August 13, 2019 VIA ELECTRONIC SUBMISSION Secretary Alex Azar U.S. Department of Health and Human Services Herbert H. Humphrey Building, Room 509F 200 Independence Avenue SW Washington, DC 20201 RE: Docket ID HHS-OCR-2019-0007, RIN 0945-AA11, Nondiscrimination in Health and Health Education Programs or Activities Dear Secretary Azar: The Center for Medicare Advocacy (“Center”) appreciates the … Read more

The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, is launching the Transdisciplinary Collaborative Centers (TCC) for Health Disparities Research on Chronic Disease Prevention program. This program responds to the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, under-served … Read more

In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document.  The Policy Options Document was issued as part of a process begun in May 2015 to develop legislation to address challenges facing Medicare beneficiaries with chronic conditions.   According to a press release issued by the Committee, the Options … Read more

1. Comments to Senate Finance Committee Chronic Care Workgroup On June 22, 2015, the Center for Medicare Advocacy submitted comments to the Senate Finance Committee Chronic Care Workgroup in response to the Committee’s May 22, 2015 request for comments on reforming care for individuals with chronic conditions. The Committee identified three overarching goals to guide … Read more

Introduction In general, people who are eligible for Medicare may not purchase Marketplace plans (also called Qualified Health Plans or QHPs).[1] However, IRS guidance released in June, 2013 clarifies that two sub-populations of Medicare eligible individuals may be able to forego Medicare coverage to buy Marketplace plans: people who must pay Part A premiums (also … Read more

One of the deficit reduction proposals being discussed to achieve savings from Medicare is to introduce new cost-sharing for home health care. As a means to ward off such potential home health co-payments, some instead suggest capping Medicare payment for episodes of care, effectively limiting the duration of time individuals could access home health services. … Read more

Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius.[1] A proposed settlement agreement[2] was filed in federal District Court on October 16, 2012.  When the judge approves the proposed agreement, a process that may … Read more

Individuals with pre-existing conditions who have been uninsured for six months may now find it easier to obtain coverage through the Pre-Existing Condition Insurance Plan (PCIP).  PCIP was created by the Affordable Care Act to provide interim coverage until the Health Insurance Exchanges are up and running in 2014. Twenty-seven states administer their own PCIP. … Read more

  March 3, 2011 For Immediate Release Contact:  Gill Deford, (860) 456-7790 Judith Stein, (860) 456-7790 Today, the Alzheimer's Association and United Cerebral Palsy joined five other national organizations and several Medicare beneficiaries in a class action lawsuit challenging the Medicare program's Improvement Standard.  Under that Standard, Medicare patients suffering from chronic conditions … Read more

As the New York Times reported on March 31, 2002 (p.1), Medicare advocates have been successful in convincing the Centers for Medicare and Medicaid Services (CMS) to loosen Medicare’s denial practices for people with Alzheimer’s disease and other cognitive impairments. Unfortunately, Medicare has a decades-long policy of denying coverage to people who need services which … Read more

By Gill Deford, Margaret Murphy, and Judith Stein Diagnosed three years earlier with Amyotrophic Lateral Sclerosis (“ALS,” or otherwise known as “Lou Gehrig’s Disease”), 68-year-old Eileen Prendergast was suddenly informed by her home health agency that Medicare would no longer cover the home health care on which she depended.[1] Ms. Prendergast, who needed an electric … 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

Mrs. P, 68 years old, was diagnosed with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s Disease) five years ago.  She now needs a wheelchair, cannot stand on her own, needs assistance to move from bed to wheelchair, and is losing the use of her arms and hands. Mrs. P has been receiving home … Read more

The month of December began with World AIDS Day, an international day of action on HIV and AIDS. When advising Medicare beneficiaries with the diagnoses of HIV and AIDS, be aware that Medicare covers a wide array of services, for those living with HIV/AIDS including the terminal stages of AIDS.  Services covered include hospital, skilled … Read more

Older Americans are not getting six key preventive services or appropriate treatment for hypertension that clinical practice guidelines indicate they generally should receive, according to two studies recently published in the Journal of the American Medical Association.  The preventive services study raises questions about disparities in health care based on economic status, and about the … Read more

Patients enrolled in AIDS Drug Assistance Programs (ADAPs) with chronic hepatitis C will now have free access to a new combination drug therapy.  Schering-Plough Corporation announced in late February that it will provide a new combination therapy of  PEG-INTRON (peginterferon alfa-2b) Powder for Injection and REBETOL (ribavirin USP) Capsules free to 1,500 ADAP patients through their new … Read more

On February 28, 2005 the manufacturers of Tysabri, Biogen Idec and Elan Corporation, announced the voluntary suspension of the Multiple Sclerosis drug from the market and from all clinical trials.  According to the companies’ press release: This decision is based on very recent reports of two serious adverse events that have occurred in patients treated … Read more

Over the years, contractors that review Medicare claims have denied coverage for Medicare services inappropriately on the grounds that the beneficiary's condition will not improve. The Center for Medicare Advocacy, through individual appeals and other advocacy efforts, has worked to assure that beneficiaries who need services to maintain their current level of functioning are not … Read more

As the New York Times reported on March 31, 2002 (p.1), Medicare advocates have been successful in convincing the Centers for Medicare and Medicaid Services (CMS) to loosen Medicare's denial practices for people with Alzheimer's disease and other cognitive impairments. Unfortunately, Medicare has a decades-long policy of denying coverage to people who need services which … Read more

The Center for Medicare Advocacy's recent conference on adding a coordinated care benefit to the traditional Medicare program achieved a high level of agreement on the importance of changing attitudes as well as institutional factors to improve care coordination.  Of particular note is that consensus was reached on the need to get physicians directly involved … Read more