Building Capacity to Provide Behavioral Health Services to Dual Eligibles

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative (the Initiative) to improve the quality of care received by low-income adults who are eligible for Medicare and Medicaid—known as dual eligibles.  Many of these individuals have unmet behavioral health needs, ranging from mild depression to serious mental illness, like schizophrenia and bipolar disorder.  A recent update on the Initiative presented to the Medicare Payment Advisory Commission highlighted four challenges to providing behavioral health services to this …

Shingles Vaccine May Be out of Reach for Some Medicare Beneficiaries

Introduction to Shingles Shingles is a viral infection that causes a painful skin rash. It is caused by the varicella-zoster virus — the same virus that causes chicken pox. Once people recover from chicken pox, the virus remains in their body in an inactive state. In some people, it stays dormant; in others, the virus reactivates and causes shingles. The condition is most common in older adults and people with weakened immune systems. The most common complication of shingles is …

Medicare and Private Health Plans Agree to Common Standards to Evaluate Doctors: Why This Is Good News for Consumers

For over a year, a multi-stakeholder group composed of Medicare administrators, doctors, private health plan representatives, consumer groups and employers has worked together to figure out a uniform way to rate doctors’ performance. Today, the group announced agreement on a core set of quality measures that Medicare and private health insurance plans will phase in to evaluate doctors. Medicare and many private plans are transitioning to a new way to pay doctors: paying them based on the quality of their work, rather than …

7 Legislative Happenings for Older Americans

With 2015 behind us, it’s the season of “best of 2015” and “bold predictions for 2016” lists. Consider this a hybrid. Looking back, there were seven important happenings and victories for older Americans and their families in 2015. They happened in Washington, D.C., state legislatures and communities across the country and will help improve the lives of millions of people. In some cases, we solved long-standing challenges, including protecting seniors’ access to their doctors. In other areas, like supporting family …

Among Older African Americans, Depression Continues to Be Under-Detected and Undertreated

The good news is that appropriate treatment can help most older adults with depression. What’s more, Medicare has recently improved its coverage for people with mental disorders. It now covers a free annual depression screening, and beneficiaries no longer have to pay more for outpatient treatment of mental illnesses than they do for physical illnesses. In addition, Medicare’s prescription drug benefit covers essentially all antidepressants used to treat people with depression. Older African Americans’ Depression Is More Likely to Go …

Is Observation Status Substituting for Hospital Readmission?

Since October 2012, the Medicare program has penalized hospitals when too many patients in traditional Medicare are re-hospitalized within a month of discharge. This policy appears to be having unintended consequences for patients in Medicare and in the commercial market. Hospitals with readmission rates above the national average now receive lower payments across-the-board from Medicare; the higher the rate of “excess” readmissions, the greater the penalty. The fines are intended to push hospitals to provide better care for their patients …