Yahoo! News Story - Managed Care Blocks Disabled from Care: Report

July 26, 2002

Carol Langer (carol.langer@...) has sent you a news article

Personal message:

I thought you all might find this interesting -- especially the part about "homebound" patients and what they are allowed to do.Carol Rob

Managed Care Blocks Disabled from Care: Report

http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020726/hl_nm/health726_dc_3

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Managed Care Blocks Disabled from Care: Report

Fri Jul 26, 5:43 PM ET

By Todd Zwillich

WASHINGTON (Reuters Health) - Overly-restrictive "medical

necessity" determinations made by private insurance companies

are preventing many disabled persons from getting needed

services, concludes a report released Friday by a federal

advisory council.

Insurers eager to cut costs are narrowing the scope of

covered services, often at the expense of disabled persons,

according to the report. The result is that health care

services outside of the doctor's office--including speech

pathology, occupational therapy and rehabilitation therapy--are

often not covered, it states.

The report, issued by the National Council on Disability,

is also critical of insurance policies that sometimes prevent

disabled persons from seeing medical specialists without prior

authorization from an insurance plan.

Experts urged Congress and the Bush Administration to pass

insurance reform known as the "Patients Bill of Rights" with

language that expressly gives protections to disabled persons.

They said that many services, such as voice-activated

typing devices for people with carpal tunnel syndrome, improve

quality of life but are seldom covered because they have no

medical benefit for the patient.

"Only by incorporating a more pragmatic, functional

standard of improvement or benefit into the equation can the

concept of medical necessity be expanded to take fuller account

of the needs and opportunities facing Americans with

disabilities," the report states.

The council recommended that Congress fund studies looking

at the effect of expanded disability benefits on the private

insurance industry.

Different versions of the legislation have passed both the

US House and the Senate but remain stalled over disputes

between lawmakers and the Bush White House over liability

provisions.

President Bush (

news -

web sites) did not mention patients' rights legislation

or private insurance plans during a White House ceremony Friday

commemorating the 12th anniversary of the signing of the

Americans with Disabilities Act.

Instead Bush concentrated on the strides made in education

and work opportunities for disabled persons and on policies in

Medicare, the federal health insurance program for elderly and

some disabled persons.

The president announced that his administration would

"clarify" a Medicare policy that can deny benefits to persons

homebound with disabilities if they participate in activities

outside of their homes.

The program will now allow patients receiving

Medicare-funded home health services to keep their benefits and

still attend family reunions, graduations or funerals,

according to the Department of Health and Human Services (

news -

web sites).

"Medicare recipients considered homebound may lose coverage

if they occasionally go to a baseball game," Bush said. "They

should not be forced to trade their benefits for a little

freedom."

The council also recommended that Congress and the

president form a national commission of advocates, legal and

medical experts, and patients to study proposed laws governing

pain management and assisted suicide. Experts criticized

restrictions on pain relief options, including morphine and

other narcotic analgesics, that may make disabled persons more

likely to face despair and consider suicide.

"Attention devoted to these basic truths may do more to

prevent unnecessary and untimely forfeiture of precious life

than any measures to control the activities of doctors or to

restrict the availability of dangerous drugs could ever hope to

accomplish," the report states.

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July 26, 2002

Thanks Carol We had a real hard time with Ralph not being considered

home bound because he could go to church once in a while or to the fishing

hole.

Hibernation can bring on all kinds of mind boggling illness. I

wish someone would do a study on what isolation can do to a healthy mind

in a disease wracked body. And what it can do to a loving care giver.

I could tell them a thing or two.

It still makes me mad to think about it.

Barb in Arlington

Crazy rules. But I guess there are some folks who would cheat.

Barb

--

"The greater part of our happiness or misery depends on our dispositions,

and not our circumstances." --Martha Washington

July 27, 2002

One thing we found out when Ken was on Hospice is that being completely

Homebound is not required for Medicare to pay for Hospice.

Barbara

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