Displaced by Hurricane Katrina: Issues and Options for Medicare Beneficiaries

Identifies potential problems and offers options for assisting Medicare beneficiaries during the period following Hurricanes Katrina and Rita. Describes areas to be considered in future disaster planning efforts

Medicare HMO Pullouts: What Do They Portend for the Future of Medicare+Choice?

National policymakers became alarmed in the fall of 1998 when, contrary to expectations, nearly 100 Medicare HMOs announced their decisions to pull out of Medicare in certain areas or to reduce their service areas. This issue brief explores the reasons plans withdrew from certain areas, the Balanced Budget Act of 1997 provisions that most directly influenced these decisions, the impact of the withdrawals on Medicare beneficiaries, and policy options for ensuring the viability of the Medicare+Choice program

Examining the Links between Retirement and Health Insurance: Implications for Medicare Eligibility

This issue brief examines trends in labor force participation and health care coverage for early retirees, as well as the relationship between retirement and health insurance and health status

Medicare+Choice: Where to from Here?

This issue brief examines Medicare+Choice (M+C) plan participation, benefit coverage, and enrollment and the factors that have contributed to plans\u27 decisions to participate in or withdraw from certain markets. In addition, the issue brief explores what has been happening to M+C enrollees in terms of costs, benefits, and continuity of care. Lastly, the issue brief examines the reasons that alternative plan options — such as preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs) — have not taken hold. Legislative proposals that might affect the future of M+C are also discussed

Site Visit to Richmond and Hampton Roads — Bon Secours Health System, Inc.

The first in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit was designed to better understand how changing payment incentives — particularly the move to prospective payment systems for postacute services — has affected the ability to implement a continuum of care across delivery sites. It examined the Bon Secours Health System\u27s operations in Virginia, which include four hospitals in Richmond and three hospitals in the Hampton Roads area, in addition to nursing care, home health, assisted living, and ambulatory care facilities. Discussions centered on shifts in sources of revenue, market consolidation and competition, and the challenges of developing an infrastructure across the continuum of care

The Geography of Medicare: Explaining Differences in Payment and Costs

This issue brief examines the sources of variation in Medicare payment and costs across different geographic areas and different sites of care. It discusses the payment policies that address variation in the cost of providing care, such as input price adjustments and special payments to hospitals. It also considers differences due to beneficiaries’ health status and in physician practice patterns. Finally, it explores policy options to address Medicare geographic variation

Medicare\u27s Chronic Care Improvement Pilot Program: What Is Its Potential?

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines

Medigap: Prevalence, Premiums, and Opportunities for Reform

This issue brief provides an overview of Medicare\u27s coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program

Who Will Be There to Care? The Growing Gap between Caregiver Supply and Demand

This paper examines the increasing demand for long-term care services and the concurrent decrease in the supply of paid and unpaid caregivers. It considers workforce trends for paraprofessionals, such as certified nursing assistants, home health aides, and personal care attendants, as well as several public and private efforts to address staff shortages and quality-of-care. The paper explores the sociodemographic factors that have affected the demand for and supply of informal care provided by family and friends. It also reviewes policy proposals designed to provide support for family caregivers and/or to give choices to consumers

Access to Home Health Services under Medicare\u27s Interim Payment System

This issue brief explores the impact of the interim payment system (IPS) for home health agencies established under the Balanced Budget Act of 1997 (BBA). IPS was intended to constrain program outlays by imposing limits on spending per beneficiary and spending per visit in the existing cost-based reimbursement system. This issue brief examines the impact of the IPS on access to home health care, including home health agencies\u27 responses to the payment system and its impact on provider availability and, ultimately, access to care for the sickest or most expensive population