CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 32 0000. ref SDS 31 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060508 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Talked to Geoff on 071012 about legal support for Millie's case.
060902 - ref SDS 26 X58I
060904 -  ..
060905 - Called Geoff back yesterday, and discussed three issues...
060906 -
060907 -    1.  Kaiser notice of MCRC Regional Appeals Committee review per
060908 -        Paula's letter received on 071010. ref SDS 25 TH8L
060910 -         ..
060911 -        Guidance on preparing and presenting Millie's case, per the
060912 -        letter to Kaiser yesterday. ref SDS 32 TH8L
060914 -         ..
060915 -        There seem to be a bunch of procedural questions listed on
060916 -        071010, ref SDS 25 4V7H, which hopefully will be pared down
060917 -        after Paula responds to Millie's letter.
060918 -
060920 -         ..
060921 -    2.  Legal arguments for Kaiser to pay the cost of prescribed
060922 -        treatment, listed on 070927, ref SDS 19 WU6M, and beginning
060923 -        with #1 concerning the patient's right to rely on the doctor.
060924 -        ref SDS 19 8G5N
060926 -         ..
060927 -        Main need or at least curiosity is to find statute on Medicare
060928 -        requirements that underly Section 2 of Kaiser's EOC calling for
060929 -        doctor's to prescribe treatment for covered services, reviewed
060930 -        on 070927. ref SDS 19 WS6M
060932 -         ..
060933 -        On 070917 we found Title 42 part 419.40 calls for minimum 20%
060934 -        coinsurance, and Medicare pays the rest for clinical trials,
060935 -        ref SDS 17 TN3O, and further that service providers can
060936 -        advertize to compete for business to pay for conisurance with
060937 -        Medigap (supplemental) coverage. ref SDS 17 6G5H
060939 -         ..
060940 -        We would like to get the specific citation and actual languge
060941 -        that authorizes Medicare support for clinical trials, and to
060942 -        get the intent, whether "self-referral" provisions prevent
060943 -        Kaiser from prescribing treatment as explained by Millie's
060944 -        doctor at Kaiser on 040318? ref SDS 4 PU6M
060946 -         ..
060947 -        This question was submitted to CMS in a letter on 071002.
060948 -        ref SDS 20 OY4Q  CMS reported on 071009 they submitted the
060949 -        question for research. ref SDS 24 R66K
060950 -
060952 -         ..
060953 -    3.  What to do about UCSF demands for payment which Millie holds
060954 -        are payable by Kaiser, and which seem to continue escalating
060955 -        with confusing duplications and mind numbing details that lack
060956 -        any correlation to charges for services performed, and so fail
060957 -        compliance with UCSF patient Bill of Rights for information
060958 -        that is complete and clear, reported on 070830. ref SDS 14 WU5N
060960 -         ..
060961 -        A letter on 071024 asked UCSF for suggestions on making interim
060962 -        payment. ref SDS 29 EP6P
060964 -         ..
060965 -        UCSF replied with demand for immediate of a particular listing
060966 -        of charges, which turned out to be incomplete, and raised
060967 -        concerns about duplication of charges.
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0610 -