A Word from the Executive Director
News You Can Use
- CMS Backs Off on Leveling the Playing Field for Traditional Medicare and Private Plans
After announcing that Medicare Advantage payment rates would be reduced in an effort to bring in line with payments in traditional Medicare, CMS actually raised rates for MA plans. Private Medicare will continue to cost far more than it would cost to serve similar beneficiaries in traditional Medicare. While this may be good for insurance companies that offer MA plans, it is not good for Medicare, the vast majority of Medicare beneficiaries, or taxpayers. Read more.
- Paul Ryan Releases another Budget that's Bad for Medicare Beneficiaries
On April 1st Representative Paul Ryan rolled out yet another “Path to Prosperity,” as he annually calls his budget. Unfortunately, the budget is a repeat of past plans, and is not a path to prosperity for most Americans – or for Medicare. Read more.
- New CMS Guidance Regarding Hospice and Prescription Drugs is Bad News for Patients
Medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by the insurance companies that administer Medicare Part D plans. To prevent this from happening, effective May 1, 2014, all prescribed medications for hospice patients billed to Medicare Part D will initially be denied coverage. To get their medications, hospice patients will have to initiate and ultimately succeed at a Medicare appeal. In other words, to protect insurance companies, dying patients will have to jump through hoops to get medically necessary, potentially life-sustaining medications. Read more.
Legislative Update
- Medicare Physician Payment (Sustainable Growth Rate, aka SGR) – One-Year Patch
On April 1st, President Obama signed into law the "Protecting Access to Medicare Act of 2014" (H.R. 4302). This bill is a one year short-term "fix" or "patch" to pending Medicare physician payment cuts under the current physician payment formula called the "sustainable growth rate" or "SGR". The SGR patch also included the two Medicare "extenders" that the Center has followed most closely:
QI Extended for One Year
Section 201 extends the Qualified Individual (QI) Medicare Savings Program for one year, through March 31, 2015. The QI program pays the Part B premium for individuals with income between 120 and 135% of the federal poverty level, and who also have very limited resources.
Therapy Cap Exceptions Process Extended for One Year
Section 103 extends the current therapy cap exceptions process through March 31, 2015. Current law imposes a payment cap on the annual amount of Medicare coverage available for beneficiaries receiving outpatient therapy services. Two distinct caps apply to therapy services: for physical therapy (PT) and speech language pathology service (ST) combined, the cap is $1,920 in 2014. For occupational therapy (OT) services, the cap is also $1,920. In addition, claims exceeding a threshold of $3,700 (either for PT and ST combined, or separately for OT) are subject to a mandatory manual medical review (MMR) by Medicare contractors.
CMA in the Community
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- Center Senior Policy Attorney Toby Edelman appeared on FOX News' Special Report with Brett Baier to discuss the ongoing problem of Observation Status – for those who haven’t seen the video, click below to check it out!