No good deed goes unpunished. In 2007, private health insurers that provide coverage for Medicare Part D prescription drug plans will offer more plans, giving seniors more choices. But such a move will likely confuse beneficiaries already confused by current plan choices. Citing the New York Times, the Kaiser Network reports that health insurers began marketing 2007 drug plans last Sunday. The six-week enrollment period begins on November 15. Premiums more or less will remain the same, … [Read more...] about Medicare Part D Coverage News
New Hampshire Nursing Homes Sue DHHS
On occasion, I’ve blogged about nursing homes and the “burden†of Medicare Part D. In July, I told you that pharmaceutical representatives testified on Capitol Hill that nursing homes are losing money under the program. Nursing homes are also concerned about Medicaid under-reimbursements. Sixty nursing homes in New Hampshire are suing the Department of Health and Human Services for $4.4 million for care given to Medicaid beneficiaries since 2002. From the Kaiser Network: The … [Read more...] about New Hampshire Nursing Homes Sue DHHS
Provider Letter: Changes To Dental Evaluation Approval Process
In a provider letter dated September 27, 2006, the Texas Department of Aging and Disability Services (DADS) informed Community Based Alternatives (CBA) Home and Community Support Services (HCSS) providers about changes to the approval process for dental evaluations. Under the new process, an HCSS provider's registered nurse is allowed to get multiple evaluations for CBA participants without obtaining prior approval from the DADS case manager. For more information, you may download the … [Read more...] about Provider Letter: Changes To Dental Evaluation Approval Process
Agency Vacancies Create Complications
As I blogged last week, Mark McClellan, current Centers for Medicare and Medicare Services (CMS) administrator, is set to leave his post. The Hill reports that Andrew von Eschenbach, President Bush’s nominee to lead the Food and Drug Administration (FDA), is facing obstacles to his confirmation. Will the same happen when Bush nominates someone to take over McClellen’s post? According to The Hill, former “senior officials†for CMS and the FDA say that agency replacements face a … [Read more...] about Agency Vacancies Create Complications
Medicare Fee-for-Service Plan Enrollment Increases
As more beneficiaries sign up for Medicare fee-for-service plans, “experts†are concerned that Medicare may be going private, which apparently is a bad thing. Citing a New York Times story, the Kaiser Network reports that fee-for-service enrollments increased tenfold to 820,000 during the last two years. The federal government raised plan subsidies by an average of 11 percent, which some say accounts for the increased enrollment numbers. Chief Executive of the California Medical … [Read more...] about Medicare Fee-for-Service Plan Enrollment Increases
Texas Register Updates: Transfer of Assets, Provider Payments
Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 358, Medicaid Eligibility. The following are new sections: (from the September 22 Texas Register): §358.431 Transfer of Assets §358.432, Home Equity Treatment §358.433, Treatment of Entrance Fees for Individuals Residing in Continuing Care Retirement Communities HHSC adopted the changes to incorporate mandatory provisions of the Social Security Act. In related … [Read more...] about Texas Register Updates: Transfer of Assets, Provider Payments
Whistleblower Actions Under the Federal False Claims Act
Go the federal Department of Justice website (www.usdoj.gov), and you can read how the largest health care system and second largest employer in New Jersey agreed to pay $265 million to resolve a qui tam lawsuit’s allegations in of defrauding Medicare. Click here for the web page. The agreement could also mean huge rewards for the three whistleblowers who started the whole thing. As part of the settlement, St. Barnabas Care System entered into a corporate compliance agreement with the … [Read more...] about Whistleblower Actions Under the Federal False Claims Act
CMS Pressured to Delay Changes to Medical Equipment Medicare Coverage
Unless the Centers for Medicare and Medicaid Services (CMS) delays a policy change, schedule to take effect on October 1, certain Medicare beneficiaries will be forced to use medical equipment, such as scooters and wheelchairs, that doesn’t suit their particular needs, say lawmakers and stakeholders. From Medical News Today: Sen. Santorum noted that while the National Coverage Determination revamped the coverage criteria for mobility equipment more than a year ago, "since that time, others … [Read more...] about CMS Pressured to Delay Changes to Medical Equipment Medicare Coverage
Physicians Reject Offer To Block Reimbursement Rate Cuts
Last month I mentioned that the American Medical Association (AMA) and other doctors groups planned to lobby Congress during the August recess to block a scheduled reduction in Medicare reimbursement rates. In the ongoing saga, one lawmaker recently made an offer that was easy to refuse: send us quality-of-care reports, and we’ll block the reduction. (Kaiser Network) No thanks, said the AMA. Physicians are not only trying to block the cut; they’re seeking a 2 percent increase in … [Read more...] about Physicians Reject Offer To Block Reimbursement Rate Cuts
Provider Letter: Online Program Notifications
In a letter dated September 12, 2006, the Department of Aging and Disability Services informed providers that it will no longer send program notifications through the mail. Notifications will be posted online, effective October 1. Providers can access notifications in two ways: 1) By following this link and clicking on “Communications,†where you’ll find links to alerts, bulletins, and other providers letters; 2) By signing up to receive notifications through e-mail. On the home page … [Read more...] about Provider Letter: Online Program Notifications