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The Center for Medicare and Medicaid Innovation (CMMI) launched a set of initiatives to improve medical care and lower the cost of services and care provided by medical professionals. The CMMI is also committed to quickly assessing the projects at hand and putting them to use promptly if proven successful. This initiative comes after finding evidence that the current healthcare system has rising costs because patients are not getting the care they need. Also, they found that one out of seven Medicare patients are suffering from medical error, due to lacks in care. With 90 million Americans relying on Medicare and Medicaid, studies show that when doctors work together patients are hospitalized less often, recover more quickly, and have fewer complications. The initiative also hopes to reduce hospital infection and help ensure seniors take the medications prescribed to them by their doctor in order to stabilize their condition and/or get well quicker. The CMMI believes that by giving financial incentives to doctors and hospitals who work together unnecessary tests will be eliminated and chronic health conditions treated before they become larger illnesses, and end up costing Medicare more money that could have been saved. The Center for Medicare and Medicaid Innovation is starting this new plan in eight states, comprised of: Maine, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. In these states, teams of doctors will work together in "medical homes" on patient care. Also, next year the Center for Medicare and Medicaid will offer $1 million dollar grants for states to develop programs to coordinate care between doctors and hospitals. Some critics dismiss the effort, saying the CMMI is aimlessly throwing ideas out, hoping one will work; yet, some big companies are eager to move with a partnership with the government.

Rivlin-Domenici Proposed Losses for Medicare

On Wednesday Rivlin-Domenici released their proposal to reduce the deficit and it is more generous than the proposal released last week by the Presidential Fiscal Commission. Their proposal places a cap on government Medicare spending for seniors with more of the cost burden on the senior's shoulders. The plan gives very little help from the government to purchase health insurance and a choice from either traditional fee-for-service or from private firms offering plans similar to how Medicare Advantage is today. The committee predicts more seniors will opt for private insurance due to cost. The plan also includes making higher co-payments for Medicare Part B, up to 35% from the current 25%, which would save Medicare $123 billion through 2018. Starting in 2018, a cap would be put in place to limit the increase in spending on Medicare beneficiaries to economic growth rate of 1% each year. The other major element of in the plan eliminates the tax exclusion for employer-provided insurance. Capping and eventually eliminating the tax exclusion for employer-sponsored insurance could slow health care costs from increasing and would raise $10 trillion. There are speculation on whether both parties would ever be able to agree on the plan as it was proposed this week, Democrats are against cuts in benefits and Republicans are against benefit cuts as well and the large increase of out-of-pocket costs.

Presidential Fiscal Commission Update

On Thursday, the Presidential Fiscal Commission ended a three-day closed session without a consensus. The panel's co-chairmen, Democrat Erskine Bowles and former Senator Republican Alan Simpson released their own proposal last week but the group remains at odds on deciding how to slow down and eliminate some health care cost. The panel reconvenes on November 30th, with a deadline to submit to Congress on December 1st.

Nebraska Woodmen of the World/Assured Life New Rates and Plan N

Effective December 1, 2010, new rates and Plan N are released for Nebraska. Please see the new rates and notification for Nebraska.

Sources: KHN, The Fiscal Times, The LA Times, PBS, WSJ

In February, Barack Obama created a bipartisan commission on reducing the national debt; and, this week they released a proposal for a very ambitious plan with numerous spending cuts and several tax increases. None of the plans will take place before 2012 but Nancy Pelosi calls it "simply unacceptable" the way the plan is now; and, some dispute that the budget can be balanced by spending cuts alone. Some of the proposed cuts include domestic and military, mortgage interest deduction, the child tax credit, earned income tax credit, reduce cost-of-living increases for all federal programs including Social Security, reduce Social Security benefits for everyone except low-income recipients who would get higher, full social security benefits would go from 67 to 69 by 2075, and more Medicare cost savings cuts. Also, a gradual increase up to $0.15 on the federal gasoline tax would be put in place. The final deadline is December 1st and 14 of the 18 members of the commission, including 12 members of Congress and 6 private citizens, must agree in order to send anything. The group made no decisions before the election, in order to avoid publicizing unpopular options like income tax rates across the board and the largest spending cuts in decades.

Examining Medicare's Dialysis System

In 1972 Congress granted complete comprehensive coverage under Medicare to patients with kidney failure. This decision was considered the closest the United States has come to socialized healthcare. The program, once seen as a model for our national health care system, now costs about $20 billion a year using 6% of the Medicare budget. However, the United States has one of the highest mortality rates in the world, with the systems for dialysis in other counties loosing far less patients. ProPublica reviewed dialysis for a year to understand why the money used isn't helping the mortality rate. Their findings showed unsanitary clinics, lapses in care, inconsistent quality standards, and fewer provider choices afflicting mostly minorities and the dispossessed. Yet, the dominators in the dialysis-care system are consistently profitable. This study warns what could happen when neither the government nor the market controls quality or cost.

Medicare Advantage Dis-enrollment Guidelines

Annual Election Period for MA Plans and Medicare Part D Prescription Drug Plans beginning November 15, 2010 to December 31, 2010 with an effective date for dis-enrollees of January 1, 2011.

• A copy of the applicant's MA plan's disenrollment notice (needed if applying for Guarantee Issue);
• A copy of the letter the applicant sent to their MA plan requesting disenrollment (dated November 15th or later); or
• A signed statement that the applicant has requested to be dis-enrolled from their MA plan.

Special Election Period Some examples of special election periods are when an MA plan withdraws from the market or when the member moves out of the service area. The effective date of the disenrollment varies by situation. Please see the plan rules.

Required: A copy of their termination letter.

Forethought Medicare Supplement Product Release IN and KY

On Thursday Forethought Medicare Supplement was released in Indiana and Kentucky. Call PSM at 1-800-998-7715 for more information and to get contracted to sell today!

Sources: KHN, The New York Times, ProPublica

The chief executive of Avalere Health, Dan Mendelson, explains that even in cases when switching Part D plans is the most economical option, seniors are still more reluctant to do so. Yet, due to repercussions from health-care laws, there are some changes to the Part D program and it is important to have senior's evaluate their options so they can be assured they are on the best plan for their prescriptions. A new plan from Humana's Wal-Mart-Preferred Rx Plan boasts a $14.80 premium in all regions; however, premiums not only depend on cost but also deductibles, coinsurance, and doughnut hole coverage. Specific details of the Part D plans will be released in time for Annual Enrollment, on November 15th.

Setting New Medicare Skilled Care Service Standards

Two federal courts ruled that the standards for Medicare coverage of skilled nursing home care or home health care are too strict. Before this ruling, Medicare would only pay if a patient's condition would get better with the service, mistaking the belief that Medicare will only pay if treatment makes the patient "better." In correlation with the federal court's ruling, Medicare will now pay for the service if it is needed in order to maintain routine activities in daily life or to prevent the condition from getting worse. This is most significant for those patients with multiple sclerosis, Alzheimer’s disease, and a broken hip who need skilled care to assist them in their daily life.

Medicare Cuts Payments on Prostate Cancer Therapy

In order to curb inappropriate use and save health-care money, Medicare has begun paying physicians less for common prostate cancer therapy. A University of Texas study evaluated how many times adfrogen deprivation therapy was prescribed both before and since the Center for Medicare and Medicaid lowered the reimbursement rates. They found that there was no change in those who needed the treatment; however, it was prescribed 30% less in those who showed no beneficial medical evidence of needing it. These reduced reimbursements caused a positive change in health care by limiting the unnecessary care and driving a new pattern of care. Also, in this prostate cancer therapy case, negative side effects also contributed. Thus, there were both clinical and financial benefits.

Supplier Bidding Contracts Announced

On Thursday the Centers for Medicare and Medicaid Services announced the 356 suppliers who won contracts to provide durable medical equipment for nine areas around the country. With 1,217 contracts signed and 356 suppliers set to produce, prices will be cut by 32% saving a projected $28 billion over the next 10 years. The new program begins in January in Charlotte, Gastonia, Concord, Cincinnati, Middletown, Cleveland, Elyria, Mentor, Dallas, Fort Worth, Arlington, Kansas City (MO & KS), Miami, Fort Lauderdale, Pompano Beach, Orlando, Kissimmee, Pittsburgh, Riverside, San Bernardino, and Ontario. Though, a House bill to repeal the program has attracted 250 sponsors.

Woodmen Plan N Released in LA and AZ

This week the Woodmen of the World Plan N was released in Louisiana and Arizona. Contact us or call 1-800-998-7715 for more information on adding Woodmen of the World Plan N to your portfolio!

Sources: KHN, The LA Times, The Hill, National Journal