Part 4 History / Medicaid / Medicare Flashcards
(20 cards)
During the Years 1993-2008, the percentage of CHAIN-OWNED nursing facilities_____
1-Was about 5%
2-Varied between just under and just over half
3-Doubled
4-Tripled
P.284
2-Varied between just under and just over half
With the total number of facilities and beds relatively constant over recent years, due mostly to Certificate of Need requirements not permitting much new construction, it is not surprising that the number of nursing home residents has varied little.
During the years 1993-2008, the occupancy rates for U.S. nursing facilities _____
1-Remained unchanged
2-Decreased
3-Continued to increase slightly
4-Increased as hospital discharge rates spiked
P.284
2-Decresed
As an increase in Chain Ownerships rose , Occupancy rates declined.
As a result of few new nursing homes being built in recent decades it can be expected that occupancy rates in nursing home \_\_\_\_\_ over the next 30 years 1-Will remain level 2-Will decrease 3-May decrease 4-Will be near 100%
P.283-284
4-Will be near 100%
impact of government funding policies on the nursing facilities of the United States is difficult to predict due to governments’ emphasizing alternatives to facility care in recent funding. However, it clearly appears that by the year 2020 at the latest nursing home beds will likely be fully filled,
** Baby Boomer ** However the fullness will not necessary mean more MONEY if government reimbursement rates change.
The projections of daily volume of long term care assistance by all categories of caregivers is expected to _____.
1-Increase Marginally
2-Steadily increase
3-Decrease as older persons get healthier
4-Decrease
P.280
2-Steadily Increase
The projections of daily volume of long-term care assistance needed in the year 2040 is about \_\_\_\_ the need identified in 1980. 1-Equal to 2-Twice 3-Three Times 4-Four Times
P.280
4-Four Times the volume
** Baby Boomers, + people living longer the increase of the OLD-OLDS (75+)
The American Association of Homes and Services for the AGING is the \_\_\_\_. 1-National for-profit group 2-National nonprofit group 3-Federal regional authority 4-National federal authority
P.298 (Read and Update all different organizations)
2-National nonprofit group
American Association of Homes and Services for the Aging (AAHSA)—The national not-for profit industry group represents approximately 5,000 nursing homes, life care communities, assisted living and senior housing, and community services organizations (www.aahsa.org).
The proportion of MEDICARE home residents who, at any one time reside in facilities, is \_\_\_\_ the proportion who are Medicaid. 1-About equal to 2-Far Smaller than 3-Far Larger than 4-Larger and Growing
P.307
2-Far Smaller than
** Because of spend down, and rules to qualify for MEDICARE, Medicaid far outweighs the amout of people on the program
What are the Money qualifications for RESIDENTS funds that MUST be kept in an INTEREST BERING Account?
Medicaid- $50 or above
Medicare - $100 or above.
How is Medicare and Medicaid paid?
Medicare is paid through PPS (Prospective Payment System) Through the federal Government
Medicaid is paid on a “Per diem” Amount per day per resident depending on there Case MIX/ Paid by the State through the Federal Government who pays for the program.
Medicare Part A pays for how many days?
**100 DAYS total (in-between benefit periods)
1- Day 1-20 = 100 % coverage
2- Day 21-100 = Co-insurance
3-Day 100+ 0% coverage
What qualifies you for Medicare Part A?
If you are: 65 + or If you receive Social Security or HAVE
End Stage Renal Disease OR
Lu Gehrigs Disease (ALS)
* In addition FOR SNF*
1-Three Midnight’s at a inpatient Hospital Stay. [Observation nights do not count]
2-Admission to the SNF is with in 30 days of a HOSPITAL Discharge
How many days must you be home and fully discharged before another you get another “Benefit Period”?
60 days from Benefit period to Benefit period.
In addition if you go from SNF to Hospital and back to SNF the days spent at the hospital are put on hold. So if your in a SNF go back to hospital for 5 days , those 5 days nod not count towards the 100 day limit.
What is the Timing Periods for Medicaid Part A coverage at a SNF?
1- 3 Might-night stays at a HOSPITAL ---Qualifies you for 100 days of coverage at a SNF. Day 1-20 is 100% covered by Medicare Day 21-100 is a Co-paymet Day 100+ is No coverage / Pt. must pay.
2-30 DAY
— 30 Days after DISCHARGE from a hospital you have 30 days to be admitted into a SNF. IF NOT you loose this benefit.
— If there is a 30 day break in SNF coverage, you need another 3 midnight stay to Re-qualify for SNF coverage., AND if you still have remaining days left. Ex: you are in a SNF, and on day 25 when discharged from the SNF. You have a 30 day break and something happens where you go to hospital for 3 mindnights, and come back to the SNF. When you come back you have only 75 days left of your SNF coverage.
3- 60 DAY
— Re-Qualifies you for a new 100 Med A benefit period.
EX: If you are in a SNF, and [a Pt. on Med A] goes to a hospital and stays for three midnights, and then come back to the SNF. You do not get anymore of a benefit period for MED A. The only way this can happen is if you are SNF/Hospital Inpatient FREE for 60 days. Once that happens a NEW benefit period starts.
*** If during any of the 100 day benefit period a pt. gose to the hospital for a stay, that day does not count towards the 100 days for the SNF.
What are the RUG Rates based on , under the PPS system of MEDICARE?
PPS Rug rates are based on:
1-Inflation – RUG Rates are adjusted each year based on inflation
2- Geographically: Wadge levels of the county you the facility is based in. ( if urban ) If RURAL there is a different set of RUGS for each state, based on a STATE- RURAL WAGE INDEX.
What are some characteristics about the MEDICARE COST REPORT? When is Report DUE?
1-Cost Finding: Calculate ALLOWABLE DIRECT COSTS and REMOVE all NON-Allowable COSTS.
** Things like Nursing HOURS worked, Food Costs.. ect [just for MEDICARE Pt.;’s]
2-Separating the costs for caring for Medicare residents from the for caring for non-Medicare residents (this is why most facilities have separate MEDICARE Dedicated WINGS.
3-determination of allowable costs.
4-Made Public
5-Used to “REBASE” the PPS System from time to time.
Report is DUE 90 days after the end of the fiscal year.
When is it OK for NON -Emergency Ambulance Transportation under MEDICARE PART B?
ALL these MUST APPLY:
1-Such transportation is needed to obtain treatment or diagnose your health condition.
2-The use of any other transportation method could endanger your health.
3-You have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition.
One of the many Medicare rules is that facilities (SNF) need to send out “beneficiary notices”. What are these “beneficiary notices”
NAB p.144
They are to WARN “beneficiaries” [Residents] about Medicare NON-COVERAGE of health services, before “non-Covered” services are received.
** this is to help make an informed decision about if someone will have to pay for some services out of pocket.
In addition SNF send out notices about services that ARE available to them.
What are “NO Pay” and “Benefit exhaust” claims?
P.144
They help the government track residents benefit periods. SNF must submit these claims at specified times even when NO benefits may be payable.
Under TEXAS NEW Medicaid Managed Care program (STAR+PLUS). What are the new responsibilities of the facility?
MCO = Managed Care = The old Medicaid Program
SC= Service Coordinator
DADS Provider letter 15-13
1-NOTIFY [with in 1 BUSINESS DAY] the new MCO SC of any “unplanned” admission or discharge to a hospital/Acute care/Emergency Room visit/ Skilled bed/ or another NF.
2-NOTIFY [with in 1 BUSINESS DAY] the new MCO SC of any ADVERSE CHANGE in a residents physical, mental condition or enviroment that could POTENTIALLY lead to HOSPITALIZATION
3-NOTIFY MCO SC if a resident ELECTS for HOSPICE CARE.
4-COORDINATE with MCO SC plan to discharge from a NF AND
5-Provide access to the NF, The NF Staff, and residents Medical Information and records.
Under TEXAS NEW Medicaid Managed Care program (STAR+PLUS). How will Hospice Services be different?
1-Delivery of care and billing will not change.
2-NF residents will be required to choose a “STAR+PLUS” health plan.
3-“STARR+PLUS” health plans will be responsible for making decision claims OUTSIDE of HOSPICE services.
EX: Acute care claims not related to the terminal Hospice care.
4-Medicaid Only -will need to pick a Primary Care Doctor
5-Dually-Eligible - will not need to pick a Primary Care Doctor.
* the hospice is required to pay no less than 95% of room and board to the facility.
