Older Americans Oppose Approval Process for Home Care Services

Eighty-three percent of seniors oppose a Medicare policy that requires a government contractor to approve claims for physician-prescribed home health care, according to a poll sponsored by Bring The Vote Home. The Centers for Medicare & Medicaid Services (CMS) recently implemented a pre-claim review demonstration that imposes documentation requirements on home health agencies and referring physicians. Doctors have to provide a broad array of eligibility-related documentation and clinical support for review by government contractors. Home health leaders warn that the new requirements could delay care and increase healthcare costs. Seniors say that requiring a government contractor to approve home heath care will have the following results:

  • 80% say it will delay care.
  • 77% say it will increase Medicare costs.
  • 75% say that will increase out-of- pocket costs.
  • 45% say it will decrease fraudulent home health claims.

For more information, visit bringthevotehome.org.

Bill Would Eliminate Medicare Advocacy Services

The Senate Appropriations Committee recently approved the FY17 Labor, HHS, Education Appropriations bill, which would eliminate funding for the State Health Insurance Assistance Program (SHIP). It’s called the Health Insurance Counseling and Advocacy Program (HICAP) in California. It is the only program that provides free, unbiased, one-on-one Medicare coverage and benefit counseling for beneficiaries, family members, and caregivers. According to California Health Advocates, “This dangerous bill aims to eliminate this important, effective program that helps millions of beneficiaries nationwide better understand and navigate the increasingly complex Medicare program.”

More Patients Are Visiting Retail Clinics

Retail clinics are playing a growing role in health care delivery, according to a study from Walgreens. Patients are relying more on nurse practitioners at retail clinics to provide chronic and preventive health services. The study also reveals marked increases in the number of patients who are making return visits to clinics. Visits to healthcare clinics for preventive services, screening, and chronic care increased from 4% in 2007 to 17% in 2013. The annual percentage of return patient visits to Healthcare Clinic climbed from 15% in 2007 to more than 50% in 2012 and 2013. For patients age 17 and under, visits for preventive services and vaccinations increased 180% For patients ages 18 to 64, visits for health testing increased 90% while preventive health service visits increased 66%. Acute visits increased 84% for patients 65 and older. The Convenient Care Association estimates that 33% of Americans live within 10 minutes of a retail healthcare clinic. Walgreens has increased the variety of services at select Walgreens clinics from providing vaccinations to diagnosing and treating a number of chronic conditions. Clinics at select locations are open seven days a week, with extended evening and weekend hours, and offer walk-in service. Healthcare Clinics accept most major insurance plans and Medicare and Medicaid, and offer affordable, transparent pricing for those without insurance coverage. Healthcare Clinic’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90%. For more information, visitwww.walgreens.com.

Rising Costs Should Prompt LTC Conversations

The cost of long term care, which is is outpacing inflation, it creating significant financial planning challenges for the nearly 12 million Americans who need long-term care services. The cost of in-home care continues to rise, though at a more moderate rate of growth. This is good news for consumers as almost three quarters of people who need long term care prefer receiving it in their homes, according to the Genworth 2014 Cost of Care Survey. Nationally, the 2014 median hourly cost for the services of a homemaker is $19 and $19.75 for home health aide hired from a home care agency. Homemaker costs have risen 1.2% a year over the past five years. Home health aide services have risen 1.32% a year. The costs of assisted living facilities are rising much faster. The median annual cost for care in an assisted living facility is $42,000, which is an increase of 4.29% annually over the past five years. The comparable cost for a private nursing home room is $87,600, which has increased 4.19% annually over the past five years. For more information, visit www.genworth.com.

DMHC Fines Kaiser Over Access to Mental Health Services

The California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser for not providing enough access to mental health services. DMHC Director Brent Barnhart, said, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” DMHC says that Kaiser does not do the following:
• Make sure that quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
• Monitor its provider network to ensure that appointments are offered within regulatory timeframes.
• Provide effective action to improve care where deficiencies are identified.
• Provide accurate and understandable mental health education materials, including information about  the availability and optimal use of the plan’s mental health care services.

The plan’s mental health educational materials, including frequently-asked-question  sheets, Website postings, and new patient presentations included inaccurate information that could dissuade an enrollee from pursuing medically necessary care. The DMHC also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

The DMHC will conduct a follow-up survey in October to make sure that Kaiser has corrected the deficiencies and is complying with the law. The full survey report can be found here:http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bh031813.pdf.

Last Updated 06/19/2019

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Email:
Jay@ArchApple.com
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul