Impact of Health Policy Flashcards
There are ______ branches of government
3
_____ work with federal and state legislator to get a bill introduced
legislature branch
______ get involved with implementation of the law through development of rules and regulations
executive branch (a bill becomes a law after the executive branch signs it)
_____ implementations of laws have been delayed by the courts until change could be made via legislature process
judicial branch
T/F As the role of the govt in health care delivery INCREASES, so does the number of rx paid for by govt programs
TRUE;
Medicare and Medicaid 1965
Medicare Part D 2006
Who is eligible for Medicare: (3)
- people greater than or equal to age 65
- disabled individuals
- patients with End Stage Renal Disease
Medicare Part A
hospital cost
Part A is provided free of cost for everyone
Medicare Part B
outpatient costs
Part B is optional
Medicare Part C
Medicare Advantage (MA)
Medicare Part D
prescription costs
coverage is voluntary (may change plans during open enrollment)
- Fee for Service plans run by the Federal Govt
- original Medicare
Medicare Part A and B
-prescription drug coverage via PDP
Part D
Supplemental insurance via a private insurer
Medicare Supplemental Insurance (Medigap)
T/F Pharmacy is the revenue generating center.
FALSE: pharmacy is the cost center
Medicare Part A
-payment is prospective and dependent on patient’s diagnosis
How can pharmacist DECREASE cost and improve outcomes for PartA: (2)
- decrease adverse drug events
- conducting Med Rec
T/F Under Medicare Part B, RPh MAY bill for outpatient services except as “incident to” MD services
FALSE : MAY NOT
examples include diabetes, education, anticoag therapy
T/F Pharmacies may elect to be a Medicare supplier and bill for DME
TRUE (competitive bidding process)
Medicare Advantage Plans vary depending on…….
where the beneficiary lives
YES or NO
Part A and B COVER vision and dental services
NO
Medicare Part C (3)
- plans may be offered by an HMO or private plan
- beneficiaries do not need a supplemental policy
- restricted to plan’s provider network
T/F The plans offer under Part C MUST cover all services covered under Part A and B, and prescription services
TRUE
You need parts ___ and ____ to get Part D
A and B
__________ established Medicare Part D
Medicare prescription drug improvement and modernization act of 2003
T/F Under Part D, Private insurance companies submit bids to, and follow CMS rules
TRUE
Medicare Part D
Most plans use a ______ copayment
tiered
Medicare beneficiaries who qualify for Medicaid
Before 2006:________
After 2006:______
before: rx covered by medicaid
after: rx covered by part d
T/F Dual eligibles who do NOT choose a plan will be assigned a Part D plan
TRUE
Dual eligible have reduced premiums and/or co-pays
Providing _____ for targeted beneficiaries was a MMA 2003 requirement
MTM services
Challenges of Part D (3)
- low reimbursement
- slow reimbursement
- complexity of plans
Opportunities of Part D (3)
- INCREASE opportunities for community RPh to provide and receive payment for MTM services
- INCREASED rx volume
- INCREASED opportunities for the profession to lobby for changes in the Part D program
Medicaid (3)
- program for low income individuals
- jointly funded by fed and state govt
- required to provide basic services
Who is eligible for Medicaid? (4)
- medicare beneficiaries
- pregnant women
- children
- parents w/dependent children
T/F Coverage for Medicaid was expanded in 2014 to include private health insurance through “marketplaces”
TRUE
T/F CHIP is an entitlement program
FALSE: CHIP is NOT an entitlement program unlike Medicaid
Purpose of CHIP
to increase the percentage of children with health insurance (covered children not
