Posts Tagged ‘Center for Medicare Advocacy’

Federal Commission on Long-Term Care Holds First Meeting

July 3, 2013

On June 27, 2013, the Federal Commission on Long-Term Care held its first meeting in Washington, DC. The bi-partisan commission of 15 appointees, including Center for Medicare Advocacy Executive Director Judith Stein, was created by the American Taxpayer Relief Act of 2012 (the so-called “fiscal cliff” bill). The Commission is tasked with developing “a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals in need of such services and supports…” Under the current timeline outlined by statute, the Commission must complete its work in September 2013. (more…)

Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

June 25, 2013

By Susan Jaffe, Kaiser Health News

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage – unless the problem got worse, in which case the treatment could resume.

This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage. (more…)

Few Seniors Complain About Medicare Denials

December 20, 2012

By Susan Jaffe, Kaiser Health News

Dan Driscoll used to be a smoker. During a regular doctor’s visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, had the test done and was surprised when he got a bill from Medicare for $214.Based on everything he had read from Medicare, he was sure this was a covered service. So Driscoll did something that seniors rarely do: He filed an appeal.Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed. (more…)

Medicare “Improvement Standard” No Longer Impedes Home Care

November 20, 2012

By Alicia Gallegos, American Medical News

Physicians are applauding a landmark settlement that will prohibit Medicare contractors from denying health coverage based on a patient’s potential for improved health status.

The agreement, which a federal judge must approve, is the result of a legal challenge by patients accusing the Centers for Medicare & Medicaid Services of using an “improvement standard” to measure a patient’s need for skilled home health care. Doctors and patient advocates said the standard has resulted in denials for necessary therapy and other home services for patients with chronic health conditions such as Parkinson’s disease, Alzheimer’s and multiple sclerosis. (more…)

Vermont Woman Was the Lead Plaintiff in National Class Action Lawsuit Against Medicare

October 29, 2012

By Andrew Stein, The Vermont Digger

Glenda and Dennis Jimmo. Photo by Andrew Stein

When 76-year-old Glenda Jimmo of Lincoln was denied Medicare coverage for home nursing services, the blind and diabetic mother of four said she felt it was an injustice.

With only one leg and one toe remaining, Jimmo became the lead plaintiff in a class action suit against the federal Department of Health and Human Services. Last week, both parties agreed to a proposed settlement, which could open the doors for thousands of the nation’s elderly to receive nursing services based on need rather than the potential for health improvement. (more…)

Settlement Eases Rules Regarding Medicare Home Health Patients

October 23, 2012

By Robert Pear, The New York Times

WASHINGTON — Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration. (more…)

NY Times: With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost

September 10, 2012

By Nina Bernstein, The New York Times

Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.

With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way. (more…)