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Medicare Celebrates 49th Birthday (1965-2014)

(article from AARP - July 30, 2014)

July 30 of this year marks the 49th anniversary of President Lyndon B. Johnson sitting next to former President Harry S. Truman and signing Medicare into law.
In 1945, President Truman had proposed a national health insurance that did not discriminate in regard to beneficiaries but it would take twenty years for his vision to be realized in the form of Medicare.

Nationwide, nearly 50 million people or 15% of Americans are Medicare recipients. The state of Maine, has one of the highest percentage of people in any state - 21% of Mainers receive Medicare benefits to help pay healthcare expenses. Many of these recipients would not have access to the medical care they need if it weren’t for Medicare. In fact, in a recent survey conducted by AARP Maine of registered voters in the state age 50 and older, over half (51%) of respondents said they were very worried about not having Medicare benefits available to them in the future.

When Medicare was passed in 1965, President Johnson had pointed out that “older people are three times as often to be hospitalized but their income is less than half that of people under 65.” The need for a program like Medicare was more than obvious in those times and that need has only grown over time as the population continues to age. Within the first week of Medicare being available, over one million people had enrolled.

Almost fifty years later, the number of Medicare recipients has multiplied by close to fifty! AARP celebrates the 49th anniversary of Medicare by recognizing the importance of the program. Though it took two decades for Medicare to be signed into law on July 30th of 1965, the fact that close to 50 million people are helped every day by the program proves that it was worth the wait.

Find more resources from AARP about Medicare (http://states.aarp.org/category/maine), including this article and its history.

Click here to Take our quiz for a fun way to test your Medicare knowledge! 

(article from AARP - July 30, 2014)

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Tags: medicare, Contract Rehab Services, Therapy Management Services, Nursing and Therapy

CMS Releases Medicare Physician Fee Schedule Proposed Rule for CY 2015

Late on July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, the Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare & Medicaid Innovation Models, & Other Revisions to Part B for CY 2015 (PFS) Proposed Rule effective for services on and after January 1, 2015. The proposed rule will be published in the Federal Register on July 11, 2014. CMS will accept comments on the proposed rule until September 2, 2014. To view the proposed rule, please visit the Federal Register Public Inspection Desk at https://www.federalregister.gov/public-inspection. CMS' Fact Sheet can be viewed  here

The Proposed Rule includes changes to the misvalued CPT code review process as well as several of the reporting initiatives that are associated with PFS payments the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on Medicare.gov. The proposed rule also continues the phased-in implementation of the physician value-based payment modifier. The modifier provides differential payments to physicians based on comparison of the quality of care furnished to beneficiaries and the cost of care. 


The following is an overview of the proposed policy and payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015 of interest to NASL members.

Sustainable Growth Rate (SGR)
Although Medicare physician and Part B provider pay rates are due to be cut by at least 20 percent under the SGR, the proposed rule does not include proposals or announcements on the PFS update or SGR as these calculations are determined under a prescribed statutory formula that cannot be changed by CMS. The final figures are announced in the final rule in November. The Protecting Access to Medicare Act (PAMA) of 2014 provides for a zero percent PFS update for services furnished through March 31, 2015.

Potentially Misvalued Services Under the PFS
CMS has been engaged in a multi-year effort to identify and review potentially misvalued codes and to make adjustments where appropriate. In this year’s proposed rule, CMS is proposing to add about 80 codes to its list of potentially misvalued codes, 65 of which account for the majority of spending under the Physician Fee Schedule. CMS identified codes by reviewing high-expenditure services by specialty that have not been recently reviewed. Codes under review include those used in therapy such as 97032 Electrical stimulation, 97035 Ultrasound therapy, 97110 Therapeutic exercises, 97112 Neuromuscular reeducation, 97113 Aquatic therapy/exercises, 97116 Gait training therapy, 97140 Manual therapy 1/> regions, 97530 Therapeutic activities and G0283 Elec stim other than wound. 

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Tags: Contract Rehab Services, Therapy Management Services, Senior Care Rehab, Nursing and Therapy