Note the sidebars when you open the lead article, especially the link about
cataract surgery. Eric
________________________________
From: Medicare Watch <medicarewatch@xxxxxxxxxxxxxxxxxx>
Sent: Thursday, April 1, 2021 5:44 PM
To: ericprussell@xxxxxxxxxxx <ericprussell@xxxxxxxxxxx>
Subject: New Issue Brief Examines Effects of Trump-Era Medicaid Policies
The brief examines the effects of the Trump administration’s Section 1115
waiver policy on Medicaid coverage and care.
[https://gallery.mailchimp.com/1621f54a596f3717c22815356/images/e85b4ab4-d959-4322-9bdf-39b96d3ad383.png]
Developed by the Medicare Rights
Center<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3Dfe3ace5e3a%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936311112%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=TL7IOIZaUhJGznkFrHeglnwfTcKHBsQk1CiiJLk4urE%3D&reserved=0>,
Medicare Watch is a weekly newsletter providing Medicare news and policy
developments, as well as useful Medicare reminders.
April 1, 2021 | Volume 12, Issue 13
New Issue Brief Examines Effects of Trump-Era Medicaid Policies
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<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D1cd8180234%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936321106%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=8RQHlX0qh3kBnGfv3UNDTQbs6zmQdhl4z4kc%2BKLvRjc%3D&reserved=0>
A new issue
brief<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D3c580763f2%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936321106%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=laUg2ker%2Bd3V7bOdG%2Bs4NHAJc00GSASc%2B%2FlEd%2BgqT8o%3D&reserved=0>
from the U.S. Department of Health and Human Services (HHS) Office of the
Assistant Secretary for Planning and Evaluation (ASPE) examines the effects of
the Trump administration’s Section 1115 waiver policy on Medicaid coverage and
care. ASPE advises the HHS Secretary on health care policy development,
research, and analysis.
Section 1115 of the Social Security Act
allows<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D820c7a8157%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936331103%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=fj3Xlr5yj68YrbC7oYgQIQTW39TDV4ylenji01gO0vs%3D&reserved=0>
states to request and HHS to approve waivers of certain Medicaid rules, as
necessary to implement demonstration projects that the Secretary determines are
likely to promote the program’s objectives. This process is intended to give
states the flexibility to test new ways to better serve people with Medicaid.
Over the years, 1115 waivers have been used to expand eligibility and benefits,
modify financing elements, and experiment with delivery system reforms.
Approved projects generally reflect state and federal priorities, the latter of
which can change from one administration to the next.
Read
More<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D0ae885aceb%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936331103%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=55PXHxUm%2By3RZpiapikx2%2BvgSQKsrURXlA4CljdmLJw%3D&reserved=0>
Kaiser Family Foundation Suggests Pathways for Lower Drug Costs
[https://mcusercontent.com/1621f54a596f3717c22815356/images/2c78d174-7207-44ae-b69d-b61838762251.png]
<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3Db95cecf615%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936341098%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2B8hMjfx6p5l5BOGThHQ9q%2FOPT9t%2Bm0BUp4YOqHSAzFI%3D&reserved=0>
High drug
prices<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3Dbab3b04c2d%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936341098%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=u4lcwQQlhvfVsassU4%2BcTWR64PM7C82wH9XubZFyDqA%3D&reserved=0>
may keep many people from accessing and affording the medications they need to
stay well. In a new issue brief, the Kaiser Family Foundation explores two ways
the Biden administration can use existing executive authority to implement
policy changes related to prescription drug costs.
The brief highlights recent efforts by previous administrations that explored
both types of executive action, including the “Most Favored Nation Model” under
CMMI authority and the proposed $200 voucher, which would have relied on
Section 402. Importantly, the latter proposal drew significant criticism and
some doubt as to whether it would have withstood judicial review under the
Administrative Procedures Act (APA).
The brief also outlines the process by which proposals under each type of
authority would move forward, including typical timelines, and administrative
and legislative limits on the types of proposals that could be pursued using
each pathway. The report concludes by suggesting that several of President
Biden’s campaign priorities, including allowing Medicare to negotiate drug
prices directly and capping drug price increases, could be pursued under this
authority.
Read
More<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3De4f86c795a%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936341098%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=tx6AvzqVrSZ5XyCOlt%2FZJJnUrJBx5mshELfNZnBeKxE%3D&reserved=0>
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Spotlight
Add Medicare to Your Inbox
The Medicare Rights Center produces a number of free newsletters and alerts
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right on their desktops and mobile devices. These include:
* Dear Marci, a biweekly email newsletter that helps consumers—people with
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options. Each issue features Medicare coverage advice, basic health tips, and
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* Medicare Rights NY, a monthly email newsletter with updates on health
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to sign up today!
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Medicare Reminder
Medicare Part B provides outpatient/medical coverage. The list below provides a
summary of Part B-covered services and coverage rules:
* Provider
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3De296d4454b%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936361084%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=JWeGk%2FNNxjWC3x6zCyIAOujLgYs%2FNLVOv6XjZbTMe6g%3D&reserved=0>:
Medically necessary services you receive from a licensed health professional.
* Durable medical equipment
(DME)<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D5d74f9897d%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936361084%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=IKjRUYiJybwBbRAiJh8kuY7CHyq9Z4pa7npp0qjVlNo%3D&reserved=0>:
This is equipment that serves a medical purpose, is able to withstand repeated
use, and is appropriate for use in the home. Examples include walkers,
wheelchairs, and oxygen tanks. You may purchase or rent DME from a
Medicare-approved
supplier<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D9d74a6de40%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936371081%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2Bn9%2FNOsRWatI4OUZigaccfHSK6wi6tGxdDvJzK%2BVCdg%3D&reserved=0>
after your provider certifies you need it.
* Home health
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D79423bce0f%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936371081%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=gJ1xrQIk8xX%2F7wyOidfhElhgi7%2BJ68VOZPaSBa3qbW8%3D&reserved=0>:
Services covered if you are
homebound<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D974ba04323%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936381075%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=onhN7NGVkZa%2BRP%2BfuDrXOh8V%2BYQDFmhlYnq3lregdEU%3D&reserved=0>
and need skilled nursing or therapy care.
* Ambulance
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3Dcf21ef90b9%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936381075%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=ZkwuklN7f0QB%2Bz9ViigWA6w6OrNeBih5mw3b1Rd5o7k%3D&reserved=0>:
This is emergency transportation, typically to and from hospitals. Coverage
for non-emergency ambulance/ambulette transportation is limited to situations
in which there is no safe alternative transportation available, and where the
transportation is medically necessary.
* Preventive
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D5afd5c9127%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936391070%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=tjAb82vBStL8qnJxb2mWLmIsqW44y64Azp7u%2BGbdcEU%3D&reserved=0>:
These are screenings and counseling intended to prevent illness, detect
conditions, and keep you healthy. In most cases, preventive care is covered by
Medicare with no coinsurance.
* Therapy
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3De5ca539181%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936391070%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=Q%2B7OLaKC97ALsBn1Z7X8n%2BjMUF2NPD%2FSduwgyXznhdA%3D&reserved=0>:
These are outpatient physical, speech, and occupational therapy services
provided by a Medicare-certified therapist.
* Mental health
services<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3De029fc6374%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936401066%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=rPfXBX8EllLWyu%2FiIxQDP2T1bb7qglDsIPoOsBXjjN0%3D&reserved=0>.
* X-rays and lab tests.
* Chiropractic care when manipulation of the spine is medically necessary
to fix a subluxation of the spine (when one or more of the bones of the spine
move out of position).
* Select prescription drugs, including immunosuppressant drugs, some
anti-cancer drugs, some anti-emetic drugs, some dialysis drugs, and drugs that
are typically administered by a physician.
This list includes commonly covered services and items, but it is not a
complete list. Keep in mind that Medicare does not usually pay the full cost of
your care, and you will likely be responsible for some portion of the
cost-sharing<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3D9e15421f4d%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936401066%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=PxKdfA6jLwFYeosEUGLeN97NEDnIYGevZyGRDoPqYZI%3D&reserved=0>
(deductibles, coinsurances, copayments) for Medicare-covered services.
Visit Medicare Interactive to learn more about Medicare
coverage.<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicarerights.us15.list-manage.com%2Ftrack%2Fclick%3Fu%3D1621f54a596f3717c22815356%26id%3Deb15513db8%26e%3Dda4d728a95&data=04%7C01%7C%7C685b9642cc844180250308d8f55761a1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637529102936411057%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=nJq%2Fv%2FyZJVCUV1g3zdxufLHKK8%2FEHv5QHagiFCou0PE%3D&reserved=0>
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Medicare Rights works to protect and strengthen Medicare to ensure access to
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