Medicare Watch

CMS Releases Proposed Rules for Medicare Payments

On July 1, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the 2012 Medicare physician fee schedule, which will set next year’s Medicare payment rates for physicians and other practitioners. According to CMS, rates in the proposed rule must be based on the current payment landscape, which includes an almost 30 percent cut in provider payment rates as a result of the Sustainable Growth Rate (SGR) enacted by the Balanced Budget Act of 1997. Congress has taken action in the past to prevent cuts based on the SGR, many times at the last minute, but no action has been taken as of yet for cuts that are due to go into effect in 2012. 

The proposed rule, which is released annually, also covers clarification and modifications to other policies. The rule includes further guidance on the criteria for a health risk assessment to be used with the Annual Wellness Visit, which was implemented in January 2011 as a result of the Affordable Care Act (ACA). The aim of the assessment is to create a comprehensive wellness and prevention plan and encourage the use of preventive services that are historically underutilized by people with Medicare. In addition, the proposed rule expands covered telehealth services to include smoking cessation, and further alters the parameters under which services may be added to the telehealth list in the future. Furthermore, the rule provides updates to the ePrescribing Incentive Program, the Electronic Health Records Incentive Program and other quality incentive programs that will take effect in the future.

CMS has also issued proposed rules that cover payment rates for home health and for outpatient care in hospitals and ambulatory surgical centers. Comments on the proposed rule to the physician fee schedule and outpatient hospital care are due August 30, 2011. Comments on proposed changes to home health payment rules are due September 6, 2011.

Read CMS’s press release on the proposed rules.

Read CMS’s fact sheets on the proposed rules.

Leadership Council of Aging Organizations Releases Budget Principles

Any budget agreement to reduce the deficit must take a balanced approach and preserve programs that help older Americans, according to budget principles approved this week by the Leadership Council of Aging Organizations (LCAO). LCAO is a coalition of more than 65 organizations, including the Medicare Rights Center, that advocate on behalf of older Americans. 

The budget principles outline parameters that LCAO believes should guide the deficit reduction negotiations that are currently underway. In addition to requiring a balanced approach that includes revenue increases to help avert deep cuts to programs like Medicare and Medicaid, the principles also demand that low- and middle-income Americans, and the programs that serve them, be protected. The principles also state that any final agreement should not make modifications to Medicare and Medicaid that would result in shifting costs to beneficiaries or states. Rather, proposals should address the root cause of spending growth in government health programs: inflation in the health care sector overall.

The budget principles also discuss the importance of protecting other programs that are essential to older Americans’ financial well-being, including Social Security. For 80 percent of older adults with Medicare, Social Security comprises roughly half of their annual income or more. As a result, decreases in Social Security and increases in health costs for those in Medicare would drastically affect the standard of living of current and future older Americans.

Read the LCAO’s budget principles.

Medicare Reminder

Your rights upon admission when a skilled nursing facility (SNF) says that Original Medicare won’t pay for your care will usually depend on whether the SNF will agree to admit you anyway.

• If a SNF will not admit you as a patient because it believes that Medicare won’t pay, you must find another SNF.
• If a SNF will admit you as a patient but believes that you do not qualify for Medicare SNF coverage, you have the right to ask the SNF to bill Medicare anyway. This is called demand billing.
• When a SNF believes that Medicare will not cover your care because your health doesn’t require it or you need only personal or custodial care, the SNF must give you a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) or a form attached to a denial letter. SNFs have a choice of which document they give you. 

Learn more about your rights in a SNF at www.medicareinteractive.org.

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