Medicaid and Medicare Flashcards
What are the updated requirements that hospitals and CAHs must meet?
- Reducing readmissions
- Reducing barriers to care
- Reducing the incidence of hospital-acquired conditions (including healthcare-associated infections)
- Improving the use of antibiotics (including the potential for reduced antibiotic resistance)
- Addressing workforce shortage issues
- Improving patient protections
Estb and implement policy
policy prohibiting discrimination on the basis of race, color, religion, national origin, sex (including gender identity), sexual orientation, age, or disability
Hospital wide prevention and control
and antibiotic stewardship programs for the surveillance, prevention, and control of infections
Allow ___ to do more work
PAs
Require that each patient’s medical record contain info to justify
justify all admissions and continued hospitalizations, support diagnoses, describe progress and responses to medications and services, document all inpatient stays and outpatient visits to reflect all services provided to the patient; require that all patient medical records document discharge and transfer summaries,
Clarifies that patients should be able to
access their medical records in a form and format requested by the patient, whether electronically or in a hard copy format, if readily producible in that form and format.
Medicare
elderly cover long-term health expenses, all Americans 65+, federal only
Medicaid
low income Americans, only available to people who meet certain eligibility requirements (differ from state to state), income restrictions, favor minority groups, state and federal government, federal: medically necessary services, state: can expand services
Managed Care
- Health care delivery system organized to manage cost, utilization and quality
- Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations that accept a set per member per month payment for services
- Contracts with health care providers and medical facilities to provide care for members at reduced cost
- Providers make up the plan’s network and how much of your care the plan will pay for depends on the network’s rules
- Plans that restrict your choices usually cost you less and a flexible plan probably cost more (HMOs, PPOs, POS)
Emergency Medicaid
- Treatment for an emergency medical condition – patient’s health in serious jeopardy, serious impairment to bodily function, serious dysfunction to an organ
- Individuals must meet eligibility requirements: can be undocumented alien or temporary non-immigrant
Block Grants
- Federal government funds programs through grants that give states fixed amounts to spend on activities permitted under the terms of the program
- Set limits on total annual spending regardless of enrollment and caps that limit average spending per enrollee
What has contributed to rising Medicaid enrollment?
High poverty rates, longer life spans and lower percent of jobs with employer-sponsored insurance
Medicaid costs have been controlled through more
community-based care, managed care and expanded access to preventative care
Entitlement will end it
if Medicaid is funded by federal block grants
Paul Ryan’s “A Better Way”
option for states to receive either a block grant or to accept per capita limits
