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Originally posted by Jenna
reply to post by mikerussellus
It's easy to do.
I counted the second claim as partly true since it will be doctors doing it and not the government. Other than that, I think we agreed on them.
PG 434 Section 1234 Military Active, Reservists, Families - If you’re not enrolled in Tricare it is mandated.
PG 434 Section 1234 Military Active, Reservists, Families - Once HealthCare bill is passed your premiums will go up.
SEC. 1234. PART B SPECIAL ENROLLMENT PERIOD AND WAIVER OF LIMITED ENROLLMENT PENALTY FOR TRICARE BENEFICIARIES.
(a) PART B SPECIAL ENROLLMENT PERIOD.—
(1) IN GENERAL.—Section 1837 of the Social Security Act (42 U.S.C. 1395p) is amended by adding at the end the following new subsection:
(l)(1) In the case of any individual who is a covered beneficiary (as defined in section 1072(5) of title 10, United States Code) at the time the individual is entitled to hospital insurance benefits under part A under section 226(b) or section 226A and who is eligible to enroll but who has elected not to enroll (or to be deemed enrolled) during the individual’s initial enrollment period, there shall be a special enrollment period described in paragraph (2).
(2) The special enrollment period described in this paragraph, with respect to an individual, is the 12-month period beginning on the day after the last day of the initial enrollment period of the individual or, if later, the 12-month period beginning with the month the individual is notified of enrollment under this section.
(3) In the case of an individual who enrolls during the special enrollment period provided under paragraph (1), the coverage period under this part shall begin on the first day of the month in which the individual enrolls or, at the option of the individual, on the first day of the second month following the last month of the individual’s initial enrollment period.
(4) The Secretary of Defense shall establish a method for identifying individuals described in paragraph (1) and providing notice to them of their eligibility for enrollment during the special enrollment period described in paragraph (2).’’.
the 12-month period beginning with the month the individual is notified of enrollment under this section.
PG 438 Section 1236 The Government will develop a patient decision making aid program that you & Dr. WILL use.
SEC. 1236. DEMONSTRATION PROGRAM ON USE OF PATIENT DECISIONS AIDS.
(a) IN GENERAL.—The Secretary of Health and Human Services shall establish a shared decision making demonstration program (in this subsection referred to as the ‘‘program’’) under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options, as compared to comparable Medicare beneficiaries who do not participate in a shared decision making process using patient decision aids.
(1) ENROLLMENT.—The Secretary shall enroll in the program not more than 30 eligible providers who have experience in implementing, and have invested in the necessary infrastructure to implement, shared decision making using patient decision aids.
(2) PATIENT DECISION AID.—The term ‘‘patient decision aid’’ means an educational tool (such as the Internet, a video, or a pamphlet) that helps patients (or, if appropriate, the family caregiver of the patient) understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.
PGs 701-704 Section 1619 If your part of HealthCare plan that isn’t in Government HealthCare Exchange but you qualify for Federal aid, no payment.
15 SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND EN
16 TITIES FROM PARTICIPATION IN MEDICARE
17 AND STATE HEALTH CARE PROGRAMS.
18 (a) IN GENERAL.—Section 1128(c) of the Social Se
19 curity Act, as previously amended by this division, is fur
20 ther amended—
21 (1) in the heading, by striking ‘‘AND PERIOD’’
22 and inserting ‘‘, PERIOD, AND EFFECT’’; and
23 (2) by adding at the end the following new
1 ‘‘(4)(A) For purposes of this Act, subject to
2 subparagraph (C), the effect of exclusion is that no
3 payment may be made by any Federal health care
4 program (as defined in section 1128B(f)) with re
5 spect to any item or service furnished—
6 ‘‘(i) by an excluded individual or entity; or
7 ‘‘(ii) at the medical direction or on the pre
8 scription of a physician or other authorized in
9 dividual when the person submitting a claim for
10 such item or service knew or had reason to
11 know of the exclusion of such individual.
12 ‘‘(B) For purposes of this section and sections
13 1128A and 1128B, subject to subparagraph (C), an
14 item or service has been furnished by an individual
15 or entity if the individual or entity directly or indi
16 rectly provided, ordered, manufactured, distributed,
17 prescribed, or otherwise supplied the item or service
18 regardless of how the item or service was paid for
19 by a Federal health care program or to whom such
20 payment was made.
21 ‘‘(C)(i) Payment may be made under a Federal
22 health care program for emergency items or services
23 (not including items or services furnished in an
24 emergency room of a hospital) furnished by an ex
25 cluded individual or entity, or at the medical direc-
1 tion or on the prescription of an excluded physician
2 or other authorized individual during the period of
3 such individual’s exclusion.
4 ‘‘(ii) In the case that an individual eligible for
5 benefits under title XVIII or XIX submits a claim
6 for payment for items or services furnished by an ex
7 cluded individual or entity, and such individual eligi
8 ble for such benefits did not know or have reason to
9 know that such excluded individual or entity was so
10 excluded, then, notwithstanding such exclusion, pay
11 ment shall be made for such items or services. In
12 such case the Secretary shall notify such individual
13 eligible for such benefits of the exclusion of the indi
14 vidual or entity furnishing the items or services.
15 Payment shall not be made for items or services fur
16 nished by an excluded individual or entity to an indi
17 vidual eligible for such benefits after a reasonable
18 time (as determined by the Secretary in regulations)
19 after the Secretary has notified the individual eligi
20 ble for such benefits of the exclusion of the indi
21 vidual or entity furnishing the items or services.
22 ‘‘(iii) In the case that a claim for payment for
23 items or services furnished by an excluded individual
24 or entity is submitted by an individual or entity
25 other than an individual eligible for benefits under
1 title XVIII or XIX or the excluded individual or en
2 tity, and the Secretary determines that the indi
3 vidual or entity that submitted the claim took rea
4 sonable steps to learn of the exclusion and reason
5 ably relied upon inaccurate or misleading informa
6 tion from the relevant Federal health care program
7 or its contractor, the Secretary may waive repay
8 ment of the amount paid in violation of the exclusion
9 to the individual or entity that submitted the claim
10 for the items or services furnished by the excluded
11 individual or entity. If a Federal health care pro
12 gram contractor provided inaccurate or misleading
13 information that resulted in the waiver of an over
14 payment under this clause, the Secretary shall take
15 appropriate action to recover the improperly paid
16 amount from the contractor.’’.
PG 444 Lines 1-6 Government’s Accountable Care Program will mandate services & infrastructure thru reward/penalty system.
SEC. 1301. ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM.
Title XVIII of the Social Security Act is amended by inserting after section 1866C the following new section:
ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM SEC. 1866D.
(a) IN GENERAL.—The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection
(b)(1)) in order to—
(1) promote accountability for a patient population and coordinate items and services under parts A and B;
(2) encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery; and
(3) reward physician practices and other physician organizational models for the provision of high quality and efficient health care services.
PG 460 Section 1302 Knock, Knock - It’s the Government and I’m here with the Medical Home Program - YOUR home.
PG 460 Section 1302 The Government WILL provide medical services in your home. Paging Nurse Pelosi!!
SEC. 1302. MEDICAL HOME PILOT PROGRAM.
(a) IN GENERAL.—Title XVIII of the Social Security Act is amended by inserting after section 1866D, as inserted by section 1301, the following new section:
MEDICAL HOME PILOT PROGRAM
SEC. 1866E. (a) ESTABLISHMENT AND MEDICAL HOME MODELS.—
(1) ESTABLISHMENT OF PILOT PROGRAM.—
The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to high need beneficiaries (as defined in subsection (d)(1)(C)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).
PG 686-700 Increased Funding to Fight Waste, Fraud, and Abuse. LMAO!! You mean the Government with an $18 mil website?
6 TITLE VI—PROGRAM INTEGRITY
7 Subtitle A—Increased Funding to
8 Fight Waste, Fraud, and Abuse
9 SEC. 1601. INCREASED FUNDING AND FLEXIBILITY TO
10 FIGHT FRAUD AND ABUSE.
8 (b) FLEXIBILITY IN PURSUING FRAUD AND
9 ABUSE.—Section 1893(a) of the Social Security Act (42
10 U.S.C. 1395ddd(a)) is amended by inserting ‘‘, or other
11 wise,’’ after ‘‘entities’’.
(a) Establishment of Program
There is hereby established the Medicare Integrity Program (in this section referred to as the “Program”) under which the Secretary shall promote the integrity of the medicare program by entering into contracts in accordance with this section with eligible entities to carry out the activities described in subsection (b) of this section.
(b) Activities described
The activities described in this subsection are as follows:
(1) Review of activities of providers of services or other individuals and entities furnishing items and services for which payment may be made under this subchapter (including skilled nursing facilities and home health agencies), including medical and utilization review and fraud review (employing similar standards, processes, and technologies used by private health plans, including equipment and software technologies which surpass the capability of the equipment and technologies used in the review of claims under this subchapter as of August 21, 1996).
(2) Audit of cost reports.
(3) Determinations as to whether payment should not be, or should not have been, made under this subchapter by reason of section 1395y (b) of this title, and recovery of payments that should not have been made.
(4) Education of providers of services, beneficiaries, and other persons with respect to payment integrity and benefit quality assurance issues.
(5) Developing (and periodically updating) a list of items of durable medical equipment in accordance with section 1395m (a)(15) of this title which are subject to prior authorization under such section.
(6) The Medicare-Medicaid Data Match Program in accordance with subsection (g).
trends, adverse event patterns, incidence and prevalence of adverse events, and other information the
Secretary determines appropriate, which may include
data on comparative safety and outcomes trends;
‘‘(E) shall establish procedures to permit public
access to the information in the registry in a manner
and form that protects patient privacy and proprietary information and is comprehensive, useful, and
not misleading to patients, physicians, and scientists.
‘‘(5) To carry out this subsection, there are author
ized to be appropriated such sums as may be necessary
for fiscal years 2010 and 2011.’’.
ELECTRONIC EXCHANGE AND USE IN CERTIFIED
4 ELECTRONIC HEALTH RECORDS OF UNIQUE DEVICE
6 (1) RECOMMENDATIONS.—The HIT Policy
7 Committee established under section 3002 of the
8 Public Health Service Act (42 U.S.C. 300jj–12)
9 shall recommend to the head of the Office of the Na10
tional Coordinator for Health Information Tech11
nology standards, implementation specifications, and
12 certification criteria for the electronic exchange and
13 use in certified electronic health records of a unique
14 device identifier for each device described in section
15 519(g)(1) of the Federal Food, Drug, and Cosmetic
16 Act, as added by subsection (a).
17 (2) STANDARDS, IMPLEMENTATION CRITERIA,
18 AND CERTIFICATION CRITERIA.—The Secretary of
19 the Health Human Services, acting through the
20 head of the Office of the National Coordinator for
21 Health Information Technology, shall adopt stand22
ards, implementation specifications, and certification
23 criteria for the electronic exchange and use in cer24
tified electronic health records of a unique device
25 identifier for each device described in paragraph (1),
PG 464 Lines 17-22 Independent Patient Center Home Medical Services - Drs. don’t have to be at your home just some directed by D
(B) INDEPENDENT PATIENT-CENTERED MEDICAL HOME DEFINED.—In this section, the term ‘independent patient-centered medical home’ means a physician-directed or nurse-practitioner-directed practice that is qualified under paragraph (2) as—
(i) providing beneficiaries with patient-centered medical home services; and
(ii) meets such other requirements as the Secretary may specify.
(C) TARGETED HIGH NEED BENEFICIARY DEFINED.—For purposes of this subsection, the term ‘targeted high need beneficiary’ means a high need beneficiary who, based on a risk score as specified by the Secretary, is generally within the upper 50th percentile of Medicare beneficiaries.
PG 469 Community Based Home Medical Services=Non profit organizations. Hello, ACORN Medical Services here!!?
PG 489 Section 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into your marriage.
Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED Organization - 1 monthly payment to a community-based organization Like ACORN?
‘‘(i) PAYMENT TO COMMUNITY-BASED ORGANIZATION.—One monthly payment to a community-based or State-based organization.
PG 476 19-20 Chapter 35/ title 44, (Privacy of personal records) shall not apply Home Medical Services. ACORN ACCESS
(3) ADMINISTRATION.—Chapter 35 of title 44, United States Code shall not apply to this section.
PG 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.
(2) DEFINITION.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as previously amended, is amended by adding at the end the following new subsection:
Mental Health Counselor Services
(kkk)(1) The term ‘mental health counselor services’ means services performed by a mental health counselor (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A PHYSICIAN.— The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for mental health counselor services for which payment may be made directly to the mental health counselor under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) under which such a counselor must agree to consult with a patient’s attending or primary care physician in accordance with such criteria.
(7) INCLUSION OF MENTAL HEALTH COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by subsection (a)(7), is amended by adding at the end the following new clause:
(viii) A mental health counselor (as defined in section 1861(kkk)(2)).’’.