Ukuxilongwa kunye noTyango olwahlukileyo kwi-Medicare kunye nabaxhamli beMedicaid
Imithetho yobuqhetseba yempilo ikhona ukukhusela ukusetyenziswa kakubi kwezigulane. Ngokukodwa, uMthetho we-Stark usetyenziswe ukwenzela ukuthintela ukuzithumela abantu abazondeza oogqirha ukuba banobungozi balabo abakhathalelayo. Umthetho we-Stark uthonya njani ukusetyenziswa kweyeza lokulala? Fumana indlela imimiselo eyithintela ngayo ukubonelelwa kokuvavanya kunye nokunyangwa kwe- apnea yokulala kwizigulane ezithathwe iinkqubo zempilo zonyango ezifana ne-Medicare neMedicaid.
Imithetho ikhona ukukhusela ukuChengisa
Ukukhusela ukusetyenziswa kakubi kunye nokukhwabanisa kwizigulane ezandleni zabanikezeli bezempilo, oorhulumente kunye noorhulumente baseUnited States bamkele imithetho ethile. Enye yeyokuqala, eyaziwa ngokuba yi-Federal False Claims Act, ibuyele ngexesha leMfazwe yombango. Imigaqo yokulwa nokukhawuleza ikhona ukwenqabela nayiphi na umntu ekuhlawuleleni okanye ekufumaneni imali okanye ezinye izinto ezixabisekileyo zokuthunyelwa kweenkonzo zonyango. Ukususela ngo-1989, uMthetho we- Stark uye wanciphisa ukuzithumela kubomi kwaye le miselo inokuchaphazela unyango lwe-apnea yokulala.
Nguwuphi umThetho osisigxina?
Ngendlela elula, uMthetho we-Stark uvimbela oogqirha ukuba bangabhekiseli kwizigulane zabo kwiinkampani apho amagqirha (okanye iintsapho zabo ezisondeleyo) zinobunini okanye enye inzala yemali. Ngamanye amaxesha kuthiwa ngumthetho we-Stark wokutyelela.
Le miqobo ichaphazela iinkonzo zempilo ezikhethiweyo, kodwa kuphela ukuba ezi nkonzo zibuyiselwa yi-Medicare, Medicaid, okanye enye inkqubo yokunakekelwa kwempilo yonyango, njengeTricare (esetyenziswe ngabasebenzi beenkonzo ezixhobileyo).
Lo ngumgaqo-sipala kunye nemithetho emininzi ichaze imithetho efanayo echaphazela ukubuyiselwa kwemveliso okanye iinkonzo ngeenkqubo zinshurensi zempilo yenkxaso-mali. Kwamanye amazwe, kwanokuba ukuzithumela izigulane ezizimeleyo ezizimeleyo ukuya kwiinkampani eziphethwe ngugqirha kunokungekho mthethweni ukuba kukho ilungiselelo lokuhlaziywa engagqithwanga ngenye indlela.
Le migaqo iye yahlaziywa maxesha amaninzi ukususela ekuqaleni kwayo. Ngo-2008, amaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS) akhiphe isitatimenti esichaphazela ukunikezelwa ngokubambisana kokuhlolwa kwe-apnea yokulala nokunyanga kwawo, kubandakanywa nokukhutshwa konyango oluphambili lwe- airway (CPAP) kunye nezixhobo zomlomo .
Olu hlaziyo luye lwawuthintela ukubambisana phakathi komboneleli wokuhlola kunye nomthengisi we-CPAP. I-CMS ikholelwa ukuba kukho inzuzo yokuzimela kwisiphumo sokuvavanya ukuba kukho i-incentive yokuvavanya kaninzi kunokuba imfuneko yonyango kwaye isichaze umphumo wokuvavanya nge-bias ethanda unyango olubuyiselwe. Ngaloo ndlela, nayiphi na umntu okanye inkampani ayikwazi ukwenza zombini iinkonzo kwizigulane ezigqitywe yinkqubo yononophelo lwempilo.
Ngenxa yolu tshintsho, i-CMS yamkelwe isithintelo sokuhlawulwa esikhethekileyo sokunciphisa oku kubakho ukusetyenziswa gadalala ngo-2008. I-Medicare ayikwazi ukuhlawula umthengisi wezixhobo zonyango ezihlala njalo (CPP) ukuba umthengisi unxulumene nomboneleli wokuhlola ukulala apho ukuxilongwa kwe-apnea yokulala. Olu dlelwane lubhekisela nakuphi na ubudlelwane phakathi kwamaqela anembuyekezo okanye yobunini.
Ngako oko, umntu akakwazi ukuvavanya ukuba ufumane i-apnea yokulala aze athengise idivayisi ye-CPAP kwaye ube ne-Medicare ukuyihlawula. Nangona kunjalo, njengawuphi na umgaqo, kukho ezinye iimeko.
Izixhobo ezifihliweyo, Akunjalo konke ukuvavanya
Okokuqala, ku funeka kuqatshelwe ukuba le nqobo yokukhutshwa kweentlawulo ezikhethekileyo kusebenza kuphela ekuhloleni i- home sleep apnea . Ukuba isigulane singena kwi- polysomnogram yokuhlola , senziwa njengesifundo sobusuku kwiziko lokuvavanya, umqobo awusebenzi, nangona ukuba ukubandakanya imali kukhona. Okweninzi, impembelelo enkulu kuMthetho we-Stark kulungiselelwe izixhobo ze-CPAP kunye nezixhobo zomlomo ukuze unyango lwe-apnea yokulala.
Ngaphansi kwe-US imithetho yokutya kunye nezobisi, i-CPAP yinkqubo yezempilo echanekileyo ekwahlulwa njengento yezixhobo zonyango ezizinzileyo. Ezi zikhundla ezibalulekileyo zibalulekile kumgaqo-nkqubo welizwe kunye neenjongo zokubuyiselwa kwe-inshorensi.
Izixhobo ezigqitywe ngumyalelo we-Stark Law uquka:
- I-CPAP kunye nezixhobo ze-bilevel
- Masks
- Ukuhlamba
- AbaHumidifiers
- Amagumbi amanzi
- Iifayile
- Zixhobo zombane
- Oxygen unyango
Oogqirha, oogqirha bamazinyo kunye nabanye ababoneleli ngezempilo abanakho ukuthumela isigulane kumthengisi we-DME ukuba loo mntu (okanye intsapho yakhe esondeleyo) inomdla-mali okanye inzala-ukuba umthengi ucela intlawulo yento evela kwiprogram yokunakekelwa kwempilo karhulumente. Ngendlela efanelekileyo, ugqirha awukwazi ukubonelela i-CPAP kwisigulane ngaphakathi kwe-ofisi yezobugcisa kulo mongo.
Ukuqonda uMthetho we-Stark ngokusebenzisa iiCaff
Makhe sicinge ngamatyala ambalwa ngendlela uMthetho we-Stark onokuchaphazela ngayo unyango lwe-apnea yokulala:
- Usomashishini uyaqaphela ukuba ukulala kwe-apnea yinto eqhelekileyo kwaye ukuba ukubuyisela i-CPAP izixhobo kwenza ukuba ishishini elinokuba yinzuzo. Unquma ukudala inkampani eya kuthumela i-home sleep apnea. Ukuba uvavanyo luchanekile, njengoko luguqulelwe ngugqirha wokulala oqinisekisiweyo webhodi, uya kuthengisa i-CPAP okanye iinkcukacha zomlomo ngqo kwisigulane. Ngelishwa, uMthetho we-Stark uvimbela ukubuyisela zonke izigulane ezithatha inxaxheba kwinkqubo yokunakekelwa kwempilo yonyango. Ezi gulane ziza kufuneka zifakwe ngaphandle.
- Umlingiswa ongeyena uzama ukuceba icebo lokusebenza malunga noMthetho we-Stark. Uvavanya izigulane, kodwa ke uxelela abo abane-Medicare ukuba i-CPAP yabo ayiyi kubanjelwa i-inshurensi yabo. Ufuna ukuba bahlawule izixhobo eziphuma esikhwameni, nangona bebeza kuba neenkcukacha zokuba bahamba kwesinye isibonelelo se-DME esizimeleyo. Izigulane ziyabamba xa zihamba ziya kwelinye umboneleli, kwaye zifake izikhalazo ezikhokelela kwisenzo somthetho.
Ukungafani noMthetho we-Stark kunye nezohlwayo
Kubalulekile ukuqaphela ukuba uMthetho we-Stark awusebenzi kuzo zonke i-inshorensi, ngokukodwa kubanini-mali bomshuwalense wabucala okanye kwiintlawulo zokuzimela.
Kukho kwakhona kunokungabikho kwamaphandle kwabanikezeli beendawo zasemaphandleni njengoko izibonelelo ezingenakho ukuba zingekho kumalungiselelo angafanelanga. Kunokuba ajezise izigulane ngenxa yokungakwazi ukufikelela, oogqirha banokukwazi ukubonelela i-CPAP kwizigulane zabo kwiofisi enye.
Kukho iintlobo zezohlwayo ezikhoyo xa ababoneleli bephula umthetho we-Stark. Iintlawulo zinokuphikiswa kunye nokubuyiselwa kwembuyekezo kungenziwa ukuba kuhlawulwe kwixabiso eliqokelelwa ngokuphula umthetho. Ukongezelela, iintlawulo zomntu ezifikelela kwii-15,000 zama-altare nganye kwibango enqatshelweyo ingahlolwa. Ukuba ugqirha uzama ukukhupha umthetho ngokulungelelanisa, i-penalty ye-civic penalty iya kwi $ 100,000 kwisikimu ngasinye.
ILizwi
Le mithetho ikhona ukukhusela izigulane kwiintlobo ezingenangqiqo eziza kuthatha inzuzo yezemali kubantu abahluphekileyo. Uninzi lwababanikeli banikezeli ukwenza i-buck bakhawuleza kwaye baziphathe ngendlela efanelekileyo yokukhonza izigulane zabo. Ngelishwa, le mingcele yomthetho ingafuneka ukuba ujezise abo abangagcini izigulane zabo kuqala. Kunokuba kukho utshintsho oluthe xaxa emthethweni, kodwa xa unomuva ngathi uthathe inzuzo, fi kelela kwi-Ofisi yoMhloli-Jikelele kwiSebe lezeMpilo neSebe lezeMpilo yase-United States ngokubiza (800) 447-8477.
> Imithombo:
> I-American Academy ye-Medicine Sleep. IKomiti yezeMali yeSenate ibona ukuhlaziywa komthetho weStark. " Julayi 14, 2016.
> Brown, DB. "Ukulala kweMithi yeMpilo kunye nokuthobela-eMelika" kwiMigaqo kunye nokuSebenza kweMithi yokulala , ehleliwe nguKryger, MH et al . Elsevier , edition 6, 2017, iphe. 670-674.
> " Amasebe e-Medicare kunye neeNkonzo zeMilicaid . Agasti 2014.
> "I-Ofisi yoMhloli-Jikelele. I-roadmap yamagqirha amatsha: imithetho yokukhwabanisa nokusetyenziswa kakubi." Septemba 2017.
> UStaman J. " Ukunyamekelwa kwempilo yonyango kunye nokusetyenziswa kakubi komthetho ochaphazela i-Medicare neMedicaid: umxholo ." (I-Congressional. Bika iNombolo 2222743). IWashington DC: iThala leeNcwadi yeCongress Research Service, ngoSeptemba 8, 2014.