Category

Medicare

The Republican Health Care Bill is Bad News for Your Grandparents. And Your Parents. And You.

By | Affordable Care Act, BLOG, Health Care Defense, Medicaid, Medicare, Nursing Homes | No Comments
Who needs Medicaid? Probably someone you know. Medicaid is the backstop government program that provides coverage when someone can’t afford necessary health care. Historically, Medicaid coverage focused on children, older adults, and persons with disabilities, although 2010’s Affordable Care Act expanded Medicaid coverage to some low-income adults without disabilities. The Better Care Reconciliation Act, which Senate Republicans just released, not only aims to take away the expanded coverage, but also makes deep cuts to the core Medicaid program that inevitably will lead to health care rationing. Read More

QMB Identification Practices: A Survey of State Advocates

By | ISSUE BRIEF, Medicare, REPORTS | No Comments

Ensuring that Qualified Medicare Beneficiaries (QMBs) are not illegally billed for Medicare costs requires improvements on many fronts. One important piece is better identifying QMBs and informing both QMB consumers and their providers that they are subject to billing protections. Justice in Aging is pleased to share two new important resources contributing to that effort.

QMB Identification Survey
The new issue brief, authored by legal services attorney Peter Travitsky, looks at practices in 13 states in identifying QMBs. It finds that, although several states provide no QMB identification cards, others offer examples of best practices to ensure that QMB consumers and their providers know their protected status. The survey was supported by a post-fellowship grant from the Borchard Foundation Center on Law and Aging.

Incorporating QMB protections into Medicare notices
In October 2017, the Medicare program will be rolling out revised Medicare Summary Notices (MSNs) to QMB consumers and revised remittance advice notices to providers. On both notices, for each covered service, a notation will show that the individual is a QMB and that the co-insurance responsibility for each service is zero. To prepare providers for the revised system, CMS released a new Medicare Learning Network Matters article, Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System. As the new system is implemented, the article will be a useful tool for advocates to share with providers and their billing departments.

Visit the improper billing webpage, where you can find many more resources including a toolkit that with model letters to providers, an issue brief on recent improvements in QMB reporting and enforcement, recordings of past webinars on QMB billing and other valuable tools, including an improper billing tracking form that you can use to report instances of improper billing to inform our advocacy.

New Fact Sheet: Medicare Part D – 2017 Transition Rights

By | FACT SHEET, Medicare, REPORTS | No Comments

The Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary (medication list), file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan.

Transition rules apply to stand-alone Medicare Prescription Drug Plans (PDPs), Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs), and Medicare-Medicaid Managed Care Plans participating in the Dual Eligible Financial Alignment Demonstrations.

Transition rules are particularly important for low-income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications.

In addition, all plans change their formularies each year, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements.

To assist advocates with transition issues, this fact sheet sets out the CMS minimum requirements for all plans.

For further information, contact Georgia Burke, gburke@justiceinaging.org.

Repeal of the ACA—Without a Replacement—Threatens California Seniors

By | Affordable Care Act, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, Health Care Defense, HOMEPAGE, Medicaid, Medicare | No Comments
There are currently 7.6 million older adults living in California who rely on Medicare, Medi-Cal, and the Affordable Care Act (ACA) to see a doctor, receive care in their home, and pay for prescription drugs. The repeal of the ACA threatens these critical programs, jeopardizing the care seniors receive every day. Read More

Repealing the Affordable Care Act without a Replacement Hurts Seniors

By | Affordable Care Act, BLOG, DUAL ELIGIBLES, Health Care, Health Care Defense, HOMEPAGE, Medicaid, Medicare, Safety Net Defense | No Comments
Every day, whether seniors need to see a doctor, receive care in their home, or pay for prescription drugs, Medicare, Medicaid, and the Affordable Care Act (ACA) are lifelines for older adults. However, the entire health care system upon which older adults rely is at risk in the new Congress. Changes to the ACA will dramatically alter the Medicare and Medicaid programs, and jeopardize the care seniors receive each day. Read More

Systemic Denti-Cal Problems Increase Financial Hardship for Older Adults

By | BLOG, Health Care, HOMEPAGE, Medicaid, Medicare, Oral Health | No Comments
Linda—a low-income older adult living in Los Angeles County—applied for a dental credit card after being advised to do so by her dentist. Her dentist’s office explained that, while she has dental coverage through Denti-Cal, it often takes a long time to get authorizations approved and it would be in her best interest to pay right now with the card and get reimbursed later. When Linda received her statement, it showed she owed over $2,000. Not only did she receive services that were not covered by her insurance, she also was charged for services that should have been covered by Denti-Cal but that were denied because her dentist’s office did not properly submit the claim to Denti-Cal. Unable to pay the $2,000 within the no-interest six month promotional period, Linda was hit with the balance plus six months of interest that accrued at 26.9%. Distraught, Linda contacted a legal advocate who is now working to dispute the charges and to rescind the credit card contract. Read More

WEBINAR: Sec. 1557 Civil Rights Protections – What Aging Advocates Need to Know

By | Affordable Care Act, Medicaid, Medicare, WEBINAR | No Comments
When: Tuesday, October 25 at 11:00 a.m. PT/ 2:00 p.m. ET

One important yet sometimes overlooked protection of the Affordable Care Act is its non-discrimination mandate Section 1557. This critical provision incorporates existing civil rights laws that protect against discrimination on the basis of race, ethnicity, sex, age, and disability, and applies them directly to the provision and delivery of health care. Earlier this year, the U.S. Department of Health and Human Services (HHS) released final regulatory guidance on Section 1557 with an effective date of July 18, 2016 for most covered entities.

Join Justice in Aging as we explored how the protections of Section 1557 affect the obligations of Medicare and Medicaid programs and providers serving older adults.

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Cal MediConnect: A Long Way to Go

By | Affordable Care Act, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, HOMEPAGE, Medicaid, Medicare | No Comments
Evaluation and enrollment data on the Cal MediConnect program reveals that the program has a long way to go to deliver on the promise of integrated person-centered care. While the data contains some promising trends, it also reveals serious deficiencies that demand focused attention from the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Services (DHCS).

The Cal MediConnect (CMC) program, which created new health plans integrating Medicare and Medi-Cal benefits for dually eligible beneficiaries, has been in effect for over two years in seven California counties. Enrollment data released by DHCS and a recent series of evaluations, including surveys, focus groups, and polling, paint a picture of how the program is performing and how enrollees are faring so far. Read More