Some Medicare beneficiaries lost prescription drug coverage at the end of 2010 because their Medicare Advantage (MA) plan or prescription drug plan (PDP) either did not renew its contract with the Centers for Medicare & Medicaid Services (CMS) or … [Read more...] about Extension of Time to Enroll In a Prescription Drug Plan for Medicare Beneficiaries Who Lost Coverage
Weekly Alert
Concern over Skilled Nursing Facilities’ Upcoding Medicare Reimbursement Should Not Be Allowed to Deprive Residents of Necessary Care
Between 2006 and 2008, skilled nursing facilities (SNFs) increasingly billed for residents' care at higher-paying reimbursement categories (upcoding) under Medicare's prospective payment system. Medicare uses Resource Utilization Groups … [Read more...] about Concern over Skilled Nursing Facilities’ Upcoding Medicare Reimbursement Should Not Be Allowed to Deprive Residents of Necessary Care
Judge Rejects “Eden Alternative” Defense In Nursing Home Appeal
The nursing home industry has called for major changes in the federal survey process by which federal and state survey agencies determine whether facilities are complying with federal standards of care and providing residents with high quality of … [Read more...] about Judge Rejects “Eden Alternative” Defense In Nursing Home Appeal
2011 Poverty Levels Affect Eligibility for Many Federal Programs
Federal poverty level (FPL) guidelines for 2011 were published in the Federal Register January 20, 2011. 76 FR 3637 (January 20, 2011). The guidelines provide the baseline for eligibility levels for many public benefits, including health … [Read more...] about 2011 Poverty Levels Affect Eligibility for Many Federal Programs
New Hospice Regulations are a Mixed Bag for Beneficiaries Seeking High Quality End of Life Care
Hospice care is available for Medicare beneficiaries who are certified by a hospice physician as having a life expectancy of six months or less if the terminal illness runs its normal course. In 1983, the hospice benefit was designed to cover … [Read more...] about New Hospice Regulations are a Mixed Bag for Beneficiaries Seeking High Quality End of Life Care
45 Day Disenrollment Period for Medicare Advantage Members
Starting this year, the Medicare Advantage Open Enrollment Period (OEP) has been replaced by a new Medicare Advantage Disenrollment Period (MADP), which lasts from January 1st through February 14th.[1] During the MADP, one can switch from an MA plan … [Read more...] about 45 Day Disenrollment Period for Medicare Advantage Members
Is it Time for Federal Regulation of the Assisted Living Industry?
IntroductionThe assisted living industry is regulated by states. No federal law regulates, or even defines, assisted living. It has generally been assumed that Congress would not become involved in assisted living until either (1) a … [Read more...] about Is it Time for Federal Regulation of the Assisted Living Industry?