Month: March 2011

Main Category: Medicare / Medicaid / SCHIP
Article Date: 25 Mar 2011 – 11:00 PDT

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Krystal Knight, M.P.H., will join the Medicare Rights Center’s Washington, D.C. office to serve in the newly created position of State Program and Policy Coordinator. Ms. Knight will oversee a new project funded by Atlantic Philanthropies to expand the Medicare Rights Center’s community-based education and policy programs in five states-Alabama, Florida, Kansas, Maine and Wisconsin.

Through the project, Medicare Rights will partner with local organizations in each state to establish, or in the case of Kansas, to expand, the award-winning Seniors Out Speaking (SOS) program. Through the SOS program, Medicare Rights works with host organizations nationally to enlist, train and track the outcomes of SOS volunteers as they help their peers understand Medicare and related health insurance coverage. Ms. Knight will also oversee the launch of Medicare Advocacy Coalitions in each state, bringing together consumers, advocacy organizations, policymakers and other stakeholders to help ensure that health reform is responsive to the needs of people with Medicare.

“I am delighted that Krystal will join Medicare Rights as our State Program and Policy Coordinator,” said Joe Baker, president of the Medicare Rights Center. “She brings a wealth of knowledge and experience to the Medicare Rights Center to help us serve people with Medicare and build coalitions with stakeholders across the country.”

“I am thrilled to come on board at the Medicare Rights Center at a time of great opportunity to create positive change for people with Medicare,” said Ms. Knight. “Health reform represents a tremendous opportunity for the American health care system, and much work is required to ensure that the needs of older adults and people with disabilities are met as implementation unfolds.”

Ms. Knight was formerly Public Policy Associate at the National Association of Community Health Centers, and holds a B.A. and an M.P.H. from the University of Florida.

Source:

Medicare Rights Center

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Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Mar 2011 – 0:00 PDT

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Deciding when a resident is eligible to move to skilled care ranks among the most challenging dilemmas for long-term care facilities. Tracking Medicare Part A admissions rules, MDS assessments, eligibility requirements and benefits periods can stymie even the most careful administrators and clinicians — and negatively impact reimbursements, which can average from $350 to $650 per day for each Medicare resident.

Author Elizabeth Malzahn takes the mystery out of the process with “Long-Term Care Skilled Services: Applying Medicare’s Rules to Clinical Practice,” a practical, easy-to-read, 147-page guide for anyone involved in resident care decisions, compliance or payments in the long-term care arena.

Chock-full of clear examples, the book illustrates the roles of key players like nursing or therapy directors, chief financial officers or administrators, and explains how to properly manage the skilled services maze to minimize critical mistakes like over- or under-payment. Malzahn covers a range of important topics, walking the reader through complex regulations, technical eligibility rules and the all-important MDS 3.0 assessment process. She provides tips and insight into virtually every aspect of skilled services, including how to properly communicate with residents and families, and attempts to dispel popular “myths” about Medicare.

Malzahn leverages her experience as national director of health care for Covenant Retirement Communities, a Chicago-based not-for-profit with 12 continuing care retirement communities across the country. Her observations there, as well as the decade she spent in an accounting firm’s Health Care Consulting Group specializing in skilled nursing facilities, can help facilities set up a win-win: residents get the services they need (and have paid into over a lifetime), and the facilities receive the appropriate Medicare reimbursement. This book is designed, Malzahn said, to help facilities increase their Medicare Part A census and avoid discharging residents too soon as well as improve staff support for the process.

“By cutting to the basics, the book makes Medicare admission clear and concise,” says author Elizabeth Malzahn. “It should make providers confident about admitting residents on Medicare and allow them to help patients access all appropriate services.”

“Long-Term Care Skilled Services: Applying Medicare’s Rules to Clinical Practice,” is published by HCPro, Inc. and available online April 8, 2011 in the HCPro Healthcare Marketplace.

Source: Covenant Retirement Communities

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 23 Mar 2011 – 9:00 PDT

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On the eve of the one-year anniversary of the health care reform bill, a survey of 321 seniors 65 and older revealed that 61%1 think the bill has weakened Medicare in the year since it became law. At the same time, 57% of those surveyed say they will take advantage of a free physical exam and personal wellness plan benefit included in the bill that went into effect this year.

Moreover, 73% of seniors surveyed think the health care bill will continue to weaken Medicare over the long term. When asked about attempts underway in the U.S. House of Representatives to defund the bill, 43% support defunding the bill entirely and 29% think only certain provisions of the bill should be defunded.

The survey was fielded from March 18-21, 2011 by Extend Health, Inc., which operates the nation’s largest private Medicare exchange. The results highlight seniors’ varying opinions and in some cases, misperceptions about the health care reform bill. As the bill stands now, it does not cut any Medicare benefits, and instead adds some benefits, including the previously mentioned free physical exam and other free preventative care services.

Bryce Williams, CEO of Extend Health said, “Clearly, many seniors are worried about their Medicare benefits and believe that health care reform threatens them. No one can predict the future, but the current bill actually strengthens Medicare benefits, and that’s the message that needs to get out so seniors can make informed decisions about their health care.”

The questions and detailed results from the survey are as follows:

What is your opinion of the overall impact of the health care reform bill on
Medicare in the ONE YEAR since the bill was signed into law?

The bill has weakened Medicare 60.8%

The bill has had no effect on Medicare 13.9%

The bill has strengthened Medicare 10.1%

I have no opinion 15.2%

What is your opinion of the overall long-term FUTURE impact that the health care
reform bill will have on Medicare?

The bill will weaken Medicare 72.4%

The bill will strengthen Medicare 13.3%

The bill will have no effect on Medicare 2.5%

I have no opinion 11.7%

Earlier this year, the U.S. House of Representatives voted on a bill that would have
repealed the health care reform law, but the bill was voted down when it was sent to
the U.S. Senate. Now, the House is trying to stop implementation of some provisions
of the law by not funding them. How do you feel about efforts to fund or not fund
certain provisions of the health care reform law?

I support defunding the entire bill 42.8%

I support efforts to defund certain provisions of the law 28.8%

I think there are more health care needs that should be added to the bill and funded 11.3%

I think the bill should remain intact and be funded in its entirety 7.2%

I do not support efforts to defund certain provisions of the law 4.7%

I have no opinion 5.3%

A new Medicare benefit that went into effect this year offers people covered by
Medicare a free full physical exam and a personal wellness plan that focuses on
prevention. What are your plans for taking advantage of this new benefit?

I definitely plan to have a free physical exam and personal wellness plan this year 40.0%

I have not decided yet whether to get a free physical exam and personal wellness plan this year 25.5%

I have already received a free physical exam and personal wellness plan this year 16.5%

I have no interest in this benefit 18.1%

Extend Health has helped more than 300,000 seniors compare and choose the private Medicare plans that best meets their needs and budgets. Extend Health is the only place seniors can compare more than 3,500 plans from 70 carriers side by side and find a plan that best meets their needs. Licensed benefit advisors are available to help seniors evaluate their Medicare coverage and explore new options quickly and easily.

Source:

Extend Health

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Main Category: Medicare / Medicaid / SCHIP
Article Date: 23 Mar 2011 – 9:00 PDT

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Through provisions of the Affordable Care Act, nearly 4 million people with Medicare who reached the program’s Part D coverage gap in 2010 have received a one-time, tax-free $250 rebate check. U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today that a similar number of Medicare beneficiaries are likely to enter the coverage gap in 2011 and will benefit from additional Affordable Care Act provisions that work to reduce and close the “donut hole” by 2020. Already, nearly 48,000 Medicare enrollees have saved $38 million – an average of $800 per person – thanks to a new 50-percent discount on covered brand-name drugs in the donut hole.

“For too long, many seniors and people with disabilities have struggled to choose between paying for needed prescription medication and other necessities, like food, rent and utilities,” Sebelius said. “The Affordable Care Act is delivering more affordable prescription drugs to seniors and giving everyone on Medicare better benefits.”

The new health care law is working to make Medicare stronger and more secure for all beneficiaries. Its provisions have increased benefits to beneficiaries and helped extend the life of the Medicare Trust Fund by 12 years. Today, HHS also released a new video outlining how the Affordable Care Act is helping seniors and others with Medicare. To watch the video, visit here.

Beginning in 2011, the Affordable Care Act provides a 50-percent discount on covered brand name prescription drugs to seniors and others with Medicare who reach the donut hole. For the 11,000 beneficiaries with the highest out-of-pocket costs, savings have averaged $1,775. The five states with the largest number of individuals who received a rebate check are: California, Florida, New York, Pennsylvania, and Texas. Millions more beneficiaries are expected to receive the discount over the course of the year. In addition, this year, Medicare began shrinking the donut hole by increasing coverage for generic drugs.

The Centers for Medicare Medicaid Services (CMS) has mailed almost 4 million rebate checks to people with Medicare, providing nearly $1 billion in out-of-pocket relief. It is clear that the $250 rebate checks provided significant financial relief to these individuals as the checks were cashed, on average, within 15 days of the checks being issued, with almost half of all beneficiaries cashing the check within 10 days of issue.

“The closing of the donut hole is just one of the ways seniors will benefit from the Affordable Care Act,” CMS Administrator Donald M. Berwick, M.D. said. “Adding even greater value to their savings on prescription drugs, the new health care law gives people with Medicare new benefits as soon as they visit their doctors this year.”

Since January 1, Original Medicare began:

– Providing a free annual wellness visit; in the first six weeks of 2011, over 150,000 beneficiaries benefited from this new option.

– Making critical preventive services, including certain cancer screenings such as mammograms and colonoscopies available for most people with Medicare, at no cost.

– Giving qualifying doctors and other health care professionals that provide primary care to people with Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to offer professional health care services to Medicare patients.

Thanks to these types of Medicare improvements, an analysis issued by the U.S. Department of Health and Human Services in November 2010 estimated that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years.

The new report on how the Affordable Care Act is helping lower drug costs for people with Medicare is available here. To find out how many rebate checks have been distributed in your State, visit here.

For more information on how the Affordable Care Act benefits seniors, visit here, a web portal made available by the U.S. Department of Health and Human Services. People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by visiting here.

Source:

HHS

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Main Category: Medicare / Medicaid / SCHIP
Article Date: 24 Mar 2011 – 2:00 PDT

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The AMA today released its Position Statement on Medicare Locals and urged the Government to adopt the AMA recommendations to establish better primary health care organisations (PHCOs) than the currently proposed Medicare Locals model.

AMA President, Dr Andrew Pesce, said today that the main function of Medicare Locals must be to better support the role of the GP in delivering services to patients.

“GPs are the highest trained practitioners in the primary health care setting and have a key role in the coordination and management of care for patients,” Dr Pesce said.

“They provide 120 million services to patients each year.

“Medicare Locals could be useful to GPs by supporting them in carrying out their role and assisting them in accessing allied health services in the community.

“There must be no fundholding arrangements for GP and other specialist services and Pharmaceutical Benefits Scheme medicines.

“Local doctors must be on the Boards of Medical Locals and have leadership roles on other governance committees.

“These important arrangements and conditions are missing from the Government’s guidelines, which means the AMA cannot support Medicare Locals as currently proposed.

“We call on the Government to defer the current processes to establish Medicare Locals so that there can be proper consultation with the medical profession about the future of primary care in this country.

“Many stakeholders and commentators see problems with the proposed Medicare Locals.

“Even those who offer their support qualify that support with concerns about the proposed structure and governance of Medicare Locals, especially how they will coordinate care between primary and acute care settings.

“The AMA Position Statement contains sensible achievable recommendations to deliver quality primary care services to the Australian community,” Dr Pesce said.

The AMA Position Statement on Medicare Locals is on the AMA website.

Source:

Australian Medical Association

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 24 Mar 2011 – 6:00 PDT

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One year ago, on March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, the Health Care Reform law[1] that will provide access to health insurance for virtually all Americans.

As the Center for Medicare Advocacy has reported over the past year, Health Care Reform is good for Medicare, good for families, and good for the country. Health Care Reform does not cut Medicare benefits. In fact, Health Care Reform expands Medicare coverage, by eliminating cost-sharing for preventive services, adding a yearly Wellness Visit, limiting some cost-sharing in private Medicare plans, and closing the Part D “Donut Hole.” It also improves the solvency of the Medicare program itself, while helping reduce the deficit and creating 260,000 new jobs for Americans.[2]

Even one year after passage of the historic law, misstated reports of these changes continue to encourage public fear of cuts to Medicare benefits.

Threats to Medicare, including benefit cuts and the dismantling of the Medicare program, are real, but they do not come from Health Care Reform. The biggest threats to Medicare are from deficit reduction proposals[3] and the repeal of Health Care Reform, not from the Health Care Reform law itself. The proposals that threaten Medicare are often made by the same policy-makers who decried Health Care Reform as hurting, not helping, Medicare and Medicare beneficiaries. One year after enactment of Health Care Reform, it is these purported deficit reduction proposals that, if enacted, would cause the sweeping changes to Medicare that are often wrongly attributed to Health Care Reform.

The chart below compares Health Care Reform, deficit reduction proposals, and repeal efforts and their effect on the Medicare program.

Health Care ReformDeficit Reduction ProposalsRepeal of Health Care ReformDeficit ReductionReduces deficit by $1.2 trillion over twenty years. [4]Do not address the issue of sharply rising health care costs in the private sector, which are reflected in the costs to the federal government.[5]Adds $230 billion to the deficit[6] Medicare SolvencyExtends Medicare Part A Trust Fund solvency by 12 years to 2029. [7]Do nothing to promote Medicare solvency. Eliminates cost-savings, including development of new delivery systems, that promote Part A Trust Fund solvency. Protects Medicare’s Guaranteed Benefits“Nothing in the provisions of, or amendments made by, this Act shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act [the Medicare title]” Additionally, “Nothing in this Act shall result in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans.”[8]Eliminate Medicare as we know it by turning Medicare into a voucher program. There would be no guaranteed benefit package, and beneficiaries would face less extensive coverage or pay higher premiums than under the current system.[9]Increases the vulnerability of the Medicare Trust Fund, leading to a corresponding threat to beneficiaries’ guaranteed benefits. Medicare EligibilityMedicare eligibility is not changed. Most people are eligible at age 65.Increase the age of Medicare eligibility to 67. [10]If Health Care Reform is repealed and the age of eligibility is increased, people between ages 65 and 67 who would otherwise have had Medicare coverage would be uninsured.[11] Medicare Cost-SharingReduces cost-sharing by:

1. Eliminating co-insurance and deductibles for most preventive services;
2. Closing the Part D prescription drug donut hole; and
3. Prohibiting Medicare Advantage plans from charging more than traditional Medicare for costly services.[12]

Increase cost-sharing by:

1. Increasing deductibles and coinsurance for Parts A and B through a combined deductible and 20% coinsurance for all further costs; [13]
2. Adding a co-payment for home health services;[14]
3. Changing Medigap (Medicare supplemental) insurance so that beneficiaries would have to pay a co-payment for all services.[15]

These proposed increases in cost-sharing would most affect poor and sick beneficiaries, leaving them with higher costs and less access to the care they need.[16]Reinstates cost-sharing for preventive services and reopen the “Donut Hole,” ensuring higher out-of-pocket costs. Some beneficiaries would forego preventive care and stop taking their medicine. Medicare PremiumsFreezes the income level at which beneficiaries with higher incomes pay more for Part B; requires beneficiaries with higher incomes to pay more for Part D.[17]Requires ALL Medicare beneficiaries to pay higher Part B premiums, in addition to the extra premiums that people with higher incomes pay for Part B and Part D. Some proposals would increase Part B and D premiums by 30% by 2021.[18]Rescinds freeze on income levels for increased premiums. Fraud, Waste, and AbuseTargets fraud, waste, and abuse in Medicare by:

1. Eliminating overpayments to Medicare Advantage plans.[19]
2. Implementing stricter screening procedures and billing procedures on Medicare providers and suppliers;
3. Appropriating additional funds[20]

Do not address fraud, waste, and abuse.Eliminates programs that target fraud and abuse, and reinstates wasteful Medicare Advantage overpayments.[21] Coordination of Care and Improved QualityAdds specific programs to improve quality of care. For example: payment reforms; auditing unnecessary hospital admissions and hospital acquired conditions; promoting programs to improve care coordination, particularly for beneficiaries with complex health conditions; improving quality measures and quality reporting.[22]Apply across-the-board payment cuts and do not seek to reduce costs by improving care coordination or quality of care. Eliminate programs that seek to coordinate care and improve quality for beneficiaries. Promotion of Health Care Delivery System ReformsCreates the Center for Medicare Medicaid Innovations (CMMI) to promote delivery systems that improve care and reduce costs, creates Medical Home and Accountable Care Organization models to improve care for people with multiple chronic conditions.[23]Eliminate funding for CMMI and for innovative delivery system models without alternative delivery system reforms to address high costs.Eliminates authority and funding for delivery system innovations, including for CMMI, thereby eliminating opportunities to find solutions to the growth in health care costs. Protection for People Dually Eligible for Medicare and Medicaid (Dual Eligibles)Creates the Federal Office of Coordinated Health Care to improve access to care for dual eligibles;[24] improves access to benchmark Part D drug plans for people eligible for the Part D low-income subsidy.[25]Turn Medicaid into a block grant program, thereby providing less or no assistance to people with limited incomes and resources, including people who need long-term care.[26]Reverses the creation of critical initiatives to improve access and navigation through the health system for vulnerable dual eligibles.

Conclusion

Enactment of the Health Care Reform law has improved the lives of the millions of Americans and their families who count on Medicare for their health insurance coverage. The law ensures future generations will have access to benefits by strengthening the Medicare trust fund and by supporting delivery system reforms that will help reduce the growth in health care costs. Health Care Reform promotes health and wellness for beneficiaries by emphasizing prevention, quality, and care coordination. Health Care Reform also benefits the families of Medicare beneficiaries by extending access to health insurance coverage to millions of uninsured individuals, and by protecting everyone against insurance company practices that deny health insurance coverage to people when they need it.

Efforts to eliminate Health Care Reform and deficit reduction proposals are dangerous threats to Medicare and harmful to its most vulnerable beneficiaries. They shift the burden of rising health care costs to Medicare beneficiaries, who do not have the means to absorb these costs, while ignoring the real culprit of skyrocketing overall costs in the private market. If passed, repeal of health care reform and deficit reduction proposals will result in substantial cuts to Medicare; cuts that will be felt most by women, sick beneficiaries, and poorer beneficiaries already paying high out-of-pocket costs.

Simply put, Health Care Reform is good for Medicare, families, and taxpayers. Medicare beneficiaries and their families should celebrate the first anniversary of the Patient Protection and Affordable Care Act, and should work hard to ensure that its provisions are fully implemented.

[1] Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148 (March 23, 2010), and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010). The laws often are collectively referred to as the Affordable Care Act (ACA).
[2] “The Employment Situation.” Economic News Release. U.S. Bureau of Labor Statistics, http://www.bls.gov/news.release/empsit.nr0.htm.
[3] For a comparison of the various deficit reduction proposals, see, Kaiser Family Foundation, Comparison of Medicare Provisions in Deficit Reduction Proposals (January 2011), http://www.kff.org/medicare/upload/8124.pdf.
[4] “Preliminary Analysis of the President’s Budget for 2012,” March 18, 2011, http://www.cbo.gov/doc.cfm?index=12103.
[5] Even before enactment of health care reform, experts argued that lowering spending growth in Medicare is only possible if lower spending growth is reflected in the private sector. Gail Wilensky, “The Challenge of Medicare,” in Restoring Fiscal Sanity 2007: The Health Spending Challenge, Brookings Institution Press, 2007.
[6] Congressional Budget Office, H.R. 2, Repealing the Job-Killing Health Care Law Act. Feb 18, 2011, available at: http://www.cbo.gov/doc.cfm?index=12069
[7] “2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,” August 5, 2010, https://www.cms.gov/ReportsTrustFunds/downloads/tr2010.pdf.
[8] PPACA §§ 3601, 3602.
[9] Douglas W. Elmendorf, Director, Congressional Budget Office, Letter to the Honorable Paul D. Ryan, November 17, 2010, http://www.cbo.gov/ftpdocs/119xx/doc11966/11-17-Rivlin-Ryan_Preliminary_Analysis.pdf; Paul N. Van de Water, Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs To States And Beneficiaries(Center on Budget and Policy Priorities, March 17, 2011), http://www.cbpp.org/cms/index.cfm?fa=viewid=3429.
[10] Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs to States and Beneficiaries, supra.
[11] Ibid.
[12] PPACA §§ 3203,3301, 3315 4103, 4104, HCERA § 1101,amending 42 U.S.C. §§1395l(a)(1), 1395w-22(a)(1)(B); and adding 42 U.S.C. §1395w-114A.
[13] Alice Rivlin and Paul Ryan, A Long-Term Plan for Medicare and Medicaid, November 17, 2010, available at http://paulryan.house.gov/UploadedFiles/rivlinryan.pdf
[14] Medicare Payment Advisory Committee, Report to the Congress: Medicare Payment Policy, Chapter 8 (March 2011) http://www.medpac.gov/documents/Mar11_EntireReport.pdf.
[15] Report of the National Commission on Fiscal Responsibility and Reform, The Moment of Truth, December 2010.
[16] Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs to States and Beneficiaries, supra.
[17] PPACA §§ 3308, 3402, amending 42 U.S.C. §§ 1395r(i), 1395w-113(a).
[18] Center for American Progress, “Higher Tolls on the Roadmap”, February 15, 2011, available at http://www.americanprogress.org/issues/2011/02/ryan_roadmap.html.
[19] HCERA §§ 1102, amending 42 U.S.C. §1395w-23.
[20] PPACA, §§ 6401-6411, HCERA § 1304.
[21] Congressional Budget Office, H.R. 2, Repealing the Job-Killing Health Care Law Act, supra.
[22] PPACA §§ 3001-3015.
[23] PPACA §§ 3021, 3022, adding 42 U.S.C §§ 1315a, 1395jjj.
[24] PPACA § 2602, adding 42 U.S.C. § 1315b.
[25] PPACA §§ 3302, 3303,amending 42 U.S.C. §§ 1395w-114(a),(b).
[26] Edwin Park, Matt Broaddus, Medicaid Block Grant Would Shift Financial Risks and Costs to States, (Center for Budget and Policy Priorities, February 23, 2011) http://www.cbpp.org/cms/index.cfm?fa=viewid=3409.

Source:
Matthew E. Shepard
Center for Medicare Advocacy, Inc.

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