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Related Guides on this Topic

You may also want to see this guide on a related topic: Medicaid, Medicare Part D Prescription Drug Benefit

Introduction

Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services for Americans aged 65 and older and for younger adults with permanent disabilities. Nearly 44 million Americans are projected to be covered in 2007 and total Medicare spending is expected to reach $462 billion in 2007.

Rural America has a large percentage of elderly residents so any changes in Medicare policy would have implications on rural people and communities.  Medicare is often a part of discussions about how to limit the growth in federal spending and limit health care costs. It is a great challenge to provide increasingly expensive medical care to an aging population as well as keep the program financially secure for future generations.

Source: The Basics: Medicare, National Health Policy Forum, 2007

Frequently Asked Questions

Tools

Benefit Eligibility Screening Tool (B.E.S.T.)
Web site
A tool to find out if a person could be eligible for benefits from any of the programs Social Security administers.
Sponsoring organization: Social Security Administration

BenefitsCheckUpRX
Web site
Helps Medicare beneficiaries learn about and enroll in government benefits, including Medicare Part D, the new outpatient prescription drug benefit, and other federal, state and private programs that can help save money on health care and prescription drugs.
Sponsoring organization: U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services Regional Offices
Web site
Locator and contact information for the CMS Regional Representatives serving 10 regions across the United States.
Sponsoring organization: Centers for Medicare & Medicaid Services

CMS Hospitals Center
Web site
Contains Medicare manuals, forms, and regulations for hospitals.
Sponsoring organization: Centers for Medicare & Medicaid Services

CMS State Survey Agency Directory
Web site
Directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards.
Sponsoring organization: Centers for Medicare & Medicaid Services

KaiserEDU
Web site
Detailed resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, the uninsured, quality of care, and more. Designed for health policy students and faculty.
Sponsoring organization: Kaiser Family Foundation

Medicare and Medicaid at 40
Web site
Resources that examine how Medicare and Medicaid came into existence and how they have evolved over the past 40 years. Includes documentaries and extended interviews with key policymakers and government officials examining the origins of Medicare and Medicaid, new interactive historical timelines, and a chart pack of key information and statistics.
Sponsoring organization: Kaiser Family Foundation

Medicare Contracting Reform
Web site
Information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs), which will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Health and Prescription Drug Plan Tracker
Web site
Interactive tool providing information about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. Includes national statistics specific to rural areas.
Sponsoring organization: Kaiser Family Foundation

Medicare Health Plans - General Information
Web site
Information for current and future contracting Medicare Advantage Organizations, other health plans, and other parties interested in the operational and regulatory aspects of the Medicare Advantage program.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Information for Health Professional Shortage Areas (HPSAs) and Physician Scarcity Areas (PSAs)
Web site
Information and resources concerning Medicare bonus payments effective January 1, 2005 to physicians who provide services to Medicare beneficiaries in areas that are designated as Physician Scarcity Areas (PSAs) and Geographic Health Professional Shortage Areas (HPSAs). Includes lists of eligible zip codes for receiving the bonus payments
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Interactive Counselor
Web site
A one-stop source for information about health care rights, options and benefits. Helps older and disabled Americans, their caregivers and the professionals who serve them, understand their health care rights and benefits.
Sponsoring organization: Medicare Rights Center

Medicare Learning Network Publications
Web site
Contains publications and resources for the health care professional.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Modernization Act
Web site
Information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Part D & Safety Net Providers
Web site
Provides contacts for the State Health Insurance Assistance Program.
Sponsoring organization: Health Resources and Services Administration

Medicare Part D Changes in Enrollment & Eligibility for Low Income Subsidy
Web site
Describes common situations facing safety net patients during the Medicare Part D open enrollment period that ends December 31, 2006 and ways that safety net providers can help.
Sponsoring organization: Health Resources and Services Administration

Medicare Prescription Drug Coverage - General Information
Web site
Links to important information on the new Medicare prescription drug benefit. Includes prescription drug benefit pharmacy training information.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare Prescription Drug Plan Finder
Web site
Online tool for identifying and enrolling in Medicare prescription drug plans. Includes information about plans available in each state. Available in Spanish.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare RX: National Conversation-Friends and Family First
Web site
Aids faith-based and community organizations working with individuals eligible for the Medicare prescription drug benefit. Describes five steps to select a Medicare prescription drug plan.
Sponsoring organization: Centers for Medicare & Medicaid Services

Medicare.gov
Database
Searchable database on a host of Medicare related tools, including prescription drug plans, publications, and nursing home comparing.
Sponsoring organization: Centers for Medicare & Medicaid Services

MedlinePlus: Medicare Prescription Drug Plan
Web site
Links to resources, tools and news related to the Medicare prescription drug plan (Part D).
Sponsoring organization: National Library of Medicine

National Provider Identifer (NPI) Information for Medicare Fee-for-Service Providers
Web site
Information on how to apply for a National Provider Identifier (NPI) and links to resources and education materials related to the NPI.
Sponsoring organization: Centers for Medicare & Medicaid Services

National Provider Identifier Standard (NPI)
Web site
Overview of the National Provider Identifier (NPI) requirement, with links to resources and additional information. The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims.
Sponsoring organization: Centers for Medicare & Medicaid Services

Rural Health Research: Medicare
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Medicare, produced by the Office of Rural Health Policy's funded rural health research centers.
Sponsoring organization: Rural Health Research Gateway

Toolkit for Healthcare Professionals: Medicare Prescription Drug Coverage
Web site
Educational materials for physicians and other healthcare professionals to learn about Medicare's prescription drug coverage. Also includes materials physicians can distribute to Medicare patients.
Sponsoring organization: Centers for Medicare & Medicaid Services

Funding

Medicare Incentive Payments in Health Professional Shortage Areas and Physician Scarcity Areas
Medicare bonus payments to physicians in geographic HPSAs and PSAs.

Inactive Funding

Inactive Funding Opportunities - Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.

Regulations, Forms & Other Useful Documents

2006 CMS Statistics
Sponsoring organization: Centers for Medicare & Medicaid Services
Summary information about health expenditures and Centers for Medicare & Medicaid Services (CMS) programs. Includes data on populations served by Medicare and Medicaid, Medicare providers, and expenditures.
Date: 2006

2006 Medicare Advantage: Benefits and Premiums
Author(s): Marsha Gold, Maria Cupples Hudson, Sarah Davis
Sponsoring organization: Mathematica Policy Research, Inc.
Analyzes in detail how premiums and benefits are structured in the Medicare Advantage plans 2006.
Date: 11 / 2006

2007 Report to the Secretary: Rural Health and Human Service Issues
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Report to the Secretary of the U.S. Department of Health and Human Services. Examines three key topics in health and human services and their effects in rural areas: Medicare Advantage in Rural Communities, Head Start in Rural Communities, and Substance Abuse in Rural America. Includes recommendations to address these topics.
Date: 01 / 2007

2008 Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MA-PD), Cost-Based Plan, and Stand Alone Prescription Drug Plan (PDP) Call Letter
Sponsoring organization: Centers for Medicare & Medicaid Services
Provides information for health plans regarding how to implement CMS policies and procedures and comply with critical program requirements for the 2008 contract year. Includes detailed information on the Medicare Advantage (Part C) and prescription drug (Part D) programs.
Date: 04 / 2007

Basics: Medicare
Author(s): Mary Ellen Stahlman
Sponsoring organization: National Health Policy Forum
Describes the basics of Medicare including each Medicare part, who is eligible, what services are covered under each part, what services are not covered, cost-sharing requirements for beneficiaries, and how Medicare is financed.
Date: 01 / 2007

Basics: Medicare's Mental Health Benefits
Author(s): Christopher Loftis
Sponsoring organization: National Health Policy Forum
Describes the mental health coverage policies for Medicare beneficiaries.
Date: 02 / 2007

Chartpack: Seniors and the Medicare Prescription Drug Benefit
Sponsoring organization: Kaiser Family Foundation
Charts highlight data from a poll on seniors and the Medicare Prescription Drug Benefit, conducted jointly by the Kaiser Family Foundation and the Harvard School of Public Health between November 9 and 19, 2006. It included a nationally representative sample of 718 seniors, including 275 who reported being enrolled in a Medicare drug plan.
Date: 12 / 2006

CMS’ Legal Authority to Support Caregivers
Sponsoring organization: Centers for Medicare & Medicaid Services
Describes the Centers for Medicare and Medicaid Services’ legal authority to support caregivers and the ways in which CMS currently supports caregivers through its programs. Intended to serve as a resource for organizations that work on behalf of caregivers.
Date: 09 / 2007

Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
Date: 12 / 2005

Data Book: Healthcare Spending and the Medicare Program
Sponsoring organization: Medicare Payment Advisory Commission
Provides data, including some rural-specific statistics, on various aspects of the Medicare program. Covers beneficiary demographics, quality and access, national health care spending, and data for specific provider settings. Includes sections on Medicare Advantage and prescription drug coverage for Medicare beneficiaries.
Date: 06 / 2007

Depression and the Initiation of Alcohol and Other Drug Use among Youths Aged 12 to 17
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Provides discussion and statistics regarding the association between mental health disorders and substance use disorders among youth.
Date: 05 / 2007

Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States. Updates findings presented in RUPRI Center Policy Brief PB2006-8.
Journal citation: RUPRI Rural Policy Brief Volume 12 Issue 1
Date: 01 / 2007

Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
The findings from this study, along with specific suggestions made by pharmacists during the interviews, suggest short-term actions that can be taken to address the challenges faced by rural independent pharmacies who are the sole providers in their communities. A joint publication of the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis.
Date: 11 / 2006

Fact Sheet on the 2006 Medicare Trustees Report
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of Medicare's financial outlook, as reported in the 2006 Medicare Trustees Report.
Date: 05 / 2006

Impacts of the Medicare Modernization Act on Rural Health Systems and Beneficiaries
Author(s): Keith J. Mueller, Andrew F. Coburn, Charles W. Fluharty, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
This paper offers an analysis of rural-pertinent provisions of the Medicare Modernization Act of 2003. A highlights section summarizes legislative and regulatory provisions of special significance to rural beneficiaries and health care systems. The final section includes Panel analysis of all provisions identified by the Panel as important to rural interests.
Date: 02 / 2005

Medicare "Pay-for-Performance (P4P)" Initiatives
Sponsoring organization: Centers for Medicare & Medicaid Services
Identifies various CMS initiatives to encourage improved quality of care in all health care settings where Medicare beneficiaries receive their health care services, including physicians' offices and ambulatory care facilities, hospitals, nursing homes, home health care agencies and dialysis facilities.
Date: 01 / 2005

Medicare & You: 2007
Sponsoring organization: Centers for Medicare & Medicaid Services
Highlights what's new, what's covered, health plans, prescription drug plans, and your rights.
Date: 10 / 2006

Medicare Advantage Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare Advantage (MA) program. Includes information on MA benefits, premiums, enrollment, and future issues.
Date: 03 / 2007

Medicare Advantage in Rural Areas
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Chapter from the 2007 Report to the Secretary: Rural Health and Human Service Issues. Addresses Medicare Advantage (MA), a program that provides health care benefits for elderly Americans through private insurance companies, and the impact that MA may have on rural beneficiaries and providers.
Date: 01 / 2007

Medicare Advantage Payment Policy
Author(s): Mark Merlis
Sponsoring organization: National Health Policy Forum
Discusses Medicare Advantage (MA) plans, which are an important source of supplemental benefits for many Medicare beneficiaries. Also, discusses rural issues regarding Medicare Advantage plans.
Date: 09 / 2007

Medicare Advantage Plans in Rural America
Author(s): Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
Identifies key policy issues and questions concerning the impact of Medicare Advantage (MA) in rural areas.
Date: 10 / 2007

Medicare Advantage, Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare Advantage program, describes program changes made by the new drug law in plan participation and beneficiary enrollment, presents data on benefits and premiums and explains changes in Medicare payments to participating plans.
Date: 02 / 2007

Medicare at a Glance, Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides a basic overview of the Medicare program, including characteristics of people on Medicare, Medicare's structure, beneficiary cost sharing, role of private plans in Medicare, and data on current and future Medicare spending.
Date: 02 / 2007

Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare rural billing charts for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), skilled nursing facilities, home health agencies, and Critical Access Hospitals (CAHs). Provides information on where to submit claims for different services.
Date: 05 / 2007

Medicare Chart Book, Third Edition
Author(s): Juliette Cubanski, Molly Voris, Michelle Kitchman, Tricia Neuman
Sponsoring organization: Kaiser Family Foundation
More than 80 charts and tables with data on the Medicare program and Medicare beneficiaries. Includes rural-specific and state-specific data for selected topics.
Date: 2005

Medicare Disproportionate Share Hospital Fact Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of the Medicare Disproportionate Share Hospital adjustment and how a hospital can qualify to receive it.
Date: 03 / 2007

Medicare Drug Coverage under Medicare Part A, Part B, and Part D
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of drug coverage under Medicare Part A, Part B and Part D, with information on what drugs are covered under each part of the Medicare program.
Date: 08 / 2007

Medicare Guide to Rural Health Services Information for Providers, Suppliers and Physicians: Errata Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
Errata updates applicable to the print version of the Medicare Guide to Rural Health Services Information for Providers, Suppliers and Physicians.
Date: 08 / 2007

Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare & Medicaid Services
Offers Medicare providers, suppliers, and physicians rural health information and resources including Ambulance Services, CAH's, FQHC's, HPSA, Home Health, Hospice, Medicare, Prescription Drug Plan, Quality Improvement, RHC's, Sole Community Hospital, Swing Bed, and Telehealth.
Date: 02 / 2007

Medicare Home Health Care in Rural America
Author(s): Sheila J. Franco
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Describes results of a study evaluating the degree to which Medicare beneficiaries received home health care from agencies outside of their county and the extent to which urban agencies served rural beneficiaries.
Date: 01 / 2004

Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Early information on enrollment in the Medicare prescription drug program in rural and urban areas. Includes findings from an analysis of plans available to rural persons under Medicare's Part D program.
Date: 04 / 2006

Medicare Payment Basics: Outpatient Hospital Services Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of Medicare payments for outpatient hospital services. Includes information on how payment rates are set.
Date: 09 / 2006

Medicare Payment Basics: Part D Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of the Medicare Part D prescription drug benefit. Includes information on Medicare subsidies, Medicare payments to plans, and the calculation of enrollee premiums.
Date: 09 / 2006

Medicare Physician Payment: Impacts of Changes on Rural Physicians
Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense and the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
Date: 09 / 2006

Medicare Physician Services: Use of Services Increasing Nationwide and Relatively Few Beneficiaries Report Major Access Problems
Sponsoring organization: Government Accountability Office
Reports on Medicare beneficiaries' perceptions of the availability of physician services, utilization of physician services, and physician supply and willingness to serve Medicare beneficiaries. Includes rural-specific information.
Date: 07 / 2006

Medicare Prescription Drug Benefit (Fact Sheet)
Sponsoring organization: Kaiser Family Foundation
Provides information and data about the Medicare Drug Benefit, including a breakdown of the standard benefit, updates on additional low-income assistance, and the latest 2006 enrollment data.
Date: 06 / 2007

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173). A Summary of Provisions Important to Rural Health Care Delivery
Author(s): Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Overview of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) as it relates to rural health care. Includes information on how this Act will impact beneficiaries, health care access, and payments to rural health care providers.
Date: 01 / 2004

Medicare Spending and Financing Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides an overview of spending on the Medicare program, how the program is financed, and Medicare’s future financial outlook.
Date: 06 / 2007

Medicare: A Primer
Sponsoring organization: Kaiser Family Foundation
Looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program's overall costs and future financing challenges. Also provides information about the Medicare Advantage program and the Medicare drug benefit.
Date: 03 / 2007

Medicare: Communications to Beneficiaries on Prescription Drug Benefit Could Be Improved
Sponsoring organization: Government Accountability Office
Review of the quality of Center for Medicare and Medicaid Services (CMS) communications on the Medicare Part D prescription drug benefit. Includes evaluation of written materials, web-based tools and the 1-800-MEDICARE Help Line.
Date: 05 / 2006

Medicare: Geographic Areas Used to Adjust Physician Payments for Variation in Practice Costs Should Be Revised
Sponsoring organization: Government Accountability Office
Describes the method CMS uses to vary physician payments based on practice cost using 89 localities. Examines how CMS has revised the localities, the extent to which they accurately reflect variations in physicians’ costs, and alternative approaches to constructing the localities. Includes comparison of urban and rural physician payments.
Date: 07 / 2007

MMA - Physician Education for the Revisions to the Health Professional Shortage Area (HPSA) Bonus Payment Processes and Implementation of the Physician Scarcity Area (PSA) Bonus Payments
Sponsoring organization: Centers for Medicare & Medicaid Services
Reflects proposed billing and claims processing guidance consistent with the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) bonus requirements as discussed in the Notice of Proposed Rulemaking for the 2005 Physician Fee Schedule published August 5, 2004.
Date: 2004

Navigating Medicare and Medicaid, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates
Author(s): Bob Williams, Henry Claypool, Jeff Crowley
Sponsoring organization: Kaiser Family Foundation
Explains the role of Medicare and Medicaid for the roughly 20 million children, adults and seniors with disabilities. Offers a basic introduction to the Medicare and Medicaid programs.
Date: 02 / 2005

Perspectives on Medicare Part D and Dual Eligibles: Key Informants’ Views From Three States
Author(s): Lori Buchsbaum, Janet Varon, Emma Kagel, Randolph T. Boyle, Kathleen C. McGarvey
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides information on the ongoing successes and challenges that dual eligibles of Medicare and Medicaid faced in the first eight months of Medicare Part D and how different state approaches may affect dual eligibles’ ability to access prescription medications.
Date: 05 / 2007

Premiums and Cost-Sharing Features in Medicare's New Prescription Drug Program, 2006
Author(s): Marsha Gold
Sponsoring organization: Kaiser Family Foundation
Describes the premiums and selected cost-sharing characteristics of the Medicare drug benefit offered by Medicare PDPs and MA-PD plans in 2006. The latter include health maintenance organizations (HMOs), local preferred provider organizations (PPOs), regional PPOs, and private fee-for-service (PFFS) plans.
Date: 05 / 2006

Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
Author(s): Keith J. Mueller, Lisa Bottsford
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Discusses how state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary health care services, including prescription medications. Implementation of Part D creates an opportunity to help beneficiaries through leadership, by connecting beneficiaries and those who serve them to resources that will help them react appropriately to changes in the program.
Journal citation: RUPRI Rural Policy Brief Volume 10 Issue 2
Date: 08 / 2005

Private Plans in Medicare: A 2007 Update
Author(s): Marsha Gold
Sponsoring organization: Kaiser Family Foundation
Examines changes between 2006 and 2007 in the availability of and enrollment in Medicare Advantage and Medicare prescription drug plans overall and in urban and rural areas.
Date: 03 / 2007

Report to the Congress: Increasing the Value of Medicare
Sponsoring organization: Medicare Payment Advisory Commission
Examines issues affecting the Medicare program and makes recommendations to the Congress. Topics covered include care coordination, pricing accuracy in the hospice and physician payment systems, quality measures in home health, gathering data on outpatient therapy, Medicare Advantage, the Part D prescription drug program, and cost-effectiveness analysis.
Date: 06 / 2006

Report to the Congress: Issues in a Modernized Medicare Program
Sponsoring organization: Medicare Payment Advisory Commission
Examines issues affecting the Medicare program. Addresses Part D, Medicare's new outpatient prescription drug benefit, with some coverage of rural issues. Includes overview of the Medicare Advantage program. Discusses the effects of the Critical Access Hospital (CAH) provisions in the MMA.
Date: 06 / 2005

Report to the Congress: Medicare Payment Policy, 2008
Sponsoring organization: Medicare Payment Advisory Commission
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. (Large file)
Date: 03 / 2008

Report to the Congress: Promoting Greater Efficiency in Medicare
Sponsoring organization: Medicare Payment Advisory Commission
Describes the changing beneficiary profile in Medicare and its implications for the program. Examines approaches to promote greater efficiency in the Medicare program. Includes discussion of Medicare Advantage (MA), the wage index, and Medicare coverage of drugs.
Date: 06 / 2007

Report to the Congress: Rural Payment Provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Sponsoring organization: Medicare Payment Advisory Commission
Examines the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provisions on rural hospital payments. Present the effect of eight MMA provisions on Medicare inpatient and outpatient payments to traditional (non-CAH) hospitals. Summarizes the MMA changes to Critical Access Hospital (CAH) payment policies discussed in MedPAC's interim report. Examines the effects of higher payments on hospital costs.
Date: 12 / 2006

Rural Enrollment in Medicare Advantage Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.
Date: 07 / 2007

Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas. Includes rural and urban data on enrollment in Medicare Advantage and other pre-paid plans by type of plan. Also provides state-level information on MA enrollment.
Date: 04 / 2007

Rural Health Clinic and Federally Qualified Health Center Manual
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare manual for Rural Health Clinics and Federally Qualified Health Centers. Covers agreements and terminations, coverage and exclusions, payment and billing procedures. Available as a ZIP file download.

Rural Referral Center Fact Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of the Rural Referral Center program, which supports high-volume rural hospitals that treat a large number of complicated cases.
Date: 02 / 2007

State Updates on Medicare Advantage Enrollment
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
These state-by-state reports compare MA enrollment in December 2005 to that in September 2007, including information on overall and rural enrollment in all MA plans.
Date: 2007

Summary/Chartpack: National Survey of Pharmacists and National Survey of Physicians, Findings on Medicare Part D
Sponsoring organization: Kaiser Family Foundation
Highlights key data from separate surveys of pharmacists and physicians related to the new Medicare drug benefit.
Date: 09 / 2006

Update on Rural Enrollment in Medicare Advantage: Growth Continues
Author(s): Timothy D. McBride, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides findings about rural enrollment in the Medicare Advantage (MA) program and other pre-paid plans, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.
Date: 10 / 2007

Value of Extra Benefits Offered by Medicare Advantage Plans in 2006
Author(s): Mark Merlis
Sponsoring organization: Kaiser Family Foundation
Discusses Medicare Advantage Plans. Enrollees are still in HMOs and other managed care plans, and the most rapid enrollment growth has been in private fee-for-service (PFFS) plans, which now account for 22% of Medicare Advantage enrollment. Addresses issues in rural areas.
Date: 01 / 2008

Voices of Beneficiaries: Medicare Part D Insights and Observations One Year Later
Author(s): Michael Perry, Adrianne Dulio, Juliette Cubanski
Sponsoring organization: Kaiser Family Foundation
Describes the views and experiences of 35 Medicare beneficiaries under the new drug benefit in advance of the 2007 open enrollment period. The report finds that drug plan enrollees generally say that they are satisfied with their drug coverage and have not encountered major difficulties using their plan. At the same time, many of them do not fully understand how their plan works even after almost a year of experience with this new benefit.
Date: 12 / 2006

Journals

Health Care Financing Review
Seeks to contribute to an improved understanding of the Medicare and Medicaid programs and the U.S. health care system by presenting information and analyses on a broad range of health care financing and delivery issues. Sponsoring organization: Centers for Medicare & Medicaid Services

MLN Matters: Information for Medicare Providers
Articles for health care providers to help them understand new or changed Medicare policy. Sponsoring organization: Centers for Medicare & Medicaid Services

Organizations

Center for Medicare Advocacy
National organization
A national non-partisan education and advocacy organization that identifies and promotes policy and advocacy solutions to ensure that elders and people with disabilities have access to Medicare and quality health care.

Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.

Medicare Payment Advisory Commission (MedPAC)
Federal government
An independent federal body that advises the U.S. Congress on issues affecting the Medicare program.

Medicare Quality Improvement Community (MedQIC)
Nonprofit/Foundation
Supports state Quality Improvement Organizations (QIOs) and providers of services to Medicare beneficiaries in finding, using and sharing quality improvement resources thereby advancing the quality improvement community. Provides a list of contacts for state QIOs.

Research Data Assistance Center (ResDAC)
Federal government
Provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and Medicare Current Beneficiary Survey (MCBS) data for research.

Terms & Acronyms

CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.

Critical Access Hospital (CAH) Rural hospital that provides essential services to a community and receives cost-based reimbursement from Medicare. Requirements include a maximum of 25 beds (swing or acute care) and a maximum 96 hour average length of stay for acute care patients.

Federally Qualified Health Center (FQHC) FQHCs include all organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. FQHCs benefit from enhanced reimbursement from Medicare and Medicaid under the prospective payment system.

Late Enrollment Penalty A penalty applied to the monthly Part D premium if an eligible beneficiary enrolls in the Medicare drug benefit outside of the initial enrollment period or enrolls after a period of more than 63 days without equivalent coverage after they become eligible for Medicare.

Medicaid Federal assistance program that helps pay for medically necessary services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations.

Medicare Federal health care insurance program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.

Medicare Administrative Contractor (MAC) Will replace the current Medicare fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.

Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Legislation passed in 2003 that included significant Medicare reforms including a prescription drug benefit for Medicare beneficiaries and reimbursement improvements for rural healthcare facilities.

Medicare Rural Hospital Flexibility Program (Flex Program) Federal initiative created by the Balanced Budget Act of 1997 that provides funding to State Governments to strengthen rural health. Requires the development of state rural health plan. Provides funding to States network development, quality improvement, designation of Critical Access Hospitals (CAHs), and improvement of rural EMS.

Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.

Rural Health Clinic (RHC) Clinic certified to receive special Medicare and Medicaid reimbursement. RHCs must be located in underserved rural areas and provide primary care services. RHCs use a team approach of physicians, nurse practitioners, physician assistants, and certified nurse midwives to provide services.

Contacts

For questions about CMS regulations:
CMS Regional Rural Representatives

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Page last updated 5/16/2008
Topic last reviewed 8/13/2007

News
May 16, 2008 -- CMS Announces Demonstration to Encourage Greater Collaboration and Improve Quality Using Bundled Hospital Payments

May 16, 2008 -- Medicare Program; Revisions to the Medicare Advantage and Prescription Prescription Drug Benefit Programs: Proposed Rule; Comment Request

May 16, 2008 -- May 23rd is Days Away – Are you Prepared?

May 15, 2008 -- 2008 Physician Quality Reporting Initiative (PQRI) National Provider Conference Call with Question & Answer Session

May 15, 2008 -- Medicare DMEPOS Competitive Bidding Program Q&A Session

May 13, 2008 -- CMS to Host Special Open Door Forum on Wage Index Reform

May 12, 2008 -- CMS Launches Pilot to Test Personal Health Records for Medicare Beneficiaries in South Carolina

May 12, 2008 -- CMS Proposes New Protections for Medicare Beneficiaries in Medicare Advantage and Prescription Drug Programs

May 6, 2008 -- Nation’s Front Line Caregivers Say New CMS Rule Undermines Care Needs of America’s Oldest, Sickest Seniors

May 6, 2008 -- Changes for Long-Term Care Hospitals Required by Certain Provisions of the Medicare, Medicaid, SCHIP Extension Act of 2007: 3-Year Delay in the Application of Payment Adjustments for Short Stay Outliers and Changes to the Standard Federal Rate

May 5, 2008 -- CMS Announces Rate Year 2009 Payment and Policy Changes for Long-Term Care Hospitals

May 5, 2008 -- Department of Health and Human Services; Notice of Semiannual Regulatory Agenda

May 2, 2008 -- CMS Proposes New Payment Rates for Medicare Skilled Nursing Facilities; Recalibration of Case-Mix Adjustment

May 1, 2008 -- Medicare Program; Proposed Hospice Wage Index for Fiscal Year 2009; Proposed Rule; Comment Request

Apr 30, 2008 -- Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician; Self-Referral Rules; Comment Request

Apr 29, 2008 -- Important Information about the Upcoming DMEPOS Competitive Bidding Program!

Apr 29, 2008 -- CMS Announces Proposed Wage Index Changes for the Medicare Hospice Benefit

Apr 29, 2008 -- May 7 is "Legacy Free" Day – An Opportunity to Check Your NPI Readiness!

Apr 25, 2008 -- Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2009; Proposed Rule; Comment Request

Apr 24, 2008 -- Important NPI Information for ALL Providers – Medicare and Non-Medicare

Apr 22, 2008 -- Congress Seeks to Ease Doctor Shortage

Apr 21, 2008 -- CMS Proposes More Accurate Payments for Inpatient Rehabilitation Services in FY 2009

Apr 21, 2008 -- Congress Should Ban Physician Self-referral, Hospital Groups Say

Apr 18, 2008 -- Congress Aims to Ease Doctor Shortage

Apr 18, 2008 -- Quality Reporting Initiative Will Help Improve Health Care for Beneficiaries and Provide Incentives for Eligible Professional

Apr 17, 2008 -- Medicare Program; Modification to the Weighting Methodology Used to Calculate the Low-Income Benchmark Amount; Correction of Final Rule

Apr 15, 2008 -- CMS Proposed to Expand Quality Program for Hospital Inpatient Services in FY 2009

Apr 15, 2008 -- Medicare Program; Policy and Technical Changes to the Medicare Prescription Drug Benefit; Final Rule

Apr 15, 2008 -- Medicare and Medicaid Programs; Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule

Apr 15, 2008 -- OIG Refines Self-Disclosure Protocol

Apr 14, 2008 -- National Hospice Study Reveals Gaps in Service

Apr 11, 2008 -- MedPAC Recommendations Would Improve Hospital-based SNF Funding

Apr 11, 2008 -- MedPAC Recommends Action Toward Payment Bundling for Hospital Care

Apr 9, 2008 -- CMS Announces 2009 MA Payment Rates

Apr 8, 2008 -- Hospital Capacity Drives Costs

Apr 7, 2008 -- Medicare Announces Funding for Health Insurance Counseling Programs for 2008

Apr 7, 2008 -- Medicare Program; Standards for E-Prescribing Under Medicare Part D and Identification of Backward Compatible Version of Adopted Standard for E-Prescribing and the Medicare Prescriptions Drug Program (Version 8.1); Final Rule

Apr 3, 2008 -- CMS Releases Regulation Modernizing Dialysis Centers

Apr 3, 2008 -- E-Prescribing Tools to Help Prevent Adverse Drug Interactions

Apr 3, 2008 -- Medicare Program; Modification to the Weighting Methodology Used to Calculate the Low-Income Benchmark Amount; Final Rule

Apr 2, 2008 -- AMA Physicians Make a House Call on Congress

Apr 1, 2008 -- Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--October Through December 2007

Apr 1, 2008 -- Medicaid Program; Final State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals for Federal Fiscal Year 2007

Apr 1, 2008 -- Medicare Acts to Reduce the Number of Yearly Drug Plan Reassignments Among Low-Income Beneficiaries

Mar 28, 2008 -- Medicare and Medicaid Programs; Approval of the Joint Commission for Continued Deeming Authority for Home Health Agencies; Final Notice

Mar 28, 2008 -- Medicare and Medicaid Programs; Approval of the Community Health Accreditation Program for Continued Deeming Authority for Home Health Agencies; Final Notice

Mar 26, 2008 -- Medicare and State Health Care Programs: Fraud and Abuse; Issuance of Advisory Opinions by OIG; Interim Final Rule with Comment Period

Mar 26, 2008 -- Report: Medicare Hospital Fund Outlook Basically Unchanged

Mar 25, 2008 -- Report Examines Tax Incentives to Ease Retiree Health Care Costs

Mar 24, 2008 -- Baucus Tackles Cuts in Subsidies for Medicare Advantage

Mar 19, 2008 -- CMS Selects National Government Services to Administer Medicare Claims Payment in Connecticut and New York

Mar 19, 2008 -- New Poll Shows Public Worried About Medicare Cuts Impact on Seniors, Boomers -- Wants Congress to Act

Events
May 20, 2008
Centers for Medicare and Medicaid Services Special Open Door Forum: Wage Index Reform
Centers for Medicare & Medicaid Services
2pm-4pm Eastern Time
Dial: 1-800-837-1935
Reference Conference ID: 46680542
Conference Call Only

May 27, 2008
Medicare DMEPOS Competitive Bidding Program Q&A Session
Centers for Medicare & Medicaid Services
1:00-2:30 Eastern
Conference Call Only

Sep 4 - 5, 2008
Meeting of the Medicare Payment Advisory Commission (MedPAC)
Medicare Payment Advisory Commission
Ronald Reagan Building, The International Trade Center
Washington, DC
Contact:
  202.220.3700


About this Page
Credits

Developed by:
Holly Gabriel
holly@raconline.org

Contributors:
Michelle Goodman and Caroline Cochran, Office of Rural Health Policy



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