On June 24, 2011, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA), released amendments to a set of interim final rules regarding claims and appeals review processes that were originally published in July 2010.[1] The rules and amendments implement requirements … Read more

  Congress continues to propose Medicare changes that will have severe repercussions for beneficiaries and their families. Policymakers and pundits are feeding the media and the public misinformation about Medicare. The truth is, most people with Medicare are low-income and most pay more for health care than other insured Americans.  Nonetheless, Medicare Works. For 46 years it … Read more

This week, Congress passed, and the President signed, the Budget Control Act of 2011.  The bill raises the nation's debt ceiling and makes debt and deficit reductions in federal spending over the next 10 years.[1]  Between now and Thanksgiving 2011, a new Joint Committee of Congress will be tasked with seeking $1.2 to $1.5 trillion … 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

Next week, the House of Representatives is scheduled to vote on a proposal that will directly impact and harm Medicare beneficiaries, Social Security recipients, and others that rely on critical safety net programs. The Goodlatte-Walsh Balanced Budget Amendment, H.J.Res.1, will come to a vote Wednesday, July 20. The bill requires Congress to pass a balanced … Read more

Introduction The Affordable Care Act includes a provision establishing a Center for Medicare and Medicaid Innovations (CMMI) that is authorized to test models to reduce Medicare and Medicaid expenditures while preserving or improving quality for beneficiaries of those two programs. The provision includes appropriations of $5 million for fiscal year 2010 and $10 billion for … Read more

One year ago on July 1, 2010, Secretary of Health and Human Services Kathleen Sebelius announced the availability of new insurance coverage for individuals who were denied insurance because they had a pre-existing condition.[i]  These plans, called Pre-Existing Condition Insurance Plans (PCIPs), were created by the Affordable Care Act of 2010 (ACA). [ii]  As required … Read more

For many years, advocates for nursing home residents have argued that when residents are denied good care, the costs of trying to treat and correct avoidable conditions and bad resident outcomes are high.  Advocates refer to this phenomenon as "the high cost of poor care."  Others identify the phenomenon as "the business case for quality."  … Read more

In a decision issued earlier today, the United States Court of Appeals for the Sixth Circuit issued the first appellate decision on the Patient Protection and Affordable Care Act (ACA, often referred to as Healh Care Reform) and held that it was constitutional.  Thomas More Law Center v. Obama, No. 10-2388 (6th Cir., June 29, … Read more

Medicare and Medicaid, which together serve over 95 million Americans,[1] or nearly one third of the U.S. population, are our two major national public health insurance programs offering secure and stable access to health care for beneficiaries, and peace of mind for their families. Last month's upset victory by Democrat Kathy Hochul in a traditionally … Read more

Once again the House of Representatives’ leadership are proposing to change Medicare into a private voucher system. Their proposals would have severe repercussions for Medicare beneficiaries and their families.[1] Sound solutions that would preserve Medicare coverage while reducing costs are still not being seriously addressed.  With the President on record as recommending that we lower Medicare's … Read more

On April 15, 2011, the Centers for Medicare & Medicaid Services (CMS) issued final regulations to provide policy and technical changes to the Medicare Parts C (Medicare Advantage) and D programs.[1]  The regulations address concerns raised by Medicare beneficiary advocates, and implement provisions of the Affordable Care Act.  They also codify into regulation some existing … 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

Combating fraud, waste and abuse in health care and in other federal programs remains a popular refrain for reducing federal expenditures. In a survey conducted by AARP in September 2009, 80% of Medicare beneficiaries age 65 and older agreed that eliminating waste, fraud, and abuse in Medicare "should be at least one of the top … Read more

The Medicare Trustees issued their annual report on Medicare's financial status on Friday, May 13, 2011.  According to this year's report, the Hospital Insurance (HI) Trust Fund has sufficient reserves to pay out the full amount of Medicare Part A benefits until 2024. Should nothing else change, and the Trust Fund reserves be depleted in … Read more

The Center is concerned about the use of MSNs that do not reveal to beneficiaries that their service was denied based on a National Coverage Determination.  Such an MSN will instead provide a misleading explanation, such as "Medicare does not cover this service," or "information provided does not support the need for this service." If … Read more

The Center for Medicare Advocacy would like to bring to your attention this request from the National Academy of Elder Law Attorneys (NAELA) for stories about the importance of Medicaid. Do you provide time and financial support to a family member who receives Medicaid for nursing home services? Are you married to someone who is … Read more

On April 4, 2011, the Center for Medicare Advocacy (the Center) filed comments on a proposal by the Centers for Medicare & Medicaid Services (CMS) to establish a new condition of Medicare participation (CoP) for certain Medicare service providers.  These providers would be required to give Medicare beneficiaries notice of the right to seek review … Read more

Eligibility for Medicare coverage of hospice care is contingent in part upon a hospice physician certifying that the beneficiary has a life expectancy of six months or less if the terminal illness runs its normal course.   In an effort to promote physician engagement in the process of certifying patients as eligible for the Medicare hospice … 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

An article from NAELA Journal, Volume 7, Number 1, written by Center for Medicare Advocacy attorneys Vicki Gottlich, Patricia Nemore, and Alfred J. Chiplin Jr. Read it at: http://viewer.zmags.com/publication/4afec968#/4afec968/25 (external link)

Under the proposed budget resolution passed by Republicans in the House of Representatives, nearly a million nursing home residents could immediately lose coverage for nursing home care.  Further, all of the standards that govern nursing home care today could disappear.  A study of the costs of nursing home care, released April 21, 2011 by John … Read more

In April 2011, the Center for Medicare Advocacy celebrates 25 years of advocating for, and on behalf of, older people and people with disabilities who rely on Medicare.  We started as a small organization in Connecticut, added a Data Unit in Maine, a policy office in Washington, D.C., and satellite offices in Tucson, Arizona, Massachusetts, … Read more

Medicare and Medicaid have been providing health insurance coverage to older people, people with disabilities, women, and families with children for more than 45 years.  These programs ensure that vulnerable populations who could not get health care coverage from private health insurance have access to basic health coverage. The futures of the Medicare and Medicaid … Read more

Medicare and Medicaid, which together serve over 95 million Americans,[1] are our two major national public programs offering secure and stable access to health care for beneficiaries, and peace of mind to the their families. Medicaid is under attack by proposals that would limit its scope and/or eliminate current program structures that provide important protections … Read more

One year ago, on March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, the Health Care Reform law[1] that will provide access to health insurance for virtually all Americans. As the Center for Medicare Advocacy has reported over the past year, Health Care Reform is good for Medicare, good … 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

Medicare provides a vital foundation for the health and wellness of Americans who are 65 or older or have significant disabilities. The program currently covers a portion of health care costs for over 47 million individuals throughout the United States. [1] While Medicare is critical in helping older people and people with disabilities pay for … Read more

For Immediate Release Contact: Judith Stein, 860-456-7790 February 17, 2011 The House of Representatives will vote today on an amendment to the 2011 Continuing Budget Resolution that would prevent all spending to implement the Affordable Care Act, the health reform law enacted almost one year ago. “This amendment is not in the interest of Medicare, … Read more

For Immediate Release Contact: Judith Stein, 860-456-7790 February 9, 2011 Vicki Gottlich, 202-293-5760 Medicare reforms included in the Affordable Care Act do not reduce Medicare’s guaranteed 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, closing the … Read more

Hospice care is available for Medicare beneficiaries who are certified by a hospice physician as having a life expectancy of six months or less if the terminal illness runs its normal course. In 1983, the hospice benefit was designed to cover approximately 210 days of care. There were four benefit periods: two 90 day periods, … Read more

The Centers for Medicare & Medicaid Services (CMS) issued new regulations on November 17th regarding coverage for home health services. The new regulations clarify Medicare coverage for home health services, including physical therapy, occupational therapy and speech-language pathology services.[1] The regulations are effective January 1, 2011; however, since they clarify rather than change coverage rules, … Read more

This Alert serves as a reminder about changes to Medicare that go into effect on January 1, 2011. 1.      The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program[1] Beginning January 1, 2011, beneficiaries in nine areas around the country will have to get medical equipment and supplies through suppliers that have a … Read more

Concerned about the well-being and rights of dually eligible older and disabled people, 38 national, state and local advocacy organizations, individual advocates, and law professors sent the following letter to Secretary of Health and Human Services Kathleen Sebelius on December 13, 2010.  The letter urges her to promulgate regulations that would protect those dually eligible … Read more

For Immediate Release Contact: Judith Stein, 860-456-7790 December 14, 2010   Thirty-six national, state and local advocacy organizations, individual advocates and legal scholars released a letter to Secretary Kathleen Sebelius yesterday, seeking strong beneficiary protections for any combined Medicare-Medicaid models to be tested by the Secretary under authority of the Affordable Care Act's new Center … Read more

CMA ALERT, DECEMBER 12, 2010 New Medicare Home Health Regulations: Improvement is NOT Required to Maintain Coverage! Congress Passes the Medicare and Medicaid Extenders Act of 2010 CMS Issues Corrected "Choosers" Letter Remember, You CAN Go Home for the Holidays! NEW MEDICARE HOME HEALTH REGULATIONS: IMPROVEMENT IS NOT REQUIRED TO OBTAIN COVERAGE The Centers for … Read more

December 3, 2010 For Immediate Release Contact: Judith Stein, (860) 456-7790 jstein@medicareadvocacy.orgVicki Gottlich, (202) 293-5760 vgottlich@medicareadvocacy.org This week’s report by the National Commission on Fiscal Responsibility and Reform offers recommendations that will pull the Medicare safety net from under older and disabled people most in need of security. The Commission’s proposals to reduce the Medicare … 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

September 22, 2010 For Immediate Release Contact: Judith Stein, (860) 456-7790 jstein@medicareadvocacy.org Vicki Gottlich, (202) 293-5760 vgottlich@medicareadvocacy.org The Affordable Care Act has already helped millions. For example, over one million Medicare beneficiaries have already received rebate checks during the Donut Hole gap in coverage, helping them pay for necessary medications. Next year, more low-income older … Read more

The Affordable Care Act[1] (ACA) adds coverage for a new "Wellness Visit" and eliminates cost-sharing for almost all of the preventive services covered by Medicare, effective January 1, 2011. This Alert discusses both provisions. Wellness Visit Starting next year, Medicare will cover a new annual wellness visit and will provide payment for the creation of … Read more

“Observation” is the term used to describe the outpatient status of a patient who is in a hospital, but not as an inpatient. Although the Medicare Manuals limit observation to 24-48 hours, many beneficiaries nationwide are experiencing extended stays in acute care hospitals under observation. A major consequence for beneficiaries of not being classified as … Read more

July 30th marks the 45th anniversary of Medicare. When President Johnson signed the Medicare program into law in 1965, he ushered in an era of better health and financial security for older Americans and their families. Medicare did what private insurance failed to do – provide health coverage for people age 65 and older. Over … Read more

The Centers for Medicare & Medicaid Services (CMS) has recently issued new rules for Medicare and Medicaid participating hospitals that require written policies protecting patients’ rights to choose their visitors during a stay in the hospital.[1] The landmark rules ensure same-sex partners will have visitation rights, along with friends and other family members.[2] The final … Read more

Medicare beneficiaries who enter the prescription drug coverage gap (known as the "Donut Hole") anytime before the end 2010 should receive a one time $250 rebate check from Medicare.  The first checks, for people who hit the Donut Hole by March 31, 2010, should arrive around June 10, according to Secretary of the Department of … Read more

Much of the current talk about the problems of Medicare misses the point. The proposals could end up "fixing" a successful program out of existence. Before supporting any fix, remember: Medicare has been a success Medicare assures the elderly and people with disabilities that neither they nor their families will have to bear the full … 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