Category: CMS

The next steps for US vaccine mandates

January 27, 2022

Volume 399, Issue 10323

28 January 2022

WORLD REPORT As the Supreme Court blocks one of the Biden Administration’s plans to raise COVID-19 vaccination rates but approves another, Susan Jaffe looks at the next steps.

President Joe Biden’s efforts to encourage the most reluctant Americans to get fully vaccinated against COVID-19 have hit one legal roadblock after another. About one in four adults have still not received either the two-dose or single regimen of the vaccine, according to the Centers for Disease Control and Prevention. However, the path to greater vaccination uptake is shrinking as federal courts muddy his Administration’s pro-vaccine message, cases of infection driven by the Omicron variant continue to rise in many parts of the country, and the president’s popularity ratings fall. …In the first of two rulings on Jan 13, the Supreme Court decided 6–3 to block the Biden Administration’s mandate for private companies with more than 100 employees to require weekly COVID-19 tests for employees who have not been fully vaccinated. ,,,Yet in a pair of lawsuits the court heard along with the employer mandate cases, the court came to the opposite conclusion. In a 5–4 decision, they upheld the Biden Administration’s requirement of vaccination for 10·4 million workers at 76 000 health-care facilities that treat patients covered by the government’s Medicare or Medicaid health insurance.[Continued here.]

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Holmes verdicts prompt questions over justice for patients

January 14, 2022

Volume 399, Issue 10321

15 January 2022

WORLD REPORT The founder of Theranos was found guilty of defrauding some investors, but cleared of charges that she misled patients. Susan Jaffe reports.

On Jan 3, a federal jury in California found Elizabeth Holmes, creator of the blood-testing startup Theranos, guilty of lying to some of her investors about a portable blood analyser that she claimed would transform health care. It could run dozens of tests from a fingerprick of blood, she said, and deliver dependable results quickly. However, government prosecutors’ account of Holmes’s empty promises and hype failed to convince the jury that she also deceived patients and their doctors who depended on her device’s inaccurate readings. [Continued here.]

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Theranos founder counters fraud charges in federal trial

November 26, 2021

Volume 398, Issue 10315

27 November 2021

WORLD REPORT Federal prosecutors charged Theranos’ founder Elizabeth Holmes and former Theranos president Ramesh Balwani with wire fraud and conspiracy to commit wire fraud, alleging that they deceived investors and patients and their doctors by claiming that Theranos’s machine could produce accurate test results from blood collected in its tiny “nanotainer” device instead of several vials. But witnesses for the prosecution testified that the devices did not operate as promised…. “When something is brought forward as the next new thing regardless of whether it’s a drug or device, it needs to go through the process of rigorous scientific and clinical testing, then presented to the scientific community for peer review and ultimately publication”, said Roy Silverstein a haematologist and chair of medicine at the Medical College of Wisconsin. “And I’m not aware of any single publication that ever came out of this Theranos technology.” [Full story here.]

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Legal challenges threaten Biden’s COVID-19 vaccine rule

November 20, 2021

Volume 398, Issue 10314

20 November 2021

WORLD REPORT Almost a year after the first COVID-19 vaccine was approved for emergency use in the USA, roughly a third of adults have still not received it. After urging Americans to get vaccinated, US President Joe Biden has taken a tougher approach: under his administration’s new workplace safety standard, people must get vaccinated or undergo weekly tests for the virus if they work for companies with at least 100 employees. “The rule will protect more than 84 million workers from the spread of the coronavirus on the job”, said Jim Frederick, Deputy Assistant Secretary of Labor for Occupational Safety and Health. …A day after OSHA’s announcement on Nov 4, 2021, multiple lawsuits to block the rule started rolling in to federal courts across the country.[Continued here.]

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Medicare’s Open Enrollment Is Open Season for Scammers

November 8, 2021

By Susan Jaffe | Kaiser Health News | November 11, 2021 | This KHN story also ran in The Washington Post.

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured based on questionable information — that may not cover their drugs or include their doctors.

In response, the Centers for Medicare and Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. The agency has also revised rules making it easier for beneficiaries to escape plans they didn’t sign up for or enrolled in only to discover promised benefits didn’t exist or they couldn’t see their providers.

The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7. A common trap begins with a phone call like the one Linda Heimer, an Iowa resident, received in October. [Full story in The Washington Post and Kaiser Health News.]

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3 States Limit Nursing Home Profits in Bid to Improve Care

October 25, 2021

“If they choose to rely on public dollars to deliver care, they take on a greater responsibility,” says New York Assemblyman Ron Kim. “It’s not like running a hotel.”

By Susan Jaffe | KAISER HEALTH NEWS | October 25, 2021 | This story also ran on

Nursing homes receive billions of taxpayers’ dollars every year to care for chronically ill frail elders, but until now, there was no guarantee that’s how the money would be spent.

Massachusetts, New Jersey and New York are taking unprecedented steps to ensure they get what they pay for, after the devastating impact of covid-19 exposed problems with staffing and infection control in nursing homes. The states have set requirements for how much nursing homes must spend on residents’ direct care and imposed limits on what they can spend elsewhere, including administrative expenses, executive salaries and advertising and even how much they can pocket as profit. …With this strategy, advocates believe, residents won’t be shortchanged on care, and violations of federal quality standards should decrease because money will be required to be spent on residents’ needs. At least that’s the theory. [Continued on Kaiser Health News, Fortune, NBC News, Yahoo Finance, and Chicago Sun-Times]…

The Push For Nursing Home Reform In The Middle Of A Pandemic

September 20, 2021

Sept. 20, 2021 | Today on NPR‘s news program “1A,” reporter Susan Jaffe discusses her Kaiser Health News story about new state laws protecting nursing home residents in response to the COVID-19 pandemic. Changes affect staffing, visitation rights, virtual communications, “essential support persons,” and more. A resident of a Connecticut nursing home quoted in this KHN article is also a guest. …

After pandemic ravaged nursing homes, new state laws protect residents

August 17, 2021

So far, 23 states have passed more than 70 new pandemic-related provisions affecting nursing home operations.

By Susan Jaffe | KAISER HEALTH NEWS | August 17, 2021 | This story also ran in

When the coronavirus hit Martha Leland’s Connecticut nursing home last year, she and dozens of other residents contracted the disease while the facility was on lockdown. Twenty-eight residents died, including her roommate.

“The impact of not having friends and family come in and see us for a year was totally devastating,” she said. “And then, the staff all bound up with the masks and the shields on, that too was very difficult to accept.” She summed up the experience in one word: “scary.”

But under a law Connecticut enacted in June, nursing home residents will be able to designate an “essential support person” who can help

take care of a loved one even during a public health emergency. Connecticut legislators also approved laws this year giving nursing home residents free internet access and digital devices for virtual visits and allowing video cameras in their rooms so family or friends can monitor their care.

Similar benefits are not required by the Centers for Medicare & Medicaid Services, the federal agency that oversees nursing homes and pays for most of the care they provide. But states can impose additional requirements when those federal rules are insufficient or don’t exist. And that’s exactly what many are doing, spurred by the virus that hit the frail elderly hardest. [Continued at Kaiser Health News and USA Today]

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Chiquita Brooks-LaSure: innovative US federal health director

August 14, 2021

Volume 398, Issue 10300

14 August 2021

PROFILE

Chiquita Brooks-LaSure, President Joe Biden’s choice to lead the Centers for Medicare and Medicaid Services, presides over an agency with a US$1 trillion budget that provides health insurance to more than 154 million people. Tackling health-care inequities is one of her top priorities. “These disparities have long existed, but COVID-19 has illuminated them in a way that is really unprecedented”, she said. [Full story here.]

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Zooming Into the Statehouse: Nursing Home Residents Use New Digital Skills to Push for Changes

June 10, 2021

By Susan Jaffe | Kaiser Health News | June 9, 2021 | This KHN story also ran onand

Patty Bausch isn’t a Medicaid expert, lawyer or medical professional. But she still thinks Connecticut legislators need her input when they consider bills affecting people like her — the roughly 18,000 residents who live in the state’s nursing homes.

With help and encouragement from Connecticut’s Long Term Care Ombudsman Program, Bausch signed up and testified remotely before a legislative hearing this year. Nursing home residents who have been using digital technology to reach out to family and friends — after the covid pandemic led officials to end visitation last year — could also use it to connect with elected officials once the legislature moved to remote hearings. Speaking into an iPad provided by the ombudsman’s office, Bausch testified without ever leaving her room at the Newtown Rehabilitation & Health Care Center, where she has lived since having a stroke three years ago. The combination of a virtual legislature and nursing home residents equipped with internet access has created an opportunity most nursing home residents rarely have — to participate in their government up close and in real time. [Continued on Kaiser Health News, Next Avenue and Connecticut Public Radio.]…

Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill

March 22, 2021

By Susan Jaffe | Kaiser Health News | March 21, 2021 | This KHN story also ran in The Washington Post

For years, Medicare officials considered some surgeries so risky for older adults that that the insurance program would cover the procedures only for patients admitted to the hospital. Under a new Medicare policy that took effect this year, these operations can be provided to patients who are not admitted. But patients still have to go to the hospital. The change saves Medicare money while patients can pay a larger share of the bill — for the same surgery at the same hospital. [Full story in The Washington Post and Kaiser Health News.]

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Biden’s first legislative victory: $1·9 trillion for COVID-19

March 19, 2021

Volume 397, Issue 10279

20 March 2021

WORLD REPORT US President Joe Biden’s first legislative triumph will fund the COVID-19 response and economic recovery, and address social determinants of health. Susan Jaffe reports from Washington, DC.

By narrowly approving a massive COVID-19 response and economic relief package last week, Democrats in Congress handed President Joe Biden his first legislative victory after only 50 days in the White House. The US$1·9 trillion, 628-page, American Rescue Plan Act is a signature achievement so monumental that it has been compared to President Lyndon B Johnson’s sweeping Great Society legislation that raised many Americans out of poverty, with a safety net of social and health services, including the Medicare and Medicaid insurance programmes.

…As the government begins to roll out these benefits, Biden promised “fastidious oversight to make sure there’s no waste or fraud, and the law does what it’s designed to do. And I mean it: we have to get this right… because we have to continue to build confidence in the American people that their government can function for them and deliver.” [Full story with “where the money goes” sidebar here.]

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What Happens to Nursing Home Workers Who Missed COVID-19 Vaccinations?

March 2, 2021

by Susan Jaffe | AARP | March 26, 2021

COVID-19 has rampaged through nursing homes and other long-term-care facilities, leaving a death toll near 180,000 and counting. So when the first coronavirus vaccines became available at the end of last year, nursing home residents and staff were first in line, given top priority along with emergency responders and health care providers.

The federal government paid CVS and Walgreens to offer three vaccination clinics for residents and staff at nearly every nursing home in the U.S. That effort, called the Pharmacy Partnership for Long-Term Care Program, wraps up this month. So how do new nursing home residents and workers who missed the onsite clinics get vaccinated now? For residents, plans are in the works to make sure they get the shots. But so far, many of those plans don’t include the staff members who care for them. [Continued here.]…

Nursing Homes Fined for COVID Infection Control Lapses

November 25, 2020

By Susan Jaffe | Contributing Writer | MedPageToday | November 25, 2020

During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has fined 218 nursing homes more than $17.6 million for the most serious infection control violations that put residents in “immediate jeopardy,” conditions CMS believes are likely to seriously injure or kill them.

More than 91,000 residents and staff of long-term care facilities have died after contracting COVID-19 — about 40% of the total deaths in the U.S., according to a Kaiser Family Foundation analysis. …Frustrated by repeated violations of infection control requirements during the pandemic, CMS raised the penalty amounts and announced a crackdown on egregious offenders in August. But the hard-line approach doesn’t seem to have produced the intended results. (Click here for a list of nursing homes that were fined.) [Continued here.]

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House Committee Approves Bill to Ease Medicare Part B Enrollment

July 15, 2020

Seniors would be notified about eligibility to avoid late fees, coverage gap

By Susan Jaffe | Contributing Writer | MedPageToday | July 15, 2020

A House committee unanimously approved legislation Wednesday that would make changes for the first time in 50 years to the complex rules for enrolling in Medicare’s Part B, which covers doctor visits and other outpatient care.

Currently, seniors who don’t get Part B when they first become eligible for Medicare pay permanent, recurring late enrollment penalties and can only sign up during the first 3 months of the year for coverage that begins July 1, unless they qualify for an exception. To make matters worse, they cannot buy other health insurance during their months-long wait. [Continued here.]

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Whether By Luck Or Safety Protocols, Some Nursing Homes Remain COVID-19 Free

June 15, 2020

BY SUSAN JAFFE | CONNECTICUT HEALTH INVESTIGATIVE TEAM | JUNE 15,2020

The coronavirus has decimated many of the nation’s nursing homes, and elderly, chronically ill residents of these facilities account for 64% of the state’s 4,201 death toll. They are roughly 100 times more likely to die of the virus than other people in the state.

So, the fact that some 41 of Connecticut’s 214 nursing homes have managed to keep out the virus, according to an analysis by C-HIT, is both remarkable and mystifying. Did they just get lucky?

This article also ran on Connecticut Public Radio.

Administrators at several COVID-19-free facilities use the word “fortunate” to describe a situation they acknowledge could change at any time. [Continued here, with map and table of COVID-19 free nursing homes.]

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Hundreds Died of COVID at NYC Nursing Homes With Spotless Infection Inspections

May 28, 2020

By Susan Jaffe | THE CITY | May 27, 2020

More than 600 residents have died from COVID-19 at 25 New York City nursing homes that received clean bills of health for controlling the spread of infections, state Department of Health inspection reports obtained by THE CITY show.

Those facilities include homes with some of the highest coronavirus death tolls in the nation — including the Sapphire Center for Rehabilitation and Nursing in Flushing, which reports 54 residents died of confirmed or presumed COVID….

At the Franklin Center for Rehabilitation and Nursing, also in Flushing, 60 residents — nearly one in five — succumbed to the virus. Its May 4 inspection report found no problems.

Also passing its May 11 infection-control inspection was New York State Veterans Home in St. Albans, Queens. Staff there previously told THE CITY that the state Health Department-run home failed to separate COVID-positive and uninfected residents, something that was a violation at other facilities….

“It’s very shocking that at the apex of this pandemic, our inspectors went in and reported that that there’s nothing out of the ordinary when it’s clear that the infection rate had spread,” said Assemblymember Ron Kim (D-Queens), whose district includes Sapphire and the Franklin Center. [continued here].

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As Congress Weighs COVID Liability Protections, States Shield Health Providers

May 15, 2020

By Susan Jaffe | Kaiser Health News | May 14, 2020 | This story also ran on

Coronavirus patients and their families who believe a doctor, nurse, hospital or other provider made serious mistakes during their care may face a new hurdle if they try to file medical malpractice lawsuits.

Under pressure from health provider organizations, governors in Connecticut, Maryland, Illinois and several other states have ordered that most providers be shielded from civil ― and, in some cases, criminal— lawsuits over medical treatment during the C OVID-19 health emergency. In New York and New Jersey, immunity is now part of state law….

Some legal experts and seniors’ advocates worry that the state immunity guarantees go too far, leaving patients with no way to hold providers accountable. Supporters argue that health care providers and facilities deserve protection from lawsuits as they battle a deadly virus during an unprecedented public health emergency. [Continued at Kaiser Health News and Daily Beast. ]

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Nursing Home Watchdogs Scarce At NYC Facilities As Hundreds Die Within

April 23, 2020

CLOSED DOORS | THE CITY | April 23, 2020

By Susan Jaffe

Eyes and ears usually trained on New York’s nursing homes and adult care facilities have been nearly locked out as the coronavirus has claimed the lives of more than 3,500 residents statewide.

Almost entirely out of the picture are nursing home inspectors,employed by the state Department of Health and

coordinated by the federal government, who are responsible for ensuring that the facilities comply with federal health and safety requirements.

“Nursing facilities are essentially free of public scrutiny right now, at a time when scrutiny is more important than ever,” said Susan Dooha, executive director of the Center for Independence of the Disabled in New York [continued here].

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Federal Judge Rules Medicare Patients Can Challenge ‘Observation Care’ Status

March 30, 2020

By Susan Jaffe | Kaiser Health News | March 30, 2020| This story also appeared in

Hundreds of thousands of Medicare beneficiaries who have been denied coverage for nursing home stays because their time in the hospital was changed from “inpatient” to “observation care” can now appeal to Medicare for reimbursement, a federal judge in Hartford, Connecticut, ruled last week.

If the government does not challenge the decision and patients win their appeals, Medicare could pay them millions of dollars for staggeringly high nursing home bills….

“If I had gone home, I would have died,” said Ervin Kanefsky, 94, a plaintiff [in a class action lawsuit against Medicare] from suburban Philadelphia. He was admitted to the hospital as an inpatient after fracturing his shoulder in a fall. When he was about to leave after five days to recuperate at a nursing home, a hospital official told him his status had changed to observation. With one arm in a sling, stitches in the other and unable to hold onto his walker, he learned Medicare wouldn’t pay for the nursing home. [Continued at Kaiser Health News or The Philadelphia Inquirer.]

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Coronavirus Stresses Nursing Home Infection-Control Practices

March 14, 2020

I-TEAM IN-DEPTH | CONNECTICUT HEALTH INVESTIGATIVE TEAM | MARCH 12,2020

As coronavirus cases increase, posing heightened risks to the elderly, nursing homes will face growing scrutiny from state health inspectors.

In Connecticut and nationally, complying with federal infection-control requirements is a challenge for some nursing homes. Between 2017 and 2019, 145 of Connecticut’s 217 nursing homes – or about 67 percent – were cited for infection-control violations, according to a Conn. Health I-Team analysis of data from the Centers for Medicare & Medicaid Services (CMS). [Continued here, with list of nursing home infection violations.]

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Website Errors Raise Calls For Medicare To Be Flexible With Seniors’ Enrollment

December 6, 2019

Seniors will be able to change plans any time next year if they discover their coverage doesn’t provide what the government’s Plan Finder promised.

By Susan Jaffe | Kaiser Health News | December 6, 2019 | This article also ran on

Saturday is the deadline for most people with Medicare coverage to sign up for private drug and medical plans for next year. But members of Congress, health care advocates and insurance agents worry that enrollment decisions based on bad information from the government’s revamped, error-prone Plan Finder website will bring unwelcome surprises.

Beneficiaries could be stuck in plans that cost too much and don’t meet their medical needs — with no way out until 2021.

On Wednesday, the Centers for Medicare & Medicaid Services told Kaiser Health News that beneficiaries would be able to change plans next year because of Plan Finder misinformation, although officials provided few details. [Continued at Kaiser Health News or NPR.] …

As Medicare Enrollment Nears, Popular Price Comparison Tool Is Missing

October 8, 2019

By Susan Jaffe | Kaiser Health News | October 8, 2019 | This article also ran in the

Millions of older adults can start signing up next week for private policies offering Medicare drug and medical coverage for 2020. But many risk wasting money and even jeopardizing their health care due to changes in Medicare’s plan finder, its most popular website.

For more than a decade, beneficiaries used the plan finder to compare dozens of Medicare policies offered by competing insurance companies and get a list of their options. Yet after a website redesign six weeks ago, the search results are missing crucial details: How much will you pay out-of-pocket? And which plan offers the best value? [Continued at Kaiser Health News, San Francisco

Chronicle Chicago Tribune and The Seattle Times]…

Class-Action Lawsuit Seeks To Let Medicare Patients Appeal Gap in Nursing Home Coverage

August 1, 2019

By Susan Jaffe | Kaiser Health News | August 12, 2019 | This KHN story also ran on Salon and Next Avenue

Medicare paid for Betty Gordon’s knee replacement surgery in March, but the 72-year-old former high school teacher needed a nursing home stay and care at home to recover.

Yet Medicare wouldn’t pay for that. So Gordon is stuck with a $7,000 bill she can’t afford — and, as if that were not bad enough, she can’t appeal.

The reasons Medicare won’t pay have frustrated the Rhode Island woman and many others trapped in the maze of regulations surrounding something called “observation care.”

Patients, like Gordon, receive observation care in the hospital when their doctors think they are too sick to go home but not sick enough to be admitted. They stay overnight or longer, usually in regular hospital rooms, getting some of the same services and treatment (often for the same problems) as an admitted patient….

(Photo courtesy of Betty Gordon)

But observation care is considered an outpatient service under Medicare rules, like a doctor’s appointment or a lab test. Observation patients may have to pay a larger share of the hospital bill than if they were officially admitted to the hospital.Medicare’s nursing home benefit is available only to those admitted to the hospital for three consecutive days. Gordon spent three days in the hospital after her surgery, but because she was getting observation care, that time didn’t count.

There’s another twist: Patients might want to file an appeal, as they can with many other Medicare decisions. But that is not allowed if the dispute involves observation care.

Monday, a trial begins in federal court in Hartford, Conn., where patients who were denied Medicare’s nursing home benefit are hoping to force the government to eliminate that exception. A victory would clear the way for appeals from hundreds of thousands of people. [Continued at Kaiser Health News, Next Avenue or Salon]

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