Elder Law Commons^™

What's So Special About Medicare Advantage Special Needs Plans? Assessing Medicare Special Needs Plans For "Dual Eligibles", Alissa Halperin, Patricia Nemore, Vicki Gottlich

Marquette Elder's Advisor

In 2003 Medicare Part C became Medicare Advantage, which included provisions for Special Needs Plans (SNP's), which have significant implications for dual eligibles, persons eligible for both Medicare and Medicaid. The authors explore why SNP's are needed, their advantages to beneficiaries if properly set up, why many plans do not meet beneficiaries' needs as well as they might, and draw conclusions for improvement.

The Medicare Part D Prescription Drug Benefit: Who Wins And Who Loses? , Enrich Andreas Drotleff

Marquette Elder's Advisor

The author examines the new Medicare Part D Program, discusses first the background history which led to its enactment, and then explains how enrollment decisions affect different classes of beneficiaries. The politics involved in the passage of this legislation are explored. Transitioning dual eligibles (those covered by both Medicare and Medicaid) into the new drug program has often resulted in reduced benefits.

Fillial Responsibility: A Survey Across Time And Oceans , Andrea Rickles-Jordan

Marquette Elder's Advisor

In the United States, Medicare and Medicaid are helping fund the cost of caring for the elderly. However, long before these programs existed, several states enacted statutes requiring children to care for their elderly parents. These filial responsibility statutes still exist in many states today, although their effectiveness and use has been called into question by opponents. To understand the current need for these statutes, this article first looks at the reasons the statutes were created. The article then follows their growth throughout the history of the world and the United States. As further means of comparison, the article examines …

When Never Happens: Implications Of Medicare's Never-Event Policy, Hudson T. Rowland

Marquette Elder's Advisor

This article discusses the Healthiest Wisconsin 2010 (HW2010) statute and its implementation to improve patient care through a denial of payment to hospitals when a selected condition takes place. The state of Wisconsin has created a program to improve the state's overall health through a partnership between the state department of health, universities, and other health providers. While the two programs have their differences, this article explores how the Centers for Medicare and Medicaid Services can learn from Wisconsin and HW2010 to create a more reasonable plan to improve patient safety.

Happy 65th Birthday: What Now?, Peter J. Strauss

Articles & Chapters

No abstract provided.

La Caja De Pandora: Improving Access To Hospice Care Among Hispanic And African-American Patients, Kathy L. Cerminara, Alina M. Perez

Faculty Scholarship

Many patients clinging to hope in the form of potentially curative treatment could benefit from hospice services, but, for the most part, it is not until the patient accepts the finality of his or her condition that the physical, psychological and social benefits of hospice care become accessible to the patient and his or her family. Under current Medicare regulations and other health care payers’ policies, patients must abandon the hope of curative treatment before opting for hospice services. As a result, many terminally ill patients access the services late, sometimes a few hours before death. Scholars have proposed that …

To Pay Or Not To Pay: Medicare And The Preventable Adverse Event: A Rational Decision Of Dangerous Philosophical Change, Amy J. Chaho M.D.

Journal of Law and Health

The proposed Medicare reimbursement schedule intended to become effective in October 2008 represents a drastic change to the traditional policy of payment for needed services. The proposal mandates that certain preventable adverse events should not be reimbursed. This spending scheme is intended to improve quality while decreasing cost to the Medicare system. The goals of the spending scheme are laudable. Quality improvement, when used to improve the health, safety and general welfare of the intended patient beneficiary of the Medicare program, is a rational and compelling government interest that warrants coercive use of authorized spending power. This beneficial interest may …

A Philosophy Of Privatization: Rationing Health Care Through The Medicare Modernization Act Of 2003, Eleanor Bhat Sorresso

Journal of Law and Health

The trend in coping with these rising Medicare costs has been to increase the role that private insurance plays in providing coverage for Medicare recipients. Much of this movement towards an increased "privatization" of Medicare has been born of the belief that the private sector of health care insurance coverage has been made more efficient by existing market forces and will provide a way to both continue providing health care to elderly Americans while containing Medicare costs through these increased efficiencies as exemplified through the managed care model. This premise will be further explored in this article. First, this article …

Blame Canada (And The Rest Of The World): The Twenty-Year War On Imported Prescription Drugs, Daniel L. Pollock

ExpressO

Rising budget deficits and sticker shock over the new Medicare drug benefit have put the issue of prescription drug costs back into the spotlight. The growth in the cost of prescription drugs continues to represent a staggering burden for taxpayer-funded health care programs, even while costs of non-drug health care services have slowed or even decreased. Among the many proposals for cutting prescription drug costs, drug importation is unique. Although bipartisan support for drug importation has existed in Congress for over five years, the federal government continues to maintain that a system of safe and effective drug importation is impossible. …

Advising The Elderly Or Disabled Client, Melissa Brown, Lawrence Frolik

McGeorge School of Law Scholarly Books

Advising the Elderly or Disabled Client provides specific answers and solutions to legal and practical questions and problems that arise in daily practice when representing elderly or disabled clients. This resource offers coverage across the full range of elderly or disabled client concerns, including: planning for Medicare, Medicaid, and private insurance; medical decision-making and right-to-die issues; retirement and disability income planning; acute, chronic or changing medical conditions such as AIDS, Alzheimer's, strokes and mental illness. Includes practice aids such as official forms, model documents, detailed real-world examples, checklists for interviewing and planning, and a quick-reference glossary of technical terms, concepts, …

Funding Kinship Care: A Policy-Based Argument For Keeping The Elderly In The Family, Holly Shaver Bryant

William & Mary Journal of Race, Gender, and Social Justice

No abstract provided.

Elder Law In The Nineties, Peter J. Strauss

Articles & Chapters

The need to reconsider estate planning, placing a greater emphasis on life planning, is the theme of Peter J Strauss's essay. He provides an overview of the status of the elderly in the United States and reminds the reader that the legal profession has not yet adequately addressed the needs of this segment of the population. The life planning components are discussed and corporations are urged to attend to such employee planning needs so as to enhance productivity at work and to improve the quality of their employees' lives.

Medicare Supplemental Insurance: Today's Crisis, Health Care For All, Gerontology Institute, University Of Massachusetts Boston

Gerontology Institute Publications

The purpose of health insurance is to spread risk. The system works under the assumption that, at any given point in time, only a percentage of the people in a given group will be sick. Regardless of health status, all members of the group will be paying premiums in order to cover the cost of care for those who need it.

As a group, however, seniors represent a high-risk population. They are more likely than younger people to need health care services and tend to require longer hospital stays. Yet, while their expenses are greater, their financial resources are generally …

Serving The Elderly: Need Versus Policy, Wornie L. Reed

William Monroe Trotter Institute Publications

Medicare was established in 1965 under Title XVIII of the Social Security Act. It was originally meant to eliminate the financial barriers to medical care for the aged. It has been called a form of national health insurance for persons age 65 and over. But it was deliberately designed in a manner to avoid modification of the fee-for-services system that is the basis of American Medical Care (Estes, 1979). As a result, inflation in the cost of care has seriously reduced financial benefits to the beneficiaries and in turn limited the access to medical care by the elderly.

Case Note: Constitutional Law - Fair Hearing - A Provider Of Services Has A Right To Challenge A Determination Of Medicaid Benefits For Its Patients, Leonard J. Morreale, Jr.

Fordham Urban Law Journal

In this case note, Leonard J. Morreale, Jr. analyzes Peninsula General Nursing Home v. Sugarman, 57 App. Div. 2d 268, 394 N.Y.S.2d 644 (1st Dep't 1977). Jacob Stupler, an alleged indigent, was enrolled in the federal Medicare program which reimbursed the petitioner, Peninsula General Nursing Home, for the cost of medical care and services rendered to him. When federal benefits were terminated, petitioner promptly applied for Medicaid coverage on behalf of Mr. Stupler pursuant to the New York State Medical Assistance for Needy Persons Plan. The Social Services Department of the City of New York denied the application because Mr. …