If an owner or operator fails to run its facilities effectively, why give them more?Nursing facilities must be licensed to do business in their state. To be eligible for reimbursement under the Medicare or Medicaid programs, or both, they must … [Read more...] about Special Report | The Urgent Need for Criteria for Federal Certification of Nursing Facilities
Archives for August 2024
Know Jimmo | Individualized Assessment Required
Longstanding federal law requires each Medicare determination to be based on the particular facts of the individual beneficiary’s condition and circiumstances. General norms based on algorithms, diagnoses, or other “rules of thumb” should not be the … [Read more...] about Know Jimmo | Individualized Assessment Required
Low-Income Areas Have Fewest Highly Rated MA Plans
A recent study published in JAMA Network Open, “Medicare Advantage Plan Star Ratings and County Social Vulnerability,” found that “the most socially vulnerable counties . . .have the fewest highest-rated plans for MA beneficiaries.” Though the Star … [Read more...] about Low-Income Areas Have Fewest Highly Rated MA Plans
Melanie Lambert – Senior Medicare Advocate
Melanie Lambert recently joined the Center for Medicare Advocacy as Senior Medicare Advocate. Ms. Lambert has a background in public service, advocacy, and program management, and with a passion for promoting health equity and social justice. As … [Read more...] about Melanie Lambert – Senior Medicare Advocate
Medicare Advantage Plans Propose Cuts While Continuing to Maximize Overpayments
With the Medicare Annual Enrollment Period on the horizon (starting October 15th), Medicare Advantage plans are beginning to announce some of the changes they are implementing for 2025. Changes include benefit and service area reductions, which … [Read more...] about Medicare Advantage Plans Propose Cuts While Continuing to Maximize Overpayments
Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
Long-standing Federal regulation makes that clear:“Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services … [Read more...] about Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
AARP Poll Finds Potential Voters Support Minimum Staffing Standards for Nursing Homes
A new AARP poll finds that 94% of respondents “would be more likely to vote for a Congressional candidate who supports the new federal requirement to have a registered nurse available in nursing homes at all hours of the day.” The range of support … [Read more...] about AARP Poll Finds Potential Voters Support Minimum Staffing Standards for Nursing Homes
Medicare Oral Health Updates
The Center joined more than 240 organizations in a statement applauding the important steps taken by CMS and the Biden Administration to explore and clarify payment policies for dental services that are critical to the success of certain medical … [Read more...] about Medicare Oral Health Updates
Non-Medicare Drug Plans May Not Meet CMS “Creditable” Standards in 2025
As a result of the Inflation Reduction Act (IRA), the out-of-pocket maximum under all Medicare Part D plans will be capped at $2,000 per year starting January 1, 2025. While this significant change gives current Part D enrollees peace of mind when it … [Read more...] about Non-Medicare Drug Plans May Not Meet CMS “Creditable” Standards in 2025
Know Jimmo | Documentation Tips
New Documentation Guidance was included in the Jimmo Manual revisions.Nurses and therapists should document what they do and why. IF improvement is occurring, note it. If the goal is, or includes maintenance or changes to maintenance, make sure … [Read more...] about Know Jimmo | Documentation Tips