In 2010, as in previous years, some Medicare Advantage (MA) plans and some prescription drug plans (PDPs) have decided not to renew their contracts with the Centers for Medicare & Medicaid Services (CMS) for the coming year.[1] This Alert will … [Read more...] about When a Medicare Advantage Plan Does Not Renew Its Contract
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Action Alliance v. Leavitt
No. 06-1607 (D.D.C.), filed September 15, 2006, appeal filed May 21, 2009 (No. 09-5191, D.C.Cir.) Last Update: October 22, 2010 Issue: Whether the Secretary's refusal to inform 230,000 Part D-enrolled beneficiaries, who … [Read more...] about Action Alliance v. Leavitt
CMA REPORT: MEDICARE COVERAGE FOR OFF-LABEL DRUG USE
September, 2010 While the Medicare prescription drug benefit provides assistance for many people with their drug costs, the requirements for coverage of the off-label use of a drug are onerous and often result in beneficiaries not being able to … [Read more...] about CMA REPORT: MEDICARE COVERAGE FOR OFF-LABEL DRUG USE
Extended Observation Stays in Acute Care Hospitals: Criticism, Legislation and Discussion
"Observation" is the term used to describe the outpatient status of a patient who is in a hospital, but not as an inpatient. Although the Medicare Manuals limit observation to 24-48 hours, many beneficiaries nationwide are experiencing extended stays … [Read more...] about Extended Observation Stays in Acute Care Hospitals: Criticism, Legislation and Discussion
Recommendations for a Beneficiary-Centered Office for Dual Eligibles
The Affordable Care Act creates an office within the Centers for Medicare & Medicaid Services (CMS) whose focus is beneficiaries who are eligible for both Medicare and Medicaid (dual eligibles). [1] Specifically, the Federal Coordinated Health … [Read more...] about Recommendations for a Beneficiary-Centered Office for Dual Eligibles
Health Reform: The Nursing Home Provisions
This is the sixth in a series of Alerts by Center for Medicare Advocacy regarding Patient Protection and Affordability Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). This Alert focuses on provisions … [Read more...] about Health Reform: The Nursing Home Provisions
Interim Final Rules to Implement the Mental Health Parity and Addiction Equity Act of 2008 Go Into Effect on April 5, 2010
On February 2, 2010, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration of the Department of Labor (DOL), (collectively referred to as the … [Read more...] about Interim Final Rules to Implement the Mental Health Parity and Addiction Equity Act of 2008 Go Into Effect on April 5, 2010
CMS Sanctions Missouri Medicaid for Overly Restrictive Home Health Standards
The state of Missouri requires Medicaid beneficiaries to be "confined to the home" in order to receive home health services provided under its Medicaid program. While this so-called "homebound" rule has been required by statute … [Read more...] about CMS Sanctions Missouri Medicaid for Overly Restrictive Home Health Standards
How the 'Improvement Standard' Improperly Denies Coverage to Medicare Patients with Chronic Conditions – text of article printed in Clearinghouse Review, Vol. 43, No. 9-10, Jan-Feb. 2010
By Gill Deford, Margaret Murphy, and Judith Stein Diagnosed three years earlier with Amyotrophic Lateral Sclerosis ("ALS," or otherwise known as "Lou Gehrig’s Disease"), 68-year-old Eileen Prendergast was suddenly informed by her home health agency … [Read more...] about How the 'Improvement Standard' Improperly Denies Coverage to Medicare Patients with Chronic Conditions – text of article printed in Clearinghouse Review, Vol. 43, No. 9-10, Jan-Feb. 2010
Observation Services: What Can Beneficiaries and Advocates Do?
What are Observation Services? CMS Brochure Favorable Decisions What Should Beneficiaries and their Advocates Do? Continuing Work Being in a hospital bed in a … [Read more...] about Observation Services: What Can Beneficiaries and Advocates Do?