CMS announced on February 14, 2025, that it had ceased implementation of the Hospice Special Focus Program (SFP) in order to “further evaluate the program.” The purpose of the SFP is to identify and strengthen oversight of poorly-performing … [Read more...] about CMS Suspends Launch of Program to Identify Poor-Quality Hospice Providers
Archives for February 2025
Issue Brief | Medicaid Cuts Will Devastate Nursing Home Residents
Medicaid is the primary payer for nursing home care. Medicaid pays directly for residents’ care and provides financial support that enables many residents to use their Medicare benefit as well. The budget resolution passed by the House of … [Read more...] about Issue Brief | Medicaid Cuts Will Devastate Nursing Home Residents
Center Supports Free Preventive Care and Prescription Drug Negotiation
This week the Center for Medicare Advocacy joined two amicus curiae (“friend of the court”) briefs in litigation of importance to older adults and people with disabilities.In Kennedy v. Braidwood, CMA joined members of the Chronic Illness and … [Read more...] about Center Supports Free Preventive Care and Prescription Drug Negotiation
Largest Medicare Advantage Insurer Under Increasing Scrutiny, As Insurance Industry Cheerleader Nominated to Run Medicare
UnitedHealth Under New Scrutiny for Billing PracticesA recent Wall Street Journal article titled “DOJ Investigates Medicare Billing Practices at UnitedHealth” by Christopher Weaver and Anna Wilde Matthews (Feb. 21. 2025) describes a new … [Read more...] about Largest Medicare Advantage Insurer Under Increasing Scrutiny, As Insurance Industry Cheerleader Nominated to Run Medicare
Know Jimmo | Home Health Care is Available for Medicare Beneficiaries with Long Term, Chronic, and Terminal Conditions
The key to coverage is whether the individual requires skilled nursing or therapy and whether care would be safe and effective if skilled care was not provided. (And the individual meets other qualifying criteria: is homebound and has proper provider … [Read more...] about Know Jimmo | Home Health Care is Available for Medicare Beneficiaries with Long Term, Chronic, and Terminal Conditions
Observation Status Appeals Are In Effect
Beneficiaries are seeing information about “a new appeal right” on the Medicare Summary Notices they receive in the mail. This right resulted from the Center for Medicare Advocacy’s class action on behalf of beneficiaries who have harmed by … [Read more...] about Observation Status Appeals Are In Effect
New Jersey State Comptroller Protects Nursing Home Residents Again
Just weeks after KBWB-Atrium and its former Chief Executive Officer Kevin Breslin “pleaded guilty [in Wisconsin] to one count of health care fraud and one count of tax conspiracy related to the operation of numerous skilled nursing facilities” (for … [Read more...] about New Jersey State Comptroller Protects Nursing Home Residents Again
Threats to Medicare, Medicaid and Other Health Programs Increasing
One month into a new administration, there are increasing threats to our country’s foundational health programs and those that they serve. Such threats range from dire cuts to the Medicaid program that Congress will begin voting on next week, to the … [Read more...] about Threats to Medicare, Medicaid and Other Health Programs Increasing
“DOGE” and Access to Data
There have been multiple media reports about personnel from the newly-formed “U.S. DOGE Service” gaining access to data from federal agencies. Some officials have stated that DOGE’s objective in reviewing agency data is to help eliminate government … [Read more...] about “DOGE” and Access to Data
Know Jimmo | Frequently Asked Questions (FAQs) Regarding Jimmo Settlement
(CMS.gov, Sept 10, 2024. Last visited 2/28/2025.)Q1: What is the Jimmo Settlement Agreement (January 2013)?A1: The Jimmo Settlement Agreement clarified that when a beneficiary needs skilled nursing or therapy services under Medicare’s skilled … [Read more...] about Know Jimmo | Frequently Asked Questions (FAQs) Regarding Jimmo Settlement