Category Archives for Medicare

Bill Seeks to Soften Impact of Medicare Cuts

Published in Pawtucket Times on September 23, 2002

One week to go before the new federal Medicare cuts go into effect – cuts that will slash $1.7 billion in 2003 funding for the developmentally disabled and frail seniors in nursing facilities.

According to the American Health Care Association (AHCA), over the next two year’s cumulative Medicare cuts, called the “Medicare Cliff,” will total a whopping $5.2 billion.

Meanwhile, AHCA, representing 12,000 nonprofit long-term care providers, has been lobbying Congress for federal relief from the draconian reductions.

A new ad appearing in the Capitol Hill newspaper, Roll Call, reminds lawmakers that the upcoming cuts could lead to reduced nurse staffing and puts residents at risk.

In the upcoming November elections, voters might just get riled up too, over Medicare being cut by 10 percent, says AHCA.

The Roll Call ad notes a recent national survey of 800 persons found that 84.6 percent of the respondents opposed cutting Medicare funding for nursing facility care by 10 percent.

Additionally, 64.1 percent were less likely to vote for a candidate running for Congress if they knew that the candidate “voted to cut Medicare funding for nursing facility for nursing facility care by billions.”

Charles H. Roadman, II, M.D., AHCA’s president and CEO noted that a recent study by the University of North Carolina School of Public Health confirms the devastating impact of the impending Medicare cuts.

The study says that cuts could lead to reduced numbers of staff caring for seniors in nursing facilities, thus jeopardizing quality of care.

“At a time when the Centers for Medicaid and Medicare Services (CMS) and nursing care providers are actively pursuing efforts to improve the quality of care in nursing facilities throughout the nation, new federal cuts to Medicare are inconsistent with achieving this important goal,” says Dr. Roadman.

Roberta Hawkins, executive director of the Alliance for Nursing Home Care and state ombudsman agree with Roadman’s assessment.

“Huge Medicare cuts pull the carpet from under the federal quality initiatives that take effect across the country in October,” she tells All About Seniors. “The right hand of the federal government does not seem to know what the left hand is doing.”

According to Hawkins, the staffing shortage in Rhode Island is having a drastic impact on the quality of care delivered to more than 10,000 residentes.

“The upcoming Medicare cuts combined with an outdated Medicaid payment system will only further compromise patient care in the Ocean State,” she says.

U.S. Rep. James Langevin and House colleagues today announced a legislative fix that would delay scheduled cuts for nursing facilities and assisted living facilities in Rhode Island.

Langevin is co-sponsoring the Medicare Skilled Nursing Beneficiary Protection Act, sponsored by Congressman Tom Allen (D-ME), that would extend Medicare reimbursement add-ons for three years, through 2005, to allow the Bush administration more time to implement an adequate reimbursement formula for skill nursing facilities.

Langevin and the other bill sponsors hope this new timetable will obviate the need for further cuts in Medicare reimbursement rates, which would place severe financial burdens on nursing facilities.

Langevin stated that unless Congress acts this year, Medicare funding for skilled nursing care will be cut by 10 percent in 2003 and 19 percent in 2004 – translating to cuts of nearly $ 35 per patient per day in 2003 and $68 in 2004.

The Rhode Island congressman believes that in the Ocean State, the Medicare cuts will be even greater than the national average totaling $ 38.81 in 2003 and $ 76.90 in 2004.

“Difficult decisions were made in 1997 with passage of the Balanced Budget Act, and some of the changes were not implemented as Congress intended,” Langevin said. “The Medicare Skilled Nursing Beneficiary Protection Act will postpone further cuts and ensure that critical funding remains available for thousands of Rhode Islanders who rely on skilled nursing services.”

According to Langevin in mid-1998, the new Medicare prospective payment system (PPS) was implemented for skilled nursing care, as mandated in the 1997 Balanced Budget Act (BBA).

He noted that the new system resulted in cuts far deeper than intended by Congress.

In 1999 and 2000, Congress temporarily restored some of the unintended cuts as part of the Balanced Budget Refinement Act (BBRA) and the Benefits Improvement and Protection Act (BIPA).

These temporary add-ons helped restore beneficiary access to care, but overall Medicare funding levels for skilled nursing facilities continue to be below BBA projections, Langevin said.

“I am wholly committed to making the restorations of 1999 and 2000 permanent,” he said.

“We cannot turn our backs on a generation who built and defended the very foundation of this nation. They answered the call of our nation -now we must answer theirs.”

Kennedy Must Lead Fight Against Medicare HMO Rate Hikes

Published in The Pawtucket Times on November 19, 2001

Across the nation, seniors who have enrolled in Medicare HMOs are getting hit hard in the pocketbook.  Premiums and copays for hospital care, nursing services and prescription drugs are skyrocketing. Complaining about inadequate federal funding offered to provide health care services to seniors, a growing number of Medicare HMOs are opting out of the program, leaving their senior enrollees high and dry.

In Rhode Island, seniors are also seeing this alarming trend. Last year, United Healthcare discontinued its Medicare Plus Choice program, first in Newport County, then in Bristol County.  Now Blue Cross Blue Shield of Rhode Island (BCBS) informs its seniors that higher premiums and copays come next year for two of their three BlueCHiP for Medicare plans. The increases include prescription drugs, inpatient care, skilled nursing services, and more. The added out-of-pocket costs impacts about 41,000 seniors across the state.

However, Rep. Patrick Kennedy (D-RI) is not buying BlueCHiP’s request for a rate increases.

In a strongly worded letter Tom Scully, the administrator of the Centers for Medicare and Medicaid Services, the agency charged with overseeing the Medicare program, the Rhode Island congressman strongly protested the rate hikes.

He called on the federal official to investigate whether the current market for Medicare HMOs in Rhode Island has created a situation where the types of increases charged by BCBS are more likely to occur and be approved.

Furthermore, he requested a review to determine if the increases are actuarially sound.

Scott Fraser, BCBS spokesperson, acknowledges that the premium increases of the two BlueCHiP plans were the result of higher medical costs passed onto the BlueCHiP plans by hospital and other medical providers. “It’s medical inflation,” he quips, adding that even higher medication costs charged by drug companies has resulted in an increase in drug copays.

Even with next year’s increases, the BlueCHiP plans will not increase the premiums for the most commonly used services, specifically physician visits, laboratory tests and X-ray services, Fraser adds. “These co-pays have been the same for the last three years.”

CMS has reviewed BCBS’s application for the changes in rates and benefits over the summer, says Fraser, adding that the rate increase was given a thumbs up by the Feds.

Are BCBS’s rate increase actually sound thus justifiable?

CMS spokesperson Peter Ashkenaz told All About Seniors “the fact that the request has been approved by CMS speaks for itself. If the costs seem to be higher than what would be paid for in fee-service Medicare, we would have questioned them.”

Ed Zesk, president of Aging 2000, a non-profit consumer advocacy group. Believes that Rep. Kennedy has asked the right questions in his letter to CMS, specifically, “Are these premium and deductible increases justifiable?”

“Consumers just don’t have access to that type of information, Zesk said.

With Medicare reform now on the back burner as the nation gears up to fight terrorism, Rep. Kennedy must use his position on the House Appropriations Committee and Subcommittee on Labor, Health and Human Services and Education, to address the rising out-of-pocket healthcare costs for Medicare HMO enrollees. As the Congressional elections approach, seniors will want to see concrete congressional action leading to meaningful Medicare reforms.

Kennedy Must Lead Fight Against Medicare HMO rate Hikes

Published in the Pawtucket Times on November 19, 2001

Across the nation, seniors who enrolled in Medicare HMOs are getting hit hard in the pocket book. Premiums and co-pays for hospital care, nursing services and prescription drugs are skyrocketing. Complaining about the inadequate federal funding offered to provide health care services to seniors, a growing number of Medicare HMOs are opting out of the program, leaving their senior enrollees high and dry.

In Rhode Island, seniors are also seeing this alarming trend. Last year, United Healthcare discontinued its Medicare Plus Choice program, first in Newport County, then in Bristol County. Now Blue Cross and Blue Shield of Rhode Island BCBSRI) informs its seniors that higher premiums and copays come net year for two of their three BlueCHiP for Medicare plans. The increases include prescription drugs, inpatient care, skilled nursing services and more.  The added out-of-project costs impact about 41,000 seniors across the state.

However, Rep. Patrick Kennedy (D-RI) is not buying  BlueCHiPs request for rate increases.

In a strongly worded letter to Tom Scully, the administrator of the Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing the Medicare program, the Rhode Island congressman strongly protested the rate hikes.

He called on the federal official to investigate whether the current market for Medicare HMOs in Rhode Island has created a situation where the types of increases charged by BCBSRI are more likely to occur and be approved.

Furthermore, he requested a review to determine if the increases are actuarially sound.

Scott Fraser, BCBSRI spokesperson, acknowledges that the premium increases of the two BlueCHiP plans were the result of higher medical costs passed onto the BlueCHiP plans by hospitals and other medical providers. “It’s medical inflation,” he quips, adding that even higher medication costs charged by drug companies has resulted in an increase in drug copays.

Even with next year’s increases, the BlueCHiP plans will not increase the premiums for the most commonly used services, specifically physician visits, laboratory tests and X-ray services, Fraser adds.  “These co-pays have been the same for the last three years,” he says.

CMS has reviewed BCBS’s application for the changes in rates and benefits over the summer, says Fraser, adding that the rate increases were given a thumbs up by the feds.

Are BCBSRI’s rate increases actually sound, thus justifiable?

CMS spokesperson Peter Ashkenaz told All About Seniors “the fact that the request has been approved by CMS speaks for itself. If the costs seem to be higher than what would be  paid for in fee-for-service Medicare, we would have questioned them.”

Ed Zesk, president of Aging 2000, a non-profit consumer advocacy group, believes that Rep. Kennedy has asked the right questions in his letter to CMS, specifically, “Are these premium and deductible increases justifiable.”

“Consumers just don’t have access to that type of information,” Zesk said.

With Medicare reforms now on the back burner as the nation gears up to fight terrorism, Rep. Kennedy must use his position on the House Appropriations Committee and the Subcommittee on Labor, Health and Human Services and Education to address the rising out-of-pocket health care costs for Medicare HMO enrollees.  As the Congressional elections approach, seniors will want to see concrete congressional action, leading to meaningful Medicare reform.