Today’s Hot Topics in Medicare News

Supreme Court passes on Medicare case in victory for Planned Parenthood

BY ED ADAMCZYK: The U.S. Supreme Court on Monday handed a legal victory to Planned Parenthood, opting not to hear an appeal concerning the rights of Medicare recipients.

In declining to hear appeals from the states of Kansas and Louisiana, the high court chose to left lower court rulings stand. The issue did not concern abortion but is abortion-related.

After an anti-abortion group released videos in 2015 that supposedly showed Planned Parenthood officials discussing the sale of fetal tissues, Kansas and Louisiana terminated Medicare agreements with providers affiliated with Planned Parenthood. Medicaid patients in those states said they violated a requirement that allowed patients to seek medical care from any qualified and willing provider. Lower federal courts agreed, and the bans in both states against Planned Parenthood, and funding for health services, were lifted. (read more)

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MedPAC considers direct Medicare billing for NPs, PAs

BY KELLY GOOCH: The Medicare Payment Advisory Commission, an independent federal agency that advises Congress on Medicare, is considering a recommendation to eliminate “incident to” billing for nurse practitioners and physician assistants, effectively swapping a 100 Medicare reimbursement rate for one that is 85 percent of Medicare’s fee schedule.

Nurse practitioners and physician assistants currently bill “incident to” services, such as evaluation and management visits, using the physician’s CMS-issued unique 10-digit identification number, known as a national provider identifier. Reimbursement for “incident to” billing is 100 percent of the Medicare fee schedule. However, nurse practitioners and physician assistants cannot use “incident to” billing in certain circumstances, such as for new patients in a hospital setting or for a new issue for an existing patient. (read more)

Medicare beneficiaries need to prepare for 2019 drug costs

BY NICK GOSNELL: Medicare beneficiaries should take a close look at their finances as we come to the end of the year.

“They need to plan ahead, particularly if they’re taking an expensive medication,” said Dan Klein, President and CEO of the Patient Access Network Foundation. “At the beginning of the year, they’re going to need to pay for their deductible, their copay and of course, they’ve got, in Medicare, the donut hole that they have to get through before their co-insurance drops down.”

This is particularly true for those facing debilitating long-term conditions.

“At the beginning of the year, you could face as much as five thousand dollars out of pocket before catastrophic coverage kicks in,” said Klein. “If you have cancer, or if you have Parkinson’s or MS or another serious illness and you’re taking an expensive medication, it can be very costly.” (read more)

OPINION: If you want Medicare-for-all, prepare for a long and bloody fight

BY PAUL WALDMAN: Over the last two years, the idea of government-guaranteed universal health coverage, often shorthanded as Medicare-for-all (I’ll refer to it as M4A from here) has grown from a minority belief within the Democratic Party to a majority belief, and one that is on its way to becoming consensus. We are now entering a period of debate within the party about what universal coverage should look like and how to transition from the system we have now to the system we want.

This is an extremely complicated policy challenge, but it’s an even more difficult political challenge. And to be honest, I worry that many of the M4A advocates — whose basic principles I share — may not fully appreciate what they’re going to be up against. (read more)

A million more seniors will have to pay for gym memberships as SilverSneakers disappears from two AARP plans

BY RICHARD CRAVER WINSTON-SALEM: North Carolinians who have AARP’s Medicare Advantage and Supplement plans will no longer be able to participate in the popular SilverSneakers fitness program, beginning Jan. 1.

AARP’s plans, offered through UnitedHealthcare, will not continue the benefit in 11 states for Medicare Advantage and nine states for Medicare Supplement. In both instances, that includes North Carolina.

Overall, about 1.2 million Medicaid Advantage customers and 1.3 million Medicare Supplement are being affected in those states. (read more)

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