In 2013, a federal district court approved a settlement agreement in the case of Jimmo v. Sebelius that confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement. The … [Read more...] about Updated Factsheet: Medicare Skilled Nursing Facility Coverage Does Not Require Improvement
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Issue Brief 80 | May 2023 – Final Part C & D Rule, and Other Issues
I. FINAL PART C & D RULE On April 12, 2023, the Centers for Medicare and Medicaid Services (CMS) published a final rule for 2024 regarding Medicare Advantage (MA) and Part D. The final rule is available in the Federal Register at 88 Fed … [Read more...] about Issue Brief 80 | May 2023 – Final Part C & D Rule, and Other Issues
Medicare Agency is Seeking Comments on Medicare Advantage
On August 1, 2022, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) that “seeks input from the public regarding various aspects of the Medicare Advantage program. Responses to this request for … [Read more...] about Medicare Agency is Seeking Comments on Medicare Advantage
Home Health Comments 2023
August 5, 2022 Centers for Medicare & Medicaid ServicesDepartment of Health and Human ServicesAttention: CMS-1766-P, P.O. Box 8013Baltimore, Maryland 21244-8013 Submitted electronically to: https://www.regulations.gov Re: File … [Read more...] about Home Health Comments 2023
CMA Alert | April 21, 2022
Members of Congress Send Letter to CMS Urging Agency to Address Medicare Advantage Overpayments On April 20, 2022, 19 members of the House and Senate sent a letter to Centers for Medicare & Medicaid (CMS) Administrator Chiquita Brooks-LaSure … [Read more...] about CMA Alert | April 21, 2022
When Artificial Intelligence in Medicare Advantage Impedes Access to Care: A Case Study
The use of artificial intelligence (AI) in healthcare is capturing headlines as a potential tool to streamline operations and predict patient needs for favorable health outcomes, among other things.[1] The Center for Medicare Advocacy, however, has … [Read more...] about When Artificial Intelligence in Medicare Advantage Impedes Access to Care: A Case Study
Home Health Webinar Q & A
January 2022 The Center for Medicare Advocacy is pleased to share the following information based on questions that were received from the January 12, 2022 webinar on Medicare coverage of home health services. Recordings of that webinar and … [Read more...] about Home Health Webinar Q & A
CMA Alert | January 20, 2022
CT Governor Issues Executive Order Requiring Nursing Home Visitors Have Vaccine and Booster or Proof of Negative COVID Test - CT Long Term Care Ombudsman Expresses Support and Offers Assistance if Needed Citing a nearly 700% increase in confirmed … [Read more...] about CMA Alert | January 20, 2022
Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
Artificial intelligence (AI)-powered decision-making tools that are used in health care utilization management (UM) are increasingly used by providers and plans to automate the medical review and prior authorization processes, direct post-acute care, … [Read more...] about Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
CMA Alert | January 13, 2022
CMS Releases Proposed 2023 Rule for Medicare Advantage and Part D Plans On January 6, 2022, CMS released CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P) and an accompanying Press Release describing the overall rule, and a separate … [Read more...] about CMA Alert | January 13, 2022