Modern Healthcare: Medicare Cuts Mean Nursing Home Layoffs: Survey Medicare nursing home reimbursement cuts will lead to direct-care staff layoffs at 63 percent of nursing home facilities, according to a survey of such facilities conducted on behalf of the Alliance for Quality Nursing Home Care, which represents for-profit nursing homes. In addition, 77 percent of respondents said they would be delaying expansion and renovations as a result of the 11 percent Medicare reimbursement cut to skilled-nursing facilities that went into effect Oct. 1, according to the online survey of association members and non-members, which was conducted by Avalere Health (Barr, 11/7).
Video: Medicaid, Nursing Homes and Asset Protection
Kentucky Elder Abuse Attorneys Say Medicare Adjustment Should Not Impact Nursing Home Care
Partners J. Marshall Hughes and Lee Coleman are accomplished injury attorneys and advocates for people who have suffered from nursing home neglect and abuse, as well as auto accidents, brain injury, drug injury, defective products, environmental dangers, fire and burn injury, insurance disputes, motorcycle accidents, premises liability, Social Security disability, stock fraud, truck accident injury, workers’ compensation and wrongful death.
Nurses In Nursing Home Settings Find It Very Difficulty To Report Errors
The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare, in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more. However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs. Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care. Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans. Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.” There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.” Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans. On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism. In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars. Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees. Others have reported that minority enrollment is not particularly above average. Another study has raised questions about the quality of care received by minorities in MA plans. The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.  Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Nursing Home’s Failure to Notify Leaves Beneficiary Not Liable for Custodial Care Services
A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25. The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct. 25, 2011) concerned the application of 42 C.F.R. 411.404, which states a beneficiary is considered to have known custodial care or services that are not reasonable and necessary are not covered services under Medicare, provided the beneficiary received adequate notice the services are not covered under Medicare.
Learn About Medicare Benefits at Hillsborough County Nursing Home Event
Hillsborough County Nursing Home and Home Health and Hospice Care present an educational lecture for the community, “Making the Most of Your Medicare Benefit.” The lecture takes place Wednesday, November 9, at 5:30 pm at the Hillsborough County Nursing Home, 400 Mast Road Goffstown. Denise Rivard, an expert on long-term care benefit utilization, will provide education and handouts to participants in an informal setting allowing plenty of time for questions and answers. A light meal will be provided for participants, and space is limited. RSVP by alling Sheryl Ramsay at 627-5540, ext 7231
How To Choose a Nursing Home
What to Ask The best way to learn about nursing homes is to talk to staff members. Setting up an interview with the nursing home administrator is especially helpful; here is a useful list of questions you should ask the administrator. Some general questions to ask staff members or the administrator are: 1. May I see the most recent state survey as well as surveys? a. Any nursing facility that receives Medicaid or Medicare funding must be inspected annually by a state official. 2. Is the home licensed? Is the administrator licensed? 3. Do all staff members undergo background checks? Are they screened for a history of abuse? 4. What is the staff to resident ratio? 5. How many hours per day do staff members spend with residents? 6. If I have a complaint, what is the procedure? 7. Do you have isolation rooms available in the event of a contagious resident? 8. May I try the food you give to residents? 9. Are residents routinely weighed? 10. How are emergency situations handled? Which hospital do you send residents to?
Senior Care Options:Nursing Home Costs and Ratings for Medicare and Medicaid Insurance : Silvercensus Blog
As an entrepreneur in digital media, Julie Northcutt launched Caregiverlist.com to deliver the efficiencies of digital technology to senior care companies, professional senior caregivers and families. After graduating from the Missouri School of Journalism, she jumped fence from writing to advertising sales, due to her attraction to launching new business streams for companies. She credits her entrepreneurial skills to experiences gained while growing up on a family farm. She joined USA Today and then became a pioneer in the internet, launching the online advertising sales for Morningstar.com. Often having hobby businesses on the side, she finally saved her money to start her own business, a senior home care agency, combining her entrepreneurial skills with a service she had personal experience in. She grew the agency to be a leader in the Chicagoland market and sold it to a national company in order to focus full-time on Caregiverlist. Caregiverlist.com provides the online tools she wished she had when she owned the senior home care agency, serving as a reliable resource for senior care professionals, adult children and seniors. Caregiverlist answers all the questions that begin when senior care becomes a need, while providing efficient business tools for senior care companies. She credits clients, employees and business colleagues with keeping the idea for Caregiverlist.com on track and contributing to the continued success with their suggestions and feedback.
Nursing homes struggle with Medicare cuts
In a surprise twist, Adobe has decided to stop developing Flash Player for mobile devices. Instead, the software company whose most notable products include Acrobat Reader and Photoshop will focus on the development of HTML5, an open set of Web standards, featuring tools that enable developers to create Flash-enabled standalone apps. Flash has endured a rough road since the large push began to penetrate the mobile device market. For mobile devices, the software has been known to drain batteries and diminish processing power. By focusing on HTML5 technology, Adobe will still allow developers to create apps using Flash content that will be offered though all the major phones’ app stores, including, you guessed it, Apple’s.
Illinois Medicaid Changes: Look
The state of Illinois now will now make it possible to “look back” at a senior’s finances for 5 years, instead of 3 years. The lengthening of the look-back period will enable the state to be sure that money wasn’t given away if you really could afford to pay for the nursing home care on your own (seniors may gift the money to their children so they will have some inheritance, rather than using this money to pay for their nursing home care and now there are limits on how much money can be “gifted” in order to qualify for Medicaid). This requirement was added because in the past there were some very wealthy families who were asking for the state to pay for their nursing home care and pretending they had no financial resources when they had really just given all their money away to a loved one.
Medicare is Popular : South Carolina Nursing Home Blog
“Medicare Part D has reached popularity levels that you seldom, if ever, see from a government program,” said Mary R. Grealy, president of the Healthcare Leadership Council and co-chair of Medicare Today. “Over the last five years of satisfaction surveys, Part D has stayed consistently above an 80 percent approval rating. And given the fact that competition is keeping the program affordable – and that average premiums won’t increase in 2012 – satisfaction should stay very high.”
Aging and Parkinson’s and Me: Watch Out For This Nursing Home Scam!
One fifth of Medicare nursing home patients with advanced Alzheimer’s or dementia were sent to hospitals for questionable reasons in their final months, often enduring tube feeding and intensive care. Researchers suspect that it’s not a coincidence, since Medicare pays a nursing home about three times the normal daily rate when it takes patients back after brief hospitalizations. A group of researchers from Brown University, Harvard University and Dartmouth Medical School studied about 475,000 nursing home patients who had been transferred to hospitals. Among them, 19 percent were moved for questionable reasons. The large state-by-state variation suggested that extra Medicare money may be playing a role. The rates of dubious transfers ranged from 2 percent in Alaska to more than 37 percent in Louisiana. (Dubious or “burdensome” transfers occured when a patient was moved in the last three days of life, moved several times in the last three months of life, or moved into a new nursing home after hospitalization.) Transfer rates also varied greatly among cities. In McAllen, Texas, 26 percent of study participants had multiple hospitalizations for urinary infections, pneumonia or dehydration — conditions that usually can be treated in a nursing home. That figure compares to just 1 percent in Grand Junction, Colo. (Interestingly, McAllen was the subject of a 2009 story in The New Yorker because it spends more per person on healthcare than any other city with the exception of Miami, which has much higher labor and other costs. In 2006. Medicare spent $15,000 per enrollee in McAllen, nearly twice the national average.) Medicare pays on average $175 per day, depending on the state, for long-term care. Nursing homes can receive three times that amount after patients return from hospitalizations of at least three days. For nursing homes just scraping by, this opportunity creates a tremendous incentive to hospitalize patients. Researchers found that patients who had dubious transfers were more likely to have feeding tubes inserted, to spend time in intensive care in the last month of life, to have a severe bedsore, or to be enrolled in hospice late (three days or less before they died). Dubious care was more common with blacks and Hispanics and those without advance directives that spell out the patient’s care wishes. The study was published in the New England Journal of Medicine. See http://www.nejm.org/doi/full/10.1056/NEJMsa1100347 Tips for Getting the Best Nursing Home Care Beth Kallmeyer , who runs programs for caregivers for the Alzheimer’s Association, has these suggestions for caregivers whose patients are admitted to nursing homes: