NAELA Public Policy Priority 2013-2014: Reforming Observation Status

Pre-Existing Conditions and Sale of Medigap Policies
NAELA Public Policy Guidelines

The Medicare program is an important source of health care coverage for seniors and people with disabilities. It must be comprehensive in its scope of coverage and services, affordable for individuals and for the public fiscal arena, flexible in the array of covered options and designed to maximize the good health and quality of life of all its beneficiaries.

A. NAELA advocates for the Medicare program to continue to offer coverage for a set of comprehensive services that includes, at a minimum, preventive, acute care, rehabilitation, skilled nursing facility, home health care and hospice services. NAELA supports the addition of long-term and chronic care services to the comprehensive service package.

B. NAELA encourages supporting staffing and funding of the administrative component of the Medicare program to be adequate, diverse, and responsive to program and beneficiary needs, including monitoring and enforcement of program standards and quality of care.

C. NAELA advocates that the Medicare program improve and streamline processes to ensure the flexibility to add new services and options as technology expands and needs arise.

D. NAELA advocates that proposals for privatization in all its forms be studied in light of avoiding fragmentation and assuring the broad public policy objectives of social insurance as recognized in our current Social Security System.

E. NAELA encourages that financing for the Medicare program be reasonable and adequate and reflective of the cost of providing coverage for a comprehensive scope of services, including the impact of any beneficiary cost-sharing. Financing mechanisms should not favor managed care delivery mechanisms over the traditional Medicare program.

F. NAELA advocates that Medicare beneficiaries and their legal representatives be provided notice and an opportunity to appeal the denial, reduction, or termination of services and benefits in any health care delivery setting, including prescription drug benefits, pre-termination review, and expedited review of requests for urgently needed services.

G. NAELA advocates that the Medicare program provide guidance to its program contractors, service providers, and program administrators about establishing a process for beneficiary complaints about such matters as location of services, provider-beneficiary relations, and courtesy of service. NAELA suggests that procedures include the resolution of complaints about quality of care.

H. NAELA supports the availability of benefit counselors through the Aging and State Health Insurance Assistance Program (SHIP) networks and standardized, clear, and accurate descriptions of the Medicare program, reasonable and fair information about how to make choices among options, including comparative marketing and performance information.

I. NAELA supports the establishment of a program of advocacy assistance for assuring patients’ rights and services, comprised of at least two components: (a) government funded advocates (including lawyers) for low-income persons and (b) unrestricted access to private attorneys for those who can afford them.

J. NAELA opposes the concept of allowing Medicare providers to opt out through private contracting while remaining in the Medicare program.

K. NAELA opposes the concept of measuring Medicare solvency by the percentage of Medicare funding that comes from general revenues, when Medicare Parts B and D were designed to be funded by a combination of general revenues and beneficiary premiums.

L. NAELA opposes further efforts to means test Medicare benefits.

Resolutions adopted by the NAELA Board of Directors May 6, 1998
Revised November 19, 1998, November 11, 2004 and June 29, 2007
Posted March 2013