Medicare "Advantage" Oversight & Pediatrician Training's At Risk
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Republicans Take Pediatricians Hostage
House Republicans attempting to tie the reauthorization of a critical pediatrician training program to efforts to limit gender-affirming care for transgender children acknowledge those efforts may collapse. Now lawmakers are looking to fund the program as-is through the appropriations process.
Federal authorization for the Children’s Hospitals Graduate Medical Education Program, which trains more than half of pediatric specialists and almost half of general pediatricians nationwide, lapsed on Sept. 30, 2023.
Earlier this year, the Republican-led House Energy and Commerce Committee approved a reauthorization bill that bars any federal funds from going to hospitals that provide gender-affirming care. That provision was a nonstarter for Democrats, who wanted to see a clean reauthorization of the physician training program.
The proposed House Labor-HHS funding bill includes $400 million for the program, a $15 million boost above the 2023 enacted level — but it includes the gender-affirming care restrictions. The Senate bill proposes $385 million — flat funding — without restrictions.
We have a shortage of doctors in this country and that includes pediatricians. Let’s let our Senators and Members of Congress know that holding doctor’s training hostage to punish trans people is just wrong.
ACTION
Use RESISTBOT by texting SIGN PKQNSB to 50409 to send the message below. You can also call/email your representatives with the info. Their contact data is in the Resources section at the bottom of the newsletter.
“I am your constituent and I want you to know that Federal authorization for the Children’s Hospitals Graduate Medical Education Program, which trains more than half of pediatric specialists and almost half of general pediatricians nationwide, lapsed on Sept. 30, 2023. WE HAVE A SHORTAGE OF DOCTORS AND THAT INCLUDES PEDIATRICIANS.
I am asking you to pass the Labor-HHS funding bill without gender affirming care restrictions at inthecreased $400 million level. Children need doctors and this is how they get trained to do their job. You were elected to help people not punish them.”
Medicare Advantage Changes - Comments Needed by Jan 5, 2024
More than 62 million people across the country rely on Medicare for their health care, and nearly half of those recipients are enrolled in Medicare Advantage, an alternative to traditional Medicare coverage for seniors through private health insurance companies. Funds from the traditional Medicare trust are used to pay the health insurance companies offering Medicare Advantage plans -- and because these companies are private, their focus is ultimately on their bottom line.
Over time, Medicare Advantage companies have committed widespread fraud, put patients’ care and lives in peril by denying their claims, and threatened the solvency of Medicare. It’s time for the Center for Medicare and Medicaid Services (CMS) to step up and stop the swindling.
The federal government is considering an important rule change that would allow CMS to better regulate these companies and is soliciting the public to leave formal comments about this proposed change by Friday, January 5, 2024. By sending in a flood of comments calling on CMS to do everything in its power to stand up for America's seniors and rein in the Medicare Advantage fraudsters, we can show the government that this issue matters.
The changes include:
Improving Access to Behavioral Health Care Providers
Special Supplemental Benefits for the Chronically Ill
Mid-Year Enrollee Notification of Available Supplemental Benefits
Enhance Guardrails for Agent and Broker Compensation (There are too many cases of misleading consumers with these plans)
Annual Health Equity Analysis of Utilization Management Policies and Procedures (Make sure that healthcare is provided where needed and that pre authorizations are not used to restrict care and increase profits).
Enhance Enrollees' Right To Appeal an MA Plan's Decision To Terminate Coverage for Non-Hospital Provider Services
Make it harder for Part D drug plans from changing formularies mid year
For D–SNP PPOs, Limit Out-of-Network Cost Sharing
Extra Credit
Let the Federal government know how you feel about the rule changes. Here is the Here is a link to the comment page and the proposed changes.
Here are my comments for your reference.
My name is Dr. Alan Unell PhD. I am retired and I am glad that the government is considering these changes. I write a daily column on substack called healthcare advocacy (https://healthcarereformau.substack.com/?r=1n82x4&utm_campaign=pub&utm_medium=web).
I have written often about Medicare "Advantage" companies cheating the government and the consumer.
They use false and misleading advertising to sign up patients. They then are involved in upcoding risk levels to collect extra monthly payments from the government. They deny claims illegally, knowing that few people contest denials. They deny necessary prior authorizations leading to increased severity of medical conditions and even unnecessary death. This is true for all the top Part C providers. The DOJ has criminal complaints open against most of them. All this to hold on to money as long as possible because they keep it invested.
Look the real answer is Medicare for all like HR 3421, but if we can't have that then I want you to watch these people like a hawk because they are cheating all of us.
Implement the rules.”
I said I was posting the comment about the Federal Government.
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Organizations to Contact
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Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
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Chop Wood, Carry Water by Jessica Cravens
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