Hospitals Get Behind Bill Notifying Patients About Medicare ‘Observation Care’
In the meantime, a rift between advocates and insurers and states opens over a Medicaid managed-care rule on long-term care, and the Justice Department hires a compliance expert to more closely monitor health care fraud.
Providers Back Bill Notifying Medicare About Observation Stays
Healthcare providers are expressing support for legislation overwhelmingly approved by Congress requiring hospitals to notify Medicare patients when they are receiving observation care but have not been admitted. The bill is a partial response to the problem of beneficiaries facing sticker shock when they go to a skilled nursing or rehab facility after leaving the hospital and finding that Medicare won't cover the tab. That's because to qualify for skilled-nursing facility coverage, beneficiaries must first spend three consecutive midnights as an admitted patient in a hospital; observation days don't count. Another common issue is beneficiaries facing unexpected Medicare Part B co-pays for drugs received during hospital care, since they were never actually admitted into the hospital and the drugs therefore are not covered under Part A. (Dickson, 7/30)
Advocates Split With Health Plans, States Over Medicaid Long-Term Care Rules
Patient advocates are praising a section of the CMS' proposed Medicaid managed-care rule related to long-term care. But health plans and states are sharply critical of provisions imposing new credentialing requirements on long-term care providers and allowing beneficiaries to opt out of managed care if their provider is not in a health plan's network. The CMS included in the proposed rules a provision requested by patient advocates that allows beneficiaries enrolled in managed long-term care services and supports to switch plans or switch to fee-for-service Medicaid if their provider is out of network. Health plans blasted that provision. (Dickson, 7/30)
U.S. Justice Department Hiring Compliance Expert
The U.S. Department of Justice is in the process of hiring a compliance expert to help evaluate whether to charge corporations that fail to detect and prevent wrongdoing by employees, a top department official said on Thursday. Weissman said the fraud section will increasingly focus on compliance in health care, noting that companies need the tools to spot illegal transactions such as Medicaid referral payments disguised to get around anti-kickback statutes. (Freifeld, 7/30)