"I am a private nurse care manager who has advocated for my clients regarding the application of Jimmo decision for the last several years... without success. The therapists and nurses in the room continue to repeat 'Must discharge because of lack of … [Read more...] about Know Jimmo | Provider Education is Key
Weekly Alert
Client Win – Billed for Services When Medicare Wasn’t Available
The Center recently worked with an ombudsman whose client was billed nearly $10,000 for almost two weeks of care in a skilled nursing facility (SNF) and physical therapy when the resident remained in the SNF after she had received 100 days of … [Read more...] about Client Win – Billed for Services When Medicare Wasn’t Available
Addressing the “Medigap Trap”
A recent Center for American Progress report, “Escaping the Medigap Trap: A Path to Real Choice in Medicare,” presents policy reforms to address the “Medigap trap” - the term often used to refer to the experience of beneficiaries who would like to … [Read more...] about Addressing the “Medigap Trap”
Crucial Care at Risk from Unfounded Fraud Claims
A recent Health Affairs Forefront piece, “Unfounded Fraud Allegations Threaten Vital Medicaid Home And Community-Based Services,” counters CMS’s justification for its crackdowns on “fraud” in home and community based services (HCBS). The article … [Read more...] about Crucial Care at Risk from Unfounded Fraud Claims
Quality Measure Ratings for Nursing Homes Fraudulently Boost Overall Ratings
Since 2008, the Centers for Medicare & Medicaid Services (CMS) has rated nursing homes using a five-star quality rating system (with five stars being the highest and best performance). CMS publicly reports the ratings on its Care Compare website. … [Read more...] about Quality Measure Ratings for Nursing Homes Fraudulently Boost Overall Ratings
2026 Part D Reminders for Beneficiaries
The 2022 Inflation Reduction Act (IRA) enacted major changes to the Part D program that have reduced Medicare prescription drug spending for both beneficiaries and the Medicare program itself. Beneficiaries should be aware of enhancements to the Part … [Read more...] about 2026 Part D Reminders for Beneficiaries
Know Jimmo | What Care Settings?
The Jimmo Settlement applies to:See www.cms.gov/medicare/settlements/jimmo … [Read more...] about Know Jimmo | What Care Settings?
Know Jimmo | Home Health Coverage Requires Individual Review
Medicare regulations set out coverage rules for home health care, including physical therapy, occupational therapy, and speech-language pathology services. Significantly, especially for people with longer term and chronic conditions, the regulations … [Read more...] about Know Jimmo | Home Health Coverage Requires Individual Review
New Issue Brief | Retiree Auto Enrollment in Medicare Advantage
When an employer or union contracts for a Medicare Advantage plan for its retirees, Medicare allows them to enroll the retirees automatically. In 2021, the Center for Medicare Advocacy wrote about the increasing automatic enrollment of retired … [Read more...] about New Issue Brief | Retiree Auto Enrollment in Medicare Advantage
State-Level Nursing Home Staffing Mandates Improve Staffing without Harming Finances or Causing Closures
Evaluating the impact of state nurse staffing mandates on nursing homes over a 14-year period, researchers find that “staffing mandates were effective at increasing staffing levels but had no detectable effect on nursing home finances and did … [Read more...] about State-Level Nursing Home Staffing Mandates Improve Staffing without Harming Finances or Causing Closures