A project of the Galen Institute

Issue: "Medicare"

U.S. officials reach deal with Pennsylvania on Medicaid

Hilary Russ and David Morgan, Reuters
Fri, 2014-08-29
"Federal officials have reached an agreement with Pennsylvania Gov. Tom Corbett over his plan to use federal funds to pay for private health insurance coverage for up to 600,000 residents, the governor said on Thursday. The deal highlights a growing number of Republican governors who are finding ways to accept money under President Barack Obama's Affordable Care Act, despite political opposition that has so far prevented nearly half of U.S. states from moving forward with the Medicaid expansion plan. Corbett sought a waiver in February to use those expansion funds to instead subsidize private health insurance for low-income residents."

Arizona Medicaid appeal to be heard by court

Mary Jo Pitzl, Arizona Republic
Thu, 2014-08-28
"PHOENIX — The Arizona Supreme Court has agreed to hear Gov. Jan Brewer's appeal of an appeals-court decision that could unravel the Medicaid expansion she fought for last year. The high court has not yet set a date, but indicated it will hear Brewer's argument that about three dozen Republican lawmakers don't have the legal standing to challenge the controversial vote. The court's decision, reached in a scheduling conference, comes on the heels of Tuesday's primary election in which every Republican lawmaker who voted to expand the state's Medicaid program won re-election. That means it would be highly unlikely the next Legislature would vote to reverse the 2013 decision, which was a consistent fault line in numerous GOP legislative primaries. The case revolves around whether the Legislature's 2013 vote to impose an assessment on hospitals to help cover the cost of expanding the Arizona Health Care Cost Containment program was a tax.

Talks on Pennsylvania Medicaid plan said to be nearing end

The Associated Press
Thu, 2014-08-28
"An announcement could be made soon on Pennsylvania Gov. Tom Corbett's plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday. Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps. HHS officials did not immediately respond to a request for comment Wednesday, and the federal agency consistently has declined to publicly discuss details of Corbett's plan. The 124-page plan was formally submitted in February, and closed-door negotiations began in April after a public comment period."

Medicare Limbo: A Question Seniors Need To Ask If They're In The Hospital

Northwestern Mutual team
Forbes magazine
Wed, 2014-08-27
"Bill Jacobs spent four nights in a hospital in Florida battling pneumonia. His kids visited each day, fluffed his pillows, brought his favorite Sudoku puzzles and got regular updates from his nurses and doctors. Imagine their surprise when they found out that their 86-year-old father was never actually admitted; instead, he was treated as an outpatient under what Medicare refers to as “observation status.” What difference does that make? Actually, more than you might think. If your parents are on Medicare, the difference between being considered an inpatient or an observation patient could be thousands of dollars out of their pocket, if not more. First, Medicare Part A will cover all hospital services, less the deductible, but only if you’re admitted to the hospital as an inpatient. The one-time deductible covers all hospital services for the first 60 days in the hospital. Doctors’ charges are covered under Medicare Part B.

Cover Oregon: At least 2,000 Oregonians need to change coverage due to health exchange errors

Nick Budnick, The Oregonian
Wed, 2014-08-27
"Cover Oregon will hold a special open enrollment period for 1,400 Oregonians who were incorrectly enrolled into the low-income Oregon Health Plan by the state's troubled health insurance exchange. Starting Aug. 31, the people affected will have no coverage through the OHP, the state's version of Medicaid. However, they will have the option to sign up for coverage from private insurers and to qualify for tax credits through Cover Oregon to bring down premiums. Meanwhile, Cover Oregon is contacting at least 700 people who should have been enrolled in the Oregon Health Plan, but were incorrectly enrolled in a commercial health plan instead. If they were receiving tax credits for private plans, those will go away immediately, though they can keep their plan. Cover Oregon is currently negotiating with the federal government over whether those people will have to refund to the IRS all the tax credits they received incorrectly, said Amy Fauver, Cover Oregon communications director.

Hospitals squeezed as revenue growth slows to all-time low

Beth Kutscher, Modern Healthcare
Wed, 2014-08-27
"Revenue at not-for-profit hospitals grew at an all-time low of 3.9% last year with sluggish gains in both inpatient and outpatient activity, according to a report on 2013 medians from Moody's Investors Service. In comparison, hospital revenue increased 5.1% in 2012 and historically has grown about 7% per year. Moody's pegged the increased popularity of high-deductible health plans for leading people to postpone care or seek out lower cost retail clinics. “Patients have more skin in the game,” said Jennifer Ewing, an analyst at Moody's. The volume decline also is coming amid a number of Medicare reimbursement cuts, including the ones known as sequestration triggered by the 2012 Budget Control Act and reductions in disproportionate-share hospital payments under the Patient Protection and Affordable Care Act.

Medicare Star Ratings Allow Nursing Homes to Game the System

Katie Thomas, NY Times
Mon, 2014-08-25
"CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.

The Secret Committee Behind Our Soaring Health Care Costs

Katie Jennings
Politico
Thu, 2014-08-21
"It was late in the afternoon on a warm Friday in early fall and Doug Sumrell was mowing the lawn outside his suburban home in Evans, Georgia. As he pushed the mower across the yard, Sumrell began to feel faint — his chest tightened and the back of his neck started throbbing — so he went inside to take a break and drink a glass of water. But each time he went outside to finish the job, the feeling came back. He drove himself to the hospital as the sun was setting. On the way there, he left a message for his primary care doctor, Dr. Paul Fischer. At the hospital, a cardiac enzyme test showed Sumrell’s levels were extremely high, a strong indication that Sumrell had experienced a heart attack. The emergency room doctors said that they wanted to admit him, but it was already after midnight and Sumrell’s symptoms had subsided. His wife was out of town and their dog Buddy needed to be let out. Sumrell checked himself out of the hospital. He was jolted awake at 7:30 a.m. by the telephone.

Carondelet to pay $35 million in rehab overbilling case

Modern Healthcare
Wed, 2014-08-20
"Carondelet Health Network, a Tucson, Ariz.-based division of Ascension Health, has agreed to pay $35 million to settle allegations that two of its hospitals inappropriately billed Medicare and other federal health programs for inpatient rehabilitation care. The settlement is the highest amount paid in Arizona under the False Claims Act, according to the U.S. attorney's office in Phoenix. From 2004 to 2011, the Justice Department alleged, the Carondelet hospitals billed the government for inpatient rehab services for patients who didn't meet coverage criteria. The Roman Catholic hospital system “expressly denies” the allegations in the settlement agreement."

Analysis: California's Enrollment Success Is Its Greatest Challenge

Anna Gorman
Kaiser Health News
Thu, 2014-08-14
"California is coming face to face with the reality of one of its biggest Obamacare successes: the explosion in Medi-Cal enrollment. The numbers — 2.2 million enrollees since January — surprised health care experts and created unforeseen challenges for state officials. Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state's population. That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state's health care system, and it has raised concerns about California's ability to meet the increased demand for health care. Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past."

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