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Medicare

CMS To Extend Existing Duals Demos, Invites Other States To Join

By | Health Care, IN THE NEWS, Medicaid, Medicare

Inside Health Policy (April 24, 2019)

The Centers for Medicare and Medicaid Services (CMS) has invited states that aren’t currently participating in the duals demonstration to talk with the agency about starting their own version, whether through the capitated financial alignment model, the managed fee-for-service model or some other state-specific model worked out with the agency. CMS also said it plans to allow states that are already in the demonstration to make some changes, if necessary, or to extend the ongoing-demo for multiple years. Justice in Aging attorney Georgia Burke was interviewed for the article and noted that she’s happy CMS intends to work with states to continue the ongoing demonstrations and hopefully drawing on lessons learned for new states to incorporate in their demos. She also praised CMS for encouraging multiple models, and touted CMS’ emphasis on stakeholder involvement and beneficiary protections. She also noted that passive demonstration enrollment and locking in participation are not a good idea because consumer choice is important. Justice in Aging will be looking for beneficiary ombudsman programs to be included in new demonstrations. This article is unavailable online. This is a summary.

Fact Sheet: CMS Regulations Set Ground Rules for D-SNP

By | DUAL ELIGIBLES, FACT SHEET, Health Care, Medicaid, Medicare, REPORTS

The Centers for Medicare and Medicaid Services (CMS) recently finalized rules implementing regulations governing minimum integration standards for Dual Eligible Special Needs Plans (D-SNPs) pursuant to the Bipartisan Budget Act of 2018. D-SNPs are Medicare Advantage plans that limit enrollment to individuals who are dually eligible for Medicare and Medicaid. With the permanent authorization of D-SNPs, we expect to see an increase of D-SNPs entering the market across the country.

Justice in Aging has analyzed the new regulations and created a new factsheet summarizing the major integration requirements including special considerations for advocates.

Issue Brief: Older Immigrants and Medicare

By | Health Care, Health Care Defense, ISSUE BRIEF, Language Access, Medicare

Accessing the Medicare program as an older immigrant can be a complex and confusing process – especially when an immigrant is not a citizen, has limited work history, and limited English proficiency. Justice in Aging’s new issue brief, Older Immigrants and Medicare, is intended to provide advocates who work with older immigrants a summary of the policies and practices to help immigrants enroll in and pay for Medicare coverage.

The issue brief specifically covers the following topics and includes numerous hypothetical examples to illustrate the myriad of rules and scenarios older immigrants face when attempting to access Medicare:

  • Eligibility and enrollment, with particular attention to rules affecting non-citizens
  • Help paying for coverage
  • Post-enrollment issues potentially affecting immigrant beneficiaries
  • Language access rights and resources in Medicare

A Dental Benefit in Medicare: Examining the Need in California

By | CA Health Network Alert, IN THE NEWS, Medicare, Oral Health

California Dental Association: A Dental Benefit in Medicare: Examining the Need in CA (copyright April 2019)

Justice in Aging’s Executive Director Kevin Prindiville and Director of Health Team Amber Christ co-authored this paper that discusses the oral health care need of California’s older adults. Lack of access to affordable and comprehensive dental coverage has resulted in California’s older adults having a high prevalence of oral disease. The addition of a comprehensive dental benefit to Medicare Part B would help lower the rates of oral disease.

CMS Considering Regulation For D-SNP Look-Alike Plans

By | Health Care, IN THE NEWS, Medicaid, Medicare

Inside Health Policy (April 3, 2019)

The Centers for Medicare and Medicaid Services (CMS) is considering regulating duals special needs plan look-alikes because they get in the way of state efforts to integrate Medicaid and Medicare services through Medicare-Medicaid Plans or D-SNPs and are confusing for beneficiaries. The agency asked for advocates’ feedback on the impact of the D-SNP look-alikes—which don’t have to follow D-SNP requirements—on integration, beneficiary choice, competition, state Medicaid policy and other areas.

In a call letter CMS said state commenters were unanimous in saying that D-SNP look-alikes get in the way of the comments reinforce that the proliferation of D-SNP look-alike plans impedes progress toward developing products that meaningfully integrate Medicare and Medicaid benefits for dually eligible individuals. Justice in Aging attorney Georgia Burke was interviewed for the article and said, “we are pleased CMS has identified that the look-alikes are impeding progress toward integrating Medicare and Medicaid benefits and we hope CMS moves quickly to rein in the look-alikes.”

Lawsuit over observation status, SNF payment finally going to trial

By | IN THE NEWS, LITIGATION, Medicare

McKnight’s Long-Term Care News: Lawsuit over observation status, SNF payment finally going to trial (March 29, 2019)

A lawsuit, co-counseled by Justice in Aging, may go to trial which could have significant implication for providers and patients. The lawsuit involves a group of individuals having to pay out of pocket for skilled nursing facility care because Medicare would not cover it. The patients received needed care but were classified as under “observation status” and were not formerly admitted as inpatients resulting in large medical bills.

Issue Brief: Creating an Oral Health Benefit in Medicare

By | ISSUE BRIEF, Medicare, Oral Health, REPORTS

Fewer than half of older adults have access to oral health care each year. One in five older adults has untreated tooth decay and 70 percent have gum disease. Poor oral health and lack of access to health care are even more acute for low-income seniors, seniors of color, and rural seniors. Because oral health is an integral part of overall health and untreated dental problems can cause and/or exacerbate other serious health issues, it is critical to expand older adults’ access to oral health care.

Because all older adults rely on Medicare for their health care needs, integrating oral health benefits into Medicare Part B is the most effective way to deliver comprehensive benefits to all Medicare beneficiaries. Justice in Aging’s statutory analysis shows how such a benefit could be structured and where statutory language could be changed to accommodate such a benefit.

Read the Brief

Fact Sheet: Medicare Plan Enrollment Changes for Dual Eligibles and Low-Income Subsidy Recipients in California

By | CA Health Network Alert, FACT SHEET, Health Care, Medicaid, Medicare

The Centers for Medicare and Medicaid Services (CMS) issued new rules that limit enrollment and disenrollment from Medicare Advantage and Part D prescription drug plans for low-income Medicare beneficiaries. Previously, dual eligibles – individuals with Medicare and Medi-Cal coverage – and beneficiaries who receive the low-income subsidy (LIS) to make Part D prescription drug coverage more affordable could make enrollment changes any time throughout the year. The new rule, which became effective January 1, 2019, limits enrollment changes to once per quarter.

Justice in Aging has created a factsheet that explains these changes in detail and how they impact low-income Medicare beneficiaries in California.

Report: Older Women & Poverty

By | Economic Security, Health Care, Health Care Defense, Health Disparities, Health Equity, Long Term Care, Medicaid, Medicare, Nursing Homes, Oral Health, Safety Net Defense, SENIOR POVERTY, Social Security, Special Report, Supplemental Security Income

Because of structural inequities that impact women more than men, a significant percentage of older women are struggling to stay out of poverty.

There are 7.1 million older adults living in poverty in the United States, with nearly two out of three of them being women. Women like Venorica, who is working three jobs at the age of 70, and Vicky, who once ran a successful business with her husband, are struggling to stay afloat.

A new Justice in Aging report surveys the reasons more women are aging into poverty than men, discusses the support systems that are in place to help older women, and recommends ways we can strengthen and expand those support systems. The brief is accompanied by videos of women telling their own stories. Older women have cared for us and worked hard all of their lives. It’s imperative that we enact policies so they don’t have to struggle to make ends meet.

READ THE REPORT
WATCH THE VIDEOS HERE

Free Webinar: Improvements to the Qualified Medicare Beneficiary Program (QMB) – Part Two

By | Health Care, Medicare, WEBINAR, Webinar Trainings

Part 2: Tuesday, September 25, 2018 at 11:00 a.m. PT / 2:00 p.m. ET.

The Qualified Medicare Savings Program (QMB) helps low-income Medicare beneficiaries pay for their health insurance by covering Part A and B premiums and cost-sharing. State Medicaid programs, which administer QMB, have a responsibility to screen for eligibility, but many individuals still face challenges enrolling into the QMB program. Another challenge is that even after beneficiaries are enrolled in the program, some Medicare providers, in violation of federal law, bill QMBs for costs covered by Medicare. In the past two years, the Centers for Medicare and Medicaid Services (CMS) has implemented a number of changes to the QMB program, which touch both beneficiaries and providers, and are designed to reduce improper billing.

This two-part webinar, The Qualified Medicare Beneficiary Program: Eligibility, Challenges, and New Developments, provides an overview of the QMB program and eligibility criteria. The webinar also covers challenges to eligibility and under-utilization, and reviews the recent CMS administrative changes intended to curb improper billing.

Part Two of the two-part webinar provides:

  • An overview of the improper billing rules under the QMB program
  • A review of the recent CMS administrative changes

Who Should Participate: 

  • Aging and legal advocates, community-based providers, health plan leadership, and others wanting to learn more about the QMB program and improper billing.

Presenters:
Georgia Burke, Justice in Aging
Denny Chan, Justice in Aging

Part Two took place on Tuesday, September 25, 2018.

WATCH THE RECORDING
DOWNLOAD THE POWERPOINT

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