Posts tagged 'CMS'
Whether you are a caregiver, a family member or a Medicare – Medicaid recipient, chances are that obtaining durable equipment has not been an easy task over the past few years. The wait is usually longer than what would be desirable or comfortable, the approval process often takes forever and then some – if the approval comes at all, and then comes the price and financial issues.
It is difficult enough to deal with a disability and many of the day-to-day issues surrounding taking care of yourself. When you add the rest of the red tape including approvals, reviews, appeals, finances and more, the difficulties become strong barriers for individuals needing the most help to understand and/or over-come.
There is good news that was just released from Centers for Medicare and Medicaid Services. CMS announced that there are 325 providers who have contracted with Medicare to provide certain services and equipment in 10 communities throughout the country including Kansas City. These providers will provide the services and equipment at much lower prices than Medicare pays now.
CMS sent out a press release stating that Medicare is pleased that beneficiaries living in the first round of 10 communities will be receiving high quality service and supplies they have been receiving, but it will be at a much more cost effective price.
All of the companies that are suppliers have to meet Medicare’s requirements. In addition, they must bid to receive contracts, and companies with the best combination of best bids and best products receive contracts with Medicare. This will save Medicare and Medicare recipients an average of 26%, especially because Medicare recipients must pay co-pays in a lot of situations, so the 26% they save could end up being substantial.
If you have any questions regarding this information, contact CMS. You can go on the internet at www.Medicare.gov, www.Medicaid.gov , or www.cms.gov .
If you live in Indiana and you have children, there may be some good news coming your way. The Centers for Medicare and Medicaid Services (CMS) has expanded the Children’s Health Insurance Program. Under the expansion, if you are a family that earns less than 2 ½ times the poverty level, you can be eligible to enroll your children in the SCHIP.
The way the income amounts work out translate to families of two earning up to $35,000 annually or a family of four earning up to $53,000 annually. If your family fits into these financial guidelines and your children need to obtain health insurance, you can apply for the SCHIP program for them.
There are reasonable premiums for the program. The premiums range from approximately $22 to $70 monthly, depending on income and the number of children. Basically the premiums work on a sliding scale.
The expansion of the SCHIP program is a positive step toward making sure that as many children as possible have health insurance benefits. The eventual goal is to cover all children living in the state. The state of Indiana and the SCHIP program are actively trying to connect with families who fit the income limits and whose children are not insured.
Most states have some sort of Children’s Health Insurance Plan (CHIP). These are state-backed programs, usually approved by the federal government through the Centers for Medicare and Medicaid Services (CMS) and facilitated in your local area in conjunction with the county health departments.
For information regarding CHIP benefits in your state, or to see if you qualify, contact your local Social Services or Health Department. Even if you are not sure you qualify or you think your earnings are too high, don’t hesitate to check into CHIP coverage. Your circumstance might fit into some of the regulations that would allow you to participate. It is worth checking into. Remember, the states are trying to insure as many children as possible so no child will be left without necessary medical care
Private Fee-For-Service Plans are Medicare Supplemental Plans that are offered by private insurance companies as part of Medicare Advantage. There are some policies that are excellent and offer good coverage but not all of them offer what individuals need. Though many plans sound great, it is essential that Medicare recipients thoroughly research any plans that they are thinking about purchasing.
The way that Private Fee-For-Service (PFFS) plans work is that Medicare pays insurance companies for coverage for Medicare recipients. The Medicare recipient can then go to any Medicare-approved provider who will accept the plan’s payment. The important difference between PFFS and original Medicare is that there is no limit to the co-payments, nor is there a limit to the premiums that can be charged. This is an area that it is very important to look closely at, because this means that the Medicare recipient in this situation will have to share a portion of the costs involved and this can add up. Medicare allows providers to charge up to 15% above the plan’s payment amount for services.
The Medicare Rights Center has reported that even though the plans seem like they have some advantages, there are often more disadvantages with Medicare Advantage than the older, original basic Medicare. Care can be more expensive due to higher co-payments, and many doctors and health care centers that accept basic Medicare as payment will not accept Medicare Advantage.
Another issue is that Medicare Advantage has been looked at very closely because of aggressive – and sometimes fraudulent – marketing and sales practices. Many Medicare recipients are being pressured and tricked into changing coverage, and, as a result, have been put in a situation where they are not better off at all. In fact, in many cases, they are receiving a plan that does not cover them as well as the coverage they are replacing.
If you are thinking of enrolling in a PFFS plan, it is important to do some research to be sure it is legitimate and advantageous. One of the best ways to protect yourself is to look at the cost of co-pays, premiums and extra coverage and make sure you can afford them. Also, be sure you are comfortable with the individual and company you are buying from, and don’t hesitate to check them out.
To be certain that you are purchasing what you truly need, contact Medicare at www.medicare.gov, www.cms.gov , or call them at 1-800-MEDICARE to talk to trained individuals who will answer your questions and help you to look carefully and understand the coverage you have now and the coverage that is proposed.
A stunning and positive development has taken place with regard to Medicare coverage. The Centers for Medicare & Medicaid Services (CMS) has approved coverage for the artificial heart, manufactured and distributed by Abiomed.
This is a huge step forward. With heart-related illness and issues comprising a very large percentage of hospitalizations and deaths, there has been the discovery of more and more individuals that need ear transplants.
However, the waiting lists are long, and even if a person is on the list, waits their turn and moves to the top of the list, they may not be able to find a heart that is a match for them. Now that hospitals can be reimbursed by Medicare for the cost of the heart itself and the cost of implanting it into individuals, many people may have the opportunity for this operation to save their life.
Because this is an artificial rather than a human heart, the possibility of rejection is much less than the human heart. There are fewer question marks, and there are less complications projected. In addition to less complications, the recovery rate with the artificial heart is said to be shorter than with a human heart.
During the pilot part of this new development, there are four hospitals that are slated to be able to use the artificial heart and the operation to put it into individuals. These four hospitals are Johns Hopkins University Hospital in Baltimore, Robert Wood Johnson University Hospital in New Brunswick, N.J., Texas Hear Institute in St. Luke’s Episcopal Hospital in Houston, and St. Vincent in Indiana. If the program is successful, it will expand over time.
The fact that Medicare will be prepared to cover this artificial heart procedures a great stride forward. This should save many lives as it increases over time. Even if it saves only one life, it will have been an important step forward in Medicare coverage.
As of Monday, thousands of Medicare beneficiaries enrolled in fee-for-service plans will be able to access their doctor and hospital claims online as part of a new pilot program in South Carolina. This Personal Health Pilot is a new program from the Center for Medicare Services (CMS) and will help thousands of Medicare beneficiaries.
CMS has created the program to help encourage consumers to learn the use of PHRs and see how much and how well consumers use them. Beneficiaries who use the PHR will also be able to enter some of their own information such as prescriptions they are taking and over the counter medications as well. In addition, they will be able to use links to find websites with information about their individual health conditions.
On excellent benefit of the PHR is that individuals using it will be able to share their health information with their health care providers and their families by giving them authorization to be their authorized representatives. These representatives will be given their own user I D’s and passwords.
The PHR Pilot began in South Carolina at the beginning of April 2008, and will continue indefinitely. Security is of the utmost importance, and, as a result, the PHR Pilot was delayed by the concerted effort to make sure that the program is in strict compliance with federal data security standards and the highest privacy safeguards for patient information.
The PHR Pilot is an important step in involving all individuals in the medical process. Of course, the Medicare recipient is the individual who will make the decision as to who has permission to access their information. In the event that the beneficiaries allow their families or their physicians to access the information, the result could be better communication leading to better health care and more support.
It will be both interesting and important to see the progress and results of the Personal Health Records Pilot. Hopefully it will be a foundation for more pilots and permanent programs throughout the country.
Most people who are Medicaid recipients know that their income must stay below a certain level in order for them to maintain their Medicaid eligibility and benefits. Therefore, they must carefully check their finances so that they do not exceed that amount and lose their benefits. This is critical, since Medicaid is a lifeline for many who can’t otherwise get health care and need to continue treatment, medicine or both.
There has been a lot of confusion regarding the tax rebate checks that are being distributed right now. Individuals receiving Medicaid are worried about whether this extra money will count as income and cause them to lose their benefits.
The answer to this is, “No.” The economic stimulus rebate will not count as income; therefore will not cause individuals to lose their Medicaid, according to South Dakota State University.
Some Medicaid programs count resources as assets, so it is best to check the information at www.ssa.gov, which is the federal Social Security Administration website. Some nursing-home waiver and other SSI-related programs count resources as assets, so it is important to check the site to see if any of these situations apply to you. They could include Disabled Adult Children, Widow/Widower, Grandfathered Children or a few others. You can get specific information regarding these situations on the site.
If you or someone in your family is part of any of these programs, Medicaid will not count the tax rebate as income during the month the rebate is received or for two months afterward. That means that this money will not be counted when Medicaid is deciding whether a person is eligible for that month and the two months after the rebate is received. It is important, however, to note that if the money has not been spent or otherwise disbursed by the fourth month, it will be counted as a resource for the programs listed in the previous paragraph.
If you are a Medicaid recipient, hopefully this clears up the confusion so you can breathe a bit easier now. If you have further questions, go to www.medicaid.gov or www.ssa.gov for more information.
There is a lot of information around about what a Medigap or Supplemental Medicare Insurance policy is and what it covers. What it does not cover is just as important to you if you are contemplating whether or not you should purchase a supplement.
The 12 Medigap plans cover basic benefits, but each differs depending upon what state you are in. The twelve plans are labeled A through L, with plan A being the basic policy. Plan B through L offer the same basic coverage found in plan A, and also offer other additional benefits. Plans K and L offer similar coverage as plan A, but the cost sharing is different.
None of the standard or basic Medigap plans cover certain benefits, such as long term care for help with bathing, dressing or using the bathroom. They also do not cover vision, dental care or hearing aids, private duty nursing or prescription drugs. As mentioned, there are other variations based on the state you are living in and receiving benefits from.
To explore the differences and to look for coverage you can contact your state insurance department, or find The Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy.
Another offering is Medicare Select, which is a type of Medigap policy that often costs less than standard Medigap plans. That’s the plus part. The negative is that you can only go to certain participating physicians and hospitals if you need any sort of medical treatment or assistance. To find out if Medicare Select is available in your state, simply call your state insurance department.
Since Medicare Part A is the most basic plan let’s start there. Plan A covers your hospital stay up to 60 days. Starting with day 61, you are responsible for costs through day 150. Since Medicare doesn’t pay at that point, All Medigap plans cover days 61 to 150, though you will have to pay the shortfall, as the Medigap plans don’t cover the entire cost during that time. You will also be responsible for any deductible before Medigap kicks in.
With Part B, you will pay your annual deductible which is $135 in 2008. Medicare then pays 80% of the doctor and other medical services, 50% of some health services and 100% of some preventative services.
Since Medicare does not pay for all services, as described in the paragraphs above, this is where a Medigap policy takes over. Plans B through J cover expenses such as the deductible above, skilled nursing home costs, some deductibles for other services, including at home recovery, preventive care, prescription drugs and foreign travel emergency or urgent care.
As you can see, the expenses that the right Medigap policy covers can offset a lot of out of pocket expenditures. It is an excellent idea to research this type of coverage so that you can see how cost-effective the coverage could be and whether it is right for you. To research the plans more thoroughly you can call Medicare at 1-800-MEDICARE or you can check on the internet at www.aarp.org and www.cms.gov. These sites have links to other information, as well.
Whatever you decide to do, research thoroughly, ask questions, calculate the cost of purchasing a Medigap plan vs. the cost in out of pocket expenses if you don’t purchase one. Get information from your employer, your insurance agent and any other sources on the web. Another great way to get information is to ask friends what type of insurance they have and how happy they are with the coverage.
They say that people spend more time looking for furniture or buying groceries than they do researching their insurance, yet it is your insurance – especially Medigap – that can literally make them or break them. Don’t get caught without protection. Determine what your needs are and then do your homework. You’ll be glad that you did.
There are many people that are enrolled in Medicaid and receive benefits, but are not aware of the fact that there are dental benefits available. Dental benefits are available as an option to individuals over the age of 21 who are enrolled in Medicaid. These benefits are a required benefit for individuals under 21. They are a component of the Early Periodic Screening and Diagnostic Treatment (EPSDT) portion of Medicaid.
EPSDT is a mandatory program through Medicaid and it focuses on prevention, early diagnoses and treatment, beginning with children and continuing through the age of 21. Dental services must be provided through this program in an effort to watch for any problems or illnesses and address them before they become worse, or before they become chronic conditions. At the very least, services must include relieving the child of pain and eliminating infection, restoring teeth and helping children and young adults maintain dental health. While some plans (usually private) only deal with emergency dental issues, this is not the case with EPSDT. EPSDT must provide regular services and not only help people when there is an emergency. The idea is that regular treatment will diminish or eliminate dental emergencies, thus keeping the system efficient and not creating additional problems for the client either.
The state sets up dental referrals at various intervals and the dentist is required to do a thorough exam, not just an oral screening only. ESPDT requires that all services covered by the Medicaid program must be provided to recipients as long as they are Medically Necessary procedures or services. In other words, if you have a cavity or need a root canal and it is necessary to be fixed, those services are covered. If, however, you are thinking of getting implants or special veneers, these services might not be covered, since they are often considered “cosmetic” procedures – not only by Medicaid, but by private dental insurance plans, as well. If a condition is discovered during an exam or screening, the state is obligated to provide treatment for that condition, even if it is not covered through the state’s dental coverage.
For further information and answers to your questions, contact Centers for Medicare and Medicaid Services (CMS). You can find them on the web at www.Medicare.gov and www.Medicaid.gov. or you can call them at 1-800-633-4227 (1-800-Medicare).
Most of us think about Medicare in terms of types and amounts of plans and coverage. Sometimes we only think about it when we are feeling ill or having to visit the doctor or hospital.
This is not all that Medicare does. There are many types of information that Medicare collects and Medicare provides. One important type of information that Medicare tracks is information regarding nursing homes. Medicare has just released information and created a database that lists the lowest quality nursing homes in the country.
The Nursing Home Compare website now has a searchable database that gives the names the lowest 5% of nursing homes around the nation. In addition to the database, CMS provides a monthly update showing results of nursing home inspections.
CMS is working hard to provide Medicare recipients and others more access and easier access to information regarding nursing homes. There are senators and congressmen who are pushing for bills to disclose even more information regarding nursing homes and the nursing home community. This may take time, but it is an important issue and it is being looked at carefully and pushed forward.
Whether you are actually at the point where you are looking for a nursing home, or you are a relative, friend or caretaker of an individual looking for or needing one, the information that CMS/Medicare has released is essential.
There is much more information at www.medicare.com, including frequently asked questions with answers and links to other sites and further information.
If you are approaching retirement, already retired and on Medicare or just looking for answers about Medicare or nursing homes, take the time to explore the subject in advance. It could certainly keep you from ending up in the wrong place in a bad situation later on.
If you receive Medicaid, there have probably been some times that you wanted to go to a community health center but ended up having to go to the emergency room waiting for hours to get care. If you feel you have missed out on other services, such as education and non-emergency assistance, help is on the way.
A $50 million grant through the Centers for Medicare and Medicaid Services has been granted to be used by 20 states to provide alternative healthcare services and programs, such as establishing new community healthcare clinics, extend the hours of many existing clinics, create new services and provide electronic (computerized) sharing of information and more.
All of these are important improvements, and electronic sharing of information is critical because in the event that you live in a particular town – especially in a rural town – and a specialist in a large city 500 miles away can help you if he or she has your current information and tests, being able to share this information online could very well save you a 500 mile drive and save your life, as well. In fact, there are more and more reports of procedures – and even surgeries – have been done with electronic assistance.
It is important to note that this will not diminish or eliminate the benefits that you already have. The funding will help improve services and add additional ones.
They will also help individuals receiving services get the best services they can locally at a healthcare office instead of having to go to the hospital or having to go hours away.
If you want more information or have questions, click here or visit http://www.cms.hhs.gov/GrantsAlternaNonEmergServ/
Many individuals receiving Medicare benefits rely on home health care as one of the main benefits they receive. Home Health Care for these individuals – usually seniors or individuals with disabilities – is their lifeline and an essential link in their services and well-being.
The Center for Medicare and Medicaid Services (CMS) has once again recognized the Joint Commission’s deeming authority for accrediting Home Health Care.
This is important to beneficiaries because more than 2.4 elderly individuals and individuals with disabilities receive Home Health Care services. In order to be able to provide such services, agencies need to be accredited and “deemed” as meeting Medicare and Medicaid requirements and standards. When a Home Health Care agency has “deemed status” by the Joint Commission, research shows that the particular agency usually exceeds the standards set out for Home Health Care Providers by CMS, providing a higher level of service.
Because more and more individuals and patients are trying to get treatment as outpatients and stay in their homes rather than hospitals, the partnership between the public CMS and private Joint Commission has become essential in helping to set the highest standards, therefore encouraging and ensuring the highest quality services.
The Joint Commission, which started granting deeming authority in 1993, accredits over 3,800 organizations. Accreditation is voluntary, and Home Health Care Agencies can seek deemed status by the Joint Commission, but it is not a requirement. They can also seek accreditation by state surveyors on behalf of CMS.
The Joint Commission works to continuously improve the quality of services to the public. It evaluates and accredits over 15,000 health care programs in the country, including hospitals, home care organizations, assisted living, ambulatory care services and laboratories. It also accredits organizations dealing with specific health issues, such as stroke centers, and it is a non-profit organization.
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