LITIGATION UPDATE (Beneficiary Appeals of Observation Status). In November 2011, the Center for Medicare Advocacy and Justice in Aging filed a proposed class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage … [Read more...] about Issue Brief – March 2022 – Litigation Update Including Observation Status, Off label Drugs & Other Issues
Federal nurse aide training standards in nursing facilities have been largely waived during the COVID-19 emergency. When the emergency declarations end, however, all “temporary nurse aides” are required by federal law to receive training and pass … [Read more...] about Issue Brief | States Are Weakening Training Standards for Nursing Facility Aides
As nursing homes continue to ask for more reimbursement, a number of states have begun to question more directly how facilities spend the reimbursement they already receive, with some states enacting legislation to require more transparency and … [Read more...] about Report | How Do Nursing Homes Spend the Reimbursement They Receive for Care?
Artificial intelligence (AI)-powered decision-making tools that are used in health care utilization management (UM) are increasingly used by providers and plans to automate the medical review and prior authorization processes, direct post-acute care, … [Read more...] about Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
FEDERAL UPDATE Medicare and Build Back Better During the last Alliance webinar in November 2021, we discussed the legislative package Congress was debating called the Build Back Better Act (BBB) that was to be passed through the … [Read more...] about Issue Brief – January 2022 – Home Health Survey Report and Other Issues
Home health services as authorized by Medicare law, regulations, and policies are too often unavailable in practice. For example, for patients who meet qualifying criteria, Medicare law authorizes up to 28 to 35 hours a week of home health aide … [Read more...] about CMA Home Health Survey | Medicare Beneficiaries Likely Misinformed and Underserved
Many poor quality providers are expanding the numbers of facilities that they own or operate. Why is this disturbing trend apparently increasing? Unfortunately, there is no easy or simple answer to the question. In fact, there are likely multiple … [Read more...] about Special Report | Why Do Nursing Home Operators Who Provide Poor Quality Care Control Increasing Numbers of Facilities?
MEDICARE and the RECONCILIATION PACKGE Overview Over the last several months, Congress has been debating a legislative package called the Build Back Better Act (BBB) to be passed through the reconciliation process in order to avoid a filibuster … [Read more...] about Issue Brief – November 2021 – Medicare & Build Back Better, and Other Issues
Increasingly, employers and unions that offer retirement health benefits are contracting with private insurance carriers to provide group Medicare Advantage benefits in place of traditional (or original) Medicare. The Center for Medicare Advocacy has … [Read more...] about New Issue Brief | Retiree Auto Enrollment in Medicare Advantage Plans – Choice is Under Threat
Starting in the Fall of 2017, the Center for Medicare Advocacy (the Center) and other advocacy organizations highlighted that, in a marked change from previous practice, the Trump Administration’s Centers for Medicare & Medicaid Services’ (CMS) … [Read more...] about MEDICARE & YOU 2022 – An Important First Step Towards Reversing Bias in Favor of Medicare Advantage