Wanted: New Medicare Slogan
Steve Shain: Hey everybody, welcome back. So, I got a lot of shout outs today, I’m just giving you a heads up right at the beginning. A lot of people to thank for this video, just because they had some good ideas and I’m trying to implement them into today’s video. First of all, thank you to Jerry Freedman for recommending that we put the text down at the bottom for those people who are not listening but are actually just reading along with the video. Honestly, I don’t really understand why you wouldn’t blast the volume on really loud so everybody could enjoy what we have to say here but I guess it’s your prerogative. For you guys that are not listening, you got the text here on the bottom. Thank you, Jerry.
Second shout out goes to Yehuda Davis, he mentioned to us a while back about this change and it’s actually going into place. So thanks Yehuda for this tip-off, which I’d like to share with everybody else as well if you did not already hear. New York Medicaid used to obviously be working with MLTC plans – managed long-term care plans – so the managed long-term care plans were covering the long-term care patients in the skilled nursing facilities. What’s happening now is that a rule has gone into place that the MLTC plans only need to extend for three months – 90 days – after that a long-term care patient can disenroll from the MLTC plan and revert back to straight Medicaid. That’s right, they can go back to straight Medicaid, providers will be billing Medicaid directly, communicating with Medicaid directly and the MLTC plans will no longer be covering the resident after three months in the facility. This is actually great news for everyone. It’s good for the providers because providers don’t need to work through a middleman like MLTC. They can work directly with Medicaid. It’s also great for the MTLC plans in a way because they have members of the insurance as a whole and the more complex ones are the ones that are constantly institutionalized, so now that those members are being disenrolled, it kind of makes their job easier for the members that they do need to care for. So it sounds like a real win-win but I’m not sure how Medicaid feels about this, but you know, it’s going back to how it used to be so I don’t really see a problem with that either.
Now there’s one thing that I’m not sure everybody does know about and that is Medicare’s soul-searching that they’ve been doing recently. Medicare was established in 1965. At the time, the concept for what Medicare was there for was to provide care for coverage that was “primarily health-related.” That was their tag line, anything that’s “primarily health-related” is what Medicare covered for Medicare recipients. Now, that was a long time ago. What seems to be happening now is that the folks at Medicare got together and they’re scratching their heads and they’re like “This doesn’t seem right. If our coverage is for ‘primarily health-related’ care, we should be covering more.” And that’s exactly what they’re looking into. And at the same time the Medicare Advantage Plans, which is the insurance plans, that are replacing Medicare, are looking into this as well. Because if the coverage should be “primarily health-related,” it should really be expanded to more services and more kinds of healthcare settings. So to give you some examples of things that are being speculated; nutritious food, transportation to health-related services, independent living, assisted living, adult daycare, other healthcare settings are now considered for Medicare reimbursement. This is an extremely exciting idea for healthcare providers, this is something that they plan on putting in place in 2019, which is not too far away. We’ve actually been in talks with a lot of the national healthcare insurers that are working with us to try to figure out exactly how they can provide services to Medicare members and in what avenues they can now cover. So hold on tight for 2019, we’re expecting that some of these services in some of these avenues will be covered, but hold on tight, it’s not determined yet.
So for the last shout out, I want to give a shout out to Seema Verma at CMS. Your tagline is “primarily health-related” for Medicare. Come on, you can do better than that, I’m going to give you two suggestions and whoever is watching this please put in the comments any other suggestions you think the Medicare tagline should be. I’m sure we can do better with what they have right now. So here’s my two suggestions, they’re not awesome but it’s a start; Medicare – You Paid Into It, Now Cash Out. You like that? How about this one; Medicare – We Keep Your Providers Happy So They Can Keep You Healthy. Right? You like that one, I see you like that one. If you have anything better, put it in the comments and I’m going to take it, stuff it in an envelope, mail it to Seema Verma, and hopefully we can trademark something really quick. Of course, if you have questions, comments, or anything you think can make this video better, please let us know so we can make this better for you. Take care.