[QUAD-L] Fwd: Medicare Watch #18, August 30, 2005

[DAANOO]

Medicare watch! Dana (C4-5, 31 years post, 51, KC)

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Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center

Vol. 8, No. 18: August 30, 2005

 

Contents:

 

1.   FAST FACT

2.   MEDICAID CUTS HEAT UP

3.   COST OF DRUG BENEFIT RISES HIGHER

4.   MEDICARE TO COVER ADULT DAY CARE

5.   CASE FLASH: PAYING FOR AN AMBULANCE

 

 

1.   FAST FACT

 

Sixteen million working age adults—almost one of every 10 working adults—is caring for a sick or disabled family member, and an addition 2 million caregivers are over the age of 65. More than 9 million of these caregivers have health problems of their own (Commonwealth Fund/Detroit Free Press, August 2005).

 

2.   MEDICAID CUTS HEAT UP

 

            The federal Medicaid Commission last week reported out $11 billion worth of cuts over five years, in the nation’s largest public health insurance program that provides health care coverage for 57 million impoverished Americans.

            But experts warn that the cuts are not likely to be well received in Congress.

            In one recommendation the Commission called on Congress to toughen Medicaid asset transfer rules to save $1.5 billion over five years. 

            The proposal would penalize those who give away their assets, such as savings and stocks, to become eligible for Medicaid. This proposal would fall heaviest on seniors who transfer their assets in order to become eligible for Medicaid long-term care coverage.

            According to Congressional Quarterly, restricting asset transfers—even though its supported by the Bush Administration, National Governors Association, and the federal Medicaid Commission—might “prove politically unpalatable” because of the number of voters it would impact and the stated opposition of AARP to the proposal.

 

3.   ESTIMATED COST OF DRUG BENEFIT RISES HIGHER

 

            Government officials now expect the Medicare prescription drug benefit to cost more than $850 billion, and Senate Budget Committee Chairman Judd Gregg, Republican of New Hampshire, called the program “unaffordable.”

            Conservatives say they are feeling hoodwinked by the Bush Administration as they have watched the cost of the Medicare drug benefit skyrocket since the bill’s passage in 2003. During negotiations over the Medicare legislation, the program was billed by the Bush Administration as costing $395 billion from 2004 to 2013. In March, the Congressional Budget Office (CBO) upped its estimate to $593 billion from the period of 2004 to 2015.  And now, CBO estimates the cost of the drug benefit to be $855.7 billion from 2006 to 2015.

            The Centers for Medicare and Medicaid Services’ chief Mark McClellan explained the rapid increase in cost estimates was because of the dropping the two years when the drug benefit was not in place (2004 and 2005), and adding at the end two years when the benefit would be drawn upon (2014, 2015).

            Senator Gregg said: “With American taxpayers and their children already burdened with almost $30 trillion in unfunded liability for the Medicare program, Congress and the Administration have an obligation to limit the drug benefit to its original size.”

            President George W. Bush already announced that he would veto any changes to the Medicare drug benefit this year.

 

4.   MEDICARE TO COVER ADULT DAY CARE

 

            Under a three-year Medicare demonstration project scheduled to start next year, Medicare will cover adult day care services for 15,000 people who would otherwise require a nurse home visit.

            Medicare wants to see if treating more patients at fewer locations is more efficient.

            Todd Lyles, head of administration for a home health agency, made the analogy that: “The [visiting nurse] model is very similar to the physical model that disappeared years ago. Doctors used to make a lot of house calls. But doctors don’t make house calls today because it’s not an efficient use of their time.” Lyles pointed out that visiting nurses only see up to five or six patients a day, leaving room for improvements in efficiency.

            However, Visiting Nurse Associations of America are skeptical. Bob Wardwell, vice president of regulatory and public affairs, suggests that seeing more patients at one place may not save money and that it may increase the home health companies’ liability.

            There are currently some 3,400 adult day-care facilities in the United States, and more than 60 percent provide some health care services, according to a Wake Forest University study.

           

5.   CASE FLASH: PAYING FOR AN AMBULANCE

 

When Mr. E was 72 he had a stroke that left him paralyzed and unable to speak. After he had recuperated in the hospital, he was sent home in an ambulance. Medicare denied coverage for Mr. E’s ambulance ride home, saying the trip was not an emergency.

 

Mrs. E contacted her State Health Insurance Assistance Program (SHIP) and asked for help in appealing Medicare’s denial of coverage. A counselor informed her that Medicare covers non-emergency ambulance transportation if it is medically reasonable and necessary, and if there is no other safe means of transportation available. Mr. E’s doctor wrote a letter saying that the ambulance ride was medically necessary because of Mr. E’s paralysis there was no other way to get Mr. E safely home. In Mrs. E's appeal she included the doctor’s letter. Medicare decided in her favor ruling that Medicare should paid for her husband’s ambulance trip home.

 

To read more cases by subject, go to “Interesting Cases” on our web site at www.medicarerights.org/interestingcasesframeset.html.

 

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Web site: www.medicarerights.org

 

Medicare Watch is MRC’s fortnightly newsletter, established to strengthen communication with national and community-based organizations and professional agencies about current Medicare policy and consumer issues. Each edition contains the latest Medicare policy developments, case stories from our hotline and action steps that professionals can take to ensure that older adults and people with disabilities get good, affordable health care.

 

 

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.

 

 

 

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