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Physical, occupational and speech therapy services for some patients, especially those who have long-term severe illnesses, are the services that have been impacted the most. Under a new Medicare reimbursement system, home health agencies now have a stronger financial incentive to treat patients who need short-term therapy after a stay in the hospital or rehabilitation facility. Payments under the new reimbursement system are higher for people who are discharged from an institution and have services provided within the first 30 days - and get lower after that..Senior advocates are concerned that all of Medicare's 60 million beneficiaries will likely see their premiums for Medicare Part B, and Medigap supplements, rise significantly to cover this one new medication. Because the drug is administered in a physician's office, it would be covered under Medicare Part B, not part D plans which pay for drugs purchased from pharmacies. Medicare typically reimburses doctors 103% of the list price of drugs administered in their office..The concern is well justified. The Office of the Inspector General for the Department of Health and Human Services has reported that Medicare Advantage plans deny care inappropriately at high rates. When the Office of the Inspector General collected data, it found that when beneficiaries and providers appealed pre-authorization and payment denials, Medicare Advantage Organizations over-turned 75% of their own denials over the 2014-2016 period. The OIG noted "This is especially concerning because beneficiaries and providers rarely use the appeals process, which is designed to ensure access to care and payment." Only 1 percent of beneficiaries and providers appealed denials..This week, members of the bicameral budget conference seemed to hit an impasse, and The Senior Citizens League announced its support for the Social Security and Medicare Lock-Box Act. In addition, two key bills gained cosponsors this week..This estimate is still just that - an estimate. The 2020 COLA is based on CPI data through September 2019 and won't be announced until October. Inflation could start going up again, but with the first five months of data so low, we are likely to see another low COLA in 2020..Seniors deserve a Washington that works for them, and every American should be able to retire and live with dignity. I'm committed to doing everything I can in the Senate to ensure that happens..When it comes to the Social Security cost-of-living adjustments many, if not most, of you say that you feel the government is cooking the inflation data. The COLA seldom seems to reflect the growing costs you experience. Two factors are to blame; the choice of a consumer price index used to calculate your COLA, and the methodology that our government uses to calculate price inflation to begin with..Such a minimum guarantee would go a long way to protect beneficiaries in years when there is no COLA. Had such a 3% minimum COLA guarantee been in effect since 2009, the average benefit of ,075 in 2009 would be 5 per month/ ,580 year higher today - about 18%. A minimum COLA would also eliminate the problem of benefits remaining flat for years, at a time during periods when Medicare Part B premiums increase more than the COLA raises benefits..In a statement that was released after the final vote, Senator McCain said: "We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation's governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve." In addition, Senator Murkowski told reporters: "We cannot let the public believe that we are done with health care. We're just beginning."