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?
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Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
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
Issue Brief – January 2022 – Home Health Survey Report and Other Issues
FEDERAL UPDATE Medicare and Build Back BetterDuring 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
CMA Home Health Survey | Medicare Beneficiaries Likely Misinformed and Underserved
Home health services as authorized by Medicare law, regulations, and policies[1] 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
Special Report | Why Do Nursing Home Operators Who Provide Poor Quality Care Control Increasing Numbers of Facilities?
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?
Issue Brief – November 2021 – Medicare & Build Back Better, and Other Issues
MEDICARE and the RECONCILIATION PACKGEOverviewOver 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
New Issue Brief | Retiree Auto Enrollment in Medicare Advantage Plans – Choice is Under Threat
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
MEDICARE & YOU 2022 – An Important First Step Towards Reversing Bias in Favor of Medicare Advantage
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
Issue Brief – September 2021 – Exp[anfing Medicare to Cover Dental, Hearing & Vision, and Other Issues
MEDICARE and the RECONCILIATION PACKGEOverviewCongress is currently debating a $3.5 trillion legislative package that, according to the New York Times (Aug. 11, 2021) “is aimed at creating the largest expansion of the federal safety net in … [Read more...] about Issue Brief – September 2021 – Exp[anfing Medicare to Cover Dental, Hearing & Vision, and Other Issues
Issue Brief – July 2021 – Medicare Coverage of Substance Use Disorder Care, and Other Issues
MEDICARE COVERAGE of SUBSTANCE USE DISORDER CARE Legal Action Center Issue Brief: Medicare Coverage of Substance Use Disorder Care: A Landscape Review of Benefit Coverage, Service Gaps and a Path to ReformIn February 2021, the Legal … [Read more...] about Issue Brief – July 2021 – Medicare Coverage of Substance Use Disorder Care, and Other Issues