My opinion about Bush is no secret.

  1. And my opinion towards Bush and his political regime just has lowered even more.

    On many levels, I don't like this administration's policies. . . .

    I'm posting this here for many reasons. One is to show evidence why the motives of and decisions of this administration need to be closely scrutinized. Also, while we debate decisions made about the "if's and how's" with a potential war with Iraq . . . we should also be debating issues being brought forth by this administration that more imminently effect our daily lives! ! !

    This article was found in the 3/15/2003 New York Times:
    _________________________________

    Bush Pushes Plan to Curb Appeals in Medicare Cases
    By ROBERT PEAR

    WASHINGTON, March 15-The Bush administration says it is planning major changes in the Medicare program that would make it more difficult for beneficiaries to appeal the denial of benefits like home health care and skilled nursing home care.

    In thousands of recent cases, federal judges have ruled that frail elderly people with severe illnesses were improperly denied coverage for such services.

    In the last year, Medicare beneficiaries and the providers who treated them won more than half the cases-39,796 of the 77,388 Medicare cases decided by administrative law judges. In the last five years, claimants prevailed in 186,300 cases, for a success rate of 53 percent.

    Under federal law, the judges are independent, impartial adjudicators who hold hearings and make decisions based on the facts. They must follow the Medicare law and rules, but are insulated from political pressures and sudden shifts in policy made by presidential appointees.

    President Bush is proposing both legislation and rules that would limit the judges' independence and could replace them in many cases.

    The administration's draft legislation says, "The secretary of health and human services may use alternate mechanisms in lieu of administrative law judge review" to resolve disputes over Medicare coverage.

    Under the legislative proposal, cases could be decided by arbitration or mediation or by lawyers or hearing officers at the Department of Health and Human Services. The department recently began testing the use of arbitration in Connecticut under a law that permits demonstration projects.

    Tommy G. Thompson, the secretary of health and human services, said the proposed legislative changes would give his agency "flexibility to reform the appeals system" so the government could decide cases in a more "efficient and effective manner."

    The department said there was an "urgent need for improvements to the Medicare claim appeal system," in part because the number of appeals was rising rapidly.

    Consumer groups, administrative law judges and lawyers denounced the proposals. Judith A. Stein, director of the Center for Medicare Advocacy in Willimantic, Conn., said, "The president's proposals would compromise the independence of administrative law judges, who have protected beneficiaries in case after case, year after year."

    Beneficiaries have a personal stake in the issue. When claims are denied, a beneficiary is often required to pay tens of thousands of dollars for services already received. In a typical case, an administrative law judge ordered Medicare to pay for 230 home care visits to a 67-year-old woman with breast cancer, heart disease and arthritis. Medicare officials had said the woman should pay the cost. But the judge ordered Medicare to pay because the woman was homebound and the services were "reasonable and necessary."

    When federal agencies issue rules or decide cases, they generally must follow the Administrative Procedure Act, a 1946 law intended to guarantee the fairness of government proceedings.

    Ronald G. Bernoski, president of the Association of Administrative Law Judges, said: "We see President Bush's proposals as a serious assault on the Administrative Procedure Act, a stealth attack on the rights of citizens to fair, impartial hearings. These hearings guarantee due process of law, as required by the Constitution."

    The American Bar Association and the Federal Bar Association, which represents lawyers who practice in federal courts and before federal agencies, have expressed similar concerns.

    Health care providers, which are involved in many of the appeals, share those concerns.

    Robert L. Roth, a Washington lawyer who has represented hospitals and suppliers of medical equipment, said: "The interests of providers and beneficiaries are aligned. Access to an independent decision maker, an administrative law judge, is quite valuable because it's often your first opportunity to get a fair review of government action."

    Medicare officials could adopt the proposed rules, regardless of whether Congress accepts Mr. Bush's recommendation for changes in the law.

    The proposed rules would require administrative law judges to "give deference" to policies adopted by Medicare and its contractors, which review and pay claims for the government. Beneficiaries would have to show why such policies should be disregarded.

    That would be a significant change. Administrative law judges are now required to follow Medicare statutes and regulations, but not the agency's policies. As a result, the judges often grant benefits previously denied by the Medicare agency or its contractors.

    In the Connecticut experiment, arbitration will be used to resolve some claims disputes, and beneficiaries may opt out. If this approach produces prompt, fair decisions with less paperwork, it could be a model for Congress in changing the appeals process.

    But Matthew L. Spitzer, dean of the University of Southern California Law School, said that consumers "should think long and hard before they agree to binding arbitration." It is, he said, extremely difficult for an individual to overturn an arbitrator's decision.

    Ms. Stein, who has represented Medicare patients in hundreds of cases, agreed. "The president proposes replacing administrative law judges with some form of dispute resolution," Ms. Stein said. "This puts beneficiaries at a disadvantage, with unequal bargaining power and inadequate expertise to do battle with the Medicare agency."

    The judges are full-time government employees who typically receive salaries of $95,000 to $140,000 a year.

    To ensure that federal agency hearings would be fair, Congress in 1946 protected the decision makers, providing that they could be dismissed or demoted "only for good cause." The judges who hear Medicare cases have extra protection because they are employed by the Social Security Administration, an independent agency.

    Congress revamped the appeals process in 2000, to enhance the rights of beneficiaries and to expedite decisions. The changes were supposed to take effect in October 2002. But Medicare officials said that without more money, they could not meet the new deadlines, so they have postponed many of the changes.

    Medicare officials said they wanted to end the arrangement under which Social Security judges decide Medicare cases. They have announced plans to transfer responsibility for hearing appeals to the Medicare agency from Social Security, and they hope to do so by Oct. 1.

    A bipartisan bill introduced by Representative Nancy L. Johnson, Republican of Connecticut, would make the transfer in 2005. The bill requires the secretary of health and human services to preserve the judges' role as independent decision makers.

    The potential for conflict seems to be inherent in the relationship between agency officials and administrative law judges, with tensions flaring periodically. In 1983, the Association of Administrative Law Judges filed a lawsuit, saying that Social Security officials appointed by President Ronald Reagan had put improper pressure on them to deny benefits to people with disabilities.

    A Federal District Court found that Social Security had engaged in practices "of dubious legality," which tended to encroach on the judges' independence. The agency halted the practices after the lawsuit was filed.
    Last edit by Ted on Mar 15, '03
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  2. 107 Comments

  3. by   Furball
    Oh boy Ted.....!

    Interesting article......does Bush really know what his administration is doing to everyday people? Sometimes I wonder........
  4. by   Ted
    Originally posted by Furball
    Oh boy Ted.....!

    Interesting article......does Bush really know what his administration is doing to everyday people? Sometimes I wonder........
    That a good question. I don't know. . .
  5. by   Furball
    The folks today who "benefit" from medicare are the "greatest generation".....how sad.....
  6. by   Hellllllo Nurse
    Many of us feel the same way- we are discouraged, disheartened and fearful of the current administration's motives and what is happening in and to our country.

    Please, everyone, let's make ourselves heard in the next election.

    I'm sure most of us probably voted. I know I did.

    But, I've met several nurses who have told me that they never vote. Some of these same nurses are now very upset about some of the things the current adm is doing.

    Next election, I hope we will ALL vote.
  7. by   hoolahan
    Wow Ted, you know my opinion on Bush is no secret either. What is wrong with this guy, oh wait, if you answered that question here, you would use up all of Brian's bandwidth!!

    Thank you for posting this, esp since I am a home health nurse, and I wasn't even aware that all of these kinds of denials and appeals were going on, let alone who is making the decisions.

    Frankly, I am baffled as to why Medicare would deny the benefit to the consumer, I always thought it was the agency who took the hit if the admission was "inappropriate" and therfore had to eat that loss. I guess a lot of these agencies turn around and pass the loss on to the consumer. My agency doesn't do that, if we did, we'd get a bad rap fast with the high population of seniors we serve, as we are amongst al least 12 senior buildings in this county alone.

    I am praying every single night on my knees that in the next election we get him out.
  8. by   hoolahan
    Ted, I am going to copy this article into the HH forum too, OK?
  9. by   sbic56
    It will be interesting to see who comes ahead as the Democratic candidate. I haven't decided who I think would be right, yet. I do see whoever it is keeping gwb to one term. At least I have a positive feeling about that much.
  10. by   passing thru
    Let's hope so. I'd like to see brain damaged by alcohol outa there.
    Ever see a sotty brain when you were in nursing school? We went thru the teaching hospitals' pathology lab. What impressed me is the damage done by < one year of alcohol abuse...How long --how many years was he an alcoholic? Personally, if I had to choose, ex-druggie/alcoholic or skirt chaser, I know which one I'd choose.

    The alcohol shrinks the meninges and destroys the grey matter, the brain is visably damaged and shrinking in one year of "besottedness."
  11. by   Q.
    Originally posted by passing thru
    Let's hope so. I'd like to see brain damaged by alcohol outa there.
    Ever see a sotty brain when you were in nursing school? We went thru the teaching hospitals' pathology lab. What impressed me is the damage done by < one year of alcohol abuse...How long --how many years was he an alcoholic? Personally, if I had to choose, ex-druggie/alcoholic or skirt chaser, I know which one I'd choose.

    The alcohol shrinks the meninges and destroys the grey matter, the brain is visably damaged and shrinking in one year of "besottedness."
    Considering that Bush is by no means an alcoholic, and my father is and certainly not the fargin' President of the United States, I take offense to your comments. So, like um, knock it off. It does nothing for your credibility and waters down your argument.

    Secondly, let's not forget Clinton's marijuana history. If you're going to speak in hyperbole, for God's sake at least be accurate in your history.
    Last edit by Susy K on Mar 15, '03
  12. by   Gomer
    Sorry, Suzy K, but GWB is an admitted alcoholic. He hasn't touched a drop in some years...but he still calls himself one.

    Oh, and remember Billy never inhaled.
  13. by   J.Cro
    Passing thru- I understand Winston Churchill had a HUGE drinking problem, yet he was considered one of the greatest statesman in history. Explain that.
  14. by   mark_LD_RN
    won't even bother wasting my time with the ignorance of this thread

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