DISCUSSION QUESTIONS

1. What do we mean when we say that the long-term care system is reimbursement-driven?

2. Who is covered by Medicare? Medicaid?

· Medicare:
· Medicaid:

3. What long-term care services does Medicare cover? What restrictions are placed on them?

· Skilled nursing care in nursing facilities and subacute care
· Home health care
· Hospice care

4. What long-term care services does Medicaid cover? What restrictions are placed on them?

5. What is the "spend down" provision of Medicaid, and why is it controversial?

6. What is the purpose of waiver programs?

7. What are public-private partnerships?

8. Why has managed care taken hold more slowly in long-term care than in other segments of health care?

9. What are the most common forms of managed care organizations?

10. What is the managed care bill of rights and why is it needed?