The Jimmo Settlement Agreement provides for the re-review of certain Medicare claims under clarified maintenance coverage standards for the SNF, HH, and OPT benefits, applicable when a patient has no restoration or improvement potential, but … [Read more...] about Improvement Standard Update: Re-Review Request Form Now Available
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Examining Inappropriate Use of Antipsychotic Drugs, Part Two: How Surveyors Describe How, When, and Why They Cite Antipsychotic Drug Deficiencies (Note: Nearly 200 pages)
Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives. First, it analyzes the antipsychotic drug … [Read more...] about Examining Inappropriate Use of Antipsychotic Drugs, Part Two: How Surveyors Describe How, When, and Why They Cite Antipsychotic Drug Deficiencies (Note: Nearly 200 pages)
October, 2013 – Medicare Annual Election period, and the ACA Marketplaces and Other Issues
1. PRESENTATION: MEDICARE ANNUAL ELECTION PERIOD & THE MARKETPLACES Medicare Annual Coordinated Election Period (ACEP) – 10/15/13 – 12/7/13 During the Annual Coordinated Election Period (ACEP) people with … [Read more...] about October, 2013 – Medicare Annual Election period, and the ACA Marketplaces and Other Issues
Comments on Post Acute Care (PAC) Reform Proposals
August 19, 2013 Senate Finance Committee House of Representatives, Committee on Ways and Means United States Congress Submitted electronically to: postacutecarereform@finance.senate.gov and postacutecarereform@mail.house.gov Re: Comments … [Read more...] about Comments on Post Acute Care (PAC) Reform Proposals
August, 2013 – Update on Hospital Observation Status and Other Issues
1. PRESENTATION: UPDATE ON HOSPITAL OBSERVATION STATUS Observation status is getting a lot of attention from Congress, the media, and researchers. The bipartisan federal legislation, the Improving Access to Medicare … [Read more...] about August, 2013 – Update on Hospital Observation Status and Other Issues
June, 2013 – New Hospital Discharge Planning Guidance & Other Updates
1. PRESENTATION CMS Issues New Hospital Discharge Planning Guidance On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its … [Read more...] about June, 2013 – New Hospital Discharge Planning Guidance & Other Updates
Jimmo v. Sebelius Improvement Standard Case Summary
Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius, No. 11-cv-17 (D.VT), filed January 18, 2011. A … [Read more...] about Jimmo v. Sebelius Improvement Standard Case Summary
Frequently Asked Questions (FAQs) Regarding the Jimmo v. Sebelius “Improvement Standard” Settlement
General Question: Are professional therapy services available under Medicare only for patients who are improving or who are expected to improve? Answer: No. The Jimmo Settlement confirms that services by a physical therapist, occupational … [Read more...] about Frequently Asked Questions (FAQs) Regarding the Jimmo v. Sebelius “Improvement Standard” Settlement
Medicare’s Future: Letting the Affordable Care Act Work, While Learning From the Past
This article is part of a NAELA Journal symposium edition that focuses on "The Future of Elder Law and Special Needs Planning." This article will provide an overview of the policy debate that led to the creation of the Medicare … [Read more...] about Medicare’s Future: Letting the Affordable Care Act Work, While Learning From the Past
Medicare Paid $5.1 Billion to SNFs that Did Not Provide Care-Planning and Discharge-Planning (February 2013 OIG Report)
In its most recent report on nursing home payments and quality, February 2013, the Office of Inspector General (OIG), Department of Health and Human Services (HHS) reports that many skilled nursing facilities (SNFs) failed to provide adequate care … [Read more...] about Medicare Paid $5.1 Billion to SNFs that Did Not Provide Care-Planning and Discharge-Planning (February 2013 OIG Report)