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The Centers for Medicare & Medicaid Services has a new website, cms.hhs.gov . Please visit cms.hhs.gov for the latest news and information. Over the next several months, we will completely migrate from the www.hcfa.gov website to the cms.hhs.gov website. Please see " About cms.hhs.gov " for further information.
CMS provides health insurance for over 74 million Americans
through Medicare, Medicaid and SCHIP. The majority of these
individuals receive their benefits through the fee-for-service
delivery system, however, an increasing number are choosing
managed care plans.
In addition to providing health insurance, CMS also performs a number of quality-focused activities, including regulation of laboratory testing (CLIA), development of coverage policies , and quality-of-care improvement. CMS maintains oversight of the survey and certification of nursing homes and continuing care providers (including home health agencies, intermediate care facilities for the mentally retarded, and hospitals), and makes available to beneficiaries, providers, researchers and State surveyors information about these activities and nursing home quality.
To ensure public and expert involvement in running our programs,
CMS maintains a number of chartered advisory
committees . These committees, whose meetings are open
to the public, are used to provide advice or make recommendations
on a variety of issues relating to CMS's responsibilities
and activities.
DHHS/CMS Initiatives
include:
Beneficiary Notices Initiative
Medicare Learning Network (MedLearn)
The American Customer Satisfaction Index
Home and Community Based Services:
Americans with Disabilities Act / Olmstead
New Freedom Initiative
Real Choice for Systems Change Grants
Systems Change Grants for Community Living
Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA)
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The Health Insurance Portability and
Accountability Act of 1996 (HIPAA) Page
HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. HCFA is responsible for implementing various
unrelated provisions of HIPAA, therefore HIPAA may mean different things to different people. Here's a directory of HIPAA's impact
on what HCFA does.
HIPAA Health Insurance Reform - Title I of the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. Visit this site to
find out about pre-existing conditions and portability of health insurance coverage.
Administrative Simplification - (Electronic Data Interchange, Health Information Privacy)
General Information about HIPAA Administrative Simplification - The
Department of Health and Human Services Administrative Simplification Web Site is the authoritative source for the law, regulations, FAQs,
and links to other important sites. This is an excellent starting point to learn about the basics of Administrative Simplification and
specific legal requirements.
NEW:
HIPAA Standard Model Compliance Form
HIPAA Administrative Simplification Compliance Act Questions and Answers
Standards for Privacy of Individually Identifiable Health Information—The HIPAA Privacy
Rule - HHS published the final Privacy Rule on December 28, 2000. This rule gives patients greater access to their own medical records
and more control over how their personal health information is used.
Medicare (Medicare EDI) - This is the official Medicare website that contains important information
about how providers can communicate electronically with the Medicare program. This site contains EDI formats and instructions, transaction
mapping information, statistics, FAQs about Medicare EDI, and other valuable EDI data.
Medicaid HIPAA Information - including Medicaid HIPAA Plus, the Medicaid
HIPAA-Compliant/Concept Model, Informational briefs, Implementation tools, and National Medicaid EDI HIPAA Workgroup Information.
National Provider Identifier
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Helping you compare health plans in your area.
Nursing Home Compare
Compare nursing homes in your area.
Prescription Drug Assistance Programs
Programs that offer discounted or free medications.
Dialysis Facility Compare
Compare dialysis facilities in your area.
Participating Physician Directory
Locate Medicare participating physicians in your area.
Supplier Directory
Locate Medicare participating suppliers in your area.
Helpful Contacts
Find phone numbers and websites.
Publications
View, order, or download Medicare publications.
Your Medicare Coverage (coming soon)
Your health care coverage in the Original Medicare Plan.
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Includes events on Medicare related topics.
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Compare health plans in your area.
Medigap Compare
Locate supplemental insurance policies to cover expenses not paid by Medicare.
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Overview
Medicare Health Plan Choices in 2002: Describes
your health plan choices for 2002.
Search Tools
Medicare Personal Plan Finder:
Helps you compare the Original Medicare plan, Medicare + Choice
plans and Medigap plans available in your area.
Medicare Health
Plan Compare: Helps you comparison shop for health plans by
looking at costs, benefits, and quality. Also included is information
on plan members leaving managed care plans. Health plans include:
Original Medicare Plan, Medicare Managed Care Plans (HMOs), and
Medicare Private Fee-for-Service Plans.
Medigap Compare:
Helps you locate supplemental insurance policies to cover expenses
not paid by Medicare. It also gives you information on how to contact
the insurance companies.
Local Medicare Events:
Allows you to search for upcoming beneficiary events in your area.
These events cover a broad range of Medicare topics and many types of
events may be sponsored in your area.
Supplemental Insurance
Guide to Health Insurance for People With Medicare:
links you to an information guide to help beneficiaries with
purchasing Medigap supplemental insurance, using Medigap supplemental
insurance and other kinds of health insurance.
Employer or Union Group
Health Insurance: describes the special rules that apply to
beneficiaries who have group health plan coverage through their own or
their spouse's current employment.
Other Information
Medicare Plan Options
and Supplemental Insurance Publications: links you to the site's
Publications Page. You will be taken directly to the section
containing "Medicare Plan Options and Supplemental Insurance"
related publications.
Easy Print
Overview
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Health Insurance Information, Counseling and Assistance Program
(HIICAP) Web Site
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Counseling & Assistance Program
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Center Relief Fund
HEADLINES
Governor
Pataki Signs New Legislation to Help Medicare Beneficiaries - Under new legislation
effective April 1, 2002, assets (such as savings) will not be counted when
determining eligibility for Qualified Individual 1 and Qualified Individual 2
benefits.
Aging
News Online - The latest edition of the
Aging News , the
New York State Office for the Aging's quarterly newsletter, is online. Find a
variety of articles and news items on new State initiatives, and more for older
New Yorkers.
A Vaccine
for Pneumonia? - Yes! If you haven't had the
pneumococcal shot, it's available now and year-round.
The
Pneumonia Review answers your questions about the pneumococcal vaccine and
the protections it offers!
New
Medicare Benefits - Medicare now provides
two new benefits -- medical nutrition
therapy and glaucoma screening for Medicare beneficiaries considered to be at
risk. Medicare also covers other Preventive
Services and Screening Benefits .
Benefit
Facts Updated - Since January 1, 2002, several
public benefit programs (such as HEAP and Medicaid) have new income eligibility
requirements. Check HIICAP's updated Benefit
Facts for details.
Future of Long Term Care
- What does the future hold for long term care as Baby Boomers expand the
senior citizen population? Read
Long
Term Care , an article from
Project 2015:
The Future of Aging in New York State .
Rules for
Changing Medicare Health Plans - Different rules for
when and how often you can switch your Medicare health maintenance organization
were put in place in January. If you are in a Medicare health plan, or are
considering joining one, you will want to know
how the rules affect you .
See
NEWS & UPDATES for
full stories.
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Canada Health Act
Fast find
Introduction
CHA
Annual Report
Brief
History
CHA
Annual Report 2000-2001
Now Available
Canada Health Act:
Text version
Acrobat version
R.S.
1985, c. C-6
Commission on the Future of Health Care in Canada
Introduction
The five principles of the Canada
Health Act (CHA) are the cornerstone of the Canadian health
care system. The Act ensures that all residents of Canada have
access to medically necessary hospital and physician services
based on need, not on ability to pay, by setting the criteria
and conditions that provinces and territories must satisfy to
qualify for their full cash transfers under the Canada
Health and Social Transfer (CHST).
The five criteria of the Canada
Health Act are:
public administration : the administration of the health
care insurance plan of a province or territory must be carried
out on a non-profit basis by a public authority;
comprehensiveness : all medically necessary services
provided by hospitals and doctors must be insured;
universality : all insured persons in the province or
territory must be entitled to public health insurance coverage
on uniform terms and conditions;
portability : coverage for insured services must be
maintained when an insured person moves or travels within Canada
or travels outside the country; and
accessibility : reasonable access by insured persons
to medically necessary hospital and physician services must
be unimpeded by financial or other barriers.
The Canada Health Act also
contains provisions that ban extra-billing and user charges:
no extra-billing by medical practitioners or dentists for
insured health services under the terms of the health care insurance
plan of the province or territory;
no user charges for insured health services by hospitals or
other providers under the terms of the health care insurance
plan of the province or territory.
The Canada Health Act Annual Report
The purpose of the Canada
Health Act Annual Report is to report to Parliament all
relevant information on the extent to which provincial and territorial
health care insurance plans have satisfied the criteria and conditions
for payment under the Canada Health
Act. Provinces and territories are required to provide information
on the operation of their health care insurance plans as they relate
to the Act. The approach to this information gathering has been
collaborative, where provinces, territories and the federal government
have worked together to supply the information needed by the Minister
of Health to fulfill his responsibilities in administering the Act.
The Canada Health Act Annual Report
2000-2001 was presented to Parliament in February
2002. Health Canada has expanded the range and depth of information
in this latest Report to facilitate a better understanding of how
provinces and territories comply with the Canada
Health Act.
You can view the Annual Report online, download
it to your computer, or order a copy directly from Health
Canada Publications.
Once you have read the Report, please complete our feedback questionnaire. We value your comments.
The responses from the questionnaire will help us to improve the style and format of future annual reports.
A Brief History of the Canada Health Act
The Canadian health care system has evolved into its present
form over four and a half decades. Saskatchewan, in 1947, was
the first province to establish public, universal hospital insurance,
and 10 years later, the government of Canada passed legislation
to allow the federal government to share in the cost of provincial
hospital insurance plans. By 1961, all 10 provinces and two territories
had public insurance plans that provided comprehensive coverage
for in-hospital care.
Saskatchewan again pioneered in providing insurance for physicians'
services outside hospitals, beginning in 1962. The federal government
enacted medical care legislation in 1968, and by 1972, all provincial
and territorial plans had been extended to include doctors' services.
A health services review was undertaken in 1979 by Justice Emmett
Hall. He reported that health care in Canada ranked among the
best in the world, but warned that extra-billing by doctors and
user fees levied by hospitals were creating a two-tiered system
that threatened the accessibility of care.
In response to these concerns, Parliament passed the Canada
Health Act in 1984 to discourage hospital
user charges and extra-billing by physicians. The Act provides
for an automatic dollar-for-dollar penalty if any province permits
such charges for insured health services.
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IMPORTANT REMINDER
Whether you are retired or still employed, if you are not already receiving Social Security benefits you must begin the process of signing up for Medicare Part A three months before your 65th birthday ( you can delay the start of Part B ).
Send questions on the FEHB program to fehb@opm.gov .
Send comments on these pages to insure-webmaster@opm.gov .
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FEHB Coverage for Former Spouses
FEHB and Medicare
Temporary Continuation of Coverage (RI 79-27, 12/00)
Information for Agency Human Resources Personnel
U. S. Office of Personnel Management
Federal Employees Health Benefits Program
Providing health insurance benefits to 9 million Federal enrollees and dependents.
Program Overview |
Frequently Asked Questions |
Glossary
Open Season Plan Information Pages
In November of each year we post the guides, plan brochures, and other files used to choose a FEHB plan for the following year. These files are available for 1997 through this year.
To plan information for:
2002 | 2001 | 2000 | 1999 | 1998 | 1997
Choosing a Plan
Considerations in Selecting a Plan
Considering Dental Benefits FAQ
Changing Plans FAQ
Enrolling in a Plan
When Can I Enroll, Change Plans, or Drop My Enrollment ?
How to Enroll
Election Form (SF 2809)
FEHB and Medicare
FEHB and Medicare Bookle t
Medicare Web Site
Quality Care is Vital to Your Health
Satisfaction Surveys and Accreditation
Your Guide to Choosing Quality Health Care
Health Plan Report Card An interactive tool that gives quality information on FEHB managed care plans.
Getting the Most from Your Plan
Getting the Most Benefits
Prescription Drugs FAQ
Continuation of Coverage
Temporary Continuation of Coverage
TCC and HIPAA
Former Spouses
Retirees and Survivor Annuitants
TRICARE and TRICARE-for-Life
Regulations
Frequently Asked Questions
RIGHTS OF RESERVISTS CALLED TO ACTIVE DUTY
On November 16 we posted a fact sheet and frequently asked questions on FEHB coverage for Federal civilian employees called to active duty service. This supplments the information issued September 14 in
Compensation Memo 2001-09 . FEHB coverage is discussed in item 7 of Attachment 1 to that letter.
Is there a local HMO that you would like to join but can't because they don't participate in the FEHB program? Ask them to consider joining the program, and tell them to take a look at http://www.opm.gov/insure/carriers/index.htm .
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Page updated 17 April 2002
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Latest News
Pricey Hospital? Your Plan May Ask You to Pay More (05/08/2002, Reuters Health)
Women Skip Healthcare Due to Costs (05/07/2002, Reuters Health)
Drugs, Devices Drive Rise in US Health Costs (04/24/2002, Reuters Health)
Early Release of Health Insurance Coverage Estimates: New Data from Quarter 3 of the 2001 National Health Interview Survey ( 03/06/2002, National Center for Health Statistics )
More News on Health Insurance
General/Overviews
Guide to Health Insurance (Health Insurance Association of America)
Life Changes Require Health Choices: Know Your Benefit Options (Dept. of Labor)
Top 10 Ways to Make Your Health Benefits Work For You (Dept. of Labor)
Specific Conditions/Aspects
Evaluating Access to Emergency Care Through Your Health Plan: A Checklist for Consumers (American College of Emergency Physicians)
Financial Assistance for Cancer Care (National Cancer Institute)
Financing Your Transplant (United Network for Organ Sharing)
Frequently Asked Questions: Dental Benefits/Insurance (American Dental Association)
Guide to Long-Term Care Insurance (Health Insurance Association of America)
Guide to Medical Savings Account(MSA)/High Deductible Health Plans (Health Insurance Association of America)
Health Care Costs and Your Insurance Premium (Health Insurance Association of America)
How To Pay For Nursing Facility Care (American Health Care Association)
How to File a Claim for Your Benefits (Dept. of Labor)
Insurance, Legal Issues and Advance Directives (American Heart Association)
Pension and Health Care Coverage: Questions and Answers for Dislocated Workers (Dept. of Labor)
Understanding Your Mental Health Insurance (American Academy of Child and Adolescent Psychiatry)
Viatical Settlements (Federal Trade Commission)
Dictionaries/Glossaries
Glossary of Insurance Terms (Health Insurance Association of America)
Private Health Insurance (Cystic Fibrosis Foundation)
Directories
Disability Insurance Directory 2001 (Health Insurance Association of America)
Long-Term Care Insurance Directory 2001 (Health Insurance Association of America)
Law and Policy
Health Benefits Under the Consolidated Omnibus Reconciliation Act (COBRA) (Dept. of Labor)
Questions and Answers on the Health Insurance Portability and Accountability Act (HIPAA) Nondiscrimination Requirements (Dept. of Labor)
Questions and Answers: Recent Changes in Health Care Law (Dept. of Labor)
Organizations
Centers for Medicare & Medicaid Services (CMS) (Centers for Medicare and Medicaid Services) - Information on Medicare, Medicaid, child health insurance programs and health related laws and regulations.
Dept. of Labor
Health Insurance Association of America
Statistics
FASTATS: Health Insurance Coverage (Centers for Disease Control and Prevention)
Health Insurance Coverage: 2000 (Bureau of the Census)
National Employer Health Insurance Survey Data Highlights: Selected Charts (National Center for Health Statistics)
Children
Children's Health Insurance (Bureau of the Census)
Insure Kids Now: Find Your State (Dept. of Health and Human Services) - links to state programs for free or low cost health insurance for children.
Insure Kids Now: Questions and Answers (Dept. of Health and Human Services)
State Children's Health Insurance Program (SCHIP) (Dept. of Health and Human Services)
Seniors
Can the Retiree Health Benefits Provided By Your Employer Be Cut? (Dept. of Labor)
Women
Health Insurance (National Women's Health Information Center)
WISEWOMAN: Improving the Health of Uninsured Women 2001 (Centers for Disease Control and Prevention)
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Asegure a sus Hijos Ahora: Encuentre el Programa de su Estado (Dept. of Health and Human Services)
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Ayuda Financiera Para el Cuidado del Cáncer (National Cancer Institute)
Elección y Uso de un Plan de Salud (Agency for Healthcare Research and Quality)
Entienda Bien los Beneficios de Salud Mental de su Seguro Médico (American Academy of Child and Adolescent Psychiatry)
Guía de Asistencia de Larga Duración (Health Insurance Association of America)
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Results from search: http://www.insurance.wa.gov/shibahelpline.htm
Washington Insurance Department - SHIBA Contact List
Statewide Health Insurance Benefits Advisors (SHIBA)
HelpLine
Popular Consumer Publications
(Download/Read Online)
Discount
Plans for Health Care and Prescription Drug Services
Fact Sheet updated 3-21-02
Health
Insurance Options for Consumers with Disabilities
updated
2-25-02
Health Insurance Options in the Individual
Market
updated 2-25-02
Paying
for Prescription Drugs
updated 2-25-02
Plan
Comparison Chart
updated
2-25-02
Approved
Medigap (Medicare Supplement) Plans
updated 5-10-02
Authorized
LTC Insurers in Washington State
updated 2-25-02
Medicare
A and B Charts
updated 2-25-02
Medicare
and Choice Plans 2002
updated 2-25-02
10
Standardized Medigap Plans Charts
updated 2-25-02
PUBLICATIONS :
You can order
these and other publications electronically from this website,
or call the Insurance Commissioner's Consumer Advocacy Division
to have them mailed to you. Simply call toll-free 1-800-562-6900.You
can also view many of our publications
on-line .
CONTACTING
SHIBA HELPLINE : SHIBA HelpLine operates a toll-free statewide
referral hot line (1-800-397-4422). You can leave your name and address there, or you
can e-mail SHIBA HelpLine with information and
questions. Either way, SHIBA HelpLine's referral system will help set you up with a SHIBA
HelpLine volunteer in your own community or nearby town.
LINE UP A SPEAKER : : If you would like to have someone speak to your group about a health
insurance topic, please contact the Outreach section of the OIC and SHIBA HelpLine.
MEDICARE/MANAGED
CARE ASSISTANCE : Help
for people who are losing their Medicare managed care plans.
SHIBA HELPLINE
EVENTS : SHIBA HelpLine volunteers and coordinators often speak
at gatherings and meetings across the state. These events are usually
publicized in local media outlets, but you can also check SHIBA's
state calendar for happenings in your area.
SHIBA
HELPLINE MISSION :
The Statewide Health Insurance Benefits Advisors (SHIBA)
HelpLine is a service of the Office of Insurance Commissioner: a
statewide network of trained volunteers who help consumers and their
families with questions about health insurance. The free service
involves about 350 highly-trained and impartial volunteers who educate
and advocate for their peers in local communities. Learn more here .
SHIBA HELPLINE SITE MAP : This is
a special Table of Contents for SHIBA HelpLine information and
features on the Office of the Insurance Commissioner website. Questions
or comments are welcome.
SHIBA
VOLUNTEERS AND SPONSORS : Current
information and resources for SHIBA volunteers and sponsors.
LINKS :
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social service agencies and advocacy groups
that may be of assistance to Medicare beneficiaries
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