Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert | September 24, 2020

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  1. In Memory of Justice Ginsburg – From our Executive Director, Judy Stein
  2. Candidates: Don’t Forget Medicare
  3. Extra Time to Pay Medicare Premiums Ends September 30, 2020
  4. Second Circuit Court of Appeals Rules Beneficiaries Can “Aggregate” Medicare Claims at Federal Court
  5. Elder Justice Newsletter – Vol 3, Issue 1 Now Available
  6. Free Webinar: Skilled Nursing Facility Staffing

In Memory of Justice Ginsburg – From our Executive Director, Judy Stein

What a loss. Just the sense of not having Justice Ginsburg in the world shakes the solidity of an already shaken soul. We in the public interest lawyering community, as well as all of those who work to repair the world, feel adrift. Again. John Lewis. Elijah Cummings. Ruth Bader Ginsburg.

An important thing about Justice Ginsburg’s legacy is what only happened, and could only happen, in the last decade. As the Justice got older, she got cooler – or so pop culture decided. How often does that happen? Our young country mostly relishes youth and forgets to honor elders. But as an octogenarian, Justice Ginsburg became RBG. Notorious for her extraordinary tenacity, intelligence, and wit. The law and the Court were noticed. Girls had a hero in a wise old woman who led with her words, analysis, truth, writing, and public speaking. Those were her super powers. That was her might. 

The Center for Medicare Advocacy, our colleagues, and country are mourning. Many of us have the honor of doing so as lawyers and as part of the lawyering community. We will continue to advocate for older people, and for everyone left behind in these transactional times.

Ruth Bader Ginsburg’s memory is a blessing – and a constant instruction to do justice.

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Candidates: Don’t Forget Medicare

As the nation prepares for the November election and debates, health care news and concerns are understandably dominated by COVID-19.  Amid the pandemic, the Center for Medicare Advocacy urges candidates to remember the increased need for health care coverage and access to care. Specifically, don’t forget that Medicare remains the primary source of health care coverage for 62 million older people and people with disabilities.

Candidates should answer the call to preserve and improve the core Medicare program and those it serves. Voters need answers to the following questions:

  • Payroll Tax Cuts – The President has announced a temporary suspension of payroll taxes that fund the Social Security and Medicare Trust Funds, and said he wants to make the cuts permanent, which could lead to the de-funding of these programs. Are you in favor of defunding Social Security and Medicare? If elected, what are you going to do to stabilize Medicare and Social Security for current and future generations?
  • Privatization – Private “Medicare Advantage” plans cost taxpayers more money than traditional Medicare and include less choice of health care providers. Are you in favor of increasing privatization of Medicare?
  • Covid-19 – The Federal Government’s hands-off approach to regulating nursing homes has been widely reported as contributing to the loss of life in these facilities from COVID–19. What will you do to enhance nursing home infection-control rules and staffing requirements, and to protect residents, staff, and their families?
  • Drug Pricing – During the last campaign, President Trump said he favored allowing Medicare to negotiate the price of prescription drugs in the way that the V.A. does because it would save billions for taxpayers, Medicare, and Medicare beneficiaries. The House of Representatives passed a bill to require this, but the Senate didn’t act. If elected, will you support a bill authorizing Medicare to negotiate drug prices?  What will you do to bring down the high costs of prescription drugs for individuals and the Medicare program?

Candidates should not simply repeat talking points. The health care of millions depends on the answers to these questions.

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Extra Time to Pay Medicare Premiums Ends September 30, 2020

In light of the COVID-19 Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) allowed beneficiaries extra time to pay premiums. The opportunity to submit past-due premiums ends on September 30, 2020. In a letter sent to Medicare beneficiaries owing past-due premiums, CMS announced that beneficiaries must pay the full amount owed by September 30th in order to retain Medicare coverage. (Sample Letter at https://medicareadvocacy.org/wp-content/uploads/2020/09/DB-COVID-19-Relief-end-Letter-Template_V4.0-2020-08-05-FINAL.pdf).

As detailed in the Sample Letter, CMS will allow various premium payment options, including paying online with a credit or debit card through a beneficiary secured Medicare account. The Sample Letter also provides information for beneficiaries who have trouble paying their premiums and what beneficiaries can do if coverage has already been cancelled.

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Second Circuit Court of Appeals Rules Beneficiaries Can “Aggregate” Medicare Claims at Federal Court

Beneficiaries who wish to “aggregate” Medicare claims to meet the monetary threshold for appeals can do so for the first time at the federal district court level, an appeals court ruled. The case involves a Medicare beneficiary who is appealing for coverage of equipment for his Continuous Glucose Monitor, which helps control his “brittle” (particularly acute) diabetes.

After pursuing several separate appeals through Medicare’s multi-level administrative appeal system, he wished to aggregate three claims and have a federal district court decide the coverage question for all of them together. However only one of the three claims was over the amount-in-controversy threshold, which was $1500 at the time he filed suit.[1] Unless he could aggregate the claims, the district court would not have jurisdiction to decide the two claims that fell below the monetary threshold.

Medicare law allows appellants to aggregate claims to meet the amount-in-controversy threshold when the appeals involve “delivery of similar or related services to the same individual by one more providers of services or suppliers.”[2] The government argued and a lower court held that this provision applies only to appeals that are still in Medicare’s administrative appeal system. Thus, unless the claims had already been aggregated, the beneficiary could not pursue claims that did not meet the monetary threshold in federal court.

The U.S. Court of Appeals for the Second Circuit disagreed. It reviewed the history of the aggregation provision in detail and concluded that aggregation is not limited to Medicare agency review and applies to judicial review as well. It sent the case back to the district court to decide whether the three aggregated claims will receive coverage. Bloom v. Azar, — F. 3d —, 2020 WL 5648519, *5, *7 (2d Cir. Sept. 23, 2020).

The decision applies in the Second Circuit (New York, Connecticut, and Vermont) and is a welcome recognition of the importance of appeal rights in Medicare. Aggregation is important for beneficiaries who want to seek coverage of claims that fall under the amount-in-controversy threshold, but that represent a significant amount of money to an older or disabled individual. Half of all Medicare beneficiaries lived on yearly incomes below $29,650 per person in 2019; one in four had incomes below $17,000 per person.[3] The case was brought by the Parrish Law Offices. A copy of the decision is available here.

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[1] 42 U.S.C. § 1395ff(b)(1)(E)(i) (setting annually-adjusted amount-in-controversy thresholds for Administrative Law Judge hearings and for judicial review).
[2] 42 U.S.C. § 1395ff(b)(1)(E)(ii).
[3] Kaiser Family Foundation, Medicare Beneficiaries’ Financial Security Before the Coronavirus Pandemic (Apr. 24, 2020).

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Elder Justice Newsletter – Vol 3, Issue 1 Now Available

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home residents. Our latest issue has real stories from nursing homes in New York, New Jersey, Michigan, and Minnesota.

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Webinar: Skilled Nursing Facility Staffing

September 30, 2020 – 2:00 PM EDT

The Center for Medicare Advocacy has been examining the broad variety of approaches to nurse staffing in nursing homes, and their effectiveness, or lack of effectiveness, in achieving improved staffing levels and competencies. This webinar will discuss some of our findings.

Presented by Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman.

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