Outpatient Maintenance Physical Therapy, Occupational Therapy and Speech Language Pathology Services (Medicare Benefit Policy Manual Ch. 5, §220.2D)Outpatient Physical Therapy, Occupational Therapy and Speech Language Pathology Services “may be … [Read more...] about Know Jimmo | The Medicare Policy Manual
Weekly Alert
Issue Brief on Substance Use Disorder Treatment for Duals Released
The Legal Action Center recently released an issue brief, “Two Plans Are Not Always Better Than One: Barriers to Substance Use Disorder Treatment for Dual-Eligible Individuals,” that identifies the unique barriers to substance use disorder treatment … [Read more...] about Issue Brief on Substance Use Disorder Treatment for Duals Released
2024 Federal Poverty Guidelines Released
The Department of Health and Human Services (HHS) updates the poverty guidelines at least annually, with new guidelines published recently. The new guidelines are available here: Federal Register :: Annual Update of the HHS Poverty … [Read more...] about 2024 Federal Poverty Guidelines Released
Studies Show Nursing Home Closures Have Declined
Although the nursing home trade associations argue that inadequate reimbursement and a lack of people to hire have led to closures of nursing homes and that closures will become an even greater problem if the Centers for Medicare & Medicaid … [Read more...] about Studies Show Nursing Home Closures Have Declined
Know Jimmo | Right from the Medicare Agency
The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under … [Read more...] about Know Jimmo | Right from the Medicare Agency
As Medicare Advantage Enrollment Grows, So Does Awareness of Problems
In an effort to foster informed decision-making by Medicare beneficiaries about their coverage options, the Center for Medicare Advocacy has long tried to highlight the trade-offs of enrolling in Medicare Advantage (MA) plans. In the past, … [Read more...] about As Medicare Advantage Enrollment Grows, So Does Awareness of Problems
Medicare Advantage Industry Support Letter Circulating in Senate – Center for Medicare Advocacy Urges Senators Not to Sign On
Medicare Advantage (MA) payment rates for the coming year are released early in the prior year. As of this writing, the proposed 2025 rates are imminent. As noted in previous CMA Alerts (see, e.g., this one from 2020), release of this information … [Read more...] about Medicare Advantage Industry Support Letter Circulating in Senate – Center for Medicare Advocacy Urges Senators Not to Sign On
Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
In order to manage costs, Medicare Advantage (MA) plans are able to restrict their enrollees to a contracted network of health care providers that is “sufficient to provide access to covered services to meet the needs of the population served.”* Some … [Read more...] about Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
An examination of 2019 Medicare cost reports finds that nursing facilities spent more of their revenue on administration, capital, other, and profits (34%) than on nursing (27%). “United States’ Nursing Home Finances: Spending, Profitability, and … [Read more...] about Nursing Facilities Spend More on Administration, Capital, and Profits Than Nursing: 2019 Medicare Cost Reports
KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing
In “A Look at Nursing Facility Characteristics Between 2015 and 2023,” KFF reports that between 2015 and 2023, the hours of nursing care provided to residents in nursing facilities declined by 9% (from 4.13 hours per resident day (HPRD) in 2015 to … [Read more...] about KFF: Increased Numbers of Deficiencies Cited at Nursing Facilities May Reflect Insufficient Staffing