Thursday, July 29, 2010

Many Americans Still Confused About New Healthcare Reform Law and its Provisions

/PRNewswire/ -- Not sure what's in--and not in--the new healthcare legislation signed into law by President Barack Obama in March? You're not alone. More than 2,100 adults were given a list of 18 reform items and asked to identify what's included and what's not included in the law. Only four items were correctly identified by the majority of those polled.

Most (58 percent) know that the reform package will prohibit insurers from denying coverage to people because they are already sick; 55 percent know the law permits children to stay on their parents' insurance plan until age 26; and 52 percent realize that people who don't have insurance will be subject to financial penalties. Additionally, half are aware that employers with more than 50 employees will have to offer their workers affordable insurance.

These are some of the major findings of today's HealthDay/Harris Poll, conducted between July 15 to 19, 2010 among 2,104 adults (aged 18 and over).

Among other findings: 82 percent think the bill will result in rationing of health care or that it might (it won't); 79 percent don't know or aren't sure if drug companies will pay an annual fee, (they will); 73 percent don't know the law establishes a new tax on the sale of medical devices; 66 percent don't know or aren't sure if the legislation will result in insurance exchanges where people can shop for insurance, (it will); and 63 percent either aren't sure or don't know if the new law will increase the number of people eligible for Medicaid, (it will).

"The problem for the (Obama) administration is healthcare reform is fiendishly complicated because the healthcare system is fiendishly complicated, and it is not politically feasible to tear up the system and build it again," said Humphrey Taylor, chairman of the Harris Poll, Harris Interactive's long-running public opinion poll. "Instead you have to build on the system that you have. When you try to build on a fiendishly complicated system, you have fiendishly complicated reforms."

Another cause of the confusion is due to the long and heated political debate that surrounded the bill before it was passed, Taylor said.

"The level of ignorance and misinformation is sort of astounding," he said. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."

For more information, click here to read the full report and methodology. HealthDay's news report is available here. Full data on the poll and its methodology are available at Harris Interactive.

  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                        Is Not
                                        Is Included/   Included/
                                        Will Result    Will Not
                                            From     Result From  Not
  Not allowing insurers to deny
   coverage to people                 %           58            9      34
  because they are sick
  Allowing children to stay on their
   parents' insurance until           %           55            9      35
  they are 26 years old
  Financial penalties for all
   individuals who do not have or     %           52            9      39
  do not buy insurance
  All employers with more than 50
   employees must offer               %           50            9      41
  their employees affordable
  Tax credits for small business to
   provide insurance to               %           43           14      43
  their employees
  Increasing the number of people who
   are eligible for                   %           37           13      50
  Insurance exchanges where people
   can shop for                       %           35           14      52
  A new tax on the sale of medical
   devices                            %           27           13      60
  An annual fee to be paid by drug
   companies                          %           21           14      65

  Note: Percentages may not add up exactly to 100% due to rounding.

                                     TABLE 2
  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                       Is Not
                                       Is Included/   Included/
                                       Will Result    Will Not
                                           From     Result From  Not
  An increase in the federal
   government's budget deficit       %           45           13      42
  Higher income taxes for the middle
   class                             %           37           22      41
  All Americans will have health
   insurance                         %           36           29      35
  New ways to ration health care     %           36           18      46
  A new government run health plan
   to compete with                   %           36           22      43
  private insurance plans
  A cut in Medicare benefits         %           33           21      45
  Higher tax deductions from
   workers' pay                      %           33           16      50
  Panels to decide what care very
   sick, older people                %           30           26      44
  should receive
  Illegal aliens will have health
   insurance                         %           28           27      45

Note: Percentages may not add up exactly to 100% due to rounding.


This survey was conducted online within the United States July 15 to 19, 2010 among 2,104 adults (aged 18 and over). Figures for age, sex, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents' propensity to be online.

All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Interactive avoids the words "margin of error" as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal.

Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the adult population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated.

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Tuesday, July 27, 2010

U.S. Files Suit Against Georgia Medical Center and Physician; Allegedly Submitted Claims for Worthless Services to Federal Health Care Programs

/PRNewswire/ -- The United States has filed a complaint under the False Claims Act against Dr. Najam Azmat and the Satilla Regional Medical Center in Waycross, Ga., the Justice Department announced today. The complaint, filed in U.S. District Court for the Southern District of Georgia, alleges that the defendants submitted false or fraudulent claims to federal health care programs, such as Medicare. Specifically, the United States contends that certain operative procedures performed by Dr. Azmat at Satilla, and hospital services provided by Satilla in connection with those procedures, were not reasonable and necessary, were incompatible with standards of acceptable medical practice, and were of no medical value. The United States further alleges that the defendants' misconduct endangered the lives of federal health care program beneficiaries.

The government's complaint alleges that in the Spring of 2005, Satilla recruited Dr. Azmat, a general surgeon by training, to relocate to Waycross and join the hospital's medical staff. Shortly after Dr. Azmat came aboard, Satilla allowed him to begin performing endovascular procedures - highly specialized operative procedures that require formal training - in Satilla's Heart Center cath lab. Satilla did so despite the fact that Dr. Azmat lacked training to perform such procedures, was not qualified or competent to perform such procedures, had never performed such procedures before at any of the hospitals where he had been on staff, and did not even have privileges at Satilla to perform such procedures.

The complaint further alleges that it was obvious to the cath lab nursing staff that Dr. Azmat was not qualified or competent to perform endovascular procedures. The nurses repeatedly voiced their concerns to Satilla's management, but the hospital took no formal action for at least five months, during which patients were seriously injured and one patient died from hemorrhagic shock following an endovascular procedure during which Dr. Azmat perforated her renal artery. The complaint also states that not only did Satilla's management ignore its nurses' concerns for several months, but it also performed no formal oversight of Dr. Azmat, categorically excluding all of his endovascular procedures from Satilla's peer review process.

"When health care providers cut corners by allowing unqualified doctors to perform complicated medical procedures, patients suffer," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Here, we allege individuals were endangered because of these defendants. The seriousness of this case illustrates why we remain committed to protecting patient safety and the integrity of our federal health care programs by aggressively enforcing our health care fraud laws."

"The filing of this complaint is but one example of the willingness of the Department of Justice to take action to protect the health and safety of the American people. The United States Attorney's Office will take the necessary legal actions to comply with our vigorous enforcement responsibilities under the False Claims Act," said Edward Tarver, U.S. Attorney for the Southern District of Georgia

This lawsuit was originally filed by Lana Rogers, a nurse who formerly worked in Satilla's Heart Center. Under the qui tam, or whistleblower, provisions of the False Claims Act, a private citizen can file an action on behalf of the United States and receive a portion of any recovery. In April of this year, the United States intervened in the lawsuit, and today filed its own complaint. Under the False Claims Act, the government may recover up to three times the amount of its losses, plus civil penalties based on the number of false claims filed

The suit is entitled United States ex rel. Lana Rogers v. Najam Azmat, M.D. and Satilla Health Services Inc., dba Satilla Regional Medical Center.

The United States' intervention is part of the government's emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $4 billion.

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Friday, July 23, 2010

Six Key Tips for Caregivers Navigating the System on Behalf of Their Parents, Grandparents and Others

/PRNewswire/ -- According to the National Alliance for Caregiving, more than 65 million people in the United States serve as informal caregivers, typically for family members, which equates to more than one out of every four people serving as unpaid caregivers.

A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.

"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."

Gathering Information

The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:

-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and

This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.

Getting Permission

Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.

"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."

Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.

These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.

Enrolling in a Chronic Disease Program

Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.

"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."

Knowing Your Rights

Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.

If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit to get a free copy of "Your Rights and Protections."

Investigating 'Extra Help'

As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to

Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.

Caring for Yourself

The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.

According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.

"Caregivers need to know that there's no shame in asking for help," said Connolly.

For more information about care giving and Medicare, including helpful forms, please visit

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Thursday, July 22, 2010

AHRQ State Snapshots Expanded To Include New Data on Health Insurance Coverage

Editor Note:  According to this new database, Georgia has improved its health care quality from "weak" to a low "average."

/PRNewswire/ -- The Agency for Healthcare Research and Quality's annual release of state-by-state quality data has been expanded to include new data on health insurance, including data on health care quality categorized by source of payment, including private insurance, Medicare, Medicaid and those without insurance.

The new health insurance section allows users to compare payer-specific quality rates as well as differences among payers. For example, a state can compare the quality of care received by Medicaid or uninsured patients with that received by these same patients nationally. In addition, a state can assess whether its insurance-related disparities are larger or smaller compared with the nation as a whole.

The 2009 State Snapshots provide state-specific health care quality information, including strengths, weaknesses and opportunities for improvement. State-level information used to create the State Snapshots is based on data collected for the 2009 National Healthcare Quality Report. Overall, states get mixed reviews for the quality of care they provide. As in previous years, AHRQ's 2009 State Snapshots show that no state does well or poorly on all quality measures.

Maine, Maryland, Wyoming, South Carolina and the District of Columbia showed the greatest improvement. The five states showing the smallest improvement were North Dakota, Texas, West Virginia, Nebraska and Washington State. For each state, specific clinical conditions could be identified that account for different rates of improvement.

"The addition of the insurance information to the State Snapshots adds one more dimension to the picture of health care quality and disparities in individual states and regions," said AHRQ Director Carolyn M. Clancy, M.D. "The 2009 State Snapshots continue to evolve into an invaluable resource for state officials and other stakeholders."

The 2009 State Snapshots summarizes health care quality in three dimensions: types of care (preventive, acute and chronic care), settings of care (hospitals, ambulatory settings, nursing homes and home health care) and clinical conditions (cancer, diabetes, heart disease, maternal and child health and respiratory disease). There are also special focus areas on diabetes, asthma, Healthy People 2010 objectives, clinical preventive services and disparities.

Additional features in the 2009 State Snapshots provide more ways to analyze the quality of health care for each state compared with all states, as well as with states in the same region. New and enhanced features include enhanced sections on asthma care, diabetes care and health care disparities.

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Wednesday, July 14, 2010

Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care

The Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations today, requiring new private health plans to cover evidence-based preventive services and eliminate cost sharing requirements for such services. The new rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children.

"Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," said HHS Secretary Sebelius. "From the Recovery Act to the First Lady's Let's Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy."

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation's health spending - and often are preventable. Nationally, Americans use preventive services at about half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Cost sharing, including deductibles, coinsurance, or copayments, has been found to reduce the likelihood that preventive services will be used.

"Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure," said First Lady Michelle Obama. "And good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother - and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them."

"One of the best ways to improve the quality of your life - and control health care costs - is to prevent illness in the first place," said Dr. Jill Biden. "Focusing on prevention and early treatment makes more sense than trying to play catch-up with a potentially deadly disease. Quite simply, these preventative services will save lives."

Under the regulations issued today, new health plans beginning on or after September 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider. Specifically, these recommendations include:

* Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a "grade" of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

* Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.

* Prevention for children: Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults. The types of services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

* Prevention for women: Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.

Today's announcement builds on other provisions in the Affordable Care Act that support prevention, including the creation of a first-ever National Prevention, Health Promotion and public Health Council tasked with developing a national strategy and a Prevention and Public Health Fund to invest in prevention initiatives and, this year, policies to increase the number of primary care professionals to help ensure access to these services. The Affordable Care Act also helps make it easier and more affordable for Americans enrolled in Medicare or Medicaid to access critical preventive screenings and services.

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Tuesday, July 13, 2010

Enactment of New FSA Restriction Will Pose Problems for Consumers, Retailers and Benefit Providers

/PRNewswire/ -- A provision of health care reform could blindside consumers and create an administrative nightmare for providers and retailers as its January 1, 2011 implementation date draws closer. Without intervention, the Patient Protection and Affordable Health Care Act, passed earlier this year, will require consumers to obtain a physician's "prescription" in order to use their pre-tax flexible spending accounts (FSAs) to pay for over-the-counter (OTC) medicines other than insulin. Rep. Earl Pomeroy (D-ND) and industry groups have called for clarification of the new regulations to give providers and retailers an opportunity to educate consumers and develop compliance procedures.

In a letter to U.S. Treasury Secretary Timothy Geithner, Rep. Pomeroy encouraged the Treasury " work with consumers and stakeholders to address certain compliance issues in advance of the mandated implementation date." Without clarifying the policy, "...consumers are left confused and frustrated and benefit administrators and retail merchants will be left with increased processing and consumer service costs," wrote Rep. Pomeroy.

An industry group responsible for establishing standards for electronic payment processing for health spending accounts, such as those used to identify eligible OTC purchases, argues additional guidance is needed to clarify how the new regulations will work in practice before it can be implemented. The law currently states that only "prescribed" OTC drugs are eligible for reimbursement; however, it does not specify whether a prescription is required or if a letter of medical necessity will suffice.

"Without clarification on the type of permission needed for FSA reimbursement for OTC drugs, consumers, retailers and third party administrators will be confused and unlikely to fully comply with the new regulations by the start of the new year. Meanwhile, we're likely to see doctor's offices overwhelmed with patients seeking prescriptions to use their spending accounts for Claritin, Zyrtec and other OTC items," said Jody Dietel, president and chair of the Special Interest Group for Inventory Information Approval System Standard (SIGIS). "A delay in implementation will provide time for all parties to be better educated on the issue and prepared to comply with the new rules."

Both Rep. Pomeroy and SIGIS warn that forcing retailers to quickly change their distribution practices for a January 1, 2011 start date will be difficult given the current electronic systems structure, which, in turn, will lead to processing errors, consumer frustration and major challenges for FSA administrators.

"This restriction will hurt millions of consumers who rely on their FSAs to manage their out of pocket health care costs and pay for necessary over-the-counter therapies," noted Joe Jackson, CEO of WageWorks Inc., a benefits company based in San Mateo, California. "If Congress is intent on putting this provision into effect, they should at least push back the deadline so that consumers and especially retailers are ready for the transition."

Currently, consumers may contribute money to their FSAs to cover out-of-pocket medical expenses not covered by insurance, including co-pays and over-the-counter items such as asthma and allergy supplies, aspirin and flu medications.

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Wednesday, July 07, 2010

Oxendine: Flood Insurance Program Resumes Issuing Policies

Insurance Commissioner John W. Oxendine said the National Flood Insurance Program has been reauthorized by Congress, and flood policies are again available through your homeowners insurance agent or company.

Flood coverage is federally backed by the NFIP. The National Flood Insurance Extension Act extends the NFIP through September 30 of this year, and is retroactive back to June 1, 2010. The program had been inactive since May 31.

Oxendine said a flood policy can be a valuable addition to standard homeowners coverage.
“Purchasing flood insurance is an important consideration for Georgia consumers, even if you think a flood is unlikely in your area,” Oxendine said. “Twenty-five percent of flood claims occur in areas considered medium or low-risk for floods.”

Oxendine said flood insurance is available for up to $250,000 for damage to your home. A standard flood policy will cover the basic structure as well as the furnace, water heater, air conditioner, floor surfaces (carpeting and tile) and debris clean up.

You can buy NFIP flood insurance directly from your property and casualty insurance agent or insurance company, if your community participates in the NFIP. Your insurance agent or insurance company can confirm whether flood insurance is available to you and what it would cost. You can buy flood insurance for your home or business regardless of whether the property is in or out of a floodplain, as long as the property is located in a participating community.

It is very important to plan ahead; a flood insurance policy will not go into effect until 30 days after you buy the policy. You can obtain more information about flood insurance at

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Monday, July 05, 2010

Medicare Proposes New Rules to Ensure Equal Visitation Rights for All Hospital Patients Patients to Designate Their Own Visitors, Including Domestic Partners

The Centers for Medicare & Medicaid Services (CMS) on June 23 proposed new rules for hospitals that would protect patients' rights to choose their own visitors during a hospital stay, including visitors who are same-sex domestic partners.

The new proposed rules implement an April 15, 2010, Presidential memorandum, in which the President tasked HHS with developing proposed standards for Medicare- and Medicaid-participating hospitals (including critical access hospitals) that would require them to preserve the rights of all patients to choose who may visit them when they are inpatients of a facility.

The proposed rules would require every hospital to have written policies and procedures detailing patients' visitation rights, as well as instances when the hospital may restrict patient access to visitors based on reasonable clinical needs.

A key provision of the proposed rules specifies that visitors chosen by the patient (or his or her representative) must be able to enjoy visitation privileges that are no more restrictive than those for immediate family members.

"Every patient deserves the basic right to designate whom they wish to see while in the hospital," said HHS Secretary Kathleen Sebelius. "Today's proposed rules would ensure that all patients have equal access to the visitors of their choosing-whether or not those visitors are, or are perceived to be, members of a patient's family."

The proposed rules would update the Conditions of Participation, which are minimum health and safety standards all Medicare- and Medicaid-participating hospitals and critical access hospitals must meet.

Specifically, the proposed rules would add new requirements for hospitals and critical access hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, or a domestic partner (including a same-sex domestic partner), as well as the right to withdraw such consent at any time.

"This proposed rule is an important step forward in the rights of all Americans to expect equal rights and privileges from the health care system, regardless of their personal and familial situations," said Marilyn Tavenner, CMS acting administrator. "In the environment of inclusion that this rule promotes, patients and providers can expect improved patient experiences of care."

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Statement from Secretary Sebelius on Proposed CMS Rule to Expand Medicare Preventive Services and Expand Access to Primary Care

On June 25, the Centers for Medicare & Medicaid Services (CMS) took another important step to help improve the health status of Medicare beneficiaries. The proposed regulation will implement the new preventive health benefits created under the Affordable Care Act for the seniors and persons with disabilities who rely on Medicare for their health care coverage.

The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.

To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.

Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.

With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.

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Sunday, July 04, 2010

HHS Secretary Sebelius Announces New Pre-Existing Condition Insurance Plan

The U.S. Department of Health and Human Services (HHS) announced on July 1 the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.

Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.

“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”

The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website,

“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”

In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.

Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.

All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.

“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.

Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.

Information on how to apply for the Pre-Existing Condition Insurance Plan is available at Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on

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