Medicare limiting therapy payments

Aside from Medicare drug benefits in shambles, the Medicare therapy caps are also causing problems for senior citizens. It essentially means they cannot go to therapy clinics after a set amount of visits even if they are still suffering. The Congress-approved Medicare system will not allow them to come back to therapy clinics despite the fact that the treatment is not complete.

Read more below..

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Source: Lindy Washburn / North Jersey Media Group Inc.
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By LINDY WASHBURN
STAFF WRITER

Overshadowed by the furor over Medicare's new prescription drug plan, another change in Medicare benefits took place on Jan. 1 that could have a serious impact on stroke victims and others who need rehabilitation therapy.

A limit of $1,740 will be imposed this year on physical therapy and speech therapy services. Another $1,740 limit will be imposed on occupational therapy services, which include adaptations such as brighter lights, grab bars or stair lifts to make the activities of daily life easier.

The caps apply to care received at free-standing practices, not at hospital-affiliated centers or nursing homes. Originally imposed as part of the 1997 budget-balancing act to cut Medicare costs, the caps have been delayed three times by Congress. The most recent moratorium lapsed on Dec. 31.

"It makes a huge difference to me," said Tobi Goldstein, 72, of Little Falls, who has Parkinson's disease.

Without physical therapy, "I would probably be in a wheelchair," she said. "I thought I would have to go into some sort of facility with assistance, whereas now I can live in my own apartment."

Goldstein says there is no way she can pay for her twice-weekly sessions at Suburban Physical Therapy in Cedar Grove. "Without them, I can tell you: Very, very quickly my condition will deteriorate," she said. "It took such a long time to reach this point. It would be such a pity to plateau and go downhill."

Few patients have hit the limits yet. But active seniors - who might injure themselves twice in one year, or recover from a fall and then have joint surgery - are also concerned, said Matthew Riordan, a physical therapist at Suburban. Others, such as stroke patients, rely upon therapy to learn to walk and swallow again. The caps essentially limit them to about 12 physical therapy sessions.

Once coverage runs out, they must pay their own way, switch to a hospital-based center or do without.

"We're dealing with the most frail patients," sad Richard Stoneking, president of the American Physical Therapy Association in New Jersey. "The problem will escalate as the year goes forward. ... Then people will ask, do I forgo necessary care or do I pay out of pocket?"

About 3.7 million people, or 9 percent of Medicare beneficiaries, receive one or more types of outpatient therapy a year, according to the Government Accounting Office. The services are covered under Medicare Part B, if necessary to improve a patient's condition.

Congress has long struggled to control spending on Medicare outpatient therapy, which grew at double the rate of overall Medicare spending in the early 1990s. In 1997, it adopted caps on the payments for services.

"Every Medicare beneficiary should care about this," said Dave Mason, vice president for governmental affairs of the American Physical Therapy Association. Even a relatively healthy person might encounter a problem early in the year that eats into his cap, and then not have enough later in the year to pay for therapy services after surgery or a stroke, for example.

Rep. Frank Pallone, D-Monmouth, has introduced a measure to repeal the Medicare therapy caps. "I've always supported eliminating the caps," said Pallone, the senior Democrat on the House of Representatives health committee. "A lot of people who are impacted by them can't pay out of pocket."

So far, 241 House members - a majority - have endorsed his bill, "The Medicare Access to Rehabilitation Services Act of 2005." It also has the support of 41 senators.

"The reason caps don't make sense," Pallone said, "is that they're not based on what's medically necessary. ... It's just budget driven."

Conference committee members on this year's budget reconciliation bill took a different approach, however. They recommended that the caps remain, with exceptions granted for medical necessity by the secretary of Health and Human Services. The House is likely to take up that modification when the next session begins on Jan. 31.

Physical therapists have urged the director of the Centers for Medicare and Medicaid Services to allow exceptions to the caps while the issue is pending in Congress.

The American Occupational Therapy Association is looking "forward to working with Congress in the next year in order to provide a more permanent solution for the cap problem," said its spokesman, Rob Black.

If the caps had been in place in 2002, last year's GAO report found, about a quarter of Medicare's payments for outpatient therapy, or about $800 million, would not have been paid unless an exception had been granted.

What it means

What's new: Medicare patients are limited to $1,740 for physical and speech therapy services at free-standing centers. There is another $1,740 limit for occupational therapy.

What's next: U.S. Rep. Frank Pallone, D-Monmouth, has introduced a measure to repeal the caps. A majority of House members has endorsed the bill.

Google, in defense of its users

In a remarkable stance of protecting privacy, Google has refused a subpoena from the federal government asking for search information. Although the information requested by the Justice Department requires no personal information and only asks for search information, it could later ask for more in-depth data further.

Google's theme since its inception was: "to do no evil" -- and they have continued to follow this motto despite the U.S. government's insistence. Where Microsoft's MSN, and Yahoo! gave in, Google is fighting a lone battle in defending its users.

Yet another reason why people like Google...they defend you and me.

Tokyo stock market crashing! Other markets being affected.

Tokyo's main stock exchange crashed!

It was shutdown 20 minutes early due to capacity reasons. The stock exchange's early closure is causing widespread speculation throughout the world that tomorrow's session will be worst. The increased sell-off trading was due to an Enron-like scandal involving Livedoor, a major Internet services company in Asia (our Yahoo! in the U.S.). Livedoor was raided late Monday by government officials on allegations the company violated securities and exchange laws.

According to MarketWatch, the U.S. market could follow the downtrend in the coming days. BBC News has already reported that Tokyo's crash has already affected Europe. Specifically, London, Paris, and Frankfurt markets. Additionally, oil prices have been affected, raising the price per barrel range to $66, largely due to the negative speculation regarding the Tokyo market crash and Iran/Nigeria.

How I stopped Cuba from making money off Google

Did you know the federal government has a list of individuals, companies, and web sites that you are not allowed to transact with financially? If you didn't, you may want to review the Office of Foreign Assets Control. Their web site is found here:

http://www.treas.gov/offices/enforcement/ofac/

How Cuba Was Making Money off Google
I was surfing through the Office of Foreign Assets Control and saw that they had a number of web sites listed that should not be involved in any financial transaction with any US individual or firm.

Through the list, I found that http://www.realestatecuba.com/ was using Google's AdSense network. They were showing off Google's advertisements in return for some financial benefit. Here's how it works (roughly): Let's say Google gets 10 cents if someone clicked on an advertisement, Cuba would get 1 cent for displaying it on their www.realestatecuba.com web site.

There's no problem in making money this way, except for the fact that Google isn't allowed to financially transact with Cuba or any other sanctioned government (ie: like North Korea or Iran).

I sent off an e-mail to Google
I like Google because they are not evil (except their stock price). So I sent them a kind email telling them they might be breaking a few laws. Here's my email on January 8th:


From: "Don Sausa"
Subject: Google AdSense possibly violating federal sanctions
Date: Sun, 8 Jan 2006 04:36:57 -0500

Dear Google,

Please escalate to management or legal team for advise. On your AdSense program, you currently have http://www.realestatecuba.com/ listed. This web site is blacklisted in the Treasury Department's Office of Foreign Assets Control (OFAC) and any transaction with this web site and its owners could be in violation of U.S. trade sanctions against Cuba.

OFAC's publications regarding violation of sanctions state that:

"Economic sanctions are used by the U.S. government to prevent targeted countries, entities, and individuals from, among other things, accessing the U.S. financial system for purposes that are contrary to U.S. foreign policy and national security objectives."

...

"Depending on the program involved, criminal violations of the statutes administered by OFAC can result in penalties ranging from $50,000 to $10,000,000 and/or up to 30 years imprisonment for willful violations. OFAC also has authority to impose civil penalties of up to $1,075,000 per violation depending on the sanctions program."

I highly suggest that your web site managers compare the list of "Specially Designated Nationals (SDN) List" to make sure that you are legally compliant with U.S. trade sanctions. The most recent list of individuals can be found here:

http://www.treas.gov/offices/enforcement/ofac/sdn/sdnlist.txt

If you have any questions about US trade law or the persons listed in this list, please forward these questions over to OFAC. If you ever need help in doing compliance audits with your company, let us know.

Thanks,

Don Sausa
Team Asylum Compliance Team
http://www.team-asylum.com
"Security requires manual vigilence."


Google responds within 48 hours
What I like about Google is that when they find something that's broke, they fix things. I received a response from them on January 11th, 2006 (see email below). As of January 13th, 2006, the web site http://www.realestatecuba.com/ is no longer displaying advertisements for Google's AdSense. YEY! Castro's no longer making money off Google on this web site.


-----Original Message-----
From: Google AdSense Policy Enforcement [mailto:adsense-support@google.com]
Sent: Wednesday, January 11, 2006 8:30 PM
To: Don Sausa
Subject: Re: [#43211366] Google AdSense possibly violating federal sanctions


Hello Don,

Thank you for reporting this to us. We will investigate this matter and take necessary actions, as appropriate.

Sincerely,

The Google AdSense Team


If anyone else is bored out there, feel free to do what I did. Fight against terrorists or Communists by simply...surfing the Internet. :-)

-dohboy

Health: Smoking cigarettes affect global warming

For awhile now most scientists say that methane gas is one of the primary causes of global warming. After seeing a Truth commercial on TV about smoking and methane gas, I wanted to see the type of impact cigarette smoking has on our atmosphere.

According to FSU's science department [1], smoking worldwide releases about 2.6 billion kilograms of carbon dioxide in the air every year. It also releases about 5.2 billion kilograms of methane every year.

So there's another reason to quit smoking, not only are you helping yourself but also the environment.

[1] http://scienceu.fsu.edu/content/tobaccoyou/enviroment/docs/globalwarming.html

A New Year in the Gulf

Happy New Year to all!

I started the New Year by launching over 600 grams of gunpowder into the air (in the form of fireworks). I think Jan 1st and July 4th are the two days in the year that drastically affect the world's air quality the most. Why do we do it? Cuz it's so much fun. Check out the party photo below, this was taken during the fireworks show at my house. Notice the smoke...



After blowing up the sky with mortars and other types of fireworks, we continued the New Year celebration by going to the Gulf of Mexico. My goal was to fish for snook, salmon, or grouper. What'd I catch? Sting rays and cat fish. Yuck! However, my better half did catch snapper, sheephead, trout, etc. She caught more fish than anyone on the boat.



My resolution

I only have one resolution this year. More time for family recreation! I haven't fished in years and when I went out on the boat, it felt so relaxing that I definitely wanna do it everyday!