CHA Blog

• 14Jan

  Hospital Errors Rise in California – Medicare Refuses to Pay for Avoidable Mistakes

  Medicare and other health insurance, Medicare billing and claims No Comments

  The number of reported hospital errors increased across California during the last year, according to data from the state Department of Public Health.

  While a 2006 state law requires officials to publicly report hospital errors, California’s DPH has not yet reported the information to the state Legislature.

  California hospitals reported 1,538 serious and preventable events for fiscal year 2008-2009, up from last year’s reported 1,224 errors. About 90% of the reported errors are currently under investigation, according to a recent article from the Sacramento Business Journal, 1/8.

  Health insurers and hospitals are working to reduce the incidence of preventable medical errors through new policies and procedures. Medicare has also chosen not to pay for preventable medical errors, and many major health insurance companies are following suit.

  In addition, hospitals are enacting new safety protocols in an effort to prevent such events. One system gaining more attention from lawmakers stems from a unique and successful strategy used in Pittsburgh to improve the quality, safety, efficiency and cost of hospitals in the area. The system took its ideas from one of the most efficient companies, Toyota. While this approach, modeling after an industry, may seem a bit strange and impersonal, hospital after hospital in the Pittsburgh area saw and sustained dramatic improvements. This approach is now being considered for other hospitals throughout the country. To learn more, see the book, The Pittsburgh Way to Efficient Health Care.

  Here’s a chart that outlines the types and numbers of medical errors in California last year.

• 06Jan

  COBRA Subsidy Extended to 2/28/2010

  Medicare and other health insurance No Comments

  In late December, President Obama signed H.R. 3326, a defense appropriations bill with a provision that extends the COBRA subsidy to involuntarily terminated workers until Feb. 28, 2010.

  The subsidy, originally from the American Recovery and Reinvestment Act (ARRA) passed in February 2009, was for people who involuntarily lost their jobs between September 2008 through December 31, 2009 and would last a period of 9 months. This bill extends the timeframe for people to qualify for the COBRA subsidy another 2 months and extends the amount of time people can receive the subsidy to 15 months.

  As mentioned in our earlier article, COBRA, the Consolidated Omnibus Budget Reconciliation Act passed in 1985, allows involuntarily laid-off workers to continue their health coverage for 18-36 months by assuming the premium payments formerly paid by their employers. As these health premiums are extremely expensive, the federal subsidy pays for 65% of a qualifying person’s COBRA premium, making this insurance much more affordable.

  In addition to extending the eligibility period and the duration of subsidy benefits, the H.R. 3326 COBRA subsidy extension provision makes a number of subtler changes in the subsidy program rules. The provision will:

  • Require a special notice describing the new subsidy provisions to go out to all “assistance eligible individuals” (AEIs) who have been on COBRA on or after Nov. 1, 2009, or whose qualifying event is an “involuntary termination” of employment occurring on or after Nov. 1, 2009.
  • Allow for a 60-day period for the retroactive payment of premiums for “assistance eligible individuals” whose subsidy period expired Nov. 30 and who failed to pay their premium for December coverage.
  • Let employees who are involuntarily terminated before Feb. 28, 2010, but get COBRA coverage that starts after Feb. 28, 2010, qualify for the subsidy.

  Employers and their benefits advisors will have to move quickly to comply with this legislation. The new statute requires employers to send extension letters within 90 days of enactment.

  The U.S. Department of Labor, the U.S. Department of Health and Human Services, and the Internal Revenue Service may all issue guidance concerning the subsidy extension.

  Update on California’s Cal-COBRA

  While the federal COBRA subsidy only applies to businesses with at least 20 employees, last year California lawmakers passed AB 23, a measure that expanded the state’s Cal-COBRA program to employers with 2 to 19 workers.

  Lawmakers wrote AB 23 to align with the federal subsidy’s initial expiration date of Dec. 31, 2009, but the state likely will lengthen the Cal-COBRA program to conform with the recent federal extension.

  Gov. Arnold Schwarzenegger’s administration doesn’t think additional legislation will be necessary to extend AB 23; the Assembly Health Committee will examine the issue.

  For more details on H.R. 3326, see the summary and full text.

  See our COBRA and Cal-COBRA sections for general information.

• 21Dec

  Health Reform Moves Forward as Senate Gets 60 Required Votes

  Medicare and other health insurance No Comments

  Early this morning, the U.S. Senate held a pivotal vote; it successfully gathered the required 60 votes to end the debate and move forward to subsequent votes to pass major health reform from the Senate floor later this week. Both California Senators, Barbara Boxer and Dianne Feinstein joined all 60 Democratic and Independent Senators to vote for the motion; all 40 Republican Senators voted against it.

  Next votes are planned for Tuesday and Wednesday, and final passage is planned for Thursday, December 24th.

  After passage, the next step is negotiations between the House and Senate to reconcile the Senate bill with the House health reform measure passed in November. Negotiations will most likely go into January with the goal of having a final agreement and final vote in both the House and Senate by the end of January.

  See the full text of the bill and the 380+ page “manager’s amendment” (contains several changes that allowed for the passing 60 votes this morning). This link also has a video clip of Senator Reid’s speech right before the 1 a.m. vote this morning.

  A Health Access blog article has a good summary of some of changes in the “manager’s amendment.”

  Related to a different aspect of the health reform debate, Kaiser Family Foundation recently held a live interview with key advocates in women’s and minority health and released a video on what health reform may mean for women of color.

  See: What Might Health Reform Mean for Women of Color?

• 27Oct

  Listen to a Rap on Health Care Reform!

  Medicare and other health insurance No Comments

  A couple of fellow advocates put together a rap on health care reform and posted it on Youtube. A 30 second version of it is also being entered into a nationwide competition for the best short informative clip on health reform.

  Enjoy!

  Zap the Crap Out of Health Care Rap

• 12Aug

  What Role Can Family Play in Chronic Illness Care?

  Medicare and other health insurance No Comments

   

  While having health care insurance plays a major role in helping people successfully manage or recover from chronic illness or disease, having the support of family members also plays a valuable and crucial role. Family may be one’s spouse, or children or other relatives who many live nearby or far away in another state or country. Regardless, a variety of family intervention programs are available. The California HealthCare Foundation recently published a report that draws together a broad range of research findings, case studies, and resources to assist patients, their families, and health care providers to maximize the benefits of family involvement in chronic care support. 

  The report highlights 3 examples of such family intervention programs: 

  • A couple-oriented education and support program focused on setting goals for osteoarthritis self-help and care;

  • A program that covers communication techniques to support the autonomy of patients with heart failure; and

  • A technology-enabled program for people with heart failure that helps distant family members monitor their relative’s symptoms and test results. 

  These programs are a sampling of strategies for handling challenges, improving communications, and maximizing the benefits of family involvement in chronic illness care. 

  Click here to download the report. 

  While having health care insurance, such as Medicare, plays a major role in helping people successfully manage or recover from chronic illness or disease, having the support of family members also plays a valuable and crucial role. Family may be one’s spouse, or children or other relatives who many live nearby or far away in another state or country. Regardless, a variety of family intervention programs are available. The California HealthCare Foundation recently published a report that draws together a broad range of research findings, case studies, and resources to assist patients, their families, and health care providers to maximize the benefits of family involvement in chronic care support. 

  The report highlights 3 examples of such family intervention programs: 

  • A couple-oriented education and support program focused on setting goals for osteoarthritis self-help and care; 
  • A program that covers communication techniques to support the autonomy of patients with heart failure; and 
  • A technology-enabled program for people with heart failure that helps distant family members monitor their relative’s symptoms and test results. 

  These programs are a sampling of strategies for handling challenges, improving communications, and maximizing the benefits of family involvement in chronic illness care. 

  Click here to download the report (pdf).

• 19Jun

  Where Does Health Care Reform Stand In Congress?

  Medicare and other health insurance No Comments

  As the Obama Administration is asking Congress to put together a health care reform package by October 2009 to revamp our $2.5 trillion U.S. health care system, much conversation, debate, and research is taking place in Congress. Reuters recently published a good summary article on what’s happening in health care reform in the Senate, House of Representatives and several special interest groups. 

  Click here to read the article.

• 07Apr

  Californians Laid Off from Small Businesses May Be Eligible for COBRA Subsidy

  Medicare and other health insurance Comments Off

  Last Thursday, the California Assembly voted unanimously to pass a bill AB 23 that amends state law to allow workers at firms with fewer than 20 employees to qualify for the federal subsidy for COBRA coverage.

  The legislation applies to the Cal-COBRA program, which facilitates coverage for workers laid off from firms with no more than 19 employees.  It also would require health plans to alert people to the availability of the subsidy.

  Currently, the federal subsidy, which was enacted through the economic stimulus package, applies only to people eligible for COBRA who had worked for employers with 20 or more employees. If passed, under this new bill by Democratic Assemblyman Dave Jones, California workers laid off between Sept. 1, 2008, and Dec. 31, 2009, will be able to receive the 65% federal subsidy for up to 9 months to keep their private health insurance through the Cal-COBRA program.

  The Assembly Appropriations Committee estimates that the bill will make 60,000 to 100,000 unemployed Californians and their families eligible for the federal subsidy, accounting for about $400 million from the stimulus package.

  Now going to the Senate for consideration, the legislation will become effective immediately if passed.

  For more information, see:

  • Our website section on COBRA & CalCOBRA insurance
  • Our article, Know Your Rights to COBRA? – Extended Healthcare Benefits for Terminated or Reduced Employment
• 31Mar

  Stimulus Bill Provides Important Health Care & Benefit Provisions

  Low-income help, Medicare and other health insurance, Medicare basics Comments Off

  On February 17, 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009, Pub. L. No. 110-329. The Recovery Act authorizes $789 billion in new federal spending to save or create 3.5 million jobs, reduce taxes for low- or moderate-income households, help provide health coverage for people who have lost their jobs, protect Medicaid beneficiaries from state cuts, invest in the nation’s infrastructure, and more. The law contains provisions relating to Medicare, Medicaid (Medi-Cal in California), the Administration on Aging (AoA), and Social Security, including a one-time payment of $250 to each of the more than 60 million beneficiaries receiving Social Security and/or Supplemental Security Income (SSI). Below is a brief highlight of the Recovery Act’s provisions relating to these programs.

  • The Qualified Individual (QI) program is extended to December 31, 2010. (The Medicare Improvements for Patients and Providers Act of 2008 – MIPPA – extended it until December 31, 2009.) This program pays the Medicare Part B monthly premium for qualified beneficiaries with low-incomes and assets.
  • A 65% tax subsidy for the cost of health benefits through COBRA. COBRA, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 (PDF) is the federal law that gives certain employees the right to continue their group health insurance when it would otherwise end.   As COBRA coverage can be quite expensive, this tax subsidy makes this continued health care coverage more affordable for the unemployed and their families. Millions of individuals, including those who previously declined employer-provided coverage under COBRA, are eligible to receive a subsidy on their premiums for up to 9 months after being involuntary terminated from their job. People who lost or lose their jobs on or after September 1, 2008 through December 31, 2009 can qualify for this subsidy. See the Department of Labor’s website for more information on the COBRA subsidy.
  • A one-time payment of $250 will be sent to people who receive Social Security benefits, Supplemental Security Income (SSI), Veterans Affairs or Railroad Retirement benefits. The Administration on Aging expects all payments to be delivered by late May 2009.  People should not contact the Social Security Administration (SSA) unless they do not receive the check by June 4, 2009. Payment will not count as income when determining eligibility for or the amount of benefits under any Federal or federally funded program, such as SSI, Medicaid (Medi-Cal in California), Medicare Part D’s Low-Income Subsidy, Food Stamps or housing assistance. Also, it does not count toward the resource limit for SSI or any other Federal or federally funded program for 9 months following the date of receipt.
  • Increased Federal Medical Assistance Percentage (FMAP) of Medicaid payments. The FMAP is the federal reimbursement rate for state Medicaid spending. The Recovery Act includes at least a 6.2% increase in every state’s FMAP – this will provide more federal dollars for every dollar California’s Medi-Cal program spends.
  • Funding for Health Information Technology (IT) in Medicare and Medicaid. The Recovery Act requires the Federal government to take the lead in health information technology (such as electronic health records) by establishing standards for nationwide electronic exchange and use of health information to improve quality and coordination of care by 2010. The provision also invests $19 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals and other providers to use health IT for electronically exchanging patients’ health information.
  • Funding for Administration on Aging provisions. The Recovery Act includes $100 million for congregate meals programs and home-delivered meals programs run by the AoA.

  For more information on the Recovery Act, see:

  • White House press release and fact sheets on the Recovery Act
  • California’s website to track the Recovery Act’s funds for health and other efforts
• 23Feb

  Economic Stimulus Bill Offers Relief on COBRA Premiums

  Medicare and other health insurance No Comments

  The $787 billion economic stimulus bill that President Barack Obama signed into law last week includes some relief on COBRA premiums. COBRA, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 (PDF) is the federal law that gives certain employees the right to continue their group health insurance when it would otherwise end, such as when being fired or laid off from work. This coverage is generally for 18 months, though in California it can often be extended to 36 months. While COBRA gives people important continued access to health coverage, the one problem with it  is it can cost people $1,000 a month or more to keep the coverage. 

  Yet, now with the stimulus bill, the federal government will subsidize 65% of a person’s COBRA premium for up to 9 months. To be eligible, you need to have been forced out of your job between Sept. 1, 2008, and Dec. 31, 2009. Also, your income in the year you receive the subsidy cannot be more than $125,000 for individuals or $250,000 for married couples filing their taxes jointly.

  If you lost your job after Sept. 1, 2008, and declined Cobra coverage, you’ll now get another chance. Call your former company in the next two months to find out how this will work.

  If you also have Medicare or are about to become eligible for Medicare and have questions about how COBRA works with Medicare, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

  In addition, see:

  • Our recent news article, Know Your Rights to COBRA? – Extended Healthcare Benefits for Terminated or Reduced Employment; and 
  • Website section, COBRA and CalCOBRA. 
• 09Dec

  Employer Contracts with Medicare Advantage Private-Fee-For-Service Plans Increase for Retiree Coverage

  Medicare Advantage, Medicare and other health insurance Comments Off

  A recent Medicare Advantage (MA) enrollment boom is largely due to employers using the program to cover their retirees, according to a recent Kaiser Family Foundation report, prepared by Avalere Health. Employers can contract with MA plans to provide Medicare and supplemental benefits to Medicare-eligible retirees. The report shows that employers are increasingly using private fee-for-service (PFFS) plans over other types of MA plans as an option for offering retiree health benefits.

  Between 2006 and 2008, the number of Medicare beneficiaries enrolled in Medicare Advantage group plans increased to 1.7 million, from 900,000, and most of that growth came from growth in employer PFFS plan contracts.

  Prospects for continued enrollment growth in the group PFFS market, however, are uncertain because of changes in Medicare Advantage payments and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 signed into law in July that will require PFFS plans to create provider networks by 2011. See our article on MIPPA for more information.

  Also see our website sections on:

  • Medicare Advantage
  • Retiree Plans

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