Showing posts sorted by relevance for query health care. Sort by date Show all posts
Showing posts sorted by relevance for query health care. Sort by date Show all posts
Friday, April 30, 2021
NJ Governor Murphy Signs the Healthy Terminals Act
NJ Governor Phil Murphy today signed the Healthy Terminals Act (S989) which creates new minimum wage and benefits requirements for certain Newark Liberty International Airport (EWR) and Newark Liberty International Train Station workers. The legislation will expand access to livable wages and affordable health care for workers at the airport and train station who often cannot afford employer-provided health care plans.
Saturday, March 5, 2011
Vermont Universal Health Care to Embrace Workers Compensation
The legislation " proposes to set forth a strategic plan for creating a single payer and unified health system. It would establish a board …. ; establish a health benefit exchange for Vermont as required under federal health care reform laws; create a public-private single payer health care system to provide coverage for all Vermonters after receipt of federal waivers.”
The plan proposes covering all workers' compensation claims:
"(3) To the extent allowable under federal law, the Vermont health benefit exchange may offer health benefits to employees for injuries arising out of or in the course of employment in lieu of medical benefits provided pursuant to chapter 9 of Title 21 (workers’ compensation)."
"(c) If the Vermont health benefit exchange is required by the secretary of the U.S. Department of Health and Human Services to contract with more than one health insurer, the Vermont health benefit exchange shall determine the appropriate method to provide a unified, simplified claims administration, benefit management, and billing system for any health insurer offering a qualified health benefit plan. The Vermont health benefit exchange may offer this service to other health insurers, workers’ compensation insurers, employers, or other entities in order to simplify administrative requirements for health benefits."
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. The proposed Vermont single payer system is a unified state approach to the co-ordinated delivery of medical care.
Sunday, August 19, 2018
Total Disability and an Aging Workforce
Workers' Compensation is synonymous with disability and a recent report by the US Centers for Disease Control and Prevention (CDC) highlights how prevalent disabilities are for adults. It is no wonder why so many injured workers suffered who suffer a minor work-related injury become totally disabled. Comorbidity is now a major issue, especially in an ever-expanding aging workforce.
Thursday, December 5, 2013
President Obama Statement on the Benefits of the Affordable Care Act
Thanks to Monica, thanks to everybody standing behind me, and thanks for everybody out there who cares deeply about this issue. Monica’s story is important because for all the day-to-day fights here in Washington around the Affordable Care Act, it’s stories like hers that should remind us why we took on this reform in the first place.
And for too long, few things left working families more vulnerable to the anxieties and insecurities of today’s economy than a broken health care system. So we took up the fight because we believe that, in America, nobody should have to worry about going broke just because somebody in their family or they get sick. We believe that nobody should have to choose between putting food on their kids’ table or taking them to see a doctor. We believe we’re a better country than a country where we allow, every day, 14,000 Americans to lose their health coverage; or where every year, tens of thousands of Americans died because they didn’t have health care; or where out-of-pocket costs drove millions of citizens into poverty in the wealthiest nation on Earth. We thought we were better than that, and that’s why we took this on. (Applause.)
And that’s what’s gotten lost a little bit over the last couple of months. And our focus, rightly, had to shift towards working 24/7 to fix the website, healthcare.gov, for the new marketplaces where people can buy affordable insurance plans. And today, the website is working well for the vast majority of users. More problems may pop up, as they always do when you’re launching something new. And when they do, we’ll fix those, too. But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1st -- some for the very first time. We know that -- half a million people. (Applause.) And that number is increasing every day and it is going to keep growing and growing and growing, because we know that there are 41 million people out there without health insurance. And we know there are a whole bunch of folks out there who are underinsured or don’t have a good deal. And we know the demand is there and we know that the product on these marketplaces is good and it provides choice and competition for people that allow them, in some cases for the very first time, to have the security that health insurance can provide.
The bottom line is this law is working and will work into the future. People want the financial stability of health insurance. And we’re going to keep on working to fix whatever problems come up in any startup, any launch of a project this big that has an impact on one-sixth of our economy, whatever comes up we’re going to just fix it because we know that the ultimate goal, the ultimate aim, is to make sure that people have basic security and the foundation for the good health that they need.
Now, we may never satisfy the law’s opponents. I think that’s fair to say. Some of them are rooting for this law to fail -- that’s not my opinion, by the way, they say it pretty explicitly. (Laughter.) Some have already convinced themselves that the law has failed, regardless of the evidence. But I would advise them to check with the people who are here today and the people that they represent all across the country whose lives have been changed for the better by the Affordable Care Act.
The other day I got a letter from Julia Walsh in California. Earlier this year, Julia was diagnosed with leukemia and lymphoma. “I have a lot of things to worry about,” she wrote. “But thanks to the [Affordable Care Act], there are lots of things I do not have to worry about, like…whether there will be a lifetime cap on benefits, [or] whether my treatment will bankrupt my family…I can’t begin to tell you how much that peace of mind means...” That’s what the Affordable Care Act means to Julia. She already had insurance, by the way, but because this law banned lifetime limits on the care you or your family can receive, she’s never going to have to choose between providing for her kids or getting herself well -- she can do both.
Sam Weir, a doctor in North Carolina, emailed me the other day. “The coming years will be challenging for all of us in family medicine,” he wrote. “But my colleagues and I draw strength from knowing that beginning with the new year the preventive care many of our current patients have been putting off will be covered and the patients we have not yet seen will finally be able to get the care that they have long needed.” That’s the difference that the Affordable Care Act will make for many of Dr. Weir’s patients. Because more than 100 million Americans with insurance have gained access to recommended preventive care like mammograms, or colonoscopies, or flu shots, or contraception to help them stay healthy -- at no out-of-pocket cost. (Applause.)
At the young age of 23, Justine Ula is battling cancer for the second time. And the other day, her mom, Joann, emailed me from Cleveland University Hospital where Justine is undergoing treatment. She told me she stopped by the pharmacy to pick up Justine’s medicine. If Justine were uninsured, it would have cost her $4,500. But she is insured -- because the Affordable Care Act has let her and three million other young people like Monica gain coverage by staying on their parents’ plan until they’re 26. (Applause.) And that means Justine’s mom, all she had to cover was the $25 co-pay.
Because of the Affordable Care Act, more than 7 million seniors and Americans with disabilities have saved an average of $1,200 on their prescription medicine. (Applause.) This year alone, 8.5 million families have actually gotten an average of $100 back from their insurance company -- you don’t hear that very often -- (laughter) -- because it spent too much on things like overhead, and not enough on their care. And, by the way, health care costs are rising at the slowest rate in 50 years. So we’re actually bending the cost of health care overall, which benefits everybody. (Applause.)
So that’s what this law means to millions of Americans. And my main message today is: We’re not going back. We’re not going to betray Monica, or Julia, or Sam, or Justine, or Joann. (Applause.) I mean, that seems to be the only alternative that Obamacare’s critics have is, well, let’s just go back to the status quo -- because they sure haven’t presented an alternative. If you ask many of the opponents of this law what exactly they’d do differently, their answer seems to be, well, let’s go back to the way things used to be.
Just the other day, the Republican Leader in the Senate was asked what benefits people without health care might see from this law. And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it. He just repeated “repeal” over and over and over again. And obviously we’ve heard that from a lot of folks on that side of the aisle.
Look, I’ve always said I will work with anybody to implement and improve this law effectively. If you’ve got good ideas, bring them to me. Let’s go. But we’re not repealing it as long as I’m President and I want everybody to be clear about that. (Applause.)
We will make it work for all Americans. If you don’t like this law -- (applause) -- so, if despite all the millions of people who are benefitting from it, you still think this law is a bad idea then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure. You can’t just say that the system was working with 41 million people without health insurance. You can’t just say that the system is working when you’ve got a whole bunch of folks who thought they had decent insurance and then when they got sick, it turned out it wasn’t there for them or they were left with tens of thousands of dollars in out-of-pocket costs that were impossible for them to pay.
Right now, what that law is doing -- (baby talks.) Yes, you agree with me. (Laughter.) Right now, what this law is doing is helping folks and we’re just getting started with the exchanges, just getting started with the marketplaces. So we’re not going to walk away from it. If I’ve got to fight another three years to make sure this law works, then that’s what I’ll do. That’s what we’ll do. (Applause.)
But what’s important for everybody to remember is not only that the law has already helped millions of people but that there are millions more who stand to be helped. And we’ve got to make sure they know that. And I’ve said very clearly that our poor execution in the first couple months on the website clouded the fact that there are a whole bunch of people who stand to benefit. Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what’s at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost through choice and competition on this marketplace and tax credits that you may be eligible for that can save you hundreds of dollars in premium costs every month, potentially.
So we just need people to -- now that we are getting the technology fixed -- we need you to go back, take a look at what’s actually going on, because it can make a difference in your lives and the lives of your families. And maybe it won’t make a difference right now if you’re feeling healthy, but I promise you, if somebody in your family -- heaven forbid -- gets sick, you’ll see the difference. And it will make all the difference for you and your families.
So I’m going to need some help in spreading the word -- I’m going to need some help in spreading the word. I need you to spread the word about the law, about its benefits, about its protections, about how folks can sign up. Tell your friends. Tell your family. Do not let the initial problems with the website discourage you because it’s working better now and it’s just going to keep on working better over time. Every day I check to make sure that it’s working better. (Laughter.) And we’ve learned not to make wild promises about how perfectly smooth it’s going to be at all time, but if you really want health insurance through the marketplaces, you’re going to be able to get on and find the information that you need for your families at healthcare.gov.
So if you’ve already got health insurance or you’ve already taken advantage of the Affordable Care Act, you’ve got to tell your friends, you’ve got to tell your family. Tell your coworkers. Tell your neighbors. Let’s help our fellow Americans get covered. Let’s give every American a fighting chance in today’s economy.
Thank you so much, everybody. God bless you. God bless America. (Applause.)
Thursday, July 5, 2012
Path to Federalization: A National Workers Compensation System--US Supreme Court Validates
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation's fragmented and chaotic workers' compensation medical delivery system.
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| John G. Roberts Jr., Chief Justice US Supreme Court |
Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."
The Chief Justice, writing for himself, stated, "Every reasonable construction must be resorted to in order to save a statute from unconstitutionality." If it is "fairly possible" to interpret the statute as merely imposing a tax on those who've failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.
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| Constitution of the United States |
The Court indicated that the assessment is not really a "penalty." "Taxes that seek to influence conduct are nothing new," the Chief Justice wrote. He reasoned for the Court that there are no negative legal consequences to not buying health insurance, because beyond requiring a payment to IRS, Congress anticipated that some 4 million people would pay the penalty, and Congress did not treat them as "outlaws."
While certain taxes are prohibited under the U.S. Constitution, the penalty under the Affordable Health Care for America Act 2009 is not barred. The Court reasoned that the Constitution states, "No Capitation, or other direct, Tax shall be laid, unless in Proportion of the Census or Enumeration herein before directed to be taken." The majority of the Court held that a tax on "going without health insurance" does not fall within any recognized category of direct tax since it is triggered by certain specific circumstances.
The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment. The state-enacted systems were created for the protection of the lives, health and safety of the employees. The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault. The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment. New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).
The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment. The state-enacted systems were created for the protection of the lives, health and safety of the employees. The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault. The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment. New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).
Medical Delivery & Fees
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments.
Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust." They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality," and they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format.
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments.
Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust." They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality," and they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format.
Non-Traditional Revenue Stream
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."
"Libby Care"--Universal Care
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| Center for Asbestos Related Disease Libby, MT. |
The Future: Universal Health Care
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| Landmarks on the Path to Federalization |
History reveals that a series of efforts have been made by the Federal government to federalize medical care for industrial accidents and illnesses. Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has accelerated the nation down that promising path.
....
Jon L.Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Apr 03, 2010
The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully ...
May 19, 2010
The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs will now be available to ...
Related articles
Thursday, August 22, 2013
Tacking Health Care Costs Onto California Farm Produce
Farm labor contractors across California, the nation’s biggest agricultural engine, are increasingly nervous about a provision of the Affordable Care Act that will require hundreds of thousands of field workers to be covered by health insurance.
While the requirement was recently delayed until 2015, the contractors, who provide farmers with armies of field workers, say they are already preparing for the potential cost the law will add to their business, which typically operates on a slender profit margin.
“I’ve been to at least a dozen seminars on the Affordable Care Act since February,” said Chuck Herrin, owner of Sunrise Farm Labor, a contractor based here. “If you don’t take the right approach, you’re wiped out.”
Monday, June 17, 2013
Proposed Medicare Payment Reductions Will Impact Workers' Compensation Costs
A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices. The impact of those proposed adjustments will significantly impact the national workers' compensation systems because of both direct and indirect links between the two programs, including medical fee schedules, and Medicare Secondary Payment reimbursements.
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
May 18, 2013
A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS ...
Mar 29, 2013
A new Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available to be downloaded on the CMS (Centers for Medicare & Medicad Services) website.
Jan 11, 2013
"The legislation changes the way Medicare collects money from people whose negligence caused a patient to incur medical bills. Murphy said the new law will streamline an outdated process, making it easier to close cases ...
Tuesday, January 18, 2022
CMS Health Care Workers Vaccination Deadline March 15, 2022
The Centers for Medicare and Medicaid Services (CMS) issued guidance that the full vaccination compliance deadline is March 15, 2022, for all health care workers subject to the Omnibus Health Care Staff Vaccination rule.
Thursday, October 30, 2014
CDC Issues Revised Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure
CDC Issues Revised Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure
The Centers for Disease Control and Prevention (CDC) issued today revised Interim U.S. Guidance for Monitoring and Movement of Persons with Ebola Virus Exposure. This guidance (hyperlink to the guidance here) provides new information public health authorities and other partners can use to determine appropriate public health actions based on Ebola exposure risk factors and clinical presentation. It also includes criteria for monitoring exposed people and for when movement restrictions may be needed.
In determining the right approach, we have put the health and safety of Americans first and foremost, and our deliberations have been informed by our most knowledgeable and experienced public health and homeland security professionals. As with everything we have done to respond to the threat of Ebola both at home and abroad, we have been guided by the best science available.
Coordinated public health actions are essential to stop and reverse the spread of Ebola virus. CDC announced last week that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea and arrive at one of the five airports in the United States doing enhanced screening. The revised interim guidance released today is intended to guide state and local health officials with decisions about managing the movement of individuals being monitored, including travelers from the countries with widespread transmission and others who may have been exposed in the United States.
Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be contacted daily by state and local health departments for 21 days from the date of their departure from Liberia, Sierra Leone, or Guinea. Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, will start active monitoring today, with the remainder of the states starting in the days following.
This guidance also outlines appropriate public health actions for those individuals classified as “some risk.” These include health care workers who are providing direct care to Ebola patients in West Africa or others, such as observers, who enter an Ebola treatment area where Ebola patients are being cared for. Additional precautions, such as direct active monitoring, are recommended for those classified as “some risk.” In addition, the guidance recommends public health authorities determine on an individualized case-by-case basis whether additional restrictions, such as controlled movement, workplace exclusions, or restrictions on other activities, are appropriate. This daily health consultation will give additional confidence to the community that a returning health care worker is asymptomatic and therefore not contagious.
Returning health care workers should be treated with dignity and respect. They, along with our civilian and military personnel in the region, are working tirelessly on the frontlines against Ebola, and their success is what ultimately will enable us to eliminate the threat of additional domestic Ebola cases. We must not prevent or unduly discourage them from undertaking this indispensable and selfless work.
Guidance for returning health care workers from West Africa should be distinguished from health care workers providing care for Ebola patients in the United States. There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital. A U.S. hospital provides a more controlled setting than a field hospital in West Africa. A U.S. healthcare worker would be able to anticipate most procedures that would put them at risk of exposure and wear additional personal protective equipment as recommended. In some places in Africa, the same may not be true and workers may not have the ability to prepare for potential exposures.
This guidance is interim guidance and could be updated or changed as new information becomes available.
The Centers for Disease Control and Prevention (CDC) issued today revised Interim U.S. Guidance for Monitoring and Movement of Persons with Ebola Virus Exposure. This guidance (hyperlink to the guidance here) provides new information public health authorities and other partners can use to determine appropriate public health actions based on Ebola exposure risk factors and clinical presentation. It also includes criteria for monitoring exposed people and for when movement restrictions may be needed.
In determining the right approach, we have put the health and safety of Americans first and foremost, and our deliberations have been informed by our most knowledgeable and experienced public health and homeland security professionals. As with everything we have done to respond to the threat of Ebola both at home and abroad, we have been guided by the best science available.
Coordinated public health actions are essential to stop and reverse the spread of Ebola virus. CDC announced last week that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea and arrive at one of the five airports in the United States doing enhanced screening. The revised interim guidance released today is intended to guide state and local health officials with decisions about managing the movement of individuals being monitored, including travelers from the countries with widespread transmission and others who may have been exposed in the United States.
Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be contacted daily by state and local health departments for 21 days from the date of their departure from Liberia, Sierra Leone, or Guinea. Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, will start active monitoring today, with the remainder of the states starting in the days following.
This guidance also outlines appropriate public health actions for those individuals classified as “some risk.” These include health care workers who are providing direct care to Ebola patients in West Africa or others, such as observers, who enter an Ebola treatment area where Ebola patients are being cared for. Additional precautions, such as direct active monitoring, are recommended for those classified as “some risk.” In addition, the guidance recommends public health authorities determine on an individualized case-by-case basis whether additional restrictions, such as controlled movement, workplace exclusions, or restrictions on other activities, are appropriate. This daily health consultation will give additional confidence to the community that a returning health care worker is asymptomatic and therefore not contagious.
Returning health care workers should be treated with dignity and respect. They, along with our civilian and military personnel in the region, are working tirelessly on the frontlines against Ebola, and their success is what ultimately will enable us to eliminate the threat of additional domestic Ebola cases. We must not prevent or unduly discourage them from undertaking this indispensable and selfless work.
Guidance for returning health care workers from West Africa should be distinguished from health care workers providing care for Ebola patients in the United States. There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital. A U.S. hospital provides a more controlled setting than a field hospital in West Africa. A U.S. healthcare worker would be able to anticipate most procedures that would put them at risk of exposure and wear additional personal protective equipment as recommended. In some places in Africa, the same may not be true and workers may not have the ability to prepare for potential exposures.
This guidance is interim guidance and could be updated or changed as new information becomes available.
Tuesday, November 5, 2013
Johnson & Johnson to Pay More Than $2.2 Billion to Resolve Criminal and Civil Investigatio
Today's post is shared from justice.gov
Allegations Include Off-label Marketing and Kickbacks to Doctors and Pharmacists\Global health care giant Johnson & Johnson (J&J) and its subsidiaries will pay more than $2.2 billion to resolve criminal and civil liability arising from allegations relating to the prescription drugs Risperdal, Invega and Natrecor, including promotion for uses not approved as safe and effective by the Food and Drug Administration (FDA) and payment of kickbacks to physicians and to the nation’s largest long-term care pharmacy provider. The global resolution is one of the largest health care fraud settlements in U.S. history, including criminal fines and forfeiture totaling $485 million and civil settlements with the federal government and states totaling $1.72 billion.
“The conduct at issue in this case jeopardized the health and safety of patients and damaged the public trust,” said Attorney General Eric Holder. “This multibillion-dollar resolution demonstrates the Justice Department’s firm commitment to preventing and combating all forms of health care fraud. And it proves our determination to hold accountable any corporation that breaks the law and enriches its bottom line at the expense of the American people.”
The resolution includes criminal fines and forfeiture for violations of the law and civil settlements based on the False Claims Act arising out of multiple investigations of the company and its subsidiaries.
Allegations Include Off-label Marketing and Kickbacks to Doctors and Pharmacists\Global health care giant Johnson & Johnson (J&J) and its subsidiaries will pay more than $2.2 billion to resolve criminal and civil liability arising from allegations relating to the prescription drugs Risperdal, Invega and Natrecor, including promotion for uses not approved as safe and effective by the Food and Drug Administration (FDA) and payment of kickbacks to physicians and to the nation’s largest long-term care pharmacy provider. The global resolution is one of the largest health care fraud settlements in U.S. history, including criminal fines and forfeiture totaling $485 million and civil settlements with the federal government and states totaling $1.72 billion.
“The conduct at issue in this case jeopardized the health and safety of patients and damaged the public trust,” said Attorney General Eric Holder. “This multibillion-dollar resolution demonstrates the Justice Department’s firm commitment to preventing and combating all forms of health care fraud. And it proves our determination to hold accountable any corporation that breaks the law and enriches its bottom line at the expense of the American people.”
The resolution includes criminal fines and forfeiture for violations of the law and civil settlements based on the False Claims Act arising out of multiple investigations of the company and its subsidiaries.
Tuesday, July 15, 2014
Why Improving Access to Health Care Does Not Save Money
| One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time. Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true. One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse.  You can make the health care system achieve better outcomes. But that will usually cost more or require some change in access. You can make it cheaper, but access or quality may take a hit. And you can expand access, but that will increase cost or result in some change in quality. The A.C.A. was primarily about access: making it easier for people to get insurance and the care it allows. The law also tries to make changes that may bend the curve of spending... |
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