Posts Updated, New Information On Medicare, Medicaid

New and updated data, has added new and updated data on Medicare and Medicaid. New data from the CMS Office of the Actuary on Medicare on Medicare spending estimates by state of residence for 1995 through 2004 are available for all states. These estimates are based on where individuals reside and include total Medicare spending; spending on hospital care, physician services, dental services, home health care, drugs and nursing home care; total per enrollee spending; per enrollee spending by service type; and the average annual percent growth in Medicare spending from 1995 to 2004. New data on total Medicaid spending estimates by state of residence for 1995 through 2004 also are available for all states (Kaiser Family Foundation release, 5/1).

MedPAC Proposes Negative Change for Efficient Senior Care Providers

The Medicare Payment Advisory Committee is proposing changes to Medicare reimbursement to skilled nursing facilities that could lower payments to those facilities performing a high-volume of therapy related services.

The report recommends lower payments made by medicare based upon the efficiencies of scale that the Council has stated that any high volume provide should have achieved by technology and standardization processes. Is the council recommending punishing quality providers by reducing their payments? This could be a big blow to long term care for those who need to use these facilities.

The report criticizes that the current medicare system does not provide the best delivery and the use of private sector physicians and facilities is necessary to cope with the growing needs of the system. The council should recognize that private physicians are not government employees or programs and have every right to run their business as they see fit from an operational and financial perspective. The good news for those in private practice is that the proposal could be years from enactment and is contradictory to previous statements that it believes that highly efficient facilities are better for the long-term health of the medicare program (yeah, but if you cut their margins….). Additionally, Congress has routinely ignored the suggestions of this PAC.

DRA and long-term care for senior Americans with disabilities

Here is the conclusion to her article:

There is no question that this nation needs to look closely at the means by which long-term care for elders with disabilities-indeed, all heath care, for everyone-is financed. Many options for restructuring the financing of long-term care for the elderly are available-including adding a long-term care benefit to Medicare or following the leads of Japan and Germany in creating a separate social insurance program to provide long-term care for older Americans. These will require additional taxes and may involve some general cost-shifting back to consumers who use government-financed health care services. But such cost-shifting should impact everyone, not just the elderly and disabled.

The DRA's solution to a crisis (that at the moment is largely manufactured) entailing the shifting of additional burdens onto groups that already bear most of the tremendous economic and emotional burdens that long-term disabilities implicate should not be considered acceptable. Nor should taxpayers be forced to support the long-term care partnerships, which amount to government sponsored discrimination benefiting a small group of wealthy, non-disabled Americans. The asset-transfer and LTCP provisions of the DRA should be repealed while Congress seeks gender- and ability-neutral solutions to the nation's future financing of long-term care for the millions of seniors who will need it in the coming decades.

AARP Seeks U.S. Supreme Court Ruling That EEOC Lacks Authority To Allow Employers To Reduce Health Care Benefits For Medicare-Eligible Retirees

AARP has petitioned the U.S. Supreme Court to review whether the Equal Employment Opportunity Commission had the authority to issue a Dec. 26, 2007, regulation that allows employers to legally eliminate or reduce health benefits for retirees when they reach age 65 and become eligible for Medicare while retaining benefits for retirees under age 65, CQ HealthBeat reports (Reichard, CQ HealthBeat, 1/3).

The ruling allows employers to create two classes of retirees -- those younger than age 65 and those older than 65 -- and offer different benefits to each group. In addition, the ruling allows employers to eliminate or reduce benefits provided to spouses or dependents of retirees older than 65. EEOC proposed the rule in response to a 2000 U.S. Court of Appeals decision that required benefits to be offered at the same level for Medicare-eligible retirees and those younger than 65 (Kaiser Daily Health Policy Report, 1/2). A June 2007 decision by the Third Circuit Court of Appeals found that EEOC has the authority to create the exemption under the Age Discrimination in Employment Act.

Update on Medicare Therapy Caps and ADA Restoration Act

MS Exceptions Set to Expire on Medicare Therapy Caps
Rehabilitation therapy under Medicare might no longer be affordable for some people living with multiple sclerosis and other conditions. The exceptions process to Medicare's arbitrary reimbursement limits, or therapy caps, on rehabilitation services is set to expire on December 31, 2007.

MS activists have long been determined to eliminate Medicare therapy caps altogether on reimbursement for physical therapy (PT), speech language pathology, and occupational therapy (OT) services. In 2008, the therapy cap reimbursement level is scheduled to be $1,810 for PT and speech therapy, and a separate cap of $1,810 will apply to OT services.