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Medicaid (AND Medicare) to Quit Paying for Preventable Events ( read what they consider as such)
Medpagetoday ^ | June1, 2011 | Emily P. Walker

Posted on 06/01/2011 6:32:08 PM PDT by UniqueViews

WASHINGTON -- The Centers for Medicare and Medicaid Services (CMS) has announced that hospitals and healthcare providers will no longer be reimbursed for treating their Medicaid patients for illnesses, injuries, or readmissions that should have been prevented.

A final rule announced Wednesday enacts a portion of the Affordable Care Act (ACA) that prohibits states from making Medicaid payments to providers for conditions that are deemed "reasonably preventable."

In 2008, Medicare stopped reimbursing hospitals for treating conditions, infections, or illnesses that were acquired in the hospital, and for any readmissions associated with treating those hospital-acquired conditions.

The Medicaid list of what is preventable mirrors the Medicare list, which includes transfusing the wrong blood type; falls that result in dislocation, fractures, or head injuries; burns and electric shocks; catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control.

In addition, CMS has issued National Coverage Decisions stating that Medicare won't pay for certain so-called "never events" -- those which should never happen -- including performing the wrong procedure; performing the procedure on the wrong body part, or performing the correct procedure, but on the wrong patient.

Medicaid will also follow Medicare's lead on that issue and not pay for never events.

"These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors," CMS Administrator Donald Berwick, MD, said in a press release. "As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time."

States can identify additional preventable conditions for which Medicaid payment will be denied.

The final rule is effective July 1, 2011, but gives states the option to implement between its effective date and July 1, 2012.

Since Medicare enacted its policy of not paying for preventable events, private insurers have begun to do the same.

For instance, Aetna doesn't reimburse for eight hospital-acquired infections or for three never events, according to information provided by America's Health Insurance Plans (AHIP), an industry trade group. Cigna doesn't pay for never events, reduces payments for hospital-acquired infections in certain cases, and offers payment incentives for hospitals who follow standardized protocols to improve patient safety, AHIP said.


TOPICS: Culture/Society; Extended News; Front Page News; Government
KEYWORDS: deathpanels; health; lifehate; medicaid; medicare; obamacare; populationcontrol; rationing; sociopaths
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Note the list includes things like:

"catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control."

Not paying for treatment of infection -- almost any infection can be claimed to be "preventable" -- , not paying for diabetes complications, if they can be blamed on "poor glycemic control" -- what is going to happen to those people -- if this isn't rationing, what is?!

They also consider preventable and won't be paying for accidents: "falls that result in dislocation, fractures, or head injuries; burns and electric shocks"

Everything is all your fault and Obamacare won't cover it. If you have an accident or acquire an illness that "THEY" consider "preventable" your medical care is not covered. And if Medicaid and Medicare won't pay for it, watch private insurance exclude those also -- for however long there is private insurance.

"Since Medicare enacted its policy of not paying for preventable events, private insurers have begun to do the same"

Instead of focusing on eliminating fraud and abuse in Medicaid and reforming Medicare, they are not paying for treatment, let them all die!

And as for things that happen in hospitals -- are all patients supposed to sue the hospital now?

Obamacare is worse than anything anyone could have imagined and this is going to get much worse.

1 posted on 06/01/2011 6:32:10 PM PDT by UniqueViews
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To: UniqueViews

With abortion, everything is preventable. So does that mean we will be abolishing medicare?


2 posted on 06/01/2011 6:36:10 PM PDT by Brilliant
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To: UniqueViews
A final rule announced Wednesday enacts a portion of the Affordable Care Act (ACA) that prohibits states from making Medicaid payments to providers for conditions that are deemed "reasonably preventable."

Well, there go the abortionists.

3 posted on 06/01/2011 6:36:22 PM PDT by hinckley buzzard
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To: UniqueViews

Just wait till the first time granny falls and breaks her hip in the hospital and they refuse to treat it because Medicare won’t pay...


4 posted on 06/01/2011 6:39:08 PM PDT by apillar
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To: UniqueViews

bookmarked


5 posted on 06/01/2011 6:40:03 PM PDT by BlueAngel
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To: UniqueViews

You’re fat because you have poor self control and eat lots of junk food. Your heart attack and hospital stay can be directly attributed to your obesity. And since your obesity is something you refuse to control, we ain’t gonna pay for your heart attack.

Just wait.


6 posted on 06/01/2011 6:41:52 PM PDT by upchuck (Think you know hardship? Ha! Wait till the dollar is no longer the world's reserve currency.)
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To: ExTexasRedhead; JulieRNR21

No doubt that ObamaCare contributed to this.


7 posted on 06/01/2011 6:42:25 PM PDT by Clintonfatigued (Muslims are a people of love, peace, and goodwill, and if you say that they aren't, they'll kill you)
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To: UniqueViews

What are the odds that if the insurer won’t pay for it, somehow it will become the financial responsibility of the patient? Oh and don’t forget that if it is related to pre-existing conditions-like you being obese or a smoker, it is YOUR FAULT and not covered either. REPEAL the entire egregious ObamaCare bill!


8 posted on 06/01/2011 6:42:59 PM PDT by Pat4ever (AF Vet)
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To: UniqueViews

Pregnancy is preventable.


9 posted on 06/01/2011 6:43:07 PM PDT by ez ("Abashed the devil stood and felt how awful goodness is." - Milton, Paradise Lost)
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To: UniqueViews

rationing.


10 posted on 06/01/2011 6:43:28 PM PDT by Doogle ((USAF.68-73..8th TFW Ubon Thailand..never store a threat you should have eliminated))
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To: UniqueViews

Pregnancy is ‘resonably preventable’. Does this mean Medicaid will no longer cover abortions?


11 posted on 06/01/2011 6:46:41 PM PDT by PeaceBeWithYou (De Oppresso Liber! (50 million and counting in Afghanistan and Iraq))
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To: UniqueViews

Death Panels. Pure and Simple.
Media assists Demoncrats in saying Paul Ryan’s Budget proposal will kill Granny. Well, no, the HHS is doing it now.

Get the government the hell out of healthcare.


12 posted on 06/01/2011 6:47:22 PM PDT by Shady (The President has become Judas.......)
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To: UniqueViews
The Medicaid list of what is preventable mirrors the Medicare list, which includes... falls that result in dislocation, fractures, or head injuries.

Oh, sweet. Under the new Medicaid rules, I would have had to pay for having my broken elbow repaired after I fell while crossing the street on an Army post. Even though the Army did an investigation and determined that I fell because it was a construction zone which I had to cross to get to the parking lot--that just confirms that the injury was preventable (they could have put the construction zone elsewhere, right?).

When you get right down to it, most conditions are preventable. Well, Obama *did* claim that Obamacare would save money.

13 posted on 06/01/2011 6:47:22 PM PDT by exDemMom (Now that I've finally accepted that I'm living a bad hair life, I'm more at peace with the world.)
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To: UniqueViews

This list is similar to existing practice with a twist. If a hospital admits neglience or neglience is demonstrated through a civil proceeding, Medicare, Medicaid, and most private insurance must be reimbursed. The legal term is subrogation. Neither government nor private insurers will initiate the proceedings. They essentially pile on the plaintiffs case, doing nothing to contribute to the case. However, they will take the plaintiffs judgment if the plaintiff does not include reimbursement.

This policy seems to be taking a more active role. Government will probably require more hospital reporting potentially increasing costs. In addition, government may decide to become the judge of these acts. Government can just refuse to pay making its own judgment. Most of the major cases are already handled through litigation and voluntary hospital settlements.

I see this policy primarily as a tool to stiff health care providers. Health care providers will in turn pass the added costs to consumers. I am not sure anyone can provide much evidence on many minor cases. Unfortunately, hospitals cannot eliminate all of these incidents. Some level of these incidents will still occur no matter the care taken.

Welcome to Obamacare! Please answer the questions from the health care police or go directly to jail.


14 posted on 06/01/2011 6:48:01 PM PDT by businessprofessor
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To: Brilliant
I remember the patient who went to the OR for brain surgery and woke up with a bandaged knee.
15 posted on 06/01/2011 6:51:02 PM PDT by JPG (Sarah Palin, driving the MSM crazy one day at a time.)
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To: UniqueViews
I recall a meeting between doctors and Medicaid and Medicare reps, at the state mental hospital. After an hour of incomprehensible bureaucratic B.S., I asked what we could do to reduce our citation rate (i.e., we goofed and got nailed for it)--and isn't there a manual we can follow that tells what your rules are?

The reps said--'No Manual, just do what you do and we'll tell you when you violate...'

I walked out and the rest of my colleagues followed.

16 posted on 06/01/2011 6:51:26 PM PDT by Rudder (The Main Stream Media is Our Enemy---get used to it.)
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To: apillar
The hospital can't refuse to treat it. They are just stuck with not getting paid.

All of these things they aren't paying for, by the way, are things happening in the hospital, not on the outside.

According to Medicare, and now Medicaid, the hospital shouldn't allow Granny to fall and break her hip. If she does, it's their fault, so they should eat the cost.

Those of us who live in the real world know that when you deal with people, things don't always go according to plan. My dad, now deceased, fell multiple times in the nursing home and the hospital. It's a wonder he never broke anything. Not a single fall was the fault of anyone but himself. He circumvented everything that was tried to keep him from falling, including incessant reminders not to get up by himself. He was determined to do it anyway. (Once he even took a nursing assistant down with him).

In an ideal world, patients would never fall, never get catheter infections, never get surgical wound infections, but we don't live in an ideal world. Sometimes the best everyone can do isn't good enough and things can happen. (I'd like to see the people who write the rules keep the diabetic's blood sugar under control when the diabetic has family members smuggling in food, or when the patient sneaks out to the vending machines in the cafeteria- or to the convenience store down the street!)

Right now this applies to hospitals. I would not be shocked to hear in the fairly near future that it applies to individual patients and providers.

17 posted on 06/01/2011 6:54:34 PM PDT by susannah59
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To: exDemMom

Not that I agree with the policy, but they are talking about “fall that result...” that occur while you are in the hospital (and probably nursing home as well)


18 posted on 06/01/2011 6:55:49 PM PDT by SendShaqtoIraq
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To: Doogle
"rationing"

With the Ascended 0ne and his minions, rationing is the end game, but this rule actually makes some sense. Granny gets a hospital acquired infection but is discharged home anyway but has to be readmitted in a few days to treat the infection that the hospital was at fault for. Old system, the hospital would get two payments, one for each admission. New system the hospital no longer has incentive for a premature discharge because they will receive only one payment for the episode of care. Granny incurs no financial risk for the unnecessary second admission. Should not the hospital have some accountability for quality of care?

19 posted on 06/01/2011 6:57:01 PM PDT by buckalfa (Confused and Bewildered With a Glass Half Empty)
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To: UniqueViews
Wonder if a preventable but “politicized disease” like AIDs will be on “the list.”
20 posted on 06/01/2011 6:57:20 PM PDT by dhs12345
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To: upchuck

Just wait until the queers figure this one out, LOL.


21 posted on 06/01/2011 6:58:27 PM PDT by org.whodat
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To: UniqueViews

This is just the start. By the time they are finished...there won’t be anything that isn’t the patient’s “fault”.

The idea that any of this will “save money” is laughable...because failing to treat these issue ...will lead to far more serious ones I would expect.

They are broke. and rather than step up to the plate and honestly admit it...they gonna play games with We the People..their employers. That can’t lead to a peaceful collaborative outcome in the end.


22 posted on 06/01/2011 6:58:35 PM PDT by mo ("If you understand, no explanation is needed; if you do not, no explanation is possible")
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To: Brilliant
The pregnancy is preventable .. so no coverage; thus, the abortion is 'preventable' .. no coverage.


Congress .. grow a pair and throw this shit out lock, stock and barrel.

Then get rid of obama.

23 posted on 06/01/2011 6:58:48 PM PDT by knarf (I say things that are true ... I have no proof ... but they're true)
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To: UniqueViews
We will still sleep well as long as we know that Congress,
Obama and all federal bureaucrats will keep their taxpayer
paid gold plated medical care covering all contingencies.


24 posted on 06/01/2011 7:00:05 PM PDT by Iron Munro (The purpose of fighting is to win. There is no possible victory in defense. -- John Steinbeck)
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To: buckalfa

...and do you expect there WILL NOT BE any special wavers?..for certain class of people?...union members?


25 posted on 06/01/2011 7:01:57 PM PDT by Doogle ((USAF.68-73..8th TFW Ubon Thailand..never store a threat you should have eliminated))
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To: Doogle
And those in power will decide you gets treatment and who doesn't.

Sort of like the current waiver frenzy. Who gets waivers and who doesn't — apparently the well connected and those who are in good favor with the those in power... and supported the thing, Obamacare, that the want waivers for.

Does this make sense? Absolutely not. But when you realize that it is a huge power play, then yes it makes sense.

26 posted on 06/01/2011 7:02:13 PM PDT by dhs12345
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To: Doogle

wavers?=waivers


27 posted on 06/01/2011 7:03:25 PM PDT by Doogle ((USAF.68-73..8th TFW Ubon Thailand..never store a threat you should have eliminated))
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To: UniqueViews
are all patients supposed to sue the hospital now?

Yes, indeed we should if a hospital does things like this to us:

""transfusing the wrong blood type; falls that result in dislocation, fractures, or head injuries; burns and electric shocks; catheter-associated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control...
performing the wrong procedure; performing the procedure on the wrong body part, or performing the correct procedure, but on the wrong patient.""

28 posted on 06/01/2011 7:03:46 PM PDT by iowamark
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To: UniqueViews

Just tweeted ... does this mean everyone to be aborted to prevent life?

After all, if no one was born, nothing medical would occur to them.

SHAMELESSLY HATEFUL Obama!


29 posted on 06/01/2011 7:04:34 PM PDT by HighlyOpinionated (I am a US Citizen, A Patriot, A TEA Partier, An Oath Keeper, A Voter, An Auburn Fan!)
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To: Brilliant

Well now that’s real humane.

How’s that going for you, dems?


30 posted on 06/01/2011 7:08:04 PM PDT by TribalPrincess2U (VOTE out the RATS! Go Sarah!)
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To: UniqueViews

The government is only talking about not reimbursing events which occur in hospital, for which the hospital is held accountable. The hospital will have to eat the losses for such things as falls in hospital. But will Medicaid and Medicare pay for a sitter in with each disoriented post-op patient or sundowning demented patient? No.

Will the gov’t not require hospitals to treat patient-generated never events, such as skipping three dialysis treatments or hold-mah-beer injuries? No, EMTALA will still require hospitals to treat and stabilize patients, even if no payment is forthcoming.


31 posted on 06/01/2011 7:11:33 PM PDT by heartwood
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To: UniqueViews

“... performing the correct procedure, but on the wrong patient. “

I don’t know- how about paying half? They were half right...


32 posted on 06/01/2011 7:12:17 PM PDT by mrsmith
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To: UniqueViews

A classic example of how Ayn Rand warned about the consequences of allowing someone else to dictate what you “need”. You don’t need that
big car or a gun. You do need an insurance policy...and we’ll prosecute you if you fail to buy one. The control freaks are itching to direct your every move.


33 posted on 06/01/2011 7:13:08 PM PDT by Myrddin
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To: UniqueViews

We The People will have to organize and ensure that this Holocaust is repealed. Anyone in DC not on board with stopping this Nazi scheme must be voted out.


34 posted on 06/01/2011 7:13:52 PM PDT by ExTexasRedhead
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To: UniqueViews

They will die.

Or they will pay their own way. But I suspect that won’t be allowed much longer anyway.


35 posted on 06/01/2011 7:17:54 PM PDT by redgolum ("God is dead" -- Nietzsche. "Nietzsche is dead" -- God.)
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To: susannah59

“They are just stuck with not getting paid.”
... and therefore having to make the cost up from charges to the other patients.

That’s always been their only recourse with government healthcare. There’s no negotiation.

(These rules do sound reasonable, though a very small amount of error could be allowed.)


36 posted on 06/01/2011 7:19:16 PM PDT by mrsmith
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To: iowamark
Certainly, wrong site/wrong patient procedures should never happen (they are called "never events" for a reason) and are likely grounds for a suit.

Falls, infections, and the like are not always preventable. Not every bad thing that happens to a hospitalized patient is the result of malpractice, negligence, poor technique, or an error.

Sometimes, things just happen. Sometimes, people play an active role in bad things happening to them in the hospital, just as they do outside the hospital.

37 posted on 06/01/2011 7:19:35 PM PDT by susannah59
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To: Doogle
“and do you expect there WILL NOT BE any special wavers”

I too share your skepticism, but this is a reimbursement issue and not a coverage issue. Having worked in hospital management for thirty years, too many hospitals spend more time gaming the government reimbursement system than they do in promoting quality care. Hospitals should do the right thing and provide some modicum of quality (value) in exchange for payment from the tax payers. The down side is that each new regulation is a step towards a national health system.

38 posted on 06/01/2011 7:20:41 PM PDT by buckalfa (Confused and Bewildered With a Glass Half Empty)
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To: JPG

That is probably preferable to going in for knee surgery and waking up with a bandaged head.


39 posted on 06/01/2011 7:20:46 PM PDT by RipSawyer (Trying to reason with a liberal is like teaching algebra to a tomcat.)
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To: UniqueViews

How’s that hope and change tasting now you bunch of Obama hack AARP @$$holes?


40 posted on 06/01/2011 7:22:32 PM PDT by RoadKingSE (How do you know that the light at the end of the tunnel isn't a muzzle flash ?)
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To: UniqueViews

The American people should know who is on the Death Panel and be given a map of directions to their houses, pictures of their families, places of business, schools, etc. I think I’ll begin working on just that.


41 posted on 06/01/2011 7:23:57 PM PDT by Dogbert41
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To: redgolum

Texas has considered and a lot of other states will be considering dropping Medicaid. Texas did a study and found that by dropping the federal funding and requirements, they could possibly come out better by going alone with a strictly controlled state program (no abortions, no illegals, mandatory co-pays, etc.). Hopefully Texas will do it in the future.


42 posted on 06/01/2011 7:23:57 PM PDT by RetiredTexasVet (There's a pill for just about everything ... except stupid!)
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To: apillar

Liberal-designed Holocaust II. Pelosi et al. want the power to decide who lives and who dies by their decree. Do you doubt that we’re all labeled in Big Bro’s database by religion, political affiliation, activism, Freeper status, and whatever else they will deem their enemies to be.


43 posted on 06/01/2011 7:26:55 PM PDT by ExTexasRedhead
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To: UniqueViews

This is all more confusing than tax law.

Also, I’m starting to wonder if Karl Marx got his start selling insurance.


44 posted on 06/01/2011 7:35:07 PM PDT by 668 - Neighbor of the Beast (Please sir...permission to protest?)
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To: RetiredTexasVet

I love the idea of dropping it and going private. I worked Medicaid cases for the State several years ago and found the potential for fraud was enormous. Not enough oversight or control....and too many people “working the system”.


45 posted on 06/01/2011 7:38:04 PM PDT by LaineyDee (Don't mess with Texas wimmen!)
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To: UniqueViews

Does Medicaid/Medicare still pay for Viagra??


46 posted on 06/01/2011 7:42:31 PM PDT by elpadre (AfganistaMr Obama said the goal was to "disrupt, dismantle and defeat al-Qaeda" and its allies.)
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To: apillar

Oh, they’ll treat it. It’s just that YOU are going to pay for it ...through your state and local taxes ... for that hospital to stay standing.

And the “care” is going to look waaaaay different.

Hey, Cuba supposedly has the BEST care in the world, man! Now, they don’t pay their doctors anything...but heck, who cares!


47 posted on 06/01/2011 7:43:43 PM PDT by LibsRJerks
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To: upchuck
"You’re fat because you have poor self control and eat lots of junk food. Your heart attack and hospital stay can be directly attributed to your obesity. And since your obesity is something you refuse to control, we ain’t gonna pay for your heart attack."

I see no reason for the taxpayer to pay for that under ANY circumstances.

48 posted on 06/01/2011 7:47:33 PM PDT by Mariner (War Criminal #18)
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To: susannah59
Regulations don't allow any kind of restraint for chronic "fallers" like your Dad... which has increased these types of episodes in facilities.

You take an elderly person who is confused or disoriented, put them in a bed with no side rails or a wheelchair with no lap buddy... and you're asking for disaster. If they're easily excitable, it just compounds the chances of injuries.

The reasoning? They have a "right" to fall. We live in an upside down world.

49 posted on 06/01/2011 7:47:50 PM PDT by LaineyDee (Don't mess with Texas wimmen!)
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To: PeaceBeWithYou
"Pregnancy is ‘resonably preventable’. Does this mean Medicaid will no longer cover abortions?"

Yes, and it shouldn't pay for the births either.

50 posted on 06/01/2011 7:51:41 PM PDT by Mariner (War Criminal #18)
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