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
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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
Early Reports on WISeR Model Are Troubling
As outlined a prior CMA Alert (Sept. 18, 2025), a new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, launched this year in Arizona, Ohio, Oklahoma, Texas, New Jersey, and Washington. The model is designed, in … [Read more...] about Early Reports on WISeR Model Are Troubling
Administration Exploring Default Enrollment into Medicare Advantage
Under current Medicare rules, Medicare beneficiaries who do not make a choice between traditional Medicare (TM) and Medicare Advantage (MA) are defaulted into TM. As outlined in a recent CMA Issue Brief: “Retiree Auto Enrollment in Medicare … [Read more...] about Administration Exploring Default Enrollment into Medicare Advantage
Medicare Summary Notices (MSNs) Mailings Reduced to Six Months
Beginning January 2026, Medicare beneficiaries will receive a Medicare Summary Notice (MSN) every 180 days, a change from every 120 days. This change, claimed as an effort to reduce costs, is part of a larger shift for beneficiaries to conduct most, … [Read more...] about Medicare Summary Notices (MSNs) Mailings Reduced to Six Months