For Immediate Release
December 18, 2020
Contact: Matthew Shepard: 202-293-5760, MShepard@MedicareAdvocacy.org
The incoming Biden administration has vowed to improve health care, especially in light of the COVID-19 pandemic, which has taken a particularly harsh toll on older Americans and people with disabilities. On December 17, 2020, the Center for Medicare Advocacy (the Center) submitted a comprehensive Transition Memorandum to members of the Presidential Transition team, detailing a number of measures that the Department of Health and Human Services (HHS) and its Centers for Medicare & Medicaid Services (CMS) can take immediately to strengthen Medicare for all its beneficiaries.
The Center’s Transition Memorandum recommends administrative actions that do not require legislation from Congress. Some of these actions will restore protections and procedures that were rolled back during the Trump Administration, resulting in unnecessary suffering.
According to Judith Stein, Executive Director of the Center for Medicare Advocacy, “Medicare improvements are necessary to successfully respond to the raging pandemic. It is time to build a better Medicare for all who need it now – and will in the future. As welcome as it is, we cannot rely on the COVID vaccine alone to insure the health and safety of our most vulnerable citizens. Medicare can and should help now.”
The Center recommends the following administrative actions to ensure that all Medicare beneficiaries receive comprehensive coverage, quality care, and equitable treatment:
- Ensure Quality Care for Skilled Nursing Facility Residents
The pandemic has laid bare the extent of poor quality care, inadequate staffing levels, and insufficient infection protections for residents of skilled nursing facilities. Regulations must be restored and rigorously enforced to ensure enough professional staff are available on site and that infection control procedures are restored in every facility. Lax enforcement must end.
- Properly Classify Hospital In-patients
All too often, hospitals inappropriately classify Medicare patients who spend many days in the hospital as outpatients on “observation status.” This deprives these patients of Medicare Part A hospital coverage and access to appropriate coverage for subsequent nursing home and home health care. CMS must end this practice.
- Ensure Access to Home Health Care
Remove unlawful barriers to essential home health care that Medicare beneficiaries are entitled to but are frequently (and unlawfully) denied. The Center also calls for monitoring providers to ensure they are meeting patients’ needs and Medicare provider requirements.
- Ensure Parity Between Traditional Medicare and Medicare Advantage and Promote Consumer Protections in Medicare Advantage
The universal traditional Medicare program, preferred by most beneficiaries, has been neglected for years, while the private Medicare Advantage (MA) system has been repeatedly bolstered and promoted. This is leading to increased MA marketing and MA enrollment, even when it is not in the best interest of beneficiaries, Medicare, or taxpayers.
- Provide Appropriate Medicare Coverage and Care for People with Chronic Conditions
CMS must ensure that patients aren’t denied Medicare because they are not improving when they need skilled care to maintain their condition or prevent decline. Despite a court settlement reached between CMS and the Center for Medicare Advocacy, too many people are still denied Medicare and needed care that will sustain them although a cure isn’t possible. CMS needs to enforce this settlement once and for all.
- Cover Medically Necessary Oral Health Care
While Medicare excludes coverage for “routine” dental care, this should not be misconstrued to mean that medically necessary oral health treatment is automatically denied – as is almost always the case. The Medicare statute clearly allows for coverage of medically necessary oral health care. CMS should implement it accordingly.
The Center also includes a number of other suggested administrative changes to improve Medicare, including addressing flaws in the appeals system and rolling back harmful proposed and final rules in Medicare and related health programs.
As the Center for Medicare Advocacy’s Stein states “We urge President-Elect Biden to take action as soon as possible to reverse damage that’s been done to Medicare and harm to its beneficiaries. The incoming administration should begin the process immediately of guaranteeing the lawful implementation of the Medicare program for all who depend on it.”
The Center for Medicare Advocacy’s comprehensive Transition Memorandum also recommends a number of legislative fixes that would dramatically improve Medicare and ensure it better meets the needs of its 62 million beneficiaries.
There is important work ahead to open doors to proper Medicare coverage and quality care for all older adults and people with disabilities who depend on it. The Center for Medicare Advocacy is eager to help.