Last week’s CMA Alert (Aug. 29, 2024) discussed the insurance industry’s launch of a campaign to convince policymakers that Medicare Advantage (MA) plans need more money and less regulation. While the industry is trying to convince lawmakers and … [Read more...] about Medicare Advantage Needs More Oversight, Less Overpayment
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Report Urges Closing Medicaid Coverage Gap to Reduce Health Inequities
A recent report from the Center on Budget and Policy Priorities highlights the Medicaid coverage gap and how it exacerbates health inequities. The report, “Closing Medicaid Coverage Gap Would Help Diverse Groups and Reduce Inequities,” … [Read more...] about Report Urges Closing Medicaid Coverage Gap to Reduce Health Inequities
Nursing Homes Make Changes to Increase Staffing
Although nursing home owners, operators, and trade associations (see AHCA’s “Report: Access to Nursing Home Care is Worsening” (Aug. 22, 2024)) continue to complain about the final rule mandating minimum nurse staffing levels in nursing facilities, … [Read more...] about Nursing Homes Make Changes to Increase Staffing
Know Jimmo | Jimmo Applies to Medicare Advantage Plans
As far back as 2013, The Center for Medicare & Medicaid Services made it clear that the Jimmo Settlement applied to private Medicare Advantage plans. In a memo from April that year, announcing a new Jimmo Fact Sheet they stated:The goal of … [Read more...] about Know Jimmo | Jimmo Applies to Medicare Advantage Plans
Medicare Advantage Industry Launches Campaign to Protect Profits and Avoid Oversight
With Medicare’s Annual Enrollment Period fast approaching, the time during which beneficiaries can make changes to their Medicare Advantage (MA) and Part D coverage for the following calendar year, the public will soon learn about plan changes for … [Read more...] about Medicare Advantage Industry Launches Campaign to Protect Profits and Avoid Oversight
Court Denies Motion to Dismiss AG’s Fraud Suit against NY Nursing Home Chain
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
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