The Medicare Secondary Payer (MSP) law was enacted by Congress to assure that Medicare does not pay for medical expenses that could be covered by private insurance. When beneficiaries are injured, Medicare will pay for care related to the injury if … [Read more...] about Limits on Medicare’s Recovery Health Care Payments When the Beneficiary Has Liabaility or Workers’ Compensation Insurance
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The Center for Medicare Advocacy v. U.S. Department of Health and Human Services
No. 1:05CV2266 (D.D.C.), filed November 23, 2005 Updated: April 9, 2009 Issue: Whether HHS violated the Freedom of Information Act when it failed to respond to a request for documents about the videoconferencing technology to be … [Read more...] about The Center for Medicare Advocacy v. U.S. Department of Health and Human Services
Establishing A Coordinated Care Benefit In The Traditional Medicare Program
The Center for Medicare Advocacy is pleased that there is renewed interest in the Congress for establishing a coordinated care benefit in the traditional Medicare program. Any health care reform, including Medicare reform, must embrace a coordinated … [Read more...] about Establishing A Coordinated Care Benefit In The Traditional Medicare Program
The "Improvement Standard" is a Barrier to Necessary Care
Mrs. P, 68 years old, was diagnosed with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease) five years ago. She now needs a wheelchair, cannot stand on her own, needs assistance to move from bed to wheelchair, and is losing … [Read more...] about The "Improvement Standard" is a Barrier to Necessary Care
Miles v. Leavitt
No. 08 CV 0432(PAC) (S.D.N.Y.), filed January 17, 2008 Updated: January 5, 2009 Issue: Whether a letter sent to state officials by CMS in August 2007, in which the agency restricted states' rights to expand eligibility in their State … [Read more...] about Miles v. Leavitt
Older Americans Act Provides Assistance for Supportive Services
Introduction Advocates assisting Medicare beneficiaries, including those who are dually eligible for Medicare and Medicaid, should review the supportive services available under the Older Americans Act (OAA) for individuals in their homes or … [Read more...] about Older Americans Act Provides Assistance for Supportive Services
Consumer Assessment of Health Care Providers and Systems (CAHPS)
Beneficiary Satisfaction Measure is Not Used to It's Fullest Extent Unlike report cards that use clinical measures, The Consumer Assessment of health care Providers and Systems (CAHPS) reports patient ratings of their experience with … [Read more...] about Consumer Assessment of Health Care Providers and Systems (CAHPS)
Part Covered, Part Not: "Straddle Claims" in Medicare Part D
Medicare Part D coverage is complex, particularly when a prescription drug claim crosses multiple phases of the benefit. These "straddle claims" make it particularly challenging to determine what a beneficiary owes, but it is important to be … [Read more...] about Part Covered, Part Not: "Straddle Claims" in Medicare Part D
Part D And People Who Are “Medically Needy”
Warning: this Alert may cause headaches. Those readers who have ever roamed the Serbonian Bog[1] that is Medicaid will feel right at home. THE MEDICAID BOG The so-called Medically Needy - Medicare beneficiaries whose Medicaid eligibility depends on … [Read more...] about Part D And People Who Are “Medically Needy”
Medicare Cost-Sharing for Dual Eligibles: Who Pays What for Whom?
Guidance released recently by the Centers for Medicare & Medicaid Services (CMS) sheds new light on an issue that has created hardships for beneficiaries and challenges for advocates trying to help them. The guidance addresses two issues: balance … [Read more...] about Medicare Cost-Sharing for Dual Eligibles: Who Pays What for Whom?