Increases Payment and Rolls Back Consumer ProtectionsIn recent days, the Centers for Medicare & Medicaid Services (CMS) has issued policy – a Rate Notice and a final rule, both for 2027 – that significantly favor the Medicare Advantage (MA) … [Read more...] about CMS Caves to Medicare Advantage Industry
Archives for April 2026
Know Jimmo | Use the CMS Information
CMS says very clearly that "skilled nursing and skilled therapy services in the Skilled Nursing Facility (SNF), Home Health (HH), and Outpatient Therapy (OPT) settings does not turn on the presence or absence of a beneficiary’s potential for … [Read more...] about Know Jimmo | Use the CMS Information
Enforcement Against Nursing Homes Must Be Strengthened
Evidence debunks the common nursing home complaint that the enforcement system is punitive. In fact, enforcement is, more typically, weak. A recent example in Indiana illustrates the point. Despite identifying 25 of a chain’s 30 nursing homes in … [Read more...] about Enforcement Against Nursing Homes Must Be Strengthened
Recent Victory in Appeal for Coverage of Rolling Shower Chair
The Center for Medicare Advocacy (CMA) recently helped Michigan schoolteacher Cara Bunnell successfully challenge her Medicare Advantage (MA) plan’s denial of prior authorization for a rolling shower chair prescribed by her physician.Ms. Bunnell … [Read more...] about Recent Victory in Appeal for Coverage of Rolling Shower Chair
CMA Comments on CMS Requests for Information
Request for Information (RFI) Related to Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH)The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare submitted comments on CMS-6098-NC, the … [Read more...] about CMA Comments on CMS Requests for Information
New Issue Brief | Premature Terminations of Coverage by Medicare Advantage Plans
Private Medicare Advantage (MA) plans are allowed under the law to employ utilization management techniques in order to control spending and ensure that plan enrollees receive medically necessary care. Prior authorization, or pre-approval, for … [Read more...] about New Issue Brief | Premature Terminations of Coverage by Medicare Advantage Plans
40 Years of Advocacy
April 1, 2026 marked the 40th anniversary of the Center for Medicare Advocacy. In its forty years, CMA has seen Medicare move from a universal program with two coverage parts, Part A for hospital and other inpatient care, and Part B, for … [Read more...] about 40 Years of Advocacy
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