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CMS Announces New Opportunities to Test Innovative Integrated Care Models for Dually Eligible Individuals

Posted by www.psmbrokerage.com Admin on Fri, Apr 26, 2019 @ 11:39 AM

Letter to State Medicaid Directors invites states to partner with CMS to improve outcomes for those dually eligible for Medicare and Medicaid

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.  Many of the 12 million dually eligible beneficiaries have complex healthcare issues, including multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. CMS and states spend over $300 billion per year on the care of dually eligible individuals, yet still do not achieve acceptable health outcomes. Today’s letter opens new ways to address those complex needs, align incentives, encourage marketplace innovation through the private sector, lower costs, and reduce administrative burdens for dually eligible individuals and the providers who serve them.

“Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems.  This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all,” said Administrator Seema Verma. “We must do better, and CMS is taking action.”

As one of CMS’ Strategic Priorities for 2019, we are redoubling efforts to better serve older adults and people with disabilities dually eligible for Medicaid and Medicare. Our goal is to bring shared accountability for creating a more seamless experience for beneficiaries and providers across the two programs, while ensuring that the program’s incentives are aligned and pointed toward lower cost and better outcomes.

Approaches discussed in the State Medicaid Directors letter include:

  • The Capitated Financial Alignment Model. Through a joint contract with CMS, states and health plans, this model option creates a way to provide the full array of Medicare and Medicaid services for enrollees for a set capitated dollar amount.
  • Managed Fee-for-Service Model. This model is a partnership between CMS and the participating state and allows states to share in Medicare savings from innovations where services are covered on a fee-for-service (FFS) basis.
  • State-Specific Models. CMS is open to partnering with states on testing new state-developed models to better serve dually eligible individuals and invite states to come to us with ideas, concept papers, and/or proposals.

Today’s letter complements a State Medicaid Director Letter CMS released in December 2018 that highlighted ten opportunities to improve care for dually eligible individuals, including using Medicare data to inform care coordination and program integrity initiatives, and reducing administrative burden for dually eligible individuals and the providers who serve them. The opportunities in today’s letter, together with the Primary Cares Initiative, present an array of options for transforming care delivery.

The State Medicaid Director letter is available through Medicaid.gov at:  https://www.medicaid.gov/federal-policy-guidance/downloads/smd19002.pdf.

A letter from Administrator Verma to state Governors is available here:  https://www.cms.gov/sites/drupal/files/2019-04/04-24-2019%20Governor%20Letter.pdf

A blog by Administrator Verma, titled "Better Care For People Dually Eligible For Medicare And Medicaid," is available in Health Affairs here: https://www.healthaffairs.org/do/10.1377/hblog20190423.701475/full/

 
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Tags: Medicare, Medicaid

Updated Federal Poverty Guidelines Announced

Posted by www.psmbrokerage.com Admin on Mon, Feb 25, 2019 @ 10:01 AM

Updated Federal Poverty Guidelines Announced

piggy bank poverty guidelines

Each year, the Department of Health and Human Services (HHS) updates the federal poverty guidelines, which are then used to determine eligibility for programs including Medicaid, the Low Income Subsidy for Part D (LIS), and Medicare Savings Programs.

Some government programs that rely on the guidelines to determine eligibility use the numbers directly, while other programs use a percentage multiplier. For example, the income limit for LIS, which is also called Extra Help, is 138% of the federal poverty guideline.

Source: https://blog.medicarerights.org/updated-federal-poverty-guidelines-announced

Photo by rawpixel.com from Pexels

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Tags: Medicare, Medicaid, LIS

Medicaid Changes Likely in 2019

Posted by www.psmbrokerage.com Admin on Wed, Jan 16, 2019 @ 09:40 AM

Medicaid Changes Likely in 2019

2-8519

Julie Carter / Medicare Watch

As 2019 gets underway, the Medicaid program continues to be in the spotlight. This week, the Kaiser Family Foundation (KFF) released an issue brief that highlights some of the major program changes that states, the Administration, and Congress may pursue in 2019.
 
Over 66 million people receive their health coverage through Medicaid, including older adults, people with disabilities, children, low-income parents, and other adults. Any changes to the program, therefore, have the potential to affect millions of families.

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Tags: Medicare, Medicaid

CMS Issues Guidance to Help States Better Serve People with Medicare and Medicaid

Posted by www.psmbrokerage.com Admin on Fri, Dec 28, 2018 @ 11:27 AM

CMS Issues Guidance to Help States Better Serve People with Medicare and Medicaid

medicaid

Medicare Rights Center / 

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a Dear State Medicaid Director letter highlighting ten opportunities for states to better serve individuals dually eligible for Medicare and Medicaid.

Medicaid is an important source of coverage for nearly 12 million people with Medicare. It covers needed services that Medicare does not, such as long-term care. Medicaid also helps make Medicare more affordable by helping pay Medicare premiums and/or cost-sharing, which can be high for people with low incomes.

Helping states navigate these complementary programs in ways that prioritize the health and economic security for dually eligible individuals is critical, as this population tends to have greater medical needs and functional limitations than other Medicare beneficiaries.

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Tags: Medicare, Medicaid

Congress Close to Finalizing Important Medicaid Extensions

Posted by www.psmbrokerage.com Admin on Fri, Dec 14, 2018 @ 10:50 AM

Congress Close to Finalizing Important Medicaid Extensions

(Credit: rrodrickbeiler/Thinkstockphotos.com)

Lindsey Copeland / December 13, 2018 / Medicare Watch

On Tuesday, the U.S. House of Representatives passed the IMPROVE Act (H.R. 7217), which extends two critical Medicaid programs for older adults and people with disabilities. The U.S. Senate is expected to approve the bill before adjourning for the year.

First authorized in the Deficit Reduction Act of 2005, the Medicaid Money Follows the Person Demonstration Program (MFP) officially launched in 2007. Since then, it has helped over 88,000 older adults and people with disabilities transition from nursing and other facilities back to the community, and it has consistently been a cost-effective, successful program. According to independent, national evaluations MFP participants who have transitioned to community-based settings experience lasting improvements in quality of life, and they also decrease their overall Medicare and Medicaid expenditures by roughly 23%, generating considerable cost savings for the programs.

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Tags: Medicare, Medicaid

Plans to disclose physician reimbursement fee may be underway

Posted by Guadalupe Cantu on Fri, Jan 17, 2014 @ 10:50 AM

Medicare Supplements A new policy that informs the public how much money Medicare pays individual doctors may be underway and could violate physicians' privacy rights if poorly handled, warns the American Medical Association.

The Department of Health and Human Services (HHS) has announced that it will start responding to Freedom of Information Act requests for physician-payment data. Government officials will be using a ‘balancing test’ to determine who gets access to the information, and not guaranteeing the data to all filed request. This has prompted groups to say the administration needs to do much more in making payment data broadly accessible and transparent.

Under the FOIA's privacy exemption, some of the doctor’s information may be kept from public view if the damage to physician privacy is deemed greater than the public interest. Disclosure of the doctor’s data will exclude patients information; however, the information released will depend on the outcome of the “balancing test”, which varies by circumstance, analysis, facts, and per case. In all cases, the HHS says they “are committed to protecting the privacy of Medicare beneficiaries.”

In addition, the Center for Medicare & Medicaid will begin “aggregating” data sets about Medicare physician services, 60 days after the new policy appears in the Federal Register.

Disclosure of doctor payment data “from government healthcare programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures” says Dr. Ardis Dee Hoven, president of the AMA, who has long opposed the release of data.

Over the past 3 decades, Medicare physician-payment data has been highly sought by media groups, government watchdogs and private organizations. They argue that the disclosure of information informs consumers of a doctor’s competence, performance, and highlights any possible abuse or fraud. The release of information should only be done in the efforts of “improving the quality of healthcare services and with appropriate safeguards,” Hoven said.

Critics against disclosure argue that the release of information would reveal proprietary details the general public does not need to know, and that inaccurate data presentation would damage a doctor’s reputation.

In spite of responding to Freedom of Information Act requests for physician-payment data, the government is not planning to put the entire Medicare physician-payment data online in a searchable format. It will require individuals seeking data to submit specific request under the FOIA’s. Any information that gets released will be filtered and judged by its worthiness, and will take physicians privacy concerns into consideration.

On May 2013 a 1979 federal injunction ruling, that barred the release of Medicare payment data and identified doctor’s specifics, was dissolved by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla., ruling on the grounds that physicians' privacy concerns no longer outweighed the public interest.

Following the ruling, CMS followed suit to and decided to release physician-payment data, citing disclosure under the Freedom of Information Act. Disclosure of the data will be determined on the outcome of the “balancing test,” as a result every case will be treated as an individual basis (FR Doc. 2014-00808).




Please give us your feedback!
Question: Will disclosing physician fees help stop Medicare fraud and save money in the long run or will it have an adverse effect and persuade more physicians to stop accepting new Medicare patients?

Source: ModernHealthCare
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Tags: Centers for Medicare & Medicaid Services, Department of Health and Human Services, HHS, physician reimbursement fee, privacy rights, Medicare, Medicaid, CMS

Should the Medicare eligibility age be raised to 67?

Posted by Guadalupe Cantu on Fri, Nov 22, 2013 @ 11:19 AM

Medicare Supplements Medicare, the U.S. health care insurance that provides benefits to seniors over 65, and to certain individuals who qualify for the program at an earlier age, has been on the cross hairs of the Congressional Budget Office (CBO), who have been questioning whether it is time to phase in and raise the eligibility age to 67.

With millions of baby boomers retiring and enrolling into Medicare program, and the recent Medicare spending explosion, is threatening the stability of the U.S. economy.

Projection of Medicare spending in the coming decades is expected to continue to exceed domestic per capita growth. Further adding to the growth is increase of life expectancy, translating to; the cost of Medicare has increased along with the life span of the people covered since the program began in 1965.

Currently, there is a two prong camps for and against rising the eligibility age of Medicare. One side says that raising the age would save around 3 million a year or about $19 billion, between 2016 and 2023. This would reduce our current deficit to about 1% (our current deficit is $680 billion). Others argue that it is not fair for people to wait two extra years to qualify for Medicare. And that increasing the age would shift the cost to those ages 65 to 66. Seniors would incur an increased out-of-pocket expense of $3.7 billion, and employers tab would increase to 4.5 billion and states would face increased Medicare cost, estimates the Kaiser Family Foundation.


Please give us your feedback!
Question: What’s your stance on rising the eligibility age to 67? By rising the age and saving 1% on the deficit, will this help our economy or will it dig the U.S. economy deeper into a hole?

Source: LifeHealthPro
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Tags: Medicare, Medicaid, Baby Boomers, Medicare Cost, Congressional Budget Office, Seniors, Retired

What Medicare Advantage means for private insurers

Posted by Guadalupe Cantu on Fri, Nov 15, 2013 @ 03:36 PM

Medicare AdvantageAs seniors reach 65 many are faced with a lot of questions about their health, health coverage, and the many plans accessible to them. Currently there has been a tremendous enrollment increase for Medicare Advantage (MA) plans or Medicare Plan C as they are known. This growth has been on the rise since 2004, and it currently makes up about 25 percent of traditional Medicare enrollee opting for MA plans, reports the Kaiser Family Foundation. This trend has more the doubled beneficiaries’ enrollment from 5.3 million to 13.1 million in 2012.
According to the Congressional Budget Office, Medicare Advantage enrollment is expected to grow from 14 million, in 2013, to 21 million by fiscal year 2023.

What it means to seniors?
More and more seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage which are of higher-quality care, with better services, and provide additional benefits. These plans are also used by elderly and people with disabilities to cover additional medical expenses that Medicare does not already cover.  Additionally, MA plans are more likely to be purchased by healthy seniors than other supplemental insurance options because these policies are more affordable on a monthly basis.

Cost savings is the driving force behind the increased enrollment of Medicare Advantage plans. With Medicare’s Part A, the insured is provided with inpatient hospital care; however, the enrollees are stuck to cover fluctuating deductibles associated with this plan yearly. Part B covers doctor’s expenses and preventive services, such as, flu. Medicare Part C is the Med Advantage plan that covers the additional expenses not covered by both Part A and B plans, excluding End-Stage Renal.

Further savings can be seen with MA premiums. The Kaiser Family Foundation reports that 50% of seniors enrolled in Medicare Advantage plans have no extra premiums, and two-thirds enrolled in the HMO Advantage plans pay nothing extra.

What does this growth mean to private insurers?
Earlier this year the House mandated a proposal that would make payment cuts to MA plans beginning 2014. By law, Medicare Advantage plans are required by law, to lower cost as much as 7 to 8%, and use 85 percent of their revenue on medical care and quality improvement efforts. Those who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of noncompliance.

However, that proposal changed when the Centers for Medicare and Medicaid Services (CMS) decided to increase payments by 3.3 percent. The proposed change could average $50 or more per month for a Med Advantage enrollee.  According to the CMS, the change was made to improve program stability and payment accuracy.

Selling Medicare Advantage plans is not as simple as having a basic health insurance license. By law, CMS requires agents, brokers and all licensed sales representatives to complete a CMS certification program before any marketing and selling can be done.

Additionally, with the certification comes responsibility. It is very important for agents to educate enrollees to what exactly the products they are buying.

Another factor private insurer’s face is the CMS Complaint Tracking Module. The CTM is a complaint tracking module used to track the accuracy of incidents and complaints, responses to those complaints and to ensure compliance.
  
With the advancement in technology, private insurers should embrace the latest technologies to facilitate the response time to any compliance needs. And with the help of their well-trained CMS certified representatives and producers, they should be able to quickly address any concerns or request their clients may have.


Please give us your feedback!
Question: Do you feel that the CMS abrupt change to increase MA payments by 3.3% will further encourage the quality of care seniors receive? Will this help insurers improve CTM compliance?

Source: LifeHealthPro
Additional Updates:

    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Beneficiaries, Centers for Medicare & Medicaid Services, Medicare benefits, Medicare Part A, Medicare Part B, Medicare Advantage, Medicare, Medicare News, Medicaid

CMS keeps steady Medicare Part B premiums

Posted by Guadalupe Cantu on Fri, Nov 08, 2013 @ 10:50 AM

Medicare Supplements The Centers for Medicare & Medicaid Services (CMS) have decided to keep Medicare Part B monthly premiums at bay.

Medicare Part B helps pay for physician services, medical supplies, and other outpatient services not covered by Medicare Part A service plan.

In 2014, the monthly base actuarial rate for seniors’ participants will be $209.80 per month, while those low to moderate-income enrollees will pay premiums at $104.90.

2013 monthly premium levels remain unchanged and the $147 deductible will continue for Part B plans per year.

Less relevant to participants are the Medicare Part A hospitalization premiums, this is highly due to about 99% of Medicare enrollees qualify for Part A coverage without having to pay a premium, says CMS.

In a notice published at the Federal Register, October 30, CMS notice, CMS-8055-N, enrollees that do pay monthly premiums will range between $15 $426 in 2014.

An income-related monthly adjustments amount has been imposed by the Medicare program on beneficiaries with an annual taxable income less than or equal to $85,000 or joint annual taxable income less than or equal to $170,000, is $104.90.

The most a Medicaid enrollee can pay in monthly premium is $335.70, with an annual taxable income greater than $214,000 or joint annual taxable income greater than $428,000.


Please give us your feedback!
Question: Do you think the government will keep Medicare Part B premiums at bay in 2015 or will there be a premium hike?

Source: LifeHealthPro
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Tags: Beneficiaries, Centers for Medicare & Medicaid Services, Medicare benefits, Medicare Part A, Medicare Part B, Medicare, Senior Market, Medicare News, Medicaid

Medicare Advantage – Who’s Covered?

Posted by Guadalupe Cantu on Fri, Oct 18, 2013 @ 11:31 AM

Medicare Supplements Many seniors and people with disabilities who are on traditional Medicare find themselves searching for additional coverage to cover for medical expenses that Medicare does not already cover. More and more of these beneficiaries find the help through private health coverage of Medicare Advantage plans.

Seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage, higher-quality care, better services, and additional benefits, reports The Coalition for Medicare Choices, a national grassroots organization who sole purpose is to protect and improve Medicare Advantage.

Medicare SupplementsWho’s covered? According to CMC’s website MedicareChoices.org, Medicare Advantage covers over 14 million people nationwide. Out of those 14 million, 41% are blue-collar workers who earn less than $20,000 year, 1 in 5 being minorities.

In February 15, 2013, the Centers for Medicare & Medicaid Service enrollment data showed Hawaii, Oregon, Arizona, Pennsylvania, California, Florida, Ohio, Rhode Island, New York, Nevada and Utah as having the highest traditional Medicare beneficiaries enrolled in Medicare Advantage.

Medicare SupplementsDoes Medicare Advantage have high satisfaction and better quality care? In a new survey from The North Star Opinion Research firm commissioned by America’s Health Insurance Plans (AHIP), found 9 out of 10 seniors are satisfied with their Medicare Advantage coverage.

It has also been reported that 13 out of 20% of beneficiaries with Medicare Advantage had fewer patient readmissions into hospitals than Medicare fee-for-service, according to the American Journal of Managed Care. The quality of care for seniors under the Medicare Advantage program has improved as well, outperforming Medicare fee-for-service in 9 out of 11 quality measures.


Please give us your feedback!
Question: Despite the recent government’s budget cuts changes made to Medicare Advantage program, do you feel Medicare Advantage satisfaction and quality measure will decline overtime or will it make it have the opposite effect?

 

Source: MedicareChoices.org

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Tags: Medicare Advantage, Medicare, Medicare Advantage News, Affordable Care, Medicaid

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