Concerned about executives' salaries and perks, the Senate Committee on Finance has asked the Centers for Medicare and Medicaid Services (CMS) to investigate Medicare Quality Improvement Organizations (QIOs) for effectiveness and improprieties. (Medical News Today) The call for an investigation was likely prompted by the American Health Quality Association's request for more funding and broadened responsibilities. According to the Kaiser Network, CMS currently pays $300 million per year to … [Read more...] about Senate Committee Asks CMS to Investigate QIOs
Update: Medicare to Allow Spinal Disk Coverage
You may recall previous posts about Medicare's potential coverage of the artificial spinal disk Charite. As late as February, the Centers for Medicare and Medicaid (CMS) wanted to deny coverage for the surgery. CMS allowed a 30-day comment period, and at the time, the chances of coverage didn't look promising. According to Johnson & Johnson, the company that manufactures the disk, Medicare will allow its local medical directors to approve coverage for beneficiaries under 60. From the New York … [Read more...] about Update: Medicare to Allow Spinal Disk Coverage
Provider Letter: Freestanding Inpatient Hospice Evac Requirements
In a letter dated May 19, the Texas Department of Aging and Disability Services reminds freestanding inpatient hospices about patient safety during disasters. All Home and Community Support Services Agencies are bound by law to have a written policy for "publicly known natural disaster preparedness for clients receiving services." Inpatient hospices must also have an evacuation plan and periodically rehearse this plan with staff. Freestanding inpatient hospices are also required to have … [Read more...] about Provider Letter: Freestanding Inpatient Hospice Evac Requirements
Politicians Push to Eliminate Medicare Drug Penalty
The deadline to sign up for Medicare's prescription drug program has come and gone, but a bipartisan group of politicians is pushing to eliminate the late fee for beneficiaries who missed the deadline. The next open enrollment period begins in November. (Kaiser Network) Department of Health and Human Services Secretary Mike Leavitt wants Congress to wait until final enrollment numbers are determined before passing the legislation. I agree. The proposed legislation would cost taxpayers $18 … [Read more...] about Politicians Push to Eliminate Medicare Drug Penalty
Medicaid Personal Responsibility Contracts
At least one state wants Medicaid beneficiaries to take responsibility for their own care strongly enough to put incentives in place. West Virginia proposed and the feds approved a plan for "personal responsibility contracts." (Medical News Today) To receive credits for health care services, beneficiaries must choose a primary care provider - a "medical home" - and take measures to stay healthy and improve health by taking medications, attending doctors appointments and exercising. … [Read more...] about Medicaid Personal Responsibility Contracts
Senate Rejects Medical Care Access Protection Act
The American Health Care Association and the National Center for Assisted Living issued a statement about the U.S. Senate's rejection of the Medical Care Access Protection Act, a bill that would have implemented health care liability reforms. Long term care providers have had to reduce patients' access to certain services because of the high costs of medical liability insurance caused by expensive litigation. The Medical Care Access Protection Act (PDF) was designed to reform the system by … [Read more...] about Senate Rejects Medical Care Access Protection Act
Provider Letter: Joint Training Survey Announcement
In a letter dated May 12, the Texas Department of Aging and Disability Services (DADS) asked providers to participate in an online survey for joint training courses. Based on the survey, DADS will assess the needs of nursing, assisted living, adult day care, and intermediate care facilities when developing joint training courses for long term care providers. According to the letter, there is no fee to take the confidential survey, which will be accessible for the next 60 days, starting today. … [Read more...] about Provider Letter: Joint Training Survey Announcement
CMS Proposes Competitive Bidding for Durable Equipment
In a move designed to reduce out-of-pocket expenses for beneficiaries and save the money for the Medicare program, the Centers for Medicare and Medicaid Services (CMS) is seeking to open up bidding for durable medical equipment. From the press release: "We intend to implement these DME competitive reforms to get savings for beneficiaries and taxpayers, while maintaining and improving quality," said CMS Administrator Mark B. McClellan, M.D., Ph.D. "This is another way in which Medicare is … [Read more...] about CMS Proposes Competitive Bidding for Durable Equipment
GAO Report: Medicare Reps Give Bad Information
According to a new report (PDF) by the Government Accountability Office (GAO), customer service representatives at the Centers for Medicare and Medicaid Services (CMS) often give inaccurate information to beneficiaries, and CMS documents are needlessly complicated, loaded with technical jargon. GAO investigators called CMS operators while posing as beneficiaries. According to the report's abstract, representatives gave correct responses 90 percent of the time when asked about eligibility. … [Read more...] about GAO Report: Medicare Reps Give Bad Information
Provider Letter: Preadmission Screening and Resident Review
In a provider letter dated May 5, the Texas Department of Aging and Disability Services reminds federally-funded nursing facility providers that rules at 40 TAC ยง19.2500 require that they screen potential new admissions to determine if there are indicators of mental retardation. Whether the admittees pay through Medicaid, Medicare, private insurance, or private pay, screening is still required. If someone is admitted without a completed screening, the facility may not receive payment if DADS … [Read more...] about Provider Letter: Preadmission Screening and Resident Review