Beneficiaries are seeing information about “a new appeal right” on the Medicare Summary Notices they receive in the mail. This right resulted from the Center for Medicare Advocacy’s class action on behalf of beneficiaries who have harmed by … [Read more...] about Observation Status Appeals Are In Effect
Weekly Alert
New Jersey State Comptroller Protects Nursing Home Residents Again
Just weeks after KBWB-Atrium and its former Chief Executive Officer Kevin Breslin “pleaded guilty [in Wisconsin] to one count of health care fraud and one count of tax conspiracy related to the operation of numerous skilled nursing facilities” (for … [Read more...] about New Jersey State Comptroller Protects Nursing Home Residents Again
Threats to Medicare, Medicaid and Other Health Programs Increasing
One month into a new administration, there are increasing threats to our country’s foundational health programs and those that they serve. Such threats range from dire cuts to the Medicaid program that Congress will begin voting on next week, to the … [Read more...] about Threats to Medicare, Medicaid and Other Health Programs Increasing
“DOGE” and Access to Data
There have been multiple media reports about personnel from the newly-formed “U.S. DOGE Service” gaining access to data from federal agencies. Some officials have stated that DOGE’s objective in reviewing agency data is to help eliminate government … [Read more...] about “DOGE” and Access to Data
Know Jimmo | Frequently Asked Questions (FAQs) Regarding Jimmo Settlement
(CMS.gov, Sept 10, 2024. Last visited 2/28/2025.)Q1: What is the Jimmo Settlement Agreement (January 2013)?A1: The Jimmo Settlement Agreement clarified that when a beneficiary needs skilled nursing or therapy services under Medicare’s skilled … [Read more...] about Know Jimmo | Frequently Asked Questions (FAQs) Regarding Jimmo Settlement
CMA Comments on Proposed Medicare Advantage Payment for CY2026
On January 10, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the “Calendar Year (CY) 2026 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2026 … [Read more...] about CMA Comments on Proposed Medicare Advantage Payment for CY2026
RFK Jr. Confirmed as Next HHS Secretary
This Mistake Must Not be Followed by Confirming Dr. Oz as CMS AdministratorThe United States Senate voted 52-48 today, almost completely along party lines, to confirm Robert F. Kennedy Jr. as the next Secretary of Health and Human Services. The … [Read more...] about RFK Jr. Confirmed as Next HHS Secretary
Researchers Call for Implementation of Final Nurse Staffing Rule for Nursing Homes
In “Your Parents Deserve More From Their Nursing Home,” a Guest Essay in The New York Times (Feb. 7, 2025), University of Pennsylvania Researchers Norma B. Coe and Rachel M. Werner support implementation of a final rule, promulgated by the Biden … [Read more...] about Researchers Call for Implementation of Final Nurse Staffing Rule for Nursing Homes
Know Jimmo | It’s Not About Care Setting
The Jimmo Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and … [Read more...] about Know Jimmo | It’s Not About Care Setting
General Enrollment Period and Part A Buy-In
Most people enroll in Medicare Part B either during their Initial Enrollment Period (IEP) surrounding their 65th birthday or during a Special Enrollment Period (SEP) that entitles them to enroll into Medicare Part B later (for example, people aged 65 … [Read more...] about General Enrollment Period and Part A Buy-In