Tag Archives: Medicare

Are we there yet?

No kids, no we aren’t. We are approaching halfway though, so that’s something to write home about.

The next Subtitle – B – Improving Medicare for Patients and Providers. You might ask yourself, weren’t we already doing that? Apparently not.

Poor section 3101 was repealed before she even got to become enacted. And it was apparently about physician pay. Sorry docs!

Section 3102 has a really long title. Extension of the Work Geographic Floor and Revisions to the Practice Expense Geographic Adjustment Under the Medicare Physician Fee Schedule. To summarize – they are changing how much they increase the payments to physicians who live in more expensive parts of the country. And then they will study whether they are doing the right thing on that. (You’ll be happy to know that this was continued in the recent “Fiscal Cliff” law.

Section 3103 extended for 1 year the exceptions process for Medicare therapy caps. But that was until December 31, 2010. So it could be moot at this point. Same for Section 3104, the extension of payment for technological component of certain physician pathology services. And 3105 – Ambulance Add-Ons. 3106 – extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities. That one at least got until 2012. (All extended in the “Fiscal Cliff” Bill. )

3107 – Physican Fee Schedule Mental Health Add-On, we don’t know if you are still going strong. (You are! “Fiscal Cliff” Law to the rescue.)

3108 allows Physician Assistants to order post-hospital extended-care services.

3109 exempts certain pharmacies from accreditation requirements. These are pharmacies that don’t do much Medicare billing or only provide durable medical equipment, orthotics or prosthetics. So they don’t have to provide all of the things that other Medicare pharmacies would have to.

3110 gives a special enrollment period for Medicare Part B to Disabled Tricare Beneficiaries. They are very particular about stating that this is only open to you once in a lifetime. Tricare, for those of you who don’t know, is the military health insurance.

3111 pays for Bone Density Tests.

3112 takes $22,290,000,000 out of the Medicare Improvement Fund. No explanation given there.

3113 is a demonstration project for complex laboratory testing namely gene protein expression, topographic genotyping, or a cancer chemotherapy sensitivity assay.

3114 improves access for nurse-midwife services by increasing payment from 65% to 100%. You might be wondering why Medicare pays for nurse-midwives in the first place, but you would then be reminded that Medicare covers people under 65 who have been determined to have a disability.


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More Improvements! Protections! Moms! Kids! Baseball! Pie!

The next large subsection looks at improving the Medicaid and CHIP Payment and Access Commission. Not the actual payments and access, mind you, but the Commission.

Section 2801 calls for an assessment of policies on these issues. Which they did in this section, and changed some things.

That’s it.

I’m not sure that deserved its own subsection.

Moving on!

The next large subsection calls for protection for American Indians and Alaska Natives.

Section 2901 is special rules relating to Indians. It increase the poverty line level below which there is no cost-sharing to 300%, identifies the Indian Health Service as the payer of last resort for health care provided to Indians, and facilitates enrollment by including them in the Express Lane options.

Section 2902 eliminates the sunset of the clause that allowed reimbursement for Medicare Part B services furnished by certain Indian hospitals and health clinics. You get that? They were going to take that reimbursement away, and now they aren’t.

The next large subsection (which really, if you think about it, is quite the misnomer. The subsections play like they are large, but when you actually read them, they are pretty small.) is about Maternal and Child Health Services

Section 2951 creates the funding and authority for statewide needs assessments that identifies communities with higher rates of premature and low-birth weight infants, infant mortality, poverty, crime, domestic violence, high-school drop-out rates, substance abuse, unemployment, or child maltreatment. (Unfortunately, these are probably going to have a high overlap with each other). It will also look at the programs for home visitation, early childhood programs (which, btw, have been shown to make significant impact in the long run in reducing these things). It will also provide grants for increasing the number of these programs.

Section 2952 provides funds for studying, and hopefully reducing, postpartum depression. There will be studies!

Section 2953 gives the states more money for Personal Responsibility Education. This apparently discusses both abstinence and contraception’s role in reducing unintended pregnancy and sexually transmitted diseases. It does say that the information has to be medically accurate and complete.

Section 2954 restores funding for abstinence-only sex education at least through the year 2014. $50,000,000 a year.

Section 2955 is important, but relevant only to a small portion of the population. The title pretty much says it all – “Inclusion of information about the importance of having a health care power of attorney in transition planning for children aging out of foster care and independent living programs“.

Ok – so there was no baseball, and there was no pie. But we did manage to make it 1/3rd through the PPACA! That’s right. 1/3rd. I’ll keep pressing on, you keep reading!

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