‘‘(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The process under clause (i) shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application.
The new facility requires proof over a 5 year time frame there is a need. In other words, a hospital, regardless of the nature of the facility can't just build to be building. There has to be a demonstrated need. Page 324, lines 1 through 9.
‘‘(i) that is located in a county in which the percentage increase in the population during the most recent 5-year period for which data are available is estimated to be at least 150 percent of the percentage increase in the population growth of the State in which the hospital is located dur8
ing that period, as estimated by Bureau of the Census and available to the Secretary;
There is a discussion regarding physician or investor owned facilities whereby there is not a physician on the premises 24 hours, 7 days a week; there has to be in place full disclosure to the Secretary.
Page 327, Lines 6 through 8 allows the Secretary to conduct unannounced visits on these facilities.
The Secretary may use unannounced site reviews of hospitals and audits to verify compliance with such requirements.
The bill continues with the jargon regarding implementation, funding, administration and quality assurance. The quality assurance is to maintain evaluation to the availability of health care work force and resources in relation to the population of the region they serve. There is 'consideration' in payments of Medicare and Medicaid where work markets are stressed and need incentive to bring in more opportunity for workers. Such changes occur after January 1, 2014. There is more jargon to replace language in the Medicare and Medicaid legislation to reflect these changes.The House Bill provides for an increase in the monies Medicare Advantage is to receive. There is a 'bridge' of services when the bill is implimented.
I think this is going to be eliminated. Medicare Advantage is a 'private industry service.' President Obama has already stated, the Medicare Advantage program would be suspended as it is very costly and does not provide the same benefits as Medicare. The Medicare Advantage Program limits the doctors and hospitals citizens can obtain care. It is a HMO. It provides a small advantage to the out of pocket costs as the co-pays are slightly lower, but, basically there is no need for it. When a citizen enters into a contract with Medicare Advantage it removes any and all 'equity' one would receive through regular Medicare. The care citizens receive is not facilitated by the government. I believe this section of the Bill will be eliminated and/or modified. The cost to the government in administering this insurance is disproportionate to the cost of administering regular Medicare.
This is from an information page from Medicare Advantage: "When you join a Medicare Advantage Plan (click here), you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services."
Page 341, Lines 3 through 9:
‘‘(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS.—In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.
"...The group of academics outlined dozens of changes in their report, (click title to entry - thank you) from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications.
All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush...."
There is significant verbiage ad nauseam dedicated to the interface between the new law and Medicare Advantage. It appears the 'change' bqck to Medicare will be 1012.
Page 344,, Lines 7 through 19:
SEC. 1167. IMPROVING RISK ADJUSTMENT FOR PAYMENTS.
(a) REPORT TO CONGRESS.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that evaluates the adequacy of the risk adjustment system under section 1853(a)(1)(C) of the Social Se13
curity Act (42 U.S.C. 1395–23(a)(1)(C)) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid, and non-Medicaid eligible low-income beneficiaries; and the need and feasibility of including further gradations of diseases or conditions and multiple years of beneficiary data.
These are steps to make the transition from Medicare Advantage. Page 350, Lines 21 through 25 and Page 351, lines 1 through 9.
‘‘(A) the Secretary shall require the Medicare Advantage organization offering the plan to give enrollees a rebate (in the second succeeding contract year) of premiums under this part (or part B or part D, if applicable) by such amount as would provide for a benefits ratio of at least .85;
‘‘(B) for 3 consecutive contract years, the Secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year; and ‘‘(C) the Secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for 5 consecutive contract years.’’.
Dingell, Stupak Continue Investigation of Predatory Sales Practices of Medicare Advantage Plans (click here)
Monday, 13 October 2008 17:00
Washington, D.C. - Reps. John D. Dingell (D-MI), Chairman of the Committee on Energy and Commerce, and Bart Stupak (D-MI), Chairman of its Subcommittee on Oversight and Investigations, today sent two letters as part of their continued investigation into predatory sales practices of Medicare Advantage (MA) plans.
I know the Acostas. They are great Florida attorneys that have worked in Medicare benefits and fraud for a long time. Nice people. Really nice people.
For Immediate ReleaseMay 11, 2009
United States Attorney's Office
Southern District of Florida Contact: (305) 961-9000
Two Suspects Arrested in $21 Million Medicare Advantage Fraud Scheme Spanning Five States (click here)
R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, Daniel W. Auer, Special Agent in Charge, Internal Revenue Service, Criminal Investigation Division, and Al Lamberti, Sheriff, Broward County Sheriff’s Office, announced that defendants Michel De Jesus Huarte and Ramon Fonseca, both of Miami, FL, were arrested today on a criminal complaint charging them with conspiracy to commit health care fraud, health care fraud, and conspiracy to commit money laundering. If convicted, each defendant faces a statutory maximum penalty of 10 years in prison on the health care fraud charges, and 20 years in prison on the money laundering charges.
The bill goes on to discuss Medicare Advantage provisions until page 353, line 12. I am going to end it here for tonight. Please give President Obama your support to pass effective health care reform. It is the right thing to do to insure our citizens are receiving the best of care.
