Question

Long-Term Care Reimbursement The federal and state governments are the largest payers of health care services in the United States. The largest federal programs are the Medicare and Medicaid services. Using the information from the textbooks, lectures, and Internet resources, provide a brief summary of Medicare and Medicaid services in a Microsoft Word document. To get up-to-date information on the programs, review the information shared on the following websites: The Centers for Medicare and Medicaid Services The Social Security Administration In your summary, include the following points: An overview of the different Medicare and Medicaid services The population covered under Medicare and Medicaid services The services of long-term care covered under Medicare and Medicaid, including the restrictions placed on them REFERENCE: Title:Long-Term Care: Managing Across the Continuum Author: John Pratt Edition/Year: 4th Ed./2016 Publisher: Jones & Bartlett ISBN: 978-1-284-05459-0

Answer 1

Title XVIII of the Social Security Act, designated "Health Insurance for the Aged and Disabled", is commonly known as MEDICARE. As part of of the Social Security Amendments of 1965, the MEdicare legislation established a health insurance program for aged persons to complement the retirement, survivors and disability insurance benefits under Title II of the Social Security Act.

Part A is generally provided automatically, and free of premiums to persons aged 65 or older who are eligible for Social Security or Railroad retirement benefits whether they have claimed monthly cash benefits or not.

The following health care services are covered under Part A:

• Inpatient Hospital care--- semi private room, meals, regular nursing services, operating and recovery rooms, intensive care, inpatient prescription drugs, laboratory tests, X-rays, inpatient rehablitation, psychiatric hospitals and medically necessary services and supplies provided in the hospital. An initial deductible payment is required of benefeciaries who are admitted to a hospital, plus copayments for all hospital days following day 60 within a benefit period
• Skilled NUrsing Facility (SNF) care: Coverage is provided by Part A only if the care follows within 30 days of a hospitalizaation of 3 days or more and is certified as medically necessary. The number of SNF days provided under Medicare is limited to 100 days per benefit period , with a copayment requird for days 21 through 100
• Home Health Agency (HHA) care: Home Health care under Part A and Part B has no copayment and no deductible. Fulltime nursing care, food , blood and drugs are not provided as HHA services.
• Hospice care: Coverage is provided for services to terminally ill persons with life expectancies of 6 months orless who elect to forgo the standard Medicare benefits for treatment of their illness and to receive only hospice care for it. Such care includes pain relief, supportive medical and social services, physical therapy, nursing services and symptm management.

Part B covers certain medical services and supplies including the following:

• Physicians and surgeons services
• Services provided by Medicare approved practitionerrs who are not physicians, including certified registered nurse anesthetics, clinical psychologists, clinical social workers, physician assistants and nurse practitioners and clinical nurse specialists in colloboration with a physician.
• Services in an emergency room, outpatient clinic, or ambulatory surgical cancer including same day surgery.
• Home Health care not covered under part A
• Laboratory tests, X-rays, and other diagnostic services.
• Most physical and occupational therapy and speech pathology ervices.
• Comprehensive outpatient rehabilitation facility services
• Radiation therapy, renal dialysis and transplants and heart, lung, liver , pancreas,bone marrow and intestinal transplants.
• Drugs and biologicals that are not usually self administred such as HEpatitis b vaccines and immunosuppressive drugs.
• Certain services specific to people with diabetes
• Ambulance services when other methods of transportation are contraindicated

MEDICAID

Title XIX of the Social Security Act is a Federal/ State entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. This program , known as MEDICAID, became law in 1965 as a cooperative venture jointly funded by the Federal and State governments to assist States in furnishing medical assistance to eligible needy persons. Medicaid is the largest source of fundng for medical and health related services for America's low income population.

Scope of Medicaid services

• Inpatient hospital services.
• Outpatient hospital services.
• Pregnancy related services including prenatal care and 60 days postpartum pregnancy related services.
• vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planningservices and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled nursng services
• Laboratory and X-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health center services adn ambulatory services of an FQHC that would be available in other settings
• Early and periodic screening, diagnostic and treatment services for children under age 21.

States also receive Federal matching funds to provide certain optional services.

Following are some of the most common, currently approved optional Medicaid Services

• Diagnostic services
• Clinic services
• Intermediate care facility services
• Prescribed drugs and prosthetic services
• Optometrist services naad eyeglasses
• Nursing facility services for children under age 21.
• Transportation services
• Rehabilitation and physical therapy services
• Hospice care
• Home and community based care to certain persons with chronic impairments
• Targeted case management services