additional education issued August 18, 2016 Exley (formerly Lessler) (ALJ Delay Case) Settlement approved August 1, 2016 Sherman (Lower level Medicare appeals) Defendant’s motion to dismiss denied, class certification granted August 8, 2016 Bremby (Per se skilled services) Coverage … 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

​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

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

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

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

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

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

Welcome and Housekeeping  (David Lipschutz, Moderator)  Legislative/Budget Update    Medicare physician payment (Sustainable Growth Rate, or SGR) (David Lipschutz) House passed SGR bill – review of what is and is not in the bill for beneficiaries Senate takes the bill up now … Dueling Budgets: Overview of House and Senate, Republican and Democratic Budgets and … 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

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

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

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

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

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

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Gill Deford) Overview Claims Eligible for Review Deadlines and Request Form Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Medicare “Doc Fix” (Physician payment, or “SGR”): Where are we now? Extenders: QI program and therapy cap exceptions … 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

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

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL Monday, August 12, 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 … 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

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

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  The Road Forward on Jimmo: Post-Approval Update on the Improvement Standard Litigation – Jimmo v. Sebelius  (Judith Stein) Presentation: Update on Medicare Secondary Payor (MSP): CMS to Establish a New Website For Medicare Secondary Payer Claims Information (Alfred Chiplin) Legislative Update:  The Federal Budget and Medicare (David Lipschutz) … 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

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

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

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

Monday, October 17, 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.   ______________________     Special Topic Presentation:   The Supercommittee and Medicare: What Advocates Need to Know    … Read more

Monday, August 8, 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. ______________________ Special topic presentation:  implications and effects of the debt-ceiling deal on medicare and beneficiaries ______________________  AGENDA Welcome … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL* Monday, June 13, 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. ______________________ Understanding Accountable Care Organizations (ACOs) AGENDA Welcome and Housekeeping  (David Lipschutz, CMA, … Read more

NATIONAL MEDICARE ADVOCATES ALLIANCE CALL* Removing the Barrier to Medicare Coverage for Chronic Conditions: Regulatory Clarification, Litigation, And Education Regarding the Medicare Improvement Standard Monday, April 11, 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 … Read more