Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
This coverage is critical for many ESRD patients across the nation. As a result, DPC is an active force when Medicaid funding is threatened at the state level. Medicare Open Enrollment began October 15 — and will remain open through December 7, As many state legislative sessions are winding down or have recently wrapped-up, it is a good time to update DPC members on state legislation important to dialysis patients.
The participation of our Patient Ambassadors [ The emergency declaration is expected to end soon, and states will again require Medicaid enrollees prove their eligibility. Our Annual Membership Survey is live, and it will remain [ Email: dpc dialysispatients.
Web: Dialysis Patient Citizens. Join us in making a difference for those with kidney disease by enrolling as a DPC member today. Membership is free. The network of participating nephrologists for the demonstration consisted primarily of those clinicians with whom HOI contracted for nephrology services for all HOI enrollees prior to the demonstration.
HOI had preexisting relationships with 51 dialysis units in the target area and established demonstration-specific contracts with at least several dozen of the dialysis facilities, relying on a contract with one of the major national chains to secure the services of about 20 units.
As with the nephrology contracts, HOI generally limited its network of dialysis facilities to those with which the plan had existing contracts. Dialysis facilities were selected based on where the nephrologists practiced. Nephrologists were compensated in the form of a global capitation rate, based on primary care services delivered in the inpatient and outpatient settings, renal care and management of dialysis in both settings, and referral to other specialties.
Dialysis units were paid on a negotiated composite rate inclusive of equipment, supplies, labor, selected drugs, and medications, similar to the way Medicare currently pays for these services. HOI intended to use incentive programs with nephrologists and with dialysis facilities, though the structure of the initial incentive program for nephrologists raised concerns at CMS about the potential negative impact on patients' hospitalization. Specifically, the original incentive plan for nephrologists included bonus payments for meeting target hospitalization rates, along with other targets such as 75 percent of patients receiving appropriate preventive services and 60 percent of patients participating in educational programs.
The incentive program was restructured with government approval; however the plan included the requirement that the medical loss ratio had to reach 90 percent before HOI would make physician payments. HOI used established contracts with the 36 hospitals in the area to provide needed care for demonstration patients, with payment based on per diem rates.
Transplant services were provided through a contract with Jacksonville Methodist Hospital, located about miles from HOI's demonstration service area. Access to non-nephrology specialists e. Additionally, part way through the demonstration, HOI contracted with freestanding clinics to provide routine vascular access services. HOI also developed a multidisciplinary team approach to providing care. Each team included a nephrologist, nurse practitioner, case manager, social worker, dietitian, facility nurse, technicians, radiologist, and a vascular surgeon.
Additional specialists that could have participated in a patient's care plan included cardiologists and endocrinologists. The nephrologist served as the primary care physician and provided referrals, authorizations, and arrangements for specialty and hospital care. The nephrologist was responsible for: 1 establishing a plan of care for all patients; 2 assessing transplant candidacy; 3 determining modality and access type when appropriate ; 4 working with the patient to identify an appropriate rehabilitation plan; and 5 determining dietary, nutritional, and pharmaceutical prescriptions.
The nurse practitioner's role was to work with the nephrologist and serve as the primary caregiver for both renal and non-renal services. It was anticipated that the nurse practitioner would see patients on a weekly basis and would be in a position to identify and treat potential problems early on. The case manager's role was to coordinate all aspects of clinical and supportive care. The case manager also held quarterly meetings with nephrologists, and participated in monthly facility care management meetings at the dialysis facility.
On average, each case manager handled 50 patients. Toward the end of the demonstration, when HOI resources for the demonstration were strained and the program was winding down Dykstra et al. Although HOI had anticipated developing demonstration-specific quality assurance activities, the basic operations of the demonstration demanded all the resources HOI allocated to the project, and HOI did not implement planned activities.
HOI did implement an initiative to identify why drug costs were higher than expected in the early phase of the demonstration. Dialysis-related costs were slightly elevated due to high utilization of EPO in certain practices. Specifically, the new initiative was a review system for every instance that a physician prescribed more than a level determined potentially excessive by HOI. The review used clinical guidelines to determine whether the prescribed dose was actually warranted, approving it for those extreme cases.
However, if the high-dose prescription was determined to be unnecessary, the clinic was responsible for its cost. In joining the demonstration, Xantus sought to prove that a program of care for ESRD patients could be developed from scratch, relying on a small, locally designed program. The Xantus site was distinguished from the other sites in that it did not treat Medicare or ESRD patients prior to the demonstration.
For reasons described later in this article, the Xantus demonstration site never hit its stride, enrolling only 50 patients prior to its early withdrawal from the program. Nevertheless, basic structures were in place to provide care for its enrollees. Specifically, all HMO management services e. A for-profit network independent practice association model HMO, licensed to operate throughout Tennessee, Xantus operated through individual contracts with providers.
For the demonstration, Xantus had contracts with all of the nephrologists in the region and nearly 20 dialysis facilities.
The hospitals contracted for the demonstration were those hospitals in the demonstration service area with existing Xantus contracts. Similarly, non-nephrologist physicians were also among those with current Xantus contracts. Xantus also contracted with various other entities for the provision of ancillary services, including home health, durable medical equipment, skilled nursing facilities, transportation, pharmacy, and psychiatry. Transplantation was available at two locations.
Nephrologists served as primary care providers, working with Xantus-employed case managers. The case managers visited newly enrolled patients at their homes and met with patients at least bimonthly. Case managers reportedly were successful at facilitating communication between patients and nephrologists. One goal in evaluating the marketing and enrollment activities of demonstration sites is to determine whether programs sought to attract a favorable mix of patients, encouraging comparatively healthier, and thereby less costly, patients to the demonstration.
The service packages offered in each site and a review of marketing and enrollment activities are described below, and Shapiro et al. The basic service package offered at demonstration locations was similar and is summarized in Table 3. All sites eliminated co-insurance and deductibles on services and offered coverage for prescription drugs, as well as provided nutritional supplements at no cost to the enrollee.
Consistent with the CMS requirements, the sites offered extra benefits beyond the services offered in the traditional Medicare Program.
The benefits were supposed to equal the additional 5 percent payment the sites were receiving above the 95 percent rates paid to regular Medicare-risk contractors. Beyond the nutritional supplements and health education services, the additional services offered at each site were different.
Kaiser covered dental services, and eye care; and HOI provided transportation to dialysis, home health services, and a rehabilitation program. Xantus covered home visits and educational seminars and videotapes. IDPN is intradialytic parenteral nutrition.
Kaiser used a two-pronged marketing approach to attract patients to the demonstration. First, Kaiser contacted patients directly to publicize the demonstration and highlight the enhanced benefits and services they expected to be attractive to patients. Second, they expanded provider contracting arrangements in order to expand the pool of beneficiaries who might be eligible to enroll in the demonstration without having to change nephrologists.
For all marketing activities Kaiser developed materials that included brochures, letters, open houses, and videos. In actuality, most of their marketing focused on patients, reflecting in part the provider community's ambivalence toward the demonstration caused by concern that patients who joined the demonstration would remain Kaiser patients at the conclusion of the program.
Kaiser's marketing to patients was seen as essential in order to counteract these attitudes by the non-Kaiser provider community. As a result of this intense outreach, marketing costs for the demonstration were significantly higher than anticipated Dykstra et al.
Enrollment processes were in place by the time the first patients joined the demonstration. To facilitate enrollment and data collection, Kaiser had established a database to track the enrollment issues that influenced ESRD patients' willingness and ability to participate in the demonstration. However, Kaiser reported that there was a to day gap between the submission of the enrollment application and the start of service delivery.
Much of this delay was caused by the process of eligibility screening with CMS, as it was difficult to determine when patients did not pay their Part B premiums, and therefore lost eligibility for the demonstration. Enrollment of rollover patients—ESRD patients already in Kaiser's existing managed care plan that were otherwise eligible for the demonstration—occurred once a CMS-set minimum number of patients new to Kaiser through the demonstration program had enrolled.
Kaiser sent a letter to its ESRD patients explaining the demonstration to them and offering them participation. For every two new demonstration patients Kaiser enrolled, it was allowed to enroll one rollover patient. Kaiser's administrators reported the impression that patients enrolled in the demonstration primarily for financial reasons.
Patients without supplemental insurance and those who had recently lost their insurance were both likely to enroll in the demonstration. Medi-Cal California's Medicaid Program patients who had a cost share also saw some cost savings by joining the demonstration, although MediCal patients with no cost share tended not to enroll.
As the demonstration proceeded, Kaiser reported that a reputation for high quality of care became a factor in patients' reported decisions to enroll. Kaiser was concerned about the initial enrollment, which was lower than expected. Discussions with patients and providers revealed three main concerns about enrolling in the demonstration: 1 what would happen to patients at the end of the demonstration; 2 concerns about participating in managed care, and 3 a lack of knowledge about the demonstration among providers.
Kaiser implemented several steps to address patient concerns. These activities included developing additional contracts with nephrologists that allowed patients to enroll in the demonstration without changing providers, paying CMS to send out additional mailings to patients; distributing informational materials to dialysis units, working with facility social workers to encourage demonstration referrals, and speeding up the contacting of rollover patients by using electronic files to track enrollment.
These initiatives to boost enrollment were successful. By the end of the demonstration Kaiser had enrolled 1, patients, 50 3 percent of whom disenrolled including patients who left the service area before the end of the demonstration, and another died while in the demonstration. Table 4 provides demographic characteristics by modality for the sample of Kaiser's enrollees included in the data collection effort for evaluation.
Hemodialysis Rollover patients were receiving care from Kaiser prior to the demonstration. Hemodialysis Active patients were newly enrolled in the Kaiser program. HOI selected the target areas of Dade, Broward, and Palm Beach counties because of the size of the patient population in these counties, as well as the population's racial and socioeconomic diversity.
HOI's marketing approach was based on educating nephrologists in the area about the potential benefits of the demonstration, and it was hoped that nephrologists, in turn, would encourage their patients to enroll.
HOI utilized a dedicated sales force to market the demonstration to providers and patients in the service area. This educational outreach was based on networking among physicians, direct mailing to providers, and in-person meetings with groups of providers. In addition to efforts aimed at nephrologists, HOI launched educational meetings with potential patients and marketed the program through the Florida ESRD patient newsletter.
At the start of the demonstration, HOI modeled its enrollment processes for the demonstration on its existing programs. Specifically, enrollment was handled by HOI's telemarketing unit, which was experienced in managed care. Additional training was provided to staff to ensure that they were prepared to handle demonstration-related issues. The primary enrollment collection instruments were an enrollment form and a toll-free enrollment line.
The enrollment process was highly focused on providing personal attention; for instance, followup calls were provided even after a patient enrolled. HOI changed its enrollment process to counter problems that arose and to make the process run more smoothly.
At the start of the demonstration, outdated criteria used by CMS to determine patient eligibility resulted in the initial rejection of many eligible patients who wanted to enroll in the demonstration. HOI responded to this problem by working with CMS' regional and national offices on streamlining the eligibility determination process, which, although successful in terms of streamlining the enrollment process, caused HOI to expend more resources than had expected.
At the beginning of the demonstration, HOI enrolled patients based on self-reported Medicare eligibility. However, they found that some of these patients were determined by CMS to be ineligible for the program. In order to minimize financial risk, HOI began enrolling patients only after their eligibility status had been verified through Medicare and the patient was determined to be in the CMS data system.
Similar to Kaiser, initial enrollment at HOI was also slower than anticipated. Patients cited the following reasons for not wanting to join the demonstration: 1 not wanting to change physician or dialysis unit, 2 fear of managed care and participating in a demonstration project, 3 physicians' active discouragement against joining, 4 concern about giving up supplemental health insurance, and 5 questions about insurance coverage after the demonstration ended. HOI addressed some of these patient concerns early in the enrollment process.
For instance, they addressed questions about supplemental insurance by telling patients to keep their supplemental insurance for a few months in case they did not like the demonstration and wanted to disenroll. In response to patient concerns about the distance to the transplant center in Jacksonville, HOI implemented a program to have the hospital transplant surgeon regularly visit the Miami region.
The care managers also discussed patients' concerns about what was to happen at the end of the demonstration and assured patients that they would be able to enroll in HOI after the demonstration concluded. In November , HOI closed its enrollment period for new patients as part of the wind-down process of the demonstration.
They enrolled patients in the demonstration program, 12 percent of whom disenrolled including patients that moved out of the service area , and another died while in the demonstration. Table 5 provides demographic characteristics by modality for the sample of HOI enrollees included in the data collection for the evaluation.
Initially, Xantus marketed the demonstration program through multiple direct mailings to eligible patients. In addition, Xantus representatives set up information booths at dialysis centers to promote enrollment in the demonstration. Xantus began service delivery in September In the first 8 months of the program, Xantus enrolled a total of 26 patients in the restricted five-county service area.
Although demonstration managers were optimistic about expanding into a larger service area, they experienced significant delays in obtaining an expanded Medicare-risk contract. The site believed that these changes positively affected enrollment levels. By the time enrollment at the Xantus demonstration site was frozen in November , a total of 50 patients had enrolled in the program. In assessing what can be learned from the demonstration experiences, in terms of operational outcomes, that may be relevant for future organizations, three questions can be explored:.
Each of the demonstration sites faced challenges contracting with providers, and the underlying issues are likely to be faced again should MCOs be allowed to develop managed care programs for ESRD patients in the near future. Kaiser faced negative attitudes initially about the demonstration by community physicians and dialysis facilities, and HOI and Xantus experienced difficult, and ultimately unresolvable, negotiations with the providers they expected to contract with for significant service lines.
During the initial stages of the demonstration, reaction to the demonstration program from the non-Kaiser provider community, including both physicians and dialysis units, was fairly negative. Both nephrologists and facilities were concerned that Kaiser would use the demonstration to expand its market share resulting in a loss in revenue for both categories of providers.
At the time of demonstration startup, the non-Kaiser dialysis units were particularly concerned because of Kaiser's partnership with Fresenius in which Kaiser opened new dialysis facilities. Non-Kaiser nephrologists were also concerned about disruptions in the continuity of care due to difficulty communicating routine patient updates with Kaiser nephrologists. Nevertheless, both nephrologists and facilities acknowledged to the evaluation team Kaiser's reputation for providing high-quality care and reported that they would maintain a neutral stance about the demonstration when asked by their patients for advice about participating in the demonstration.
However, according to Pifer et al. Over time, community nephrologists and contract dialysis units exhibited a more positive attitude toward the demonstration.
In interviews conducted by the evaluation team, providers reported that Kaiser made substantial efforts in their communications with community providers, including involving community providers in demonstration service delivery-related issues through special committees and the provision of quality monitoring reports. Kaiser care managers also made efforts to strengthen relationships with the community providers.
Further, comfort with Kaiser increased on the part of contracted providers when providers did not experience a substantial decline in patient volume due to enrollment in the demonstration. However, subsequent contract negotiations, which lasted more than a year, proved exceedingly difficult and ultimately the two organizations could not come to a financial agreement. The failure to contract with the only transplant center local to the demonstration counties forced HOI to contract with Jacksonville Methodist Hospital, miles away.
To address the issue of distance between the contracted transplant center and demonstration enrollees, halfway through the demonstration HOI arranged for the transplant surgeon to spend time each month in Miami to conduct pre-transplant workups.
The clinical consequences of this arrangement are currently being analyzed. It is reasonable to assume that this aspect of the demonstration program affected HOI's patient recruitment to the demonstration, and possibly patient satisfaction as well. HOI experienced a larger number of disenrollees from the demonstration than did Kaiser.
Many metropolitan areas have a single transplant center, which may put some MCPs at a disadvantage in negotiating for services that meet geographic proximity requirements. The Xantus demonstration plan as proposed to CMS was based on a partnership with and model of care institutionalized by the largest single nephrology practice in the region representing more than 60 percent of patients and 75 percent of nephrologists.
Shortly after winning the demonstration contract, difficult negotiations resulted in dissolution of the partnership between the two groups. This change required Xantus to remodel their demonstration program. One key change was that Xantus established contracts with all nephrologists in the service region instead of just nephrologists in the large nephrology group practice.
Thus, the program looked more like a network model than originally anticipated the original plan looked more like a hybrid between staff model for nephrology, case management, and primary care services, and network model for other services. Another change was that Xantus hired case managers originally it was planned that the case managers would be hired, managed, and compensated by the large nephrology group practice. This arrangement failed to create the hoped-for close, day-to-day working relationship between the case manager and nephrologists.
It was also originally planned that the group practice would hire social workers and dieticians; instead, demonstration patients were required to access such services in the traditional manner through their dialysis facility. Finally, with the loss of the partnership with the large group practice, the site lost much of its management-level ESRD expertise and its primary planned referral source the group practice had over patients and Xantus assumed that most of these patients would enroll at the encouragement of their physician.
Two additional issues significantly affected Xantus' ability to maintain a demonstration program. The first was the requirement that Xantus obtain a Medicare-risk contract, and the second was the financial health of the larger Xantus Corporation.
Xantus won the demonstration contract prior to obtaining a Medicare-risk contract. Only after the award was made and the contract was signed did CMS clarify that Xantus needed to acquire such a contract in order to provide demonstration services.
Therefore, before Xantus could begin providing demonstration services, it was necessary for the plan to invest considerable resources and time into obtaining the Medicare-risk contract. One outcome of this effort was that Xantus was able to obtain their risk contract for a service region of only five counties as opposed to the 40 county region proposed for the demonstration. Thus, the demonstration was also limited to operating in the five-county area.
This change reduced the estimated eligible number of demonstration patients from 1, to The Xantus demonstration program was able to develop a new network of physicians and succeeded in obtaining the required Medicare-risk contract, however, due to financial difficulties in the organization's other business lines, Tennessee placed Xantus, as a whole, under receivership, and CMS placed a freeze on ESRD demonstration enrollment effective November 1, By mutual agreement between Xantus and CMS, the demonstration at this site was discontinued as of April 1, The residual 44 demonstration enrollees were notified March 1, , and received assistance from Xantus staff, dialysis facility social workers, State Department of Commerce and Insurance staff, the ESRD network, and the CMS regional office in obtaining secondary coverage to supplement Medicare.
One goal in conducting the demonstration evaluation was to determine whether ESRD patients are willing to participate in managed care and whether enrolling patients are representative of the underlying population. The two sites that completed the demonstration proved that ESRD patients are indeed willing to trade some freedom of choice in health care for increased access to pharmaceuticals and reduced copayments.
For a separate presentation and discussion of the patient characteristics willing to enroll in the demonstration, refer to Shapiro et al.
As shown, patients who enrolled in this demonstration were not representative of the typical ESRD patient; they tended to be younger and healthier. Additionally, demonstration disenrollees spent more time in the hospital during the program compared to continuous enrollees, indicating that selection effects continued to appear even after initial enrollment. Another evaluation finding was that patient satisfaction with the demonstration was generally quite high Pifer et al.
It is worth noting that HOI, using the network model, appeared to have an easier time recruiting patients than Kaiser during the early days of the demonstration, which may have been related to the level of encouragement patients in each location received from their providers Pifer, While Xantus' limited enrollment of patients was due to numerous factors, one factor that was seen to influence enrollment was the preponderance of dually-eligible patients i.
TennCare Tennessee Medicaid Program benefits were quite comprehensive—TennCare beneficiaries with ESRD received unlimited prescription benefits; were able to apply for a transportation benefit; and were not required to pay copayments.
Thus, many eligible patients lacked any real incentive for joining the program. This demonstration can be considered a success in that two sites were able to implement managed care programs for ESRD patients. Although Xantus faced significant hurdles developing its demonstration program, it was ultimately undone by factors unrelated to the demonstration, and thus its failure should not diminish the accomplishments of CMS, Kaiser, and HOI in executing this initiative.
Thus, HOI's approach and experiences are possibly more relevant to other potential programs than the program at Kaiser. Many aspects of the service package were similar between the sites. In other ways, the programs were structured in very different ways. This distinction had implications beyond the way providers were paid—it likely affected the degree of control that the HMOs exercised over provider practices.
Kaiser tried to actively influence provider practices, thereby instituting what might be called a disease management program. Examples include Kaiser's move to subcutaneous EPO, its aggressive vascular access program, and its protocol for primary care physician nephrologists and other caregivers to perform quarterly preventive checkups for all patients. In contrast, HOI exerted little effort to influence provider practices. Although HOI's structure certainly did not prohibit it from pursuing such management approaches, it is likely that due to the exclusive relationship between Kaiser and its nephrologists, Kaiser had an easier time influencing behavior change among providers.
Other factors unrelated to the demonstration program structure also shaped the demonstration plans' experiences. These include the sites' previous experience with ESRD patients, relative size, and their relationships with providers.
A major criterion by which to evaluate the feasibility of implementing a managed care option in Medicare ESRD is whether providing such care is financially feasible for the sponsoring organization. From the perspective of the demonstration sites, the initiative did not produce a financial windfall for either Kaiser or HOI. The capitation revenues received by HOI did not cover total demonstration expenses in any year of the demonstration.
Kaiser experienced a net loss during the first year of the program and very modest net income 2 percent or less in the final 2 years of the demonstration Dykstra et al. Nevertheless, some stand-alone ESRD disease management programs have been developed.
We raise the issue here to acknowledge the importance of the financial outcomes from the plans' perspectives on the future of manage care in the ESRD market. However, it is worth noting that both Kaiser and HOI received authorization from CMS to receive a capitated payment for demonstration patients based on the demonstration rates.
Developing and implementing a demonstration program of this magnitude requires a great deal of resources and commitment on the part of the demonstrations sites and the sponsoring organization. The demonstration outcomes, viewed in the context of the structural and operational arrangements described in this article, provide a strong foundation for CMS, Congress, and the broader ESRD community to rely upon as they consider the full range of policy options regarding ESRD patient and provider participation in managed care programs.
Caitlin Carroll Oppenheimer and Daniel S. Gaylin are with the National Opinion Research Center. Jennifer R. Nancy Beronja is with The Lewin Group. Dawn M. Dykstra and Philip J. Robert J. Rubin is with Georgetown University School of Medicine.
EPO is a synthetically produced drug that has helped reduce the rates of anemia among dialysis patients National Kidney Foundation, a. Dose is a function of patient characteristics e.
Daugirdas and Ing, In the HMO industry, a medical loss ratio close to 85 percent is considered reasonable, with the remaining 15 percent or so of revenue available to cover administrative costs and profit Dykstra et al.
Future analyses will investigate access to transplantation in the demonstration. E-mail: ude. Health Care Financ Rev. Caitlin Carroll Oppenheimer , M. Shapiro , M. Dykstra , Daniel S. Gaylin , M.
Held , Ph. Rubin , M. Copyright and License information Disclaimer. Copyright notice. The purpose of this article is to describe the operational outcomes of the demonstration with regard to three aspects: What was the structure of these managed care programs for ESRD patients?
What do these sites' experiences tell us about the challenges of introducing managed care programs in the ESRD arena? The demonstration was intended to test the feasibility and effectiveness of the following: Permitting year-round enrollment and disenrollment options for ESRD beneficiaries to enroll in participating HMOs.
ESRD-focused case management, with particular emphasis on whether outcomes of care were improved. Preventive and supportive interventions and more comprehensive benefit coverage for ESRD patients.
Integrated administrative and financial arrangements among providers of services to ESRD beneficiaries. Service Integration and Case Management. Demonstration sites were required to invest in the structuring of care delivery in order to better coordinate services and improve outcomes of care and satisfaction for patients. Organizations were expected to provide all Medicare-covered health services, including kidney transplants, plus additional benefits, and to use a case manager in fully integrating these services at the level of the individual beneficiary.
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|Adventist health career sogn in||Transportation Benefit Not offered. Inpatient hospital services provided to demonstration patients were provided by Kaiser hospitals and specialty care was also provided using Kaiser's own network of specialists. In addition to efforts aimed at nephrologists, HOI launched educational meetings with potential patients and marketed the program through the Florida Https://rvtrailercamperpartsinteriorforsale.com/amerigroup-insurance-provider-name/5871-lansing-capital-humane-society.php patient newsletter. Additionally, the FFS system poses challenges for systematic implementation of patient care guidelines to encourage best practices. Outpatient Dialysis Treatments and Ancillaries Mostly contracted facilities. Patients cited the following reasons for not wanting to join the demonstration: 1 not wanting to change physician or dialysis unit, 2 fear of managed care and participating in a demonstration project, 3 physicians' emblemhealth syracuse ny discouragement against joining, 4 concern about giving up supplemental health insurance, and 5 questions about insurance coverage after the demonstration ended. The literature substantiates that for the majority of dialysis patients, subcutaneous administration of EPO is more effective, on average, by about 33 percent.|
The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees.
Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership. The Medicare payroll taxes and premiums go into the Medicare Trust Fund. Bills for healthcare services to Medicare recipients are paid from that fund. If you have Medicare and full Medicaid coverage, you can change plans once per calendar quarter for the first three quarters.
The new plan will take effect the first day of the following month. Fourth-quarter changes must be made during Medicares Open Enrollment Period.
Also known as the Annual Enrollment Period, it runs from October 15 and December 7, and changes will go into effect January 1. Public opinion polling suggests that Medicaid has broad support. Seven in ten Americans say they have ever had a connection with Medicaid including three in ten who were ever covered themselves. Even across political parties, majorities have a favorable opinion of Medicaid and say that the program is working well.
In addition, polling shows that few Americans want decreases in federal Medicaid funding. In addition to broad-based support, Medicaid has very strong support among those who are disproportionately served by Medicaid including children with special health care needs , seniors , and people with disabilities.
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If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months. RMHP offers program for pregnancy care as well. Home-and Community-Based Services help you and your family in your home. You may qualify for home health care and non-skilled home help.
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