Court Upholds Right of Residents in Publicly-Owned Nursing Facilities to Sue for Violations of the Nursing Home Reform Law The U.S. Supreme Court upholds the right of nursing home residents in publicly-owned nursing facilities to file lawsuits … [Read more...] about Supreme Court Victory for Court Access and Nursing Home Residents
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Home for the Holidays | Leaving the Nursing Home During a Medicare-Covered Stay
Summer brings various holidays and family vacations. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Over the years, the Center for Medicare … [Read more...] about Home for the Holidays | Leaving the Nursing Home During a Medicare-Covered Stay
Senate Committee Holds Hearing re: Medicare Advantage Denials and Delays in Care
On May 17, 2023, the Senate Homeland Security & Governmental Affairs Committee, Permanent Subcommittee on Investigations chaired by Senator Richard Blumenthal (CT) held a hearing titled “Examining Health Care Denials and Delays in Medicare … [Read more...] about Senate Committee Holds Hearing re: Medicare Advantage Denials and Delays in Care
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
CMS Proposes Updates to Medicare Part A Reimbursement for Skilled Nursing Facilities
The Centers for Medicare & Medicaid Services’s (CMS) proposed annual update to Medicare Part A reimbursement for skilled nursing facilities, published at 88 Federal Register 21316 (Apr. 10, 2023), includes a number of significant changes to … [Read more...] about CMS Proposes Updates to Medicare Part A Reimbursement for Skilled Nursing Facilities
Barriers to Care for Medicare Advantage Enrollees Highlighted even as Insurance Industry Continues Effort to Retain Their Overpayments
As the Center for Medicare Advocacy has outlined in recent CMA Alerts (including here, here and here), the Centers for Medicare & Medicaid Services (CMS) has recently taken long overdue steps to address Medicare Advantage (MA) overpayments and … [Read more...] about Barriers to Care for Medicare Advantage Enrollees Highlighted even as Insurance Industry Continues Effort to Retain Their Overpayments
Medicare Advantage Industry Continues to Fight Minor, Overdue Course Corrections
The Centers for Medicare & Medicaid Services (CMS) has recently taken long overdue steps to address Medicare Advantage (MA) overpayments and oversight, including restrictive prior authorization and marketing misconduct. While we applaud these … [Read more...] about Medicare Advantage Industry Continues to Fight Minor, Overdue Course Corrections
Medicare Advantage Industry Continues to Mislead Public to Protect Their Overpayments
As discussed in a recent CMA Alert “Insurance Industry Response to Proposed Medicare Advantage Payment for 2024” (Feb. 16, 2023), the Centers for Medicare & Medicaid Services (CMS) recently released proposed Medicare Advantage (MA) payment … [Read more...] about Medicare Advantage Industry Continues to Mislead Public to Protect Their Overpayments
Insurance Industry Response to Proposed Medicare Advantage Payment for 2024
“Our Profits are The Sky is Falling!” This is the time of year – between the Centers for Medicare & Medicaid Services’ (CMS) release of proposed Medicare Advantage (MA) payment rates for the following year and the finalization of these … [Read more...] about Insurance Industry Response to Proposed Medicare Advantage Payment for 2024
Medicare Advantage Updates – Audits, Payment, and Prior Authorization
There is consistent and growing evidence that Medicare Advantage (MA) plans are paid more on average than traditional Medicare for a given beneficiary, and such payments are causing significant challenges for Medicare’s financial sustainability. … [Read more...] about Medicare Advantage Updates – Audits, Payment, and Prior Authorization