Medicare Patient News

Updates on services and programs covered under Medicare to help senior patients achieve optimal health.

CMS Launches Concurrent Care Demonstration

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As many as 30 Medicare-certified home health agencies will test a care model that provides palliative support services in their routine home care offerings, in accordance with the Patient Protection and Affordable Care Act.

 

Home health agencies to test palliative care under new CMS program.

Home health agencies to test palliative care under new CMS program.

The Centers for Medicare & Medicaid Services (CMS) announced the launch of the “concurrent care” demonstration under the Medicare Care Choices Model, reports the National Association for Home Care & Hospice (NAHC). Palliative support services will be offered to patients with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements.

Under the demo, patients will “concurrently receive services provided by their curative care providers,” NAHC notes.

Hospices selected for the three-year demonstration will receive $400 per beneficiary per month to provide the palliative care services.

To be selected, hospices must be Medicare-certified and able to “demonstrate experience providing care coordination and/or case management with a network of various types of healthcare providers, as well as shared decision-making to beneficiaries prior to electing the Medicare hospice benefit in conjunction with their referring providers/suppliers,” says NAHC.

Courtesy Home Health Care News

Read more at NAHC


Accountable Care Organizations Improve Care for Medicare Beneficiaries

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More partnerships between doctors and hospitals strengthen coordinated care for Medicare beneficiaries.

Doctors, hospitals and other health care providers have formed 123 new Accountable Care Organizations (ACOs) in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States, according to Health and Human Services Secretary Kathleen Sebelius in a December 2013 announcement.

123 new Accountable Care Organizations join program to improve care for seniors.

123 new Accountable Care Organizations join program to improve care for seniors.

Doctors, hospitals and health care providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. Since passage of the Affordable Care Act, more than 360 ACOs have been established, serving over 5.3 million Americans with Medicare. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs when they meet standards for high quality care. Read more


CMS Clarifies Homebound Criteria

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Homebound Criteria

New homebound definition designed to prevent confusion and foster compliance among health care providers.

The Centers for Medicare and Medicaid Services (CMS) released a clearer definition of homebound to be used when deciding if patients are eligible for home health services under Medicare.

Patients are considered “confined to the home” or “homebound” if they meet these two criteria:

  1. Patients either need supportive devices such as crutches, canes, wheelchairs, and walkers; special transportation; or help from someone else in order to leave their home because of illness or injury, OR have a condition that makes leaving the home medically inadvisable.

2. “There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.”

The new definition, which goes into effect November 19, 2013, will prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to home health agencies in order to foster compliance, CMS says.

View Change Request 8444.

Tips to Remember:

*The designation of homebound is contingent upon a patient’s individual ability – not caregiver support. [Patients may be highly functioning due to caregiver assistance.]

*Homebound does not mean bedbound.

Homebound criteria applied to psychiatric patients:

*Illness is manifested by a refusal to leave the home (e.g., severe depression, paranoia, agoraphobia).

*Due to illness it would be unsafe for the patient to leave the home (e.g., hallucinations, violent outbursts).

NOTE: Psychiatric patients may have no physical limitations.