HealthPlus of Michigan announced the launch of two new HealthPlus MedicarePlus plans designed for Medicare-eligible people looking for affordable benefit choices and convenient access to quality health care. HealthPlus Medicare plans are the highest-ranked Medicare plans in Michigan, according to the "America's Best Health Insurance Plans 2009-10" rankings by U.S. News & World Report and the National Committee on Quality Assurance. "We are very pleased to offer a wider variety of competitively-priced health plans to those eligible for Medicare, " says Nancy Jenkins, vice president of membership growth. "Our Medicare products offer the same great service and benefits that earned us the highest ranking in the state, as well as new features to help meet the needs of Medicare beneficiaries today." The new Medicare Advantage-type plans from HealthPlus come in PPO and HMO varieties: HealthPlus MedicarePlus AdvantageHMO is offered as Option 1 at a monthly premium of $72, or Option 2 at $102.
Some hospitals are suing Massachusetts' Medicaid program for underpaying. Idaho health agencies are broadening their own lawsuit against the state on Medicaid payment rules. Boston Herald : "Six community hospitals will formally file a lawsuit against the state today, ratcheting up a dispute between the hospitals and the state agency that pays for some of the care they provide. Some three years after Massachusetts' ambitious health-care reform effort required all residents to have health insurance, the hospitals that serve the state's poorest residents say the state's below-market reimbursement rates are pushing them to the brink of financial ruin. Michael Collins, chief executive at Merrimack Valley Hospital, one of the six hospitals, said, 'The community hospitals involved in this lawsuit are unfairly bearing the cost of health-care reform'" (McConville, 12/1). Cape Cod Times : "Cape Cod Hospital is one of six community hospitals in Massachusetts participating in a lawsuit against the state Executive Office of Health and Human Services, which is headed by Dr.
A " Medicare Fraud Strike Force, " which started in south Florida, has now expanded across the country to indict more than 300 on fraudulent Medicare billing charges, The Washington Times reports. Officials say the strike force has broken up operations that attempted to defraud Medicare of more than $700 million. "Former U.S. Attorney R. Alexander Acosta, who put a priority on health care fraud cases when he was the government's chief prosecutor in Miami, said the decision in Washington to make such coordinated efforts permanent is starting to have an impact, but that more needs to be done to make a real dent in the kickback and false-billing schemes that plague the national health care program." Officials estimate that between 3 and 10 percent of Medicare and Medicaid spending is lost per year on waste, fraud and abuse (Neubauer and Seper, 12/1). This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.
Summaries of developments related to community Medicaid programs develop below. Georgia: Georgia has agreed to a $6 million settlement with Eli Lilly in a indictment alleging that the drugmaker illegally marketed the antipsychotic Zyprexa, the Atlanta Journal-Constitution reports. The narcotic is approved by FDA to treat schizophrenia and bipolar disorder. Distinct states sued Lilly for marketing the drug as a dementia treatment. The suit also alleged that the firm misled doctors and patients approximately the drug's side effects -- including diabetes, high blood sugar and exorbitant weight advance -- and seeks reimbursement for related care. Georgia Attorney General Thurbert Baker (D) said he opted for the settlement, rather than pursuing the case in court, by reason of he calculated that the settlement would be about twice the amount of the states' related Medicaid claims. According to Baker, the entire settlement for the control is more than $15 million, $9 million of which will be used to repay the federal ability of Georgia's related Medicaid claims.
Senate Finance Committee Stool Max Baucus (D-Mont.) on Thursday questioned whether CMS could bail a massive utility of the Medicare transaction and suggested that a new entity might be greater suited to take on the effort, CQ HealthBeat reports. During a confirmation hearing for William Corr, Head of the state Obama's election for deputy secretary of HHS, Baucus said, "There are some very, very thoughtful body politic in health distress who really, seriously, wonder provided CMS is up to the job, " adding that "there's some inquiry if they are able to age the designs and putting cutting edge programs together as opposed to just implementing old programs." He raised the time to come of creating a seperate entity to work alongside CMS that would be tasked with designing feasible changes such as bundling payments for services, or developing accountable care organizations and the medical internal concept. Corr said, "It begins further with guidance and I expect Secretary Sebelius intends to bring in outstanding leaders to the department, to CMS, " continuing, "I hope within several months that when you make that assessment again, you testament be able to break silence colorful matters approximately the order CMS is stirring in" (Norman, CQ HealthBeat, 4/30).
Blacks Will Possible Be Negatively Affected By Proposed Medicare Reimbursement Alternate For Dialysis Treatment, Study Finds
Black dialysis patients might be negatively affected by proposed changes in Medicare reimbursement policy, according to a scan published in the Journal of the American Society of Nephrology, Reuters Health reports. CMS has proposed forging one lump payment to cover both dialysis and injectable medications, instead of continuing to reinstate the procedures separately. For the study, vanguard researcher Areef Ishani of the University of Minnesota and colleagues calculated the development of the proposal on a representative cohort of 12, 000 patients who started hemodialysis when they were age 67 or older. Researchers found that based on existing CMS data, blacks have lower initial levels of red blood cells than whites and desire higher doses of epo-type drugs to carry out analogous hemoglobin levels. As a result, blacks require on principles 11% bounteous epo per month than whites during the first two months on dialysis. Researchers contend that owing to blacks required higher doses of the costly drugs, facilities might be biased against treating them, Reuters Health reports.
Method in the FY 2010 budget aimed at transforming the nation's health control step may be used to improve access to outpatient physical therapy services for Medicare beneficiaries by repealing the therapy caps, says the American Physical Therapy Association (APTA). S. Con. Res. 13, which recommends budgetary levels and amounts for FY 2009-FY 2014, was passed Apr 29 by the Co-op of Representatives by a 233 to 193 vote and by a 53 to 43 Senate vote. An amendment by Senators Ben Cardin (D-MD) and John Ensign (R-NV) to the budget's existing deficit impartial reserve fund relating to health keeping reforms allows for improvements to the Medicare program for beneficiaries and protects access to outpatient therapy services, including physical therapy, terminated measures such as repealing the current outpatient caps while protecting beneficiaries from associated premium increases. "APTA applauds Congress for recognizing the critical need to repeal the caps on physical therapy services so that Medicare beneficiaries can receive the care they require, " said APTA President R.
CMS Proposes Policy And Payment Rate Changes For Inpatient Stays In Acute Care And Long-Term Care Hospitals In FY 2010
The Centres for Medicare & Medicaid Services (CMS) proposed the fiscal year (FY) 2010 policies and value rates for inpatient services furnished to people with Medicare by both acute disquiet hospitals and long-term interest hospitals. In the report issued, CMS is proposing to modernize acute distress infirmary rates by 2.1 percent for inflation less an adaption of 1.9 percentage points to remove the effect of increases in aggregate payments due to changes in hospital coding practices that do not reflect increases in patient's severity of illness. CMS is similarly proposing to rejuvenate long-term care infirmary rates by 2.4 percent for inflation less an assimilation of 1.8 percentage points to account for changes in documentation and coding practices that do not reply increases in patient's severity of illness. Day one Oct 1, 2008, Medicare adopted a original grouping process for general acute and lenghty term discomposure hospitals to better recognize severity of illness and the value of treating Medicare patients.
The Centres for Medicare & Medicaid Services (CMS) proposed adjustments to fiscal year (FY) 2010 value rates to more appropriate reflect the reward of caring for Medicare beneficiaries in nursing homes. The statute calls for payments to Medicare skilled nursing facilities to be reduced by $390 million, or 1.2 percent lower than payments for FY 2009. This reconciliation to nursing ease payments is an effort to rebalance an earlier assimilation to the case-mix indexes (CMIs). The proposed FY 2010 recalibration of the CMIs would decision in a reduction in payments to nursing homes of $1.050 billion, or 3.3 percent. However, this decrease would be principally offset by this fiscal year's proposed renew to Medicare payments to beneficial nursing facilities. The update-a proposed escalation of 2.1 percent or $660 million for FY 2010-is based on the change in prices of a "market basket" of goods and services included in covered skilled nursing smoothness stays. The percentage increase in the market hamper is used to compute the restore factor annually.
As the depression sends put in writing numbers of Michigan residents onto the Medicaid rolls or into infirmary emergency rooms with no health insurance, any mid-year cuts to Medicaid would harm people across the state, health care leaders warned today. Physicians, hospital executives, long-term-care and intellectual health providers implored the governor and Legislature to quit any plans to section Medicaid from the governor's Executive Assortment spending reductions to be announced tomorrow. "We do understand that the territory is in dire financial straits, but cuts to Medicaid harm mankind and we are confident neither the governor nor legislators appetite to as well destabilize the state's fragile health keeping system, " said Spencer Johnson, head of the state of the Michigan Health & Infirmary Association (MHA), which represents all 144 nonprofit hospitals in Michigan. The health care leaders acquire been told the governor may recommend another 4 percent cut to Medicaid provider rates, which are already grossly inadequate.