This week the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2027 Medicare Advantage (MA) and Part D Advance Rate Notice. The annual notice establishes payment rates for MA and Medicare Part D plans for the next … [Read more...] about CMS Rate Notice Includes Changes to Risk Scores
Weekly Alert
Know Jimmo | Core Medicare Coverage Principles
Medicare coverage turns on whether the care in question is reasonable and necessary and, in many settings, whether it includes skilled services. This is key to the Jimmo federal court settlement and decisions. In Summary:Per CMS, “This is … [Read more...] about Know Jimmo | Core Medicare Coverage Principles
Oklahomans Concerned about Losing Care Under Model Medicare Prior Authorization Program
In a recent piece on radio station KGOU in Oklahoma, Jillian Taylor addressed the Wasteful and Inappropriate Service Reduction Model, or WISeR, a program being tested in six states, including Oklahoma, as of January this year. The program uses … [Read more...] about Oklahomans Concerned about Losing Care Under Model Medicare Prior Authorization Program
CMA Submits Comments Opposing Repeal of the Final Nurse Staffing Rule
The Center for Medicare Advocacy has submitted its comments strongly opposing the Centers for Medicare & Medicaid Services’ interim final rule with comment, entitled “Repeal of Minimum Staffing Standards for Long-Term Care Facilities,” … [Read more...] about CMA Submits Comments Opposing Repeal of the Final Nurse Staffing Rule
Know Jimmo | Medicare Covers Therapy in Nursing Homes to Maintain or Slow Decline
“Maintenance Therapy – Therapy services in connection with a maintenance program are considered skilled when they are so inherently complex that they can be safely and effectively performed only by, or under the supervision of, a qualified therapist. … [Read more...] about Know Jimmo | Medicare Covers Therapy in Nursing Homes to Maintain or Slow Decline
Video Resource from the Long Term Care Ombudsman Programs
A new film, Breaking the Silence, emphasizes the importance of long term care residents understanding their rights and the resources available to them. It is about understanding resident fear due to a perceived power imbalance and the potential for … [Read more...] about Video Resource from the Long Term Care Ombudsman Programs
CMA Co-Director Testifies in Support of Three Medicare-Related Bills
On January 8, 2026, Center for Medicare Advocacy Co-Director David Lipschutz appeared as an invited witness before the House Energy & Commerce Committee, Health Subcommittee at a hearing titled “Legislative Proposals to Support Patient Access to … [Read more...] about CMA Co-Director Testifies in Support of Three Medicare-Related Bills
Questioning your Medicare Advantage Plan Choice? Now is the Time to Act!
The Medicare Advantage Open Enrollment Period is January 1-March 31. During this limited time, Medicare beneficiaries can change Medicare Advantage plans or switch to Traditional Medicare. If you change to Traditional Medicare, you may also obtain a … [Read more...] about Questioning your Medicare Advantage Plan Choice? Now is the Time to Act!
Know Jimmo | Looking at You, AI – Rules of Thumb Should Not Be Used to Deny Medicare
To qualify for most Medicare-covered care, the individual must need and receive skilled care. Skilled services include nursing, physical therapy, occupational therapy, and speech-language pathology services. In November 2010, CMS revised its … [Read more...] about Know Jimmo | Looking at You, AI – Rules of Thumb Should Not Be Used to Deny Medicare
From Colorado – Medicare and Medicaid care changes in 2026
In "Insurance in 2026: Fed bill will result in coverage, rate changes; impacts felt locally" an article in the Crestone (CO) Eagle, reporter Jennifer Leonard highlights significant changes coming to Colorado health care in 2026, including citing the … [Read more...] about From Colorado – Medicare and Medicaid care changes in 2026