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PG 740-757 Government sets guidelines for subsidizing the uninsured (That’s your tax dollars peeps)
PG 355-369 Line 1181 Government disguises tax on Drug Companies as rebate to Government to subsidize Drugs. We pay in the end.
(f) PRESCRIPTION DRUG REBATE AGREEMENT FOR FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.—
(1) IN GENERAL.—In this part, the term ‘covered part D drug’ does not include any drug or biologic that is manufactured by a manufacturer that has not entered into and have in effect a rebate agreement described in paragraph (2).
(2) REBATE AGREEMENT.—A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period. Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D 12(b)(7), including as such section is applied under section 1857(f)(3).
PG 399 If your a subsidy eligible individual under Medicare part D and you don’t enroll, the Government will auto enroll you.
(b) AUTOMATIC ENROLLMENT.—Section 1860D–5 1(b)(1) of the Social Security Act (42 U.S.C. 1395w–101(b)(1)) is amended by adding at the end the following new subparagraph:
(D) SPECIAL RULE FOR SUBSIDY ELIGIBLE INDIVIDUALS.—The process established under subparagraph (A) shall include, in the case of an individual described in section 1860D–1(b)(3)(D) who fails to enroll in a prescription drug plan or an MA–PD plan during the special enrollment established under such section applicable to such individual, the application of the assignment process described in subparagraph (C) to such individual in the same manner as such assignment process applies to a part D eligible individual described in such subparagraph (C). Nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate by the Secretary (or in the program under this part) or from changing such enrollment.’’.
PG 724 Lines 16-22 Government reserves right to apply face-to-face certification for patient to ANY other HealthCare service
16 (c) APPLICATION TO OTHER AREAS UNDER MEDI
17 CARE.—The Secretary may apply the face-to-face encoun
18 ter requirement described in the amendments made by
19 subsections (a) and (b) to other items and services for
20 which payment is provided under title XVIII of the Social
21 Security Act based upon a finding that such an decision
22 would reduce the risk of waste, fraud, or abuse.
PG 722 Section 1639 Government MANDATES Doctors must have face-to-face with patient to certify patient for Home Health Services.
17 SEC. 1639. FACE TO FACE ENCOUNTER WITH PATIENT RE
18 QUIRED BEFORE PHYSICIANS MAY CERTIFY
19 ELIGIBILITY FOR HOME HEALTH SERVICES
20 OR DURABLE MEDICAL EQUIPMENT UNDER
Pg 719-720 Section 1637 ANY Doctor who orders durable medical equipment or home medical services MUST be enrolled in Medicare.
11 SEC. 1637. PHYSICIANS WHO ORDER DURABLE MEDICAL
12 EQUIPMENT OR HOME HEALTH SERVICES RE
13 QUIRED TO BE MEDICARE ENROLLED PHYSI
14 CIANS OR ELIGIBLE PROFESSIONALS.
10 (c) DISCRETION TO EXPAND APPLICATION.—The
11 Secretary may extend the requirement applied by the
12 amendments made by subsections (a) and (b) to durable
13 medical equipment and home health services (relating to
14 requiring certifications and written orders to be made by
15 enrolled physicians and health professions) to other cat
16 egories of items or services under this title, including cov
17 ered part D drugs as defined in section 1860D–2(e), if
18 the Secretary determines that such application would help
19 to reduce the risk of waste, fraud, and abuse with respect
20 to such other categories under title XVIII of the Social
21 Security Act.
PG 404 Lines 12-16 Government exempts itself again from - Chap 35 of title 44, USC including privacy of Americans.
PG 404 Lines 17-19 Government doesn’t know the cost of Language services but states that money is there.
(6) AUTHORIZATION OF APPROPRIATIONS.— There is authorized to be appropriated to carry out this subsection such sums as are necessary.
(b) HEALTH PLANS.—Section 1857(g)(1) of the Social Security Act (42 U.S.C. 1395w–27(g)(1)) is amended—
(1) by striking ‘‘or’’ at the end of subparagraph (F);
(2) by adding ‘‘or’’ at the end of subparagraph (G); and
(3) by inserting after subparagraph (G) the following new subparagraph:
(H) fails substantially to provide language services to limited English proficient beneficiaries enrolled in the plan that are required under law;’’.
(g) Intermediate Sanctions.—
(1) In general.—If the Secretary determines that a Medicare+Choice organization with a contract under this section—
(A) fails substantially to provide medically necessary items and services that are required (under law or under the contract) to be provided to an individual covered under the contract, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the individual;
(B) imposes premiums on individuals enrolled under this part in excess of the amount of the Medicare+Choice monthly basic and supplemental beneficiary premiums permitted under section 1854;
(C) acts to expel or to refuse to re–enroll an individual in violation of the provisions of this part;
(D) engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment (except as permitted by this part) by eligible individuals with the organization whose medical condition or history indicates a need for substantial future medical services;
(E) misrepresents or falsifies information that is furnished—
(i) to the Secretary under this part, or
(ii) to an individual or to any other entity under this part;
(F) fails to comply with the applicable requirements of section 1852(j)(3) or 1852(k)(2)(A)(ii); or
(G) employs or contracts with any individual or entity that is excluded from participation under this title under section 1128 or 1128A for the provision of health care, utilization review, medical social work, or administrative services or employs or contracts with any entity for the provision (directly or indirectly) through such an excluded individual or entity of such services;
the Secretary may provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
PG 711 Lines 8-14 The Secretary has broad powers to deny HealthCare providers/suppliers admittance into HealthCare Exchange.
8 ‘‘(3) AUTHORITY TO DENY PARTICIPATION.—If
9 the Secretary determines that there has been at
10 least one such affiliation and that such affiliation or
11 affiliations, as applicable, of such provider or sup
12 plier poses a serious risk of fraud, waste, or abuse,
13 the Secretary may deny the application of such pro
14 vider or supplier.’’.
9 ‘‘(1) DISCLOSURE.—A provider of services or
10 supplier who submits on or after July 1, 2011, an
11 application for enrollment and renewing enrollment
12 in a program under title XVIII, XIX, or XXI shall
13 disclose (in a form and manner determined by the
14 Secretary) any current affiliation or affiliation with
15 in the previous 10-year period with a provider of
16 services or supplier that has uncollected debt or with
17 a person or entity that has been suspended or ex
18 cluded under such program, subject to a payment
19 suspension, or has had its billing privileges revoked.
PG 705-709 SEC. 1128 If Secretary gets complaints (ACORN) on HealthCare provider or supplier, Government can do background check.
1 ‘‘SEC. 1128G. ENHANCED PROGRAM AND PROVIDER PRO
2 TECTIONS IN THE MEDICARE, MEDICAID, AND
3 CHIP PROGRAMS.
4 ‘‘(a) CERTAIN AUTHORIZED SCREENING, ENHANCED
5 OVERSIGHT PERIODS, AND ENROLLMENT MORATORIA.—
6 ‘‘(1) IN GENERAL.—For periods beginning after
7 January 1, 2011, in the case that the Secretary de
8 termines there is a significant risk of fraudulent ac
9 tivity (as determined by the Secretary based on rel
10 evant complaints, reports, referrals by law enforce
11 ment or other sources, data analysis, trending infor
12 mation, or claims submissions by providers of serv
13 ices and suppliers) with respect to a category of pro
14 vider of services or supplier of items or services, in
15 cluding a category within a geographic area, under
16 title XVIII, XIX, or XXI, the Secretary may impose
17 any of the following requirements with respect to a
18 provider of services or a supplier (whether such pro
19 vider or supplier is initially enrolling in the program
20 or is renewing such enrollment):
21 ‘‘(A) Screening under paragraph (2).
22 ‘‘(B) Enhanced oversight periods under
23 paragraph (3).
24 ‘‘(C) Enrollment moratoria under para
25 graph (4).
1 In applying this subsection for purposes of title XIX
2 and XXI the Secretary may require a State to carry
3 out the provisions of this subsection as a require
4 ment of the State plan under title XIX or the child
5 health plan under title XXI. Actions taken and de
6 terminations made under this subsection shall not be
7 subject to review by a judicial tribunal.
8 ‘‘(2) SCREENING.—For purposes of paragraph
9 (1), the Secretary shall establish procedures under
10 which screening is conducted with respect to pro
11 viders of services and suppliers described in such
12 paragraph. Such screening may include—
13 ‘‘(A) licensing board checks;
14 ‘‘(B) screening against the list of individ
15 uals and entities excluded from the program
16 under title XVIII, XIX, or XXI;
17 ‘‘(C) the excluded provider list system;
18 ‘‘(D) background checks; and
19 ‘‘(E) unannounced pre-enrollment or other
20 site visits.
21 ‘‘(3) ENHANCED OVERSIGHT PERIOD.—For
22 purposes of paragraph (1), the Secretary shall estab
23 lish procedures to provide for a period of not less
24 than 30 days and not more than 365 days during
25 which providers of services and suppliers described
1 in such paragraph, as the Secretary determines ap
2 propriate, would be subject to enhanced oversight,
3 such as required or unannounced (or required and
4 unannounced) site visits or inspections, prepayment
5 review, enhanced review of claims, and such other
6 actions as specified by the Secretary, under the pro
7 grams under titles XVIII, XIX, and XXI. Under
8 such procedures, the Secretary may extend such pe
9 riod for more than 365 days if the Secretary deter
10 mines that after the initial period such additional
11 period of oversight is necessary.
12 ‘‘(4) MORATORIUM ON ENROLLMENT OF PRO
13 VIDERS AND SUPPLIERS.—For purposes of para
14 graph (1), the Secretary, based upon a finding of a
15 risk of serious ongoing fraud within a program
16 under title XVIII, XIX, or XXI, may impose a mor
17 atorium on the enrollment of providers of services
18 and suppliers within a category of providers of serv
19 ices and suppliers (including a category within a spe
20 cific geographic area) under such title. Such a mora
21 torium may only be imposed if the Secretary makes
22 a determination that the moratorium would not ad
23 versely impact access of individuals to care under
24 such program.
Claim 1: PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens end of life.
Claim 2: PG 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory!
Claim 3: PG 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death.
Advance Care Planning Consultation
(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens end of life.
PG 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory!
PG 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death.
PG 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.
PG 429 Lines 1-9 An “advance care planning consultant” will be used frequently as patients health deteriorates.
PG 429 Lines 10-12 “advance care consultation” may include an ORDER for end of life plans. AN ORDER from Government.
PG 429 Lines 13-25 The Government will specify which Doctors can write an end of life order. Logan’s Run anyone?
PG 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.
PG 432 Lines 18-21 The Government will publish “quality measures” for individual’s end of life in Federal Register.