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Andrew Julien of The Hartford Courant reports that physicians in Connecticut are becoming reluctant to provide care to low-income nursing home patients. The problem is that the doctors only receive 80% of the regular Medicare payment for that visit. Generally, physicians receive the other 20% as a co-payment from the patient, but when the patient is on Medicaid, which most nursing home residents are, doctors are not allowed to bill the patient. The state used to make up the difference, but quit doing so two years ago.

The National Association of Retired Federal Employees (NARFE) has information on their site to help federal retirees understand how Medicare blends in with their retirement insurance. They point out that some federal retirees may be paying unnecessary premiums for insurance that duplicates benefits they already have. For instance, they say that members of the Federal Employee Health Benefits Program (FEHBP) HMOs probably should NOT sign up for Medicare Part B benefits, since they already have this coverage, and they would be able to save the $600 a year premiums that Part B beneficiaries must pay. They said that some HMOs have incorrectly told FEHBP beneficiaries that they must sign up for Medicare Part B, which is not true. This is different than beneficiaries who belong to Medicare HMOs, who are required to participate in Medicare Part B. This information and more is available on the NARFE site.

Several highly-respected experts spoke to the Special Committee on Aging at a special forum titled "Living Longer, Living Better, The Challenge to Policymakers." They talked to policymakers about Medicare and Social Security reform, the need for geriatrics education in the U.S., and the impact of changing patterns of retirement and demographics. The presenters included Fay Lomax Cook, Director, Institute for Policy Research, and Professor of Human Development and Social Policy, Northwestern University; Gary Burtless, Senior Fellow, Brookings Institution; Robert Butler, Founding Director of the National Institute on Aging and President of the International Longevity Center-USA; Elizabeth Kutza, Director, Institute on Aging, Portland State University; Marilyn Moon, Senior Fellow, The Urban Institute; and Tim Smeeding, Professor of Economics and Public Administration, Center for Policy Research, Syracuse University. Their testimony is available on the Aging Committee Web site.

The Office of the Inspector General (OIG) conducted a review of the way that nursing homes bill for Medicare Part B therapy services, and concluded that the Health Care Financing Administration (HCFA) needs to crack down on therapy billing procedures in nursing homes. The OIG found that about 22% of Part B therapy billing by nursing homes was either unnecessary, undocumented, or provided by unqualified staff in 1998, prior to the implementation of $1,500 caps on therapy charges. They also noted a significant decrease in therapy billings after the caps were implemented in 1999. The OIG stated that this decrease could have meant that patients were not getting the therapy they should have received, but that it appeared that the decrease was primarily due to changes in the way that nursing homes handled therapy. They found that most nursing homes continued to provide therapy, but did it by using non-professional nursing home staff rather than outside therapists. Their conclusion was that prior billings included unnecessary and overly-expensive therapy costs.

The OIG has concluded that the removal of the $1,500 caps on Part B therapy costs for the year 2000 is likely to lead to a return to overpayments for therapy costs in 2000 and 2001, and urged HCFA to immediately ensure that fiscal intermediaries conduct adequate focused medical reviews of Part B therapy in SNFs and continue to work to improve SNFs? and therapy providers? understanding of proper billing procedures and the medical necessity guidelines for Part B therapy in SNFs.

Special programs are available for low income Medicare beneficiaries to help them pay their Medicare premiums, but a recent study by the Medicare Rights Center found that many people are unaware of the programs, or unwilling to apply for them. Their study found that 88% of the people they surveyed are unaware of these programs. They also found that 42% of the people they surveyed had contacted the Medicaid office for help, but only 12% were told about these programs. Of those who were told about the programs, only 2% applied.

Surveyors found that many Medicaid offices were screening applicants to see if they qualified for full Medicaid assistance without also checking to see if they qualified for these premium assistance programs which are available to some people who do not otherwise qualify for Medicaid. Of those beneficiaries who were told about the existance of assistance programs, the most common reasons why they did not apply was the stigma of going to the Medicaid office, the burdensome paperwork and financial disclosure requirements, and in some cases, poor health and lack of access to transportation.

The Medicare assistance programs pay for some or all of Medicare premiums, deductibles, and coinsurance for low income people who do not qualify for the Medicaid program. The available programs are called QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiaries, QI-1 and QI-2 (Qualifying Individuals). Premium assistance is available to people with income below $716-$1,238 for an individual and $958-$1,661 for a couple, depending on the program. The programs are limited to people with assets of no more than $4,000 for an individual and $6,000 for a couple, not including their home or most personal property.

>> Medicare Rights Center Press Release

A recent study published in the Journal of the American Medical Association (JAMA) found that many Medicare beneficiaries are not getting treatments like mammograms for breast cancer survivors and vision tests for patients with diabetes. The study looked at 345,253 Medicare patients aged 65 or older and found that less than two thirds of them were getting generally recommended procedures. Blacks, poor people, and people living in rural areas were least likely to be getting recommended treatments. Researchers did not investigate the reason for this undertreatment, but said that it could be due to physicians who did not order the right treatments, patients who did not follow the physicians recommendations, or discrimination by doctors. They also suggested that the lack of preventative and diagnostic treatments may have led to worse outcomes, such as the higher hospitalization rate for congestive heart failure that black patients have over white patients. The multi-specialty physician panel that conducted the study was led by Steven M. Asch, MD, MPH, of RAND.

The Office of the Inspector General of the Department of Health and Human Services (OIG-HHS) investigated Medicaid payment to skilled nursing facilities in Illinois. A Medicare skilled nursing facility (SNF) claim generally qualifies for reimbursement only if the SNF stay was preceded by an inpatient hospital stay of at least 3 days and the hospital discharge was within 30 days of the SNF admission. This final report estimates, based on a statistical sample, that Medicare inappropriately paid Illinois providers $900,000 for SNF services during calendar year 1996 because the 3-day hospital stay requirement was not met.

This occurred primarily because the fiscal intermediary did not cross check SNF claims against hospital claims. The fiscal intermediaries involved in the sample reviewed the medical records and data for the sampled claims and concurred that the SNF stays were ineligible for Medicare reimbursement and indicated they would request refunds for each incorrect payment identified.

The Department of Health and Human Services (HHS) has announced Medicare premiums and deductible amounts for the year 2001. The premium for Part B Medicare will increase from $45.50 a month to $50.00 a month. The hospital deductible rises to $792 per benefit period, and the co-insurance to $198 for days 61 to 90 and $396 for days 91 to 350 of the lifetime reserve days. The co-insurance for skilled nursing care rises from $97 a day in 2000 to $99 a day in 2001 for the 21st-100th day.

The October 3 issue of the Journal of the American Medical Association includes results of an assessment done by the Health Care Financing Administration (HCFA) of Medicare care across the country that found that treatment of Medicare patients varies widely by state when it comes to heart failure, stroke, breast cancer and other life- threatening illnesses. They found that Medicare patients in the Northeast and sparsely populated states were most likely to receive appropriate treatments for such conditions. However, those in the Southeast and more populated states were least likely to get the same treatments.

Top Five States

1. New Hampshire
2. Vermont
3. Maine
4. Minnesota
5. Massachusetts

Bottom Five States

48. New Jersey
49. Louisiana
50. Mississippi
51. Arkansas
52. Puerto Rico

Rankings of the Most Populated States

31. New York
40. Florida
41. California
45. Texas
46. Illinois

The states were ranked based on a total of 22 standards of care for heart attack, heart failure, stroke, pneumonia, breast cancer and diabetes. The standards included everything from avoiding a potentially deadly treatment - giving stroke victims the blood-pressure-suppressing drug nifedipine - to educating pneumonia patients about immunization.

The standards included everything from avoiding a potentially deadly treatment -- such as giving stroke victims the blood-pressure- suppressing drug nifedipine -- to educating pneumonia patients about immunization. HCFA officials say that the next step is to work with peer review organizations that contract with HCFA to make improvements and to examine why the disparities exist.

Medicare?s largest annual mailing to beneficiaries will take place this month and next when more than 34 million copies of the Medicare & You 2001 handbook are mailed to Medicare beneficiaries all across the United States. The new handbook includes Updated "Questions and Answers" to help beneficiaries make good decisions about their health care; Information about the first private fee-for-service Medicare+Choice plan currently available in selected states; and Updated information about managed care, including Medicare+Choice enrollment rates. The booklet is available online as a PDF file.

Health Care Financing Administration (HCFA) Administrator Nancy-Ann DeParle announced her resignation in an email to her staff. HCFA oversees the Medicare and Medicaid programs in the United States, and DeParle headed up the entire agency. DeParle will now serve as a fellow at the Kennedy School of Government's health policy program. Before taking her position as administrator of HCFA, DeParle worked in the Office of Management and Budget, where she oversaw budget and policy matters for federal health programs. She succeded Bruce Vladeck as HCFA administrator in November of 1997, when Vladeck took a professorship at Mount Sinai School of Medicine in New York. DeParle's replacement has not been named, but Michael Hash, the deputy administrator, probably will run the agency in the interim.

Ms. DeParle has several connections to Harvard's Kennedy School of Government. HCFA?s Medicaid Prescription Drug Dispute Resolution Project was recognized as a finalist in the school's Innovations in American Government Awards, and Ms. DeParle's husband Jason is a new fellow in the Kennedy School of Government's Joan Shorenstein Center on Press, Politics and Public Policy.

People who get Medicare benefits need a Medicare card to show to medical treatment sources to obtain services. Social Security currently processes about 750,000 requests a year for replacement cards from beneficiaries. They have now created an online form to allow beneficiaries to request a Medicare card to replace cards which were lost, stolen, destroyed or not received. The card will be mailed within 30 days after the online request.

Information needed for the online request:

- Name as it appears on the most recent Social Security card
- Social Security Number
- Date and place of birth
- Mother's maiden name
- Phone number in case they need to contact you about your request
- E-mail address (optional)
- Last payment amount or the month and year of last payment received for benefits paid in the last 12 months

In its first year of service more than 1.5 million callers have used the government's new telephone number for Medicare information, The Medicare Choices Helpline (1-800-MEDICARE or 1-800-633-4227). This number was set up to help Medicare beneficiaries, caregivers, family members, and advisors make decisions on the Medicare options available. The phone number is a supplement to the government Web site for Medicare information, http://www.medicare.gov.

HCFA Administrator Nancy-Ann DeParle announced that Medicare will increase payment rates to skilled nursing facilities for those residents who have the most costly medical needs. The proposed changes, which will take effect Oct. 1, 2000, would increase overall Medicare payments for skilled nursing care by an estimated 5.8% above the published rates. The proposal also creates new, higher payment categories for residents with multiple, serious health problems that require intensive care and treatment. Under the proposed refinements Medicare would pay more than $700 per day for residents with the most intensive medical needs, five times the rate for residents with the least intensive needs.

This action came partially as a response to the severe financial distress the nursing home industry has undergone due to changes in Medicare reimbursement. Over 10% of the nursing homes in the country are in bankruptcy, and many of them cite the dramatic drop in Medicare reimbursement as a significant contributing factor. In addition to the problems of the nursing home industry, hospitals and others have noted problems placing patients with significant medical needs in nursing homes when the nursing homes expected that the costs of caring for the resident would exceed the payment rate allowed by the Medicare program. As a result, some high-acuity patients have had to stay in the hospital until a suitable placement could be found.