Medicare / Medicaid



Table of Contents
HHS News Releases
Medicare.gov
Medicare Webinars & Trainings
MRC — Medicare Rights Center — Medicare Watch
CMA — Center for Medicare Advocacy — CMA Alerts
    CMA ACTION Alerts
NSCLC — National Senior Citizens Law Center (NSCLC)
CMS — Centers for Medicare & Medicaid Services — CMS News / HHS News
Kaiser Family Foundation Resources
Miscellaneous Articles & Information

MEDICARE INTERACTIVE

What advocates who don't practice health law should know about health law

2014 MEDICARE Figures

2013 MEDICARE Figures

Medicare and Social Security Scam Reporting

  • Social Security and Medicare employees will never make an unsolicited call, for any reason, to ask for banking or credit card information, or for a Social Security or Medicare number.
  • Medicare cards do not cost anything—they are free.   The Social Security Administration sends out a Medicare card when an individual first becomes eligible for Medicare.   A new Medicare card may also be issued by Medicare officials due to a change in Part A or B eligibility, a legal name change, or a lost card.
  • For helpful information on identifying and avoiding Medicare fraud, please visit www.StopMedicareFraud.gov.
    If you suspect Medicare fraud, please call 1-800-MEDICARE (1-800-633-4227).
    Report suspicious 'scam' numbers to the Federal Trade Commission at 877-382-4357

Medicare Rights Center

For Medicare questions, call our free helpline, where a Medicare counselor will work with you one-on-one.
Our helpline number is 800-333-4114, and lines are open Monday through Friday from 9:00 a.m. to 5:00 p.m. Eastern.
MRC's MedicareInteractive.org

Medicare Rights Center and the Center for Medicare Advocacy Joint Statement
Joint statement from Medicare Rights Center and the Center for Medicare Advocacy on a proposed plan to repeal and replace the Sustainable Growth Rate (SGR) formula.
Medicare Rights Compiles "Five Medicare Questions for Candidates"

CMA ACTION Alerts

  • End "Observation Status!"
    Support the Improving Access to Medicare Coverage Act of 2013
  • People Before Pharmaceutical Profits
    It's a matter of priorities.   The Medicare Drug Savings Act protects beneficiaries and strengthens Medicare for future generations, rather than spending public dollars on profits for private drug companies.

Recent CMA Alerts

  • Privatization: Not Right for Medicaid, Not Right for Medicare
  • The Impact of the President's Budget on People Who Depend on Medicare and Social Security
  • Medicare Benefit Redesign: Proposals to Restructure Could Hurt More than Help
  • Medicare Paid $5.1 Billion to SNFs that Did Not Provide Care-Planning and Discharge-Planning (February 2013 OIG Report)
  • CMS's Proposed Rules on Observation Status Would Not Help Beneficiaries
  • Bills Concerning Hospital Observation Status Reintroduced
  • Medicare and Mental Health
    • Medicare Advantage Payment "Cuts?" Don't Believe It.
    • Protect Medicare: Reject Paul Ryan's Budget Proposal... Again
  • Honor Women's History Month: Preserve a Strong Medicare Program
  • Opportunity for Help with Medicare Cost Sharing Ends Soon
  • Translating DC-Speak:   What Deficit Proposals Mean for Medicare Beneficiaries
  • Medicare Matters for Young Americans:   Expect It, Protect It!
    Expect Medicare:   Medicare is Not Broke
  • Medicare: Just the Facts!
  • Settlement Reached to End Medicare's "Improvement Standard"
    Under the Jimmo settlement, the Center for Medicare Advocacy and Vermont Legal Aid will be monitoring compliance with the terms of the settlement.   Please keep us informed of your experiences, both positive and negative.
  • Why the Jimmo Case Matters:   An Improvement Standard Story

CMS News & News Releases

      (2/15/2013)   CMS Proposes 2014 Payment & Policy Updates for Medicare Health and Drug Plans
      Greater Value for Medicare Beneficiaries and Improved Payment Accuracy
      (10/25/2012) People with Medicare Save $4.8 Billion on Prescription Drugs Because of Health Care Law
      Over 20.7 million with Medicare also receive free preventive services in the first nine months of 2012
      [Medicare Part D] 2013 Resource & Cost-Sharing Limits for Low-Income Subsidy (LIS)
CMS National Training Program — March 2013

SHIP Navigator Newsletter [CMS]

The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families.   Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.   If you want to know more about the SHIP program in your state, or you want to contact a SHIP counselor in your area, please click on the link listed in the left Menu of the website.
NATIONAL SHIP RESOURCE CENTER ANNOUNCEMENT
New SHIPtalk Website!
The newly redesigned SHIPtalk website is live!   Access the new website at www.SHIPtalk.org.   There you'll find information and resources to help you support your state's SHIP program and all the beneficiaries you serve.   If you had log in access to the former SHIPtalk website, then you can retrieve your user name and password by clicking on "Forgot password?" under the SHIPtalk Log In box at the top of the left menu bar.
National SHIP Resource Center Reintroduction
At the start of the new fiscal year, we here at the National SHIP Resource Center thought it might be helpful to reintroduce ourselves and explain just who does what — especially for those who may be new to the SHIP network.
Latest edition available only through subscription.   Subscribe to E-Letter:   Subscribe
Last previous issue (in left-hand page navigation panel):

Recent HHS News Releases

People with Medicare save $5 billion on prescription drugs because of health care law — Additional value possible with plan options during Open Enrollment/i>
Medicare beneficiaries do not have to be improving in order to be eligible for Medicare covered therapy services at home or in a long term care facility.
  • Health care law delivers higher payments to primary care physicians
  • Increased Medicaid Payment for Primary Care

Recent GAO News Releases

Government Accountability Office — Medicare and Medicaid:   Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary across Programs, Payment Systems, and States, GAO-13-100, December 5

National Senior Citizens Law Center

Long Term Care Commission Should Right the Imbalance In How Medicaid Pays for Long Term Services and Supports

Non-Hospital Stay — Action Alert

When is a hospital stay not a hospital stay?   When it's observation status!
Tell CMS to change its policies about hospital stays!
Comments are due September 4, 2012 at 11:59 pm ET

Medicare Action Project Letter to CMS — September 4, 2012

Truth and Lies About Medicare

Republican attacks on President Obama's plans for Medicare are growing more heated and inaccurate by the day.   Both Mitt Romney and Paul Ryan made statements last week implying that the Affordable Care Act would eviscerate Medicare when in fact the law should shore up the program's finances.
Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say.   Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending.

New CMS Community-based Care Transitions Program Sites Announced

Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.   More information is at innovation.cms.gov.
The Centers for Medicare & Medicaid Services (CMS) announced today 17 sites selected to participate in the Community-based Care Transitions Program (CCTP).   Together with the first 30 participants, the CCTP now includes 200 acute care hospitals partnering with community-based organizations (CBOs) across 47 sites to provide care transitions services for an estimated nearly 185,800 Medicare beneficiaries annually residing in 21 states.
The CCTP is a five-year program created by the Affordable Care Act.   Participants sign two-year program agreements with CMS, with the option to renew each year for the remainder of the program, based on their success.   As of the date of this announcement, CMS continues to accept applications and approve participants on a rolling basis as long as funds remain available.
Applications are accepted on a rolling basis.   The final panel review for 2012 will be in September.   Applications from interested parties must be received by September 3rd to be considered for this panel review.   Future panels may be announced as funding permits.
For more information on CCTP, including information on all 47 program sites, visit go.cms.gov/caretransitions

Settlement Eases Rules for Some Medicare Patients — (NYT 10/23/2012)

In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.
For more information or to read the settlement agreement, visit the Center for Medicare Advocacy at www.medicareadvocacy.org.   An article appearing this week in the NY Times is also pasted below.

How Supreme Court Ruling Impacts Medicare, Medicaid and Older Adults

The National Senior Citizens Law Center and the National Committee to Preserve Social Security and Medicare have released an analysis detailing the positive impact the Supreme Court's decision to uphold the Affordable Care Act will have on older Americans.

Late-Breaking News from Department of Health & Human Services:       Health care law saves consumers over $1 billion:   Health care law provides rebates to 12.8 million consumers

Revamping Medicare: A Guide To The Proposals, Politics And Timeline
Congress is unlikely to consider legislation that would fundamentally restructure Medicare until a new Congress —and possibly a new president— are seated in 2013.   But politicians have sought to tackle the growth in Medicare costs several times in the past two years, most notably in the 2010 health care law and, then again, in last year's budget deal.
The more immediate pressure is to reduce the deficit by the end of this year to stop automatic 2 percent spending cuts from going into effect in 2013, as required by last year's budget agreement.   That will likely entail slowing spending in Medicare, which provides health care to 47 million seniors and disabled people and consumes about 15 percent of the federal budget.
Kaiser Health News answered several frequently-asked questions about the timeline for overhauling Medicare and reducing spending, and the proposals under consideration.
CMS Factsheets 2012 Update
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents
The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO), the Center for Medicare and Medicaid Innovation (Innovation Center), and the Center for Medicaid and CHIP Services (CMCS) are issuing this Informational Bulletin to inform States about a new CMS opportunity, the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents ("Initiative").  The Initiative will focus on beneficiaries who are eligible for both Medicare and Medicaid (often known as "dual eligibles" or Medicare-Medicaid enrollees).  States will be critical partners in maximizing the success of the Initiative.

Medicare Beneficiary Alert: Are You a Hospital Inpatient?
Potential "Observation Status" Disqualification


President Obama Signs Middle Class Tax Relief & Job Creation Act of 2012
—New Law Includes Physician Update Fix through December 2012—

NIH Announcement — 2012 Feb 28

Employee Benefits— Health Plans : Raytheon Must Restore Retiree Health Benefits

80 U.S.L.W. 1644
Employee Benefits—Health Plans
Raytheon Must Restore Retiree Health Benefits
Raytheon Co. expressly agreed through collective bargaining agreements to provide company-paid health care coverage for eligible retirees, and the retirees' right to premium-free health insurance did not expire with the expiration of the agreements, the U.S. Court of Appeals for the Ninth Circuit ruled May 21 in a superseding opinion after granting Raytheon's petition for panel rehearing.
The Ninth Circuit on Sept. 7, 2010, affirmed a decision of the U.S. District Court for the District of Arizona that Raytheon had guaranteed it would provide 100 percent premium-paid retiree medical insurance to retirees until they reached age 65 under the terms of several CBAs.   The appeals court, in its initial opinion, ruled under the presumption that all parties agreed that certain pre-2003 CBAs required Raytheon to pay retiree medical insurance premiums until eligible retirees reached age 65.   In its petition for panel rehearing, Raytheon contested this presumption and asserted that its relevant Employee Retirement Income Security Act welfare benefit plans contained reservation-of-rights clauses that prevented vesting of retiree health benefits.
On rehearing, the appeals court conducted a thorough review of the relevant plans and CBAs.   The appeals court concluded that Raytheon was obligated "fully to pay eligible retirees' health insurance premiums until they attain age 65" and that the retirees' "right to premium-free health insurance did not expire with the CBAs."   Additionally, the "reservation-of-rights provisions [in the plans] were not incorporated into the CBAs with regard to the obligation to pay for eligible retirees' medical coverage" and Raytheon could not unilaterally abrogate its obligations to eligible retirees, the appeals court said (Alday v. Raytheon Co., 9th Cir., No. 08-16984, 5/21/12).   Full text at http://op.bna.com/pen.nsf/r?Open=mmaa-8ukq9p.

HHS News Releases

      HHS Current News Release Page
  • Aug 15:   HHS partners with pharmacies to educate Medicare beneficiaries about new health benefits
  • Jun 7:   New consumer assistance grants will give states more resources to help consumers get and keep health coverage — Affordable Care Act grants have saved consumers millions
  • Mar 19:   Health reform helps more than 5.1 million people with Medicare save over $3.2 billion:   Since enactment of the health care law, Medicare beneficiaries received average savings of $635 on prescription drugs
  • Mar 16:   Administration releases Advance Notice of Proposed Rulemaking on preventive services policy
  • Mar 16:   Affordable Care Act will ensure health coverage for millions of Americans
  • Feb 16:   HHS ensures consumers get better value for their health insurance dollar : Administration actions saved consumers up to $323 million
  • Feb 15:   Affordable Care Act extended free preventive services to 54 million Americans with private health insurance in 2011
  • HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT EFFORTS RESULT IN RECORD-BREAKING RECOVERIES TOTALING NEARLY $4.1 BILLION : Largest Sum Ever Recovered in Single Year

Medicare.gov
The Official U.S. Government Site for Medicare

Medicare.gov
CMS — Centers for Medicare & Medicaid Services — CMS News

Medicare Enrollment Information Sites

Medicare B specific:
IF YOU PLAN ON STILL WORKING and ARE NOT AUTOMATICALLY ENROLLED (sufficient work credits) in Medicare B at age 65, OR are not eligible for a special enrollment period due to group health insurance based on your own or your spouse's ACTIVE employment:
YOU MUST ENROLL IN MEDICARE B within the seven-month period beginning three months before and ending three months after the month of your 65th birthday, or face a possible penalty as well as a waiting period before Medicare B activates.
If you are already getting benefits from Social Security or the Railroad Retirement Board (RRB), in most cases, you'll automatically get Part A and Part B starting the first day of the month you turn 65.
If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.
You need to sign up for Medicare Parts A and/or B if:   You aren't getting Social Security or Railroad Retirement Board benefits automatically, or have not reached full retirement age —
You have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
For example, if you're eligible when you turn (65), you can sign up during the 7-month period that begins 3 months before the month you turn (65), includes the month you turn (65), and ends 3 months after the month you turn (65).
  •   Find out when you're eligible for Medicare — Medicare.gov page
Enrollment Between January 1 - March 31 Each Year
If you didn't sign up for Part A and/or Part B when you were first eligible, you can sign up during the General Enrollment Period between January 1 - March 31 each year.   Your coverage will start July 1.
However, you may have to pay a higher premium for late enrollment.
You can sign up for Medicare at your local Social Security Office.

Fight the Good Fight for Medicare & Social Security

Tell Washington you're not a pushover — Don't let them cut your Medicare and Social Security benefits.
The stakes are clear, and couldn't be higher:
"Supercommittee" members are considering proposals requiring cuts to Medicare and Social Security that would dramatically increase health care costs for seniors, threaten our access to doctors, and reduce the benefit checks we rely on to pay our bills.
Congress needs to hear from you.
Call AARP's toll-free number and be connected to your members of Congress — 1-888-722-8514

Massachusetts EOHHS/Medicaid
MA Draft Proposal to Integrate Care for Dual-Eligible Individuals

ALERT —MEDICARE is NOT calling anybody!!

Do NOT give your Medicare # or your social security # to anyone unless YOU have initiated the call!
If you feel that something is "not quite right" with a phone call, simply hang up.
We suggest you contact your local police department or town which may then initiate a 'reverse" 911 call (or internet email setup) that can inform people quickly throughout the community about this scam.
If you have any questions or concerns regarding Medicare, please call 1-800-MEDICARE (1-800-633-4223).
Courtesy:   Emmett Schmarsow, Prog. Mgr. COAs & Senior Centers, Elder Affairs

Advanced Beneficiary Notices — Medicare Manual

Mandatory ABNs can be found at 1862(a)(1)(P)
2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012
In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form.
Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version.   ABNs issued after Sun Jan 1 that are prepared using the 2008 version of the notice will be considered invalid by Medicare contractors.   2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term notification for repetitive services delivered for up to one year will remain effective for the length of time specified on the notice.
Information and a copy of the 2011 version of the ABN (form CMS-R-131) can be found online at http://www.CMS.gov/BNI, under the "FFS Revised ABN" link.

Medicare Preventive Services

CMS has posted 27 FAQs regarding preventive services for Medicare Fee-For-Service providers/suppliers to the Medicare Learning Networkฎ Products Preventive Services webpage;   to access the entire list of 27 FAQs, scroll to the "Related Links Inside CMS" section at http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and select "Preventive Services FAQs."

Revised Standard Pharmacy Notice for Pharmacies

Beginning with the 2012 plan year, each Part D plan sponsor must have a system in place that transmits codes to network pharmacies to instruct the pharmacies to provide a printed notice to enrollees when a prescription cannot be covered ("filled") under the Medicare Part D benefit at the point-of-sale (POS).   The printed POS notice will tell enrollees how to request a coverage determination by contacting the plan sponsor's toll free customer service line or by accessing the plan sponsor's Web site.

Congressional Budget Office Report

New CBO issue brief entitled "Spending Patterns for Prescription Drugs Under Medicare Part D".

MAP 2012 (and 2011) Original Medicare Out-of-pocket costs



Medicare Rights Center


The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

Medicare Interactive


You may know that November is National Family Caregivers Month.   The Medicare Rights Center has important guidance for anyone caring for a loved one with Medicare.   Visit our free, comprehensive online resource, Medicare Interactive, for answers about some of the most common concerns we hear from family members.
Pioneer Accountable Care Organization (ACOs) Model
Center for Medicare & Medicaid Innovation
Today, the Department of Health and Human Services announced that thirty-two leading health care organizations from across the country will participate in the Pioneer Accountable Care Organization (ACOs) Model.
Medicare Fact Sheet — The 2012 QMB, SLMB, and QI Programs
The Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs are federal Medicare Savings Programs (MSPs) which help low income elders and younger Medicare beneficiaries access Medicare benefits.
In Massachusetts, the programs are called MassHealth Senior Buy-In (for QMBs) and MassHealth Buy-In (for SLMBs and QIs).
Medicare Fact Sheet — 2012 Policies
CMS issues final 2012 policies for Medicare drug and health plans
Most policy and technical changes effective in 60 days
Medicare Watch — Latest Issue and/or Subscribe
  • (2012 Sep 06)   Medicare Rights Compiles "Five Medicare Questions for Candidates"
  • (2012 Aug 30)   Romney-Ryan Plan Increases Medicare Costs Now and in the Future
  • (2012 Aug 23)   Medicare Rights Releases New Fact Sheet
    ACA Strengthens Medicare and Improves Benefits for Those Enrolled
  • (2012 June 7)   New Report Underscores the Importance of Having Coverage for Accessing Needed Health Care
  • (2012 May 31)   Kaiser Releases Report on Geographic Differences Among Dual Eligible Populations
  • (2012 May 24)   GAO Finds Potential Savings in Medicare and Medicaid
  • (2012 Apr 12)   Medicare Moves Forward on Additional Accountable Care Organizations
  • (2012 Apr 05)  CMS Finalizes Plan Regulations and Guidance for 2013
  • (2012 Mar 22)  Proposed Budget Ends Medicare and Medicaid Programs As We Know Them
  • (2012 Mar 08)  Medicare Rights Submits Comments on 2013 Guidance to Medicare Private Health Plans
  • (2012 Feb 23)  CMS Releases Draft Guidance for Medicare Private Health and Prescription Drug Plans
  • (2012 Feb 16)  President Obama Releases Fiscal Year 2013 Budget, Including Changes to Medicare
  • (2012 Feb 09)  What Does Means-Testing Really Mean?   Debate Continues Over Preventing Cuts to Medicare Physician Payments
  • (2012 Feb 02)  New Guidance on State Option to Put Dual-Eligibles Into Managed Care
  • (2012 Jan 26)  Compliance Still an Issue for Medicare Advantage and Prescription Drug Plans
    According to a recent memorandum released by the Centers for Medicare & Medicaid Services (CMS), some Part C Medicare private health plans, also known as Medicare Advantage plans, and Part D Medicare Prescription Drug Plans are facing compliance issues.   The memo presents the findings of 11 program audits conducted by CMS in 2011 to monitor and improve plan compliance under the Part C and D programs.
  • (2012 Jan 19)  QMBs Protected from Balance Billing
    This month, the Centers for Medicare and Medicaid Services (CMS) released a new informational bulletin reminding state Medicaid agencies that those eligible for the Medicare Savings Program, Qualified Medicare Beneficiary, also known as QMB, cannot be "balance billed."   In most states, to qualify for QMB, an individual's income must be at or below 100% of the Federal Poverty Level (FPL).   In addition, while some states have eliminated asset tests, most states have asset limits that restrict eligibility.
  • (2012 Jan 12)  The Myth of the $247 Medicare Part B Premium
    Recently, Medicare beneficiaries have contacted the Medicare Rights Center with concerns about an e-mail circulating to the general public.   This e-mail falsely claims that the Medicare Part B premium will increase to $247 in 2014 as a result of the Affordable Care Act (ACA).
  • (2011 Dec 22)  Congress Seeks Compromise: Medicare Rights Offers Comments on Part C and D Rules
The Medicare Counselor — Latest Issue and/or Subscribe
  • Issue 6/3 (May-June 2012)
    How are immunosupressant drugs covered by Medicare?
    Understanding the Medicare Prescription Drug Coverage and Your Rights Notice
    PAST ISSUES:
  • Issue 6/1 (January-February 2012)
    What should I do if I can't access my Extra Help copays at the pharmacy?
    The Annual Wellness Visit
  • Issue 5/6 (November-December 2011)
    What are my options if my Part D plan consolidates or terminates?
    Medicare coverage of Mental Health Services in 2012
  • Issue 5/5 (September-October 2011)
    When will Medicare pay for ambulance transportation?
    How does Medicare cover vaccines?
  • Issue 5/4 (July-August 2011)
    Will Medicare cover drugs I take while in the hospital?
    How do I know if a drug is covered by Medicare Part B or Part D?
  • Issue 5/3 (May-June 2011)
    When will Medicare cover home healthcare?
Dear Marci Newsletters — Latest Issue and/or Subscribe
    • Will Medicare cover my flu shot?
  • Issue 11/14 (2012-07-02)
    • Dear Marci: When is Medicare primary?
    • Get Resources: Learn more about Medicare coordination of benefits
  • Issue 11/12 (2012-06-04)
    • Dear Marci: How can I get Extra Help to help me with my drug costs?
    • Get Resources: Learn more about how Extra Help helps with Part D costs.
  • Issue 11/11 (2012-05-21)
    • Dear Marci: Does Medicare cover insulin?
    • Get Resources: Learn more about diabetes coverage.
  • Issue 11/1 (2012-01-2)
    • Dear Marci: Can I switch from a Medicare Advantage plan to Original Medicare?
    • Get Resources: Learn more about Medicare enrollment periods in 2012.
  • Issue 10/18 (2011-8-29)
    • Dear Marci: How do I appeal a denial from Original Medicare?
    • Get Resources: Learn more about Medicare appeals.
    • Survey Says: Heart health may be linked to mental health.
  • Issue 10/13 (2011-6-20) — Billing
    • Dear Marci: Can my doctor bill me up front?
    • Get Resources: Learn more about Medicare billing

Center for Medicare Advocacy   &   CMA Alerts

CMA Advocates Homepage

2012 Medicare Part D Cost Sharing — preliminaryThe Affordable Care Act includes a provision establishing a Center for Medicare and Medicaid Innovations (CMMI) that is authorized to test models to reduce Medicare and Medicaid expenditures while preserving or improving quality for beneficiaries of those two programs.   The provision includes appropriations of $5 million for fiscal year 2010 and $10 billion for fiscal years 2011 through 2019.The Medicare Trustees issued their annual report on Medicare's financial status on Friday, May 13, 2011.
Medicare Facts & Fiction — Quick Lessons to Combat Medicare Spin
We Can Fix Medicare AND the Deficit — Our Six Point Plan
CMA ACTION Alerts Page
  • Rep. Ryan's Medicare Plan: D้jเ Vu (Again) (2012 Mar 20)
    The House Republican's budget and Medicare proposals are out today... and we've heard this before.   The language has changed, but the impact on Medicare is the same -- shifting huge costs to older and disabled Americans and their families while lining the pockets of private insurance corporations.   Make your voice heard now -- contact your Senators and Representatives and say NO!
  • Ryan-Wyden: Wolf in Sheep's Clothing (2011 Dec 16)
    Have you heard?   This week, Rep. Paul Ryan (R-WI) and Sen. Ron Wyden (D-OR) outlined yet another effort to privatize Medicare; a twist on Rep. Ryan's voucher plan from earlier this year.
  • End "Observation Status!" (2011 Oct 21)
    Tell Your Members of Congress that you Support the Improving Access to Medicare Coverage Act of 2011
If someone you know has been denied Medicare because a condition is not showing "improvement," coverage is being unfairly denied. The Center for Medicare Advocacy is working to eliminate this unfair standard.   Contact us today:   improvement@medicareadvocacy.org
CMA Alerts Page
(Check this page for Past & Current Alerts)
Recent CMA Alerts
  • Settlement Reached to End Medicare's "Improvement Standard"
    Under the Jimmo settlement, the Center for Medicare Advocacy and Vermont Legal Aid will be monitoring compliance with the terms of the settlement.   Please keep us informed of your experiences, both positive and negative.
    Why the Jimmo Case Matters:   An Improvement Standard Story
  • How the Ryan Budget (and Republican Platform) Would Hurt Current Nursing Home Residents
    Both the Ryan Budget and the Republican Platform purport not to affect current Medicare beneficiaries. But the truth is that for current Medicare beneficiaries who live in nursing facilities, the overwhelming majority of whom rely on the Medicaid Program to help pay for their nursing home care, the impact of the Ryan Budget and the Republican Platform would be immediate and devastating.
  • We Don't Need the Ryan Plan — Medicare Is Not Going Broke
  • Increased Funding for AIDS Drug Assistance Program Responds to Need for Additional HIV/AIDS Services
    On July 19, 2012, the Secretary of Health & Human Services (HHS), Kathleen Sebelius, announced the availability of roughly $80 million dollars in grant money to increase access to HIV/AIDS care, including eliminating waiting lists, which have been a challenge in operating the Aids Drug Assistance Program.
  • Brown University Confirms Observation Continues to ReplaceHospital Admission Status
    Since 2008, the Center for Medicare Advocacy (the Center) has been reporting that an increasing number of Medicare beneficiaries are being placed in acute care hospital beds for multiple days -- receiving medical and nursing care, diagnostic tests, treatments, medications, and food -- but are being called "outpatients" in observation status, rather than admitted "inpatients."
  • COBRA and Medicare, Part II
  • Medicare Under Threat: Health Reform Versus the Ryan Budget
  • Health Care Reform on Trial
  • Happy Anniversary, Health Care Reform
    To celebrate ACA's anniversary, we review significant improvements the law has made in expanding consumer access to healthcare and in promoting policies that improve the health care system in general.   We then consider specific ways in which the law is strengthening and improving Medicare, improvements that would be lost by the repeal of the law or by the enactment of various deficit reduction proposals currently under discussion.
  • Congressional Subcommittee Examines Issues of Dental Health
  • CMS Issues Final Version of New Medicare Part D Pharmacy Notice
  • Reducing Rehospitalizations... The Right Way
  • Medicare General Enrollment Ends March 31st:
    An Opportunity for Some Individuals and States to Expand QMB Coverage
  • The President's Proposed 2013 Budget: Impact on Medicare
  • Investing in Our Future: Strengthening Medicare for 2012 and Beyond
  • CMS Issues Final Version of New Medicare Part D Pharmacy Notice
  • Reminder: Medicare Advantage Enrollees Have Until February 14th to Disenroll From Their Plan
  • 2012 Poverty Guidelines: How Poverty Levels Affect Eligibility for Many Federal Public Benefit Programs
  • Center for Medicare Advocacy Files Amicus Brief In Support Of the Affordable Care Act
  • The Medicare Advance Beneficiary Notice of Non-Coverage (ABN): A Tool for Limiting Beneficiary Liability
  • Medicare Cost-Sharing for Qualified Medicare Beneficiaries:Balance Billing is Prohibited.   Period
  • Voluntary Nursing Home Improvement Campaign Does Not Work:   Nursing Facilities Participating in Advancing Excellence Still Among Worst Performers
  • New Medicare Part D Pharmacy Notice Rule In Effect; Stay Tuned for Final Model Notice
  • Ryan-Wyden: Wolf in Sheep's Clothing
    Have you heard?   This week, Rep. Paul Ryan (R-WI) and Sen. Ron Wyden (D-OR) outlined yet another effort to privatize Medicare; a twist on Rep. Ryan's voucher plan from earlier this year.
  • Payroll Tax Extension Includes Important Provisions for Medicare Beneficiaries
  • Special Focus Facility Study: Nursing Facilities' Self-Regulation Cannot Replace Independent Surveys
  • Center Attorney Toby Edelman Testifies at Senate Aging Hearing About Overuse of Antipsychotic Drugs in Nursing Facilities
  • Forcing Dual Eligibles Into Private Health Plans is No Quick Fix
  • Supercommittee Fails to Reach an Agreement
  • You CAN Leave the Nursing Home (for Thanksgiving and Holidays)
  • The President's Plan for Economic Growth & Deficit Reduction: A First Look at the Impact on Medicare
  • Preserving Access to Necessary Care: Ending "Observation Status"
  • Hospice -- Care When It's Needed Most


National Senior Citizens Law Center (NSCLC)


Table Helps Calculate Medicaid Eligibility Under Pickle Amendment

Social Security announced this fall for the first time since 2009 that there will be a cost of living adjustment in Social Security and SSI benefits effective January 1.
This adjustment will affect the calculation of Pickle Amendment eligibility for Medicaid in 2012.
Gordon Bonnyman of the Tennessee Justice Center updated this table and instructions that enables advocates to calculate Medicaid eligibility under the Amendment quickly and simply.
Download the Table

NSCLC Advocate Alerts

CMS Releases Community First Choice Option Final Regulations;   But Seeks More Input on When Housing is "Community-Based"

•   A Helpful Advocacy Tool:   CMS Memoranda on Balance Billing Protections for Qualified Medicare Beneficiaries

For Part D Advocates
Due to a coding error, CMS will be conducting a secondary reassignment of certain beneficiaries eligible for the Part D low-income subsidy (LIS) in late November.   This reassignment will move beneficiaries who are currently enrolled in de minimis plans and should have been reassigned as a part of our annual reassignment process in October.
CMS will mail reassignment notices (printed on blue paper) to the affected beneficiaries in early December.
CMS will mail a second blue letter to these beneficiaries in January.
This second notice will identify which drugs in their current drug regimen are on the formulary of the 2012 plan to which they are being reassigned, and how to request an exception or appeal, or file a grievance.•   QMB Program Needs Fixes to Operate Effectively

NSCLC Health Network Alerts

  • CMS Approves $26.5 Million to New Hampshire to Increase Access to Community-Based Care

NSCLC Monthly Webinars

This Webinar is free and part of a monthly Webinar series presented by the National Senior Citizens Law Center.
Title:   Improving the Qualified Medicare Beneficiary Program for Dual Eligibles
Date:   Wednesday, November 16, 2011
Time:   11 AM - 12 PM Pacific / 2 PM -3 PM Eastern
Register:   https://www3.gotomeeting.com/register/635597582

NSCLC News Articles:


•   Dual Eligibles Receiving Medicaid HCBS Services Now Have Zero Part D Copayments Under ACA
•   Mandatory Managed Care for Dual Eligibles Could Harm Patients and Stifle Innovation
•   Medical Health Plans of America — Letter to Washington
•   AHIP Proposal: Achieving Medicare/Medicaid Integration for Dually Eligible Beneficiaries
•   Medicare Part D LIS recipients may be getting their LIS rider late this year
•   Dual Eligibles Encounter Problems Accessing Needed Benefits (2011/07/15)
•   Consumer Protection for Dual Eligibles Important in New Integrated Care Models (2011/07/13)



Centers for Medicare & Medicaid Services — CMS News

MEDICARE PREMIUMS AND DEDUCTIBLES FOR 2012

FACT SHEET — 2011 October 27

CMS News & News Releases

      CMS Current News Release Page
(See Recent Articles Below.)

SHIP Navigator Newsletter

National SHIP Resource Center Reintroduction
At the start of the new fiscal year, we here at the National SHIP Resource Center thought it might be helpful to reintroduce ourselves and explain just who does what — especially for those who may be new to the SHIP network.
Latest edition available only through subscription.   Subscribe to E-Letter:   Subscribe
Last previous issue (in left-hand page navigation panel):

CMS Bulletin Updates

The CMS National Medicare Training Program

The CMS National Medicare Training Program On-line Training Library
The CMS National Medicare Training Program On-line Training Library has been updated with 2012 Medicare premium and deductible rates and information.
Please visit the 2012 Premium & Deductibles Page in the Training Library to access the 2012 Medicare rates, recent press release, comprehensive fact sheet, and web resources.
These documents will help you as you counsel people with Medicare to help them make good health care choices.
New Materials available for download
5-Star Plan Ratings
Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans.

Miscellaneous Medicare Part D Publications for 2012

For Part D Advocates 2011-2012
Due to a coding error, CMS will be conducting a secondary reassignment of certain beneficiaries eligible for the Part D low-income subsidy (LIS) in late November.   This reassignment will move beneficiaries who are currently enrolled in de minimis plans and should have been reassigned as a part of our annual reassignment process in October.
CMS will mail reassignment notices (printed on blue paper) to the affected beneficiaries in early December.
CMS will mail a second blue letter to these beneficiaries in January.
This second notice will identify which drugs in their current drug regimen are on the formulary of the 2012 plan to which they are being reassigned, and how to request an exception or appeal, or file a grievance.

Medicare Learning Matters (MLM) — Medicare Learning Network (MLN)

American Sign Language (ASL) Video on Medicare

Today, the Centers for Medicare & Medicaid Services (CMS) released an educational video in American Sign Language (ASL) to provide important information about the Medicare program to people who are Deaf or hard of hearing.
The video consists of an overview of the Medicare program, including what Medicare is, who qualifies, the four parts of Medicare (A, B, C, and D), new preventive services under the Affordable Care Act, and help paying Medicare costs.
The video will be available on Medicare.gov, cms.gov and the CMS YouTube channel.
To access go to http://www.youtube.com/watch?v=eskZVAg7v0o.
To download, go to http://downloads.cms.gov/media/video/ASLOverview.mp4.
ABCs of the Initial Preventive Physical Exam and Annual Wellness Visit
Materials from Thu July 21 "ABCs of the Initial Preventive Physical Exam and Annual Wellness Visit" National Provider Call Now Available.
Annual Reassignments for certain Low Income Subsidy (LIS) Eligible Individuals
This CMCS Informational Bulletin is to inform you that in June, the Centers for Medicare & Medicaid Services (CMS) started the process of annual reassignments for certain LIS-eligible individuals and issued a June 29, 2011, Informational Bulletin laying out the steps in that process. This is the second of two Bulletins about this process for 2011. This Bulletin provides an update on the next steps in the process to ensure that States understand their role in ensuring that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under the Medicare Part D prescription drug benefit.
Medicare Preventive Care Benefits
A word of caution about the wellness benefit.   The wellness visit must be coded appropriately by the provider as a wellness visit not as a routine annual physical or it will be denied, and there are still costs for some screenings.   Attached is a brochure that the AMA has provided to physicians to assist in answering patient questions and a document from NCOA that spells out the benefits and contains additional links.
Courtesy — Cynthia Phillips

HHS News Releases

      HHS Current News Release Page

Health Reform to Require Insurers to Use Plain Language in Describing Health Plan Benefits, Coverage

CMS News & News Releases

      CMS Current News Release Page

(10-25)   People with Medicare Save $4.8 Billion on Prescription Drugs Because of the Health Care Law
Over 20.7 million with Medicare also receive free preventive services in the first nine months of 2012
(08-20)   People with Medicare Save Over $4.1 Billion on Prescription Drugs thanks ot the Health Care Law
18 million with Medicare also receive free preventive services in the first seven months of 2012
(04-02)   CMS makes improvements to Medicare drug & health plans
Rate Announcement & Call Letter address 2013 payments & other program updates
Final rule strengthens beneficiary protections, codifies coverage gap discount program
(03-07)   Medicare redesigns claims and benefits statement
Empowers seniors with clear information on health care services used
(02-24)   CMS TAKES STEPS TO REDUCE IMPROPER PAYMENTS AND SAVE MONEY FOR MEDICARE
(02-07)   CMS gives consumers access to more details about infection rates at America's hospitals
New data will save lives, cut costs
(12-19)   Affordable Care Act helps 32 health systems improve care for patients, saving up to $1.1 billion
Leading health care providers will be Pioneer Accountable Care Organizations
(12-19)   Pioneer Accountable Care Organization Model: General Fact Sheet
(12-16)   HHS to give states more flexibility to implement health reform
Approach will help ensure consumers have quality, affordable coverage starting in 2014
(12-15)   CMS announces first results for program to improve care for dialysis patients
(12-05)   Medicare Gives Employers, Consumers Information to Make Better Health Care Choices
Health care law will allow patients to compare options, find best value
(11-30)   Medicare Expanding Competitive Bidding Program to Save Billions
Program Expanded by Affordable Care Act
(06-30)   Affordable Care Act cuts health care red tape, saves $12 billion
(06-28)   Affordable Care Act Delivers Cheaper Prescription Drugs to Nearly 500,000 People
Thanks to the Affordable Care Act, nearly 500,000 people with Medicare Part D who reached the gap in coverage know as the "donut hole" have received an automatic 50% discount on their covered brand name prescription drugs.
(06-22)   Up to $500 million in Affordable Care Act funding will help health providers improve care
Partnership for Patients announces Federal contracting opportunities
(06-20)   More people with Medicare receiving free preventive care
New CMS campaign to educate seniors about new free preventive care provided by Affordable Care Act

CMCS is pleased to announce today the release of a State Medicaid Director's letter regarding Same Sex Partners and Medicaid Liens, Transfers of Assets, and Estate Recovery.   The purpose of this letter is to ensure that States are informed of the existing options and flexibilities in setting their Medicaid eligibility policy.   Specifically, the letter advises States of existing choices and options regarding spousal and domestic partner protections related to liens, transfer of assets, and estate recovery.CMS PROPOSES TO EXPAND ACCESS TO SEASONAL INFLUENZA IMMUNIZATION Proposed Requirement Would Make Flu Shots Available to Patients at Most Commonly Visited Medicare-certified Health Care Facilities.

KAISER FAMILY FOUNDATION REPORTS

Kaiser Family Foundation Resources on Deficit-Reduction Plans

With Congress' debt-reduction Super Committee facing a Wednesday deadline, the Kaiser Family Foundation has compiled a number of its resources that shed light on how the ongoing national debate about deficit reduction may affect Medicare, Medicaid and other health-care programs.
The resources include summaries and comparisons of relevant elements of major deficit-reduction plans, analyses of specific savings proposals, and explanatory briefs and backgrounders describing key issues related to the debate.   All can be found online at http://www.kff.org/medicare/Medicare-Medicaid-Deficit-Resources.cfm
Medicare Advantage Fact Sheet — Update
Brief Compares Medicare Premium Support Proposals
A new Kaiser Family Foundation brief provides a side-by-side comparison of recent proposals to transform Medicare into a premium support program and slow the growth in Medicare spending.
Briefs Provide Updated Data About People Who are Dually Eligible For Medicare & Medicaid

Kaiser Health News

http://www.kaiserhealthnews.org/

Recent Kaiser Reports


Medicare Remains Less Generous Than Large Employers Plans Despite Improved Drug Benefits — Study

Public opinion data from the Kaiser February 2012 Health Tracking Poll, which probes the public's views on Medicare premium-support proposals, including options similar to the Wyden-Ryan plan. The poll also tests arguments for and against such changes and includes breakouts by age and party affiliation - Public Opinion data

An analysis of the impact on Medicaid enrollment and state spending of the Medicaid block-grant proposal as outlined in the fiscal year 2012 House Budget Plan. The fiscal year 2013 budget plan revives this proposal - Analysis

Polling data from the May 2011 Kaiser Health Tracking Poll examining the public's views on the idea of converting Medicaid to block grant financing to reduce the federal deficit - Polling Data

An issue brief examining the broad implications of converting Medicaid to block grant financing for states, localities, beneficiaries and health-care providers - Issue Brief

A brief examining issues around the Independent Payment Advisory Board, created under the 2010 health reform law, which would be repealed under the new fiscal year 2013 budget plan - http://www.kff.org/medicare/8150.cfm>Brief

Proposals to raise premiums for higher-income Medicare beneficiaries are currently being discussed along with other options to reduce federal spending on Medicare. — New Analysis Examines Implications of Proposals to Raise Medicare Premiums for More Beneficiaries

Two New Reports Examine 2012 Medicare Advantage Plan Options and Premiums and the Quality-Based Star Rating System To Be Used for Bonus Payments in 2012A Quarter Of Medicare Drug Plans Get Poor Ratings — Report

New Rule Targets Poor Performers In Medicare Advantage, Part D Program
The Centers for Medicare and Medicaid Services unveiled a rule Monday that would allow the agency to drop plans that fail for three years to earn at least three stars under a five-star rating system. — Poor Performers — New Rule

Data Spotlight and Report Examine Medicare Drug Benefit's Coverage Gap
A new data spotlight and report from the Kaiser Family Foundation reviews how the coverage gap in Medicare's drug benefit known as the "doughnut hole" is working, with updated data and new analysis. — Data Spotlight   and   Report

Raising Medicare's Age of Eligibility to 67 Would Achieve Significant Savings,
But Shift Costs To 65- and 66-Year-Olds, Other Individuals, Employers and Medicaid, New Analysis Shows.
Courtesy Diane Paulson, Medicare Advocacy Project, 197 Friend Street, Boston MA
New Analysis Estimates Impact of Medigap Reforms On Medicare Spending and Out-of-Pocket Costs — 2011 July 20
A new analysis, http://www.kff.org/medicare/8208.cfm, commissioned by the Kaiser Family Foundation examines three potential Medigap reforms, including one that is similar to a recommendation of the National Commission on Fiscal Responsibility and Reform (known as the Bowles-Simpson Commission).   The analysis estimates that the three options could save between $1.5 billion and $4.6 billion in Medicare spending in a single year.

Additional Resources


Families USA

Share the News:   New Preventive Services for Medicare
These new benefits will only be effective if seniors and people with disabilities understand their new rights.

Medicare Part D, "Donut Hole" News

The Good News:   The Medicare Part D "donut hole" is closing.
The Bad News:   Not until the year 2020.
This is where Prescription Advantage can help.

— 2010 —


Harvard Pilgrim Has Cancelled Its Medicare Advantage Plan
As you can see from the article below, HPHC has cancelled its Medicare Advantage plan.   According to the report they are instruction the 22,000 individuals that they can pick up the HP supplemental plan.   Please note -- this supplemental plan does not include prescription drug coverage.   These individuals will need to also purchase a prescription drug supplemental plan.   I suspect each/all of you may get calls on this or related matters as the open enrollment period approaches. — Jessica Costantino, AARP
Medicare Open Enrollment 15 November 2010
Medicare Prescription Drug (Part D) Plans and Medicare Advantage Plans change every year.   Many plans will no longer be available in 2011.
Don't give your personal information to anyone who calls you about the $250 rebate check!
Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this.
TTY users should call 1-877-486-2048.
For further information regarding "Donut Hole" concerns, please contact:
Cynthia Phillips, State SHINE Director, Executive Office of Elder Affairs, Suite 517, One Ashburton Place, Boston, MA 02108
Phone: 617-222-7416 — Fax: 617-727-9368 —   Email: Cynthia.Phillips@state.ma.us
Medicare Update:   Medicare & The New Health Care Law — What it Means for You.   Many Medicare Beneficiaries to receive $250 check.
Medicare beneficiaries will soon receive information in the mail about the immediate benefits they may see from the new the Affordable Care Act.   The first benefit that several million Medicare beneficiaries will receive is a one-time check for $250, if they enter the Part D donut hole and are not eligible for Medicare Extra Help.   The donut hole, or coverage gap, is the period in the prescription drug benefit in which a beneficiary pays 100 percent of the cost of their drugs until they hit the catastrophic coverage.   Next year, all beneficiaries who enter the gap will get a 50 percent discount for covered brand name Part D drugs.   Also beginning next year, Medicare beneficiaries will get preventive care services like colorectal cancer screening and mammograms without cost-sharing, in addition to an annual wellness visit.   A fact sheet about Medicare and the new health care law is available in English and Spanish.
This information has recently been updated, and can be read by visiting this link:   http://www.disability.gov/health/health_insurance/medicare
Paul J. Lanzikos, Executive Director, North Shore Elder Services, 152 Sylvan Street, Danvers, MA 01923-3568 978/624-2245 — 978/624-2244 (TTY)

Kaiser Family Foundation's analysis of how the health care bills in Congress affect the Medicare and Medicaid programs

Medigap Training Outline
The Centers for Medicare and Medicaid Services has published an informative training document on Medigap insurance.
Medicare's Role for Women — Kaiser Family Foundation

What is Medicaid?   A brief primer dealing with health care reform





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    Phone:   413-527-6425       Fax:   413-527-7138

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