Kuzindikira ndi Chithandizo Chosiyana kwa Medicare ndi Medicaid Bene Benearies
Malamulo a chinyengo amagwiritsidwa ntchito poletsa kusokoneza ndalama kwa odwala. Makamaka, Lamulo la Stark lakhazikitsidwa kuti lilepheretse anthu omwe amawatumiza okha omwe amapindulitsa asing'anga kuvulaza awo omwe akuwasamalira. Kodi Chilamulo cha Stark chimakhudza bwanji mankhwala ogona? Dziwani momwe malamulo amalepheretsa kupatsirana kwa matenda opatsirana pogonana ndi odwala omwe amagwiritsidwa ntchito ndi mapulogalamu a zachipatala monga Medicare ndi Medicaid.
Malamulo Alipo Poteteza Chinyengo
Pofuna kuteteza nkhanza ndi chinyengo kwa odwala m'manja mwa ogwira ntchito zaumoyo, mabungwe a federal ndi boma ku United States atenga malamulo enieni. Chimodzi mwa zoyambirira, chomwe chimatchedwa Federal Federal Claims Act, chinayambika nthawi ya Nkhondo Yachikhalidwe. Malamulo oletsa kutsutsa amapezeka kuti athetse munthu aliyense kupereka kapena kulandira ndalama kapena zinthu zina zamtengo wapatali zogwiritsira ntchito thandizo lachipatala. Kuyambira m'chaka cha 1989, lamulo la Stark lilepheretsanso kudzipatula kwa madokotala ndipo lamuloli likhoza kuthandizira kuchipatala.
Kodi Chilamulo Chokhazikika N'chiyani?
Mwachidule, Chilamulo cha Stark chimaletsa madokotala kuti asanene odwala awo ku mabungwe omwe madokotala (kapena mabanja awo) ali ndi umwini kapena zofuna zachuma. Nthawi zina limatchedwa lamulo lodziimira yekha.
Kulepheretsa kumeneku kumakhudza ntchito zothandizira zaumoyo, koma kokha ngati misonkhanoyi ikubwezeredwa ndi Medicare, Medicaid, kapena pulogalamu ina yothandizira zaumoyo, monga Tricare (yogwiritsidwa ntchito ndi ogwira ntchito zothandizira zida).
Awa ndiwo malamulo a federal ndi maiko ambiri omwe afotokozera malamulo ofanana omwe amakhudza kubwezeredwa kwa katundu kapena ntchito kudzera mu dipatimenti ya inshuwalansi ya umoyo wothandizidwa ndi boma. M'madera ena, ngakhale kudzipatula kwa odwala-okha omwe amapereka ndalama kuzipatala za dokotala kungakhale kosaloledwa ngati pali malipiro osakanizidwa ndi zosiyana.
Malamulo awa asinthidwa kangapo kuyambira atangoyamba. Mu 2008, Centers for Medicare ndi Medicaid Services (CMS) inatulutsa mawu okhudza kugwirizanitsa kugonana kwa apnea ndi mankhwala ake, kuphatikizapo kuperekedwa kwa mankhwala opatsirana opatsirana (CPAP) ndi zipangizo zamakono .
Izi zimangowonjezera mgwirizano pakati pa wogonana ndi ogulitsa mapulogalamu. CMS imakhulupirira kuti pali kuthekera kwodzikonda pa zotsatira za kuyezetsa ngati pali chilimbikitso choyesera mobwerezabwereza kuposa momwe kuliri kofunikira kwa mankhwala ndi kutanthauzira zotsatira za mayeso ndi chisankho chomwe chimakonda chithandizo chobwezeredwa. Momwemo, munthu aliyense kapena kampani sangathe kuchita zonse ziwiri kwa odwala omwe akuyang'aniridwa ndi pulogalamu yachipatala.
Chifukwa cha kusintha kumeneku, CMS inaletsa kupatsidwa malipiro apadera pofuna kuthetsa vutoli loperekera chiopsezo mu 2008. Medicare sangathe kulipira wogula mankhwala (DME) wathanzi kwa CPAP ngati wogulitsa ali ndi mgwirizano ndi wopereka mayesero matenda a apnea akugona. Kugwirizana uku kumatanthawuza za mgwirizano pakati pa maphwando ndi malipiro kapena umwini.
Choncho, wina sangathe kukuyesani chifukwa cha kugonana kwa kugona ndikugulitsani chipangizo cha CPAP ndipo ali ndi Medicare kulipira. Komabe, monga lamulo lililonse, pali zosiyana.
Zida Zophimbidwa, Osati Kuyesa Zonse
Choyamba, tiyenera kukumbukira kuti kuletsedwa kwapadera kumeneku kumaphatikizapo kuyesa kugonana kwapakhomo . Ngati wodwalayo ali ndi matenda a polysomnogram , akuchitidwa ngati phunziro lausiku mu malo oyesa, choletsedwa sichigwira ntchito, ngakhale kugwirizana kwachuma kulipo. Kwa ambiri, zotsatira zazikulu za lamulo la Stark ndizopangira zipangizo za CPAP ndi zipangizo zamakono kuti azitsatira matenda obisala.
Pansi pa malamulo a US Food and Drug Administration, CPAP ndi chipangizo choyenera chachipatala chomwe chimatchulidwa ngati chinthu cha zipangizo zamankhwala zotsalira. Maina awa ndi ofunikira kuti malamulo a boma akhazikitsidwe komanso cholinga cha inshuwalansi.
Zida zomwe zimaperekedwa ndi lamulo la Stark Law limaphatikizapo:
- CPAP ndi zipangizo za bilevel
- Masks
- Tubing
- Anthu odzudzula
- Chipinda chamadzi
- Zosefera
- Zida zam'manja
- Thandizo la okosijeni
Madokotala, madokotala a mano, ndi ena othandizira zaumoyo sangathe kutumiza wodwalayo kwa wothandizira DME ngati munthuyo (kapena banja lake) ali ndi chiwongoladzanja chokwanira kapena chobwezera-ngati wogulitsa akufunsira malipiro a chinthucho kuchokera ku pulogalamu ya chithandizo cha boma. Mwachidziwitso, dokotala sangathe kupereka CPAP kwa wodwala mu ofesi ya zamankhwala mu nkhaniyi.
Kumvetsetsa Chilamulo cha Stark Kupyolera Milandu
Tiyeni tikambirane zochepa chabe za momwe Lamulo la Stark lingakhudze chithandizo cha mankhwala opatsirana pogona:
- Wochita malonda amadziwa kuti kugona kwa mphuno ndizofala komanso kuti kubwezera ndalama kwa CPAP kumapangitsa kuti bizinesi ikhale yopindulitsa. Amasankha kupanga kampani yomwe imatumiza zipangizo zoyesa kugona kunyumba. Ngati mayesowa ali othandiza, ngati amatanthauzidwa ndi dokotala wogona ogona, amagulitsa mankhwala omwe amagwiritsidwa ntchito ndi CPAP kapena zipangizo zamakono molunjika kwa wodwalayo. Mwamwayi, lamulo la Stark limaletsa kubwezera kwa odwala alionse amene akugwira nawo ntchito yothandizira zaumoyo. Odwalawa adzafunika kutulutsidwa.
- Chikhalidwe chosayenerera chimayesa kupanga chiwembu chogwira ntchito kuzungulira Chilamulo cha Stark. Amayesa odwala, koma amawauza omwe ali ndi Medicare kuti CPAP yawo sidzafunsidwa ndi inshuwaransi yawo. Amawauza kuti abwezeretse zida zomwe amachokera m'thumba, ngakhale atakhala ndi chithunzi ngati apita ku DME wina wodzipereka. Odwala amavomereza pamene amachoka kupita kwa wina, ndipo amapereka madandaulo omwe amachititsa kuti amuthandize.
Kuchokera ku Chilamulo cha Stark ndi Chilango
Ndikofunika kuzindikira kuti Lamulo la Stark silikugwira ntchito kwa inshuwaransi yonse, makamaka kwa inshuwalansi zapayekha kapena payekha.
Kumeneku kungakhalenso zosiyana ndi ogwira ntchito akumidzi monga momwe zidazingakhalire zosagwiritsidwa ntchito. M'malo molanga odwala chifukwa chosowa mwayi, madokotala amatha kupereka odwala okha ku ofesi yomweyo.
Pali zilango zosiyana zomwe zimapezeka pamene opereka akuphwanya Lamulo Lolimba. Malipiro angakanidwe ndipo kubwezeredwa kukhoza kulamulidwa phindu lomwe limasonkhanitsidwa motsutsana ndi lamuloli. Kuphatikizanso, chilango chapachiŵerengero cha $ 15,000 pa chiyeso chirichonse cha ntchito yomwe yaletsedwa ikhoza kuyesedwa. Ngati dokotala amayesa kusokoneza lamulo ndi zochitika zowonongeka, chilango chapachiŵeni cha boma chimalumphira madola 100,000 pa njira iliyonse.
Mawu Ochokera
Malamulo amenewa alipo kuti ateteze odwala ku mitundu yovuta yomwe ingatenge ndalama kwa anthu omwe ali ovuta. Omwe amapereka zambiri sali kunja kuti apange buck mwamsanga ndi kuchita mwa njira zoyenera kuti athandize odwala awo. Mwamwayi, malamulo ovomerezekawa angakhale oyenera kulanga iwo omwe saika odwala awo poyamba. Lamulo lingasinthe, koma ngati mukumva ngati mwagwiritsidwa ntchito, funsani ku Ofesi ya Auditor General ku Dipatimenti ya Zaumoyo ndi Zauzimu ku United States poitana (800) 447-8477.
> Zotsatira:
> American Academy of Sleep Medicine. "Komiti ya Zigawo za Senate ikuona kuti zikugwirizana ndi Stark Law." July 14, 2016.
> Brown, DB. "Kugona Mankhwala Omwe Amagwira Ntchito Momwe Akugwiritsira Ntchito Amagulu ndi Ogwirizanitsa-United States" mu Mfundo ndi Zochita za Sleep Medicine , lolembedwa ndi Kryger, MH et al . Elsevier , edition la 6, 2017, pp. 670-674.
> " Zochitika za Medicare ndi Medicaid Services. Mankhwala oletsa chinyengo ndi kupewa nkhanza, kuzindikira, ndi kulengeza ." August 2014.
> "Ofesi ya Inspector General. Mapu a madokotala atsopano: malamulo achinyengo ndi kuzunza." September 2017.
> Staman J. "Malamulo a chinyengo ndi zachipongwe zomwe zikukhudza Medicare ndi Medicaid: mwachidule ." (Congressional. Report No. RS22743). Washington DC: Library ya Congressional Research Service, September 8, 2014.