On June 28, 2023, New York State Attorney General Letitia James filed a Verified Petition alleging that Centers Health Care, four of its 38 New York State nursing facilities, and various individually named respondents “engaged in persistent fraud and … [Read more...] about Court Denies Motion to Dismiss AG’s Fraud Suit against NY Nursing Home Chain
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Know Jimmo | CMS Reminded Providers & Contractors Back in 2021
“Skilled Nursing Care & Skilled Therapy Services to Maintain Function Or Prevent or Slow Decline: ReminderMedicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy … [Read more...] about Know Jimmo | CMS Reminded Providers & Contractors Back in 2021
KFF on Medicare Drug Negotiations – First Process Has Finished, But Politics Continue
In a recent CMA Alert, the Center summarized the first round of historic Medicare drug pricing negotiations established by the Inflation Reduction Act of 2022. In an August 19 article in Health Affairs, CMA colleagues Tricia Neuman, Juliette … [Read more...] about KFF on Medicare Drug Negotiations – First Process Has Finished, But Politics Continue
Medicare’s Coverage of Home Health Aide Care: A Case Study
Mr. P, a 56-year-old Ohio resident, has quadriplegia resulting from an accident. He uses a wheelchair for mobility and relies on a Medicare-certified home health agency (HHA) for ongoing skilled nursing services. Mr. P also requires home health aide … [Read more...] about Medicare’s Coverage of Home Health Aide Care: A Case Study
CMS Updates Medicare SNF Rates, Revises Civil Money Penalty Rules for Nursing Facilities
In its annual update to the Medicare Part A reimbursement rule for skilled nursing facilities (SNFs), 89 Fed. Reg. 64048 (Aug. 6, 2024), the Centers for Medicare & Medicaid Services (CMS) increased payments by 4.2%, approximately $1.4 billion, … [Read more...] about CMS Updates Medicare SNF Rates, Revises Civil Money Penalty Rules for Nursing Facilities
Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
The decision regarding coverage should turn on whether skill is needed, not whether the individual is expected to improve.Maintenance nursing is a Medicare-covered service if a nurse is needed to provide or supervise care.Example: … [Read more...] about Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
Medicare Announces Results of First Round of Historic Drug Price Negotiations, Effective 2026
The Inflation Reduction Act of 2022 (IRA) includes a number of provisions aimed at reducing prescription drug costs for the Medicare program, its beneficiaries and taxpayers. Among these changes is an out-of-pocket cap that is in effect for 2024 but … [Read more...] about Medicare Announces Results of First Round of Historic Drug Price Negotiations, Effective 2026
Appeals Court Disallows Case on Critical Home Health Aide Services
On August 9, 2024, the U.S. Court of Appeals for the D.C. Circuit upheld the dismissal of Johnson v. Becerra, in which disabled beneficiaries sought access to the Medicare-covered home health aide services they require to remain safely in their homes … [Read more...] about Appeals Court Disallows Case on Critical Home Health Aide Services
Special Report | The Urgent Need for Criteria for Federal Certification of Nursing Facilities
If an owner or operator fails to run its facilities effectively, why give them more?Nursing facilities must be licensed to do business in their state. To be eligible for reimbursement under the Medicare or Medicaid programs, or both, they must … [Read more...] about Special Report | The Urgent Need for Criteria for Federal Certification of Nursing Facilities
Know Jimmo | Individualized Assessment Required
Longstanding federal law requires each Medicare determination to be based on the particular facts of the individual beneficiary’s condition and circiumstances. General norms based on algorithms, diagnoses, or other “rules of thumb” should not be the … [Read more...] about Know Jimmo | Individualized Assessment Required