Health Under Medicare

>> Berwick is an admirer of Britain’s National Health Service and its National Institute for Clinical Excellence, with the Orwellian-acronym NICE.
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>> “NICE,” Berwick has said, “is extremely effective and a conscientious, valuable and — importantly — knowledge-building system.”

Last week, the U.S. Department of Health and Human Services debuted a new website that offers comprehensive information on the health insurance options available to Americans. The site, www.healthcare.gov, includes sections that are tailored to the needs of older adults and people with disabilities. The site also explains how and when health reform provisions will affect consumers.

Although the website was unveiled as a fully functional tool, more features and information will be added in the coming months. Just yesterday, the Centers for Medicare & Medicaid Services added data on care quality to Hospital Compare, a tool available through the website. The new data will help consumers evaluate the quality of outpatient and inpatient care at hospitals across the country.

Use the Hospital Compare tool.

Visit www.healthcare.gov.

May 6, 2010    Volume 1, Issue 10

People with Medicare who hit the coverage gap or “doughnut hole” in the Medicare drug benefit next year will receive a 50 percent discount at the pharmacy—without having to send in receipts or request a refund—according to draft guidance implementing the recently passed health reform law.

The guidelines from the Centers for Medicare and Medicaid Services (CMS) also state that the insurance companies offering Part D plans will inform pharmacies through their electronic claims systems when consumers are eligible for the discount, although the discounts will come from drug manufacturers.

State pharmaceutical assistance programs (SPAP) that provide coverage through the doughnut hole will also benefit from the discounts, while consumers enrolled in these programs will continue to pay the copays charged by their SPAP. Consumers enrolled in Part D plans offered by their employers, which often provide coverage through the doughnut hole, will not be eligible for the discount, according to CMS’s proposed guidance. The guidance is open for public comment until May 14, 2010.

Read the CMS draft guidance.       

Article Date: 06 Mar 2009 - 0:00 PST

The Centers for Medicare & Medicaid Services (CMS) announced today a new policy for Medicare coverage of sleep testing for the diagnosis of obstructive sleep apnea (OSA).

The decision provides coverage for specified sleep tests that are used to confirm the diagnosis in patients who have clinical signs and symptoms of OSA.

(more…)

Medicare Set-aside ProposalSubject on Medicare due to mental disability - had a workers comp case settlement - for which a set aside for health care only was arranged.

• • All parties in a Workers’ Compensation (WC) case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving WC cases that include future medical expenses. The recommended method to protect Medicare’s interests is a Workers’ Compensation Medicare Set-aside Arrangement (WCMSA), which allocates a portion of the WC settlement for future medical expenses. The amount of the set aside is determined on a case-by-case basis and should be reviewed by CMS, when appropriate. Once the CMS determined set aside amount is exhausted and accurately accounted for to CMS, Medicare will agree to pay primary for future Medicare covered expenses related to the WC injury.
• Medicare Set-aside Proposal