- Welcome and Housekeeping (David Lipschutz, Moderator)
- Medicare’s Coverage of Capped Rental Items During Part A Institutional Stays: Losing Access to Speech Generating Devices (SGDs) (Alfred Chiplin)
- Overview of Medicare coverage guidelines re: capped rental durable medical equipment (DME) when a person requires Medicare Part A institutional care (hospital, long term care or skilled nursing facility, hospice).
- On April 1, 2014, CMS reclassified SGDs from “routinely purchased” items into a capped rental regulation, 42 CFR § 414.229. As a result, effective April 1, 2014, if you are in the first 13 months of using an SGD and you must enter a hospital, long term care facility, or hospice, Medicare will take your “voice” away from you. Effective September 1, 2014, if your SGD has the potential for any function other than speaking (for example, email), then Medicare will not pay for your ability to speak – even though Medicare never before paid for additional functionality beyond speaking (this had to be privately paid).
- Hospice and Part D Guidance: Barriers to Accessing Needed Medications- (David Lipschutz and Terry Berthelot)
- In an effort to prevent Part D plans from paying for prescription medications related to a hospice beneficiary’s terminal condition, CMS issued guidance effective May 1, 2014 that requires all prescribed medications for hospice patients that are billed to Medicare Part D to be initially denied coverage by being subject to prior authorization.
- Regulatory Update
- Current Proposed Regulations Open for Comment (Notice of Proposed Rulemaking, NPRM)
- Inpatient Hospital Payment– Comments due June 30 (Toby Edelman)
- Hospice Wage Index – Comments due July 1 (Terry Berthelot)
- Prior Authorization for Certain Durable Medical Equipment (DME) – Comments due July 28 (Alfred Chiplin)
- Windsor and New Guidance from the Administration for Community Living (ACL) (Alfred Chiplin)
- In May 2014, ACL, an agency within the Department of Health and Human Services, issued guidance applicable to all ACL grantees concerning the federal government's policy on same-sex marriages following the Supreme Court Decision in United States v. Windsor, 133 S. Ct. 2675 (2013). According to its guidance, the policy of the ACL is to treat same-sex marriages the same as opposite sex marriages to the "extent reasonably possible."
- Litigation and Medicare Appeals Update (Ali Bers)
- Update on Medicare Appeals and Due Process Issues
- Jimmo – Improvement standard
- Bagnall (Observation)
- Other litigation
- General Medicare Q&A (Moderator)
- Wrap-up (Moderator)
- Keep informed: Myths and Truths, other information and updates on the Center’s Website
- Next Call
- REMINDER: Other information available at: https://www.medicareadvocacy.org/Projects/AdvocatesAlliance/AdvocatesAlliance.IssueBriefs.htm.