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
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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
Low-Income Areas Have Fewest Highly Rated MA Plans
A recent study published in JAMA Network Open, “Medicare Advantage Plan Star Ratings and County Social Vulnerability,” found that “the most socially vulnerable counties . . .have the fewest highest-rated plans for MA beneficiaries.” Though the Star … [Read more...] about Low-Income Areas Have Fewest Highly Rated MA Plans
Melanie Lambert – Senior Medicare Advocate
Melanie Lambert comes to the Center with a background in public service, advocacy, and program management, and with a passion for promoting health equity and social justice. As Senior Medicare Advocate, Ms. Lambert contributes to the Center’s … [Read more...] about Melanie Lambert – Senior Medicare Advocate
Medicare Advantage Plans Propose Cuts While Continuing to Maximize Overpayments
With the Medicare Annual Enrollment Period on the horizon (starting October 15th), Medicare Advantage plans are beginning to announce some of the changes they are implementing for 2025. Changes include benefit and service area reductions, which … [Read more...] about Medicare Advantage Plans Propose Cuts While Continuing to Maximize Overpayments
Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
Long-standing Federal regulation makes that clear:“Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services … [Read more...] about Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
AARP Poll Finds Potential Voters Support Minimum Staffing Standards for Nursing Homes
A new AARP poll finds that 94% of respondents “would be more likely to vote for a Congressional candidate who supports the new federal requirement to have a registered nurse available in nursing homes at all hours of the day.” The range of support … [Read more...] about AARP Poll Finds Potential Voters Support Minimum Staffing Standards for Nursing Homes