This special issue of the Elder Justice Newsletter takes a close look at what "Special Focus Facility" status - the status given the worst performing nursing homes - really signals for residents and families, and why repeated deficiencies in these … [Read more...] about Elder Justice “No Harm” Newsletter Volume 7 Issue 6 Now Available
Weekly Alert
List of Exclusions from Nursing Home Consolidated Billing Updated for 2026
When Medicare beneficiaries are in a skilled nursing facility (SNF) receiving Part A coverage for their stay, the SNF is required to pay for every service the resident needs, as a result of the principle of “consolidated billing.” However, CMS … [Read more...] about List of Exclusions from Nursing Home Consolidated Billing Updated for 2026
Nursing Home Residents CAN Leave the Facility Without Losing Medicare Benefits
Skilled nursing facility (SNF) residents who leave their SNF to go home or to move into another SNF do not lose their Medicare coverage. If they go home, they can use Medicare for home health care, outpatient services, and so on. If they go home for … [Read more...] about Nursing Home Residents CAN Leave the Facility Without Losing Medicare Benefits
ACA Tax Credit Update
Wednesday the House passed health care legislation that does not include extensions of premium tax credit enhancements that are set to expire on December 31, 2025. According to KFF “22 million out of 24 million marketplace enrollees currently receive … [Read more...] about ACA Tax Credit Update
Know Jimmo | It’s the Law
If you, or someone you are helping are informed that Medicare coverage is not available for necessary care because improvement isn’t possible or sufficient, remember – that’s not true. Quote and direct them to the Medicare agency’s own website, … [Read more...] about Know Jimmo | It’s the Law
Getting Chemotherapy While in a Nursing Home
Nursing homes may deny admission to a Medicare beneficiary who needs expensive drugs, often as a result of financial concerns. Because of “consolidated billing,” nursing homes must pay for whatever medications, therapies, and services a resident in a … [Read more...] about Getting Chemotherapy While in a Nursing Home
Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026
Thanks to a successful class action lawsuit led by the Center for Medicare Advocacy, if you were hospitalized between January 1, 2009 and February 13, 2025 and reclassified from inpatient to “observation status,” you may have the right to file a … [Read more...] about Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026
Know Jimmo | Outpatient Therapy to Maintain Function or Slow Decline Is Eligible for Medicare Coverage
The key to coverage is whether the individual requires a skilled provider to ensure the services are safe and effective, not whether improvement is expected.“Medicare coverage does not turn on the presence or absence of improvement from therapy, … [Read more...] about Know Jimmo | Outpatient Therapy to Maintain Function or Slow Decline Is Eligible for Medicare Coverage
CMS Rescinds Nursing Home Nurse Staffing Rule
The Centers for Medicare & Medicaid Services (CMS) repeals the 2024 nurse staffing rule, specifically, the numerical staffing requirements (3.48 hours per resident day, divided among various categories of nurses) and the requirement for … [Read more...] about CMS Rescinds Nursing Home Nurse Staffing Rule
Reminder – Open Enrollment Ends December 7th
Medicare Fall Open Enrollment ends December 7, so if you haven't reviewed your options for next year yet you still have a few days to make certain changes to coverage, including switching prescription drug plans or between traditional Medicare and … [Read more...] about Reminder – Open Enrollment Ends December 7th