Tag: Centers for Medicare and Medicaid Services
rgeries so risky for older adults that that the insurance program Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises
“We can send prescriptions to the pharmacy, including [for] narcotics,” says Marie Grosh, a geriatric advanced practice nurse practitioner and the owner of a medical house calls practice in a Cleveland suburb. “We can order lab work, x-rays, ultrasounds, EKGs [electrocardiagrams]; interpret them; and treat patients based on that. But we’re just not allowed to order home care—which is absurd.”
By SUSAN JAFFE | Health Affairs | June 2019 | Volume 38, Number 8
When Christine Williams began working as a nurse practitioner some forty years ago in Detroit, Michigan, older adults who couldn’t manage on their own and had no family nearby and no doctor willing to make house calls had few options besides winding up in a nursing home.
Not anymore.
Home check: Nurse practitioner Marie Grosh visits Leroy Zacharias at his home in a Cleveland suburb, He has Parkinson disease, and Grosh says he would be living in a nursing home if he couldn’t get medical care at home. (Photo by Lynn Ischay.)
“The move towards keeping seniors in their homes is a fast-galloping horse here,” says Williams, who settled in Cleveland, Ohio, more than a decade ago. “We don’t have space for them in long-term care [facilities], they don’t want to be in long-term care, and states don’t want to pay for long-term care. And everybody wants to live at home.”
But despite the growing desire for in-home medical care for older adults from nearly all quarters, seniors’ advocates and home health professionals claim that rules set by the Centers for Medicare and Medicaid Services (CMS) along with state regulations have created an obstacle course for the very providers best positioned—and sometimes the only option—to offer that care. [Continued here] …
Prospects for US single-payer national health care
Volume 392, Number 10149
1 September 2018
WORLD REPORT The single-payer national health-care bill, so-called Medicare for All, is gaining momentum with the public but is stalling in Congress. Susan Jaffe, The Lancet‘s Washington correspondent, reports.
Instead of fading away into legislative oblivion, some Democrats campaigning for congressional seats and candidates for state offices are supporting the Medicare for All bill—or some variation thereof—as the November election approaches. They are not alone: a Morning Consult/Politico national poll in June found that 63% of Americans support “a Medicare for All healthcare system, where all Americans would get their health insurance from the government”. [Continued here.]
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Temporary CHIP funding falls short
Susan Jaffe | Washington Correspondent for The Lancet | 29th December 2017
Despite wide bipartisan support for the Children’s Health Insurance Program (CHIP), Congress agreed last week to continue coverage for 8.9 million children only through the end of M
arch. But several of the program’s state directors say the $2.85 billion rescue plan won’t even last that long, and federal health officials are not offering much reassurance. [Continued here.] Temporary CHIP 122917…
New Nursing Home Rules Offer Residents More Control Of Their Care
By Susan Jaffe | Kaiser Health News | January 4, 2017 | This KHN story also ran in 
About 1.4 million people living in nursing homes across the country can now be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years.
The cha
nges reflect a shift toward more “person-centered care,” including requirements for speedy development of care plans, more flexibility and variety in meals and snacks, greater review of a resident’s drug regimen, better security, improved grievance procedures, and scrutiny of involuntary discharges.
“With proper implementation and enforcement, this could really transform a resident’s experience of a nursing home,” said Robyn Grant, director of public policy and advocacy for the Consumer Voice, a national group that advocates for residents’ rights. The federal Medicare and Medicaid programs pay for most of the nation’s nursing home care — roughly $75 billion in 2014 — and in return, facilities must comply with government rules. [Continued in Kaiser Health News and The Washington Post]
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Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans
By Susan Jaffe | Kaiser Health News | July 27, 2016 | This KHN story also ran in
Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.
Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.
“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that becaus
e she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.
“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”
With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. [Continued in The Washington Post and Kaiser Health News]…