Your Weekly Medicare Consumer Advocacy Update
Decreases in Medicare Spending are Good News for Beneficiaries
New Data Reveals Reductions in Medicare Spending
A recent report from the Kaiser Family Foundation (KFF) reveals good news for Medicare advocates and beneficiaries alike. Medicare spending has decreased significantly between August 2010 and April 2014. The article explains that Medicare will spend approximately $1,000 less per person in 2014 than was originally projected in August 2010. What’s more, Medicare spending per capita is expected to drop even further. The projected spending per person in 2019 is $2,400 lower than was expected.
Much of the credit for the spending slowdown is given to the Affordable Care Act (ACA). Signed into law in 2010, the ACA included payment reforms intended to contain Medicare costs. These reforms include reductions in overpayments to Medicare Advantage plans, reduced payments to hospitals that do not meet quality and efficiency standards, and incentives for primary care providers who regularly report data to the Centers for Medicare & Medicaid Services (CMS). Already several ACA reforms are producing results: CMS reports large drops in hospital readmissions between January 2012 and August 2013, indicating that hospitals are better coordinating patient care.
Said Joe Baker, president of the Medicare Rights Center, in a March 2014 statement: “The ACA tackles the systemic causes of rising costs in the Medicare program, and so far the results are promising. Most importantly, the ACA demonstrates that the federal government can contain costs without shifting even higher health care costs to beneficiaries, all while improving Medicare benefits. Continued implementation of the Affordable Care Act is essential to preserving and strengthening Medicare for today’s and future beneficiaries.”
Proposed Legislation to Reform Post-Acute Care
Health care providers, advocates, and Medicare beneficiaries have long had difficulty comparing the quality and appropriateness of different post-acute care options. Post-acute care includes care provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. To confront this problem, a bipartisan bill was recently introduced in both the Senate and the House of Representatives. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) seeks to improve post-acute care by first improving data reporting across post-acute care settings. These data can then be used to adjust Medicare post-acute care payments as needed and improve quality of care.
A draft of the IMPACT Act of 2014 was released earlier this year and incorporates input from more than 70 stakeholders. According to a Senate Committee on Finance press release, this bipartisan, bicameral legislation seeks to require “data standardization to enable Medicare to:
- Compare quality across different post-acute care (PAC) settings;
- Improve hospital and PAC discharge planning; and
- Use this information to reform PAC payments (via site neutral or bundled payments or some other reform) while ensuring continued beneficiary access to the most appropriate setting of care.”
Overall, the pending legislation has two goals. The first is to help providers more effectively determine the post-acute care setting that is most appropriate for a Medicare beneficiary using quality and cost data. The second is to allow Medicare to examine post-acute care payments to encourage the continual improvement of care quality while decreasing costs.
Volume 5, Issue 27
Medicare covers skilled nursing facility (SNF) care in certain situations. SNF care includes care in Medicare-certified nursing homes and inpatient rehabilitation facilities. Medicare will only cover SNF care if:
- You need skilled nursing care seven days a week or skilled therapy services at least five days a week;
- You were formally admitted as an inpatient to a hospital for at least three consecutive days;
- You enter a Medicare-certified SNF within 30 days of leaving the hospital;
- You have Medicare Part A before you are discharged from the hospital; AND
- You need care that can only be provided in a SNF.
If you meet these requirements, Medicare should cover the skilled nursing facility care needed to improve your condition, maintain your ability to function, and/or help to prevent the worsening of your condition. Medicare only covers up to 100 days in a SNF per benefit period.
The National Seniors Citizens Law Council (NSCLC) is introducing a free webinar series covering changes affecting same sex-couples in the wake of the overturn of the Defense of Marriage Act (DOMA). Following the Supreme Court’s ruling in United States v. Windsor, overturning DOMA, several government agencies issued rules about how the decision affects same-sex couples’ eligibility for different programs. NSCLC’s webinar series delves into potential changes to same-sex couples’ eligibility for Social Security benefits, Supplemental Security Income (SSI), Medicare, Medicare low-income programs, Medicaid, and more. To register for the webinar series, taking place on July 22, 2014 and July 23, 2013 at 2:00 p.m. (EST), please click on the links provided below.