LTC News: No Medicaid Payments

--  Medicare Part D, 2014 --  "In a blow to Medicaid-certified long-term care providers in the nation's capital, officials announced the District of Columbia would not make Medicaid payments during the federal government shutdown." – McKnight's --  "In the two years since an 11.1% reimbursement cut for skilled nursing facilities hit, providers have regrouped and have achieved modest successes, the president of the American Health Care Association/National Center for Assisted Living told … [Read more...]

News from CMS

>> CMS recently announced that a 60-day supplier bidding period for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies will begin at the end of October. (Source) CMS's Jonathan Blum said, "Competitive bidding is an essential tool to help Medicare pay appropriately for health care—important not only to maintain Medicare beneficiaries' access to high quality medical items and services, but also to lower the cost … [Read more...]

Extending Medicare Drug Coverage May Lower Other Costs

A recent study showed that extending Medicare Part D coverage to Medicare enrollees who previously had limited or no drug coverage may result in lowering other medical costs. (Source) According to the study, prescription drug spending for newly enrolled beneficiaries without previous coverage rose by $41 a month, $27 a month for those who'd had a $150 quarterly cap, and $13 a month for who'd had a $350 cap. The study also found that spending for other forms of medical care for the … [Read more...]

Pharmaceutical Industry Agrees to Cut Drug Costs

The Wall Street Journal reports that the pharmaceutical industry has agreed to cut the cost of Medicare drugs to prevent larger cuts President Barack Obama may impose to fund his health care reform plan. Under the cost-cutting plan, the drug industry would pay for half the Medicare drug's price when it's not covered by the gap under Part D. Over 10 years, pharmaceutical companies will sacrifice $80 billion by covering a larger share of brand-name prescription drug costs. The health care … [Read more...]

CMS News: Preventable Readmissons, Bidding Program Resumed

The Centers for Medicare and Medicaid Services (CMS) has announced a pilot program called the Care Transitions Project, designed to reduce preventable hospital readmissions. (Source) The national program, running through summer 2011 in 14 communities, will look at readmission rates at hospitals and develop ways to reduce readmissions. Acting administrator Charlene Frizzera said one in five patients leaving hospitals will be readmitted within the next month, and 75 percent of those … [Read more...]

CMS Quick Links for Tuesday

Last week the Centers for Medicare and Medicaid Services (CMS) announced that it would postpone implementation of a competitive bidding rule for durable medial equipment providers until April. CMS was required do another round of bidding and make changes, so the implementation date was pushed back. The comment period for the final rule ends on March 17, 2009. (Kaiser Network) CMS would like to make it easier for Medicare beneficiaries with conditions like epilepsy, mental illness, and … [Read more...]

HHS: Medicare Part D Beneficiaries Overcharged

According to a report released by the U.S. Department of Health and Human Services Office of the Inspector General, private insurers under Medicare Part D have overcharged beneficiaries and taxpayers by billions of dollars since the program began in 2006. (Kaiser Network) An estimated 80 percent of private insurance companies owe Medicare $4.4 billion. The Centers for Medicare and Medicaid Services (CMS) has not conducted audits it should have performed in 2006. Consequently, CMS doesn't know … [Read more...]

Medicare Advantage and Part D Under Obama

Last summer, President George W. Bush vetoed a bill that would have halted a 10.6 percent Medicare physicians pay cut. Democrats proposed to reduce payments to Medicare Advantage (MA) plans to fund the physicians pay cut. President Bush reportedly vetoed the bill because it would "harm beneficiaries by taking private health plan options away from them" and urged Congress to send him a bill "that reduces the growth in Medicare spending, increases competition and efficiency, implements … [Read more...]

Medicare News: MedPAC and Part D

The Medicare Payment Advisory Commission (MedPAC) has recommended that hospitals receive full market basket Medicare payment increases in fiscal year 2010. (Kaiser Network) Among the proposals is a 1.6 percent payment increase recommendation for long term care hospitals based on quality of care delivered. A final vote will come in January. MedPAC advises Congress on Medicare issues. In other Medicare news, Kaiser reports that close to 133,000 beneficiaries in Tennessee have not taken … [Read more...]

Medicare Part D’s Home-Infusion Therapy Coverage Gap

The Wall Street Journal reports that a gap in Medicare coverage makes the hospital-to-home care swap more difficult. Under "home-infusion therapy," patients can receive cost-effective care in their own homes and forgo lengthy hospital stays. But Medicare doesn't fully cover home-infusion therapy. For instance, the list of intravenous drugs has grown, and patients can get these treatments at home. Home drug administering costs between $150 and $200 a day, as opposed to $1,500 to $2,500 a day … [Read more...]