12/28/14 7:00am
12/28/2014 7:00 AM

Under provisions in the Affordable Care Act of 2010, some Medicare recipients are suddenly finding themselves without a safety net when in need of subsequent care at a skilled nursing facility.

It has resulted in the proposal of new legislation in Washington — along with a national class action lawsuit challenging what the nonprofit Center for Medicare Advocacy of Connecticut calls an “illegal policy.”


01/12/14 12:00pm
01/12/2014 12:00 PM

The New Year brought about a welcome change for Medicare patients seeking mental health services.

Effective Jan. 1., Medicare coverage of mental health treatment is now in line with that available for other types of medical care — covering 80 percent of most fees and leaving only 20 percent up to the patient.

The change has been in the works for several years, thanks to the Medicare Improvements for Patients and Providers Act, which amended the Social Security Act in 2008.

Previously, patients seeking treatment such as psychotherapy from a clinical psychologist, Ph.D. or social worker were responsible for half the bill.

Medicare has been boosting its coverage for such services incrementally since 2008, covering to 55 percent in 2010, 60 percent in 2012 and 65 percent last year, according to the bill. Coverage will now remain at 80 percent.

Up to now, many patients seeking mental health services had to rely on supplemental coverage such as Medigap insurance to fill in the void, said Eric Hausman, Medicare consultant for the county Department for the Aging.

“The people who will be impacted most will be the people who don’t have other insurance aside from Medicare,” he said. “That’s a good change for them in terms of what they are paying out of pocket.”

With increased access to affordable care, patients who have thought about seeking mental services in the past should seriously consider utilizing care, he said.

Another recent change makes accessing care even easier: Medicare patients are now eligible for one free annual depression screening, which is now covered in full by Medicare, thanks to the passage of the Affordable Care Act, Mr. Hausman said.

“It’s at no cost as long as the doctor or provider accepts Medicare. This is a good way for somebody to get screened to see if they might need mental health counseling,” he said.

Once diagnosed, patients can access the affordable therapy they need — or be put on prescribed medication that has also only recently become available to Medicare patients, he said.

Before 2013, Medicare Part D, which covers prescription medications, did not cover many common psychological drugs such as benzodiazepine and barbiturates, Mr. Hausman said.

“Drugs like Valium and Xanax that people might take for anxiety, originally those classes of drugs were excluded from Medicare part D drug plans when it first started in 2006,” he said. “They started to cover those in 2013.”

The combined changes show that mental health treatment has become “better accepted and more recognized” in the field of medicine, he said.

Mr. Hausman said the best way to find a mental health provider in the area who accepts Medicare is to visit the Medicare website and use the “physician compare” tool, filling in the Zip code and type of provider.

He cautions, however, that even if a Medicare provider is listed, it does not necessarily mean he or she is able or willing to take on new Medicare patients.

“The best thing they can do is call and ask,” Mr. Hausman advised.

Got a health question or column idea? Email Carrie Miller at [email protected]. Follow her on twitter @carriemiller01.

11/12/13 7:00am
11/12/2013 7:00 AM
Patients relying on Medicare to cover the costs of hospital care should ask additional questions next time they find themselves having to visit an area hospital — even if everything looks like it’s business as usual during a hospital stay.

As a notice from Eastern Long Island Hospital explained, patients could find themselves staying on an inpatient floor, sharing a room with an inpatient, and even receiving the same care as an inpatient – but still be considered an outpatient by Medicare. This can make them responsible for unexpected expenses.

A Medicare enrolled patient who has been admitted to a hospital is considered an inpatient, and would be covered under Medicare Part A, explained Maureen Ruga, director of quality management at Peconic Bay Medical Center. But a hospital patient can also be placed on “observation status,” making that person an outpatient  – in which case they would be covered under Medicare Part B, she said.

Part B holds beneficiaries responsible for deductibles for some testing and medication, according to the Centers for Medicare & Medicaid Services.

Effective Oct. 1, new Medicare & Medicaid Services rules make time the determining factor of whether a Medicare patient should be officially admitted to the hospital or not. Under those rules, if a physician expects a patient will require hospitalization for at least two overnight days, or two “midnights,” they should meet qualifications for admittance to the hospital.

If not, the patient will be placed on observation status.

“Patients should always ask if they are being admitted into the hospital as an inpatient. That is number one,” Ms. Ruga said. “If they are being treated on observation status, they should check with their physician each day to see if their status has changed.”

On Oct. 22., Gov. Andrew Cuomo signed a new law requiring state hospitals to provide Medicare beneficiaries with both oral and written notice within 24 hours if they are placed under observation during their hospital stay. Under the state law, the hospital must also explain how the status will affect the patient’s health insurance coverage – and give them the right to appeal the observation status.

The Medicare & Medicaid Services rules have been criticized by health care advocacy groups, including the StateWide Senior Action Council, because, Ms. Ruga said, Medicare “isn’t using diagnosis or care as the criteria for coverage, they are using a time frame.”

She said the quality of care patients receive should not be affected by Medicare billing.

Understanding one’s status during a hospital stay becomes especially important for patients who might need subsequent care at a skilled nursing facility, said Eric Hausman, Medicare consultant for the state Department for the Aging. According to the new rules, Medicare patients must spend at least three consecutive days as a hospital inpatient in order to qualify for Part A coverage for subsequent care at a skilled nursing facility.

Got a health question or column idea? Email Carrie Miller at [email protected]. Follow her on twitter @carriemiller01.