MOVING FORWARD WITH HOPEIt’s no surprise that the election has left many of us worried and disoriented. But we’ll regroup.We may not understand where we’ve landed, but we’ll acclimate and march forward – … [Read more...] about November 2016 – The Election’s Impact on Medicare, New Nursing Home Requirements of Participation and Other Issues
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Medicare Home Health Benefit’s Face-to-Face Encounter Requirement
As a condition of payment for Medicare home health benefits, a physician must certify that a patient is confined to the home, needs skilled services, receiving the services under a plan of care established and periodically reviewed by a physician, … [Read more...] about Medicare Home Health Benefit’s Face-to-Face Encounter Requirement
Medicare Annual Enrollment Period Has Begun – Ends December 7
Fall is the time for Medicare beneficiaries to explore their options regarding traditional Medicare, Part D prescription drug plans and Part C Medicare Advantage plans. The Annual Coordinated Election Period (ACEP) starts on October 15th and … [Read more...] about Medicare Annual Enrollment Period Has Begun – Ends December 7
Lodge v. Burwell
No. 3:15-cv-00390-JBA (D.Conn.), filed March 17, 2015Issue: Whether extraordinary dental care should be covered because the exclusion for coverage of dental care should be limited to routine dental care.Relief Sought: Reversal of the Secretary’s … [Read more...] about Lodge v. Burwell
Haro v. Johnson
No. 09-cv-134-TUC-DCB (D.Ariz.), filed March 10, 2009. Appeal filed June 30, 2011 (No. 11-16606, 9th Cir.).Issue: Whether the Secretary's aggressive methods for attempting to collect payments under his Medicare Secondary Payer (MSP) program, … [Read more...] about Haro v. Johnson
CMS Releases New Nursing Facility Regulations: Both Pluses and Minuses for Nursing Facility Residents
For Immediate Release Contact: Toby S. Edelman, Senior Policy Attorney TEdelman@MedicareAdvocacy.org, (202) 293-5760The Centers for Medicare & Medicaid Services has just released a comprehensive revision of federal nursing facility … [Read more...] about CMS Releases New Nursing Facility Regulations: Both Pluses and Minuses for Nursing Facility Residents
Transition of Coverage: The Affordable Care Act and Medicare
The Affordable Care Act (ACA), signed into law in 2010, was enacted to increase the quality and affordability of health care and lower the rate of uninsured by expanding private and public health insurance. One mechanism the ACA established to … [Read more...] about Transition of Coverage: The Affordable Care Act and Medicare
September 2016 – Progress In Impact Litigation & Other Issues
National Medicare Advocates AllianceIssue Brief #41, September 2016LITIGATION UPDATEBarrows v. Burwell (formerly Bagnall v. Sebelius), No. 3:11-cv-1703 (D. Conn.) (Observation Status). In November 2011, the Center for Medicare … [Read more...] about September 2016 – Progress In Impact Litigation & Other Issues
Center Comments on Proposed Rule that Would Significantly Alter the Medicare Administrative Appeals Process
August 29, 2016Office of Medicare Hearings and Appeals Department of Health & Human Services Attention: HHS-2015-49 5201 Leesberg Pike, Suite 1300 Falls Church, VA 22041 Submitted electronically … [Read more...] about Center Comments on Proposed Rule that Would Significantly Alter the Medicare Administrative Appeals Process
Medicare Prior Authorization
Prior authorization is a requirement that a health care provider obtain approval from Medicare to provide a given service. Prior Authorization is about cost-savings, not care. Under Prior Authorization, benefits are only paid if the … [Read more...] about Medicare Prior Authorization