No. 09-1747 (E.D.Pa.), filed April 24, 2009 Final Update: October 22, 2010 Issue: Whether the failure of the state and federal defendants to coordinate the exchange of information necessary to ensure that the beneficiaries of the Medicare Savings … [Read more...] about Garcia v. Johnson
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CMS Reins in Overpayments to Skilled Nursing Facilities
For many years, the Medicare Payment Advisory Commission (MedPAC) has reported that the Medicare program overpays skilled nursing facilities (SNFs) for rehabilitation services and underpays SNFs for certain residents needing specialized services and … [Read more...] about CMS Reins in Overpayments to Skilled Nursing Facilities
Court Emphatically Rejects Beneficiaries’ Right to Sue a Part D Plan When the Plan Delays Enrollment
In a lengthy, detailed, and complex decision, a federal appellate court rejected the right of Part D beneficiaries to sue a plan for damages when the plan fails to enroll them in a timely manner.[1] The decision, which was issued on August 31, 2010, … [Read more...] about Court Emphatically Rejects Beneficiaries’ Right to Sue a Part D Plan When the Plan Delays Enrollment
CMA REPORT: MEDICARE COVERAGE FOR OFF-LABEL DRUG USE
September, 2010While the Medicare prescription drug benefit provides assistance for many people with their drug costs, the requirements for coverage of the off-label use of a drug are onerous and often result in beneficiaries not being able to … [Read more...] about CMA REPORT: MEDICARE COVERAGE FOR OFF-LABEL DRUG USE
Affordable Care Act Expands Medicare Coverage for Prevention and Wellness
The Affordable Care Act[1] (ACA) adds coverage for a new "Wellness Visit" and eliminates cost-sharing for almost all of the preventive services covered by Medicare, effective January 1, 2011. This Alert discusses both provisions. Wellness … [Read more...] about Affordable Care Act Expands Medicare Coverage for Prevention and Wellness
Private Medicare Plans Do Not Offer Better Health Outcomes
For more than a year, the Center for Medicare Advocacy has been outspoken about the overpayments made to the private insurance plans in the subsection of the Medicare program called "Medicare Advantage." [1]During this same time period, the … [Read more...] about Private Medicare Plans Do Not Offer Better Health Outcomes
Extended Observation Stays in Acute Care Hospitals: Criticism, Legislation and Discussion
"Observation" is the term used to describe the outpatient status of a patient who is in a hospital, but not as an inpatient. Although the Medicare Manuals limit observation to 24-48 hours, many beneficiaries nationwide are experiencing extended stays … [Read more...] about Extended Observation Stays in Acute Care Hospitals: Criticism, Legislation and Discussion
Preventable Emergency Department Visits by Nursing Home Residents
One of the goals of health care reform is the reduction of unnecessary hospital readmissions of patients.[1] The Centers for Disease Control and Prevention (CDC) reports in 2010 that, in 2004, 8% of nursing home residents nationwide – 123,600 … [Read more...] about Preventable Emergency Department Visits by Nursing Home Residents
The Medicare Improvement Standard: 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 … [Read more...] about The Medicare Improvement Standard: A Barrier to Necessary Care
Medicare's 45th Anniversary: Promise Kept and Promises to Keep
July 30th marks the 45th anniversary of Medicare. When President Johnson signed the Medicare program into law in 1965, he ushered in an era of better health and financial security for older Americans and their families. Medicare did what private … [Read more...] about Medicare's 45th Anniversary: Promise Kept and Promises to Keep