As described by the HHS Office of Inspector General (OIG), as part of a discharge assessment that is required for each resident who is hospitalized,CMS calculates two nursing home quality measures from the MDS that reflect the percentage of … [Read more...] about Skilled Nursing Facilities Failed to Report Falls with Major Injury and Hospitalization
Archives for September 2025
Observation Status Appeal Results in Hospital Coverage
This week a Medicare beneficiary won a retrospective change of status appeal that granted him coverage of costly hospital services. The appeal was made possible by CMA’s class action litigation regarding “observation status.” These types of appeals … [Read more...] about Observation Status Appeal Results in Hospital Coverage
CMA Co-Director Testifies at Congressional Hearing re: Medicare Bills
On September 18, 2025, the House Energy & Commerce Health Subcommittee held a hearing titled “Examining Policies to Enhance Seniors’ Access to Breakthrough Medical Technologies”. CMA Co-Director David Lipschutz was an invited witness and … [Read more...] about CMA Co-Director Testifies at Congressional Hearing re: Medicare Bills
Article Recommends Improvements to Substance Use Disorder Care in SNFs
A recent Health Affairs article, “Improving Access To Substance Use Disorder Care In Nursing Facilities,” outlines the need for comprehensive substance use disorder (SUD) care in nursing facilities. The article also provides an overview of the … [Read more...] about Article Recommends Improvements to Substance Use Disorder Care in SNFs
Know Jimmo | Key Medicare Coverage Principles
Key Medicare Coverage PrinciplesSearch CMS.gov for Jimmo and An Important Message About JimmoHelp Open Doors to Necessary Care! … [Read more...] about Know Jimmo | Key Medicare Coverage Principles
Advocates Seek Transparency on Lawfully Present Immigrants’ Loss of Medicare
A coalition of national advocacy organizations has filed a Freedom of Information Act request seeking transparency from the Social Security Administration and the Centers for Medicare and Medicaid Services regarding new Medicare restrictions for … [Read more...] about Advocates Seek Transparency on Lawfully Present Immigrants’ Loss of Medicare
Repeal the 3-Day Hospital Stay Requirement for Care in a Skilled Nursing Facility
Since Medicare was enacted in 1965, the statute has limited coverage in a skilled nursing facility (SNF) to beneficiaries who first spent at least three consecutive days in an acute care hospital. The requirement has increasingly become both … [Read more...] about Repeal the 3-Day Hospital Stay Requirement for Care in a Skilled Nursing Facility
New AI Prior Authorization Model is Dangerous for Medicare Beneficiaries
A new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, is set to launch next year in Arizona, Ohio, Oklahoma, Texas, New Jersey, and Washington. The model, designed in theory to cut down on “fraud” and … [Read more...] about New AI Prior Authorization Model is Dangerous for Medicare Beneficiaries
Know Jimmo | CMS Fact Sheet
Jimmo v. Sebelius Settlement Agreement Program Manual Clarifications Fact Sheet“… Medicare has never supported the imposition of an “Improvement Standard” rule-of-thumb in determining whether skilled care is required to prevent or slow … [Read more...] about Know Jimmo | CMS Fact Sheet
New, Temporary, Special Enrollment Period
In August, CMS announced that Medicare Advantage provider directory information would be included in the online Medicare Plan Finder (MPF). Though CMS expects that information to be accurate, they announced on September 12 that they are making a new, … [Read more...] about New, Temporary, Special Enrollment Period