History
Medicaid initially only covered whom? Medicare?
Medicaid - Individuals who required cash assistance
Medicare - Americans who did NOT have health insurance.
According to healthcare professionals, the 1960s were known as ________.
The decade of social reform.
What setting was early proposals of the act focused on?
Hospital setting.
What type of medical care does Medicare Part A cover?
Inpatient stay.
What does SSI stand for?
Supplemental Security Income.
Who signed the Medicare/Medicaid Act of 1965 into law?
President Lyndon B. Johnson signed it into law on July 30, 1965, in Independence, MO.
What was the name of the OT treatment approach that came out of the 1960’s social reform?
Therapeutic Milleu approach.
What services were deliberately excluded from early drafts of the act?
Physician Care.
What law signed in 2010 expanded access of health care insurance coverage to millions of uninsured Americans as well as advocated for OT practitioners, consumers, and services overall?
Affordable Care Act/Obamacare.
What does ABN Stand for?
Advanced Beneficiary Notice.
How is Medicare funded? Medicaid?
Medicare - Payroll taxes paid by most employees, employers, and people who are self-employed. And other sources including interest earned on trust fund investments, income taxes paid on SS benefits, and Medicare Part A premiums from people who aren’t eligible for premium-free Part A.
Medicaid -The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).
What occupational therapy theory or model was created around the 1960s?
Occupational Behavior by Mary Reilly.
During which war did the U.S. experience a shift from States to the Federal Government as the preferred administrator of health insurance?
The Second World War.
What term, under Medicare Part B, is used to describe two therapists of the same or different discipline that simultaneously provide service care for a patient?
Co-treatment.
What does PACE stand for?
Program of All Inclusive Care for the Elderly.
Why was the Medicare law created?
To provide more than 56% of the population over 65 health insurance, since they could no longer get it from work.
What were some of the positive changes that occurred after the Medicare/Medicaid laws were enacted?
CMS shifted patient treatment focus and ended up decreasing the amount of beds patients would take up, decreased the financial loss of hospitals, and increased quality of care.
What was President Kennedy’s rationale for the act related to a global scale?
U.S. was behind, as most of Europe already had a similar system in place.
In regards to the Medicare therapy cap on outpatient services, what two services are combined, as opposed to the separate amount provided for OT?
Speech Language Pathology (SLP) and Physical Therapy (PT).
BONUS (worth double!!)
1) How many parts does the Medicare program have? and 2) What does each part cover?
1) 4: A, B, C and D.
2) Part A covers inpatient hospital, skilled nursing and hospice, Part B covers physician services, Part C covers managed care plans and Part D covers pharmacy.
Why did Congress choose to focus on the growing elderly population when drafting the Medicare Act?
Many Americans were being covered by work insurance.
What program asks the therapist to use G-codes, corresponding severity modifiers, and therapy modifiers to see the connection between rehab therapy and a patient’s progress during the initial evaluation, progression of treatment, and discharge?
Functional Limitation Reporting (FLR).