Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert | March 25, 2021

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  1. Reminder: Medicare Advantage Open Enrollment Period Ends March 31st
  2. ACA Celebrates 11th Anniversary with Expansions in Enrollment and Coverage
  3. Center Report: Billions of Dollars to Nursing Homes in Covid-19 Relief
  4. Center for Medicare Advocacy submits Statement for the Record for Senate Finance Committee March 17 Hearing on Nursing Homes and COVID-19
  5. Nursing Home Trade Associations’ Legislative Agenda for 2021: More Familiar Than Bold

Reminder: Medicare Advantage Open Enrollment Period Ends March 31st

People who began 2021 enrolled in a Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D plan during the first 3 months of the calendar year, ending next week, on March 31st.  This enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is not available to individuals who are in traditional Medicare and enrolled in a stand-alone Part D plan.  As discussed in a recent CMA Alert, there is unequal access to different coverage options in Medicare, and there are flaws in several means of comparing such options.

In addition, there are certain rights to use a Special Enrollment Period (SEP) to change or get out of a plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents).  For a full list of available SEPs, see, e.g., for MA SEPs: Medicare Managed Care Manual, Chapter 2 (2021 update available here) and Title 42, Code of Federal Regulations §422.62(b); for Part D SEPs see Medicare Prescription Drug Manual, Chapter 3 (2021 update available here) and Title 42, Code of Federal Regulations §423.38.

ACA Celebrates 11th Anniversary with Expansions in Enrollment and Coverage

March 23rd marked the 11th anniversary of the Affordable Care Act (ACA). Fortunately, the anniversary was greeted with support for, and recent expansions of, the law.

This week The New York Times reported that more than 200,000 Americans sought health insurance through the ACA’s online marketplace during the first two weeks of a new, additional open enrollment period created by President Biden’s January executive order. The executive order created an extra enrollment period starting on Feb. 15, 2021.

On ACA’s anniversary, President Biden further  announced that this extra open enrollment period would be extended to August 15, 2021. It had been scheduled to expire on May 15. This is in addition to the regular open enrollment period coming in the fall. 

Additionally, the American Rescue Plan Act, the COVID-19 relief package that became law on March 11, 2021, contains Medicaid provisions that could also expand coverage to more people. Reports indicate that even conservative states that had not previously expanded Medicaid under the ACA are now considering the expansion.

Expanding access to quality health care is particularly important now as we continue to battle the COVID-19 pandemic, and the associated job losses that have reduced employer-based coverage for many Americans.

For more information see:

Center Report: Billions of Dollars to Nursing Homes in Covid-19 Relief

More than one-third of all people who have died from COVID-19 have been nursing home residents, although residents account for less than .05% of the country’s population.[1] During the pandemic, the federal government waived many longstanding resident protections and facility reporting requirements.[2] Accountability and oversight were severely limited, as CMS waived virtually all standard and complaint surveys[3] and barred long-term care ombudsmen and families from visiting.

What also changed during the pandemic was the large influx of public funds provided to facilities.  During the coronavirus pandemic, nursing homes have received billions of dollars and non-monetary support from all levels of government in addition to reimbursement for care through the Medicare and Medicaid programs. The Federal Government has given, or in some cases, loaned facilities (with many loans forgiven) hundreds of millions of additional dollars through multiple programs. Most of these federal payments have been made without regard to facilities’ performance. Many states have also increased Medicaid rates across-the-board or paid higher rates for COVID-19-positive residents or established COVID-19-only facilities and paid them high rates. In addition, the Federal and State Governments have provided indirect financial support to nursing facilities, supplying personal protective equipment, tests and testing equipment, multiple training opportunities, the National Guard, and “strike teams” to help facilities in crisis situations during the pandemic. 

The Center for Medicare Advocacy has released a report – Nursing Facilities Have Received Billions of Dollars in Direct Financial and Non-Financial Support During Coronavirus Pandemic – that identifies the primary sources of financial aid given to facilities and concerns that have been raised about COVID funding for poor performing facilities.

Our on-going concern is quality care for residents. Public funding should be spent on increased, quality care and staffing. 

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[1] The Centers for Disease Control and Prevention reports that 1.3 million people lived in nursing facilities in 2015.  CDC, National Center for Health Statistics, Nursing Home Care, https://www.cdc.gov/nchs/fastats/nursing-home-care.htm.  The U.S. Census Bureau projected that the country’s population on January 1, 2016 would be 322,762,018.  U.S. Census Bureau, “Census Bureau Projects U.S. and World Populations on New Year’s Day” (Dec. 30, 2015), https://www.census.gov/newsroom/press-releases/2015/cb15-tps113.html
[2] CMS, “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” (as of Feb. 19, 2021), https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf (Skilled nursing facility waivers are at pp. 16-21
[3] CMS, “Prioritization of Survey Activities,” QSO020-20-ALL (updated 9/28/2020), https://www.cms.gov/files/document/qso-20-20-all.pdf

Center for Medicare Advocacy submits Statement for the Record for Senate Finance Committee March 17 Hearing on Nursing Homes and COVID-19

The Senate Finance Committee held a hearing on March 17, 2021, “A National Tragedy: COVID-19 in the Nation’s Nursing Homes.”[1]  The Center for Medicare Advocacy has now submitted a Statement for the record that asks Congress to address longstanding problems in nursing facilities – inadequate nurse staffing levels, both professional and paraprofessional; poor infection control practices; and limited enforcement of standards of care.  The Center asks Congress to require meaningful nurse staffing levels and reverse the dismantling of the enforcement system.

In addition, the Center asks Congress to address changes in the nursing home industry since the 1987 Nursing Home Reform Law was enacted that have reduced accountability for the quality of care that facilities provide and for public spending, and, specifically, to: 

  1. Enact laws to prohibit or at least restrict/reduce provider self-dealing
  2. Enact law (with enforceable consequences for violations) limiting the amount of public reimbursement that can be spent on profits, administration, and overhead
  3. Enact laws (with enforceable consequences for violations identifying who is eligible to own and manage nursing facilities

The Center’s Statement is available at https://medicareadvocacy.org/statement-to-the-senate-finance-committee/ 

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[1] See “Senate Finance Committee Hearing on Covid-19 and Nursing Homes” (CMA Alert, Mar. 18, 2021), https://medicareadvocacy.org/senate-finance-committee-hearing-on-covid-19-and-nursing-homes/

Nursing Home Trade Associations’ Legislative Agenda for 2021: More Familiar Than Bold

The American Health Care Association and LeadingAge, the two national nursing home trade associations, have jointly proposed a legislative agenda for 2021, which they call “Care for Our Seniors Act: Improving America’s Nursing Homes By Learning From Tragedy & Implementing Bold Solutions For The Future.”[1]  Unfortunately, the agenda seems all too familiar – seeking more public funding and less public oversight.

The joint document begins with a discussion of “How Did This Happen?,” identifying four factors that led to the enormous toll of coronavirus cases and deaths in nursing facilities.  All four factors shift blame away from nursing facilities:

  1. Demographic data document that “frail and elderly adults with underlying health conditions” were at particular risk.
  2. Early public health directives focused on a symptoms-based approach and did not recognize asymptomatic and pre-symptomatic spread of the virus. Changing guidance and conflicting guidance from different levels of government created challenges for facilities.
  3. “Independent research” showed “that COVID-19 outbreaks in nursing homes are principally driven by the amount of spread in the surrounding community. Even the best nursing homes with the most rigorous infection control practices could not stop this highly contagious, invisible enemy.”
  4. Long term care facilities were not made “a priority for necessary resources,” despite provider requests for help. “The LTC community was left behind, forgotten, or even blamed.”

The statement calls out “crucial mistakes . . . made by public health officials,” but the only acknowledgment of providers’ “role and responsibilities in this response” is self-serving, highlighting staff’s unwittingly bringing in COVID-19 from the community and facilities’ conserving personal protective equipment.

The trade associations identified four Nursing Home Reform Principles (Clinical, Workforce, Oversight, Structural), but did not support these principles with meaningful proposals, except for the excellent inclusion of 24-hour registered nurse staffing in the Clinical Principle.

The Workforce Principle, for example, calls for loan forgiveness, tax credits for licensed LTC professionals, “programs for affordable housing and childcare assistance,” and “increased subsidies to professionals’ schools whose graduates work in nursing homes for at least five years.” The Principle does not include the living wage recommendation in LeadingAge’s own September 2020 report, Making Care Work Pay: How Paying at Least a Living Wage to Direct Care Workers Could Benefit Care Recipients, Workers, and Communities.[2] 

The Oversight Principle calls for changing the “punitive” survey system, turning around or closing chronically poor performers, and adding “customer satisfaction” to the government’s five-star rating system.

Ultimately, the legislative agenda asks for additional Medicaid money.

At least 172,000 nursing home residents and staff members have died of coronavirus, accounting for 34% of all COVID-19 deaths in the United States.[3]  Many cases and deaths could have been prevented with better nurse staffing levels, better infection control practices, and better enforcement of federal standards of care, among other factors.[4]

The nursing home industry’s “bold” agenda fails to address these disturbing facts and should be dismissed.

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[1] Care for Our Seniors Act is available at https://www.ahcancal.org/Advocacy/Documents/Care%
20for%20Our%20Seniors%20Act%20-%20Overview.pdf
[2] https://leadingage.org/sites/default/files/Making%20Care%20Work%20Pay%20Report.pdf.  The report is discussed in “Paying Direct Care Workers a Living Wage” (CMA Alert, Oct. 15, 2020), https://medicareadvocacy.org/paying-direct-care-workers-a-living-wage/
[3] “More Than One-Third of U.S. Coronavirus Deaths Are Linked  to Nursing Homes,” The New York Times (updated Feb. 26, 2021), https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html
[4] Cinnamon St. John, “Geography Is Not Destiny: Protecting Nursing Home Residents from the Next Pandemic” (Feb. 2021), https://medicareadvocacy.org/wp-content/uploads/2021/02/CMA-NH-Report-Geography-is-Not-Destiny.pdf