Health and Fitness

People With Medicare Should Act Now To Ensure Uninterrupted Drug Coverage In February, Consumer Group Advises

Every winter, millions of people with Medicare discover that their Medicare private drug plan will no longer cover a medicine they need. Consumers affected include: members of drug plans that dropped certain drugs from their list of covered drugs in 2010 or imposed new restrictions on a covered drug in the new year; consumers who switched plans but failed to check that all their medicines are covered under their new plan; and many of the one million low-income people with Medicare who were randomly reassigned to a new drug plan because their 2009 plan no longer qualified for a full premium subsidy. To help minimize the negative impact of plans' restrictions on consumers, drug plans are required to have a transition policy to ensure that new members have uninterrupted access to drug therapy that started before they joined, and that existing plan members do not face interruptions to drug therapy when their plan imposes new coverage restrictions in the new year. Transition policies are effective for the first 90 days of the new plan year, and require that plans cover at least one 30-day supply of drugs even if they are not on the formulary, and also require that plans override their restrictions.

Survey: Medicaid Beats Private Insurance When It Comes To Prevention

Sen. Lamar Alexander - as well as other conservative lawmakers - characterized Medicaid as a "medical ghetto" during Senate floor speeches on the health overhaul debate last year, American Medical News reports. But, the 2007 National Survey of Children's Health contradicts that common perception. "Based on nearly 92, 000 interviews, it found that in 36 states, children in Medicaid and CHIP were as likely or more likely than privately insured kids to have had at least one preventive health care visit over a 12-month period." The program's advantage stems from the federal government requirement that "it to cover a standardized package of preventive care benefits for children called the Early Periodic Screening, Diagnosis, and Treatment program. ... By contrast, private insurance coverage for children is 'all over the map, '" (a former president of the American Academy of Pediatrics) said. Some wonder whether expanding Medicaid to more people would stretch the program too thin to preserve that edge (Trapp, 2/1).

Medicare, Consumers Face Challenges When Trying To Make Choices Based On Value

News outlets report on concerns about Medicare costs and the difficulties consumers face when trying to find value in their health services. Jacksonville Business Journal reports on concerns about proposals to base Medicare pay on rewarding quality and notes that variation in hospital performance often occurs because of the amount of charity cases, Medicaid and uninsured patients. "Rewarding high-quality, efficient hospitals with more Medicare dollars may be one of the most effective cost-control measures in health care reform legislation, which explains why moving to such a system is included in both the House and Senate bills. But the prospect of a shift toward paying for value has raised familiar questions about how it is measured, and concerns over who would be on the losing end if the new formula were to become law. At the center of the debate are the vast regional disparities in Medicare spending, and what are legitimate causes for the variations that may be unrelated to a provider's cost and efficiency" (Morrison, 1/19).

CMS Approves Three National Organizations To Accredit Suppliers Of Advanced Imaging Services

The Centers for Medicare & Medicaid Services (CMS) is designating three national accreditation organizations - the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission (TJC) - to accredit suppliers furnishing the technical component (TC) of advanced diagnostic imaging procedures. The accreditation requirement will apply only to the suppliers furnishing the imaging services, and not to the physician's interpretation of the images. As required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all suppliers of the TC of advanced imaging will have to become accredited by an accreditation organization designated by the Secretary of Health and Human Services by Jan. 1, 2012. The accreditation requirement applies to physicians, non-physician practitioners, and physician and non-physician organizations that are paid for providing the technical component of advanced imaging services under the Medicare Physician Fee Schedule.

Blogs Comment On Mass. Senate Race, Tiller Murder Trial, Other Issues

The following summarizes selected women's health-related blog entries. ~ " Why Brown Is Not the Pro-Life Candidate in Massachusetts Senate Race, " Kathleen Kennedy Townsend, Huffington Post blogs: While it is "not surprising that conservative political groups have sought to use" abortion-rights issues "to elect Republican candidates, " it is surprising "how quickly groups like Massachusetts Citizens for Life are willing to abandon their principles on abortion to reveal their real priority: electing a Republican to the U.S. Senate regardless of his views on abortion in order to kill health care reform, " Kennedy Townsend, chair of the University of Maryland's Institute for Human Virology and member of the Board of Catholic Democrats, writes. MCFL endorsed Republican Scott Brown in the race, "frequently referring to him as a 'pro-life' candidate -- despite his unequivocal support for Roe v. Wade, " she writes. Brown's views on abortion rights "are largely the same" as those of Democratic opponent Martha Coakley and President Obama, Kennedy Townsend says, noting that Brown's Web site says that abortion decisions "should ultimately be made by the woman in consultation with her doctor.

One In Five Nursing Homes Receive Poor Quality Ratings, Analysis Finds

USA Today : "One in five of the nation's 15, 700 nursing homes have consistently received poor ratings for overall quality, a USA Today analysis of new government data finds. More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009. ... nearly all homes that repeatedly received few overall stars - one or two stars - were owned by for-profit corporations, the data show." USA Today also includes a searchable database of homes (Gillum, 1/28). This information was reprinted from 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

CBO: Stimulus More Expensive Than Expected, Medicare Costs To Double By 2020

A new Congressional Budget Office report "provides more ammunition for Republicans who say the stimulus has been long on spending and short on creating promised jobs, " The Associated Press/ABC News reports. The report says the stimulus will cost $75 billion more than expected, because of increased unemployment, requirements for the food stamp program and the high popularity of an infrastructure bonds program. The report comes as Democrats consider a second stimulus bill that could include another extension of unemployment benefits, job creation tax credits and further help for jobless people to buy health coverage (Taylor, 1/26). Medicaid spending is one of the largest parts of the stimulus package, but it proved less costly than anticipated, CNNMoney reports. "The largest decrease in cost was for the Medicaid match program, in which the government helps states pay for Medicaid expenses. The CBO now estimates that the program will cost $3 billion less than originally thought" (Goldman, 1/26).

Partnership For Medicaid Urges Health Reform Efforts To Continue

The Partnership for Medicaid, a national coalition of health care, local government, and labor organizations, today applauded the work of pro-health care reform lawmakers and urged them to continue their push for comprehensive legislation. At a Capitol Hill briefing today, the Partnership for Medicaid stressed that during these tough economic times and lengthy period of high unemployment, millions more lower-income and disabled Americans depend on the Medicaid system for their health care. The non-partisan coalition - an alliance of 18 organizations representing doctors, health care providers, Medicaid-focused health plans, counties, and labor - praised Congress' recognition of the importance of Medicaid when it voted to expand the program significantly in both the House and Senate health care reform bills. "Achieving real health care reform must remain a top priority, " said Margaret A. Murray, the Chief Executive Officer of the Association for Community Affiliated Plans (ACAP), a member of the Partnership.

APTA Calls On Congress To Restore Access To Rehabilitative Services For Medicare Beneficiaries

Congress must act immediately to restore access to rehabilitative services for Medicare beneficiaries as many senior citizens and people with disabilities are nearing arbitrary limits (also known as therapy caps) on services provided by physical therapists and other health care providers in outpatient health care settings, says the American Physical Therapy Association (APTA). The Medicare program began enforcement of the $1, 860 limit on outpatient rehabilitation services on January 1. "With many Medicare beneficiaries approaching the arbitrary $1, 860 cap, it's imperative that Congress act now to ensure coverage for necessary services, " said APTA President R. Scott Ward, PT, PhD. "The most vulnerable patients-those with chronic conditions or with multiple comorbidities, who experience stroke, hip fracture, or who have Parkinson disease or osteoporosis-are most likely to soon be negatively affected by this arbitrary payment cap." Immediate action is required by Congress to prevent thousands of Medicare beneficiaries from exceeding the therapy caps on outpatient physical therapy, occupational therapy, and speech-language pathology services.

Statement By Medicare Rights Center President Joe Baker On President Obama's State Of The Union Speech

President Obama last night called on Congress to finish the job on health care reform. The Medicare Rights Center agrees. While the political challenges of passing health care reform are real, they pale in comparison to the real-life challenges that Americans face under our fractured health care system. Older adults and people with disabilities in particular continue to face major obstacles to getting the medical care they need. Prescription drugs remain unaffordable to many, preventive services are underutilized and medical care from hospitals and specialists is often uncoordinated and wasteful. Passage of the health reform legislation now before Congress will help on all three counts. Health reform legislation holds the promise of closing the coverage gap, or "doughnut hole, " in Medicare drug coverage, which forces people with Medicare to pay the full price for their medicines. The health care bills would eliminate copayments for preventive services and provide coverage for an annual health risk assessment to help manage chronic conditions.

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