Rumor has it.
Sorry if you got all excited about a post I reprinted about EFT being endorsed by the Psychological Association. It seems, it was just a rumor, taken out of context from someone who was hoping it would be true.
On the bright front, we have been hearing that the NYS Health Planning Committee has speeded up the contingent approval process for licensed home health care agencies. We believe this is due to the requirements that Medicaid patients in nursing homes and long term home health care situations will be forced to select a managed care program or will be assigned to one in October of this year. Many companion agencies are rushing to get their license so as not to be left out of the Medicaid marketplace.
For those who are considering Long Term Care Insurance
This article makes some interesting points. I have to tell you that it is much easier for me to help people when they have long-term care insurance. It gives them many more options for housing and home care. It also allows them to spend their money on the little extras that make life more complete, and not having to spend all their savings on medical care. Many people think they will just spend down and then go on Medicaid. But, then they realize that it poverty isn’t all it’s cracked up to be. One woman asked me recently, “Can’t Medicaid pick up all the bills while I’m sick and then give me back my savings after I get better?” You know the line,” if it sounds too good to be true, it usually is.”
The article doesn’t talk about the cuts that have been made recently in Medicare and Medicaid long-term care coverage. It also doesn’t talk about health care reforms that will cause many people using home health aides to lose their coverage. Long Term Care insurance is still a very good investment.
http://online.wsj.com/article/SB10001424052702303425504577352031401783756.html
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Caryn coordinates speakers for the Taste of Sunrise at Mill Basin events.
Tim Seitz, The World’s Happiest Hypnotist
Miller Calberto, MS, OTR/L Adapting Spaces
George Fehling discusses money management, ramps and lifts for home, business, pool and bathtubs with Occupational Therapy Candidate Kayan Sahadi.
Rev. Dr. Barbara Simpson, Director Of Outreach at Compassionate Care Hospice talks about Keeping Life Positive
Iris Bikel, Attorney & Troy Kirschner, Professional Organizer visit Sunrise at Mill Basin
Iris Bikel, Attorney talks to residents and members of the community about Advanced Directives, Estate Planning and other legal matters.
Troy Kirschner, Professional Organizer chats about de-cluttering and downsizing.
Caryn gives referrals and talks about what to do when the doctors say nothing can be done.
Gottfried still solid on Single-Payer
Let New York Health help pay the bills
By Richard N. Gottfried
Published 11:31 p.m., Sunday, April 1, 2012
.
You buy a health insurance policy that covers care by “in-network” doctors and other providers, but also promises that if you go to an “out of network” provider, it will pay based on “usual and customary charges.” Your family doctor refers you to an out-of-network specialist, and it turns out the insurance company offers to pay about half the bill you get.
A few years ago, then-Attorney General Andrew Cuomo and a group of physicians brought a massive lawsuit against the top insurance companies. The charge was that those insurers were promising to pay based on “usual and customary” rates for out-of-network services, but those rates were bogus — and outrageously low.
The insurance companies agreed to settle the case. They agreed that the attorney general would set up an independent nonprofit organization, called Fair Health, to publish legitimate data the insurance companies would use for determining “usual and customary” charges.
Now, insurers are getting around the settlement by no longer promising to pay based on usual and customary; they will pay whatever they choose to pay.
So I have introduced a bill in the Assembly, carried in the Senate by Senate Health Committee chairman Kemp Hannon. It says that your health insurer company must disclose how it calculates out-of-network payments, and state them as a percentage of the Fair Health usual-and-customary rate. And it says the state Department of Financial Services — the new name of what used to be the Insurance Department — may not approve an out-of-network insurance policy unless it actually provides “significant coverage” of the Fair Health usual-and-customary rate.
In other words, insurers have to be open with their customers, and they can’t claim a policy covers out-of-network services if it doesn’t really pay reasonable amounts for them.
A Times Union Commentary page article last week, by an executive of the for-profit insurance company Empire Blue Cross-Blue Shield, says that our bill would “mandate a minimum reimbursement [to out-of-network providers] based on the Fair Health database.”
The bill does not do that. It would require disclosure and stop insurance companies from selling products that don’t really provide what consumers expect.
The Fair Health court settlement was hailed as a landmark. But the health insurance companies quickly found a way around it. If our bill becomes law, they may find a way around that, too. The problem is, whatever reforms we enact, our health coverage still relies on insurance companies.
Instead, New York should establish a universal publicly funded single-payer system, funded by broad-based revenue based on ability to pay. I sponsor an Assembly bill, carried in the Senate by Tom Duane, to set up such a system, called “New York Health.”
You and your doctor would work on keeping you healthy, and New York Health would pay the bill.
Richard N. Gottfried of Manhattan is chairman of the state Assembly Committee on Health.
Ronald Fatoullah and Associates educates the elder care experts.
Ronald Fatoullah
Caryn attended the Ronald Fatoullah & Associates Update Luncheon last week along with hundreds of elder care experts. There was some good news and some warnings about transferring and protecting assets for long term care planning. The good news is that the Medicaid Epanded Estate Recovery Law was repealed. Assets such as the Life Estate deed, are once again safe if properly divested before applying for Medicaid. This repeal was hard fought for and our thanks to the efforts of the New York State Bar Association and the elder law community.
Other good news they brought was in the area of EPIC coverage. Although EPIC is still not what it was, and there will be a fee and a requirement to pay for Part D Coverage, the plan has been greatly improved from last years plan.
Some of the warnings we recieved included making sure you have a Living Will and meeting with your financial planner to discuss the type of Annuities you have, because you may not be protected from Medicaid recovery if you have a revocable annuity. Also, the method of calculating life estates has been raised and you should talk with your attorney to discuss your options.
Mandatory Long Term Managed Care
Reinforced in this years budget is the move to mandatory managed care with adding dual eligibles to be added into fully managed care plans in 2015. The Public Health and Health Planning Council (PHHPC) has a broad array of advisory and decision-making responsibilities with respect to New York State’s public health and health care delivery system. It is charged with adopting and amending the Sanitary Code and health care facility, home care agency, and hospice operating regulations. The PHHPC also makes decisions concerning the establishment and transfer of ownership of health care facilities, home care agencies and hospice programs. It makes recommendations to the Commissioner of Health concerning major construction projects, service changes, and equipment acquisitions in health care facilities and home care agencies. It also advises the Commissioner on issues related to the preservation and improvement of public health. The Council’s powers and duties are set forth in section 225 of the Public Health Law. Watch the entire day’s discussions http://www.totalwebcasting.com/view/?id=nysdoh#
Dr. Emanuel Sergi talks about bunions.
Dr. Sergi has an office in NYC and also on Staten Island.
New Medicare Prevention Benefits Ad Campaign
The Affordable Care Act expanded the availability of many of the prevention benefits available to Medicare beneficiaries. A cable advertising campaign was just launched, including ads discussing the fact that many more prevention benefits are available through Medicare. Please share with your members and other partners so that they can see the benefit of taking advantage of these prevention benefits now. The ads are available through the YouTube link.
Here is the link to the Video. Downloading it and viewing shows the best resolution:
And this is the link for the digital banners:
http://cms.sawyermillerhost.com/CMS_Prevention_300x60.html
Here is the YouTube link:
STATE OF NEW YO…
STATE OF NEW YORK PUBLIC HEALTH AND HEALTH PLANNING COUNCIL
SCHEDULE
March 22, 2012 Century House
997 New Loudon Road (Route 9)
Main Ball Room
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Latham
JOINT MEETING OF THE COMMITTEE ON PUBLIC HEALTH
AND COMMITTEE ON HEALTH PLANNING
The Public Health Committee is charged with addressing the statewide governmental public health infrastructure (including workforce, IT, laboratory and other organizational capacity consistent with the Essential Public Health Functions) and support actions to assure readiness for future public health agency accreditation and public health workforce certification. The Committee also promotes interagency collaborations across government to support a “Health in All Policies” approach by State leadership. The Health Planning Committee advises the Council on need-methodologies, health facility plans, and emerging health care issues. Monitors major health care initiatives and advises the Council on progress and/or problems. The Committee will also include functions from the SHPRC’s Committee on Major Medical Equipment and Appropriateness Review in the evaluation of high technology equipment, and specialized services such as organ transplants. The Committee will also take into consider rural health matters in collaboration with the Rural Health Council. The Committee will also handle matters formerly considered under the SHPRC’s Information Systems Review Committee whose general purpose was to advance a framework for CON to ensure interoperable health information technology as an underpinning to health care delivery. |
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TIME
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STAFF CONTACT
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9:45 a.m.
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Sylvia Pirani at (518) 473-4223 or Karen Madden at (518) 402-0935
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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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