PURPOSES, FOR THE MEDICALLY NEEDY. MANDATORY SERVICES WHICH WOULD MOST LIKELY BE UTILIZED BY AIDS PATIENTS ARE INPATIENT HOSPITAL SERVICES, OUTPATIENT HOSPITAL SERVICES, RURAL HEALTH CLINIC SERVICES, OTHER LABORATORY AND RADIOLOGY SERVICES, SKILLED NURSING FACILITY (SNF) SERVICES, AND
HOME HEALTH CARE FOR INDIVIDUALS AGED 21 AND OVER.
STATES MAY ALSO CHOOSE TO COVER ADDITIONAL SERVICES AS SPECIFIED IN FEDERAL REGULATIONS. SOME EXAMPLES OF OPTIONAL SERVICES OFFERED INCLUDE CLINIC SERVICES, PRESCRIBED DRUGS, INTERMEDIATE CARE FACILITY SERVICES, MISCELLANEOUS DIAGNOSTIC SERVICES, SKILLED NURSING FACILITY AND HOME HEALTH SERVICES FOR INDIVIDUALS UNDER 21 YEARS OF AGE, AND OTHER ANCILLARY SERVICES SUCH AS PERSONAL CARE SERVICES, PRIVATE DUTY NURSING, PRIVATE PRACTITIONERS' SERVICES, AND REHABILITATION SERVICES. NEARLY HALF THE STATES OFFER 20 OR MORE ADDITIONAL SERVICES. CALIFORNIA AND NEW YORK, WHICH HAVE RECORDED ALMOST 60 PERCENT OF ALL AIDS CASES IN THE UNITED STATES, OFFER 30 AND 28 OPTIONAL SERVICES, RESPECTIVELY, TO THEIR MEDICAID POPULATIONS. THROUGH HOME AND COMMUNITY-BASED WAIVERS, STATES CAN ALSO COVER A WIDE ARRAY OF NONINSTITUTIONAL LONG TERM CARE SERVICES THAT ARE NOT OTHERWISE OFFERED. UNDER CURRENT MEDICAID LAW, STATES ARE NOT PERMITTED TO OFFER HOSPICE SERVICES. HOWEVER, WITH THE WIDE RANGE OF OPTIONAL SERVICES OFFERED BY STATES, MANY HOSPICE-RELATED SERVICES MAY BE MADE AVAILABLE TO AIDS PATIENTS.
MEDICARE IS A FEDERAL HEALTH INSURANCE PROGRAM FOR MOST AGED AND CERTAIN DISABLED INDIVIDUALS WHO QUALIFY FOR SOCIAL SECURITY CASH BENEFITS. AN INDIVIDUAL WITH AIDS CAN BE ELIGIBLE FOR THE MEDICARE PROGRAM IF HE IS:
O AGE 65 OR OVER AND ELIGIBLE FOR SOCIAL SECURITY PAYMENTS OR ENROLLED ON A PREMIUM-PAY BASIS
UNDER PARTS A OR B OF MEDICARE;
O UNDER 65 AND ELIGIBLE FOR THE SOCIAL SECURITY DISABILITY INSURANCE (DI) PROGRAM; OR
AFFLICTED WITH END STAGE RENAL DISEASE.
THE STANDARDS FOR DETERMINATION OF DISABLILITY UNDER THE DI PROGRAM ARE IDENTICAL TO THOSE UNDER SSI. BECAUSE THE PROGRAM IS TARGETED TO THE LONG-TERM DISABLED POPULATION, NEWLY ENTITLED DI BENEFICIARIES DO NOT RECEIVE MEDICARE UNTIL THEY ARE ON THE ROLES FOR TWO YEARS.
AIDS PATIENTS WHO ARE ENTITLED TO MEDICARE ARE ELIGIBLE
FOR THE SAME RANGE OF SERVICES AND BENEFITS THAT ARE AVAILABLE TO OTHER SEGMENTS OF THE MEDICARE POPULATION. BENEFITS THAT WOULD TYPICALLY BE UTILIZED BY AN AIDS PATIENT INCLUDE, UNDER THE MEDICARE PART A HOSPITAL INSURANCE PROGRAM, INPATIENT HOSPITAL CARE, MEDICALLY NECESSARY INPATIENT CARE IN A
SNF AFTER A HOSPITAL STAY, HOSPICE CARE, AND HOME HEALTH
CARE. PART B OF MEDICARE WOULD HELP PAY FOR DOCTORS' SERVICES, OUTPATIENT HOSPITAL CARE, OUTPATIENT PHYSICAL THERAPY AND SPEECH PATHOLOGY SERVICES, HOME HEALTH CARE, RADIOLOGY AND LABORATORY SERVICES, AND A VARIETY OF OTHER HEALTH SERVICES AND SUPPLIES WHICH ARE NOT COVERED BY THE PART A PROGRAM.
DEPARTMENTAL INFORMATION INTIATIVES
HCFA HAS BEEN INVOLVED IN SEVERAL DEPARTMENT INITIATIVES TO AID THE PLIGHT OF AIDS VICTIMS. IN COOPERATION WITH THE SSA, WE HAVE BEGUN A PUBLIC INFORMATION CAMPAIGN THROUGH THE PUBLIC HEALTH SERVICE (PHS) TO ENSURE THAT PEOPLE WITH AIDS ARE AWARE OF THE POTENTIAL BENEFITS AVAILABLE TO THEM UNDER THE MEDICAID AND MEDICARE PROGRAMS. IN ADDITION, WE HAVE ENCOURAGED STATE MEDICAID DIRECTORS TO PROVIDE MAXIMUM INFORMATION ABOUT MEDICAID BENEFITS AND SERVICES TO THE CLIENTS OF THEIR RESPECTIVE AGENCIES. THERE IS ALSO A TOLL-FREE NATIONAL AIDS HOTLINE OPERATED BY THE PHS THAT REFERS AIDS VICTIMS, AS APPROPRIATE, TO HEALTH DEPARTMENTS AND OTHER SUPPORT SERVICES WHICH IN TURN MAY REFER THEM TO SSA OFFICES FOR SSI, DI, MEDICAID, AND MEDICARE INFORMATION; TO STATE AND LOCAL WELFARE OFFICES AND TO
HOSPITAL SOCIAL WORKERS; AND OTHER PRIVATE ORGANIZATIONS.
INFORMATION ON THE NUMBER OF AIDS PATIENTS WHO ARE RECEIVING CARE UNDER THE MEDICAID AND MEDICARE PROGRAMS, AND THE AMOUNT OF FEDERAL AND STATE EXPENDITURES FOR THAT CARE,
IS NOT AVAILABLE AT THIS TIME.
UNDER OUR CURRENT STATISTICAL GATHERING CAPABILITIES FOR MEDICAID AND MEDICARE, INFORMATION
ON RECIPIENTS IS REPORTED BY BROAD ELIGIBILITY GROUPS. MECHANIZED BILLING RECORDS FOR PAYMENT OF MEDICAID AND MEDICARE BENEFICIARIES' MEDICAL CLAIMS ARE NOT CODED BY DIAGNOSIS AND THUS PROVIDE NO CLUES TO THE NUMBER OF AIDS VICTIMS RECEIVING BENEFITS.
IN OUR EFFORTS TO GATHER INFORMATION ON AIDS PATIENTS, HCFA HAS SIGNED AN INTERAGENCY AGREEMENT WITH THE PHS TO DEVELOP STATISTICS ON CARE BEING PROVIDED TO AIDS PATIENTS UNDER MEDICAID. SINCE THE AWARDING OF THE GRANT FROM THE CENTER FOR DISEASE CONTROL (CDC) ON SEPTEMBER 30, WE HAVE BEEN LOOKING AT OUR CAPABILITIES FOR GATHERING SUFFICIENT INFORMATION ON AIDS PATIENTS TO DO A RELIABLE ANALYSIS. HCFA WILL BE UTILIZING AN ONGOING RESEARCH EFFORT, KNOWN AS THE MEDICAID TAPE-TO-TAPE PROJECT, WHICH HAS DEVELOPED THE CAPABILITY TO ANALYZE PERSON-LEVEL DATA ON PROGRAM ENROLLEES, SERVICES, EXPENDITURES, AND PROVIDERS IN FIVE STATES (INCLUDING CALIFORNIA AND NEW YORK). AS MEDICAID DATA FROM 1983 AND 1984 IS SUBMITTED BY THE STATES LATER THIS YEAR, WE WILL HAVE MORE CURRENT INFORMATION ON AIDS TO STUDY. IN ADDITION, A NUMBER OF STATES HAVE INDICATED THAT THEY HAVE BEGUN TO ASSEMBLE STATISTICS ON SOURCES OF PAYMENT FOR AIDS VICTIMS AND WE WILL CONTINUE TO MONITOR AND COLLECT ANY SUCH DATA FOR OUR RESEARCH EFFORTS.
THE ADDITION OF AIDS TO THE PRESUMPTIVE DISABILITY LISTING UNDER THE SSI AND DI PROGRAMS EARLIER THIS YEAR HAS HELPED EXPEDITE THE ELIGIBILITY PROCESS SO THAT PERSONS WITH THE DISEASE CAN RECEIVE NEEDED HEALTH CARE BENEFITS. SYSTEMS IN PLACE WITHIN THE DEPARTMENT HAVE BEEN MAKING SIGNIFICANT CONTRIBUTIONS IN DIRECTING AIDS SUFFERERS TO PUBLIC AND PRIVATE SOURCES OF HELP AND IN DISSEMINATING COMPREHENSIVE PUBLIC INFORMATION.
WE SUPPORT THE CONTINUED PROVISION OF HEALTH CARE SERVICES UNDER MEDICAID AND MEDICARE WITHIN CURRENT PROGRAM REQUIREMENTS. WE BELIEVE THAT MAJOR ELIGIBILITY CHANGES TO MEDICAID AND MEDICARE LAW TO ALLOW SPECIAL TREATMENT OF AIDS SUFFERERS ARE NOT NEEDED. UNDER CURRENT MEDICAID LAW, STATES HAVE SUFFICIENT FLEXIBILITY TO PROVIDE NECESSARY SERVICES TO CERTAIN AIDS SUFFERERS WHO HAVE NO OTHER SOURCES OF PAYMENT. WE ARE OPPOSED TO ANY ATTEMPTS TO ALTER MEDICARE ELIGIBILITY REQUIREMENTS TO INCLUDE SPECIFIC DISEASE DIAGNOSIS AS A BASIS FOR COVERAGE: THE MEDICARE PROGRAM WAS DESIGNED TO
PROVIDE ACUTE HEALTH CARE SERVICES TO BROAD GROUPS OF ELDERLY AND DISABLED INDIVIDUALS AND WE CONTINUE TO SUPPORT THIS
AIDS IS A MENACING PUBLIC HEALTH PROBLEM THAT THE FEDERAL GOVERNMENT WILL CONTINUE TO FIGHT UNTIL THE MYSTERY OF THE DISEASE IS UNRAVELED. BY THE END OF FISCAL YEAR 1986, APPROXIMATELY $400 MILLION IN FEDERAL FUNDS WILL HAVE BEEN EXPENDED FOR RESEARCH TO ELIMINATE AIDS. OUR COMMITMENT TO BATTLE AIDS IS WELL ESTABLISHED AND WE INTEND TO CONTINUE UNTIL AIDS IS ELIMINATED AND THE SUFFERING HAS ENDED.
I WILL BE HAPPY TO ANSWER ANY QUESTIONS YOU MAY HAVE.
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