In an effort to foster informed decision-making by Medicare beneficiaries about their coverage options, the Center for Medicare Advocacy has long tried to highlight the trade-offs of enrolling in Medicare Advantage (MA) plans. In the past, … [Read more...] about As Medicare Advantage Enrollment Grows, So Does Awareness of Problems
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Know Jimmo | Share a Success Story
Have you or someone you know successfully argued for coverage of skilled care to maintain a condition, or slow decline, rather than being told there's a need to "improve?"Let us know! Share your story with us at … [Read more...] about Know Jimmo | Share a Success Story
Medicare Advantage Industry Support Letter Circulating in Senate – Center for Medicare Advocacy Urges Senators Not to Sign On
Medicare Advantage (MA) payment rates for the coming year are released early in the prior year. As of this writing, the proposed 2025 rates are imminent. As noted in previous CMA Alerts (see, e.g., this one from 2020), release of this information … [Read more...] about Medicare Advantage Industry Support Letter Circulating in Senate – Center for Medicare Advocacy Urges Senators Not to Sign On
Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
In order to manage costs, Medicare Advantage (MA) plans are able to restrict their enrollees to a contracted network of health care providers that is “sufficient to provide access to covered services to meet the needs of the population served.”* Some … [Read more...] about Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
An examination of 2019 Medicare cost reports finds that nursing facilities spent more of their revenue on administration, capital, other, and profits (34%) than on nursing (27%). “United States’ Nursing Home Finances: Spending, Profitability, and … [Read more...] about Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing
In “A Look at Nursing Facility Characteristics Between 2015 and 2023,” KFF reports that between 2015 and 2023, the hours of nursing care provided to residents in nursing facilities declined by 9% (from 4.13 hours per resident day (HPRD) in 2015 to … [Read more...] about KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing
Center for Medicare Advocacy Submits Comment on Proposed 2025 Medicare Advantage and Part D Rule
On January 5, 2024, the Center submitted comments to a proposed rule for Medicare Advantage (MA) and Part D issued by the Centers for Medicare & Medicaid Services (CMS) titled: Medicare Program; Contract Year 2025 Policy and Technical Changes to … [Read more...] about Center for Medicare Advocacy Submits Comment on Proposed 2025 Medicare Advantage and Part D Rule
Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options
Building on several recent studies that have found massive overpayments to Medicare Advantage (MA) plans, the Center for Medicare Advocacy released a report outlining how policymakers can look to utilize cost savings by reining in overpayments to … [Read more...] about Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options
Know Jimmo | It’s about the Care
Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Services can be skilled and covered when:CMS revised Medicare policy manuals, guidelines, instructions to reflect these … [Read more...] about Know Jimmo | It’s about the Care
Know Jimmo | No Improvement Needed
The Jimmo Settlement, approved by the federal district court in 2013, confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement; and that Medicare covers skilled care to … [Read more...] about Know Jimmo | No Improvement Needed