New impact study shows how Republican plan effects patients.
District by District Impact of Republican Medicare Plan and Medicaid Cuts.
Rep. Henry A. Waxman, Ranking Member of the Energy and Commerce Committee, and Rep. Frank Pallone, Jr., Ranking Member of the Health Subcommittee, have released new analyses detailing the impact of the Republican Medicare and Medicaid proposals on each congressional district.
Click here to view the full text of the letter sent by Reps. Waxman and Pallone to their colleagues to assist them in understanding the ramifications of the Republican Medicare and Medicaid proposals.
Will Affordable Care Act make Health Insurance Affordable?
Jonathan Gruber and Ian Perry
Abstract: Using a budget-based approach to measuring affordability, this issue brief explores whether the subsidies available through the Affordable Care Act are enough to make health insurance affordable for low-income families. Drawing from the Consumer Expenditure Survey, the authors assess how much “room” people have in their budget, after paying for other necessities, to pay for health care needs. The results show that an overwhelming majority of households have room in their budgets for the necessities, health insurance premiums, and moderate levels of out-of-pocket costs established by the Affordable Care Act. Fewer than 10 percent of families above the federal poverty level do not have the resources to pay for premiums and typical out-of-pocket costs, even with the subsidies provided by the health reform law. Affordability remains a concern for some families with high out-of-pocket spending, suggesting that this is the major risk to insurance affordability. FROM THE COMMONWEALTH FUND
GOVERNOR CUOMO ANNOUNCES ON-TIME PASSAGE OF HISTORIC, TRANSFORMATIONAL 2011-12 NEW YORK STATE BUDGET
Redesigning Medicaid and Health Care
Total Medicaid spending including federal, state and local spending of $52.6 billion represents a decrease of $337 million, or minus 1 percent. Future growth in Medicaid will be limited to the 10-year rolling average of the Medical CPI, currently 4 percent. As with education, the budget includes a two-year appropriation.
The budget includes a cap of $15.3 billion on Department of Health Medicaid state expenditures, which represent the largest and one of the fastest growing component of state spending.
The budget process brought together health care providers, labor, government and other Medicaid stakeholders to form Governor Cuomo’s Medicaid Redesign Team (MRT). Tasked with identifying ways to provide critical health care services at lower costs and control unsustainable growth, the MRT recommended a series of proposals to fundamentally restructure and reform New York extensive Medicaid program.
Overall, the budget implements a majority of the MRT recommendations. The budget reflects $2.3 billion in spending reductions supplemented by $425 million in lower-than-expected expenditures to achieve the Governor’s original savings target of $2.85 billion.
The budget implements significant reforms including a major expansion of patient-centered medical homes, better control of home health care services, and care management for individuals with complex and continuing health care needs. New models of integrated care, such as Accountable Care Organizations, will help assure long-term control of health care spending.
Savings will be assured by an overall spending cap, enabling the Commissioner of Health to make additional savings actions during the year, if necessary. Here is the briefing book by subject.
http://publications.budget.state.ny.us/eBudget1112/fy1112littlebook/index.html
Health Commissioner Endorses New Federal Model to Help Elderly, Disabled New Yorkers to Remain in Their Homes
“Allowing disabled and elderly New Yorkers additional options to stay in their homes is consistent with Governor Cuomo’s goals,” Commissioner Shah said. “This new federal opportunity will help New York reform its Medicaid program while at the same time empower elderly and disabled individuals to stay in their own homes.”
The Community First Choice Option would provide a 6 percent enhanced federal payment under Medicaid for certain types of home and community-based attendant services and supports. The program must be offered throughout the state in the most integrated setting appropriate to individuals’ needs.
Dr. Shah said Governor Andrew M. Cuomo has asked him to take all necessary steps to prepare New York to make use of the new care option. Action will include establishing a development and implementation council, whose membership must consist primarily of elderly and disabled individuals and their representatives.
“Patient-centered and patient-directed care needs flexibility to work, which Community First Choice will help provide,” Dr. Shah said. “This is an opportunity to rethink the way New York supports its elderly and disabled populations. We look forward to implementing this new concept.”
The Community First Choice option expands on New York’s current consumer directed personal assistance program (CDPAP), in which Medicaid patients are supported in their desire to live in their community by specifying the types of care and support they require.
Governor Cuomo has directed Commissioner Shah to take all necessary steps to prepare New York to make use of the new care option. Action will include establishing a development and implementation council, whose membership must consist primarily of elderly and disabled individuals, and their representatives.
The Community First Choice Option is an important part of the Affordable Care Act. The Centers for Medicaid and Medicare Services (CMS) recently published in the Federal Register proposed regulations that would implement this part of the federal health reform.
Public comment on the proposed regulations is due to CMS by April 26. This new guidance provides additional clarity on the federal option, which will help patients make the transition from institutional to home or community-based living. Enhanced federal Medicaid payments will be made for certain supports, including the set-up costs for independent living, such as rent and utility deposits, first month’s rent and utilities, bedding and basic kitchen supplies. States looking to implement the program will have to establish a quality assurance system that includes consumer feedback.
The Community First Choice option expands on New York’s current consumer-directed personal assistance program (CDPAP), in which Medicaid patients are supported in their desire to live in their community by specifying the types of care and support they require.
Dr. Shah will coordinate New York State’s comments on the draft federal regulations and accept nominations to serve on the development and implementation council.
Meaningful Use helps doctors manage practice
Caryn attended a training session cohosted by IPRO and e-MDs. A NY e-Health Collaborative representative discussed the benefits of using the services of a Regional Extension Center. e-MDs demonstrated how their integrated EMR/PM, called Solution Series, gives reports that show how close a practice meets meaningful use benchmarks. The information is used to report directly to Medicare, but is also helpful to pinpoint where the practice is falling short and who in the organization needs more training to meet practice protocols.
Don’t let the guardian ship sale away with your $
http://myelderadvocate.typepad.com/blog/2011/01/son-imprisons-dad-then-steals-his-money.html
Jack Halpern hits in the the head with this blog spot.
New York State Commissioner of Health confirmed.
Nirav R. Shah, M.D., M.P.H., is the 15th New York State Commissioner of Health. His nomination by Governor Andrew M. Cuomo was confirmed by the State Senate on January 24, 2011, making him the first Indian-American to serve as State Commissioner of Health as well as the youngest person named to the post. http://www.health.state.ny.us/commissioner/bio/
What’s Medical Necessity?
What’s the difference between medical necessity and chiropractic necessity?
According to CMS, medical necessity is a service, treatment, procedure, equipment, drug or supply provided by a hospital, physician, or other health care provider that is required to identify or treat a beneficiary’s illness or injury and which is, as determined by the contractor: a) consistent with the symptom(s) or diagnosis and treatment of the beneficiary’s illness or injury; b) appropriate under the standards of acceptable medical practice to treat that illness or injury; c) not solely for the convenience of the participant, physician, hospital, or other health care provider; and d) the most appropriate service, treatment, procedure, equipment, drug, device or supply which can be safely provided to the beneficiary and accomplishes the desired end result in the most economical manner.
According to one BCBS plan, chiropractic is a covered service when performed with the expectation of restoring the patient’s level of function which has been lost or reduced by injury or illness. Manipulations should be provided in accordance with an ongoing, written treatment plan and must be appropriate for the diagnosis reported.
From Target Coding.
AGINGICON.COM
Have you lived a life of accomplishment, doing what fulfills
you? Have you reached an age where things are harder to do?
Are you a leader and you know that you cannot do it alone?
Then, you are an Aging Icon.
My name is Caryn Isaacs.
Having been at the helm of developing hundreds of healthcare
businesses and running several multi-million-dollar companies,
my journey includes pioneering a physician-owned HMO and
active engagement in Healthcare Reform.
As a Patient Advocate, my company, GetHealthHelp, LLC,
specializes in crafting solutions that enable Aging Icons to
continue pursuing their passions.
An example is a 98-year-old author, playwriter and poet who is
suffering from fibromyalgia and thought that all her work
would be forgotten. I found a way for her legacy to continue by
publishing them as books and now working on having them
made into films.
If this sounds like something of interest, let’s meet to talk
further.
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