The use of “Observation Status” – treating certain hospitalized Medicare patients as outpatients when their care is indistinguishable from that of formally admitted inpatients – continues to garner considerable public and … [Read more...] about Observation Status: Mixed Messages from Federal Government as Beneficiaries Continue to be Hurt
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Medicare and Telemedicine (or Telehealth)
On July 11, 2014, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the 2015 calendar year. Among these proposed rules, CMS adds four additions to covered telehealth services: psychoanalysis and … [Read more...] about Medicare and Telemedicine (or Telehealth)
Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress
Medicare Advantage (MA) plans are increasingly dropping doctors and other health care providers from their contracted networks, often in the middle of a plan year, when most plan enrollees are not permitted to change plans. MA enrollees often … [Read more...] about Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress
Inpatient Rehabilitation Facilities and Skilled Nursing facilities: Vive La Difference!
A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds … [Read more...] about Inpatient Rehabilitation Facilities and Skilled Nursing facilities: Vive La Difference!
Hospice and Access to Medications Update: CMS Replacement Guidance
Quick SummaryWhen Medicare beneficiaries elect the hospice benefit, they waive Medicare coverage for all care and services related to the terminal illness that are not on the hospice plan of care and provided through the hospice provider. … [Read more...] about Hospice and Access to Medications Update: CMS Replacement Guidance
CMS Restructures Quality Improvement Organization (QIO) Program
Separating Beneficiary Complaint Review Functions from Quality Improvement FunctionsOn May 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the first phase of its restructuring of the QIO functions. In the first … [Read more...] about CMS Restructures Quality Improvement Organization (QIO) Program
CMS has Authority Under Existing Law to Define Inpatient Care
Under a 2008 decision of the Second Circuit Court of Appeals, the Secretary of HHS has authority under the Medicare statute to include a hospital patient’s time in observation as part of inpatient time in the hospital for purposes of … [Read more...] about CMS has Authority Under Existing Law to Define Inpatient Care
Delivery and Set-Up Guidelines for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation and oversight of the DMEPOS program.[1] Since the rollout of the DMEPOS competitive bidding program (CBP) in July, 2008, there has been confusion over … [Read more...] about Delivery and Set-Up Guidelines for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Memorandum: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS. Beneficiary Advocates Disagree.
To: Medicare Beneficiary AdvocatesFrom: Mario D. Ramsey, CMA Health Policy FellowSubject: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS. Beneficiary Advocates Disagree.Date: July 8, … [Read more...] about Memorandum: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS. Beneficiary Advocates Disagree.
Corporations Don’t Bleed: The Disturbing Hobby Lobby Decision
The Supreme Court decision in Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al. (5-4 decision), 573 U.S. ___ (2014) is ominous. Not only is the decision, and its interpretation of the Religious Freedom … [Read more...] about Corporations Don’t Bleed: The Disturbing Hobby Lobby Decision