Medicare and medicaid – Medic Buzz Wed, 05 Jan 2022 23:12:31 +0000 en-US hourly 1 Medicare and medicaid – Medic Buzz 32 32 Legal Experts Look at CMS Vaccination Mandate, SCOTUS Case, Implications for Nursing Homes Wed, 05 Jan 2022 23:12:31 +0000

Nursing home operators remain in limbo as the Supreme Court is due to hear arguments on Friday over the constitutionality of the Centers for Medicare & Medicaid Services (CMS) vaccine mandate.

Healthcare litigators and other legal experts expect it will be much easier to repeal previously ordered lower court injunctions, compared to those made regarding the Occupational Safety and Health Administration rule. (OSHA).

Cases challenging the legality of the CMS and OSHA vaccine warrants will be heard by the High Court on Friday, after government agencies appealed lower court rulings.

SCOTUS is not yet determining whether the vaccine’s mandate is constitutional, instead it will decide whether either mandate should remain in place while cases unfold in court.

Three of four CMS-related lawsuits resulted in injunctions temporarily blocking the warrant in 25 states, while a Florida federal judge issued the only ruling allowing the warrant to remain in effect while the case unfolds in court. .

CMS has appealed the injunctions in federal courts in Missouri, Louisiana and Texas, citing vaccine efficacy and increases in cases involving ongoing and new COVID variants.

Dorit Reiss, professor of law at UC Hastings in San Francisco, said it would be “strange” if the Supreme Court prevented the government agency from assessing and regulating the current health care conditions under surveillance of Congress. Reiss has expertise in healthcare and vaccine law and policy.

“In some ways CMS’s tenure is actually the easiest case for the Supreme Court, as CMS terms are built on a long line of precedent,” Reiss added.

The mandate issued by CMS, originally focused only on nursing homes, requires any healthcare facility with Medicaid and Medicare reimbursement to have its staff vaccinated; the original guidelines requiring 100% vaccination have already passed – the deadline was January 4.

A subsequent memo from the agency gave the facilities increased flexibility for operators with widely varying vaccination statistics.

If nursing homes meet agency staff immunization rate targets of 80% and 90% within 30 and 60 days, respectively, they effectively have 90 days to fully comply with the CMS mandate.

“It looks really promising to me. Having that kind of ramp is a good bridge between where a lot of nursing homes are today and where they need to go, ”said David Grabowski, professor and policy researcher at. health at Harvard. “We all wish [nursing home staff was] 100% vaccinated today, but that’s not realistic given the timing of it all and the variation from state to state or even the variation from facility to facility. “

CMS currently reports 79% staff vaccinated and 87.2% residents per facility, via data submitted for the week ending December 19.

It’s unclear when a decision will be made, if any, after Friday’s hearing, Reiss said.

“It could be days or months,” Reiss added. “In theory, what happens after the hearing is that the judges do not make an immediate decision. They go to a conference and then they have a majority vote.

Mandate arguments focus on government overbreadth and COVID outbreak

Arguments from lower courts – those in favor of injunctions – centered on the extent of power CMS has to implement the mandate, Reiss said, and criticism of the arbitrary and capricious nature of the mandate. Arguments also noted the lack of a notice and comment period before the mandate is implemented.

“They relied to a large extent on the balance of power between the federal government and the state governments; that should be the heart of the Supreme Court debate, ”explained Reiss. “The argument that the federal government is entering a new and vast domain without clear authorization from Congress.”

SCOTUS hears the arguments in what Reiss calls the “shadow case,” where the court makes decisions on emergency requests without a full briefing or argument.

“This is a big extension of federal power, the federal government is getting involved in areas it has not yet tested, so you need specific authorization from Congress. This is an argument that may have some validity for OSHA, ”Reiss said.

CMS, by comparison, “largely regulates” among healthcare providers who participate in Medicare and Medicaid.

It’s not that far away, Reiss added, for CMS to regulate further when programs already exist to prevent other infectious diseases with disciplinary action involving licensure and repercussions on staff.

CMS’s argument will be based on the effectiveness of vaccines, Grabowski said.

“There is very good data to suggest that when staff are vaccinated it saves the lives of residents,” Grabowski added. “Cases are increasing right now in the country and in nursing homes. We know that the staff vaccinated, obviously, by the extension staff who are fully vaccinated with boosters, it’s going to save lives. The mandate, scientifically, makes a lot of sense. “

Craig Conley, shareholder of Memphis, Tennessee-based Baker Donelson Bearman Caldwell & Berkowitz, is curious to see if the Supreme Court will make tenure decisions based on partisan politics.

“What we’ve seen with the other lower court judges is that the decisions were made on a partisan basis, with the judges conservative against the mandates and the judges more liberal in favor of the mandates,” Conley said. “Right now we have a 6-3 division in the Supreme Court. The question will become: do they respect the law or do they follow political partisanship?

Conley refers to the general Conservative influence on the Supreme Court today, with the recent appointments of Justices Amy Coney Barrett and Brett Kavanaugh.

Implications for nursing homes, their staff and future public health emergencies

The legal precedent will change, Reiss said, if the Supreme Court sides with those challenging CMS’s vaccine mandate or allowing injunctions to remain. With litigation threatening future emergency actions, government agencies will lack the autonomy to deal with such emergencies in real time.

“If the courts say you need specific permission from Congress to impose new ground rules in an emergency, they’re basically saying you can’t act in an emergency unless Congress moves. and that Congress move slowly; it’s designed to move slowly, ”noted Reiss.

Nursing home workers who have been on the fence about the vaccine will likely make their decision whether to get the vaccine or leave the profession, once a final decision on CMS’s mandate is made, Grabowski said. .

On the contrary, the tenure and ensuing lawsuits are the latest crises in an industry plagued with deeply ingrained challenges for some time.

Operators who do not have a long-standing positive work culture and worker-employer trust built over time will be the most affected, Grabowski noted.

“The current crisis is that a lot of staff are leaving because they don’t want to be vaccinated, but that’s on top of a larger crisis… we have underpaid and exploited these workers for a long time,” he said. added Grabowski.

Q&A: Andrew Behrman, CEO of FACHC, on Omicron’s impact on community health centers – State of Reform Tue, 04 Jan 2022 00:34:57 +0000

Andrew Behrman, MBA, is the president and CEO of the Florida Association of Community Health Centers (FACHC), which provides resources such as COVID-19 testing and vaccinations at hundreds of primary and skilled health care centers in federal level (FQHC) across Florida. Across the various clinics, FACHC provides a vital safety net for vulnerable populations, including Medicaid and Medicare.

During the week of December 24-30, the Florida Department of Health reported nearly 300,000 new cases of COVID, double the number of cases of the Delta variant on the rise this summer. In this Q&A, Behrman will discuss the impact of the Omicron variant on the FACHC network and policy solutions that would continue to secure access to care for vulnerable communities in Florida.

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Nicole Pasia: How does the Omicron variant impact your work and the communities you serve?

Andrew Behrman: “Community health centers, the populations we serve, are the populations of the safety net – underserved, uninsured, Medicaid, Medicare. In many places, these are patients with significant co-morbidities. Their management of chronic disease is a challenge for themselves as well as for the providers who provide primary health care services to these patients. So, anytime you come across issues related to chronic disease management situations like this, whether it’s Omicron or Delta or whatever, the sensitivities to these issues are exacerbated by the fact that you have the management of chronic diseases such as hypertension, diabetes, etc.

So, for our patients, we are fully aware of the potential they have, perhaps a little more than the general population. So of course for us, because we have a patient population with which we are in constant contact, our centers have made enormous efforts to ensure that people come to be vaccinated because they know what the value is for them, for the patient they serve. So this is a big problem. Omicron is a different variant. We’ll probably see another variation after this one. But again, I think my most important comment is that staying the course on testing and making sure vaccinations are available to people and getting them done is the best way to do it. And of course, wearing a mask and so on and so on. But when it comes to the patient getting tested and vaccinated, health centers are pushing him to do so. “

NP: Are there any other issues you are concerned about right now?

A B: “Staffing is also a big challenge for us. Hospitals — we all hear about burnout— [it’s] just absolutely awful. That’s a real problem, because it slows down the ability to serve patients, if you will. We had to deal with this like any other health care system. This has been a big problem for us, and we are facing it, but it has been very difficult for the health centers. We have over 800 locations across the state of Florida. It’s a big system for the FQHC. So staffing is a big issue for us.

NP: Whether working with the legislature or other partners across the state, what policies do you hope to see that will help address the labor shortage?

A B: Representative Colleen Burton has shown a keen interest in workforce issues in Florida, particularly in healthcare. This is a godsend for us, because it is the first time in many, many years that we have had the opportunity to engage in a discussion at the legislative level to see what needs to happen. In fact, at the association, I hired a full-time director of workforce development to come and see where we are in terms of workforce development… I’m talking about approaches. much more aggressive in the development of the workforce: models of personal development, making university health centers within the FQHC. The legislature has really stepped up as we enter this session. So I’m pretty excited about it.

Some of the other policies – there’s a lot of confusion around the CMS vaccine mandates and then the state’s no-vaccination and no-masking mandates. All of this is a challenge because we have to serve two masters. We have federal mandates that must be fulfilled in order for us to maintain Medicaid funding. And at the same time, we have the state pursuing a different model on mandates. It puts us in a rock and in a difficult place. We hope that this will take place, finally, at the federal level, where we have no problem to resolve in terms of the choice between the state mandate and the federal mandate. It’s a big problem. But now, [while] we’re waiting to do that, we’re going to stay the course with the CMS requirements for masks, vaccines and things like that. These are challenges that all of our FQHCs have to face on a daily basis.

NP: How do FQHCs manage both their COVID response, as well as their other health services?

A B: “I think it’s important for people to understand that while we are dealing with a pandemic, we still have to provide health services to people. And I know it’s lost in the reshuffle right now, but for the patients we serve, the safety net population, these are the people who really have a hard time accessing health care, whether it’s because that they don’t have insurance, or they don’t have the funds, or they don’t even have transportation. Community health centers are mandated by federal law to ensure that these patients are served. So it’s a little different from where the hospitals are. We are all primary care facilities. The front line, for us, has many faces besides the pandemic we must fight. I think it’s important for people to understand that we continue to provide primary care services to the populations who need them.

This interview has been edited for clarity and length. Image: Florida Association of Community Health Centers

$ 1.1 billion available next year to support hospitals, according to Beshear – The Advocate-Messenger Sat, 01 Jan 2022 06:15:00 +0000

FRANKFORT, Ky. (KT) – Kentucky hospitals that meet federal quality measures can receive up to $ 1.1 billion in additional payments for Medicaid services next year, Governor Andy Beshear said Wednesday.

The funding, available through a federally approved and state-led payment model, helps provide and expand quality health care to the state’s 1.6 million Medicaid members.

With more than a third of Kentucky’s population enrolled in Medicaid, the governor said the payments are key to building a better Kentucky by ensuring equal access to care across the Commonwealth.

“Health care is a basic human right and our people deserve the best possible care,” Governor Beshear said. “This year, our state has faced so much tragedy and heartache from the pandemic, tornadoes and other natural disasters, and we are grateful to our hospitals for continuing to provide quality health care to our families in Kentucky. in need. “

Cabinet Secretary for Health and Family Services Eric Friedlander said this was the second additional funding announcement for Kentucky hospitals in 2021. In January, the governor announced that Kentucky hospitals would receive an additional $ 800 billion to $ 1 billion annually, to help advance quality clinical care. to Medicaid members and provide a stable base for hospitals financially stressed by the COVID-19 pandemic.

Kentucky Hospital Association President Nancy Galvagni said, “On behalf of our members, KHA is delighted that the Centers for Medicare & Medicaid Services has approved the continuation of the Hospital Rate Improvement Program for the calendar year. 2022. The ongoing partnership between CHFS and Kentucky hospitals made this request a success. . “

“Medicaid is the largest payer of health care services in our Commonwealth, and we must continue to think outside the box to bring this program further into the 21st century,” said Lee, Commissioner of Kentucky Medicaid. “This collaboration between Medicaid and KHA is an example of this type of innovative thinking, allowing us to reward our providers for providing quality services to our members. “

The state-led payment initiative will be in place for the whole of 2022 and will need to be renewed annually in the future.

By law in the state of Kentucky, teaching hospitals and public mental hospitals are excluded from this payment increase.

Florida urges appeals court to block Biden rule requiring COVID-19 vaccine for healthcare workers Fri, 31 Dec 2021 13:45:52 +0000

TALLAHASSEE – By saying it’s among ‘unprotected’ states, Florida is pushing full federal appeals court to at least temporarily block a Biden administration rule that would require healthcare workers to be vaccinated against COVID -19.

David Costello, deputy state attorney general, filed a document Wednesday afternoon with the 11th U.S. Circuit Court of Appeals referring to a new directive from the Biden administration regarding advancing the requirement to vaccination. The directive would apply to Florida and other states that have not received preliminary injunctions against the requirement.

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The U.S. Supreme Court is due to hear arguments Jan. 7 in cases from other parts of the country regarding the legality of the requirement, but it’s unclear when the justices will rule.

A d

Pensacola-based U.S. District Judge Casey Rodgers last month dismissed Florida’s request for a preliminary injunction against the rule, and a panel of the 11th U.S. Court of Appeals also denied the Stop.

On December 16, Florida filed a motion asking the Atlanta Court of Appeals to issue an injunction that would at least put the rule on hold while an underlying appeal is decided – a decision known as request for an “injunction pending appeal”. But the court of appeal did not respond to the request Thursday morning.

In the document filed Wednesday, Costello said Biden’s new administrative directive would give Florida 30 days to comply and about two dozen other states that don’t have injunctions. He said that “the new memorandum of application emphasizes the need for rapid intervention by the (full) tribunal en banc”.

“Facilities in unprotected states now only have 30 days to ensure that 100% of their staff have received at least one dose of the vaccine,” Costello wrote. “If institutions refuse to comply, they will eventually face enforcement action, ranging from financial penalties and funding freezes to outright termination of their agreements with Medicare and Medicaid providers.”

A d

The vaccination requirement, issued in early November, would apply to workers in hospitals, nursing homes and other health care providers who participate in Medicare and Medicaid programs. The requirement was originally scheduled to go into effect on December 6, but the Biden administration was suspended. this is because of injunctions issued in the Louisiana and Missouri cases.

But the directive released Tuesday by the federal Centers for Medicare & Medicaid Services says the federal government will begin to enforce the requirement where it can. It gives health workers 30 days to have at least one dose of vaccine and 60 days to have two doses, according to a copy attached to the document filed by Costello.

“These changes are necessary to protect the health and safety of patients and staff during the COVID-19 public health emergency,” the federal memorandum said. “COVID-19 vaccination requirements, policies and procedures … must comply with applicable federal non-discrimination and civil rights laws and protections, including providing reasonable accommodation to those who legally have it. right because they have a disability or have sincere religious beliefs, practices or observations that conflict with immunization requirements.

A d

A Louisiana federal district judge initially issued a nationwide injunction against the vaccination requirement, but the 5th U.S. Court of Appeals this month said the ruling went too far. The New Orleans court of appeals reduced the injunction to apply only to 14 states that filed the Louisiana case.

This effectively left Florida without an injunction against the requirement.

Florida Attorney General’s Office, Attorney General Ashley Moody, argued in the Dec. 16 petition seeking a hearing in the full court of appeals that the rule violates federal laws and would exacerbate staff problems in the provinces. healthcare facilities, including public facilities such as veterans’ retirement homes.

“A vaccination warrant threatens to exacerbate these grim circumstances,” the petition said. “Officials of state-run health facilities expect many health workers to quit rather than get vaccinated. “

A d

But Rodgers, the Pensacola-based district judge, and a majority of the three-judge appeals court panel rejected the state’s calls to end the requirement.

The majority of the appeal panel, made up of Justices Robin Rosenbaum and Jill Pryor, underscored the rationale for the rule as the nation continues to fight the pandemic. The notice says US Department of Health and Human Services Secretary Xavier Becerra, who oversees the Centers for Medicare & Medicaid Services, considered questions such as whether the vaccination requirement would prompt workers health workers to quit their jobs.

“Even though many health workers have been vaccinated against COVID-19, the secretary has found that vaccination rates remain too low in many health facilities,” the advisory said. “Unvaccinated staff continue to pose a significant threat to patients because the virus that causes COVID-19 is highly transmissible and dangerous. The secretary cited data reflecting that the virus spreads easily among health workers and from health workers to patients and that such spread is more likely when health workers are not vaccinated. “

Medi-Cal’s Landmark Transformation in California to Improve and Expand Services Gets Federal Approval – State of Reform Wed, 29 Dec 2021 19:40:30 +0000

The California Department of Health Care Services (DHCS) announced today that it has the green light to launch its long-term commitment to transform and strengthen Medi-Cal. The federal Centers for Medicare & Medicaid Services (CMS) have approved the California Advancing and Innovating Medi-Cal (CalAIM) proposal which will launch on January 1, 2022 and will make Medi-Cal more equitable, coordinated and person-centered to help people maximize their health and their life trajectory.

“We’re making Medi-Cal, which provides health care to one-third of all Californians, the most comprehensive and robust program of its kind in the country. .

Medi-Cal covers one in three Californians, more than half of school-aged children, half of the state’s births, and more than two in three patient days in long-term care facilities. CalAIM’s bold transformation includes multiple federal approvals and aligns all elements of Medi-Cal into a standardized, streamlined, and focused system that helps registrants live healthier lives.

The approvals build on successful pilots to expand innovations statewide, align how care is delivered across delivery systems, and enable California to start the implementation of CalAIM.

“CalAIM reflects California’s commitment to a healthier, fairer state and will be a transformative model for the entire healthcare system,” said the secretary of the California Agency for Health Services and from social services, Dr Mark Ghaly. CalAIM is shifting Medi-Cal to a population health approach that prioritizes prevention and addresses the social factors of health to better serve communities, many of which have historically been underfunded and faced with structural racism in health care. “

CMS has approved new statewide Medi-Cal services that will help people stay out of hospital and live in the community, as well as certain waivers to implement program changes that go beyond. beyond what can be accomplished under state Medicaid options. They include:

Improved care management addresses the clinical and non-clinical needs of the most needy Medi-Cal registrants through intensive coordination of health and health-related services. He will meet with registrants primarily through face-to-face engagement where they live, seek care and choose to access services – on the street, in a shelter, in their doctor’s office, or at home.

Community support provides new statewide services covered by Medi-Cal managed care plans as medically appropriate alternatives to traditional medical services or settings, including housing assistance, caregiver respite, l ‘food insecurity and the transition from nursing home care to the community.

Providing Health Access and Transformation (PATH) supports provides funding to community organizations, counties and other local providers to support capacity building as they begin to implement and scale up improved care management and community supports, particularly by increasing resources available to populations and communities that have historically been underfunded and underfunded. -served. In addition, PATH will support adults and youth involved in the justice system by supporting pre-release and post-release services.

Transformation and alignment of the delivery system moves California’s managed care delivery systems – Medi-Cal Managed Care, Dental Managed Care, Specialty Mental Health Services, and Drug Medi-Cal Organized Delivery System – to a single coordinating authority to simplify and align programs, improve monitoring and standardizing the benefits and registration with Medi-Cal. The waiver reinforces the state’s commitment to ensure that registrants have access to essential managed care services through independent assessments of access to specialized mental health services, to the organized drug distribution system Medi- Cal and managed dental care and services, as well as independent assessment. compare the adequacy of the Medi-Cal managed care plan network across the Medi-Cal managed care, Medicare Advantage and the private market.

Services and initiatives for substance use disorders advances the treatment of people with substance use disorders, including evidence-based contingency management to reduce stimulant use, peer support specialists to promote recovery and prevent relapses, and short-term residential treatment if necessary to advance treatment of enrollees. California’s approval of the state’s emergency management pilot project marks the first time it has been officially approved as a benefit in the Medicaid program.

New dental benefits extends key dental benefits statewide, including a tool to identify risk factors for tooth decay for all children Medi-Cal, and silver diamine fluoride for children and select populations at high risk. Statewide pay-for-performance initiatives will reward dental providers for their focus on preventative services and continuity of care.

Support coordination and integration for dual eligibilities better coordinate coverage programs for the complex health care needs of people eligible for both Medi-Cal and Medicare (“Double Eligible”). CalAIM provides a special type of managed care plan that coordinates all benefits into one plan for eligible registrants, creating an infrastructure to integrate long-term managed services and supports for all qualifying Medi-Cal registrants.

Global Payments Program renews the California statewide funding pool for care provided to California’s remaining uninsured populations. This includes streamlining funding sources for the uninsured California population served by public hospitals, with a focus on meeting social needs and responding to the impacts of systemic racism and inequality.

Chiropractic Services for Indian Health Services and Tribal Settlements retains the authority to pay tribal providers for these services, which were phased out of benefits covered by Medi-Cal in 2009.

California is excited to begin the statewide implementation of CalAIM to provide Medi-Cal registrants with consistent access to the care they need, when they need it, regardless of zip code. or the language they speak, ”said Michelle Baass, director of DHCS. “The CalAIM transition requires sustained focus and commitment, but when completed it will fundamentally improve the lives of millions of Californians. We have a long way to go, but it’s the right path and a journey we need to take to help care for people across our Golden State. “

Additional CalAIM approvals expected in 2022

DHCS and CMS continue to work towards obtaining additional approvals for equity-focused CalAIM initiatives that provide services and supports to adults and youth involved in justice, and reimbursement for traditional healers and caregivers. caregivers. The justice initiative involved will focus on stabilizing the health of populations affected by justice prior to release, ensuring continuity of coverage through enrollment strategies prior to Medi-Cal’s release, and supporting return in the community. Traditional healers and caregivers provide culturally appropriate options and improved access to substance abuse treatment for Native Americans and Alaska Natives who receive services through Indian health care providers. CMS approval of these waivers is expected in early 2022.

“Through CalAIM, California is redefining access to care, extending beyond traditional hospitals and settings to communities, meeting people where they are and providing culturally appropriate care and support to improve health outcomes, ”concluded Jacey Cooper, state director of Medicaid. “CMS approval kicks off the transition to better person-centered care for those who need it most. “

This press release was provided by the California Department of Health Care Services (DHCS).

State Attorneys General Tackle National Health Crises, One Person at a Time (Podcast) – Food, Medicines, Health Care, Life Sciences Tue, 28 Dec 2021 02:28:52 +0000

United States: State Attorneys General Tackle National Health Crises, One Person at a Time (podcast)

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Kelley Drye Ad Law Access Podcast State Attorneys General Speak to National Health Crises, One Person at a Time

Some might get the mistaken impression that state AGs rarely look at health-related cases, believing they are largely preempted by the FDA. However, nowadays there is little doubt that attorneys general are able to exercise their unfair and deceptive marketing practices laws with considerable weight in the health field. As the tobacco, opioid, and now vaping health crises have developed, state AGs have been at the forefront of ending marketing practices and securing redress for these damages. Over the past few weeks we have seen some interesting developments from State AG as they have continued to target individuals in their health enforcement actions.

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Stimulus Control Live Fourth Update: $ 8,000, COLA 2022 Benefits, Medicare, Child Tax Credit … Sat, 25 Dec 2021 05:00:00 +0000

More Americans go hungry as child tax credit ends

Democrats in Congress have made major changes to the child tax credit for fiscal 2021. The credit increased from $ 2,000, of which $ 1,400 was reimbursable, to $ 3,600 per child under six and $ 3,000 for each child from 6 to 17 years old and the full amount of the credit was refundable.

In addition, the income floor of $ 2,500 that was in place to start applying for the credit has been removed providing access to low-income families. To top it off, the IRS was tasked with sending six advance payments in 2021, representing half of the credit. Households can claim the balance on their 2021 tax return next year.

However, the changes, which were part of the US bailout, will now expire at the end of the year. Democrats had pushed for a one-year extension of the Build Back Better Act under consideration in the Senate. Hopes to pass the law by Christmas have been dashed as negotiations dragged on and the Senate went on vacation until January.

Senator Joe Manchin created new doubts over any extension when he said he couldn’t vote for the bill, mainly because of objections to the child tax credit.

Households with children saw a a reduction in difficulties and an increased ability to put food on the table after the start of advance payments in July. However, with biting inflation, hunger is on the rise again in the United States, with 1 in 10 households reporting not having enough to eat in the first two weeks of December.

Exceptional Community Hospital accepting all insurances Fri, 24 Dec 2021 01:31:53 +0000

The Exceptional Community Hospital-Maricopa is open [Stock]

The city’s first hospital opened on Wednesday, bringing 24-hour emergency care and inpatient services to Maricopa for the first time. With this opening came questions about the insurance plans taken out by the hospital.

According to Exceptional Healthcare CEO Saeed Mahboubi, the new hospital, known as Exceptional Community Hospital-Maricopa, accepts all plans.

“Exceptional community hospital-Maricopa honors all networked benefits for the emergency services provided to our patients, ”he said. “We bill the co-payments, deductibles and coinsurance network. We accept all commercial insurance plans and all Medicare, Medicaid (ACCCHS), TriCare and HIS / Tribal and VA plans. Exceptional Community Hospital-Maricopa is state licensed but is awaiting Medicare certification. Once Medicare is certified, we will bill for services after the Medicare enrollment date. Medicare, Medicaid, and TriCare services will not be billed to insurance or patient until Medicare certification.

The new hospital is located in the heart of Maricopa on State Route 347 at the south end of the overpass. The state-of-the-art 20,000-square-foot facility includes nine inpatient rooms and eight emergency treatment rooms, allowing the sick or injured in the city to receive emergency care without a half-hour commute to the hospital to Chandler or Casa Grande.

The main feature of the hospital is its 24-hour emergency department. But it includes a hospital specializing in internal medicine, an internal laboratory and a digital imaging suite including a scanner, x-ray, mobile MRI and an ultrasound.

Mahboubi said the status of the insurance network should not affect the hospital’s ability to provide care to anyone who needs it.

“We not balance the patient bill for any amount exceeding the costs of the network’s services, so the status of the network with health plans should not hinder access to emergency care for any insured member of the community, ”he said. -he declares. “We value people who choose the Exceptional Maricopa Community Hospital and are committed to providing specialist medical care to the entire community and to all patients in need. “

Exceptional said its goal is to provide minimal wait times, caring staff, highly individualized care and cutting-edge technology, ensuring that the needs for quality care and services are met in every way.

Opening of the city’s first hospital – InMaricopa

NY’s Single Payer Health Law: Universal Access to Comprehensive Health Care Wed, 22 Dec 2021 12:10:52 +0000

Greetings. I live in Long Lake and have been a member of the Campaign for NY Health for five years. The only goal of the campaign is the enactment of the NY Health Act.

For those of you who may not be familiar with the term, “single payer” health care in the United States is so called because the government, whether national or state, becomes the Unique payer to healthcare providers for the costs of all medical services, including dental, optical, pharmaceutical, long-term care and mental health, incurred by their subscribers. This is a role now played by the Center for Medicare and Medicaid Services (CMS) for people 65 and over who are on Medicare and for those who receive Social Security disability benefits. When and if the single-payer system is adopted, commercial or private for-profit health insurance companies, the major health care payers of their subscribers over the past fifty years, will be prohibited from selling insurance policies. private and will no longer play this role; which explains, in large part, the fierce opposition to the adoption of the law of the single payer. Billions of dollars are at stake.

If you’ve heard of the one-time payment through the mass media rather than the various organizations that actively support NY Health – the Campaign for NY Health; Doctors for a national health plan; NYS Nurses Association – you have probably been misinformed.

No, single-payer health care is not socialism – like Medicare, it is informed by social democracy, by the belief that health care is a right to which all residents of the United States and individual states are entitled.

No, the single payer does not take away your right to choose your doctor or health care provider. Your current insurance policy does this by limiting which providers you are allowed to see without incurring extra charges; often requiring prior approvals for now standard tests such as MRIs and CT scans; still requiring deductibles and sometimes high user fees. Without restricting access to healthcare, which is what these measures are aimed at, private insurance companies cannot make a profit for their shareholders.

NY Health does not enforce any restrictions. Rather, it has two objectives: to provide access to full health care at all people who live or work in NYS, including the two million New Yorkers who do not have health coverage; and provide it at a reasonable cost, much lower than that charged by insurance companies, even if your health benefits are provided by your employer.

Specifically …

Advantages, for all NYS residents or those who work in the state but live elsewhere, once you sign up for NYHealth:

  • Full: all medical, hospital and outpatient care, dental care, ears and eyes, prescription drugs, mental health, long-term care, without deductible or co-payment; an exclusion – cosmetic surgery, with the exception of repairs for injury or congenital impairment; no limits on suppliers in New York State and, shortly after enactment of the law, in most states of the United States.
  • Included: If you receive any federally granted or protected medical, disability or retirement benefits – Medicare, Medicaid, VA, ERISA – you continue to keep them, but you are eligible for all NYHealth benefits.

… In addition, all registrants can see the supplier (s) of their choice in NYS and, in most states of the United States; Since all reimbursement rates, if they are low, will be increased to match Medicare rates, there will be additional providers to choose from;

… If you receive Medicare – NYHealth will pay the cost of your Medicare Part B and save subscribers an average of $ 6,100 per year;

… If you are receiving other federally protected retirement or disability benefits – eg ERISA, VA, etc.

  • Finally: Counties will no longer be forced to pay their $ 8 billion share of state Medicaid costs. These will be fully absorbed by NYHealth, allowing each county to reduce property taxes, now used to pay their Medicaid allowance.

In sum, the 2 million New Yorkers, 10% of the state’s population, who do not have access to health care will now have it; up to a third of New Yorkers who regularly postpone health care will now no longer be forced to do so; and no New Yorker will have to accumulate medical debt once enrolled with NYHealth.

Costs: A good number of costs, addressed via an elaborate financing mechanism, too complex for this article. I will give a brief overview of the data from the Rand Corporation An Assessment of the NY Health Act (2018) and Dr Leonard Rodberg Summary and assessment … from the Rand Study (2018), to be found on the Campaign for NY Health website,

Given current health spending patterns, NYS and its residents are expected to spend $ 311 billion in 2022; unlike the NY Health Act, with net savings of 3.6%…

graphic source of funding

The big changes when the NY Health Act becomes law – more private insurance underwriting by individuals, businesses and organizations and the end of deductibles and user fees for policyholders; replaced by an NYHealth tax; savings from reduced administrative billing costs and lower negotiated drug costs; resulting in a net saving of 3.6%. The estimated 11.4% savings will be used for additional health resources in anticipation of increased demand for services.

The ten-year estimate of the Rand Corporation’s cumulative net savings, expenses vs revenues, will be 2% per year for the period 2022 to 2031, with annual costs reduced by 3% or $ 10 billion by 2031.

The big bone of contention is the dramatic increase in progressive income taxes, about 20% payable by employees, the remaining 80% by their employers, with total amounts for each lower than those currently paid for employee bonuses. private insurance. According to Dr. Rodberg, NYHealth will initially need $ 159.6 billion per year in payroll taxes and non-wages to cover all costs …

pay for ny health chart

Note that the schedule’s tax rates, while hypothetical, are based on realistic assessments of the financial condition of New Yorkers; they cannot be finalized until the NY Health Act is enacted. It should also be noted that the first $ 25,000 of an individual’s income will not be taxed. Ultimately, healthcare tax rates are graduated to ensure the inclusion of the 80% of New Yorkers who earn less than $ 100,000 a year. The rates are also set per individual and not per household, so the incomes of all members are counted to determine the cost per household or family. Currently, a private health insurance policy for a family of four is $ 27,000 annually (Kaiser Santé news, 2021), over $ 3,000 in deductibles and co-payments, up from $ 21,000 in 2017. Take another look at the numbers.

Conclusions and prospects for adoption: When and if enacted, the NY Health Act will offer a full range of benefits to ordinary New Yorkers that the vast majority of us could never have afforded. This will not only provide us with unexpected income, but also great peace of mind, welcome relief from the constant fear and anxiety regarding our well-being and that of our families. As a result, the passage prospects are uncertain. Since the NYHA bordered on Legislative Assembly approval in 2019, opposition forces have rallied, galvanized by the prospect, especially those corporations with the most to lose financially, whose lobbyists will flood Albany and Washington’s unique anti-payer. Messaging.

The prospects for passage of the bill can be best measured by the support we receive from New Yorkers who will benefit from its enactment, people like many reading this.

If you want additional information or want to get involved, start by logging into the Campaign for NY Health website, If you scroll to the top of the title page, click any of the links, starting with “Learn” and scrolling down to “FAQ”, to learn more about NY Health and the campaign. If you would like to get involved, contact one of the campaign co-directors, YuLing Koh Hsu, [email protected], or Ursula Rozum, [email protected].

You can also contact me at [email protected] or log onto my FB page, North Country Access to Health Care Committee.

Jack Carney

Jack Carney

Jack Carney is a clinical social worker who retired after fifty years of practice, nearly forty of which in the public mental health system. He received his MSW from UCLA in 1969 and his DSW from CUNY in 1991. He is also a trained family therapist, trained in dialectical behavior therapy, and has devoted much of his professional life to teaching and counseling. training mental health professionals, developing and implementing innovative treatment approaches and programs, and conducting research in clinical practice. He retired in 2010 from a large New York welfare agency. He now lives with his wife and their two cats in the Adirondack Mountains of upstate New York, where he spends much of his time writing provocative leaflets and working as a community and care advocate. health care, heavily involved in the campaign for NY health and the enactment of single payer health care statewide – the New York health law – and national – Medicare for All – on a based. He is the author of a book of essays – Nation of Killers: Guns, Violence, White Supremacy – The American Dream Become Delusion, published in 2015 and available through Amazon. He has also published over 40 blog posts on Mad In America and Op-Ed News, all concerned with the political deterioration of the U.S. state and its institutions and the steps ordinary Americans can take to oppose a oppressive corporate ruling class that crushes the life and dynamism outside of us. A nearly complete list of all of his writings – a work in progress – can be found on his website, www.paddling

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]]> Nursing homes ask for visitation flexibility as Omicron rages Mon, 20 Dec 2021 22:52:59 +0000

Seniors’ service organizations are now urging the Biden administration to provide flexibility to limit nursing home visits, citing expected increases in COVID-19 cases linked to the omicron variant.

The Centers for Medicare & Medicaid Services (CMS) issued guidelines in November allowing visits for “all residents at any time.”

While visitors should be made aware of the risks of COVID-19 in a nursing home, CMS said in a note, public health emergency (PHE) limitations on resident visits will be lifted. This includes nursing homes under investigation for an outbreak.

Institutions can no longer limit the number of visitors, frequency or length of visit, which were previously all acceptable under the PHE. Visits should always follow infection prevention protocols, CMS quickly added – physical distance should always be maintained during peak hours, such as meals.

LeadingAge, the American Health Care Association and the National Center for Assisted Living (AHCA / NCAL) and the Society for Post-Acute and Long-Term Care Medicine (AMDA) sent a letter to CMS Administrator Chiquita Brooks- LaSure on Friday, suggesting that the agency give facilities the ability to impose temporary visitation restrictions to protect residents and adhere to infection prevention protocols.

“At the time of writing, it appears that an institution is not allowed to impose any restrictions on visits, regardless of staff levels, community positivity rates or the severity of the outbreak. establishment, ”the associations said in the letter. “We are concerned that outright, unconditional language may pose a risk to nursing homes and their residents, placing skilled nursing facilities in precarious situations when epidemics occur.”

The broad scope of CMS guidelines could also conflict with state and local health departments, the associations said, adding to the confusion.

While associations have spoken out in favor of reducing the isolation and loneliness of nursing home residents through visitation, medical directors and infection prevention officers as well as local health services need help. “More flexibility” to make the right call.

Before the pandemic, nursing homes were able to restrict visitors in light of influenza or norovirus outbreaks, the associations said. Canceling decision-making at the local level is “counter-intuitive and potentially dangerous” – operators are already expecting an increase in omicron cases, as well as hospitals in the region. In some cases, omicron is already rampant in facilities and the surrounding community, association leaders said.