- 79 Organizations Call on CMS and ACL to Ensure Access to Medicare-Covered Home Health Care
- Center for Medicare Advocacy Comments on Proposed Update to Medicare Reimbursement for Skilled Nursing Facilities
- New Fact Sheet | Dental Issues Related to Cancer Treatment
- Free Webinar | A Program for Medicare Beneficiaries – Coverage of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Today, the Center for Medicare Advocacy sent a letter to the Centers for Medicare & Medicaid Services (CMS) and the Administration for Community Living (ACL) asking the agencies to ensure that the current Medicare law’s scope of home health coverage is actually available to those who qualify. The letter was signed on to by 79 national, state and local organizations. The letter is available at https://medicareadvocacy.org/wp-content/uploads/2021/06/Sign-on-Letter-Medicare-Home-Health.pdf.
As stated in the letter, the Medicare home health benefit provides coverage for a constellation of skilled and nonskilled services, all of which add to the health, safety, and quality of life of beneficiaries and their families. Under the law, Medicare coverage is available for people with acute and/or chronic conditions, and for services to improve, maintain, or slow decline of the individual’s condition. Further, coverage is available even if the services are expected to continue over a long period of time.
Unfortunately, however, people who legally qualify for Medicare coverage frequently have great difficulty obtaining and affording necessary home care, particularly home health aide visits (see, e.g., Center for Medicare Advocacy issue briefs: “Medicare Home Health Coverage: Reality Conflicts with the Law” (April 2021), available at: https://medicareadvocacy.org/issue-brief-medicare-home-health-coverage-reality-conflicts-with-the-law/, and “Medicare and Family Caregivers” (June 2020), available at: https://medicareadvocacy.org/wp-content/uploads/2020/06/Medicare-and-Family-Caregivers-June-2020.pdf).
In addition to urging CMS and ACL to work in partnership to ensure the current Medicare law’s home health benefit is available to those who qualify, the 79 organizations ask the agencies to take advantage of an historic opportunity to expand home care coverage, including through President Biden’s pledged investment in home and community-based services (HCBS) by expanding access to Medicare-covered home health aide services.
Center for Medicare Advocacy Comments on Proposed Update to Medicare Reimbursement for Skilled Nursing Facilities
The Center for Medicare Advocacy’s comments on the proposed annual update to Medicare Part A reimbursement for skilled nursing facilities focus largely on the tremendous (but predicted) decline in therapy services following introduction of the Patient-Driven Payment Model (PDPM) on October 1, 2019. Under PDPM, total therapy declined 30%, from 91 minutes per resident per day to 62 minutes per resident per day, and therapy services shifted from individual therapy to group and concurrent therapy. The Centers for Medicare & Medicaid Services (CMS) claims that residents were not harmed by the changes in therapy, citing the absence of change in three self-reported quality measures: falls with major injuries, stage 2-4 pressure ulcers, and hospital admissions. However, the Center cites research studies documenting the substantial underreporting by facilities of these measures.
The Center calls on CMS to enforce its requirement that group and concurrent therapy be limited to, at most, 25% of a resident’s therapy minutes. Further, with respect to PDPM, the Center opposes CMS’s plan to delay prospective recalibration of Medicare rates. A decade ago, CMS immediately recalibrated Medicare reimbursement rates, even though the overpayments were more than twice as high as under PDPM.
The Center supports the introduction of a measure under the Quality Reporting Program to address health care associated infections (HAIs). However, the Center opposes limiting the new measure to HAIs that require inpatient hospitalization. The Center supports a second new measure – a COVID-19 vaccination measure – and encourages CMS to include all workers who have direct contact with residents, not just health care personnel.
Finally, CMS proposes to expand the Value-Based Purchasing Program to measures beyond the 30-day all cause rehospitalization measure. The Center supports the expansion of these measures, but opposes measures based on facilities’ self-reported assessment data and so-called “satisfaction” measures.
Comments on the proposed rules, CMS-1746-P, are due June 7, 2021.
The Center’s comments are available at: https://medicareadvocacy.org/center-comments-on-snf-reimbursement-fy-2022/.
 CMS, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022,” 86 Fed. Reg. 19954 (Apr. 15, 2021), https://www.govinfo.gov/content/pkg/FR-2021-04-15/pdf/2021-07556.pdf. See CMA, “CMS Confirms Steep Decline in Therapy at Nursing Facilities” (CMA Alert, May 6, 2021), https://medicareadvocacy.org/cms-confirms-steep-decline-in-therapy-at-nursing-facilities/
Developed in collaboration with Larry Coffee, DDS, the esteemed dentist who founded the Dental Lifeline Network, a national nonprofit organization that provides critical dental therapies to needy disabled, elderly, and medically fragile individuals through volunteer dentists, this series of fact sheets explains the interrelationship between oral health and major medical conditions, such as diabetes, heart disease and cancer.
Each fact sheet offers important oral health tips for persons living with these medical conditions, as well as their caregivers, advocates, and health care providers. While individual prevention and management of oral and dental disease are important in the context of certain underlying health problems, access to affordable dental coverage and care can be absolutely vital as well. This latter component is one that too many Medicare beneficiaries currently lack. We hope these fact sheets will serve to illustrate why the meaning of health care needs to include oral health care, and why oral health benefits should be added to Medicare.
- Fact Sheet – Dental Issues Related to Cancer Treatment
Free Webinar | A Program for Medicare Beneficiaries – Coverage of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
This detailed DMEPOS presentation will include:
- Medicare Definition – Durable Medical Equipment (DME)
- How a Beneficiary Qualifies for Medicare-Covered DME
- Examples of Covered and Not-Covered DME
- Repairs, Maintenance, and Replacement of DME
- Prosthetics, Orthotics and Supplies (POS)
- Patient Costs for DMEPOS – Including Purchase or Rental
- Prior-Authorization – Required and Voluntary
- Competitive Bid Program – Current Status and Future Impact
- How to Obtain Medicare-Covered Items – A Checklist
- Practice Tips, Complaints, Case Study, Advocacy
Presented by Center for Medicare Advocacy Associate Director/Attorney Kathy Holt and Medicare Advocate Sue Greeno.