Monday, August 23rd, 2010
The Workers’ Compensation Board is preparing to implement a major change in how medical care is provided to injured workers. New Medical Treatment Guidelines are anticipated to become the mandatory standard of care for the back, neck, shoulder, and knee, effective October 18, 2010. This will expedite appropriate care and speed provider reimbursement.
With few exceptions, all treatment in accordance with the Guidelines is pre-authorized. Providers can be assured that if they follow the Guidelines, they will be paid by the carrier. Treatment that is outside the Guidelines will not be reimbursed unless it is first approved through a variance process.
The Board will offer free web-based training to medical providers and their staff starting in September 2010. Details on the training, including CME accreditation, will be sent later this summer. Information on the Guidelines is available on the Board’s web site under Board Announcements.
Thursday, August 5th, 2010
New CMS Report Shows Savings of Nearly $8 Billion by 2012
Medicare will see savings of nearly $8 billion by the end of 2012 with the implementation of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) reported.
In a new study examining the impact of the new law and actions taken to achieve its goals, available at www.cms.gov, CMS reports that savings to Medicare will rise to more than $575 billion over the next decade. These reforms include new provisions that will improve the quality of care, develop and promote new models of care delivery, appropriately price services, modernize the health system, and fight waste, fraud, and abuse. The Affordable Care Act is projected to more than double the life of the Medicare Trust Fund, extending its life from 2017 to 2029.
Without enactment of the Affordable Care Act, the nation’s already excessive health care spending would have reached unsustainable levels within the next few decades. The Congressional Budget Office projected in 2009 that national health care spending would be 31 percent of the Gross Domestic Product (GDP) by 2035 and 46 percent of GDP by 2080. The Medicare Trustees projected in 2009 that the Hospital Insurance (HI) Trust Fund, which pays for Medicare services, would be insolvent in eight years, by 2017.
To read the entire CMS Press Release issued August 2, click here: https://www.cms.gov/apps/media/press_releases.asp
The report is now available under “CMS Highlights” at www.cms.gov.
Robin Fritter, Director
Division of Provider Relations & Outreach
Provider Communications Group/CMM
Monday, August 2nd, 2010
Governor David Paterson recently announced the launch of a new state website on federal health care reform. The website, www.HealthCareReform.ny.gov, includes descriptions of health care reform, how it will benefit New Yorkers, and the progress of implementation in the state. The website also includes information on how residents can obtain health insurance coverage and the public programs already in place in New York State.
The website further includes a timeline of when specific provisions of health care reform go into effect. Several reforms have or will take effect this summer, including a temporary high risk pool for people with medical conditions that are expensive to treat, an early retiree reinsurance program that will help offset the cost of providing health insurance to retirees age 55 and over who are not eligible for Medicare, and the mailing of rebate checks to Medicare Part D enrollees who reach the “donut hole” coverage gap.
“This website is a useful resource for New Yorkers to learn about the new reforms as they take effect throughout the next several years,” said Governor Paterson.
Monday, August 2nd, 2010
The CDC has announced new and revised recommendations of the Advisory Committee on Immunization Practices (ACIP) for the prevention and control of influenza in an early release of its Morbidity and Mortality Weekly Report (MMWR).
Five primary changes and updates highlight this 86-page document:
• Routine seasonal influenza vaccination is recommended for all persons aged ≥6 months.
• Two doses, at least four weeks apart, are recommended for all children aged 6 months to 8 years who are receiving seasonal vaccine for the first time. To bring all children into compliance: a) Children should also receive two doses if they were in the age group last year but received only one dose. b) Children in this age group who did not receive at least one dose of H1N1 monovalent vaccine last year should receive two doses of seasonal 2010-2011 vaccine this year regardless of previous vaccine history. c) Children in this age group should also receive two doses of seasonal 2010-2011 vaccine if the type of vaccine they received last year is not known.
• The 2010-2011 trivalent vaccines will contain A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens.
• Persons aged ≥65 years can receive the new inactivated trivalent vaccine, Fluzone High-Dose or any of the standard-dose TIV preparations.
• A new inactivated influenza vaccine (Agriflu by Novartis), has been approved for persons aged ≥18 years; and the age indications have been expanded for two previously approved inactivated vaccines (Fluarix by GlaxoSmithKline for persons aged ≥3 years and Afluria by CSL Biotherapies for persons aged ≥6 months).
More information can be accessed online in the complete Morbidity and Mortality Weekly Report (MMWR), Volume 59, titled “Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.”
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