The U.S. Department of Health and Human Services reports that the rate of hospitalization in nursing homes is steadily rising. According to some statistics, one-fourth of long-term nursing home patients require hospitalization every year and one-fifth of nursing home patients receiving Medicare benefits return to the hospital within 30-days of being released. This “boomerang” effect of repeated hospitalization and nursing home readmissions is a problem. Our Long Beach nursing home lawyer can explain this problem for you.
The Vulnerability of Nursing Home Residents
There are many risks associated with repeated hospitalizations and nursing home readmissions and nursing home patients are particularly vulnerable to them. First, they are subjected to disruption of care and the risk of infections and other complications involving their medical conditions. This all leads to a decrease in their functioning when they return to the nursing homes. Specifically, they are at higher risk for medication errors and hospital-acquired infections due to a common lack of communication between the healthcare providers at the nursing homes and the physicians who treat nursing home residents at hospitals. The U.S. Department of Health and Human Services argues that repeat hospitalizations and readmissions are avoidable. For that reason, they are concerned with implementing quality-improvement initiatives.
New Regulations Meant to Curb the Nursing Home Readmissions Problem
Not only are these repeated hospitalizations and readmissions preventable, according to the U.S. Department of Health and Human Services, but they are extremely expensive in terms of the Medicare and Medicaid programs. As a result, the government will begin exacting penalties upon nursing homes if they receive tax proceeds for preventable and unnecessary hospitalizations of nursing home residents.
These new regulations are intended to counter the financial incentives for both hospitals and nursing homes have for participating in this boomerang activity. For example, if a Medicaid patient is sent from the nursing home to a hospital, that patient most likely returns to the nursing home with 100-days of residency covered by Medicare. Medicare pays nursing homes greater benefits than Medicaid. Another example is the “bed-hold” fee that Medicaid pays the nursing home in some states in order to guarantee the patient will be readmitted. If you have questions about these new regulations, speak to our Long Beach nursing home lawyer.
Basic Information about Medicare
Medicare is a federal health insurance program available for individuals who are age 65 and older, disabled, or dialysis patients. Unlike Medicaid, eligibility for Medicare is not based on need or income. Medicare recipients are only required to pay a portion of their medical expenses through deductibles. Also, small monthly premiums are necessary for non-hospital coverage. Medicare is different from Medicaid in that benefits are provided by private companies through contracts with Medicare. Since Medicare is solely run by the federal government, eligibility and benefits are the same all around the country.
In order to be eligible for Medicare, you must be age 65 or older, a U.S. citizen or permanent resident, and either you or your spouse must have worked for at least 10 years in a Medicare-covered job. Individuals who are younger than 65, but have a disability or End-Stage Renal disease requiring dialysis or a kidney transplant, may also qualify for Medicare. If you need more information about eligibility and benefits, you can visit www.Medicare.gov.
Separate Types of Medicare Coverage
Medicare is divided into two basic types of coverage – Part A and Part B. Medicare Part A is an insurance plan for care in hospitals, skilled nursing facilities, home health care, and hospice care. Medicare Part B, on the other hand, is more like basic medical insurance covering doctor visits, outpatient hospital care, and other medical services. Usually, recipients are not required to pay for Medicare Part A.
California’s Medi-Cal Program
California’s Medicaid program is known as Medi-Cal. This comprehensive program provides free or low-cost health coverage to California residents through 21 different managed care plans for. The coverage plans that are available may depend on which county you live in. California’s State-based Marketplace is called “Covered California.”
When people start to consider the need for government benefits, many clients become confused about the difference between Medicaid and Medicare. Which one do you need? Medicaid lawyers are more than capable of explaining the differences and advising you on which type of benefits you need, or which type you are eligible for. If you have any unanswered questions about Medicare or Medi-Cal benefits, let our Long Beach nursing home lawyer know.
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