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The addition of mid-level providers to the health care continuum and the development of off-site delivery has created new insurance coverage problems. Fran O'Connell, R.N., vice president of Shand Morahan & Company Inc., explains what to look for in coverage based on the level of care provided and the variety of care centers in use.
Home health care is a compassionate, cost-effective, and practical alternative for some individuals who require long-term or constant care. However, the coverage of home health care costs is far from comprehensive under the Medicare, Medicaid, and private pay systems. A uniform and comprehensive coverage system is necessary.
This final rule stipulates the requirements for coverage of and payment for pediatric and family nurse practitioner services under the Medicaid program. The coverage of these additional services under the Medicaid program increases the availability and accessibility of medical care for specified Medicaid recipients. This final rule adds to the Medicaid regulations provisions of sections 1902(a)(10)(A) and 1905(a)(21) of the Social Security Act, as amended by section 6405 of the Omnibus Budget Reconciliation Act of 1989.
This study explores how a health maintenance organization's (HMO) capacity and incentives to manage care might be used to improve access. In the early 1990s, the Florida Healthy Kids (FHK) demonstration extended Medicaid-like HMO coverage to indigent children in the public schools of Volusia County, Florida. The study finds that uninsured student months in area public schools were likely reduced by one-half. Utilization and cost levels for these indigent enrollees proved to be indistinguishable from commercial clients; and measures of access, utilization, and satisfaction for enrollees were in line with (and in some cases, superior to) non-enrollees with private insurance. Overall, these results suggest the value of using schools as a medium for providing coverage, and the importance of taking deliberate steps to manage access to reduce non-financial barriers to care.
This notice announces the withdrawal of Medicare coverage for certain investigational intraocular lenses (IOLs). Medicare coverage of IOLs that have received approval by the Food and Drug Administration (FDA) will continue to be covered by Medicare, as well as certain other IOLs that are awaiting FDA approval.
In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.
With the enormous increase in the cost of healthcare, especially for catastrophic illnesses, employers have begun to modify their healthcare insurance plans to limit the amount of coverage an employee can receive for treatment of a particular illness, such as AIDS and its related illnesses. The passage of the Americans with Disabilities Act in 1990, however, prohibits an employer from discriminating against disabled individuals with respect to healthcare benefits even if the employer's healthcare plan is not administered by the employer. Thus, it is important for healthcare providers to actively investigate healthcare claims prior to a patient's admission to a hospital to determine whether adequate coverage exists--and to what extent it exists--for treatment of the patient's illness and how and from whom the hospital will be compensated.
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The effective date for qualifications of insurers providing liability insurance used to satisfy liability coverage requirements applicable to owners or operators of hazardous waste management facilities, as such requirements are included in 40 CFR Parts 264 and 265, is extended from July 15, 1982, to October 16, 1982. The effective date for the rest of the liability coverage requirements remains July 15, 1982. This extension is being provided to allow 6 months between the date of promulgation and the effective date for the insurer qualification provision, in accordance with Section 3010(b) of the Resource Conservation and Recovery Act of 1976, as amended. During the period between July 15 and October 16, 1982, owners or operators may use certificates of insurance or policy endorsements that do not certify to the qualifications of the insurer.
These regulations would expand Medicare coverage of services furnished by optometrists to include examination services related to the condition of aphakia (absence of the natural lens of the eye). Under our current regulations, Medicare coverage of optometric services is limited to dispensing services in connection with the actual fitting and provision of prosthetic lenses. The regulations are necessary to conform our existing Medicare regulations to a statutory change made by section 937 of the Omnibus Reconciliation Act of 1980.
This notice announces a HCFA ruling that restates Medicare policy for the coverage of the drug dimethyl sulfoxide (DMSO). DMSO is a covered service only when administered for the treatment of interstitial cystitis. This HCFA ruling assures uniform Medicare policy on the coverage of DMSO.
These regulations conform existing Medicare regulations to a statutory change that expanded Medicare coverage of services furnished by optometrists to include examination services related to the condition of aphakia (absence of the natural crystalline lens of the eye). Existing regulations limit coverage of optometrists' services to dispensing services in connection with the actual fitting and provision of prosthetic lenses. The regulations are based on section 937 of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499).
The Medicare Catastrophic Coverage Act of 1988 (MECCA) significantly enlarges the scope of federally funded health care benefits for elderly Americans. Since Medicare's inception in 1965, several inadequacies have become apparent, especially the absence of coverage for catastrophic illnesses. Now MECCA inhibits the potential financial ruin of elderly Americans faced with overwhelming, extended medical costs. The Act is budget-neutral and can reduce employers' Social Security payroll tax costs. However, the costs and complications of the maintenance-of-effort provision refunds and potential employee resistance to raised Medicare premiums, which could force some beneficiaries to cancel Part B participation and increase reliance on employer-sponsored plans, do pose problems for employers. Options and alternatives to these new opportunities and concerns are detailed herein.
The increase in arbitrary Medicare coverage denials has resulted in the degradation of American medical care. In this article, the authors discuss the positive impact of one Connecticut case, Fox v. Bowen, on the effort to end improper coverage denials.
These proposed regulations would amend the requirements for coverage of certain groups of individuals under Medicaid and the requirements for determining Medicaid eligibility. The amendments would implement or conform the regulations to various statutes, including the Tax Equity and Fiscal Responsibility Act of 1982, the Omnibus Budget Reconciliation Act of 1987, and the Medicare Catastrophic Coverage Act of 1988. The amendments also would make some administrative changes to achieve more efficient operation of the Medicaid program.
This notice announces the monthly actuarial rates for aged (age 65 or over) and disabled (under age 65) enrollees in the Medicare supplementary medical insurance (SMI) program for calendar year 1990, and the monthly SMI premium rate based on these actuarial rates to be paid by all enrollees during calendar year 1990. The 1990 monthly SMI premium will be increased from $27.90 to $29.00. This notice also announces the catastrophic coverage monthly premium for 1990 imposed by the Medicare Catastrophic Coverage Act of 1988 (Pub. L. 100-360).
By several measures of health status, the Medicaid population is in worse health than are persons without Medicaid. In addition, poor persons without Medicaid coverage are in poorer health than those who are not poor. Use of health services among those in poor health shows Medicaid eligibles use services at a level comparable to those who are not poor and without Medicaid. Among the poor without Medicaid, the reduced likelihood of seeing a physician and purchasing a prescribed drug indicates the importance of Medicaid coverage in obtaining access to care.
A new mucogingival surgical technique for root coverage is proposed. Two kinds of flaps were obtained from the tissue surrounding the recession: the first, a partial thickness-epithelial connective flap, was designed to cover the second flap, which was a connective double-papilla flap positioned directly on the root surface. This technique was used to treat 11 cases of gingival recession ranging from 3 to 5 mm. After a period of 12 months, the mean root coverage was 84% with an average recession reduction of 2.7 mm, and the keratinized gingiva obtained was adequate in width and in thickness. The advantages of the suggested surgical technique are: (1) a single-step procedure is used, (2) there is no need for a second donor site, and (3) the achievement of a good final esthetic result with uniformity in the color and morphology of the flap relative to the surrounding tissues.