Posts Tagged ‘Patient Protection and Affordable Care Act’

Bipartisan Bill Would Redefine ‘Full-Time’ Employee Under ACA

June 19, 2013

Healthcare_reformSenators Susan Collins and Joe Donnelly will introduce a bill today that bumps the health care law’s definition of full-time work from 30 to 40 hours a week.

Business owners have complained that the current 30-hour definition is inconsistent with how full-time work is typically defined and say it could lead to more workers having their hours cut. The Affordable Care Act requires employers with more than 50 full-time employees to offer health coverage.

The Collins-Donnelly bill would also clear up some lingering confusion over which employers are considered “large” under the law. The legislation would set the number of hours counted toward a full-time equivalent employee to 174 hours per month. (more…)

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

June 12, 2013

By Gretchen JacobsonPatricia Neuman and Jennifer Huang, Kaiser Family Foundation

While much of the health policy world is focused on the health coverage developments in store as the Affordable Care Act of 2010 is implemented, private insurers are also gearing up for the next Medicare Advantage open enrollment season. Four months from now, just as exchange enrollment swings into action, Medicare beneficiaries will have the option to enroll in a Medicare Advantage plan (or switch plans) during the annual open enrollment period. And, earlier this month, each of the insurers participating in the Medicare Advantage program submitted what is known as a “bid” to the federal government that essentially indicates whether they will offer more or fewer Medicare Advantage plans in 2014 than in 2013 and how they will change their plans’ benefits and premiums, which could ultimately affect how many Medicare beneficiaries enroll in Medicare Advantage plans in 2014 and future years. (more…)

Analysis: Florida Home Health Medicare Margins on Steep Decline

June 6, 2013

The Home Care Association of Florida in coordination with the Partnership for Quality Home Healthcare today released data demonstrating that the rebasing of Medicare home health payments within the proposed Home Health Prospective Payment System (HHPPS) rule for 2014 will negatively impact Florida’s home health sector and the 342,570 vulnerable Medicare beneficiaries receiving home health by driving Medicare margins to an all-time low. Leaders are urging regulators to carefully consider home health sector’s current-law economics when implementing this policy.

Under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) is directed to rebase home health payments between 2014 and 2017 by a percentage determined appropriate by the Secretary.  This percentage is to be implemented in equal increments during each year from 2014 through 2017. (more…)

Medicare Urges Seniors to Join the Fight Against Fraud

June 6, 2013

In mailboxes across the country, people with Medicare will soon see a redesigned statement of their claims for services and benefits that will help them better spot potential fraud, waste and abuse. These newly redesigned Medicare Summary Notices are just one more way the Obama Administration is making the elimination of fraud, waste and abuse in health care a top priority. Because of actions like these and new tools under the Affordable Care Act, the number of suspect providers and suppliers thrown out of the Medicare program has more than doubled in 35 states. (more…)

Sarasota Herald-Tribune: Finding Skilled Elder Home Care Workers Not Easy

May 30, 2013

Many families plunge into the mysterious universe of elder home care after a hospital stay — often an unexpected one.

Shortly before it’s time to go home, the patient or a relative typically receives a brochure for the hospital’s recommended home health agency, with a brief discussion of the limited rehabilitation services Medicare will cover.

But the family often does not realize that visiting nurses who replace catheters or therapists who monitor exercises are not much help when it comes to what recently hospitalized elders need most: assistance in bathing, dressing or just moving from bed to chair to bathroom.

And they don’t know that their search for these services could involve crippling costs, expose them to the potential for elder fraud, and immerse them in a fast-growing industry where many workers lack the training and skills needed for safe and reliable caregiving.

While most Americans — 89 percent in one survey — say they would prefer to age in place in their own homes, few understand the implications of opening those homes to strangers who can provide the help they need. And surveys show that very few Americans consider the price tag in advance. (more…)

Palmetto GBA: Medical Review Requirements for HH Face-to-Face Documentation

May 22, 2013

Palmetto GBA has noticed an increase in overpayments for Home Health Prospective Payment System (HH PPS) claims. The top reason for this increase is attributed to the requirement for a face-to-face encounter with the beneficiary.

Palmetto GBA evaluated its criteria for review of these types of claims. Effective immediately, Palmetto will begin a more comprehensive review using the regulations governing these types of claims. Palmetto GBA encourages all providers to review their internal processes to ensure that all of the criteria for coverage have been met and documented in the medical record. (more…)

Marilyn Tavenner Approved by the Senate to Lead CMS in a 91-7 Vote

May 17, 2013

Marilyn Tavenner, the acting head of the Centers for Medicare and Medicaid Services (CMS), was approved to become the agency’s official Administrator on a 91-7 vote on Wednesday night. The vote comes after Ms. Tavenner’s unanimous approval – by voice vote – in the Senate Finance Committee late last month, and after Senator Tom Harkin (D-IA) lifted his hold on her appointment because of a dispute with the Obama Administration about funds for preventive health services being diverted to help fund the implementation of the Affordable Care Act. (more…)

Obama Administration Launches $1B Initiative for Health Care Innovation

May 15, 2013

Health and Human Services Secretary Kathleen Sebelius today announced a nearly $1 billion initiative that will fund awards and evaluation to build on the Obama administration’s work to transform the health care system by delivering better care and lowering costs.  This second round of Health Care Innovation Awards will fund applicants that have a high likelihood of driving health care system transformation and delivering better outcomes.

Made possible by the Affordable Care Act, the Health Care Innovation Awards provides another opportunity to improve the quality of health care and bring down costs for taxpayers and patients. The health care law includes many tools to avoid costly mistakes and readmissions, keep patients healthy, reward quality instead of quantity, and create health information technology infrastructure that enables new payment and delivery models to work. The provisions in the Affordable Care Act are already working to reduce costs: Medicare spending per beneficiary increased by just 0.4 percent last year, far below historical averages. (more…)

Partner with CMS on Benefits Outreach and Education

May 8, 2013

The Centers for Medicare & Medicaid Services has asked the association to share the following message with providers about opportunities for providers to partner with CMS by disseminating preventative information to the public. (more…)

Ask the Obama Administration to Exempt Home Care Providers from the PPACA Employer Mandate Requirements

May 3, 2013

Please sign an industry-sponsored petition on The White House website if you feel in-home care services should be exempt from the Employer Mandate portion of the Affordable Care Act. This petition was just created and needs 100,000 signatures within the next 30 days in order to get the attention of the President and Congress. So far just over 1,000 signatures have been received.

Click here to take action by signing the petition now!