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A Word from the Executive Director

As you will see in this issue, Center staffers have been busy this month testifying before Congress and meeting with lawmakers and policy leaders to educate them about issues affecting access to health care for older people and people with disabilities. This CMA Community News highlights just a few of the many ways the Center continues to be a voice to counter  the extensive misinformation that threatens to weaken the Medicare program and hurt those it serves. 

Moving forward, the CMA Community News will be sent out every other month, making way for our new Bi-Monthly Health Care Policy e-Alert.  This new publication for our CMA Community members will include regular briefings from our Washington, DC staff summarizing the complex world of health care policy and legislation in common sense language.  If you haven't already joined, Community Membership starts as low as $25 a month—Don’t miss out, join us today!  For more information, visit www.MedicareAdvocacy.org/membership.

As always, thank you for helping us keep Medicare strong.

Judith Stein

News You Can Use

  • Executive Director Judith Stein Discusses the Improvement Standard in the New York Times

Excerpts from the May 29 article by Ann Carrns:

For years, some people on Medicare had difficulty getting insurance coverage approved for physical therapy, occupational therapy and other treatments… “They’d get denied because they weren’t improving, or because they had plateaued,” said Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit consumer group.

That is changing, as a result of a 2013 settlement of a lawsuit that the Center and others brought … The suit claimed that Medicare billing contractors were inappropriately denying coverage for "skilled" care by applying an "improvement" standard as a rule of thumb.

Because of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, "coverage cannot be denied based on the absence of potential for improvement or restoration." The update applies to therapy provided in nursing homes, in outpatient clinics and at home.

However, Ms. Stein said, the Center is still hearing from patients who say they are facing hurdles in getting maintenance treatment. "A lot of providers don’t know about the change," she said, or they remain skeptical that such care will be covered.  Read more.

Individuals and organizations interested in more information and access to the attorneys behind the settlement can register – for a per-site fee – for our upcoming webinar:  Jimmo v. Sebelius Improvement Standard Updates.

  • "Observation Status" Can Mean Extra Work to Get the Medications You Need

When a patient is in outpatient observation status at a hospital, Medicare Part B is billed, and pays for, 80% of the hospital services provided (Part A pays for inpatient hospital admissions). However,  prescription drugs received in the hospital while a patient is in observation status are not billed to Part B. Instead, the patient must submit a claim to his/her outpatient drug plan, usually a Medicare Part D plan, to receive reimbursement for these drugs.  Read more.

  • Remember, You or Your Loved Ones CAN Leave the Nursing Home

Spring and Summer are often a time for gatherings with family and friends – graduations, weddings, holidays and more. Nursing home residents who want to participate in these gatherings may worry that they will lose Medicare coverage if they leave the facility to join their families.  Residents and their families and friends can put their minds at ease about this. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage. However, depending on the length of their absence, beneficiaries may be charged a "bed hold" fee by their skilled nursing facility (SNF).  Read more.

Legislative Update

  • Little-Known Trade Deal Will Impact Medicare Drug Pricing in a Big Way

The Trans-Pacific Partnership (TPP) — a trade agreement that the United States and 11 other Pacific-rim countries are negotiating — threatens to make prescription drugs less affordable for consumers and taxpayers.  The Center recently joined with ten other organizations, including the Center on Budget and Policy Priorities, AARP and Consumers Union, to express our concerns to the Office of the U.S. Trade Representative.  Read more on the CBPP website.

  • Bill Introduced to Ensure Equality Under Social Security for Same-Sex Spouses

On May 8, 2014, Sen. Patty Murray (D-WA) and Sen. Mark Udall (D-CO) introduced a bill called the Social Security and Marriage Equality (SAME) Act of 2014, which would ensure that all same-sex spouses receive equal treatment under the Social Security Act when applying for Social Security benefits, regardless of where they live. Read more.

CMA in the Community

  • Executive Director, Judith Stein, presented at the Kaiser Family Foundation’s Briefing: How Well Are Seniors Making Choices Among Medicare's Private Plans And Does It Matter?
  • The National Academy of Elder Law Attorneys (NAELA) proudly announced that Alfred J. Chiplin, Jr., JD, MDiv, CPE, and Bethany J. Lilly, Esq. are the recipients of the 2014 John J. Regan Writing Award, presented annually to the best original article published in NAELA Journal the previous year.   Chip and Bethany won for their article, “Medicare’s Future: Letting the Affordable Care Act Work, While Learning From the Past,” published in NAELA Journal, Volume 9, Number 1, Spring 2013. Bethany co-authored the article while a law graduate fellow in the Center's Washington, DC office.
  • Senior Policy Attorney Toby Edelman testified about Observation Status before the House Ways and Means Committee.
  • Associate Director, Kathleen Holt, and Development Director, Scott Perkins, joined ALS advocates and family members for the 2014 National ALS Advocacy Day and Public Policy Conference in Washington, DC.  

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