Every year, the Center for Medicare Advocacy hears from the families of Medicare beneficiaries who cannot find a nursing facility to admit them because they need costly drugs that, under current rules, facilities would have to provide to them, … [Read more...] about CMS Seeks Comments on Consolidated Billing Exclusions
Weekly Alert
Medicare-Covered Home Health Care Declining
2024 Medicare Payment Advisory Commission Report to CongressHome health agencies provided services to 15% fewer traditional Medicare beneficiaries from 2019 to 2022.[1] In-person home health care visits declined during that time by more than 30%, … [Read more...] about Medicare-Covered Home Health Care Declining
Know Jimmo | Watch our Symposium to hear from Jimmo Pros
This past September our virtual Jimmo Symposium brought together advocates, providers, beneficiaries, and others to discuss practical tips and strategies for obtaining medically necessary services pursuant to the Jimmo settlement, as well as ongoing … [Read more...] about Know Jimmo | Watch our Symposium to hear from Jimmo Pros
Information Requested on “Corporate Greed in Health Care”
The Federal Trade Commission and the Departments of Justice and Health and Human Services have “launched a cross-government public inquiry into private-equity and other corporations’ increasing control over health care.” They held a joint virtual … [Read more...] about Information Requested on “Corporate Greed in Health Care”
CMS Must Preserve Standard Surveys for All Nursing Facilities
In an April 2024 Update, the Centers for Medicare & Medicaid Services (CMS) describes a risk-based survey (RBS) that it is testing to provide shorter, “more focused” surveys for “consistently higher-quality facilities.” CMS does not describe the … [Read more...] about CMS Must Preserve Standard Surveys for All Nursing Facilities
Medicare Advantage Payment Rates for 2025 Released
CMS Holds the Line Against Insurance Industry Pressure, but Plans Remain Significantly Overpaid.As discussed in recent CMA Alerts (see, e.g., here and here), in late January this year the Centers for Medicare & Medicaid Services (CMS) issued … [Read more...] about Medicare Advantage Payment Rates for 2025 Released
Study Examines Health Equity Differences between Medicare and Medicare Advantage
A recent Health Affairs study, Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups, examined gaps in quality of care when comparing traditional Medicare and Medicare Advantage for … [Read more...] about Study Examines Health Equity Differences between Medicare and Medicare Advantage
CMS Proposes Major Changes to Civil Money Penalties for Nursing Homes
As part of the annual update to Medicare Part A payments to skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) proposes significant changes to the civil money penalty (CMP) system for nursing homes. The Center for … [Read more...] about CMS Proposes Major Changes to Civil Money Penalties for Nursing Homes
Know Jimmo | Use the CMS Information
CMS says very clearly that "skilled nursing and skilled therapy services in the Skilled Nursing Facility (SNF), Home Health (HH), and Outpatient Therapy (OPT) settings does not turn on the presence or absence of a beneficiary’s potential for … [Read more...] about Know Jimmo | Use the CMS Information
Report on Improper Payments Shows Billions Wasted on Private Medicare Plans
The General Accounting Office (GAO) released a report on March 26, 2024 outlining payments that should not have been made, or were made in improper amounts by various government agencies. In its report, the GAO splits out payments in the … [Read more...] about Report on Improper Payments Shows Billions Wasted on Private Medicare Plans