This month, the Centers for Medicare & Medicaid Services (CMS) are offering a series of Health Insurance Marketplace training webinars. Note: Webinar audio will be delivered over the Internet and will play through your computer speakers, or you can stream audio from a mobile device such as a smart phone or tablet. Health Insurance Marketplace 101 This webinar is for people who want to better understand the basics of the Health Insurance Marketplace. It includes an overview of the accomplishments of the Affordable Care Act and a basic introduction to the Marketplace (Exchanges), highlighting who is eligible and how the…
Facing major budget and staff cuts, federal officials are scaling back several high-profile health care fraud and abuse investigations, including an audit of the state insurance exchanges that are set to open later this year as a key provision of the Affordable Care Act. The Department of Health and Human Services’ Office of Inspector General, which investigates Medicare and Medicaid waste, fraud, and abuse, is in the process of losing 400 staff members, about 20 percent of its workforce from its peak strength of 1,800 last year. About 200 will have departed by the end of the year, and the…
When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, he stated, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations.” As a result of these two programs, millions of Americans have been able to gain access to the…
Join David Wingate as he presents recent and upcoming changes in the laws and regulations and how this will affect care providers and individuals who require care on a short-term or long-term basis.
CMS summarizes the basic requirements for Medicaid administrative claiming for the state LTCO program. The ombudsman program is partially funded through the Older Americans Act (OAA), however the bulletin draws attention to activities that may qualify for Medicaid administrative funding. In the bulletin, CMS notes that some states are expanding the populations served by the LTCO program to include individuals receiving LTSS in their own homes and the community. The LTCO program activities that may be eligible for Medicaid administrative funding include: · Tracking and reporting consumer requests for assistance in obtaining medical, dental, mental health or long-term care (including…
On May 21, CMS issued a guidance to states using 1115 demonstrations or 1915(b) waivers for managed long term services and supports programs and a summary of managed long-term services and supports programs essential elements. Review the informational bulletin and the two newly released documents.
The Republican-majority Texas House and Senate sent Gov. Rick Perry (R) a proposal to prevent the state from expanding its Medicaid program as outlined by President Barack Obama's health care reform law. Perry, a Republican, notified the Obama administration last summer his state would not expand Medicaid, which provides health care for low-income people. He repeated his opposition in an April news conference at which he called expansion "foolish." The proposal, an amendment to a Medicaid-related bill, says state health officials "may only provide medical assistance to a person who would have been otherwise eligible for medical assistance or for…
Planning ahead seems daunting – but if you take it step by step, it is really not so bad! First you organize, then you decide what you want, and then you sign the appropriate documents. Get Organized! Below are some specific strategies for gathering and keeping the information you need to make a thorough plan. If you don't gather this information, it can take weeks if not months for someone else to make sense of your organizational system (or lack of a system). Some of this information you need to make a plan and some of this information you will…
Spring is often a time for gatherings with family and friends – weddings, graduations, Mothers’ Day. Nursing home residents often want to participate in these gatherings but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. This is not true. The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not,…
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