The federal government and the states currently share responsibility for Medicaid long term care. Tommy Thompson, former U.S. Health and Human Services secretary, says that should change in light of the approaching retirement of the baby boomers. Medicaid is already burdening the states, and it will get worse in the next few years. Thompson believes the federal government should be responsible for long term care of the elderly, while the states focus on "acute care for those under 65." … [Read more...] about Former HHS Chief Says Feds Should Be Responsible for Medicaid Long Term Care
Bush Administration Scales Back Medicare Reimbursement Cuts
Over the last few months, medical device makers and lawmakers have pressured the Bush administration to rethink a proposed rule that would have cut Medicare reimbursements for implanted cardiac devices by up to 30 percent in an effort to close loopholes used by specialty hospitals. The lobbying efforts worked. Under the final rule issued by the Centers for Medicare and Medicaid Services (CMS), reimbursement cuts will be smaller and phased in over three years. Groups like AdvaMed, which … [Read more...] about Bush Administration Scales Back Medicare Reimbursement Cuts
New Policy Changes for Dual Eligibles; Physician Groups to Lobby Congress
The Long Term Care Partnership Program (which encourages people to buy private long term care insurance) will be extended from five states to 50, according to the Centers for Medicare and Medicaid Services (CMS). That is one example of CMS's new policy changes for Medicaid coverage of dual eligible beneficiaries. Apparently, some recipients who wouldn't ordinarily qualify for Medicaid (created for people with low incomes) hide assets in order to qualify for the federal insurance program. … [Read more...] about New Policy Changes for Dual Eligibles; Physician Groups to Lobby Congress
New Provider Letter: License Application and Fee Changes
In a provider letter dated August 1, the Texas Department of Aging and Disability Services and the Regulatory Services Division informed assisted living facilities, adult day care facilities, intermediate care facilities for persons with mental retardation or a related condition, and nursing facilities about new requirements for submitting license applications and fees. Currently, providers are instructed to mail applications to Regulatory Services and fees to Accounts Receivable. Effective … [Read more...] about New Provider Letter: License Application and Fee Changes
DADS Rule Requiring Augmentative Communication Device to be Purchased by Nursing Homes Proposed?
In the weekly newsletter for Texas Association for Residential Care Communities, Sid Rich is reporting that DADS "is proposing a new rule that would require a nursing home to purchase an Augmentative Communication Device (ACD) to enhance an individual's communication and interaction with facilities. According to Sid, his investigation shows these devices to cost as much as $10,000. I haven't found the proposed rule on the internet as well. If any of you have, please put a link in … [Read more...] about DADS Rule Requiring Augmentative Communication Device to be Purchased by Nursing Homes Proposed?
Provider Letters: Statement of Deficiencies or Violations/Amendment to 40 TAC Resident Assessment
1) The Texas Department of Aging and Disability Services (DADS) informed providers about an electronic procedure for submitting documents following a visit from a surveyor and the finding of a deficiency or violation. From the letter (dated July 31): Question: Does sending the Statement of Deficiencies form (CMS-2567) or Statement of Violations form (DADS-3724) with the Plan of Correction (PoC) by electronic mail (e-mail) satisfy the State Operations Manual (SOM) requirement and state … [Read more...] about Provider Letters: Statement of Deficiencies or Violations/Amendment to 40 TAC Resident Assessment
Provider Letter: New Fiscal Year — Reminder
The Texas Department of Aging and Disability Services reminds providers that in fiscal year 2007, any claims remaining from fiscal year 2004 become miscellaneous and won't be paid through the standard Claims Management System payment process. If the service dates on a claim are earlier than two previous fiscal years and the current year, it is dubbed "miscellaneous." For more information, download the letter here. … [Read more...] about Provider Letter: New Fiscal Year — Reminder
Pennsylvania to Require PACE Seniors to Enroll in Medicare Drug Plans
Pennsylvania will require low-income seniors currently enrolled in the PACE prescription drug assistance program to enroll in Medicare Part D. (Medical News Today) PACE covers drug costs not covered by Medicare. The state sent letters to Pace enrollees to inform them about their new Medicare plans. Beneficiaries will have 10 days to object to the state's recommendations. After 10 days, the state will enroll beneficiaries in the recommended plans automatically. Apparently, PACE participants … [Read more...] about Pennsylvania to Require PACE Seniors to Enroll in Medicare Drug Plans
Texas Register Updates; New OIG Report
The Texas Health and Human Services Commission (HHSC) recently adopted amendments to §371.204 and §371.208, relating the Hospital Screening Criteria for Texas Medical Review Program (TMRP), Tax Equity and Fiscal Responsibility Act (TEFRA), and LoneSTAR Select II Contract Reviews and Appeals Related to Utilization Review Department Review Decisions. For more information, see this section of the July 14 Texas Register. The Board of Nurse Examiners will review and consider whether to re-adopt, … [Read more...] about Texas Register Updates; New OIG Report
An Interview With Andy Kessler
Earlier this month, I wrote a post about a new book entitled The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor written by Andy Kessler. Today, I had the opportunity to interview Andy as my guest while sitting in as a guest host for my friend Mychal Massie on his show, Straight Talk, which plays on Right Talk Radio. John, at Right Talk, graciously allowed me to download the show in order to reproduce it here. I thank John and Right Talk for giving me … [Read more...] about An Interview With Andy Kessler