...Centers for Medicaid and Medicare The Centers for Medicaid and Medicare services is a federal agency within the department of health and human services. They work in partnership with state governments to administer Medicaid, the States Children’s Health Insurance Program and Health insurance portability standards. CMS oversee the administration simplification standards in long-term care facilities and clinical laboratory quality standards under the clinical laboratory improvement amendments. CMS serves over 90 million beneficiaries and has an approximate budget of about 60 billion dollars. The plan that they aim to use suggest that it will improve health care quality and lower cost. This outlines ways in which the agency can use significant influence in the healthcare market place to effect change and order to achieve their vision of a transformed, modernized healthcare system. They plan to offer Coverage, Wellness and Prevention, Care coordination, Health Information Technology and quality. They will do this by developing new advantage plans such as dual eligibility and chronic special needs plans. They will work with private sector plans, prescription drug plans to improve Medicare choices and awareness and prescription drug coverage. They will develop strategies for emergency preparedness and pandemic planning. Expand preventive screenings and reduce disparities in preventive services by measuring trends and statistics. They will support prescription drug plan sponsor’ efforts...
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...It is a fact of life that will get sorted out when everything settles and people get used to the new system. Unfortunately, the bad does weigh out the good and people soak it up like a sponge. Healthcare Systems will always be complex and be full of imperfections. However, people need to be able to balance the good and the bad and not just focus on the bad. The Affordable Care Act offers many benefits, especially for the lower to middle income families and businesses. However, it has some obstacles for higher earners, and larger companies that do not insure their employees. One of the most noted pros to the ACA is their achievement in insuring millions of people with affordable, high-quality health insurance. Unfortunately, in order to get the money to cover these millions of newly insured people, taxes are increased, which directly affect us. You are now personally responsible to get health insurance coverage through the multiple companies that offer through the exchange. If you do not get coverage you have to pay a penalty fee. This adds more complications at tax time. However, with the new reform, many protections are in place to ensure that you can’t be dropped from coverage immediately whenever the insurance company decides you are getting sick too often. You also can’t be denied coverage or treatment for being sick or get charged more. I would say that is a big pro to the ACA. You can no longer be charged more for being a woman because you may...
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...Policy Making and the Federal System Obama Care Ashford University: POL-201 August 18, 2014 Policy Making Obamacare The United States Government plays a big role in the policies or programs that the citizens can like or dislike but really don’t have the overall say. When it comes to the policies that get put into place not everyone is going to be happy with it. Sure, some policies will benefit some people more than others and some can just plain benefit the ones who run the country. Obamacare has some history behind the issues, benefits, and policies that will be placed on Americans to abide by. Here are some of the pros and cons of such a policy and how they weigh in weather or not if it is good or bad depending on how it affects you and your family. The Pros of Obamacare What greatly increases these conflict and debates are rooted in the constitutional framework of federalism, which is derived from the 10th Amendment. Federal health care policy “Obamacare” is one of these conflicting issues that have a significant federalism component that requires national, state, and local interaction. This has also leaded to a great deal of potential tension among different levels of government. Obamacare is an overall Medicaid expansion that is supposed to be one of the biggest milestones within healthcare reform by insuring up to 21 million Americans over the next decade. This expansion to Medicaid is supposed to provide the nation’s poorest with health coverage...
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...Essay Question Medicaid is a fund given by the federal or state government for low income, disabled and children. Also, people who are eligible to receive federally assisted income maintenance payments by social security or other such programs but they have to work for at least 25 years in the state. Since 2013, the government has increased the reimbursement from Medicaid patients, so it’s difficult for a patient to pay for their doctor visit. The most hospital doesn’t even want to see Medicaid patient as they only get 40-45% from the government but the treatment cost most expensive. After Affordable Care Act (ACA) decided to include more than million people in their system, but the rise and subsequent fall have affected patients. Doctor’s...
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...of health care. This paper will discuss the financial impact and delivery of the United States health care system. It will also discuss the different types of funding that are available to uninsured and underinsured children. Last, the paper will discuss issues and challenges of this vulnerable group along with some solutions that government has come up with. Uninsured/Underinsured Children in the United States Health care is financed by different means. There are public and private financing. Public financing options are through the government and states and consist of Medicare, Medicaid, and Children Health Insurance program. Private financing options consist of group insurance, self-insurance, and Managed Care Plans. Uninsured and underinsured children can get the help they need from many public financing groups whereas the private options tend to turn them down. Financial Impact Uninsured and underinsured children have a major financial impact on the economy. “The health costs of the uninsured have become an economic burden of the business community through property taxes, higher health insurance premiums, and lost productivity of workers with sick family members” (Edelman, 2009, para. 5). In other words someone has to pay for the health care of the uninsured and underinsured children in the United States. When parents are off work with their sick children, the company they are working for is losing productivity because they are not there to work. Children...
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...Health Care Museum Latesha Leftwich Health Care Delivery in the U.S. - HCS235 June 17, 2013 Elaina Mahlan, Facilitator Health Care Museum The United States health care system did not always exist and before 1920, most people did not have health care treatment. In order to understand our current healthcare system you need to know about the history of healthcare, how it started, and its evolution. In my research, you will learn about the history of and present usage of the American Medical Association, hospitals, nurses, Medicare/Medicaid, and the HMO Act of 1973. Exhibit A: The American Medical Association The American Medical Association (AMA) came about to make sure that traditional medicine and scientific concepts was used in colleges that deemed themselves as medical schools (Encyclopedia, 2001). A group of doctors who were a part of different local and state associations formed the AMA. They thought that medical education was not keeping up on a national level, that there were no consistent curriculums, and that medicine was not about healing arts associated with mystic beliefs (Encyclopedia, 2001). Since its start, the AMA has closed huge gaps in how medical students are taught and how healthcare is delivered (Lazarus, J. 2013). I believe that the AMA should be a part of my museum because without the AMA science would not have been applied to healthcare and without those sciences how would we have developed in the knowledge of healthcare today? The AMA is committed...
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...| Health care system in the U.S. and changes by Obama | | Semir Golic30.11.2010 | Table of Contents: 1. Introduction 3 2. The History of health care in the USA 4 3. The Health Care System 5 4.1 How health insurance works 4.2 Different insurance programs 4.3 Problems 3.3.1 Financial & bureaucratic problems 3.3.2 Conflict with the American Dream 4. Changes of Obama 9 5.4 Reform of the system 5.5 Problems 5. Evaluation 11 6. Bibliography 13 1. Introduction As in we know the United States strive in most categories to be the number one of the nations, be it military power, or be it technological innovation as much as economic power. Usually they tend to have success in this aspiration and so we would assume that their health care system counts to the most modern and best working innovations on the world. As it is confirmed and proven by many different organizations we know different. “Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last...
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...Healthcare: The Patient Protection and Affordable Act Jennefer Paddock POL 201 Thomas Arndt October 26, 2013 Healthcare: The Patient Protection and Affordable Act The Patient Protection and Affordable Act, also known as Obamacare, was signed into law by President Obama in March 2010. It has been the most significant overhaul in the United States healthcare since Medicare and Medicaid. The Patient Protection and Affordable Act affirms the core principal that everybody should have some basic security when it comes to their health care. Obamacare is aimed at helping the underinsured obtain insurance when they do not have insurance. Under Obamacare, everyone would have health insurance regardless of income or anything that would prohibit the person from attaining health insurance. Health insurance will be extended by expanding Medicaid and by providing federal subsidies to help lower and middle class citizens buy private coverage. Although health insurance will be extended, Obamacare raises issues of federalism, Obamacare has advantages and disadvantages, and Obamacare is not consistent with federal policy. Federalism facilitates the problem solving synergies that arise between the separate strengths of local and national governance for dealing with different parts of inter-jurisdictional problems. Obamacare raises issues of federalism because some say that mandated healthcare can be considered unconstitutional. Some view the fact that the government telling the citizens...
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...Billing/Book Report Jonathan Cohn’s “Sick presents case studies that demonstrate how America's current system causes even many middle class Americans serious financial or medical hardship. It lays out a history of health insurance in America and points to the record of systems abroad, particularly in France, as proof that universal coverage works. Cohn quickly dispenses with the common belief that it is the forty-plus million uninsured Americans who are the problem with our present system. It is our insurance itself that forms the biggest problem, an erratic problem that fails to provide needed health. Cohn methodically discusses each piece of the book one by one, using case histories to illustrate his points. He meet a few people with no insurance at all, a few with Medicare or Medicaid, and a few with good private policies. All are hard-working, well-intentioned, and startled that they have been punished, financially, emotionally, medically, or all three, for getting sick. What sets Cohn’s book apart from other compilations of sad stories is the comprehensive, dispassionate analysis he offers of the policy behind the tragedies. He provides a history of U.S. health insurance from the beginning up through the politicking behind Medicare and Medicaid in the 1960s, the rise and fall of health maintenance organizations (HMOs) in the 1990s, and the confused debut of last year’s Medicare Part D (for prescription drugs). I suspect that committed policy wonks might find...
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...Managed, Medicaid/Medicaid Managed, Managed Care/Blue Cross/VA/Campus/WC/Other FTE’s: 1 Main Responsibilities: 1. Process intake referrals on new patients. 2. Enter new patients into the Allscripts system. 3. Do insurance authorization for new patients. 4. Enter Home Health Daily visit Record into Allscripts. 5. Contacts insurance companies when claims are denied or are placed on hold. 6. Check for remittance advices online through Ability (Medicare) and EMOMED (Medicaid). 7. Post payments received for home health. 8. Check claim status off of AR Trouble Report. 9. Check for documentation on claims on hold. 10. Pull and send Medicare claims, send through EDI Ability. 11. Pull, copy and mail out commercial claims monthly, and enter Comments in Allscripts system. 12. Fill out claim audit sheets for Medicare and Commercial insurance. 13. Bill Medicare advantage plans. Other Responsibilities: 1. System administration for all HH Health Insurance. 2. Send out patient invoices monthly. 3. Answer phone. 4. Enter daily statistics into G: Drive. 5. Fill out Authorization report every Wednesday for case conference. 6. Print and copy patient roster every Friday. 7. Do month end first day of every month. Other Information: 1. Follow-up timeframes are 30 days post billing, unpaid commercial are given additional 15 days unpaid Medicare claims are 10 – 18 days, Medicare Advantage – 30 days, Medicaid is 15 days...
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...Frontlines documentary Sick Around the World was a clear understanding of why ObamaCare was a great idea of the United States. The video wanted its viewers to think Americas healthcare system at the time was unfit for most of the citizens. The video tied in with our readings on the topic of healthcare among citizens that are wealthy vs. poor. I do agree that people that’s more wealthy aren’t necessary concerned about health care insurance because they have to money to purchase individual health care insurance. Poor people have nothing to worry about because most of them qualify for Medicaid. The problem occurs with the middle class citizens like myself who pay extremely too much for insurance through their work provider for example I have...
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...the welfare system and in this paper some of the various issues will be discussed. These issues will touch on whether the Welfare Reform Act has met the goal of helping people obtain jobs and leave the welfare program. Whether or not there has been a drop in applicants for the welfare program and if existing Medicaid beneficiaries lost their necessary coverage under the act will be covered. When the Welfare Reform Act was first created it was a replacement for Aid to Families with Dependent Children (AFDC),it was then referred to as Temporary Assistance for Needy Families (TANF),( KU, L. 1997). The welfare reform law does not change how health care is delivered or has it made any changes in who is able to able to be accepted to the program (KU, L. 1997). According to Ku (1973), “there were only four major changes to Medicaid eligibility which are: splitting the welfare and Medicaid eligibility, narrowing eligibility for disabled children in the Supplemental Security Income (SSI), terminating access for some legal immigrants because they lose SSI, and by not allowing future legal immigrants from being accepted for Medicaid.” By making these changes then it can be said that this reform has indeed not lowered the number of people who were on the Medicaid program at the federal level. It is also at the state level where changes are governed according to the individual states. While someone received AFDC under the old system also received the Medicaid as part of their...
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...According to this article, the Congressional Budget Office (CBO) released an updated federal budget outlook for the next 10 year “budget window”, during the week of February 3rd, 2015. Detailed in this report were some revisions to the previous baseline projection for the effects of the Affordable Care Act (ACA). A more defined explanation and history of ACA: Federal health reform uses an approach that starts with the health insurance system we currently have in place in the United States. Health reform builds upon our current health insurance system to provide more people with access to health insurance coverage, establish legal protections for consumers, and set up mechanisms for consumers to shop knowledgeably for insurance. On July 14, 2009, House Democratic leaders introduced a 1,000-page plan for overhauling the US health care system, which Obama wanted Congress to approve by the end of the year. After much public debate during the Congressional summer recess of 2009, Obama delivered a speech to a joint session of Congress where he addressed concerns over his administration's proposals. In March 2010, Obama gave several speeches across the country to argue for the passage of health care reform. After Obama announced an executive order reinforcing the current law against spending federal funds for elective abortion services, the House passed the version of the bill previously passed on December 24, 2009, by a 60-vote supermajority in the Senate. The bill, which includes...
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...income between 100% and 199% of the FPL (“South Dakota Medicaid,” 2014). I believe that a large number of the persons listed in this statistic are college students. For the Fall, 2013 semester there were 47,590 students enrolled in the 31 colleges and universities in South Dakota (Current Term Enrollment, 2013). I encourage you to expand the Medicaid program in South Dakota to, at the bare minimum, allow for coverage to our state’s young people who are pursuing higher education. In this report I will be reviewing the history of Social Service programs and the amendments made to them in the United States and South Dakota. The parties involved include the Federal government, the South Dakota Legislature and the citizens of South Dakota. The report will be a chronological history. Origins of Social Welfare for Medical Care The American Association of Labor Legislation (AALL) was formed in 1906 and their committee on social welfare drafted a bill in 1915 that outlined coverage to the working and low income classes. It included coverage for hospital and doctor care as well as maternity coverage and sick pay. The issue was highly debated for many years but eventually it was abandoned by the end of World War I (Palmer, 1999). Modern Community Health Program coverage has it’s beginnings in the Social Security Bill passed in 1935. That bill established the Medicare and Medicaid programs that are still in effect today. Medicaid was set up as a way to provide coverage for the disabled...
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...HCM549 WS5 Questions 1. What is the main source of funding in the U.S. for health care services? Medicare, Medicaid and private insurance are the main sources of funding for the U.S. healthcare services. 2. What are some of the factors that affect the health status of people? Include at least two access (to health services) related factors and two non-access (to health services) related factors. There are multiple factors that affect the health status of people and attaining access can be difficult due to income disparity, lack of health insurance coverage and lack of available locations particularly when people are living in rural areas. Two non-access related factors would include lack of transportation for individuals to seek care or even being too ill to travel to seek care. 3. In what ways can good leadership and management control health care costs? Excellent leaders drive accountability and efficiencies that result in controlled costs in the healthcare environment. Good leaders provide accurate and timely communication, clear expectations, attainable and incentive-driven goals resulting in controlled costs due to a well-managed environment in which to provide care. 4. How are quality issues affecting facilities? Many facilities are financially stressed and facilities are in need of improvements that management are unable to make due to lack of funding. In addition, providing care equals high expense for supplies and equipment as well...
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