The key to coverage is whether the individual requires skilled nursing or therapy and whether care would be safe and effective if skilled care was not provided. (And the individual meets other qualifying criteria: is homebound and has proper provider … [Read more...] about Know Jimmo | Home Health Care is Available for Medicare Beneficiaries with Long Term, Chronic, and Terminal Conditions
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In Defense of State Health Insurance Assistance Programs (SHIPs)
State Health Insurance Assistance Programs (SHIPs) are federally funded programs in every state and several territories that provide free, unbiased counseling to Medicare beneficiaries about navigating the Medicare program. Sometimes going by … [Read more...] about In Defense of State Health Insurance Assistance Programs (SHIPs)
CMA Comments to Proposed CY 2027 Rule re: Medicare Advantage and Part D
In collaboration with several advocacy partners, CMA submitted comments to a proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) titled “Medicare and Medicaid Programs; Contract Year 2027 Policy and Technical Changes to the … [Read more...] about CMA Comments to Proposed CY 2027 Rule re: Medicare Advantage and Part D
CMS Rate Notice Includes Changes to Risk Scores
This week the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2027 Medicare Advantage (MA) and Part D Advance Rate Notice. The annual notice establishes payment rates for MA and Medicare Part D plans for the next … [Read more...] about CMS Rate Notice Includes Changes to Risk Scores
Know Jimmo | Core Medicare Coverage Principles
Medicare coverage turns on whether the care in question is reasonable and necessary and, in many settings, whether it includes skilled services. This is key to the Jimmo federal court settlement and decisions. In Summary:Per CMS, “This is … [Read more...] about Know Jimmo | Core Medicare Coverage Principles
2026 National Voices of Medicare Summit
____________________________________________________________________Help Inspire the Future of Medicare at the2026 National Voices of Medicare SummitWednesday, May 20, 2026 12:00 - 4:30 PM EDTDefending the Public PromiseA … [Read more...] about 2026 National Voices of Medicare Summit
Oklahomans Concerned about Losing Care Under Model Medicare Prior Authorization Program
In a recent piece on radio station KGOU in Oklahoma, Jillian Taylor addressed the Wasteful and Inappropriate Service Reduction Model, or WISeR, a program being tested in six states, including Oklahoma, as of January this year. The program uses … [Read more...] about Oklahomans Concerned about Losing Care Under Model Medicare Prior Authorization Program
CMA Submits Comments Opposing Repeal of the Final Nurse Staffing Rule
The Center for Medicare Advocacy has submitted its comments strongly opposing the Centers for Medicare & Medicaid Services’ interim final rule with comment, entitled “Repeal of Minimum Staffing Standards for Long-Term Care Facilities,” … [Read more...] about CMA Submits Comments Opposing Repeal of the Final Nurse Staffing Rule
Know Jimmo | Medicare Covers Therapy in Nursing Homes to Maintain or Slow Decline
“Maintenance Therapy – Therapy services in connection with a maintenance program are considered skilled when they are so inherently complex that they can be safely and effectively performed only by, or under the supervision of, a qualified therapist. … [Read more...] about Know Jimmo | Medicare Covers Therapy in Nursing Homes to Maintain or Slow Decline
Video Resource from the Long Term Care Ombudsman Programs
A new film, Breaking the Silence, emphasizes the importance of long term care residents understanding their rights and the resources available to them. It is about understanding resident fear due to a perceived power imbalance and the potential for … [Read more...] about Video Resource from the Long Term Care Ombudsman Programs