December 2011

New Affordable Care Act Demonstration to provide care at home for Medicare patients

Source: Centers for Medicare & Medicaid Services (CMS).

Up to 10,000 Medicare patients with chronic conditions will now be able to get most of the care they need at home under a new demonstration announced by the Centers for Medicare & Medicaid Services (CMS).

“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner.

Created by the Affordable Care Act, the new Independence at Home Demonstration greatly expands the scope of in-home services Medicare beneficiaries can receive. The Independence at Home Demonstration will provide chronically ill patients with a complete range of primary care services.   Participation in the Demonstration is voluntary for Medicare beneficiaries.

“In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” said Tavenner. “When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided.”

CMS will join with medical practices to test the effectiveness of delivering primary care services in a home setting on improving care for Medicare beneficiaries with multiple chronic conditions.  Medical practices led by physicians or nurse practitioners will provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations.

The Demonstration will reward healthcare providers that show a reduction in Medicare expenditures through an incentive payment if they succeed in providing high-quality care while reducing costs.  CMS will use quality measures to ensure beneficiaries experience high quality care. 

Medical practices eligible to participate in the Demonstration must include physicians or nurse practitioners who have experience delivering home-based primary care.  Up to 50 practices will be selected and each must serve at least 200 Medicare fee-for-service beneficiaries with multiple chronic conditions and functional limitations.  Practices in the demonstration will be responsible for coordinating patient care with other health and social service professionals. 

The new demonstration is one of a series of CMS initiatives to build a Medicare program that offers beneficiaries better care and better health at an affordable cost.  It will be supported by the CMS Innovation Center, which was created by the Affordable Care Act to develop and test new models of health care delivery and payment, and disperse best practices throughout the health care system. 

Applications and Letters of Intent, if applicable, are due on February 6, 2012. Additional information about this demonstration, including how to apply, can be found at

http://www.cms.gov/DemoProjectsEvalRpts/downloads/IAH_FactSheet.pdf

November 18, 2011

The Future of Medicare and the Super Committee

President Obama announced that he will not support any bills that limit or repeal the across-the-board spending cuts that will automatically be triggered after November 23rd if the Joint Deficit Reduction Committee fails to pass the required recommendations to cut the federal deficit by $1.2 trillion over the next ten years.

Proposals are being considered by the Joint Deficit Reduction Committee to raise Medicare cost-sharing and means test premiums for higher-income Medicare enrollees.  

Among the more popular measures under consideration are combining the Part A and Part B deductible into one $550 annual deductible, imposing a 20 percent coinsurance on all services up to a $5,550 annual limit, and raising premiums in more affluent enrollees. 

November 1, 2011

Medicare expands coverage of cardiovascular disease prevention services

The Centers for Medicare & Medicaid Services (CMS) today announced that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease.  This new coverage policy will add to the existing portfolio of free preventive services that are now available for people with Medicare, thanks to the Affordable Care Act.  It contributes to the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next five years.

“Access to preventive services helps Medicare beneficiaries identify health risk factors and disease early to provide greater opportunities for early treatment,” said CMS Administrator Donald M. Berwick, M.D.  “CMS continues to carefully and systematically review the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.” 

To view this press release in its entirety, please visit CMS’ news page at: 

http://www.cms.hhs.gov/apps/media/press_releases.asp

September 15, 2011

Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011

Source: Department of Health and Human Services (HHS). Click here for FULL Media Press Release – http://www.hhs.gov/news

The Department of Health and Human Services (HHS) announced that on average, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent.  Of people with Medicare, 99.7 percent continue to enjoy access to a Medicare Advantage plan, and benefits remain consistent with those offered in 2011.  This follows an earlier announcement that average prescription drug plan premiums will remain virtually unchanged in 2012.

In 2012, all beneficiaries will have access to Medicare-covered preventive services without paying a co-pay or deductible, including an Annual Wellness Exam with their physicians.  Those who reach the donut hole will enjoy deep discounts on brand name drugs and expanded coverage for generic drugs under provisions of the Affordable Care Act.

This year marks an important change in Medicare’s annual open enrollment, the time period during which people can choose to change plans or shift from Medicare Advantage to Traditional Medicare. Open Enrollment starts earlier – on October 15, 2011 – and lasts longer (7 full weeks) to give beneficiaries more time to review and make changes to their coverage. As a result, however, beneficiaries will need to make their elections for next year’s Medicare coverage by December 7, 2011 rather than the usual December 31.