CMA Alert – The REST of the Tax Cut Plan; “Jimmo” Improvement Standard Update; QMB News; Enrollment Periods End Soon

1. The Plan: Pass a Devastating Tax Bill, Balloon the Deficit, then Gut the Social Programs We Rely On
2. Jimmo Update: Court Orders CMS to Modify Special Jimmo Webpage
3. ACA and Medicare Enrollment Periods End Soon
4. Changes to Notice of Qualified Medicare Beneficiary (QMB) Status

The Plan: Pass a Devastating Tax Bill, Balloon the Deficit, then Gut the Social Programs We Rely On

We aren’t making this up – Marco Rubio came right out and said it this week.  According to Rubio, “we have to do two things. We have to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future.”  

Or, as common sense would dictate, you could not give away trillions in revenue in the first place, and develop a bipartisan tax bill that supports the needs of all Americans.

For even more statements on the plan to destroy Medicare, Medicaid, and Social Security as we know them, including from many who promised to protect them, check out the Twitter thread from the Center on Budget & Policy Priorities at https://twitter.com/dashching/status/936003647519055873. 

Speak out!  Time is of the essence!

Contact your Senators today to tell them not to sacrifice Americans’ healthcare and future well-being to give tax cuts to the wealthy.

• Reach any Senator through the Senate switchboard at 202-224-3121
• Or use the toll-free number from Service Employees International Union (SEIU): 866-426-2631

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Jimmo Update: Court Orders CMS to Modify Special Jimmo Webpage

On November 21, 2017, the U.S. district court overseeing the Jimmo v. Sebelius settlement ordered the government to remove confusing and misleading language from CMS’s Jimmo webpage. The webpage, https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html, was published in August 2017 as part of a court-ordered Corrective Action Plan to counter continuing confusion and misconceptions about Medicare coverage of maintenance care.  The webpage contains an “Important Message About the Jimmo Settlement,” which was carefully drafted to affirmatively disavow the illegal “Improvement Standard” and to confirm that Medicare does cover skilled care to maintain function or prevent or slow decline, even if improvement is not expected.

When originally published, the “Additional Information” section of the webpage contained language that undercut the “Important Message,” and, as the court found, “present[ed] the risk of further confusion.” That language has now been removed.  The Center for Medicare Advocacy encourages Medicare beneficiaries, their advocates, and their medical providers to review the materials on the webpage. The “Important Message” specifically notes that the Jimmo settlement “may reflect a change in practice.” The webpage also contains links to a new set of Frequently Asked Questions with helpful information, and other resources that explain and support the availability of Medicare coverage for skilled maintenance care. 

ACA and Medicare Enrollment Periods End Soon

Affordable Care Act (ACA)

With just a little over two weeks left to sign up for an Affordable Care Act Marketplace plan during Open Enrollment, which ends on December 15th, recent reports show enrollment still going strong in spite of administration-led efforts to undermine the ACA. However, it is critical to continue to raise awareness about Open Enrollment and the need for quality health coverage. 
  
Throughout the enrollment season, there have been consistent attempts to sabotage the ACA and create confusion. We’ve already called attention to actions such as the Executive Order allowing the sale of junk plans; cutting the enrollment period in half; slashing funding for enrollment assistance, refusing to participate in enrollment events; shutting down www.healthcare.gov during critical times; and not paying for cost-sharing reductions. 

An article by Kaiser Health News indicates that amid the confusion about the ACA Marketplace, some companies are selling “skinny plans” that may not have the same coverage protections as an ACA plan. The ACA requires insurers to cover essential health benefits such as ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services. Those needing coverage should be cautious about “skinny plans” that don’t cover essential benefits like hospitalization or emergency room care. Consumers should also be cautious about plans that don’t count as “qualified coverage” and will not exempt them from the tax penalty. 

Medicare

As a reminder, the ACA Marketplace offers coverage for people who don’t have other forms of health coverage and are not eligible for Medicare.

Medicare Annual Enrollment ends on December 7th so it is imperative that people with Medicare review current coverage and make any changes for 2018 as soon as possible. 

Changes to Notice of Qualified Medicare Beneficiary (QMB) Status

On October 2, 2017, the Centers for Medicare & Medicaid Services (CMS) modified their Traditional Medicare computer systems to indicate the Qualified Medicare Beneficiary (QMB) status and zero cost-sharing liability of beneficiaries on the Medicare Summary Notice and Medicare Provider Remittance Advice (RA). (See our recent Alert) 

CMS  has now identified an unexpected problem with their recent systems changes that indicate zero cost-sharing for QMBs on RAs, which necessitates temporarily suspending the systems change starting on December 8, 2017, and reverting back to the pre-October 2, 2017 versions of the RAs for QMBs. The changes to the beneficiary liability on the Medicare Summary Notice are also temporarily being suspended. CMS is working to remediate these issues.
The other QMB notice that CMS announced this fall is unaffected by the above issues and will begin this fall. This change provides additional information and messages to CMS' HIPPA Eligibility Transaction System (HETS) regarding QMB status that allows providers to check Medicare beneficiary eligibility data in real-time. Including the QMB information in this system will ensure that providers are aware of QMB status in real-time, so they do not illegally bill individuals for cost-sharing. 

For more information, please see the CMS alert at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.html