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Home for sale in Quail Creek West - Just $145,000 - good example of the type of home you will find hereLocated in: Quail Creek West (Austin, TX)
I resumed my reading of HR 3200 over the past day or two, having been bogged down with actual money-making behaviors (imagine that!). If you would like to see all of my previous posts on this topic, you can visit my site at:
The notes below are for pages 368-434, out of a total 1,017. The next post should take us to the midway point of the bill. :)
Interestingly, my eight-year old daughter announced yesterday that she intends to read the entire unabridged dictionary, which is a mere 2662 (very large) pages with very small font. Frankly, I believe her, since she is the fastest reader in our house, and we are not slouches around here, believe me. This was unrelated to my own project - just thought it was supremely cool.
Incidentally, the video below is from Thomas R. Carper, an actual member of the Senate Finance Committee, who said that he has no intention of reading the bill, nor does he think that others can even understand it. Sorry to burst your bubble, Senator Carper, but some of us are actually reading it, and it's not "incomprehensible" (your word). Either you need to produce legislation in "plain English" (again, a quote from you), or read the bill before you vote on it. Anything less is criminal, especially on a topic that has the potential to affect everyone in the United States. I may need to run for Congress after all, when I see guys like this making a mockery of the process:
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As I mentioned last time, from here on out, I will provide a glossary of terms that I am learning as I read:
TELEHEALTH: According to Wikipedia, this refers to the delivery of health-related services and information via telecommunications technologies. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology.
LEP - Limited English Proficient - This is a nice/official way of referring to someone who cannot speak English very well.
ESRD - End-stage renal disease - My mother-in-law passed away from this in May, so we are relatively well-versed about kidney disease and dialysis in our house.
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SEC. 1222. DEMONSTRATION TO PROMOTE ACCESS FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH PROFICIENCY BY PROVIDING REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES.
(a) In General- Not later than 6 months after the date of the completion of the study described in section 1221(a), the Secretary, acting through the Centers for Medicare & Medicaid Services, shall carry out a demonstration program under which the Secretary shall award not fewer than 24 3-year grants to eligible Medicare service providers (as described in subsection (b)(1)) to improve effective communication between such providers and Medicare beneficiaries who are living in communities where racial and ethnic minorities, including populations that face language barriers, are underserved with respect to such services. In designing and carrying out the demonstration the Secretary shall take into consideration the results of the study conducted under section 1221(a) and adjust, as appropriate, the distribution of grants so as to better target Medicare beneficiaries who are in the greatest need of language services. The Secretary shall not authorize a grant larger than $500,000 over three years for any grantee.
MY NOTE: I realize that the paragraph above is a big portion of the bill to include, but this is proposing to allocate up to $12 million in grant money to Medicare service providers so that they can hire interpreters (referenced slightly earlier in the bill) for places where there are language barriers. I don't think I want to help fund this, frankly. Prepare yourself mentally, because this is going to sound uber-conservative of me to say, but if you are living in the United States, and you want to take advantage of this particular government benefit, shouldn't you be able to speak the language or bring along a friend or family member who does?
Sorry if that seems harsh, but I guess I have a hard time imagining other countries making provisions for English translators if I were living there and didn't speak the language. Just an opinion. I don't think that emergency medical care should be denied to anyone, but I have a tough time supporting this portion, since it deals with Medicare specifically.
Sec. 1222 (i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $16,000,000 for each fiscal year of the demonstration program.
MY NOTE: This appears at the end of the same section. This appears to add $16 million more for translation-related services each year, along with the $12 million over three years allocated in part (a). Yikes!
SEC. 1232. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT PATIENTS AND OTHER RENAL DIALYSIS PROVISIONS.
MY NOTE: Generally speaking, this section seeks to extend coverage for patients with end stage renal disease, including immunosuppressive drugs, which help transplant patients (intended to keep their bodies from rejecting the new organs).
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years.
MY NOTE: Based on what I have seen/heard on the news, this is where the "death panels" comment came from. Unfortunately, like so much other stuff bandied about by politicians and pundits alike, this innocuous section has turned into something scary by those who haven't taken the time to read the bill. Basically, this entire section requires physicians (or nurse practitioners) to explain to their patients about the continuum of end-of-life services available, along with the meaning of a living will, durable power of attorney, and more. It doesn't encourage anyone to take advantage of any of these things, nor does it put the decision making in anyone's hands other than the patient himself/herself.
`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
MY NOTE: Clearly, this is an emotional topic, but this doesn't appear to encourage anything that isn't already in place. When my mother-in-law was very ill a couple of years ago, these topics were addressed, as they should have been. The same goes for my father, who passed away back in 2005. When our loved ones are facing the end of their lives, it's a good idea to understand their directives and treatment options, right? An advance care planning consultation does not imply that someone else is making the call.
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TYPOS/MISTAKES
In Section 1233, under hhh (5)(b)(i), it states, "if a patient is pulse less" - this should read "pulseless". Better yet, it should say, "if a patient has no pulse". Just my opinion.
Capitalization error: In Section 1233, (b)(1) and (b)(3), the word "physician" should be in all caps to match the remainder of the heading.
Over the past 15 months or so, my family and I have been helping to start a new church in Georgetown, Texas. I am happy to announce that we are having our "official" grand opening for Christ Presbyterian Church this Sunday, October 11th.
We recently started meeting at the Georgetown Chamber of Commerce building, which is essentially brand-new. It's located at 100 Stadium Drive, along Austin Avenue, just north of Williams Drive. It's right across from the Georgetown Rec Center.
If you are curious about what we believe, or you want to learn a bit more about us, check out our website at http://cpcgeorgetown.org.
Our Sunday morning services run from 10am until about 11:20 or so, and we have refreshments afterwards. There is childcare provided through age five, and we are starting a "children's church" portion that will cover kids up through fourth or fifth grade in November. The kids will leave the service during the sermon, then come back near the end. We have communion every week at the very end of the service.
Pastor Whit Anderson brings challenging, timely and biblical messages each week.
If you live in Georgetown, north Austin, Round Rock, Pflugerville, Cedar Park, Leander, Liberty Hill, or Jarrell, it's pretty easy to find us. I hope to meet you sometime soon!
You can also check out our Facebook page if you're interested.
Thanks for reading!
If you have some time, join us today on Social Media Edge Radio as we welcome Jason Baer (@jaybaer). Since October 2008, Jason has bridged blogging and Twitter via the Twitter 20 Interview Series, a thought-provoking interview series on Twitter with luminaries in social media and digital marketing, recaptured on 
his blog. In essence, he asks twenty 140-character questions and they are answered in real-time. Jason should be a fun guest. His Twitter profile includes this tidbit - "I live in a forest". Needless to say, I will be asking about this. :)
We also have a handful of interesting social media stories to share today, including one about a guy who may just end up naming his son Batman. Yes, you read that sentence correctly. We have some news about social media restrictions from the world of goverment and sports, and we might even give away a Social Media Edge shirt, hat, or mug!
Mike Mueller (@mikemueller) will be sharing some tech tips on what to do if Firefox isn't working. TS Elliott will also be on hand to discuss the shift that she has observed to Friendfeed from Twitter, and the fact that more businesses are connecting on Facebook.
Here's the link to the show, which starts at noon Eastern (11am Central, 10am Mountain, 9am Pacific):
If you can't make it, you can always catch the archives, and access any of our previous shows (thanks to Mike Mueller) by visiting our Facebook page at http://facebook.com/socialmediaedge and clicking on the "Archive" tab. If you need/want a custom Facebook page, Mike is the guy to design this for you!
This is part seven in my ongoing series of posts, as I read through the entirety of HR 3200 (which is 1017 pages as of this writing). I'm sorry that I haven't taken the time to jazz up these posts with graphics, etc. I guess the content doesn't really lend itself to funny pictures as much as most of the stuff I write. :)
If you would like to see every post, you can visit my new site at:
I am planning to make it a bit easier to sort the posts there soon. On another note, I apologize to those of you who were awaiting this installment, since it took me nine days to get it completed. I have been swamped lately, so it took me awhile to find the "extra" time for my reading.
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I came up with a new technique that I think will be helpful from here on out. I will share any terms with you that required me to consult Google or an online dictionary. Here are the glossary terms that I learned during this portion:
Gainsharing - means a hospital shares a portion of cost-savings with doctors who help to reduce clinical costs.
Anti-referral and anti-kickback - "Anti-referral" is a foreign concept for me since I am in the real estate business, but these terms are pretty self-explanatory. I only included these because I had never heard them used in this fashion.
MA (Medicare Advantage): Health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can also include prescription drug coverage.
Co-morbid conditions - means one of two things:
Dual eligibles - This refers to people who are eligible for both Medicare and Medicaid.
SNP's (Special Needs Plans) - These are private Medicate plans that serve one of the following groups: 1. people in nursing homes, 2. people in intermediate care facility for the mentally disabled, 3. dual eligible individuals (see definition above), or 4. people who have a specific chronic, severe or disabling condition defined by the plan (such as diabetes or cardiovascular disease). It seems as though "special needs" in fact covers a broad range of patients.
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SEC. 1156. LIMITATION ON MEDICARE EXCEPTIONS TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS MADE TO HOSPITALS.`(f) Reporting and Disclosure Requirements-
(B) the names and unique physician identification numbers of all physicians with an ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity.
MY NOTE: As you can see, they are really trying to clamp down on any potential abuses when it comes to profits from referrals made from physicians to hospitals. The next section requires any doctor with an ownership interest to disclose this to a patient being referred, AND to disclose ownership interests on any public hospital website and in any public advertising for the hospital. Interesting stuff.
SEC. 1168. ELIMINATION OF MA REGIONAL PLAN STABILIZATION FUND -
MY NOTE: This section does exactly what it sounds like. According to my research, there was a bill introduced in an attempt to repeal this back in 2005. According to the status of the prior bill, it was read twice, then referred to the finance committee. It makes me wonder how many other bills have died a slow, ignominious death in committee over the years.
SEC. 1173. INFORMATION FOR BENEFICIARIES ON MA PLAN ADMINISTRATIVE COSTS.
(a)(4) MEDICAL LOSS RATIO TO BE DEFINED- For purposes of this part, the term `medical loss ratio' has the meaning given such term by the Secretary, taking into account the meaning given such term by the Health Choices Commissioner under section 116 of the America's Affordable Health Choices Act of 2009.'.
MY NOTES: Why would you allow the Secretary of Health and Human Services to have a (potentially) different definition of the term "medical loss ratio" than the Health Commissioner?
It says that it must take the other definition into account, but it seems as though it should be firmly understood by everyone, if you plan to: (a) rebate money to enrollees based on this definition, and (b) keep plans from enrolling more members if their loss ratio is too low for 3 consecutive years.
As a quick reminder, the medical loss ratio is normally understood to be the actual percentage of money spent by an insurance company or entity on claims. In this case, it would be the percentage spent on medical services.
(b)(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO- If the Secretary determines for a contract year (beginning with 2014) that an MA plan has failed to have a medical loss ratio (as defined in section 1851(p)(4)) of at least .85--
(A) the Secretary shall require the Medicare Advantage organization offering the plan to give enrollees a rebate (in the second succeeding contract year) of premiums under this part (or part B or part D, if applicable) by such amount as would provide for a benefits ratio of at least .85;
(B) for 3 consecutive contract years, the Secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year; and
(C) the Secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for 5 consecutive contract years.'.
MY NOTE: As you can see, they are really driving this point home - spend the money on claims, or you will be terminated.
SECTION 1181 (b) (b) Requiring Drug Manufacturers To Provide Drug Rebates for Full-Benefit Dual Eligibles-
MY NOTE: This section also does exactly what it sounds like it would, by requiring all drug companies participating in Part D of Medicare to give rebates for dual eligibles. On the surface, this seems interesting, until you realize that the money is going to the government - "Such rebate shall be paid by the manufacturer to the Secretary". In theory, this money would be used to help cover the "out-of-pocket gap" for Medicare.
The primary document that I had to refer to repeatedly during this portion of the bill was the Social Security Act, since this bill seeks to amend and add to the Act many, many times. Large chunks of this section deal with how much rebating will be required from drug manufacturers. I suppose we've all heard stories of how much profit is involved in that particular business. Maybe a specific pill costs 25 cents to make, but the end-user pays $50 or more per dose. Still, I do wonder why the rebate is limited to dual eligibles (at least so far).
Some people will probably love this, as it limits profits for drug manufacturers, who may be perceived as greedy. Others will hate this, since it appears to hinder the free market. I typically lean toward the latter, but I guess we aren't currently shopping for drugs directly from those who make them, so the costs are not really driven by demand, at least not directly.
TYPOS/MISTAKES
There is a small error in the Social Security Act as it appears on the www.ssa.gov site currently. Under Section 1859 (f), there is no subsection (1), so the numbering begins with part (2) instead. This may be a simple transcribing error on the site. Since HR 3200 now refers to it, this should be clarified.
"Section 1181 (a) In General- Section 1860D-2(b) of such Act (42 U.S.C. 1395w-102(b)) is amended--" This is referring to the Social Security Act, but this is at the beginning of a new subtitle and its the first section there, so it should specifically note which Act in order to be consistent with the rest of the Bill. Later in the same section, when they are seeking to insert a new paragraph (Paragraph 7), under (E), neither the (i) nor the (ii) are needed there. The same error occurs later in the same section, with an unnecessary (I) and (II).
On today's Social Media Edge radio show, Ken Cook and I had a chance to speak with Paul Chaney, author of the brand-new book "The Digital Handshake : Seven Proven Strategies to Grow Your Business Using 
Social Media". We were privileged to have some time with Paul on the day of his book's official launch. Paul a veteran Internet marketer, business blogger, popular speaker, social media consultant and coach.
Since I had a chance to meet and speak with Paul last October when he was the keynote speaker at the Houston RE Barcamp, I already knew that he would be a great guest, and I was happy to have a chance to interview him today. As with several of our recent episodes (Shel Israel, Tara Hunt, TwitterQueens), it was a lot of fun!
Paul is also the co-author of "Realty Blogging", which was the very first book on social media that I ever purchased, back in 2007. For those of you who know how much I love to read, you will understand what a compliment this is for the author.
If you have some time, I would definitely recommend listening to today's show, since there was some really valuable information shared there. We also had a lively conversation with Mike Mueller and TS Elliott that was instructive for all of us. :)
Paul discussed having the right mindset for social media, rather than focusing solely on the toolset. He also mentioned how important it is to take time to build relationships rather than trying to rush things (think of the tortoise vs. the hare).
I am getting my own copy of the book, and based on his first one, I would definitely suggest ordering a copy of this one as well. Paul is one of the good guys, and his thoughts on blogging and other social media tools (Twitter, YouTube, etc.) align with my own. I am hoping to write a review of the new book once I have had a chance to finish it.
I found the Amazon link if you're interested in getting it ''fresh out of the oven". :)
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I have been working as a full-time Austin area Realtor since January 1997. My years of experience serve me well as the broker and co-owner of Austin Texas Homes, LLC, which began operations in 2004.
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