In a recent letter to Center for Medicare and medicaid services (CMS) Administrator Mark McClellan, MD, PhD, Iowa Senator Charles E. Grassley, Chairman of the Senate Finance Committee, wrote that procedures being done at the nation’s Ambulatory Surgical Centers (ASCs) “would greatly reduce overall Medicare spending.”
Medicare Regulation §416.41 states “ The ASC must have an effective procedure for the immediate transfer to a hospital, of patients requiring emergency medical care beyond the capabilities of the ASC.”
This spring two Missouri lawmakers prepared legislation that would drop the transfer agreement requirement. Robert Schaaf, told the Associated Press he believes hospitals are trying to stifle competition. “Hospitals claim that surgery centers are eating into their patient base,” Schaaf said. “The point is, it’s not their patient base. It’s every competitors’ patient base. It is in the public’s best interest to have more competition in health care, not less.”
“(n) Transfer agreement (1) In accordance with section 1861(1) of the Act, the facility (other than a nursing facility located in a State on an Indian reservation) must have in effect a written transfer agreement with one or more hospitals approved for participation under the Medicare and medicaid programs that………………..(2) The facility is considered to have a transfer agreement in effect if the facility has attempted in good faith to enter into an agreement with a hospital sufficiently close to the facility to make transfer feasible.”.

Read more on this topic.In a recent letter to Center for Medicare and medicaid services (CMS) Administrator Mark McClellan, MD, PhD, Iowa Senator Charles E. Grassley, Chairman of the Senate Finance Committee, wrote that procedures being done at the nation’s Ambulatory Surgical Centers (ASCs) “would greatly reduce overall Medicare spending.”
Medicare Regulation §416.41 states “ The ASC must have an effective procedure for the immediate transfer to a hospital, of patients requiring emergency medical care beyond the capabilities of the ASC.”
This spring two Missouri lawmakers prepared legislation that would drop the transfer agreement requirement. Robert Schaaf, told the Associated Press he believes hospitals are trying to stifle competition. “Hospitals claim that surgery centers are eating into their patient base,” Schaaf said. “The point is, it’s not their patient base. It’s every competitors’ patient base. It is in the public’s best interest to have more competition in health care, not less.”
“(n) Transfer agreement (1) In accordance with section 1861(1) of the Act, the facility (other than a nursing facility located in a State on an Indian reservation) must have in effect a written transfer agreement with one or more hospitals approved for participation under the Medicare and medicaid programs that………………..(2) The facility is considered to have a transfer agreement in effect if the facility has attempted in good faith to enter into an agreement with a hospital sufficiently close to the facility to make transfer feasible.”.

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“Removing the permanent late enrollment penalty will encourage Medicare beneficiaries who currently don’t have drug coverage to enroll in Part D at the next available opportunity,” said AARP Arizona State Director David Mitchell. “It’s also important to note that some Arizonans can enroll today without penalty if a person qualifies for a Special Election Period or SEP, then that person may enroll in the prescription drug program, or change plans, after the May 15 deadline.”
To qualify for an SEP, call the Social Security Administration at (800) 772-1213 and complete the application for “extra help.”

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The variety in companies and difference in plans is where the problems arise, and some people didn’t sign up for fear of making the wrong choice. “You want to make it clear and less stressful and it’s not,” Heimberg said. “It’s been challenging for everyone.”
“A lot of prescriptions are not covered in their plan or they will be covered one month and not be covered the next,” Heimberg said. “You’re taking a vulnerable population and putting them in a vulnerable place.”
Within the confusion Heimberg sees a positive. “It seems like a small step toward Nationwide health care.” And Harrison follows that same thought with an idea for the future. “I would like to see a plan where it’s a simple single payer system with prices set by the government, where everyone knows what is covered.”

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“As a national leader in state healthcare program administration, ACS has a solid record of excellence supporting a full gamut of state and local programs, a depth of program management expertise, and world-class IT capabilities,” said Lynn Blodgett, ACS Executive Vice President and Chief Operating Officer. “CARDS is a vital tool that employers can use to help ensure compliance with CMS requirements under the RDS program, and to distinguish between Medicare Part B and D claims to maximize savings. We are very excited about introducing this pioneering solution to employers across the country.”

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According to the written version of Norwalk’s testimony, “A recent CMS survey found that up to 18 of the top 20 [prescription-drug plans] pay pharmacy claims on a twice-a-month billing cycle of 15 days or less. A 15-day billing cycle generally provides pharmacies with payment within 21-25 days. The top plans account for more than 90 percent of the drug coverage for Medicare beneficiaries.”
Norwalk also insisted to subcommittee members that CMS does not have the authority to compel drug plans to pay their claims within a set time period. “It’s a matter of contract between the pharmacy and the plan,” she said. “The statute is clear that we’re not permitted to interfere in the negotiations between plans and pharmacies.”

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The Centers for Medicare and medicaid services also told insurers on Wednesday that when they market their drug plans to consumers next year, and cite a particular company as a partner, they need to include the phrase “other pharmacies/physicians/providers are available in our network.”
“It never occurred to us that would be an issue until we started hearing from pharmacies that one plan had a big national pharmacy chain on their card,” Norwalk said. Frankly, we just didn’t see it coming. Maybe we should have, but we didn’t.”

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“Medicare’s prescription drug benefit holds great promise for improving seniors’ lives by increasing access to medications,” said NCQA President Margaret E. O’Kane. “But we need to make sure that the promise of the benefit isn’t undercut by the possibility of medication errors. This paper highlights a great opportunity to collect and report data that can lead to improvements in appropriate medication management for seniors.”
Judith Cahill, executive director of AMCP, said “Pharmacists play a significant role in health care delivery; an effective pharmacist goes a long way towards enhancement of patient care. CMS can build on the best practices of commercial health plans and pharmacy benefit management companies and adapt them to meet the particular characteristics of the Medicare pharmacy benefit.”

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“It’s saving lives, and it’s saving money,” Representative Phil Gingrey, Republican of Georgia, said last week at a rally on Capitol Hill, celebrating “the unprecedented success of Medicare Part D.”
Senator Jim Talent, Republican of Missouri, said many constituents had told him, “This is a godsend.”
Democrats say that the benefit is skimpy, that the administration mismanaged its rollout and that many beneficiaries have been tormented by “computer glitches.”
“The White House botched the implementation of the prescription drug plan,” said the Senate Democratic leader, Harry Reid of Nevada. “Millions of seniors were unable to navigate the confusing sign-up process.”
On April 20, the administration issued a news release saying, “30 Million Medicare beneficiaries Now Receiving prescription drug coverage.” On May 10, it announced, “37 Million Medicare beneficiaries Now Receiving prescription drug coverage.”
Likewise, on May 10, the White House said, “Of the more than 42 million people eligible for Medicare, more than 31 million people with Medicare now have Part D-related prescription drug coverage.”
The House Democratic leader, Nancy Pelosi of California, has urged Democrats to hold town meetings and other events to “keep up the drumbeat” against the program, which she has decried as “this disastrous Republican Medicare drug plan.”
In a typical letter to House Democrats, Ms. Pelosi said the law had been “written by special interests” ? pharmaceutical and insurance companies ? and had done “nothing to bring down soaring drug costs.” Her criticism reinforces a Democratic campaign theme: that “a Republican culture of corruption has infected our government.”
But Michael Franc, vice president at the conservative Heritage Foundation, said: “Republicans are having to invest a huge amount of time, energy and resources to get credit for creation of a new entitlement. In the abstract, you’d think that seniors would have held parades in their honor.”

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