All posts by Angela Scott

Letters to the Editor, April 21, 2019: No free care in Medicare – Richmond.com

No free care

in Medicare

Editor, Times-Dispatch:

A lot has been in the news lately about Medicare for All.

If I had no firsthand knowledge, I probably would be inclined to think it was a free government program.

Medicare definitely is not free. My personal monthly expenditures are Medicare medical insurance, $135.50; Medigap insurance Plan F, $259; and Medicare prescription drug plan, $28.50.

My total of $423 per month is $5,076 per year. My husband pays the same amount, so our household total is $10,152 per year.

The “fly in the ointment” is if Medicare does not approve a charge, it pays zero on that bill. And the Medigap insurance company also pays zero.

Right now, my husband has two charges not approved: one for a blood test and the other for a chest X-ray.

Should the “talking points” change to Congress Care for All, we seniors will sit up and take notice.

Alice E. Hague.

Natural gas a bridge

until renewables improve

Editor, Times-Dispatch:

Rhea Suh made strong arguments in her recent column, “Climate change: the central environmental challenge of our time,” particularly this one: “Protecting our children from this widening scourge [climate change] shouldn’t be a point of political division.” Unfortunately, it’s not just one side of the ideological spectrum that has politicized the issue of climate change. With zealous opposition to any fossil fuel, many so-called environmentalists are not only ignoring, but also actively opposing development of a resource that actually has helped reduce emissions.

I’m talking about natural gas, of course. Increased use of natural gas — which is a fossil fuel, but also is significantly cleaner than coal when used in electricity generation — has helped the United States reduce its emissions levels over the past decade. It is an important bridge between a past dependent on coal and a future where renewables are plentiful and affordable. Unfortunately, renewables are neither of these things today, but we are making real progress.

Certain activists want to impose additional regulations on natural gas, or ban it outright. Such action would be shortsighted and, thankfully, state lawmakers have recognized this.

I hope they’ll continue to work to ensure consumers are able to access natural gas power as an alternative to coal.

As Suh suggested, protecting our children is too important not to.

Susan Cookman.

Did Barr obstruct justice

over report release?

Editor, Times-Dispatch:

We have now been informed by the current attorney general, William Barr, that the president of the United States has not committed obstruction of justice by firing James Comey because of the “Russian thing” (Trump’s own words in a “60 Minutes” interview). The reason: The president was “angry and frustrated at that time.” This is certainly a remarkable legal defense for an illegal act that would undoubtedly not play well in any court of law.

One might also consider that the charge of obstruction of justice also should be made against Attorney General Barr for obfuscating special counsel Robert Mueller’s report by substituting his own partisan opinions for the actual wording of the report, and doing so for weeks prior to the report’s release, and then providing his own opinion of it on national television prior to anyone else (except the White House ) reviewing it.

Our previously independent Department of Justice has been compromised and all Americans (of both parties) should be frightened and outraged by this perversion and misuse of the democratic process.

Robert Glasser.

Manakin Sabot.

Henrico should fix

condition of its roads

Editor, Times-Dispatch:

Henrico County is forcing Virginia Center Commons to fix its potholes? Talk about the pot calling the kettle black! How can we force Henrico County to fix its own potholes (and correct hundreds of other deteriorated street conditions)?

Richard Carden.

Humanitarian crisis

in Gaza being ignored

Editor, Times-Dispatch:

Israel and Iran share a similar point of view, enmity toward each other. President Trump pulled the United States out of the 2015 Iran Nuclear Deal, a long-term agreement between Iran and the P5+1 — the U.S., United Kingdom, France, China, Russia and Germany.

Saudi Arabia and Iran share a similar viewpoint, again, enmity. President Trump’s veto of congressional legislation stopping United States’ support for Saudi Arabia in their proxy war against Iran, in Yemen, demonstrates President Trump’s willingness to defend not only Israel, but also Saudi Arabia.

A humanitarian crisis exists on the shores of the Mediterranean Sea as well as on the shores of the Persian Gulf. Organizations as well as the press have publicized the horror of war in Yemen. Pictures of starving children have been broadcast and have left an imprint on our collective mindset of war around the Persian Gulf.

No equal time has been given to the humanitarian crisis on the shores of the Mediterranean Sea, and the coastal prison called Gaza, in what used to be Palestine. The astronomically high infant mortality rate, malnutrition, the extreme poverty, the lack of basic human conditions (such as homes, clean water, safety) create a hopelessness and suffering unfelt or realized by any Israeli, Saudi or American individual. According to The Times of Israel, “senior Israeli official pointed to humanitarian conditions in Gaza as the main factor fueling unrest.”

Israel, Saudi Arabia and the United States share similar outlooks, selectivity on human rights. Prime Minister Benjamin Netanyahu, Prince Mohammed bin Salman and President Trump do not believe in universal human rights, but in a selective form, rights only for themselves and those like them, a separative, nationalistic sense of supremacy. Self-centered leadership undermines the way forward.

Nidal Mahayni.

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What Is Supplemental Health Care and What Does It Mean to Me? – TheStreet.com

Supplemental health insurance can come in handy if you’re short of cash and facing mounting health care bills. That’s the case even if you have health insurance, like Medicare.

A Harvard University study noted that excessive health care expenses comprised 62% of all U.S. personal bankruptcies. What’s worse, 72% of Americans who declared bankruptcy over severe health care costs had health insurance when they fell into financial decline.

Consequently, if you’re concerned you don’t have enough cash and coverage for high-volume medical care costs, adding supplemental insurance to your health care payment arsenal may just be a game-changer for you.

What Is Supplemental Health Insurance?

Supplemental insurance, also called “gap insurance,” can plug any financial holes in your health care insurance coverage, enabling you to pay the full freight for high-cost medical care.

Essentially, gap insurance fills any financial gaps – think health insurance deductibles, out-of-pocket medical expenses, and underpayments on serious illness or injury – and keeps you on top of all your health care expenses, and out of financial peril.

In real-world terms, supplemental insurance can mean the difference of owing thousands of dollars on medical care charges, or owing nothing at all if you’ve plugged that coverage gap.

Let’s say your health plan costs $400 per month, but has a deductible of $5,000 (meaning you have to pay $5,000 of all your annual medical care costs before your health insurance overage kicks in.)

If you’ve been in an auto accident, for example, and incurred $3,500 in medical care costs in treatment from the accident, supplemental health care insurance can step in and cover the $3,500 charge, keeping you cash-flush and out of medical debt troubles.

All for the average supplemental insurance cost of between $100 and $300 per month for (Medigap coverage, for Medicare plan participants), which is akin to the total cost of supplemental health care coverage for anyone looking to plug a coverage gap.

When Should You Consider Supplemental Health Care Insurance?

Beyond the desire to cover a big medical charge, there are other good reasons to opt for supplemental health care insurance.

How high is your deductible? If your health care insurance plan deductible costs exceed your regular, ongoing cash-on-hand savings, you might be a good candidate for supplemental health care insurance. Data from Bankrate shows that only 40% of Americans are able to pay a $1,000 emergency cost. Supplemental health insurance can help American with low personal savings if they face a high health care bill.

You need the cash for ancillary expenses. Let’s say you’re a single mother of three children and you’re laid low by illness for a month or two. Gap health insurance can be a big help in that scenario by covering child care or day care expenses, which can cost up to $1,500 monthly, according to industry data.

If your employer doesn’t cover out-of-work medical leave. If you’re on the job, but fall victim to injury or illness, and can’t return to work for a while, health care gap insurance would save you from turning to credit cards or banks savings to handle excessive health care costs, buying you time enough to get better, get back on the job, without a severe household financial hit.

If you’re a senior and can’t handle all of your Medicare costs. Medicare plan participants know full too well that government health insurance doesn’t cover everything. Thus, a Medigap policy – in any form – can close the loop on excess senior health care costs, at a few dollars per day.

Deductibles, Coinsurance and Out-of-Pocket Expenses

Three critical health care insurance impactors – deductibles, coinsurance and out-of-pocket costs – also factor into the need to purchase supplemental health insurance. Each of the three impactors is so important it deserves an explanation on why gap insurance is sorely needed for today’s health care consumer.

Deductibles

The average cost of U.S. health care plan deductibles (i.e. the amount of money you have to pay for medical expenses before health care plan coverage kicks in) is rising, and spectacularly so.

According to the National Business Group on Health, the average health care plan deductible stood at $1,600 for individual coverage from employers, with family-plan deductibles clocking in at $3,200.

Many Affordable Care Act plans come with deductibles as high as $5,000 or more, although taxpayer-funded subsidies cover some of those costs.

With deductible costs so high, the need for good supplemental health care insurance to cover high medical costs becomes understandable.

Coinsurance Costs

Many major medical insurance plans also come with mandates requiring plan users to pay for coinsurance costs.

In a word, coinsurance means the percentage of medical care charges you pay, in relation to your health care plan, once you’ve covered your plan deductible costs.

For example, you visit your general practitioner and pay $200 for medical services, which is the allowed amount covered by your health care plan. If you paid your deductible and your coinsurance rate is 20%, you still have to pay 40% of the $200 office visit.

Worse, if you haven’t paid your deductible, you’re on the hook for the full $200. In that event, supplemental insurance can provide additional coverage to cover health care plan coinsurance costs.

Out-of-Pocket Expenses

Out-of-pocket health care costs are the expense amounts, as listed in your health care plan contract, that you may expect to pay, with maximum limits.

For example, in 2019, the maximum out-of-pocket costs for Affordable Care Act plans is $7,900 for an individual and $15,800 for family coverage. To be precise, that’s the maximum amount you can pay and may pay, but there’s no guarantee you’ll pay those maximum out-of-pocket costs.

For instance, if you remain relatively healthy, and visit your doctor once a year for a checkup, your chances are excellent that you’ll only pay $100 or so (depending on your health insurance plan) in out-of-pocket costs.

But if you get seriously ill or suffer a serious injury, the odds of maxing out your out-of-pocket costs rise precipitously.

In that case, the total cost of deductibles, coinsurance and out-of-pocket expenses could crest $10,000 or more. In that scenario, paying the maximum plan out-of-pocket expenses, doing so can easily break the household budget and significantly set you back financially.

Supplemental health care insurance can provide some much-needed protection against high out-of-pocket health care insurance costs, especially so if you have a track record of frequent medical care visits and high health care costs.

How Much Does Supplemental Health Insurance Cost?

Paying for supplemental health care insurance or Medicare (Medigap) insurance will depend on your unique personal circumstances and the type of health insurance you possess.

Also, not all supplemental health care plans pay for the same things. For example, some gap insurance plans will pay for deductibles, coinsurance and out-of-pocket health care costs directly.

Others may opt to pay a lump sum payment for health insurance claims (it’s up to you to properly disburse the funds) or pay you a cash benefit shelled out to you over a period of time, to pay for lost earnings from work, transport to a health care clinic, hospital or physician’s office, and for prescriptions.

While supplemental health care costs do differ, costs appear manageable, given the benefits such plans provide.

For instance, Medigap insurance, the most widely used supplemental health care insurance plan, can be purchased for as low as $100 a month, although most Medicare supplement monthly plans go for closer to $150 per month, and costs rise as a consumer grows older.

If you’re looking to plug the gap on either Medicare or ACA-related health care premium costs, health insurance supplemental plans deserve a closer look.

For your best results, make sure to talk to a health care insurance specialist before locking into a specific plan and see where your general practitioner stands on accepting gap-closing health care insurance.

It’s never too late – or too early – to plan and invest for the retirement you deserve. Get more information and a free trial subscription to TheStreet’s Retirement Daily to learn more about saving for and living in retirement. Got questions about money, retirement and/or investments? We’ve got answers.

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Medicare Supplement Insurance Association to End Free Conference Recording Access – PR.com

The American Association for Medicare Supplement Insurance announced that it will no longer be offering free access to watch sessions filmed at prior national Medigap industry conferences.

Los Angeles, CA, April 19, 2019 –(PR.com)– No-cost access to watch sessions recorded at prior national Medicare Supplement insurance conferences will end soon according to an announcement by the American Association for Medicare Supplement Insurance.

“We’ve been pleased to offer free access to watch videos filmed at the national Medigap industry conference,” declares Jesse Slome, director of the Association. “Free access will shortly no longer be available for those wishing to view sessions held at the 2018, 2017 and 2016 national conferences.”

The organization announced that access will be available through the recording company’s website. The cost according to Slome will be $199 for access to all conference sessions taking place at a specific year’s event. “That still is an excellent value because you will get to see the video of the speakers along with any presentations they shared,” he adds.

The 2019 Medicare Supplement industry conference will take place June 5-7 at the Marriott Marquis hotel in downtown Atlanta. “We will not be recording this year’s event,” Slome shared. “You will need to attend if you wish to hear the latest developments in the Medicare Supplement industry.”

The premier Medigap industry national event is attended by over 1,000 industry professionals representing insurance carriers, distributors as well as insurance consultants and agents who market Medicare insurance products.

Free access to watch the videos while they are still available can be obtained by visiting the Association’s website at www.medicaresupp.org/agent-center/video-library-free-access-medigap-sales/.

Details regarding the 2019 Medigap convention can be accessed via the Association’s website at www.medicaresupp.org or by calling 818-597-3205.

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CMA Alert – April 18, 2019

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  1. The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule
  2. How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes
  3. Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations
  4. Latest Issue: Elder Justice: What “No Harm” Really Means for Residents

Join Us!

6th Annual National Voices of Medicare Summit &
Sen. Jay Rockefeller Lecture

Rep. John Lewis will deliver this year’s Sen. Jay Rockefeller Lecture

Also joining us: Sen. Jay Rockefeller; Rep. Joe Courtney; Rep. Rosa DeLauro; Judy Feder of Georgetown University; Tricia Neuman, Senior VP, Kaiser Family Foundation; Henry Claypool, Technology Policy Consultant at AAPD and Former Director of the HHS Office on Disability; Cathy Hurwit, Former Chief of Staff for Rep. Jan Schakowsky; film writer Anna Reid-JhiradBen Belton, AARP Global Partner Engagement Director; and home care worker Susie Young, courtesy of SEIU._______________

May 9, 2019
8:30 AM – 3:30 PM

_________

Kaiser Family Foundation
1330 G. Street, NW
Washington, DC

_________


_________

CLE Credit Available!

The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule

The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018.[1] As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available under Medicare Part B which have been identified as “as clinically appropriate to furnish through electronic information and telecommunications technology . . .” and not payable under Section 1834(m) of the Social Security Act.[2] CMS makes clear that MA enrollees will have the ability to decide whether to receive Part B services in-person or through the telehealth benefit, although different cost sharing may apply. In addition to this newly created basic benefit, MA plans will also be able to offer supplemental telehealth services not covered by traditional Medicare.

While expanding telehealth services may be beneficial to MA enrollees, the Center for Medicare Advocacy is concerned by the growing disparity between MA and traditional Medicare. As outlined in our Medicare Platform, parity is essential to ensuring consumer protections and quality coverage extend to all Medicare beneficiaries. Although traditional Medicare does have limited telehealth coverage, Congress’s decision to allow MA plans to offer additional telehealth services as a basic benefit is just one more example of the growing disparity between traditional Medicare and MA, and reinforces the Administration’s efforts to steer individuals to MA plans.[3] The Administration and Congress must ensure that beneficiaries in traditional Medicare have the same benefits and access to the same services as MA enrollees, including those created by the new telehealth benefit.


[1] Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021, 84 Fed. Reg. 15680, 15683 (Apr. 16, 2019), available at https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf.
[2] See id. (referring to Medicare’s limited coverage of telehealth services). 
[3] See generally, David Lipschutz, As Medicare Enrollment Period Draws to a Close, MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS, Center for Medicare Advocacy (Nov. 30, 2018), https://www.medicareadvocacy.org/as-medicare-enrollment-period-draws-to-a-close-ma-steering-continues-advocates-members-of-congress-write-letters-of-concern-to-cms/.

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How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes 

Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care they need in the SNFs. 

A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 finds that residents who were not seen by a physician or advanced practitioner (10.4% of the total) had a higher likelihood of a poor outcome – return to the hospital, death, or failure to return successfully to the community.[3] Ensuring that physicians or other advanced practitioners see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations.

For many decades, inadequate nurse staffing levels have been correlated with re-hospitalizations of residents.[4] A three-year study of non-clinical factors that contributed to the re-hospitalization of residents, published thirty years ago,[5] found “insufficient and inadequately trained nursing staff” who could not meet residents’ complex health care needs as a cause of residents’ re-hospitalizations. A paper by Kaiser Family Foundation and Lake Research Partners in 2010[6] confirmed earlier findings about the multiple causes of re-hospitalizations and the need to increase nurse staffing levels in nursing facilities.

It is time to address the actual causes of re-hospitalizations of nursing home residents by providing better health care in SNFs. 


[1] Affordable Care Act, §3025, 42 U.S.C. §1395ww(q), created the Hospital Readmissions Reduction Program.
[2] Protecting Access to Medicare Act (2014), §215, 42 U.S.C. §1395yy(h), created a Value-Based Purchasing Program for SNFs.  Beginning in fiscal year 2019 (services furnished on or after Oct. 1, 2018), the Centers for Medicare & Medicaid Services reduces Medicare payments to SNFs that have high rates of re-hospitalizations of their residents.
[3] Kira L. Ryskina, et al, “Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities,” Health Affairs 38, No. 4 (2019): 528-536, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05458 (abstract).   
[4] Center for Medicare Advocacy, “More Nurses in Nursing Homes Would Mean Fewer Patients Headed to Hospitals” (CMA Alert, Mar. 10, 2011), https://www.medicareadvocacy.org/more-nurses-in-nursing-homes-will-mean-fewer-patients-headed-to-hospitals/
[5] J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989).
[6] Michael Perry, Julia Cummings (Lake Research Partners), Gretchen Jacobson Tricia Neuman, Juliette Cubanski (Kaiser Family Foundation), “To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care facility Residents; A Report Based on Interviews in Four Cities with Physicians, Nurses, Social Workers, and Family Members of Residents of Long-Term Care Facilities (Oct. 2010), https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8110.pdf

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Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations

                     

GAO Findings. Federal law requires state survey agencies to investigate allegations of resident abuse and neglect stemming from complaints and facility-reported incidents. About three-quarters of all abuse violations nationwide stem from these investigations. Unfortunately, a recently published management report by the U.S. Government Accountability Office (GAO) concludes that the Centers for Medicare & Medicaid Services (CMS) failed to oversee the nursing home inspection process in Oregon to ensure compliance with this requirement. According to the GAO, Oregon’s Adult Protective Services (APS), not the state survey agency, has been investigating complaints and facility-reported cases of abuse in the state for at least fifteen years. The GAO’s report notes that, unlike state surveyors, APS investigators “are not trained in, or focused on, investigating abuse according to the federal nursing home regulations.”

CMS Response. CMS claims that it became aware of this astounding failure in oversight in July 2016, but the GAO notes that evidence suggests CMS previously became aware of Oregon’s improper practice in the early 2000s. Oregon’s Department of Human Services communicated to the GAO that CMS had known about the practice for “many years and said state policy changes made in 2002 regarding nursing home abuse complaints and facility-reported incidents were made at the direction of CMS.” CMS has expressed that, while there is no indication that other states are out-of-compliance with the federal requirements, “their current approach for overseeing survey agencies does not specifically examine whether survey agencies are taking responsibility for investigating all nursing home complaints and facility-reported incidents.”

Fundamentally, the GAO’s findings provide further substantiation that CMS and the state agencies too often fail to protect residents or hold providers accountable for abuse and neglect.

Report’s Implications. CMS’s failure means that the federal agency has not be able to properly penalize deficient nursing homes for complaint and facility-reported cases of resident abuse for fifteen years. Additionally, the failure means that Medicare’s Nursing Home Compare website does not provide the public with an accurate accounting of nursing home quality in Oregon. For example, as the GAO report notes, a 2015 substantiated allegation of sexual abuse by a staff member is not on Nursing Home Compare. Similarly, 2016 APS investigations of resident-to-resident abuse were not reported to CMS, making CMS unable to identify the nursing home’s failure “to prevent, investigate, or report abuse, nor could federal nursing home deficiency penalties be imposed.”

Key Recommendation. Among several recommendations, the GAO called on CMS to evaluate the nursing home inspection process of all states to ensure state survey agencies are meeting federal requirements.

Concerns for Residents and Families. Our organizations are extremely concerned by the GAO’s findings and their implications for basic resident safety and accountability. As the report indicates, CMS’s failure to properly oversee the nursing home inspection process may extend to other states throughout the country. Until CMS completes its nationwide evaluation of nursing home inspection processes, which it has agreed to do, there is no way of adequately determining whether countless other cases of resident harm have been left unaccounted for by the federal government and for how long. Fundamentally, the GAO’s findings provide further substantiation that CMS and the state agencies too often fail to protect residents or hold providers accountable for abuse and neglect. Our organizations call on Congress to hold a hearing into CMS’s failure to properly oversee the nursing home inspection process in Oregon and potentially other states.  

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New Fact Sheet Available – Medicare Inpatient Rehabilitation Hospital/Facility Coverage In Light of Jimmo v. Sebelius

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home residents. Our latest issue has real stories from nursing homes in New York, New Jersey, and Kansas.

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The Center for Medicare Advocacy is a non-profit organization.
Your contributions to the Center are essential to maintaining our ability to advance access
to comprehensive Medicare coverage and quality health care.


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The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule

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The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018.[1] As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available under Medicare Part B which have been identified as “as clinically appropriate to furnish through electronic information and telecommunications technology . . .” and not payable under Section 1834(m) of the Social Security Act.[2] CMS makes clear that MA enrollees will have the ability to decide whether to receive Part B services in-person or through the telehealth benefit, although different cost sharing may apply. In addition to this newly created basic benefit, MA plans will also be able to offer supplemental telehealth services not covered by traditional Medicare.

While expanding telehealth services may be beneficial to MA enrollees, the Center for Medicare Advocacy is concerned by the growing disparity between MA and traditional Medicare. As outlined in our Medicare Platform, parity is essential to ensuring consumer protections and quality coverage extend to all Medicare beneficiaries. Although traditional Medicare does have limited telehealth coverage, Congress’s decision to allow MA plans to offer additional telehealth services as a basic benefit is just one more example of the growing disparity between traditional Medicare and MA, and reinforces the Administration’s efforts to steer individuals to MA plans.[3] The Administration and Congress must ensure that beneficiaries in traditional Medicare have the same benefits and access to the same services as MA enrollees, including those created by the new telehealth benefit.

April 18, 2019 – D. Valanejad


[1] Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021, 84 Fed. Reg. 15680, 15683 (Apr. 16, 2019), available at https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf.
[2] See id. (referring to Medicare’s limited coverage of telehealth services). 
[3] See generally, David Lipschutz, As Medicare Enrollment Period Draws to a Close, MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS, Center for Medicare Advocacy (Nov. 30, 2018), https://www.medicareadvocacy.org/as-medicare-enrollment-period-draws-to-a-close-ma-steering-continues-advocates-members-of-congress-write-letters-of-concern-to-cms/.

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How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes

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Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care they need in the SNFs. 

A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 finds that residents who were not seen by a physician or advanced practitioner (10.4% of the total) had a higher likelihood of a poor outcome – return to the hospital, death, or failure to return successfully to the community.[3] Ensuring that physicians or other advanced practitioners see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations.

For many decades, inadequate nurse staffing levels have been correlated with re-hospitalizations of residents.[4] A three-year study of non-clinical factors that contributed to the re-hospitalization of residents, published thirty years ago,[5] found “insufficient and inadequately trained nursing staff” who could not meet residents’ complex health care needs as a cause of residents’ re-hospitalizations. A paper by Kaiser Family Foundation and Lake Research Partners in 2010[6] confirmed earlier findings about the multiple causes of re-hospitalizations and the need to increase nurse staffing levels in nursing facilities.

It is time to address the actual causes of re-hospitalizations of nursing home residents by providing better health care in SNFs.

April 18, 2019 – T. Edelman

 


[1] Affordable Care Act, §3025, 42 U.S.C. §1395ww(q), created the Hospital Readmissions Reduction Program.
[2] Protecting Access to Medicare Act (2014), §215, 42 U.S.C. §1395yy(h), created a Value-Based Purchasing Program for SNFs.  Beginning in fiscal year 2019 (services furnished on or after Oct. 1, 2018), the Centers for Medicare & Medicaid Services reduces Medicare payments to SNFs that have high rates of re-hospitalizations of their residents.
[3] Kira L. Ryskina, et al, “Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities,” Health Affairs 38, No. 4 (2019): 528-536, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05458 (abstract).   
[4] Center for Medicare Advocacy, “More Nurses in Nursing Homes Would Mean Fewer Patients Headed to Hospitals” (CMA Alert, Mar. 10, 2011), https://www.medicareadvocacy.org/more-nurses-in-nursing-homes-will-mean-fewer-patients-headed-to-hospitals/
[5] J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989).
[6] Michael Perry, Julia Cummings (Lake Research Partners), Gretchen Jacobson Tricia Neuman, Juliette Cubanski (Kaiser Family Foundation), “To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care facility Residents; A Report Based on Interviews in Four Cities with Physicians, Nurses, Social Workers, and Family Members of Residents of Long-Term Care Facilities (Oct. 2010), https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8110.pdf

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Joint Statement: Federal Report Finds That CMS Failed to Properly Oversee State’s Nursing Home Investigations

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GAO Findings. Federal law requires state survey agencies to investigate allegations of resident abuse and neglect stemming from complaints and facility-reported incidents. About three-quarters of all abuse violations nationwide stem from these investigations. Unfortunately, a recently published management report by the U.S. Government Accountability Office (GAO) concludes that the Centers for Medicare & Medicaid Services (CMS) failed to oversee the nursing home inspection process in Oregon to ensure compliance with this requirement. According to the GAO, Oregon’s Adult Protective Services (APS), not the state survey agency, has been investigating complaints and facility-reported cases of abuse in the state for at least fifteen years. The GAO’s report notes that, unlike state surveyors, APS investigators “are not trained in, or focused on, investigating abuse according to the federal nursing home regulations.”

CMS Response. CMS claims that it became aware of this astounding failure in oversight in July 2016, but the GAO notes that evidence suggests CMS previously became aware of Oregon’s improper practice in the early 2000s. Oregon’s Department of Human Services communicated to the GAO that CMS had known about the practice for “many years and said state policy changes made in 2002 regarding nursing home abuse complaints and facility-reported incidents were made at the direction of CMS.” CMS has expressed that, while there is no indication that other states are out-of-compliance with the federal requirements, “their current approach for overseeing survey agencies does not specifically examine whether survey agencies are taking responsibility for investigating all nursing home complaints and facility-reported incidents.”

Fundamentally, the GAO’s findings provide further substantiation that CMS and the state agencies too often fail to protect residents or hold providers accountable for abuse and neglect.

Report’s Implications. CMS’s failure means that the federal agency has not be able to properly penalize deficient nursing homes for complaint and facility-reported cases of resident abuse for fifteen years. Additionally, the failure means that Medicare’s Nursing Home Compare website does not provide the public with an accurate accounting of nursing home quality in Oregon. For example, as the GAO report notes, a 2015 substantiated allegation of sexual abuse by a staff member is not on Nursing Home Compare. Similarly, 2016 APS investigations of resident-to-resident abuse were not reported to CMS, making CMS unable to identify the nursing home’s failure “to prevent, investigate, or report abuse, nor could federal nursing home deficiency penalties be imposed.”

Key Recommendation. Among several recommendations, the GAO called on CMS to evaluate the nursing home inspection process of all states to ensure state survey agencies are meeting federal requirements.

Concerns for Residents and Families. Our organizations are extremely concerned by the GAO’s findings and their implications for basic resident safety and accountability. As the report indicates, CMS’s failure to properly oversee the nursing home inspection process may extend to other states throughout the country. Until CMS completes its nationwide evaluation of nursing home inspection processes, which it has agreed to do, there is no way of adequately determining whether countless other cases of resident harm have been left unaccounted for by the federal government and for how long. Fundamentally, the GAO’s findings provide further substantiation that CMS and the state agencies too often fail to protect residents or hold providers accountable for abuse and neglect. Our organizations call on Congress to hold a hearing into CMS’s failure to properly oversee the nursing home inspection process in Oregon and potentially other states.  


For additional information and resources, please visit
MedicareAdvocacy.org & NursingHome411.org.


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Latest Issue – Elder Justice Newsletter

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Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home residents. Our latest issue has real stories from nursing homes in New York, New Jersey, and Kansas.

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Shop Medigap Plan G In Waco Anytime – MENAFN.COM

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(MENAFN – PRLog) Now Available Medicare “Medigap Plan G For Waco”! You may change your Medicare Supplement at anytime of the year, making “Medigap Plan G” available right now! Senior Healthcare Direct can explain the process and make the cahnge at anytime. Bache Spread the Word
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WACO, Texas – April 14, 2019 – PRLog — “Medigap Plan G in Waco” is available right now, and you can get all the details with a call to 888-323-1149 where a Senior Healthcare Direct licensed representitive will help you understand the benefits of “Medicare Medigap Plan G for Waco”.

Medicare Supplement plans (also known as Medigap) provide optional coverage to add to your Original Medicare (Part A and Part B) insurance. Medicare Supplement Plan G covers more of your costs than most other Medicare Supplement plan types, so it might have a higher premium than those that offer less coverage. Health insurers that offer Medicare Supplement plans can set their own premium rates, but the plans are standardized and must offer the same coverage (for example, Plan G in Texas must offer the same coverage as Plan G in Vermont). However, some insurance companies may offer additional benefits.

Medicare Supplement Plan G coverage For Waco

Medicare Supplement Plan G for Waco covers the full cost of the following benefits:

• Medicare Part A hospital coinsurance and all costs up to 365 days after Original Medicare benefits are exhausted
• Part A hospice care coinsurance or copay
• Part A deductible
• Medicare Part B preventive care coinsurance coverage
• Part B coinsurance or copay coverage
• Part B excess charges
• First three pints of blood for a medical procedure, if the hospital has to buy blood
• Skilled Nursing Facility (SNF) care coinsurance coverage
• Foreign travel emergency coverage, up to the plan limit

“Medigap Plan G for Waco” is the only Medicare Supplement plan besides Plan F that covers 100% of Part B excess charges. Excess charges occur when doctors and providers do not accept Medicare assignment. When this happens, a doctor may charge more than the Medicare-approved amount. By law, providers can’t charge more than 15% above what Medicare covers. Beneficiaries are then responsible for the difference between the Medicare-approved amount and what the provider charges. Without Medicare Supplement coverage, Medicare patients are responsible paying these excess charges out of pocket; with Medicare Supplement Plan G, these expenses are paid for.

Medicare Supplement “MedigapPlan G for Waco” benefits are nearly identical to those Medicare Supplement Plan F offers, except that Plan G doesn’t cover the Medicare Part B deductible. The standard Medicare Part B deductible for 2019 is $185. Once your out-of-pocket expenses get to the deductible amount, you pay 20% of Medicare-approved amount for Part B services and supplies. “Medigap Plan G for Waco” may be a good choice for beneficiaries who want broad coverage, but don’t want or need the Part B deductible benefit.

Medicare Supplement “Medigap Plan G for Waco” costs and availability

Although Medicare Supplement “Plan G for Waco” benefits are standardized and will be the same no matter which insurer you buy from, availability and costs for this plan will depend on where you live and how the insurance company prices its Medigap premiums. States are not required to offer this plan, and insurers may charge different premiums for the same benefits.

Medicare Supplement “(Medigap) Plan G For Waco” may help cover the full cost of out-of-pocket Medicare expenses such as copayments, coinsurance, and excess charges.Medicare Supplement plans (also known as Medigap or MedSupp) provide optional coverage to add to your Original Medicare (Part A and Part B) insurance.

Simple fact for anyone that has a Medicare Supplement plan: you can shop your Medicare Supplement plan all year long. The December 7th deadline only apples to anyone that has a Medicare Advantage plan or switching your Part D drug plans. If you are experiencing a rate increase on your plan, you can shop your plan for a better rate. If you have a Plan F, Plan G, Plan N or any Medicare Supplement plan you can shop your plan all year long. There is no reason to pay more with one carrier over another because these plans are all federally regulated. The letter of the plan dictates the coverage, not the carrier. So, give our office a call and we can help you start saving today.

Texas “Medicare Supplement Plan G For Waco”. The Medicare Supplement Plan Texas that offer’s the most coverage for the lowest premium is the Medigap Plan G. The Medicare Supplement Plan G is offers the exact same benefits of the Plan F except that you will pay the Part B deductible.

WHO IS MEDICAREBOB?

“MedicareBob” is the owner and operator of Senior Healthcare Direct. Robert Bache has been a leader in the Medicare insurance industry since 2009. After personally assisting over 20,000 Medicare beneficiaries in choosing the right Medicare insurance plan as well as training over 100 insurance agents, people started referring to Robert Bache as “MedicareBob” ( https://www.seniorhealthcaredirect.com/robert-bache-medic… )!

Contact
Senior Healthcare Direct
Phone: 1-855-368-4717
***@medicarebob.com

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Shop Medigap Plan G In Waco Anytime

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Medicare Supplement Insurance Association To End Free Conference Recording Access – NewsReleaseWire.com

No-cost access to watch sessions recorded at prior national Medicare Supplement insurance conferences will end soon according to an announcement by the American Association for Medicare Supplement Insurance.

“We’ve been pleased to offer free access to watch videos filmed at the national Medigap industry conference,” declares Jesse Slome, director of the Association.  “Free access will shortly no longer be available for those wishing to view sessions held at the 2018, 2017 and 2016 national conferences.”

The organization announced that access will be available through the recording company’s website.  The cost according to Slome will be $199 for access to all conference sessions taking place at a specific year’s event.  “That still is an excellent value because you will get to see the video of the speakers along with any presentations they shared,” he adds.

The 2019 Medicare Supplement industry conference will take place June 5-7 at the Marriott Marquis hotel in downtown Atlanta.   “We will not be recording this year’s event,” Slome shared.  “You will need to attend if you wish to hear the latest developments in the Medicare Supplement industry.”

The premier Medigap industry national event is attended by over 1,000 industry professionals representing insurance carriers, distributors as well as insurance consultants and agents who market Medicare insurance products.

Free access to watch the videos while they are still available can be obtained by visiting the Association’s website at www.medicaresupp.org/agent-center/video-library-free-access-medigap-sales/.

Details regarding the 2019 Medigap convention can be accessed via the Association’s website at www.medicaresupp.org/medicare-conference-convention/.

The American Association for Long-Term Care Insurance and the American Association for Medicare Supplement Insurance advocate for the importance of planning and support insurance professionals nationwide.  Jesse Slome, founder and executive director of the organizations, is a leading consumer advocate and author of numerous consumer and professional guides focused on retirement and insurance planning that have been published by governmental agencies and private organizations.

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