News Briefs
News Briefs
Clinton’s latest Medicare plan outlined
When Clinton’s plan for Medicare was unveiled recently, it included some fundamental changes in the program’s structure, changes which the White House says will add $374 billion to the coffers over the next decade. Should the White House proposal make it through Congress, it would mark the first time that HMOs would be allowed to compete on prices charged to Medicare beneficiaries.
Moreover, beneficiaries would be allowed to keep 75 cents on every dollar saved as the result of choosing a low-cost HMO, and companies would be offered government incentives to continue providing health care to retired employees. Perhaps most significant are portions of the plan concerning coverage for prescription drugs for the elderly.
Under Clinton’s plan, the prescription program would be voluntary and begin in 2002. During the first year, beneficiaries would pay $24 a month for a total of $288 a year with Medicare covering half the costs of the beneficiary’s drugs up to an initial limit of $1,000 on the first $2,000. Each year after that, premiums would rise until reaching $44 a month in 2008 and an annual maximum of $2,500 or half of drug expenses up to $5,000.
Low-income beneficiaries (less than $17,000 for a couple) would not be required to pay either the premiums or their share of the beneficiary’s drug costs.
Other proposed changes include: raising the $100 annual deductible to match consumer prices; requiring beneficiaries to pay 20% of the cost of laboratory services; and eliminating all co-payments, deductibles, and other charges for Medicare-covered preventive services such as breast, colon, and prostate cancer screenings.
Case management groups getting new standards
The American Accreditation HealthCare Commission/URAC recently approved a system of standards to which organizations (whether stand-alone or part of a larger managed care service) or programs that provide case management services by phone or on-site must adhere.
These standards cover the areas of staff structure and qualifications, quality improvement, information management, oversight of delegated function, ethics, complaints, and the entire case management process.
Case management organization will now have to establish a means of assessing, planning, and implementing case management interventions as well as addressing ways of ensuring that appropriate patient protections — informed consent, patient confidentiality, and dispute resolution, for example — have been established.
Suppliers secure new contracts
Diversified Senior Services in Winston-Salem, NC, has selected In Home Health to provide medical and personal care to the more than 1,000 residents of the companies housing facilities. In Home Health is a publicly traded home nursing company based in Minnetonka, MN.
Olsten Health Services of Melville, NY, has named Alere Medical in San Francisco as its provider of in-home monitoring services for patients with congestive heart failure. Alere’s technology ensures that weight and symptom data will be transmitted daily over the phone lines.
A one-year contract worth an estimated $200,000 in revenues was signed by Beckett Healthcare in Philadelphia in which the home medical equipment supply company has agreed to provide respiratory, pediatric, and rehabilitation therapy to the patients of two Pennsylvania companies — Crozer-Chester Medical Center in Upland and Delaware County Memorial Hospital in Drexel Hill.
Sierra files motion against Universal/Valley Health
Sierra Health Services in Las Vegas and its subsidiaries have filed a motion for a preliminary injunction against Universal Health Services and Valley Health System (including Las Vegas-based Valley Hospital Medical Center, Desert Spring Hospital, and Summerlin Hospital Medical Center) claiming that the defendants’ practices have negatively affected their health plan patients’ care and financial well-being.
Specifically, Sierra claims: Valley Health System hospitals have failed to notify company plans when a member is receiving emergency care or has been recommended for hospital admission; Sierra case management professionals are denied access to three hospitals and therefore cannot adequately conduct case management and care coordination planning; and lastly, the defendants are "balance billing" Sierra members for services rendered even though they have already been reimbursed by Sierra at a predetermined contract rate.
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