Repeal & Replace of ObamaCare, a/k/a RyanCare

March 9, 2017

Filed under: Medicaid (MassHealth),Medical Care — rec1 @ 10:16 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

Repeal & Replace of ObamaCare, a/k/a RyanCare

Filed under: Medicaid (MassHealth),Medical Care — Alexis @ 10:14 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

South Shore Residents May Be Eligible for Alzheimer’s PET Scans (IDEAS)

January 24, 2017

Filed under: Alzheimer's,Medical Care — Alexis @ 1:33 PM

Beth Israel Deaconess-Plymouth is taking part in a study that uses PET scans to look for signs of Alzheimer’s. It is called the Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) Study.

There are many different sources of dementia, for example Alzheimer’s, vascular, and frontal lobe. Knowing which type of dementia a person has can help patients and families know how to work with the changing mind and what to expect from the course of the disease over time.

Not everyone is eligible – this is a study, so there are various criteria that a person must meet. The PET scan is paid for by Medicare. If you or a loved one has dementia, talk to your doctor about whether you can participate in the study.

For more information, see this article.

Medicare Open Enrollment Season

October 21, 2016

Filed under: Medical Care — Alexis @ 9:46 AM

Medicare Open Enrollment is happening now: it runs from October 15 to December 7.

Now is the time to check whether your supplement and Part D plans are the right ones for you. For help with the research, you can visit and you can also make an appointment with the SHINE counselor at your local senior center.

Which Hospital Must an Ambulance Take You To – Can You Demand a Specific Hospital?

February 13, 2014

Filed under: Medical Care — Alexis @ 10:43 AM

The answer is – it depends.

If there is an emergency and you are unable to express your wishes, even if you have advanced medical directives or a health care proxy in place, the Emergency Medical Technicians or Paramedics responding to the call are obligated to stabilize you and transport you to the nearest appropriate hospital. This does not necessarily mean you’ll be transported the closest hospital – for example, if you are severely burned, the ambulance may bring you to the nearest hospital with a specialized burn unit, even if there are other hospitals closer by. Once you have been evaluated, your advanced health care directives can be implemented, including transporting you to another hospital if a transport can be done safely.

In a situation where you are able to express your wishes, an ambulance may take you to the specific hospital you demand. Some ambulances, especially town or municipal ones, may be assigned to a certain “zone,” and are unable to take you to a hospital outside of their assigned region. And, if a hospital’s emergency room is full and not accepting any more patients, an ambulance may not be able to bring you there, even if that is where you wish to go.

It is also important to note that Medicare only covers ambulance services “to the nearest appropriate medical facility that’s able to give you the care you need.” If you demand transportation and are brought to another hospital instead of a closer, equivalent facility, you could be left to foot the bill on your own. An ambulance crew cannot ask you about your insurance, but it is important to know that Medicare may not cover ambulance transport if you demand a specific hospital.

Heard at the Office: “Can’t My Spouse Automatically Speak for Me at the Hospital?”

January 30, 2014

Filed under: Estate Planning,Medical Care — Alexis @ 10:40 AM

Under the law, no. In real life, sometimes.

Many people think that they don’t need to sign a Health Care Proxy because they assume that the law permits their spouse to speak for them in medical emergencies. The law actually says quite the opposite. Only you or someone you have named in a Health Care Proxy has the authority to make medical decisions for you.

Real life doesn’t precisely follow the law. If hospital staff get the sense that the family all gets along and don’t think anyone in the family will have an issue with the well-spouse being the decision-maker, they will often turn to the well-spouse to make the decisions. But if hospital staff sense any dissent among the family, they will want to see a Health Care Proxy.

But what if you never signed one? Well, the hospital will tell your family that they need to go to court to have a guardian appointed. That costs a lot of money (your money, by the way), and takes a lot of time and emotional energy.

And even if the family all gets along just fine, there are other reasons hospital staff may ask to see a Health Care Proxy (and if there isn’t one, send your family off to court). For example, if you need antipsychotic medications, like anxiety or depression medications, the staff will ask to see a Health Care Proxy. Another common example arises when hospital staff considers inserting or removing a feeding tube, or using or discontinuing use of a ventilator. As you can see, even if your family gets along, the hospital staff still will need to see a Health Care Proxy (or, you guessed it, send your family off to court for guardianship).

Moral of the story? Put a Health Care Proxy in place now. It doesn’t take much time at all.

MOLST – Getting Your End-of-Life Wishes into Your Doctor’s Orders

May 28, 2013

Filed under: Medical Care — Tags: — Alexis @ 10:00 AM

Massachusetts has recently enacted the MOLST program – that’s Medical Orders on Life-Sustaining Treatment. This is a solution to a question that a lot of clients ask: “How do I make sure my kids do what I want with end-of-life care?” Or more typically, clients say, “I want a living will.”

MOLST is better than a living will, and it goes further than a health care proxy. Until MOLST, you might share with your children what kind of treatments and care you do and don’t want as you approach the end of your life, and you might get a chance to talk about it with your doctor, and then you hope for the best as you gradually come to rely on others to make decisions for you.

With MOLST, you have a conversation with your doctor while you are able, and then – this is the key – the doctor turns those into “doctor’s orders.” The MOLST form is a pink sheet of paper, and once that is in your medical record, it’s going to carry a lot of weight.

With MOLST, you get to think about and talk to your doctor about the things that are already on your mind – would you want CPR? Ventilation and intubation? Dialysis? Artificial nutrition and hydration? And then you turn them into medical orders. That means that there is a pretty good chance (though no system is foolproof) that as you decline, your medical providers and family will not only know your wishes, but will honor them. Having them in your record as doctor’s orders makes all the difference.

What about changing your mind? Yes, you can. At any time, you can talk to your medical staff about changing a prior decision in the MOLST.

Family members may ask what to do if a parent or loved one is already at the point where they can’t discuss end-of-life care options themselves with their doctor – the MOLST process permits a health care proxy or guardian to review end-of-life choices with the doctor as well.

For more information, and to see a sample form, see the MOLST site. It’s a well written, easy to read site.

Please note that the MOLST process is meant for people with advanced illness or injuries. If you are healthier, then the best vehicle for sharing your end-of-life wishes is something like the Your Way workbook.

Department of Public Health Survey on Health Needs for People with Disabilities

May 20, 2013

This landed in my inbox. It took about 5 minutes to fill it out. Due date is May 31. Here are the details:

Help influence health care in Massachusetts! The Health and Disability Program, part of Office of Health Equity at the MA Department of Public Health (DPH) is conducting a health needs survey for people with disabilities in Massachusetts. The Office of Health Equity promotes the health and well being of minority populations, including people with disabilities throughout the Commonwealth. Results from the survey will be used to determine how best to address the current public health needs of the disability community. To that end, first, please take a few moments to complete the health needs survey yourself here.

DPH would like to get a broad range of respondents representing all the facets of the disability community, please forward the link to your friends and colleagues in the disability community and ask them to complete.

Who should complete this survey?

Residents of Massachusetts, over the age of 18 who have disabilities
Caregivers or guardians of adults or children with disabilities
Disability advocates
Staff at community based organizations or state or local government offices that serve people with disabilities
Academic researchers
Healthcare providers
Public health officials or professionals
Health and wellness promotion specialists
Health administrators
Health policy experts
We also invite participation by anyone else who has an interest in the health of people living with disabilities in Massachusetts. Please forward as soon as possible, as the survey link will only remain active until May 31, 2013. We look forward to hearing from you!

This is a voluntary and anonymous survey. The responses are compiled and we do not have knowledge of individual respondents.

The Nursing Home Stopped Medicare Payments Because my Loved One Stopped Improving, but I Heard that’s Illegal

January 3, 2013

Filed under: Medical Care — Alexis @ 10:52 AM

For many years, Medicare has stopped paying for therapies or skilled care once the patient stopped improving, or plateaud.  This is not what the regulations say, but somehow that became the practice across the country.

In December, the good folks at the Medicare Advocacy Project fought and won against this trend, and a federal judge ordered that nursing homes must now provide the full 100 days of coverage that patients are entitled to, so long as they need skilled care or therapies, whether to improve, to maintain their conditions, or to stop or slow a deterioration.

So what happens to patients who have received Medicare denials in the past few years, and had to pay out-of-pocket, often impoverishing themselves, so that they (or a loved one) could receive continued nursing home care?  Will this federal case help them?

Yes. Denials going back as far as September 20, 2010 can be re-reviewed under the new (old) standard.  So if you or a loved one were in a nursing home in the late summer of 2010 or later, and if you had to pay out-of-pocket for skilled care or therapies after a Medicare denial, then dig out your paperwork.  As the federal case is implemented, Medicare will create a process for re-reviewing these denials in light of the new (old) standard.  Check the Medicare Advocacy Project for updates on this process.

If you have a loved one currently in a nursing home and they receive a Medicare denial, if you think they need continuing skilled care or therapies in order to maintain their condition or to stop or slow their deterioration, then appeal.  It will take some time for the appeal process to get up and running, but you want to make sure you appeal on time.

P.S. These rules also apply to home care and outpatient therapies.

Has the Nursing Home Told You that Medicare Coverage is Ending Because the Patient is No Longer “Improving”?

December 27, 2012

Filed under: Medical Care — Alexis @ 10:46 AM

Every day, families of nursing home patients are told that Medicare coverage will be ending in a day or two, because the patient is no longer “improving.”  Well, that has never been what the Medicare regulations say, but somehow, that has become the common practice across the country.

The good folks at the Medicare Advocacy Project brought these infractions to court and won.  A federal judge in Vermont, whose order applies to the whole country, clarifies that nursing homes can no longer cut off Medicare just because a patient has “plateaued.”

Instead, the (old) new law is: so long as the patient needs skilled care, whether to improve, maintain her condition, or prevent or slow deterioration of her condition, she is entitled to Medicare payment for up to 100 days.  Period.  Looked at another way, if the patient needs skilled care on a daily basis, or if she needs physical, occupational, or speech therapy five days per week, then she is entitled to Medicare coverage for the full 100 days.

The doctor is the most important person for you to work with.  If she agrees that the patient needs daily skilled care or therapies, then a written statement from her will help you win the full 100 days of Medicare coverage.

See here for a further understanding of the end of the “improvement standard,” and then review the self-help packets.  These are straight-forward, easy to read packets that will help you explain to the nursing home administrator that the rules have changed (many of them haven’t heard yet), so that she will feel comfortable submitting the claim to Medicare and continuing the patient’s coverage.

P.S. These rules also apply to home care and outpatient therapy, as well.

Thank you, Medicare Advocacy Project!



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