HEARING - U.S. Senate Special Committee on Aging

13,116
Is
I , Ie I t r[Ii iiI a II tI a, I ., I .:Ir , I! I.i- ;1 I I endt1
i l'liX 'I irl " ilt Itt "i t.pl din' ( n'i lrc r itein.
iln' .leti rininaitio, ihrt ilc prm tle~r or inicr
mudiar' durtsi: Mcc;,re 'killed nursing fadilit
rovusrai:t leiii the ti :nlinglini p ician't crii-
Waion and urder tha dalv phvsicai ther li
he gihen. the providir or inicrinediarv shall
d-cribl %ith prit latriv * hY the czr'
its ,l
gr;, m
i s l tiii ertlO i t !ii NI;¢lic are pro-
149
New Developmrnns
3. Iroviders will supiP Ii st 'icid I maStir
descrilbed htlow uith opiu; is all ow erage
dctrmination nwtics cit ihtr dcni.l nuitwic, or
claims ifr cei vcaKe) i"sud Ih 'provider, for
ncirbe-r of the plaintifi cl;ss itt adldition. the
providu rS w ill itpply thei .fkcial master in eeert
aa utith an information htI to ontaining the
I iient s primar3 ail s otd arv diairnuses. and
indlicating the frequency u.f p;h mica therapi
treatments oriered hs
ph!''ican.
the paiticnt s attendlingr
iS Thte tri shall aipsrind a pciil naslivr i:,
a -i't adlministetriing aitl ii aliatii' the relie
If-IN hIL- hbV thi- Judgmiiit. On 01 before lit.
I ;h da.' follki,,g the laitc i tli Judmlnlgn.
thi parties 'hall ulmii. j .insl -r seplmateu I
the itanie ant iio~lfiaii izzen. ii inhsloa hlZ: ill
ine it) undertake the dluitif m pecial master
'jp':ifi('d in thi- Judgment Aiter .uch nominaitpn.
hl the p:artie. the court sha i issue an
Order appointing a slecial laster
C. The special mastcr shall have the following
dut ics;
I The ,pMcial nias ter hall conduct a seminar
fur all itrttrmcilia "r and provider personnel ii
Coinnecticut At thc seminar, the special
master will explain thc rulings of the court,
including the requirement that all members
of the plaintiff class receive an individualized
assessment of their entitlement to ikilled
nursing facility benefits.
2. The special master "ill rv(vici C colpis of all
skillcd nursing facilitv coverage determina-
Lion nutitec (either denial notices or claims for
coverage) issued by providers for members of
the piaintiff class, together with the additiptal
infurmatioin set forth in Sectit:
[iflAH13 aue
3. rhe special noaster ill chpss- a ra ndium
sample of claim denials ior further analvsis.
such ma thlo ofi i-tei ip ant ircqviic>tfii
ea ti Isi atl the rca',onabIc discrtrion ol
ilic ial ml isir For pJurlxise of such fur.
lie mat i the slic eisI master will ohtain
ulpises f the tertinent medical recortd nni, at
hi or her distrt tn. may int eri" rwiso itnel
it the pri, httr the plaintiff involsed. and the
attendtng phjyirian, as appropriate, to determine
whether plainliffs are receiving the indi
idualized determinatinns called for by this
Judgment and ttther rulings tf the court.
4. The slecial m.:stcr will receive copies tf all
rctdeterminatiun decisions. as set forth in Sece
ji tt I}1*Ft als\'i.
. All Ihw ume:nart material collected by the
special matter * ;il he made available for
intlK5cion t y th, pIartic
6 After the pmial saster ha, collected the
infotrmation sfm ified alav. fur a lixriewl of six
mimth, the t p-iialI master will submit a fur.
mal written rcelri III the court. with copies to
tun-. let bidm g khe lsical master's find.
ing,. lihch h tl tiloude the pruportion of
grants and denial, of Medicare coverage for
plaintiits reciiving daily physicial therapy
treatments (with respect to redete4minations
in accordance with Section I and determinatioa~
%tahl respaci to Section 11). and stating
shlther. it th special master's opinion, the
plaintiff class a, a whole is receivitg individualized
determinations as called for by the
rulings of the court.
D After receipi of the special master's writ.
ten repxrt, the court will schedule an evidentiary
hearing at which the special-msaster will be
available for examination, if requested by either
or buil) of the parties or by the court. After such
hearing, the court ma% issue ,uch further orders
as are approipriate or necessary in the circumstalies.
E. The special master shall be compensated
for services at the rate of $40 per hour, such
compensation it he included in recoverable costs
uildcr Fed. R Cii P . 4id). In no event shall
cor .,eltsa ion i l t hi- a mount of $3 i00.
It is 'p i,rdli-r,-dl
(I 36.031) GAO Report on the Needs of the Elderly in Relation to Rising Federal Cost.
Ceni'ral Acrr-ttuning Offirc R(eierr N~o C.\()'lkl).81,-13V Siptcmber 30. 1986. Subject.
M-i'-'ingI the Nt'cdts of the Elthrty While Re'Pnh((ti c, Rito
iing Fk ic rAl (-sts
Medicare/Medicaid: Elderly Needs and [-eaith Care Costs
Medicare and Medicaid-Health care costs of the elderly-Catastrophic illness insurance.--Over
the nest st -irid -irs. prsors ms ir thi Chi"!' coiUi d ,m, on ner increasing review
'1 36,031 1987. Cornmerce Clearing House. Inc.