Medicare IS available for skilled care to maintain or slow decline of an individual’s condition.“Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not … [Read more...] about Know Jimmo | No Matter Who’s In Charge – Jimmo is the Law
Archives for January 2025
CMA Special Report | Hidden Profits that Detract from Nursing Facility Care Are Unregulated and Ignored
Medicare cost reports submitted by nursing facilities are not audited to determine compliance with related party requirements.Nursing home owners and operators hide their profits by making inflated payments to companies they own and control, … [Read more...] about CMA Special Report | Hidden Profits that Detract from Nursing Facility Care Are Unregulated and Ignored
CMS Clarifies Treatment of Medicare Advantage “Flex Cards” For Public Benefit Purposes
On January 8, 2025 the Centers for Medicare & Medicaid Services (CMS) released a letter in response to Rep. Lloyd Doggett’s request for clarification that Medicare Advantage (MA) “flex cards” should be excluded from the calculation of income when … [Read more...] about CMS Clarifies Treatment of Medicare Advantage “Flex Cards” For Public Benefit Purposes
New CMS Rule Helps MA Plan Enrollees Against Repeated SNF Denials in the Same Episode of Care
The Center for Medicare Advocacy would like to highlight a recent legal development that may help enrollees and their families advocate for themselves when Medicare Advantage Plans prematurely deny Skilled Nursing Facility (“SNF”) care.In a … [Read more...] about New CMS Rule Helps MA Plan Enrollees Against Repeated SNF Denials in the Same Episode of Care
Change in Government Should Not Lead to a Change in Scrutiny of Medicare Advantage
As a new session of Congress has begun, and a new Administration begins in a matter of days, it is time to expand on important oversight and consumer protection measures surrounding Medicare Advantage (MA) plans. Over the last 4 years, progress has … [Read more...] about Change in Government Should Not Lead to a Change in Scrutiny of Medicare Advantage
Know Jimmo | Medicare Home Health Coverage Available for People with Ongoing Conditions
Medicare home health coverage offers the promise of allowing eligible individuals (legally homebound and in need of skilled care), to remain at home with the care they need. According to Medicare law, regulations, and policy, home health coverage … [Read more...] about Know Jimmo | Medicare Home Health Coverage Available for People with Ongoing Conditions
Know Jimmo | Important Message about the Settlement
“The Jimmo Settlement Agreement may reflect a change in practice for those…who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Jimmo … [Read more...] about Know Jimmo | Important Message about the Settlement
Medicaid Work Requirements Harm People with Disabilities
A recent National Health Law Program (NHeLP) issue brief, “Unfit” to Work? How Medicaid Work Requirements Hurt People with Disabilities, explores how work requirements in Medicaid particularly harm individuals with disabilities. Examining work … [Read more...] about Medicaid Work Requirements Harm People with Disabilities
Reminder: Prescription Drug Cost Cap In Effect
The new $2,000 cap on out-of-pocket costs for prescription drugs is now in effect as of January 1. As part of the Inflation Reduction Act, people with Medicare Part D will pay no more than $2,000 for all their covered prescription drugs for all of … [Read more...] about Reminder: Prescription Drug Cost Cap In Effect
New Resources on Observation Status Appeals!
New year, new right to appeal. In 2025, as a result of the Center’s class action lawsuit, certain Medicare beneficiaries will have a new right to appeal their placement on “observation status” in hospitals. Information about these appeals is now … [Read more...] about New Resources on Observation Status Appeals!