As outlined a prior CMA Alert (Sept. 18, 2025), a new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, launched this year in Arizona, Ohio, Oklahoma, Texas, New Jersey, and Washington. The model is designed, in … [Read more...] about Early Reports on WISeR Model Are Troubling
Archives for March 2026
Administration Exploring Default Enrollment into Medicare Advantage
Under current Medicare rules, Medicare beneficiaries who do not make a choice between traditional Medicare (TM) and Medicare Advantage (MA) are defaulted into TM. As outlined in a recent CMA Issue Brief: “Retiree Auto Enrollment in Medicare … [Read more...] about Administration Exploring Default Enrollment into Medicare Advantage
Medicare Summary Notices (MSNs) Mailings Reduced to Six Months
Beginning January 2026, Medicare beneficiaries will receive a Medicare Summary Notice (MSN) every 180 days, a change from every 120 days. This change, claimed as an effort to reduce costs, is part of a larger shift for beneficiaries to conduct most, … [Read more...] about Medicare Summary Notices (MSNs) Mailings Reduced to Six Months
Know Jimmo | Provider Education is Key
"I am a private nurse care manager who has advocated for my clients regarding the application of Jimmo decision for the last several years... without success. The therapists and nurses in the room continue to repeat 'Must discharge because of lack of … [Read more...] about Know Jimmo | Provider Education is Key
Client Win – Billed for Services When Medicare Wasn’t Available
The Center recently worked with an ombudsman whose client was billed nearly $10,000 for almost two weeks of care in a skilled nursing facility (SNF) and physical therapy when the resident remained in the SNF after she had received 100 days of … [Read more...] about Client Win – Billed for Services When Medicare Wasn’t Available
Addressing the “Medigap Trap”
A recent Center for American Progress report, “Escaping the Medigap Trap: A Path to Real Choice in Medicare,” presents policy reforms to address the “Medigap trap” - the term often used to refer to the experience of beneficiaries who would like to … [Read more...] about Addressing the “Medigap Trap”
Crucial Care at Risk from Unfounded Fraud Claims
A recent Health Affairs Forefront piece, “Unfounded Fraud Allegations Threaten Vital Medicaid Home And Community-Based Services,” counters CMS’s justification for its crackdowns on “fraud” in home and community based services (HCBS). The article … [Read more...] about Crucial Care at Risk from Unfounded Fraud Claims
Quality Measure Ratings for Nursing Homes Fraudulently Boost Overall Ratings
Since 2008, the Centers for Medicare & Medicaid Services (CMS) has rated nursing homes using a five-star quality rating system (with five stars being the highest and best performance). CMS publicly reports the ratings on its Care Compare website. … [Read more...] about Quality Measure Ratings for Nursing Homes Fraudulently Boost Overall Ratings
2026 Part D Reminders for Beneficiaries
The 2022 Inflation Reduction Act (IRA) enacted major changes to the Part D program that have reduced Medicare prescription drug spending for both beneficiaries and the Medicare program itself. Beneficiaries should be aware of enhancements to the Part … [Read more...] about 2026 Part D Reminders for Beneficiaries
Know Jimmo | What Care Settings?
The Jimmo Settlement applies to:See www.cms.gov/medicare/settlements/jimmo … [Read more...] about Know Jimmo | What Care Settings?