209 MIDTERM

209 MIDTERM

entitlementbn-bnanswers--
legislationbnthatbnguaranteesbnrightsbntobnbenefitsbntobnspecificbngroupsbnofbnindividuals



medicarebn-bnanswers--
federalbninsurancebnprogrambnforbnindividualsbnoverbn65bnorbnwithbnspecificbnconditions



medicaidbn-bnanswers--federal-
statebnpartnershipbnmeantbntobnprovidebnhealthbninsurancebntobnsomebngroupsbnofbnindividualsbnwhobn
cannotbnaffordbninsurancebn(generallybnpoor/limitedbnresources)

statesbnelectbnwhetherbnorbnnotbntobnparticipate



habilitativebnservicesbn-bnanswers--
healthbncarebnservicesbnthatbnhelpbnabnpersonbnkeep,bnlearn,bnorbnimprovebnskillsbnandbnfunctioningbnf
orbndailybnlivingbnthatbntheybndidbnnotbnpreviouslybnhavebn

OTbnservicesbnmaybnbebnrecommendedbntobnachievebnthesebngoals



rehabilitativebnservicesbn-bnanswers--
servicesbnthatbnhelpbnabnpersonbnkeep,bnregain,bnorbnimprovebnskillsbnandbnfunctioningbnforbndailybnlivi
ngbnthatbnmaybnhavebnbeenbnlostbnorbnimpaired



purposebnofbnhabilitativebnandbnrehabilitativebnservicesbn-bnanswers---
patientbncenteredbnoutcomesbnresearchbninstitute-comparesbneffectivenessbnofbnmedicalbntx

-communitybnlivingbnassistancebnservicesbnandbnsupports-
helpsbnpeoplebnaffordbnlongbntermbncare.bnprovidesbncashbnbenefitbntobnthosebnwithbnfunctionalbnlimita
tionsbnsobntheybncanbnpurchasebnnonbnmedicalbnservicesbnandbnsupportsbntobnstaybninbntheirbncommun
itybnresidence

,telehealthbn-bnanswers--
electronicbninfobnandbntelecommunicationbntobnsupportbnlongbndistancebnhealthbncarebnandbnadminbn

providesbnservicesbnthroughbntelephonebnorbnwebbnbasedbnintervention.bnreferredbntobnasbnabnserviceb
nmeansbnforbnwellnessbnandbnpreventionbnprogramsbnandbnforbncoordinatedbncarebnforbnmedicare,bnme
dicaid,bnandbnaccountablebncarebnorganization



whatbnisbnmeantbnbybnentitlementbnlegislationbn-bnanswers--
lawsbnwerebnpassedbnthatbnguaranteebnrightsbntobnbenefitsbntobnspecificbngroupsbnofbnindividualsbn

examples:bnsocialbnsecurity,bnmedicare,bnmedicaid,bnchildrensbnhealthbninsurancebnprogrambn(CHIP)



whybnwasbnthebnsocialbnsecuritybnactbnimportantbn-bnanswers--
laidbnthebnfoundationbnforbnfuturebnlawbnandbnreformsbninbnthebnareasbnofbnhealthbncare,bneducation,bn
community,bnandbnsocialbnsystems



ironbntrianglebninbnregardbntobnsocialbnsecuritybn-bnanswers--
thebncost,bnaccess,bnandbnqualitybnofbnhealthbncarebnreforms.bnThesebnitemsbnarebninterbndependentbna
ndbninbncompetitionbnwithbneachbnother

improvingbnonebnorbntwobncausesbnabnnegativebnimpactbnonbnthebnthird



purposebnofbnmedicarebn-bnanswers--
initialbnlawbnwasbncreatedbnasbnanbninsurancebnprogrambnforbnindividualsbnoverbn65bnandbnincludedbno
nlybnpartbnAbntobncoverbnhospitalbnservicesbnandbnpartbnBbntobncoverbnoutpatientbnservicesbnincludingbn
OT



howbndidbnreformsbntobnmedicarebnaffectbnaccessbntobnOTbnservicesbn-bnanswers--
providedbnmorebnpeoplebnwithbnaccessbnwhichbnencouragebnthebngrowthbnofbnOT



howbndidbnreformsbntobnmedicarebnaffectbnpeoplebnwithbndisabilitiesbn<65bn-bnanswers--
extendedbnhealthbninsurancebncoveragebnforbnthem



howbndidbnreformsbntobnmedicarebnaffectbnpeoplebnwithbnendbnstagebnrenalbndiseasebn-bnanswers--
extendedbnhealthbninsurancebncoveragebnforbnthisbngroup

, impactbnofbnthebnbudgetbnreconciliationbnactbnonbnOTbn-bnanswers--
eliminatedbnOTbnasbnabnqualifyingbnservicebnwithbnhomebnhealthbn

meansbnthatbnnursing,bnspeechbntherapy,bnandbnPTbnhadbntobnqualifybnabnclientbnforbnskilledbncare



whobnisbncoveredbnbybnmedicarebn-bnanswers---
peoplebn65+,bnmustbnhavebnpaidbnmedicarebntaxesbnforbnpastbn10yrs

-
thosebnyoungerbnthanbn65bnwithbnpermanentbndisabilitybnandbnreceivebnsocialbnsecuritybndisabilitybninc
ome(SSDI)bnforbnpastbn2bnyearsbn

-youngerbnthanbn65bnwhobnreceivebnSSDIbnforbnALSbn

-youngerbnthanbn65bnwhobnneedbndialysis/kidneybntransplant



whatbndobnthebnvariousbnpartsbnofbnmedicarebncoverbn-bnanswers---
PARTbnA=inpatientbnservices,bninbnhospitals,bnskilledbnnursingbnfacilities,bnhomebnhealthbnvisits,bnhospic
ebn

-
PARTbnB=coversbnoutpatientbnservices,bnphysicianbnvisitsbnandbnotherbnhealthcarebnproviders,bnprevent
ativebnservices(flubnshot),bnhomebnhealthbnvisits,bnandbndurablebnmedicalbnequipment(bathbnbench)bn

-PARTbnC=medicarebnadvantage=actsbnlikebnanbnHMO-
beneficiariesbnpurchasebninsurancebnfrombnprivatebncompanybnwhichbncontractsbnwithbnmedicarebntobn
providebnallbnpartbnAbnandbnBbnbenefitsbnandbnmaybnprovidebnadditionalbnbenefitsbn

-PARTbnD=providesbnoutpatientbnprescriptionbndrugbncoveragebn

PARTbnCbnANDbnDbnAREbnVOLUNTARY



whybnisbnmedicarebnsobnimportantbninbnthebnUSbn-bnanswers--
largestbnpayerbnofbnhealthbncarebnservicesbnandbnitsbnpoliciesbninfluencebnhowbnhealthbncarebnisbnprovi
ded.bnotherbnprivatebninsurancebnusuallybnfollowbnthebnpoliciesbnputbnintobnplacebnbybnmedicare



populationsbncoveredbnunderbnmedicaidbn-bnanswers---
groupsbnwhosebnincomebnisbn20%bnlessbnthanbnthebnfederalbnpovertybnlevelbn

-children,bnparentsbnwithbndependentbnchildrenbn

-pregnantbnwomen

-peoplebnwithbnseverebndisabilitiesbn