Kuongororwa uye Kurapa Yakaparadzaniswa neMedare uye Medicaid Vanobatsira
Mitemo yehutano hwehutano iripo kuitira kudzivirira kushandiswa kwemari kwevarwere. Kunyanya, Mutemo weStark wave uchishandiswa kurambidza kuzvidzora kunobatsira vanachiremba kuti vakuvadze avo vari kutarisira. Mutemo weStark unobatsira sei tsika yekurapa? Tsvaga kuti mitemo inorambidza sei kupiwa kwekuongorora kuongorora uye kurapwa kwekurara kwepabonde kune varwere vanobatwa nehurongwa hwehutano hwehutano hwakadai seMederal and Medicaid.
Mitemo Iripo Kudzivirira Kubiridzira
Kuti udzivise kudzvinyirirwa nekunyengera kune varwere vari mumaoko evatapi vehutano hwavo, hurumende dzehurumende nehurumende dziri muUnited States dzakatora mitemo yakananga. Imwe yekutanga-kare, inozivikanwa seFederal False Claims Act, inodzokera shure panguva yeHondo Yenyika. Mitemo yeAn anti-kickback iripo kuti inorambidza chero munhu upi zvake kubhadhara kana kugamuchira mari kana zvimwe zvinhu zvekukosha kwekutumirwa kwehutano hwehutano. Kubva muna 1989, Mutemo weStark wakadzivirirawo kuzvidzora kune vanochiremba uye mutemo uyu unogona kukanganisa kurapwa kwekurara kwepanea.
Chii Chinonzi Mutemo Wakasimba?
Mumashoko ayo akareruka, Mutemo weStark unorambidza vanachiremba kuti vataure varwere vavo kune masangano ayo vanachiremba (kana mhuri dzavo dziri pedyo) vane unhu kana zvimwe zvekubhadhara mari. Iko dzimwe nguva kunonzi mutemo weStark kuzvitora.
Izvi zvinopesana nemasangano ehutano akasarudzwa, asi chete kana izvi zvikwereti zvichibhadharwa neMurere, Medicaid, kana imwe hurongwa hwehutano hwezvehutano, hwakafanana neTricare (inoshandiswa nevashandi vehurumende).
Uyu ndiwo mutemo wezvematongerwo enyika uye nyika dzakawanda dzakanyora mitemo yakafanana iyo inokonzera kubhadharwa kwezvigadzirwa kana mabasa kuburikidza nehurumende-inobhadhara mari yehutano inshumo zvirongwa. Mune dzimwe nyika, kunyange kuzvidzora kwevamwe-vanobhadhara varwere kune masangano ane chiremba angave asingabvumirwe nemutemo kana pane hurongwa hwekubhadhara husati hwafukidzwa nechimwe chete.
Iyi mitemo yakarongedzwa kakawanda kubvira pakatanga. Muna 2008, Centers for Medicare neMedicaid Services (CMS) yakabudisa mushumo unobatanidza kugoverana kwekuongororwa kwekurara kwepnea uye kurapwa kwayo, kusanganisira kubudiswa kwechirongwa chemaitiro emhepo (CPAP) uye remidziyo .
Izvi zvinorambidza kushamwaridzana pakati pehope yekupa mupiki uye mupi wePPAP. CMS inofunga kuti kune chikonzero chekuzvifarira kune mugumisiro wekuedzwa kana pane chikonzero chekuedza kakawanda kudarika chinotarisirwa nemishonga uye kududzira chiitiko chekuedza nemafungiro anofarira kurapwa kwakadzorerwa. Sezvo zvakadaro, chero munhu kana kambani haagoni kuita mabasa maviri kune varwere vakavharwa nehurongwa hwehutano hwehutano.
Somugumisiro wekushandurwa uku, CMS yakarambidza kubhadharwa kwekubhadhara kwakakwana kuderedza izvi zvingaita zvekushungurudzwa muna 2008. Medicare haikwanisi kubhadhara mutengesi wemishonga unogara kwenguva refu (DME) wePPAP kana mupiki ane chibvumirano pamwe nemupi wehope yehope iyo kuongororwa kwepfnea yokurara yakaitwa. Kushamwaridzana uku kunoreva chero hukama pakati pemapato ane mubhadharo kana wehutano urongwa.
Nokudaro, mumwe munhu haagoni kukuedzai nekurara kwepabhesi ndokubva atengesa iwe chipera chePCAP uye ane Medicare kuribhadhara. Zvisinei, semutemo chero upi zvake, pane zvimwe zvisiri izvo.
Zvishandiso Zvakafukidzwa, Kwete Zvose Kuedzwa
Kutanga, zvinofanira kuonekwa kuti kurasikirwa kwekubhadhara kwakakosha kunoshandiswa pakuongororwa kwekurara kwepabonde kumba . Kana murwere akawana chirwere chekuongorora chirwere chepfungwa , achiitwa sechidzidzo chesiku husiku muchikwata chekuedza, kuregererwa hakushandisi, kunyange kana kuwirirana kwemari kuchipo. Kune vakawanda, chinonyanya kukosha cheStart Law ndechekugoverwa kwePCAP nemichina uye midziyo yeminzwi kuitira kurapwa kwekurara kwepanea.
Pasi pemitemo yeUnited and Drug Administration yeU.S., CPAP ndiyo inorayirwa yezvokurapa iyo inorondedzerwa sechimwe chezvinhu zvinoshandiswa zvekurapa. Aya mazita anonyanya kukosha ehurumende mutemo wekutonga uye inshuwarheni yekubhadhara zvinangwa.
Iyo midziyo yakafukidzwa nemutemo weStart Law inosanganisira:
- CPAP uye maitiro e-bilevel
- Masks
- Tubing
- Humidifiers
- Makamuri emvura
- Filters
- Mimwe midziyo midziyo
- Oxygen therapy
Vanachiremba, vanachiremba vemazino, uye vamwe vatapi vehutano vangave vasingatauri murwere kune mutengesi weDME kana iye (kana mhuri yake yepedyo) ane mari yekutsvaga kana kubhadhara-kana mupiro achikumbira kubhadharwa kwechimwe chinhu kubva purogiramu yehutano hwehurumende. Nenzira inoshanda, chiremba haagoni kupa CPAP kune murwere mukati mehofisi yezvehutano munyaya ino.
Kunzwisisa Mutemo weStark Nenyaya
Ngationgororei maitiro mashomanana ekuti Mutemo weStark ungakanganisa sei urongwa hwehutano hwekurara kwepabonde:
- Mumwe mutengesi anoziva kuti kurara kwepabhesi kwakajairika uye kuti kubhadharwa kwePPAP zvinoshandiswa kuitira kuti bhizimusi rive rakakosha. Anosarudza kugadzira kambani inotumira dzimba dzokurara dzakapinda mumba. Kana kuedza kuri kwakanaka, sekududzirwa kwebhodhi-chiremba chiremba anovhiringidzika, achatengesa kana yakatemwa CPAP kana midziyo yemuromo zvakananga kumurwere. Zvinosuruvarisa, Mutemo weStark unodzivirira kubhadharwa kune vese varwere vanotora muhurongwa hwehutano hwehutano. Ava varwere vaizofanira kusarudzwa.
- Unhu husina kunaka unoedza kuronga chirongwa chekushanda pedo neStart Law. Anoedza varwere, asi anoudza avo vane Medicare kuti CPAP yavo haizofukidzwi ne inshuwarisi yavo. Anoda kuti vabhadhara mari yacho kubva muhomwe, kunyange zvazvo vaizove vaine ruzivo kana vaenda pane imwe DME yekutengesa yakazvimirira. Varwere vanobata apo pavanoenda kune mumwe muperekedzi, uye vanopa zvikwangwani zvinotungamirira kumatongerwe enyika.
Kusiyanisa kune Mutemo weStark uye Mhosva
Zvakakosha kuziva kuti Stark Mutemo haishandisi kune inshuwarisi yose, kunyanya kune vashandi vekubhadhara vari voga kana kuti kuzvipira.
Imwewo inogona kunge iri kunze kwevatsigiri vekumaruwa sezvo hurongwa husingavepo huripo husina humwe huripo. Panzvimbo pokuranga varwere nokuda kwekushayiwa kwekuwana, vanachiremba vanogona kugovera CPAP kuvarwere vavo mukati mehofisi imwechete.
Pane zvakasiyana-siyana zvezvikwereti zvinowanikwa apo vateresi vanotyora Mutemo weStark. Mari iyo inogona kubviswa uye kudzorerwa kunogona kurayirwa mumutengo unounganidzwa mukuputsa mutemo. Mukuwedzera, zvirango zvehurumende zvinosvika $ 15,000 pamutemo wega wega webasa rinorambidzwa rinogona kuongororwa. Kana chiremba achiedza kudzingisa mutemo nehurongwa hwekuvhiringidza, chirango chemari chemunharaunda chinokwira ku $ 100 000 pane imwe sangano iri.
Shoko Rinobva
Mitemo iyi iripo kuti inodzivirira varwere kubva pamhando dzisina kunaka dzinogona kutora mari yevanhu vanotambura. Vakawanda vanopa zvinhu havakwanisi kuita buck nokukurumidza uye kuzvibata nenzira dzakanaka kuti vashumire varwere vavo. Zvinosuruvarisa, mitemo iyi yepamutemo inogona kudikanwa kuranga avo vasingaisa varwere vavo pakutanga. Panogona kuve nekumwe kuchinja mumutemo, asi kana iwe uchinzwa sokuti wakashandiswa zvakanaka, svika kuHofisi yeMupepeti Mukuru paDhipatimendi reMweya reUnited States neHuman Services nekudana (800) 447-8477.
> Sources:
> American Academy of Sleep Medicine. "Senate Financial Committee inofunga nezvekushandurwa kweStart Law." July 14, 2016.
> Brown, DB. "Kurara Mishonga Mishonga yeMitemo uye Kuteerera-United States" muMitemo uye Dzidziso dzeTeut Medicine , yakagadziriswa naKryger, MH et al . Elsevier , 6th edition, 2017, mapeji 670-674.
> " Centers for Medicare neMedicaid Services." Medicare unyengeri nekudzivirira kushungurudzwa, kuona, nekubika . " August 2014.
> "Office of Inspector General. Migwagwa yevashandi vatsva: mitemo yekunyengera uye kushandiswa kwechisimba." September 2017.
> Staman J. "Mitemo yehutano hwekushaya rusununguko uye kushungurudza mitemo inobata Medicare neMedicaid: inongorororwa ." (Congressional) Nhauriro Nha. RS22743). Washington DC: Library of Congressional Research Service, September 8, 2014.