June 20

Wisconsin Details Changes to Care for Disabled, Elderly

A revamped Medicaid program for more than 55,000 disabled and elderly Wisconsin residents will involve three agencies in each of three regions, health officials said Wednesday. The program will continue to allow people to hire their own caregivers if they want, the state Department of Health Services said in a “concept paper” about the changes. The state budget last year called for changes to the Family Care program and an alternative called IRIS — Include, Respect, I Self-Direct. Dane County and seven other counties that haven’t switched to Family Care will have to adopt it. The changes, expected to begin next year, are designed to keep spending in check for a population that makes up 20 percent of Medicaid enrollment but 40 percent of the Medicaid budget, with long-term care expected to cost $3.4 billion this year, officials said. The agencies running the new program, some of which could be from out of state, may eliminate many current providers. Public hearings will be held Monday in Eau Claire and Madison.

For the article from the Wisconsin State Journal, click here.

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June 9

Dangers Lurk Within Health Savings Accounts for Retirees

Health Savings Accounts are surging in popularity — and that can lead to some complications for older workers who enroll in Medicare. Health Savings Accounts (HSAs) are offered to workers enrolled in high-deductible health insurance plans. The accounts are used primarily to meet deductible costs; employers often contribute and workers can make pretax contributions up to $3,350 for individuals, and $6,750 for families; the dollars can be invested and later spent tax-free to meet healthcare expenses. But as more employees work past traditional retirement age, some sticky issues arise for HSA account holders tied to enrollment in Medicare. The key issue: HSAs can only be used alongside qualified high-deductible health insurance plans. The minimum deductible allowed for HSA-qualified accounts this year is $1,300 for individual coverage ($2,600 for family coverage). Medicare is not considered a high-deductible plan, although the Part A deductible this year is $1,288 (for Part B, it is $166). That means that if a worker – or a spouse covered on the employer’s plan – signs up for Medicare coverage, the worker must stop contributing to the HSA, although withdrawals can continue. Failing to do that can lead to a tax penalty.

For the article from the Reuters, click here.

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June 6

Hospice fraud becoming a costly problem for Medicare

No one knows how big the problem of hospice fraud is — all types of improper Medicare payments are estimated at $65 billion for 2010 — but federal investigators prosecuted more than 60 cases in the last year alone, involving hundred of millions of dollars nationwide. The system that was built to help dying patients live out their remaining days with dignity and comfort has few quality metrics to meet, no minimum requirements for how often care is provided, and low barriers to getting into the business. Critics say that can make end-of-life care seem ripe for abuse. “There’s a built-in incentive to get patients in the door,” said Claire Sylvia, a lawyer representing whistleblowers in health care fraud cases at the San Francisco offices of Phillips & Cohen LLP. For example, former Horizons Hospice chief operating officer Mary Ann Stewart, is under indictment in federal court in Pittsburgh on charges of inflating enrollment at her company’s Monroeville facility by recruiting patients who often weren’t really dying. A long-awaited reform in how Medicare pays hospice providers that went into effect in January will do little to curb such abuse, experts say. Medicare began staggering payments to better reflect the cost of care — the first reimbursement change since the benefit began in 1983.

For the article from the Pittsburgh Post-Gazette, click here.

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April 14

SSA Directs Local Offices to Give Specifics When Rejecting Trusts

The Social Security Administration recently issued an Emergency Message to all personnel requiring workers to specifically inform SSI applicants or beneficiaries of the reasons a special needs trust has been rejected by the agency.

In the past, when the SSA determined that assets in an SSI beneficiary or applicant’s trust were countable, the agency would frequently send a notice to the beneficiary or applicant telling him that he was ineligible for benefits because his assets exceeded the resource limit.  However, this notice almost never explained the reasoning behind the SSA’s rejection of the trust.

The new Emergency Message, which went out to all field level SSA personnel, requires caseworkers to spell out exactly what portion of the Program Operations Manual System (POMS) applies to the trust being rejected.  Unfortunately, the Emergency Message does not tell field workers that they have to explain their reasoning in plain English — merely citing the appropriate section of the POMS appears to be enough.  While this will make it relatively easy for professionals to determine what went wrong with a trust and whether an appeal is in order, it will likely give the layperson little if any guidance about his or her trust.

To read the Emergency Message, go to:  https://secure.ssa.gov/apps10/reference.nsf/links/03022016015517PM

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