Medicaid Surgery Costs

Each year, about 300,000 Americans undergo arthoscopic knee surgery to ease the pain of arthritis, but government researchers are now saying the operation is worthless for arthritis sufferers and may even be harmful in some cases.

Arthoscopic knee surgery is an attempt to clean out debris or repair damaged cartilage in the knee. In the study, some patients received the real operation, while others received a sham operation. Neither group knew whether or not their operations had really been performed.

The researchers monitored the patients’ progress over the next two years. They discovered that those who had received the fake surgery could climb stairs and walk slightly faster on average than those who had received the real operation.

The surgery generally costs about $5,000 and accounts for a total of $1.5 billion each year nationwide. The results of this study may prompt some insurers to refuse to pay for it. Other options for treating osteoarthritis of the knee include pain relievers, cortisone shots, hot packs, exercise, and knee-replacement surgery.elderly

Osteoarthritis affects about 12% of senior citizens.

Hobbies and a Social Life — the Latest Breakthrough Against Dementia

Guidance for When Drugs Are Covered by Medicare

The Centers for Medicare and Medicaid Services (CMS) has issued guidance on when Medicare pays for prescription drugs. This should help Medicare Intermediaries to determine whether a drug or biological that is furnished incident to a physician’s service is subject to the Medicare program exclusion for drugs that are usually self-administered by the patient. In general, drugs that are administered by beneficiaries more than 50% of the time will be excluded from coverage by Medicare.

Absent evidence to the contrary, drugs delivered intravenously or through intramuscular injection should be considered to be not usually self-administered. However, the opposite is generally true for drugs administered through subcutaneous injection.

For the full text of the guidance, go online:

Common Medicare Questions and Answers About HHS

Can someone who has never worked receive Social Security or Medicare based on his or her spouse’s employment?

A U.S. citizen’s spouse who has never worked can obtain both Social Security and Medicare benefits. These benefits are derived from the spouse’s work record. But these rights differ for U.S. citizens and non-citizens.

Do I have to live in the U.S. for five years and be a U.S. citizen to qualify for Medicare? When I qualify for Medicare, how much will it cost me?

It is not necessary to be a citizen of the U.S. in order to purchase Medicare. All that is required is that you be 65 or older and have lived in the U.S. for five consecutive years. If you OR your spouse have worked (combine the number of years for each of you) for more than seven years you may be eligible for Medicare at a reduced cost. Otherwise, it will cost $309 for Medicare Part A and $43.80 for Medicare Part B each month.

I am an American citizen. Next year I will be 65 years old. I also have accumulated 40 working quarters. My wife is over 65 and immigrated here in September l997. She has not worked in the states. When she has lived here for five years, will she be able to get Medicare so we won’t have to pay for it ourselves?

Yes. Because she is married to someone who has Medicare, she can get Medicare based on your contributions. If she were not married, she would need to buy-in. When she is eligible for Medicare, she can apply at the Social Security office or by calling 1-800-772-1213.


The HHS Office of the Inspector General (OIG) has released a report stating that psychotropic drug use in nursing homes is generally appropriate. The Senate Special Committee on Aging requested the OIG investigate the extent to which psychotropic drugs are being used as inappropriate chemical restraints in nursing

Psychotropic medications are drugs that affect brain activities associated with mental processes and behavior. They are divided into four broad categories: anti-psychotic, anti-depressant, anti-anxiety, and hypnotic drugs. CMS established guidelines for the appropriate use of these drugs in nursing homes. Chemical restraint is the use of a drug to control an individual’s behavior and is legally appropriate only if used to ensure the physical safety of residents or other individuals.

According to the OIG’s findings, the drugs are generally being used appropriately. The few problems involved inappropriate dosage, chronic use, lack of documented benefit to the resident, and unnecessary duplicate drug therapy.

To view the full report, look online at

Source:HHS OIG 11-2001

National Notes

November Is National Family Caregiver Month


U.S. Senator Larry Craig of the Senate Special Committee on Aging reminded the nation that November is National Family Caregiver Month. “Family caregivers are generous and compassionate people and it is appropriate that in November, the month of Thanksgiving, we acknowledge those who provide care for others who need help caring for themselves.”

Last year, Congress added $125 million to establish a new National Family Caregiver Support Program to assist family caregivers. Those services include information and assistance, training and counseling, and respite care.

If you are providing care for an older person and need help, you should contact either your state or local Area Agency on Aging. Try the Eldercare Locator-a great way to find community assistance for seniors-at 1-800-677-1116.

Also, visit our Senior Sites links page of this E-letter for great links to caregivers organizations.


A new study from the U.S. Agency for Healthcare Research and Quality (AHRQ) highlights the problem of drugs inappropriately prescribed for elderly patients in the United

According to the study, about one-fifth of the approximately 32 million elderly Americans not living in nursing homes in 1996 used at least one of 33 prescription medicines considered potentially inappropriate. Nearly one million elderly patients used at least one of 11 medications which a panel of geriatric medicine and pharmacy experts advise should always be avoided in the elderly.

These 11 medications include long-acting benzodiazapines, sedative or hypnotic agents, long-acting oral hypoglycemics, analgesics, antiemetics, and gastrointestinal antispasmodics. The list of 33 potentially inappropriate medications reflects the consensus of the expert panel. Not all physicians agree about the appropriateness of specific drugs for the elderly.

Source:AHRQ 12-11-2001

National Notes

Social Security Commission Unveils Three Plans


President Bush’s Social Security Commission has revealed three options for allowing workers to establish individual investment accounts as an alternative to the traditional Social Security system. The Commission also acknowledged that these proposals would have to be accompanied by benefit cuts or other steps to avert a long-term financial crisis.

All three proposals would allow, but not require, workers to invest part of their Social Security payroll taxes in stocks and bonds. While one plan would leave the system’s fiscal responsibility totally up to Congress, the other two proposals include measures that would strengthen the system’s long-term stability. These measures could include benefit cuts, infusions of general government revenue, or higher taxes for some workers.

Source:New York Times 11-30-2001

National Notes

The ElderCare Locator


The public is increasingly using the Administration on Aging’s (AoA’s) nationwide Eldercare Locator to find supportive services to help care for older people in their homes and communities. The average number of calls increased 15.3% from 9,043 each month in FY 2000, to 10,425 each month in FY 2001.

A survey found that most people (69%) called the service on behalf of a member of their family. Many callers are long-distance caregivers looking for services to assist their loved ones, relatives, or friends who live in another town or state. The survey also found that most (96%) callers are satisfied with the assistance they receive, and 89% are first-time callers.

The toll-free number is available Monday through Friday, 9 a.m. to 8 p.m., Eastern Time. The web site is available 24-hours a day. Try the Eldercare Locator at: 1-800-677-1116

General Accounting Office (GAO),

According to a recent report by the General Accounting Office (GAO), physical and sexual abuse of nursing home residents often goes unreported to the authorities and is rarely prosecuted. The three-state investigation also uncovered gaps in state and federal rules intended to protect nursing home residents from medicaid abuse.

According to the report, registries designed to keep abusers out of nursing homes are not consistently updated. And since there is no national registry, nursing homes that conduct checks in one state might unsuspectingly hire an individual who has been fired from nursing homes for abuse in other states.

The report recommended that CMS assess the usefulness of the state registries. Also, the GAO suggested CMS finish implementing an education effort that began over three years ago to encourage nursing home employees to report abuse. Continue reading “General Accounting Office (GAO),”

Social Security and Medicare Outlook Improves a Bit

The trustees for Social Security and Medicare have released reports that the two programs are still losing money, but could remain solvent for longer than was previously expected. The projected solvency of the Medicare trust fund was extended by one year to 2030, while Social Security is now expected to be stable until 2041, three years longer than past projections.

President Bush and Republicans in Congress pointed to the numbers as evidence that changes should be made to the systems soon, including adding a limited prescription drug benefit. But Senator Edward Kennedy (D-MA), chairman of the Senate’s health committee, downplayed the urgency, saying “these estimates discredit [the administration’s] claims that Medicare needs radical surgery to privatize the program and force senior citizens into HMOs.”

Social Security is expected to have to dip into its trust funds by 2017 because it will begin paying more benefits than it collects in payroll taxes. Under the latest projections, Medicare will be forced to dip into its trust fund by 2016. The trustees of both programs cautioned that even though these latest projections show a slight improvement, they don’t hide the fact that both Medicare and Social Security are not prepared for the retirement of the baby boomers.

Under the present shortage of skilled nurses, nursing homes are having trouble keeping their facilities staffed. But new regulations proposed by the Centers for Medicare and Medicaid Services (CMS) could help ease that strain a bit.

Current regulations allow only certified nurses to help nursing home residents eat. The new regulations would instead allow assistants to feed nursing home residents after completing training. Each assistant would be required to learn the Heimlich maneuver, resident rights, communication, and infection control. Family members and volunteers would not be required to take the training.

Feeding assistants would not count toward minimum staffing requirements, and states would have the option to implement the regulations.

The Department of Health and Human Services is warning Americans of the risks of “pre-diabetes,” a condition affecting nearly 16 million Americans that sharply raises the risk for developing type 2 diabetes and increases the risk of heart disease by 50%. Research shows that most people with pre-diabetes will likely develop diabetes within a decade unless they make modest changes in their diet and level of physical activity, which can help them reduce their risks and avoid the debilitating disease.

HHS is using the term “pre-diabetes” to describe an increasingly common condition in which blood glucose levels are higher than normal but not diabetic—known in medicine as impaired glucose tolerance or impaired fasting glucose.

Drug Stores Threaten to Pull Out of Medicaid


With a number of states planning to cut the amounts they pay to pharmacies for filling Medicaid prescriptions, drugstores are threatening to refuse to serve Medicaid patients if those plans are carried out.

Medicaid consumes about 20% of the average state budget, and many states are facing fiscal problems that need solutions. When a Medicaid participant gets a prescription filled, the state generally pays the pharmacy for the cost of the drug plus a flat fee. But sixteen states—including Arkansas, Colorado, Connecticut, Idaho, Illinois, Indiana, Maryland, Mississippi, Montana, Nebraska, North Carolina, Ohio, Oklahoma, South Carolina, Virginia, and Washington—are considering cutting reimbursements to pharmacies.

CVS and Walgreen’s, the largest drugstore chains in the U.S., said they would reduce hours, close stores, and halt expansion in any states that cut pharmacy payments. But Rite Aid and Albertsons have threatened to drop Medicaid completely in those states.

Source:Associated Press 3-11-2002

National Notes

Healthcare Spending to Double Between 2000 and 2011

Continue reading “Social Security and Medicare Outlook Improves a Bit”

CMS Launches First National Nursing Home Ratings

American seniors are living longer and better than ever before, developing fewer disabilities and smoking less. But some experts fear a surge in elderly obesity could cancel out many of those health gains. In the past decade, smoking among Americans over 50 has decreased by 29%. Between 1982 and 1999, obesity in that same group has nearly doubled, according to an AARP report. The report also found:senior living

60% of US adults are overweight or obese;

300 million people worldwide are obese, and 750 million are overweight;

In the US, preventable obesity, Type 2 diabetes, and tobacco-related illnesses cost the nation $270 billion per year.

Source: Associated Press 5-21-2002

National Notes

CMS Cites Nursing Home Complaints on Web Site


As part of its efforts to give seniors and families more information on nursing home quality, the Centers for Medicare and Medicaid Services (CMS),, has now placed the results of complaint investigations on its Web site. This data is in addition to the existing inspection results for the three most recent state nursing home inspections currently reported.

People who are looking into nursing home care for themselves or a loved one will find on the site the health deficiencies for nursing homes that have been cited as a result of investigations after complaints were filed.

You can find the new information at 5-2002

A new bill introduced in the US House of Representatives would create an outpatient prescription drug benefit for seniors, funded by the transfer of federal estate tax revenues to the Medicare program. The bill would also make substantial changes to the estate, gift, and generation-skipping transfer tax provisions of the Economic Growth and Tax Relief Reconciliation Act of 2001.

Representative Barney Frank (D-MA) introduced the bill, called the Medicare Outpatient Prescription Drug Coverage Funding Act of 2002. Under the bill, the estate tax would not be repealed in 2010. Instead, the maximum estate tax rate would be set at 45% in 2007 and thereafter, and the exemption amount of $3.5 million coming in 2009 would be made permanent. Though the estate tax would not be repealed, the sunset provisions of the 2001 Tax Act would be (for estate, gift, and generation-skipping transfer taxes), and the new bill would provide some permanent estate tax relief.

Unless the tax cuts of the Tax Relief Act of 2001 are made permanent, they will expire on midnight of December 31, 2010. The US House of Representatives recently passed legislation to repeal the Act’s sunset provisions, but the bill faces a vicious battle in the Senate, where Senate Majority Leader Tom Daschle (D-SD) has vowed to “oppose it very aggressively in the days and weeks ahead.”

The 229-198 House vote was mostly along party lines, with nine Democrats and one Republican crossing over. Democrats argued the measure would reduce federal revenues by $373 billion in 2012 and by $4 trillion over the following decade. This, they said, would make budget problems, along with the solvency of Medicare, Medicaid, and Social Security, even more troublesome.

But Republicans accused Democrats of using scare tactics and claimed that Social Security would not be affected. The more important issue, according to Republicans, is giving taxpayers the certainty to make long-term plans.