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This would entail the establishment of minimum quality criteria, as well as a willingness to participate among Mexican providers. Certification might be achieved in collaboration with Mexican institutions, such as the MoH, and would accomplish several things. First, it would enable Medicare to require providers to report cost and quality data for example, the submission of detailed hospital cost data by department, by which diagnosis related group [DRG] reimbursement rates are determined.

It also would provide a means to establish the authenticity of providers, limiting the potential for fraud and abuse. Finally, it would provide a means of enabling oversight by which quality and efficiency could be improved over time. However, unless there is some expectation that Medicare patient volume will be great enough, Mexican institutional health care providers may not be willing to participate in a costly Medicare certification process.

Determination of reimbursement rates for Mexican providers. There are roughly 20 categories of service by which Medicare pays providers.

Each has its own rules stipulating schedules for payment, and each would have to be adapted to deal with the differences between the Mexican and U. For example, Medicare pays physicians based on analyses of the resources used for each type of encounter, referred to as a resource-based relative value scale RBRVS.

Inpatient admissions are reimbursed for bundles of services based on the DRG of the admission. Reimbursement rates for DRGs are based on national hospital cost accounting, with very little geographic variation. In addition, Medicare requires that these reimbursements be accepted as payment in full and, except for applicable co-payments, prohibits balance billing, whereby providers collect any remaining charges directly from the Medicare beneficiary. Given differences in patterns of care, resource use, and prices in Mexico, each of the reimbursement schedules and methodologies would have to be revisited.

Because there are more than 40 million Medicare enrollees in the United States, the complex infrastructure generates a very small administrative cost per enrollee. However, with significantly fewer potential beneficiaries to share the costs, duplication or modification of this infrastructure for Mexico could be prohibitively expensive.

In addition, operation of this kind of Medicare program would likely require close oversight and regulation of Mexican medical institutions by a U. Coordination with existing Mexican institutions. In the United States, Medicare is always the first payer when an individual has additional types of insurance. In these cases, the additional insurance e. Medicaid, Medigap, or other supplemental insurance may cover part or all of the Medicare co-payments and deductibles for which the Medicare beneficiary would otherwise be responsible.

With the expansion of Medicare Parts A and B to Mexico, structures would be required to coordinate coverage from the potentially multiple insurers.

For example, Mexico, which currently allows Americans to buy into IMSS for a modest price, would need to revisit this policy to determine the best way to coordinate coverage with Medicare, perhaps preventing Medicare-eligible residents from purchasing IMSS.

At a minimum, appropriate coordination of coverage would require administrative oversight, which could be provided by the Mexican government, CMS, or both. Determination of premium rates. The additional administrative costs that would be required to establish Original Medicare in Mexico would be substantial. Enrollment could require the payment of additional premiums by Mexican residents to cover these costs, but they would likely be considerable.

Additional premiums required to cover administrative costs would make the Original Medicare program in Mexico particularly unattractive, especially when compared against the costs of buying into IMSS. Mexico, of course, could consider preventing Medicare-eligible individuals from joining IMSS, but expecting Mexican residents to pay such a high premium might still be unrealistic given the relatively low cost of paying out-of-pocket for care in Mexico.

Alternatively, coverage in Mexico could be automatically included as part of all Original Medicare enrollment, with the additional administrative costs borne by all Medicare enrollees.

This would, of course, eliminate the disincentive to enroll, and it could be financed in part by reductions in expenditures through the utilization of lower-priced care in Mexico.

A second policy option would be for Medicare to develop a traditional indemnity insurance plan that would cover some or all of the services covered by Original Medicare.

Such a plan potentially Medicare Part E would serve as a third-party payer, with CMS making fee-for-service payments directly to providers or to beneficiaries as reimbursement for medical services. It could be designed to mirror other insurance programs with international coverage, such as TRICARE for Life, taking advantage of their existing administrative infrastructures.

Although many of the same issues described in Option 1 would still require consideration, the most burdensome would be avoided: Medicare would reimburse based on Mexico’s existing price system in lieu of developing a new, complex reimbursement rate infrastructure specific to Mexico.

Because this is a Medicare program funded by taxpayer dollars, some—and perhaps a substantial—level of oversight might be required to address concerns about the potential for fraud and abuse, as well as about quality and quality improvement. In addition, coordination with the Mexican MoH and other relevant institutions would be necessary to address concerns about multiple insurance, additional elements of fraud, means to certify quality, and mechanisms to improve quality.

Such collaboration could significantly reduce the costs of what would otherwise be duplicative Medicare administrative structures. At the same time, it could provide opportunities for capacity-building and quality improvement within Mexican institutions, as well as contribute to the development of stronger ties and working relationships between the U. Medicare Advantage plans are managed care organizations that enroll Medicare-eligible individuals and receive capitation payments from Medicare in return for the provision of patient care.

Expansion of Medicare Advantage could be a relatively easy way to expand Medicare coverage to beneficiaries living abroad. This would entail relatively little additional administrative costs for CMS, as the Advantage plans would be responsible for administering the provision of and reimbursement for covered services provided in Mexico.

Unlike Option 2, the market would determine the extent to which the Advantage plans are available, and the Advantage plans, rather than CMS, would bear the cost risk. This option could lead to the development of niche plans that specialize in services abroad. By relying on the market, it could result in the development of plans and coverage that best meet the needs and interests of enrollees. The development of such plans, however, might be limited if the demand is not sufficient.

While this might not be a problem if large Advantage Abroad plans developed with operations across several different counties, the substantial differences in health care systems across countries could limit the potential for such multi-country plans. Country-specific plans e. Given the varying estimates of the current number of Medicare-eligible individuals living in Mexico, this is currently an open question. The Ministry for Foreign and European Affairs and Trade does not and cannot make decisions for Maltese nationals about whether, when or where they should live, work or travel to.

The decision to live, work or travel abroad is personal and so the Ministry is not liable for any decisions taken in this regard. Maltese nationals are responsible for their own safety and security, particularly whenever there is an uncertain security environment. Maltese nationals can keep up to date with travel advice by checking the travel advice section on the website of the Ministry for Foreign and European Affairs and Trade.

This app – Malta Travel Point , that can be downloaded free of charge from the App Store or Google Play aims to address difficulties that Maltese citizens may encounter while travelling abroad.

Malta Travel Point offers simple and direct information in case travellers need information on the nearest hospital or police station in the area as well as contact details of the nearest diplomatic representation. The information is available in Maltese and English languages. Thanks to this app, Maltese citizens may access important telephone numbers when they need them most as well as a host of other valuable information.

This application is part of Maltapps launched by the government to make its services more accessible to the public. Ministry for Foreign and European Affairs and Trade. Introduction The Ministry for Foreign and European Affairs and Trade of Malta provides travel advice on its website to inform the general public of conditions abroad that may affect the safety and security of Maltese nationals travelling, working or living abroad.

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Opm usa jobs government jobs in puerto vallarta – opm usa jobs government jobs in puerto vallarta

 

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Opm usa jobs government jobs in puerto vallarta – opm usa jobs government jobs in puerto vallarta.Job Openings

 
 
Podcast Episode Dr. Want to explore the surrounding area /4097.txt recruiters to review to: Human. Permanent Secretary. As Euripides said, „The god of war hates those who hesitate. American citizens living in Mexico do maintain access to Medicare benefits in the United States, but this requires often significant travel expenses and is sometimes very difficult or impossible due to health conditions. Will advi.

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