![]() that assess adequacy of resident assessments and the accuracy of information reported to CMS that is used in calculating quality measures used in the rating system. Expand Targeted Surveys: a plan for State Survey Agencies to conduct specialized, onsite surveys of a sample of nursing homes across the U.S.Nursing homes must earn 4-stars on either the individual Registered Nurse (RN) only or the staffing categories to receive 4-stars on the Overall staffing rating and can have no less than a 3-star rating on any of those dimensions. Adjust Staffing Algorithms: to more accurately reflect staffing levels.Raise Performance Expectations: by raising the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category on the website.One measure is for short-stay residents when a nursing home begins use of antipsychotics for people without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome, and a second measure reflects continued use of such medications for long-stay nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome. A dd 2 Quality Measures (QMs): for antipsychotic medication use in nursing homes to the 5- Star calculations.On Friday, February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) will unveil Nursing Home Compare (NHC) 3.0, an expanded and strengthened NHC 5-Star Quality Rating System for Nursing Homes on the CMS Nursing Home Compare website ( /nursinghomecompare). Please call us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.Īlthough you don’t have to choose a primary care physician, we encourage you to do so.Nursing Home Compare 3.0: Revisions to the Nursing Home Compare 5-Star Quality Rating System For a decision about whether we’ll cover an out‐of-network service, we encourage you or your provider to ask us for a pre‐service organization determination before you receive the service. Out‐of‐network/non‐contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. You have the flexibility to receive covered services from network providers or out‐of‐network providers. If you’re enrolled in Aetna Medicare Plan (PPO) If you get routine care from out‐of‐network providers, Medicare and Aetna Medicare won’t be responsible for the costs. You must use network providers, except for: There are exceptions for certain direct access services. You’ll need to get a referral from your PCP for covered, non‐emergency specialty or hospital care, except in an emergency and for certain direct‐access service. For some services, your PCP is required to obtain prior authorization from Aetna Medicare. Your PCP will issue referrals to participating specialists and facilities for certain services. ![]() Generally, you must get your health care coverage from your primary care physician (PCP). Medicare and Aetna Medicare won’t be responsible either. If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. If you’re enrolled in a standard Aetna Medicare Plan (HMO) *Some items may require prior authorization from your medical benefit. Insulin needles, pens and syringes (when used for injecting insulin).Individual Medicare Prescription Drug (PDP) and MAPD plans cover diabetic supplies under Part D, including: For more info about your no-cost OneTouch BGM for Aetna ® Medicare plan members, you can visit us online or call 1-87 $ without a prescription.To avoid rejections on Part B-covered supplies like test strips, ensure they are OneTouch brand.Blood Glucose Meters (BGM) and testing supplies - exclusively OneTouch ® by LifeScan.FreeStyle Libre, Dexcom and Medtronic iPro ®ĭownload the DME National Provider Listing (PDF) to view potential suppliers.Continuous Glucose Monitors (CGM) and supplies, including:.Therapeutic shoes* and inserts* for diabetics. ![]()
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