Susan Jaffe
Two million Americans rely on home-based care services paid by Medicaid to live at home, which can save Medicaid up to two-thirds of what it would cost at a nursing home.
Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days.
Medicare announced Friday that it was revising rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care. The drug categories in question were identified in a 2012 investigation by the HHS inspector general.
Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.
Medicare officials will delay until 2014 enforcement of controversial new rules that define when hospital patients should receive observation care, rather than being admitted, a distinction that makes beneficiaries ineligible for follow-up nursing home coverage.
A federal court judge dismissed a lawsuit Monday intended to eliminate the observation classification, or require hospitals to tell patients when they are under observation and then create a clear appeals process to challenge Medicare’s coverage decisions.
The federal Commission on Long-Term Care released its policy recommendations last week but did not reach a consensus on how to pay for these often expensive services.
Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to -- even when their symptoms are the same, says a new report by the HHS Inspector General.
A provision of the 2010 Affordable Care Act that intends to increase Medicare beneficiaries' share of healthcare costs is meeting resistance from a group charged with revising Medigap insurance policies that cover most out-of-pocket expenses.