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  1. Enhance and Increase Medicare: Oral Well being
  2. Middle for Medicare Advocacy is Honored to Welcome Judith Feder, Ph.D as President of our Board of Administrators
  3. Registered Nurses Are the Key to Decreasing Hospital Readmissions of Nursing Residence Residents
  4. Scorching off the Press: 2019 Medicare Handbook
  5. Nursing House Residents at Danger: Advocates Submit Briefing to Congress

Enhance and Increase Medicare: Oral Well being

Lately, the Middle for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of many core issues for Medicare, now and sooner or later, is the necessity to broaden and Enhance Medicare for all present and future beneficiaries, not simply these in personal Medicare plans. One of many key points confronted by beneficiaries within the conventional Medicare program is the shortage of protection for oral well being advantages.

As famous in final week’s CMA Alert, one of many Middle for Medicare Advocacy’s prime priorities is to increase Medicare protection to incorporate oral and dental look after all beneficiaries.  We’ve additionally lengthy advocated for protection of medically crucial oral well being care, which we consider is presently supported by the Medicare statue however is, sadly, considerably restricted in apply resulting from Medicare coverage.

The Medicare statute particularly excludes cost for providers “in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth…” (Part 1862(a)(12) of the Social Safety Act [42 U.S.C. § 1395y(a)(12)]).  The supply bars cost when the first objective of the dental work is to deal with the tooth and supporting buildings.

Importantly, the plain language of the statutory provision doesn’t prohibit cost for dental providers wanted “in connection with” remedy of medical points that reach past the tooth and supporting buildings. For instance, medical requirements and protocols for sure coated medical procedures (e.g., some organ transplants, cardiac surgical procedures, chemotherapies) require that dental infections be handled to scale back the danger of great and dear problems.

As we work towards the event of a complete Medicare oral well being profit, the Middle for Medicare Advocacy will proceed to battle towards the over-broad use of the dental exclusion to preclude protection for dental procedures in all circumstances.  This was not the legislative intent. Applicable interpretation additionally aligns with Medicare’s elementary, remedial objective to assist beneficiaries entry and afford remedy for main medical issues.

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Middle for Medicare Advocacy is Honored to Welcome Judith Feder, Ph.D as President of our Board of Administrators

The Middle for Medicare Advocacy is thrilled to announce that Judy Feder has been elected President of our Board of Administrators.

Ms. Feder is a professor of public coverage and, from 1999 to 2008, served as dean of what’s now the McCourt Faculty of Public Coverage at Georgetown College. A nationally-recognized chief in well being coverage, Ms. Feder has made her mark on the nation’s medical insurance system, via each scholarship and public service. A extensively revealed scholar, Ms. Feder’s well being coverage analysis started on the Brookings Establishment, continued on the City Institute, and, since 1984, flourished at Georgetown College. Within the late 1980s, Ms. Feder moved from coverage analysis to coverage management, actively selling efficient well being reform as employees director of the congressional Pepper Fee (chaired by Sen. John D. Rockefeller IV) in 1989-90; Principal Deputy Assistant Secretary for Planning and Analysis on the Division of Well being and Human Providers in former President Invoice Clinton’s first time period; a senior fellow on the Middle for American Progress (2008-2011) and, immediately, as an Institute Fellow on the City Institute.

Ms. Feder matches her personal contributions to coverage together with her contributions to nurturing rising coverage leaders. As dean from 1999 to 2008, she constructed Georgetown’s Public Coverage Institute into one of many nation’s main public coverage faculties, whose graduates take part in policymaking, coverage analysis, and coverage politics, not solely all through Washington however all through the nation and the world.

Ms. Feder is an elected member of the Institute of Drugs, the Nationwide Academy of Public Administration, and the Nationwide Academy of Social Insurance coverage; a former chair and board member of AcademyHealth; a member of the Middle for American Progress Motion Fund Board, the Board of the Nationwide Academy of Social Insurance coverage, and the Hamilton Venture’s Advisory Council; and a senior advisor to the Kaiser Fee on Medicaid and the Uninsured. In 2006 and 2008, Ms. Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district. Ms. Feder is a political scientist, with a B.A. from Brandeis College, and a grasp’s and Ph.D. from Harvard College.

Ms. Feder replaces outgoing President Bess Brewer, Esq.  We thank them each for his or her work on behalf of the Middle for Medicare Advocacy.  We’re honored to be related to two such fantastic thought-leaders and advocates.

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Registered Nurses Are the Key to Decreasing Hospital Readmissions of Nursing Residence Residents

States Whose Nursing Amenities Make use of Few Registered Nurses Are More Possible To Be Penalized for Readmissions of Their Residents to Hospitals

In 2014, as a part of the Defending Entry to Medicare Act, Congress created the Expert Nursing Facility Worth-Based mostly Buying Program, whose monetary incentives are meant to scale back rehospitaliations of nursing residence residents.  In December 2018, for the primary time, the Facilities for Medicare & Medicaid Providers assigned monetary bonuses and penalties to particular expert nursing amenities, judging efficiency on the rehospitalization charges of their residents inside 30 days of discharge.[1] 

Kaiser Well being Information studies that 85% of nursing amenities in Arkansas, Louisiana, and Mississippi had cost reductions, whereas greater than half the amenities in Alaska, Hawaii, and Washington State acquired bonuses.

On January 9, 2019, the Middle for Medicare Advocacy seemed on the nurse staffing ranges for the six states, as reported on the federal web site Nursing Residence Examine.  Federal nurse staffing knowledge, which at the moment are based mostly on knowledge derived from payroll, documented that registered nurses (RNs) are the important thing to decreasing readmissions of nursing facility residents to acute care hospitals.

All three states that had cost reductions have decrease RN staffing ranges than the nationwide common.  All three states that acquired bonuses have greater RN staffing ranges than the nationwide common. 

Different licensed nurses aren’t correlated with lowered hospitalizations.  The truth is, all three states with cost reductions have greater licensed sensible nurse (LPN) charges than the nationwide common and their complete licensed nurse staffing ranges are both slightly below or simply above nationwide ranges.

Furthermore, all three states receiving bonuses have decrease LPN charges than the nationwide common.  These states have larger complete licensed nurse staffing ranges, though for 2 of them (Hawaii and Washington), the licensed nurse staffing charges are between 11 and 15 minutes greater than the nationwide common.

The important thing staffing issue seems to be having satisfactory numbers of RNs on employees.


State’s RN staffing

Nationwide RN staffing

State’s LPN staffing

Nationwide LPN staffing

State’s Complete Licensed Nurses

Nationwide Complete Licensed Nurses

States with Penalties








20 min.

41 min.

1 hr. three min.

53 min.

1 hr. 23 min.

1 hr. 34 min.


17 min.

41 min.

1 hr. 9 min.

53 min.

1 hr. 27 min.

1 hr. 34 min.


37 min.

41 min.

1 hr. 5 min.

53 min.

1 hr. 41 min.

1 hr. 34 min.

States with Bonuses








2 hr. 2 min.

41 min.

41 min.

53 min.

2 hr. 43 min.

1 hr. 34 min.


1 hr. 28 min.

41 min.

21 min.

53 min.

1 hr. 49 min.

1 hr. 34 min.

Washington State

1 hr.

41 min.

45 min.

53 min.

1 hr. 45 min.

1 hr. 34 min.

The correlation of upper RN staffing ranges with decreased charges of hospitalization is in keeping with prior research which have instantly tied applicable staffing ranges with improved resident outcomes.[2] 

CMS has acknowledged the significance of applicable staffing in assembly residents’ care wants. In an April 2018 memorandum, CMS states, “[r]esearch shows the presence of an RN is strongly related to the quality and outcomes residents experience.”[3]  The memorandum features a chart displaying how nursing houses carry out on three claims-based high quality measures (30-day readmissions, emergency room transfers, and profitable discharge to group) based mostly on the decile of RN hours.[4]  Because the chart demonstrates, nursing houses with greater RN hours have higher outcomes on all three measures.[5]

[1] Jordan Rau, “Medicare Cuts Payments To Nursing Homes Whose Patients Keep Ending Up in Hospital,” Kaiser Well being Information (Dec. three, 2018), https://khn.org/news/medicare-cuts-payments-to-nursing-homes-whose-patients-keep-ending-up-in-hospital/.
[2] More Nurses in Nursing Houses Would Imply Fewer Sufferers Headed to Hospitals, (CMA Alert, Mar. 10, 2011).
[3] CMS, Transition to Payroll-Based mostly Journal (PBJ) Staffing Measures on the Nursing Residence Examine software on Medicare.gov and the 5 Star High quality Score System, QSO-18-17-NH (Apr. 6, 2018), Questions & Solutions, p. 2, https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-17-NH.pdf.
[4] Id.
[5] Id.



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Scorching off the Press: 2019 Medicare Handbook

The Middle for Medicare Advocacy’s complete Medicare Handbook is now obtainable from Wolters Kluwer.

The Medicare Handbook is an entire useful resource for attorneys, advocates, coverage specialists and well being care suppliers.  It’s the indispensable useful resource for clarifying Medicare’s complicated guidelines and laws

Ready by the specialists on the Middle for Medicare Advocacy, it addresses points it is advisable grasp to offer efficient planning, recommendation, analysis or advocacy.  It consists of in depth dialogue and examples of how Medicare guidelines apply in the actual world, case citations, checklists, worksheets, apply pointers and different instruments to assist in acquiring entry to Medicare protection.

Order On-line Now
or Name Wolters Kluwer at 1-800-638-84377

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Nursing House Residents at Danger: Advocates Submit Briefing to Congress

The Middle for Medicare Advocacy, the Lengthy Time period Care Group Coalition, the Nationwide Shopper Voice for High quality Lengthy-Time period Care, Justice in Getting older, and California Advocates for Nursing Residence Reform just lately submitted a briefing to members of Congress addressing ongoing considerations relating to the well being and security of nursing house residents.

The Nursing House Reform Regulation requires each nursing house to offer residents with the providers they should attain and keep their “highest practicable physical, mental, and psychosocial well-being.” Sadly, the Facilities for Medicare & Medicaid Providers (CMS) has been rolling again resident rights and protections, typically on the request of the nursing residence business, for the aim of decreasing so-called supplier “burdens.”

CMS’s efforts are much more harmful as a result of they exacerbate present issues in nursing houses. A number of stories from the HHS Workplace of the Inspector Common (OIG) and the Authorities Accountability Workplace (GAO) doc persistent and widespread issues dealing with nursing residence residents. The Middle for Medicare Advocacy and our companions proceed to pursue the chance to work with members of Congress to deal with the wants of this exceptionally weak inhabitants.

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