Alyssa Gerace | December 29, 2011 |
Home health care is being made available for up to 10,000 Medicare patients through a health care reform law demonstration that seeks to improve care and lower costs for seniors and people with disabilities, announced the Centers for Medicare & Medicaid Services (CMS).
“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner.
The demonstration was developed through the Affordable Care Act, and will expand the scope of in-home services that Medicare beneficiaries can receive; participation is voluntary.
In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” said Tavenner. “When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided.”
CMS plans to partner with medical practices led by physicians or nurse practitioners to test the effectiveness of delivering primary care services in a home setting on improving care for the needs of Medicare beneficiaries with multiple chronic conditions.
Healthcare providers that show a reduction in Medicare expenditures will be rewarded through the demonstration program through incentive payment, if they succeed in providing high-quality care while reducing costs.
CMS will use “quality measures to ensure beneficiaries experience high quality care,” in keeping with its series if initiatives to build a Medicare program that offers beneficiaries “better care and better health at an affordable cost.”
The demonstration will be supported by the CMS innovation Center, which was created by the Affordable Care Act to develop and test new models of health care delivery and payment.
More information on the program can be found CMS innovation Center,
hereWritten by Alyssa Gerace
Friday, December 30, 2011
Saturday, December 10, 2011
federal vouchers to control the cost of Medicare
Medicare and Private Health Insurance
Published: December 9, 2011
To the Editor:
“What About Premium Support?” (editorial, Dec. 4), about federal vouchers to control the cost of Medicare, did not mention a compelling reason for not relying on private insurance.
It is generally agreed that this industry adds 15 to 20 percent to the cost of its premiums to pay for its business overhead and profits, whereas the administrative costs of Medicare are less than 5 percent.
The Centers for Medicare and Medicaid Services actuary estimates that private insurance overhead this year will amount to $152.1 billion and will continue to rise more rapidly than the total cost of health care in the years ahead.
Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?
ARNOLD S. RELMAN
Cambridge, Mass., Dec. 4, 2011
The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.
To the Editor:
Your editorial did not mention the significant fact that many of the best doctors have opted out of Medicare.
For those of us in the middle class who are on Medicare, a premium support system would enable us to go to our doctors of choice.
A premium support system must, of course, protect the elderly from being denied insurance coverage because of pre-existing conditions. If such protection is provided, the middle-class elderly might very well prefer a premium support system that gives us access to those doctors who have opted out of Medicare.
ROBERT R. SALMAN
Marlboro, N.J., Dec. 4, 2011
To the Editor:
Your editorial about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage.
I have been an advocate for Medicare beneficiaries for almost 35 years. I’ve seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program.
I don’t recommend a private plan to my mother. That should be a good test for anyone championing premium support.
Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system.
Call it what you will, “premium support” is the latest jingle for privatizing Medicare. It’s not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what’s needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
JUDITH STEIN
Executive Director
Center for Medicare Advocacy
Mansfield, Conn., Dec. 4, 2011
To the Editor:
Any comparison between Medicare Advantage and fee-for-service Medicare must acknowledge the fact that Medicare Advantage plans provide more and better benefits.
Unlike the outdated fee-for-service model, Medicare Advantage plans also emphasize prevention, wellness, care coordination and management of chronic conditions. In fact, analyses of federal data show that these plans are reducing preventable hospital readmissions and unnecessary hospitalizations compared with fee-for-service Medicare.
Medicare Advantage is improving the health of the elderly, while fostering the innovations needed to reduce health care cost growth and put Medicare on a sustainable path.
KAREN IGNAGNI
President and Chief Executive
America’s Health Insurance Plans
Washington, Dec. 5, 2011
Published: December 9, 2011
To the Editor:
“What About Premium Support?” (editorial, Dec. 4), about federal vouchers to control the cost of Medicare, did not mention a compelling reason for not relying on private insurance.
It is generally agreed that this industry adds 15 to 20 percent to the cost of its premiums to pay for its business overhead and profits, whereas the administrative costs of Medicare are less than 5 percent.
The Centers for Medicare and Medicaid Services actuary estimates that private insurance overhead this year will amount to $152.1 billion and will continue to rise more rapidly than the total cost of health care in the years ahead.
Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?
ARNOLD S. RELMAN
Cambridge, Mass., Dec. 4, 2011
The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.
To the Editor:
Your editorial did not mention the significant fact that many of the best doctors have opted out of Medicare.
For those of us in the middle class who are on Medicare, a premium support system would enable us to go to our doctors of choice.
A premium support system must, of course, protect the elderly from being denied insurance coverage because of pre-existing conditions. If such protection is provided, the middle-class elderly might very well prefer a premium support system that gives us access to those doctors who have opted out of Medicare.
ROBERT R. SALMAN
Marlboro, N.J., Dec. 4, 2011
To the Editor:
Your editorial about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage.
I have been an advocate for Medicare beneficiaries for almost 35 years. I’ve seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program.
I don’t recommend a private plan to my mother. That should be a good test for anyone championing premium support.
Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system.
Call it what you will, “premium support” is the latest jingle for privatizing Medicare. It’s not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what’s needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
JUDITH STEIN
Executive Director
Center for Medicare Advocacy
Mansfield, Conn., Dec. 4, 2011
To the Editor:
Any comparison between Medicare Advantage and fee-for-service Medicare must acknowledge the fact that Medicare Advantage plans provide more and better benefits.
Unlike the outdated fee-for-service model, Medicare Advantage plans also emphasize prevention, wellness, care coordination and management of chronic conditions. In fact, analyses of federal data show that these plans are reducing preventable hospital readmissions and unnecessary hospitalizations compared with fee-for-service Medicare.
Medicare Advantage is improving the health of the elderly, while fostering the innovations needed to reduce health care cost growth and put Medicare on a sustainable path.
KAREN IGNAGNI
President and Chief Executive
America’s Health Insurance Plans
Washington, Dec. 5, 2011
Friday, December 9, 2011
Medicare Advantage plans for their benefits
It’s hard to believe, but Medicare’s open enrollment season began last week. And this year, as a result of the federal health reform law, seniors will have to brace for several changes.
Seniors who rely on privately administered Medicare Advantage plans for their benefits will face the biggest adjustments. That’s too bad, as Medicare Advantage has a strong track record of delivering health benefits that meet or even exceed those of conventional Medicare.
Medicare Advantage (MA) offers enrollees a different way of receiving their Part A hospital and Part B physician care. Under the program, private insurers offer competing plans, and patients themselves choose which coverage option works best for their particular health and financial needs. MA insurers must provide at least the same benefits as traditional Medicare, but most offer more. The government reimburses insurers at a preset rate per enrollee.
More than 12 million seniors participate in Medicare Advantage, about one-fourth of all those eligible for Medicare. The pool of MA beneficiaries has more than doubled since 2005.
The program has grown popular thanks in large part to its competitive structure, which encourages insurers to vie with one another for seniors’ health care dollars and thus provides them more choices.
But some policymakers believe the MA program to be wasteful. They cite the fact that Medicare Advantage costs the government more per enrollee than does traditional Medicare. They believe seniors would be better served if everyone were enrolled in the traditional Medicare program.
To aid in that pursuit, the PPACA law included a provision that changes the special Medicare Advantage open enrollment period that occurs each year in January. Previously, Medicare beneficiaries were allowed to either change from one Medicare Advantage plan to another Medicare Advantage plan or to change from Medicare Advantage to traditional fee-for-service Medicare. Beginning in January of 2012, seniors will only be allowed to opt out of the Medicare Advantage plan they chose in 2011 to enroll in traditional fee-for-service Medicare.
That’s just part of the pending assault on Medicare Advantage. This year, the health reform law froze Medicare Advantage payment rates to participating insurers at 2010 levels — that is, it didn’t allow reimbursements to be adjusted for inflation. Next year, payments will be cut even further. And over the next decade, Medicare Advantage funding is set to decline by $132 billion. By 2017, government number-crunchers expect that benefits for the average MA enrollee will be slashed by 27 percent, or $3,700.
The Congressional Budget Office (CBO) estimates these changes alone will cause some Medicare Advantage plans to exit the program and that as a result, enrollment will drop to 7.4 million by 2017. Medicare’s actuaries actually predict an even steeper fall-off of 50 percent.
Some speculate that those who dislike Medicare Advantage want to use these methods to marginalize Medicare Advantage to the point of non-existence. This is exactly what happened to Medicare + Choice in the late 1990′s when payments got so low that plans were forced to leave large areas of the country, especially in rural areas.
That’s a shame, as Medicare Advantage delivers more benefits — and superior outcomes — than traditional Medicare. According to the CBO, individual patients enjoy many value added services that help them maintain their health and well-being, such as lower co-pays, premium rebates, and coverage or deep discounts for services like dental work and eyeglasses.
MA beneficiaries are also much healthier than their counterparts in traditional Medicare. A 2004 study found that MA plans achieved better outcomes than traditional Medicare in five of seven core indicators, including breast-cancer screenings, diabetes testing, and treatment after heart attacks.
Advantage enrollees in California spend 30 percent fewer days in hospitals than those in traditional Medicare. In Nevada, they spend 23 percent fewer days. Less time in the hospital is good news not just for patients — but for federal coffers, too.
Medicare Advantage represents just the kind of innovative health care model that could help drive down long-term health costs and improve health care in this country. Congress should make it easier to opt in, not out. And if seniors want to change plans, they should have a full range of choices available to them.
By Janet Trautwein, who is CEO of the National Association of Health Underwriters.
1 Vote
Seniors who rely on privately administered Medicare Advantage plans for their benefits will face the biggest adjustments. That’s too bad, as Medicare Advantage has a strong track record of delivering health benefits that meet or even exceed those of conventional Medicare.
Medicare Advantage (MA) offers enrollees a different way of receiving their Part A hospital and Part B physician care. Under the program, private insurers offer competing plans, and patients themselves choose which coverage option works best for their particular health and financial needs. MA insurers must provide at least the same benefits as traditional Medicare, but most offer more. The government reimburses insurers at a preset rate per enrollee.
More than 12 million seniors participate in Medicare Advantage, about one-fourth of all those eligible for Medicare. The pool of MA beneficiaries has more than doubled since 2005.
The program has grown popular thanks in large part to its competitive structure, which encourages insurers to vie with one another for seniors’ health care dollars and thus provides them more choices.
But some policymakers believe the MA program to be wasteful. They cite the fact that Medicare Advantage costs the government more per enrollee than does traditional Medicare. They believe seniors would be better served if everyone were enrolled in the traditional Medicare program.
To aid in that pursuit, the PPACA law included a provision that changes the special Medicare Advantage open enrollment period that occurs each year in January. Previously, Medicare beneficiaries were allowed to either change from one Medicare Advantage plan to another Medicare Advantage plan or to change from Medicare Advantage to traditional fee-for-service Medicare. Beginning in January of 2012, seniors will only be allowed to opt out of the Medicare Advantage plan they chose in 2011 to enroll in traditional fee-for-service Medicare.
That’s just part of the pending assault on Medicare Advantage. This year, the health reform law froze Medicare Advantage payment rates to participating insurers at 2010 levels — that is, it didn’t allow reimbursements to be adjusted for inflation. Next year, payments will be cut even further. And over the next decade, Medicare Advantage funding is set to decline by $132 billion. By 2017, government number-crunchers expect that benefits for the average MA enrollee will be slashed by 27 percent, or $3,700.
The Congressional Budget Office (CBO) estimates these changes alone will cause some Medicare Advantage plans to exit the program and that as a result, enrollment will drop to 7.4 million by 2017. Medicare’s actuaries actually predict an even steeper fall-off of 50 percent.
Some speculate that those who dislike Medicare Advantage want to use these methods to marginalize Medicare Advantage to the point of non-existence. This is exactly what happened to Medicare + Choice in the late 1990′s when payments got so low that plans were forced to leave large areas of the country, especially in rural areas.
That’s a shame, as Medicare Advantage delivers more benefits — and superior outcomes — than traditional Medicare. According to the CBO, individual patients enjoy many value added services that help them maintain their health and well-being, such as lower co-pays, premium rebates, and coverage or deep discounts for services like dental work and eyeglasses.
MA beneficiaries are also much healthier than their counterparts in traditional Medicare. A 2004 study found that MA plans achieved better outcomes than traditional Medicare in five of seven core indicators, including breast-cancer screenings, diabetes testing, and treatment after heart attacks.
Advantage enrollees in California spend 30 percent fewer days in hospitals than those in traditional Medicare. In Nevada, they spend 23 percent fewer days. Less time in the hospital is good news not just for patients — but for federal coffers, too.
Medicare Advantage represents just the kind of innovative health care model that could help drive down long-term health costs and improve health care in this country. Congress should make it easier to opt in, not out. And if seniors want to change plans, they should have a full range of choices available to them.
By Janet Trautwein, who is CEO of the National Association of Health Underwriters.
1 Vote
Monday, December 5, 2011
Medicare Premiums for 2012:
Part A: (Hospital Insurance) Premium
· Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
· The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
· The Part A premium is $451.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.
In 2012, Social Security monthly payments to enrollees will increase by 3.6 percent. The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income. Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.
In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount. These income-related amounts were phased-in over three years, beginning in 2007. About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.
For additional details, see our FAQ titled: "2012 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2012:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
· A total of $1,156 for a hospital stay of 1-60 days.
· $289 per day for days 61-90 of a hospital stay.
· $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
· All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
· $144.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
· $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2012 is available in the October 27, 2011 Fact Sheet titled, "Medicare Premiums and Deductibles for 2012" on the www.cms.gov website.
· Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
· The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
· The Part A premium is $451.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.
In 2012, Social Security monthly payments to enrollees will increase by 3.6 percent. The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income. Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.
In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount. These income-related amounts were phased-in over three years, beginning in 2007. About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.
For additional details, see our FAQ titled: "2012 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2012:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
· A total of $1,156 for a hospital stay of 1-60 days.
· $289 per day for days 61-90 of a hospital stay.
· $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
· All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
· $144.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
· $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2012 is available in the October 27, 2011 Fact Sheet titled, "Medicare Premiums and Deductibles for 2012" on the www.cms.gov website.
Friday, November 25, 2011
Medicare Advantage premiums
The new health care law is cutting payments to Medicare Advantage plans. Republican lawmakers predicted that the cuts would lead insurers to increase premiums, reduce benefits or pull out of the program. But so far the dire predictions have not been borne out.
On average, the Obama administration said recently, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and insurers expect their Medicare enrollment to increase by 10 percent.
On average, the Obama administration said recently, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and insurers expect their Medicare enrollment to increase by 10 percent.
Thursday, November 17, 2011
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Alliance: Sudden Medicare Cuts Reduce Staff and Quality of Skilled Nursing Care
Alyssa Gerace | November 15, 2011 | Comments (0)
More than a third of skilled nursing facilities are expecting to lay off staff in the wake of Medicare reimbursement rate cuts, affecting the quality of care given, according to a survey conducted by Avalere Health for the Alliance for Quality Nursing Home Care. However, the impact would be less severe if the cuts were phased in rather than implemented at once, says the Alliance.
“A gradual phase-in of the federal regulation—which has been done in the past for other provider sectors – can help alleviate the dislocation and disruption causing many facilities to warn of layoffs and other negative developments,” said Alan Rosenbloom, president of the Alliance, in a statement.
Operators are expecting to tighten their belts after federal regulation for an 11.1% reduction in Medicare reimbursements to SNFs went into effect Oct. 1, 2011, with plans to reduce staff, postpone renovations or facility expansions, and cut staff benefits—all components of quality of care.
“SNF operators are deeply concerned about the implications of this rule,” said Dan Mendelson, CEO of Avalere Health, in a statement. “The facilities we surveyed reported that they plan layoffs, deferrals of facility renovations, and wage and benefit reductions—and anticipate significant financial strain moving forward.”
More than a third of facilities, at 36.8%, said they expect to lay off direct service staff, including registered nurses, licensed practical nurses, and certified nursing assistants, while 37% said they will likely indefinitely postpone or cancel hiring new direct service staff. Approximately 20,000 layoffs could be the result of the regulation, the Alliance estimates.
Nearly a quarter of survey respondents, at 23.5%, said the Medicare cuts will delay or cancel opening new facilities or expanding existing facilities.
Just under 75% of facilities said they will be making changes in wage rates, including wage cuts or freezes, eliminations of bonus plans, or smaller starting salaries for new hires. Almost half of facilities plan to make changes in employee benefits, including reducing or eliminating contributions to 401(k) plans or health insurance premiums.
Shortly after the cuts were announced, Avalere Health released a study that found the new CMS regulation would reduce Medicare funding to the SNF sector by $79 billion in the next 10 years. The reduction comes on top of $29.4 billion in Medicare cuts enacted to fund healthcare reform, and a $16.8 billion Medicare payment reduction in 2010 regulation.
The possibility of further Medicare cuts looms in the near future as the Super Committee seeks to reduce the nation’s debt deficit.
View the survey results here.
Written by Alyssa Gerace
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Shift Away From Nursing Home Care Reveals Challenges
In the past 10-plus years, there has been a trend away from nursing homes and to other, more home-like forms of long-term care for American seniors. Most say the shift is due to nursing homes’ high costs, but also some of the traditional qualities that nursing homes have represented over the years and the rise [...]
Senate Committee On Aging Exploring Ways to Modernize the Older Americans Act
Last week, the Senate Special Committee on Aging conducted a hearing on ways to further eldercare services through the reauthorization of the Older Americans Act (OAA). The current OAA programs provide assistance to over 10 million older adults by helping them to live independently in their communities through home care services, congregate and home delivered [...]
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June 1, 2011 |
Home
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Alliance: Sudden Medicare Cuts Reduce Staff and Quality of Skilled Nursing Care
Alyssa Gerace | November 15, 2011 | Comments (0)
More than a third of skilled nursing facilities are expecting to lay off staff in the wake of Medicare reimbursement rate cuts, affecting the quality of care given, according to a survey conducted by Avalere Health for the Alliance for Quality Nursing Home Care. However, the impact would be less severe if the cuts were phased in rather than implemented at once, says the Alliance.
“A gradual phase-in of the federal regulation—which has been done in the past for other provider sectors – can help alleviate the dislocation and disruption causing many facilities to warn of layoffs and other negative developments,” said Alan Rosenbloom, president of the Alliance, in a statement.
Operators are expecting to tighten their belts after federal regulation for an 11.1% reduction in Medicare reimbursements to SNFs went into effect Oct. 1, 2011, with plans to reduce staff, postpone renovations or facility expansions, and cut staff benefits—all components of quality of care.
“SNF operators are deeply concerned about the implications of this rule,” said Dan Mendelson, CEO of Avalere Health, in a statement. “The facilities we surveyed reported that they plan layoffs, deferrals of facility renovations, and wage and benefit reductions—and anticipate significant financial strain moving forward.”
More than a third of facilities, at 36.8%, said they expect to lay off direct service staff, including registered nurses, licensed practical nurses, and certified nursing assistants, while 37% said they will likely indefinitely postpone or cancel hiring new direct service staff. Approximately 20,000 layoffs could be the result of the regulation, the Alliance estimates.
Nearly a quarter of survey respondents, at 23.5%, said the Medicare cuts will delay or cancel opening new facilities or expanding existing facilities.
Just under 75% of facilities said they will be making changes in wage rates, including wage cuts or freezes, eliminations of bonus plans, or smaller starting salaries for new hires. Almost half of facilities plan to make changes in employee benefits, including reducing or eliminating contributions to 401(k) plans or health insurance premiums.
Shortly after the cuts were announced, Avalere Health released a study that found the new CMS regulation would reduce Medicare funding to the SNF sector by $79 billion in the next 10 years. The reduction comes on top of $29.4 billion in Medicare cuts enacted to fund healthcare reform, and a $16.8 billion Medicare payment reduction in 2010 regulation.
The possibility of further Medicare cuts looms in the near future as the Super Committee seeks to reduce the nation’s debt deficit.
View the survey results here.
Written by Alyssa Gerace
Rate This
Email This Post Print This Post
Category: Senior Care
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« LTC Properties Acquires Skilled Nursing Facility for $17.5 Million
Census: Older Adults Sharing Homes Longer With Children »
.
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Free Email Subscriptions:
Senior Housing Daily
Senior Housing Weekly
Sponsored By
Popular
Recent
Comments
Archives
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Nuns Go Bankrupt Over Chicago Senior Living Facility, Blame Recession
Technology Must Become High Priority for Senior Housing Operators
Brandywine Acquires Four Assisted Living Communites for Undisclosed Sum
Grubb & Ellis Healthcare REIT Under New Sponsorship, Will Change Name
Senior Housing Operators Work to Mitigate Impact of Medicare Cuts in Q4
.
.
.
.
Shift Away From Nursing Home Care Reveals Challenges
In the past 10-plus years, there has been a trend away from nursing homes and to other, more home-like forms of long-term care for American seniors. Most say the shift is due to nursing homes’ high costs, but also some of the traditional qualities that nursing homes have represented over the years and the rise [...]
Senate Committee On Aging Exploring Ways to Modernize the Older Americans Act
Last week, the Senate Special Committee on Aging conducted a hearing on ways to further eldercare services through the reauthorization of the Older Americans Act (OAA). The current OAA programs provide assistance to over 10 million older adults by helping them to live independently in their communities through home care services, congregate and home delivered [...]
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June 1, 2011 |
Saturday, November 5, 2011
policy that allows hospitals to avoid admitting elderly people with chronic ailments as inpatients
..
(Reuters) - A group of Medicare patients and their families sued the Obama administration on Thursday, saying they were deprived of coverage by the government health plan because of a policy that allows hospitals to avoid admitting elderly people with chronic ailments as inpatients.
The plaintiffs, who are seeking class-action status for the case, asked a U.S. district court in Hartford, Connecticut, to stop Health and Human Services Secretary Kathleen Sebelius from authorizing doctors to place Medicare hospital patients on "observation" status rather than admitting them for inpatient care.
The observation services policy, meant to apply mainly for hospital stays of no more than 48 hours, is instead being used to keep the elderly on outpatient status for longer stays including some lasting up to a week, according to court documents.
The plaintiffs, aged 74 to 96, suffered multiple health problems including cancer, Parkinson's disease and arthritis. Each entered the hospital as an emergency patient, usually after a fall, but remained on observation status for days of full hospital service.
None received hospital coverage under Medicare Part A for their stays. Instead they were relegated to the Part B section of the federal program that covers visits to doctors' offices and other outpatient facilities.
'SEVERE FINANCIAL PROBLEMS'
As a result, they and their families incurred medical charges as high as $30,000 for skilled nursing care, drugs and other costs that Medicare does not cover unless a patient has been admitted to a hospital for at least three days.
The policy is meant to protect hospitals from Medicare penalties for admissions made in error. But the incidence of observation status has increased sharply in recent years with the advent of federal healthcare reform and heightened scrutiny of Medicare spending, according to Medicare patient advocates.
The result can be tens of thousands of dollars in medical costs for beneficiaries, who do not qualify for Medicare hospital coverage while on observation status.
"This causes severe financial problems for beneficiaries and their families," said Judith Stein, executive director of the Center for Medicare Advocacy.
She cited federal statistics showing that tens of thousands of Medicare beneficiaries are placed on observation status in U.S. hospitals each year.
Stein's Connecticut group and the Washington-based National Senior Citizens Law Center filed the federal case on behalf of two Medicare beneficiaries in their 90s and the families of five others who have died.
Medicare advocates have filed individual lawsuits in observation cases for years but have not sought class-action status until now. A class action suit permits a large number of people to sue collectively.
Democrats have introduced legislation to address the issue in both houses of Congress. But the bills have gone nowhere.
"We've decided we can wait no longer and have turned to the courts for fairness," Stein said.
The lawsuit claims the HHS policy allowing observation status is illegal under federal law and has deprived plaintiffs of their proper Medicare benefits.
A spokesman for the Centers for Medicare and Medicaid Services, the federal agency that oversees the programs, declined to comment on the lawsuit. The American Hospital Association, a Washington-based industry trade group, also had no comment on the litigation.
(Editing by Xavier Briand)
..
(Reuters) - A group of Medicare patients and their families sued the Obama administration on Thursday, saying they were deprived of coverage by the government health plan because of a policy that allows hospitals to avoid admitting elderly people with chronic ailments as inpatients.
The plaintiffs, who are seeking class-action status for the case, asked a U.S. district court in Hartford, Connecticut, to stop Health and Human Services Secretary Kathleen Sebelius from authorizing doctors to place Medicare hospital patients on "observation" status rather than admitting them for inpatient care.
The observation services policy, meant to apply mainly for hospital stays of no more than 48 hours, is instead being used to keep the elderly on outpatient status for longer stays including some lasting up to a week, according to court documents.
The plaintiffs, aged 74 to 96, suffered multiple health problems including cancer, Parkinson's disease and arthritis. Each entered the hospital as an emergency patient, usually after a fall, but remained on observation status for days of full hospital service.
None received hospital coverage under Medicare Part A for their stays. Instead they were relegated to the Part B section of the federal program that covers visits to doctors' offices and other outpatient facilities.
'SEVERE FINANCIAL PROBLEMS'
As a result, they and their families incurred medical charges as high as $30,000 for skilled nursing care, drugs and other costs that Medicare does not cover unless a patient has been admitted to a hospital for at least three days.
The policy is meant to protect hospitals from Medicare penalties for admissions made in error. But the incidence of observation status has increased sharply in recent years with the advent of federal healthcare reform and heightened scrutiny of Medicare spending, according to Medicare patient advocates.
The result can be tens of thousands of dollars in medical costs for beneficiaries, who do not qualify for Medicare hospital coverage while on observation status.
"This causes severe financial problems for beneficiaries and their families," said Judith Stein, executive director of the Center for Medicare Advocacy.
She cited federal statistics showing that tens of thousands of Medicare beneficiaries are placed on observation status in U.S. hospitals each year.
Stein's Connecticut group and the Washington-based National Senior Citizens Law Center filed the federal case on behalf of two Medicare beneficiaries in their 90s and the families of five others who have died.
Medicare advocates have filed individual lawsuits in observation cases for years but have not sought class-action status until now. A class action suit permits a large number of people to sue collectively.
Democrats have introduced legislation to address the issue in both houses of Congress. But the bills have gone nowhere.
"We've decided we can wait no longer and have turned to the courts for fairness," Stein said.
The lawsuit claims the HHS policy allowing observation status is illegal under federal law and has deprived plaintiffs of their proper Medicare benefits.
A spokesman for the Centers for Medicare and Medicaid Services, the federal agency that oversees the programs, declined to comment on the lawsuit. The American Hospital Association, a Washington-based industry trade group, also had no comment on the litigation.
(Editing by Xavier Briand)
..
Monday, August 22, 2011
The federal government’s Medicare benefit program
Does Medicare Pay for Assisted Living?
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By K. K.
The Writers Network
Posted on June 14th, 2011
The federal government’s Medicare benefit program can be quite confusing, especially when you’re trying to plan ahead for long-term care coverage such as assisted living. Many people are under the impression the Medicare covers everything that is needed as they age. However, Medicare specifically covers medical necessities and generally does not cover expenses associated with assisted-living facilities or any other long-term care. Medicare pays for services that are medically necessary, so there may be some instances in which Medicare will pay for services associated with assisted-living arrangements.
Custodial Care
The Medicare program defines most assisted-living facilities as custodial care arrangements, meaning that support services for daily living activities are not medically necessary and are not performed by skilled nursing staff. Custodial care includes such things as bathing, dressing and using the bathroom. Because support services are not medically necessary, Medicare does not cover custodial care.
Skilled Nursing Care
Medicare covers 80 percent of skilled nursing care for up to 100 days after someone has been hospitalized for three consecutive days. These services typically are associated with short-term medical rehabilitation. For example, Medicare will pay for assisted-living facilities for someone who undergoes hip replacement surgery and needs short-term in-patient rehabilitation. Medicare does not cover expenses for permanent or long-term assisted-living facilities, such as nursing home care.
Home Health Care
Medicare covers home health services provided by Medicare-certified providers. The home health services covered by Medicare are extensive, including home health aide support services, part-time skilled nursing care, occupational and physical therapy, speech therapy, 80 percent of durable medical equipment expenses and medical supplies.
Respite Care
Medicare pays for respite care, which is a short-term stay at a hospice facility. Respite care coverage is limited to up to five-day stays; however, there is no limit on the frequency of respite care stays. Medicare covers 95 percent of all respite care services per day. The patient is responsible for no more than $5 for each prescription drug that is administered during respite care.
References:
The Centers for Medicare & Medicaid Services: Long-term Care
National Senior Citizens Law Center: Paying For Assisted Living
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Saturday, June 25, 2011
MEDICAIRE PART B PREMIUMS
The official formula for determining Part B premiums was established by Congress decades ago. The standard premium amount for each year is always calculated on the level of Medicare health care costs in the previous year — and reflects the fact that the government pays 75 percent of Part B costs and beneficiaries pay 25 percent.
This process is in no way affected by the new health care law, officially known as the Affordable Care Act. The law does, however, contain provisions to reduce the rate of Medicare costs over time (without reducing guaranteed benefits), and if this plays out as planned, it could hold Part B premiums down or possibly even lower them.
The standard Part B premium for 2012 will not be known until later this year. And there is no way of accurately predicting what it will be in 2014 or any future years.
Part B premiums affected by Social Security COLA
However, another much older law did affect Part B premiums in 2010 and 2011 in an unprecedented way. That law prohibits a premium increase in any year when there is no Social Security cost-of-living adjustment (COLA). So in the past two years when — for the first time in more than 30 years — there was no COLA, most people's premiums were frozen at the 2009 level, $96.40 a month.
But this "hold harmless" provision did not apply to about 25 percent of Medicare beneficiaries. They include people who did not have their premiums deducted from Social Security benefits (but paid Medicare directly), those who were new to Medicare, and those who paid higher premiums because their incomes were above a certain level.
These people bore the brunt of rising Medicare costs. Therefore, their standard Part B premiums were $110.50 a month in 2010 and $115.40 in 2011 (or more if they paid the higher-income surcharge) — whereas everybody else still paid $96.40.
Right now, nobody knows whether there will be a Social Security COLA next year and how this will affect 2012 premiums.
Higher income-related premiums
While the email makes bogus predictions about future increases in the standard Part B premium, the new law does make two changes that affect Medicare premiums.
Ever since 2007, under a law passed in 2003, people with Medicare have paid a surcharge on their Part B premiums if their modified adjusted gross income, as shown on their latest tax return, is higher than $85,000 for a single person or $170,000 for a married couple filing joint returns.
Currently, fewer than 1 in 20 beneficiaries pays higher-income premiums. But that percentage is likely to grow in coming years — and this development is the result of the new health care law. The law froze the income brackets at 2010 levels through 2019, which means that more older Americans will become liable for the surcharge — up from 5 percent now to 14 percent by 2019, according to an estimate from the Kaiser Family Foundation.
The new law also required the same wealthier beneficiaries to pay a premium surcharge for Medicare Part D prescription drug coverage for the first time, starting in January 2011.
For details of these surcharges, see the Social Security publication "Rules for Higher-Income Beneficiaries."
Patricia Barry is a senior editor with the AARP Bulletin.
This process is in no way affected by the new health care law, officially known as the Affordable Care Act. The law does, however, contain provisions to reduce the rate of Medicare costs over time (without reducing guaranteed benefits), and if this plays out as planned, it could hold Part B premiums down or possibly even lower them.
The standard Part B premium for 2012 will not be known until later this year. And there is no way of accurately predicting what it will be in 2014 or any future years.
Part B premiums affected by Social Security COLA
However, another much older law did affect Part B premiums in 2010 and 2011 in an unprecedented way. That law prohibits a premium increase in any year when there is no Social Security cost-of-living adjustment (COLA). So in the past two years when — for the first time in more than 30 years — there was no COLA, most people's premiums were frozen at the 2009 level, $96.40 a month.
But this "hold harmless" provision did not apply to about 25 percent of Medicare beneficiaries. They include people who did not have their premiums deducted from Social Security benefits (but paid Medicare directly), those who were new to Medicare, and those who paid higher premiums because their incomes were above a certain level.
These people bore the brunt of rising Medicare costs. Therefore, their standard Part B premiums were $110.50 a month in 2010 and $115.40 in 2011 (or more if they paid the higher-income surcharge) — whereas everybody else still paid $96.40.
Right now, nobody knows whether there will be a Social Security COLA next year and how this will affect 2012 premiums.
Higher income-related premiums
While the email makes bogus predictions about future increases in the standard Part B premium, the new law does make two changes that affect Medicare premiums.
Ever since 2007, under a law passed in 2003, people with Medicare have paid a surcharge on their Part B premiums if their modified adjusted gross income, as shown on their latest tax return, is higher than $85,000 for a single person or $170,000 for a married couple filing joint returns.
Currently, fewer than 1 in 20 beneficiaries pays higher-income premiums. But that percentage is likely to grow in coming years — and this development is the result of the new health care law. The law froze the income brackets at 2010 levels through 2019, which means that more older Americans will become liable for the surcharge — up from 5 percent now to 14 percent by 2019, according to an estimate from the Kaiser Family Foundation.
The new law also required the same wealthier beneficiaries to pay a premium surcharge for Medicare Part D prescription drug coverage for the first time, starting in January 2011.
For details of these surcharges, see the Social Security publication "Rules for Higher-Income Beneficiaries."
Patricia Barry is a senior editor with the AARP Bulletin.
Monday, June 13, 2011
Medicare Cost Control
The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
Medicare Cost Control
And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.
Tuesday, June 7, 2011
The Republican idea for killing Medicare is not new
Medicare is a good system. Cost control is what is lacking. When we speak of cost control, right wingers seem to only see cutting at the consumption side. That is, take it out of the sick old people hides. They never think about cost cutting at the supplier side because the supplier is the private insurance companies; their sacred free market cow.
The Republican idea for killing Medicare is not new. They've never been on the people's side, but rather on the corporations’ side. The voucher system proposed by Paul Ryan is a death sentence to Medicare. The vouchers will not keep pace with the rates of inflation or income increases/decreases. As a result, seniors will be left holding the bag, so to speak.
For once in your lives show some compassion towards your fellow seniors, and stop scaring them into submission. Medicare cost control should not be one sided. Sick seniors lack the power to shop, negotiate, and fight insurance companies and medical providers in a market-based environment. That is why Medicare, as well as Social Security, is a social contract between the government and its citizens. But Republicans keep referring to these two programs as "entitlements" when they are fully funded by tax payers through out their working lives.
Recommend Recommended by 300 Readers
The Republican idea for killing Medicare is not new. They've never been on the people's side, but rather on the corporations’ side. The voucher system proposed by Paul Ryan is a death sentence to Medicare. The vouchers will not keep pace with the rates of inflation or income increases/decreases. As a result, seniors will be left holding the bag, so to speak.
For once in your lives show some compassion towards your fellow seniors, and stop scaring them into submission. Medicare cost control should not be one sided. Sick seniors lack the power to shop, negotiate, and fight insurance companies and medical providers in a market-based environment. That is why Medicare, as well as Social Security, is a social contract between the government and its citizens. But Republicans keep referring to these two programs as "entitlements" when they are fully funded by tax payers through out their working lives.
Recommend Recommended by 300 Readers
Monday, June 6, 2011
Vouxhercare
Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead. Specifically, the program would pay a fixed amount toward private health insurance — higher for the poor, lower for the rich, but not varying at all with the actual level of premiums. If you couldn’t afford a policy adequate for your needs, even with the voucher, that would be your problem.
And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.
And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.
Saturday, April 30, 2011
class act MEDICARE AND LONG TERM CARE
Here’s the blunt truth: Medicare generally won’t pay for as much nursing home or in-home care as many people think it will. Your cash savings may well be insufficient, especially if you want to leave plenty of money for a spouse who may outlive you. Your family may not be willing or able to take care of you. And if you do spend all of your assets to qualify for Medicaid, there’s no guarantee Medicaid will pay for the quality of care you want and do so close to friends or family.
So we better hope that the Class Act works and helps lots of Americans. Because if it doesn’t, plenty of people will be right back in denial-land again.
That said, there are some people who have already purchased long-term care insurance from a commercial company. Limra, a market research firm, figures there are about seven million of them.
Some buy it out of an abundance of caution, while others do it because their employers offer subsidized premiums as a benefit. Many others have seen family members spend hundreds of thousands of dollars on care or struggled to provide care themselves when there was no money left.
So we better hope that the Class Act works and helps lots of Americans. Because if it doesn’t, plenty of people will be right back in denial-land again.
That said, there are some people who have already purchased long-term care insurance from a commercial company. Limra, a market research firm, figures there are about seven million of them.
Some buy it out of an abundance of caution, while others do it because their employers offer subsidized premiums as a benefit. Many others have seen family members spend hundreds of thousands of dollars on care or struggled to provide care themselves when there was no money left.
Wednesday, April 6, 2011
Medicare in 2011
Important Medicare Changes in the New Year—How ACA Impacts People with
There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare. Many of these changes will take place in 2011 – some even began as early as January 1. Below is a list of some of the changes beneficiaries will experience this year:
Access to a new Physician Compare Website
A new CMS Healthcare Provider Directory is now available through the Physician Compare Website. This consumer-friendly site is designed to help beneficiaries and their families locate and compare health professionals in communities across the country. You can find the following information on the site:
•
Contact and address information for physicians’ offices;
•
Physicians’ medical specialties
•
Where they completed their degree as well as residency or other clinical training;
•
His or her gender
•
Which languages a physician speaks; and
•
Whether or not a physician participates in the Medicare program.
CMS will continue to expand and improve Physician Compare with more information about quality of care and patient experience that can help consumers learn more about the care provided by Medicare-participating physicians. To learn more about the Physician Compare Website, please visit: http://www.medicare.gov/find-a-doctor.
Improvements to Medicare Preventive Benefits
Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit’ where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.
Improved cost-sharing for Medicare preventive services: Also, as of January 1, the ACA also eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts assignment under Medicare, meaning he or she accepts what Medicare pays for a service as payment in full) include:
•
Abdominal aortic aneurysm screening
•
Bone mass measurement
•
Breast cancer screening/mammograms
•
Cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy)
•
Diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Flu shots
•
Hepatitis B shots
•
HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services)
•
Pap tests and pelvic exams
•
Physical exams – both the “Welcome to Medicare” visit and the annual “wellness visit”
•
Pneumococcal shot
•
Prostate cancer screening
•
Smoking cessation counseling
Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.
To learn more about Medicare-covered preventive benefits, go to: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Improvements to the Medicare Advantage Program
Medicare Advantage disenrollment period: People enrolled in private Medicare Advantage plans now have a 45-day window (from January 1 to February 14 of each year) in which they may return to Original Medicare (Parts A and B) and also enroll in a stand-alone Part D prescription drug plan if they wish.
Special Needs Plans: The new law also extends the Medicare Advantage Special Needs Program for an additional three years. Special Needs Plans (SNPs) are allowed to target enrollment to people with one or more types of special needs including 1) individuals living in an institution 2) individuals dually eligible for Medicare and Medicaid; and/or 3) individuals with severe or disabling chronic conditions.
Improvements to Medicare Part D
Savings in the Coverage Gap: Beginning in 2011, people with Medicare will benefit from reduced cost-sharing for prescriptions they purchase while in the
coverage gap (also known as the “doughnut hole”) -- a 50 percent savings on covered brand-name prescriptions and seven percent discount on generic drugs. Medicare will continue to reduce beneficiary cost-sharing and phase out the Part D coverage gap until 2020. For more information (including what will count toward a person’s True Out-of-Pocket, or TrOOP costs), visit http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf.
Changes to the Annual Enrollment Period: In addition, thanks to the ACA, the annual open enrollment period in which people with Medicare may compare and enroll in Medicare Part D plans has been rescheduled and extended . Starting this year, the Annual Enrollment Period will begin October 15th and continue until December 7th.
Improvements to the Low-Income Subsidy
Reassignment: Through changes to the Medicare Advantage program, the ACA makes it easier for those receiving the Extra Help/Low-Income Subsidy (LIS) to stay in the same plan from one year to the next. The law improves the determination formula for plans to remain a $0 premium benchmark LIS plan (plans that offer basic Medicare Part D coverage with rates low enough to allow Medicare to cover 100% of a beneficiary’s premium). This will reduce the number of people reassigned to new prescription drug plans each year and increase the number of LIS benchmark plan options available to beneficiaries. In addition, those who must still be automatically reassigned to a new plan will now receive more detailed information from CMS regarding their new plan so that they can make a more informed and timely decision about their new plan.
There are many additional resources discussing the impact of ACA for Medicare beneficiaries. For more information about these changes, please visit: http://www.healthcare.gov/center/reports/affordablecareact.html.
There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare. Many of these changes will take place in 2011 – some even began as early as January 1. Below is a list of some of the changes beneficiaries will experience this year:
Access to a new Physician Compare Website
A new CMS Healthcare Provider Directory is now available through the Physician Compare Website. This consumer-friendly site is designed to help beneficiaries and their families locate and compare health professionals in communities across the country. You can find the following information on the site:
•
Contact and address information for physicians’ offices;
•
Physicians’ medical specialties
•
Where they completed their degree as well as residency or other clinical training;
•
His or her gender
•
Which languages a physician speaks; and
•
Whether or not a physician participates in the Medicare program.
CMS will continue to expand and improve Physician Compare with more information about quality of care and patient experience that can help consumers learn more about the care provided by Medicare-participating physicians. To learn more about the Physician Compare Website, please visit: http://www.medicare.gov/find-a-doctor.
Improvements to Medicare Preventive Benefits
Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit’ where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.
Improved cost-sharing for Medicare preventive services: Also, as of January 1, the ACA also eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts assignment under Medicare, meaning he or she accepts what Medicare pays for a service as payment in full) include:
•
Abdominal aortic aneurysm screening
•
Bone mass measurement
•
Breast cancer screening/mammograms
•
Cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy)
•
Diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Flu shots
•
Hepatitis B shots
•
HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services)
•
Pap tests and pelvic exams
•
Physical exams – both the “Welcome to Medicare” visit and the annual “wellness visit”
•
Pneumococcal shot
•
Prostate cancer screening
•
Smoking cessation counseling
Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.
To learn more about Medicare-covered preventive benefits, go to: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Improvements to the Medicare Advantage Program
Medicare Advantage disenrollment period: People enrolled in private Medicare Advantage plans now have a 45-day window (from January 1 to February 14 of each year) in which they may return to Original Medicare (Parts A and B) and also enroll in a stand-alone Part D prescription drug plan if they wish.
Special Needs Plans: The new law also extends the Medicare Advantage Special Needs Program for an additional three years. Special Needs Plans (SNPs) are allowed to target enrollment to people with one or more types of special needs including 1) individuals living in an institution 2) individuals dually eligible for Medicare and Medicaid; and/or 3) individuals with severe or disabling chronic conditions.
Improvements to Medicare Part D
Savings in the Coverage Gap: Beginning in 2011, people with Medicare will benefit from reduced cost-sharing for prescriptions they purchase while in the
coverage gap (also known as the “doughnut hole”) -- a 50 percent savings on covered brand-name prescriptions and seven percent discount on generic drugs. Medicare will continue to reduce beneficiary cost-sharing and phase out the Part D coverage gap until 2020. For more information (including what will count toward a person’s True Out-of-Pocket, or TrOOP costs), visit http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf.
Changes to the Annual Enrollment Period: In addition, thanks to the ACA, the annual open enrollment period in which people with Medicare may compare and enroll in Medicare Part D plans has been rescheduled and extended . Starting this year, the Annual Enrollment Period will begin October 15th and continue until December 7th.
Improvements to the Low-Income Subsidy
Reassignment: Through changes to the Medicare Advantage program, the ACA makes it easier for those receiving the Extra Help/Low-Income Subsidy (LIS) to stay in the same plan from one year to the next. The law improves the determination formula for plans to remain a $0 premium benchmark LIS plan (plans that offer basic Medicare Part D coverage with rates low enough to allow Medicare to cover 100% of a beneficiary’s premium). This will reduce the number of people reassigned to new prescription drug plans each year and increase the number of LIS benchmark plan options available to beneficiaries. In addition, those who must still be automatically reassigned to a new plan will now receive more detailed information from CMS regarding their new plan so that they can make a more informed and timely decision about their new plan.
There are many additional resources discussing the impact of ACA for Medicare beneficiaries. For more information about these changes, please visit: http://www.healthcare.gov/center/reports/affordablecareact.html.
G.O.P. Blueprint Would Remake Health Policy
By ROBERT PEAR
WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk.
House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings.
But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states.
Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership.
For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly.
Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program.
Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections.
Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget.
But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs.
Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.”
Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession.
Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums.
Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form.
Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground.
But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt.
“We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week.
Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.”
About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.
The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare.
In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.”
The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law.
Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate.
In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost.
Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage.
But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year.
What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law.
There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit.
The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.
WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk.
House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings.
But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states.
Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership.
For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly.
Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program.
Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections.
Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget.
But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs.
Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.”
Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession.
Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums.
Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form.
Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground.
But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt.
“We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week.
Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.”
About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.
The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare.
In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.”
The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law.
Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate.
In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost.
Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage.
But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year.
What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law.
There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit.
The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.
Saturday, March 26, 2011
MedPac Annual march report 2011
Washington -- The Medicare Payment Advisory Commission has recommended more beneficiary cost-sharing for home health to address concerns about rises in utilization and spending in that sector of the Medicare program.
MedPAC's annual March report to Congress suggests establishing a $150 co-pay per episode of home health care that is not preceded by hospitalization or a post-acute facility stay. Enrollees currently do not have a co-pay for these services. Recommendations by MedPAC are nonbinding, but Congress considers the panel's advice when enacting Medicare legislation.
The recommendation would address rising costs in the program, the commission states.
The report notes that a $150 co-pay per episode would amount to about $9 per visit, and Medicare would continue paying the majority of expenses. Co-pays would apply to most home health cases, as the majority of episodes are not preceded by a hospital or post-acute facility stay, MedPAC says.
There remains some concern that the co-pay could fall on a vulnerable segment of the Medicare population, MedPAC Chair Glenn Hackbarth said at a March 15 House hearing on the report. However, the commission believes it tailored the co-pay so it's not too high as to reduce necessary access, but still high enough to discourage the use of home health when the services are of low value to the patient.
AARP has come out against the recommendation. "While some of MedPAC's other proposals for home health care address the root cause of rising costs, adding a co-payment would simply shift costs to vulnerable seniors who often don't have the resources to compare alternative treatments," the association said in a statement.
The report suggests the Dept. of Health and Human Services and the Office of Inspector General scrutinize counties with aberrant home health utilization, begin a two-year rebasing of home health rates in 2013 and eliminate the market basket update in 2012. The panel also calls on policymakers to revise the home health case-mix system to rely on patient characteristics when setting payment for therapy and nontherapy services.
In addition, MedPAC recommends that lawmakers or the administration:
■Increase hospital inpatient and outpatient rates by 1% in 2012.
■Increase physician rates by 1% in 2012.
■Increase ambulatory surgery center rates by 0.5% in 2012.
■Increase hospice rates by 1% in 2012.
■Establish a quality incentive program for skilled nursing facilities.
The March MedPAC report is available online (www.medpac.gov/documents/mar11_entirereport.pdf).
MedPAC's annual March report to Congress suggests establishing a $150 co-pay per episode of home health care that is not preceded by hospitalization or a post-acute facility stay. Enrollees currently do not have a co-pay for these services. Recommendations by MedPAC are nonbinding, but Congress considers the panel's advice when enacting Medicare legislation.
The recommendation would address rising costs in the program, the commission states.
The report notes that a $150 co-pay per episode would amount to about $9 per visit, and Medicare would continue paying the majority of expenses. Co-pays would apply to most home health cases, as the majority of episodes are not preceded by a hospital or post-acute facility stay, MedPAC says.
There remains some concern that the co-pay could fall on a vulnerable segment of the Medicare population, MedPAC Chair Glenn Hackbarth said at a March 15 House hearing on the report. However, the commission believes it tailored the co-pay so it's not too high as to reduce necessary access, but still high enough to discourage the use of home health when the services are of low value to the patient.
AARP has come out against the recommendation. "While some of MedPAC's other proposals for home health care address the root cause of rising costs, adding a co-payment would simply shift costs to vulnerable seniors who often don't have the resources to compare alternative treatments," the association said in a statement.
The report suggests the Dept. of Health and Human Services and the Office of Inspector General scrutinize counties with aberrant home health utilization, begin a two-year rebasing of home health rates in 2013 and eliminate the market basket update in 2012. The panel also calls on policymakers to revise the home health case-mix system to rely on patient characteristics when setting payment for therapy and nontherapy services.
In addition, MedPAC recommends that lawmakers or the administration:
■Increase hospital inpatient and outpatient rates by 1% in 2012.
■Increase physician rates by 1% in 2012.
■Increase ambulatory surgery center rates by 0.5% in 2012.
■Increase hospice rates by 1% in 2012.
■Establish a quality incentive program for skilled nursing facilities.
The March MedPAC report is available online (www.medpac.gov/documents/mar11_entirereport.pdf).
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