- Expanded Medicare Skilled Nursing Facility Coverage During the Covid-19 Pandemic
- Speech Generating Devices: Beneficiary Voices Silenced Once Again by CMS
- Ways and Means Report Highlights National Inequities
- Free Webinar – Medicare & Health Care Updates
- Save the Date! 2021 National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture
The Centers for Medicare & Medicaid Services (CMS) has waived two limitations on Medicare Part A skilled nursing facility (SNF) coverage during the coronavirus pandemic:
- The 3-day qualifying hospital stay requirement; and
- The 100-day benefit period.
However, CMS treats the two SNF coverage expansions differently from each other with regard to connection to COVID.
- Three Day Prior Inpatient Hospital Stay
As described in CMS’s Frequently Asked Questions about COVID-19, “The qualifying hospital stay waiver applies to all SNF-level beneficiaries under Medicare Part A, regardless of whether the care the beneficiary requires has a direct relationship to COVID-19” (Question Y.1.) This means that a beneficiary can get Part A coverage in a SNF whether or not s/he was a hospital inpatient for three consecutive days, or any days at all. This is true so long as the beneficiary meets all other requirements for Part A coverage (e.g., needs skilled nursing care seven days per week or skilled rehabilitation services five days per week, or a combination of the two).
- 100-Day SNF Coverage Limit
For expansion of the 100-day limit on SNF coverage, however, the beneficiary’s COVID-19 status is relevant. CMS writes, “If the patient has a continued skilled care need (such as a feeding tube) that is unrelated to the COVID-19 emergency, then the beneficiary cannot renew his or her SNF benefits under the section 1812(f) waiver as it is this continued skilled care in the SNF rather than the emergency that is preventing the beneficiary from beginning the 60 day ‘wellness period’.” (Question Y.2) This language means that SNF residents can receive an additional 100 days of Part A coverage only when their continued need for care is related to the COVID pandemic.
Residents who qualify for the additional 100 days of coverage can continue to use them, even after the waiver of the benefit period ends. The FAQs state, “If a beneficiary has qualified for the special one-time renewal of SNF benefits under the benefit period aspect of the section 1812(f) waiver while the section 1812(f) waiver is in effect, that reserve of 100 additional SNF benefit days would remain available for the beneficiary to draw upon even after the waiver itself has expired” (Question Y.7, added Oct. 20, 2020).
 CMS, “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS Billing) (updated Jan. 7, 2021), https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
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Medicare coverage of speech generating devices (SGDs) has historically fallen victim to unintended consequences for beneficiaries who need an SGD to communicate. Most recently, it literally took two Acts of Congress to remove barriers to SGD coverage borne of discriminatory administrative policies. What could be more deserving of coverage than to provide a voice for a person who cannot otherwise be heard? But, once again, the Centers for Medicare and Medicaid Services (CMS) has created coverage obstacles for SGDs in the midst of COVID, this wretched disease we are all having to endure while isolating and social distancing. At least most of us are able to find ways to communicate. Some people unable to get SGDs, however, have been left more isolated than ever.
In the advent of COVID and the declaration of a public health emergency (PHE), CMS adopted an extensive array of policies intended to make it easier for beneficiaries to meet their health care needs while staying relatively safe. CMS greatly expanded telehealth coverage, but neglected to include evaluation for prescription of SGDs and therapeutic services for use of SGDs, creating yet another new discriminatory barrier for people who are forced to choose between risking their lives to get an SGD or to go voiceless.
Testimonials from speech-language pathologists, and other experts, about the complete ability to accurately and effectively evaluate SGD needs via telehealth have been rejected. CMS refuses to include SGD-related coverage codes in telehealth and CMS does not provide any reasons for that decision. CMS covers other speech and hearing services via telehealth. These include: speech/hearing therapy, evaluation of speech fluency, evaluation of speech production, speech sound language comprehension, and behavioral quality analysis of the voice. CMS also covers telehealth services for assistive technology assessments by physical therapists and occupational therapists for beneficiaries who have lost use of their limbs and who can benefit from new technological advances. If those services can be provided by telehealth, it defies reason why SGDs are excluded from telehealth coverage.
SGD manufacturers report a one-third decrease in Medicare-covered SGD orders since the start of the PHE. Given the lack of telehealth coverage for SGDs, this statistic is not surprising. Many people who need SGDs are also the most vulnerable to falling victim to COVID.
Forcing individuals who require SGDs to attend a face-to-face appointment with a clinician during a pandemic when there is a safe and efficacious alternative creates an impossible choice for such individuals to make – to speak or to live, but maybe not both.
The Centers for Medicare & Medicaid Services’ disturbing history of disrespecting beneficiaries who need SGDs is repeating itself during COVID. Despite concerns the Center for Medicare Advocacy has about the expansion of telehealth and potential impacts on quality of care from providers who might abuse telehealth practice, we strongly support the use of telehealth with Medicare-covered SGD codes. SGD coverage should be equivalent to other telehealth-covered services and be retroactively effective to March 1, 2020.
 Steve Gleason Act of 2015 https://www.govtrack.us/congress/bills/114/s984; Steve Gleason Enduring Voices Act of 2017 https://www.congress.gov/bill/115th-congress/house-bill/2465/text?format=txt.
 Assistive Technology Law Center: https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-Ftn-2-1-2020-08-21-Cover-Letter.pdf; https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ftn-2-2-2020-08-23-Complete-Request-File-1-pages-1-to-64.pdf; https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ftn-2-3-2020-08-23-Complete-Request-File-2-pages-65-to-84-end.pdf.
 CMS 1-20-2021 Letter: https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ALert-Ftn-3-Golinker-1.pdf.
 COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (cms.gov), pages 65, 71, 114, 154-157. MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET | CMS, pages 5-7. Microsoft Word – COVID-PhysiciansandotherClinic11-04.docx (cms.gov).
 CMS maintains a list of services that may be furnished via Medicare telehealth. This list is available here: https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes.
 Id. (Code 97755).
 Information provided by manufacturers Tobii-Dynavox and PRC-Saltillo to the United States Chapter of the International Society for Augmentative and Alternative Communication.
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The Ways and Means Committee recently released a report, Something Must Change: Inequities in U.S. Policy and Society, along with a new legislative framework, A Bold Vision for a Legislative Pathway Toward Health and Economic Equity, outlining how the Committee will address the connection between racism and health and economic inequity in the United States. The report emphasized how the COVID-19 pandemic has had a disproportionate impact on older adults, those with disabilities and chronic conditions, and communities of color. The report also highlighted a concern that the Center for Medicare Advocacy has also been wary of – that an increased reliance on telehealth during the pandemic could exacerbate some inequities, particularly for patients with poor digital literacy and for those with limited English proficiency (LEP).
The report found that in order to address the inequities exposed, and often worsened, by the pandemic, the structural racism underlying these inequities must be identified and addressed.
Thus, the pandemic has been as indiscriminate in its ability to infect as it has been in magnifying the degree to which systems and structures across sectors fail to adequately address the needs of communities with higher concentrations of people from the same socioeconomic, racial, and ethnic groups. The key to rectifying the sources of these failures is in naming and clarifying root causes and practical responses that best serve those whose actual needs have long been invisible to race-neutral policies.
The legislative framework includes Health Equity and Economic Equity Pillars, with sets of policy priorities under each pillar, including Adaptable, Accessible Technologies and Modernized Infrastructure, Affordable, Comprehensive, and Accessible Health Care, and Retirement Security. These documents follow the 2020 Ways and Means report Left Out: Barriers to Health Equity for Rural and Underserved Communities
- CMA Alert on the 2020 Ways and Means report, available at: Administration Proposes Permanent and Temporary Extensions of Pandemic-Related Medicare Telehealth – Growing Disparities and Other Concerns Remain (medicareadvocacy.org)
- CMA Alert on recent study on telehealth, available at: Study Finds Inequities in Telehealth Care | Center for Medicare Advocacy
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This presentation will examine and try to make sense of what’s happening in the Medicare and related health care world, including impacts of COVID-19, from the perspective of beneficiary advocates. This will include a discussion of Medicaid waivers.
Presented by Center for Medicare Advocacy Senior Policy Attorney David Lipschutz, Policy Attorney Kata Kertesz, and David Machledt, Senior Policy Analyst, National Health Law Program (NHeLP)
- Register now at https://attendee.gotowebinar.com/register/836653991043094283
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The Center for Medicare Advocacy is pleased to announce that the 2021 National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture will take place virtually on April 1, 2021.
This year the Center marks 35 Years of Medicare Advocacy. We will celebrate that milestone with discussions of where Medicare and health care have been, where they should be, and where we are headed.
We are honored to announce Dr. Donald M. Berwick, former Administrator of the Centers for Medicare & Medicaid Services, and former director of the Institute for Healthcare Improvement, as the 2021 Sen. Jay Rockefeller Lecturer. More news to come. Mark your calendars now!