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Medicare Policy Coverages
The Medicare Policy Coverages provides a framework for the Foundation's work related to the Medicare program and the population it serves. In this area, the Foundation conducts research and analysis on current Medicare policy issues, monitors key trends, and produces fact sheets, resource books and reports to inform policy discussions. Recent efforts focus on Medicare and prescription drugs, Medicare reform, supplemental coverage, and the challenges facing vulnerable populations, including those with low incomes and people with disabilities. The U.S. Department of Health and Human Services today proposed a national policy on Medicare Policy Coverages of cataract surgery, the most commonly performed surgical procedure covered by the Medicare program.
The proposed rules, when published in final form, "will help to protect Medicare beneficiaries from unnecessary surgery and help assure that Medicare dollars are spent effectively," said HHS Secretary Donna E. Shalala. Analyses by HHS and the General Accounting Office, a research arm of Congress, have found that a number of cataract surgeries are unnecessary.
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The Medicare Policy Coverages program is authorized by law to pay only for medically necessary services. This position is consistent with the clinical practice guideline, "Cataract in Adults, Management of Functional Impairment," developed by a panel of private sector experts with support from HHS' Agency for Medicare Policy Coverages and Research.
More and more people are realizing the possibilities of living out their later years at home, even when the need for chronic care arises. Advances in the long term care field are making it a reality for many Americans. To help improve and maintain your quality of life, the Medicare Policy Coverages will help pay for the costs of services provided by a licensed professional nurse, or a licensed physical, speech, respiratory, or occupational therapist. The panel cites several major shortcomings in Medicare GME policy that must be overcome including: the lack of a means to ensure that Medicare Policy Coverages contribute to subsidizing GME; insufficient incentives to permit market forces to regulate the production of physicians; illogical variation in reimbursement for direct medical education expenses; insufficient incentives for training physicians as generalists and in non-hospital settings; lack of incentives for controlling costs; and insufficient support for clinical education for advanced nurse practitioners and physician assistants.
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