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High efficacy of high dose intravenous ceftriaxone against extragenital gonorrhoeaCeftriaxone monotherapy is well established for treating Neisseria gonorrhoeae (NG) urethritis, cheap viagra online but data are limited for pharyngeal and rectal s. This prospective single-centre study was conducted in Japan in 2017–2020 among HIV-negative men who have sex with men cheap viagra online (MSM) who underwent routine STI screening, including nucleic acid amplification tests (NAATs) for rectal and pharyngeal NG every 3 months.1 Among 320 cases of extragenital gonorrhoea (all asymptomatic), 208 received only ceftriaxone (single 1 g intravenous dose) and 112 received additional treatment with doxycycline (100 mg two times a day for 7 days) or azithromycin (single 1 g dose) for concomitant STIs (predominantly, Chlamydia trachomatis (CT)). There was no difference in NG cure rates between the two groups (98.1% vs 95.5%) or by site.

Data are needed for other ceftriaxone dosing strategies and in cheap viagra online areas where ceftriaxone resistance is a major concern.Published in STI—The Editor’s Choice. Neisseria gonorrhoeae is associated with poor pregnancy and birth outcomesThis systematic cheap viagra online review and meta-analysis compiled data from 30 studies that reported NG testing during pregnancy and compared pregnancy and birth outcomes between women with and without NG.2 Results indicated that NG s during pregnancy nearly doubled the risk of preterm birth (summary adjusted OR 1.90. 95% CI 1.14 to 3.19).

The effect was more pronounced in low-income cheap viagra online and middle-income countries than in high-income countries. Additionally, results suggested that NG may cheap viagra online be associated with premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum, although estimates in most studies did not sufficiently control for confounders. The findings identify NG s as risk factor for poor pregnancy outcomes.Inadvertent HPV vaccination during or peripregnancy is not associated with adverse outcomesHuman papillomaviagra (HPV) vaccination is not recommended in pregnancy due to lack of safety data.

However, a cheap viagra online pregnancy test is not required prior to vaccination. This multisite cohort study collated data from 445 women who received the nonavalent HPV treatment during pregnancy and 496 that received the treatment peripregnancy (within 42 days before last menstrual period (LMP)).3 Pregnancy and neonatal outcomes in these groups were compared with those of 552 distal (16–22 weeks pre-LMP) exposures to the quadrivalent or nonavalent HPV treatment. Compared with distal-exposures, during-pregnancy or peripregnancy, exposures cheap viagra online were not associated with spontaneous abortion, preterm birth or small-for-gestational-age births.

Birth defects were rare cheap viagra online in all groups. The findings inform counselling for women who inadvertently receive the nonavalent (and possibly quadrivalent) HPV treatment during pregnancy. Data are needed for cheap viagra online the bivalent HPV treatment.Has the time come for point-of-care STI testing?.

Point-of-care (POC) STI testing has been proposed as a strategy to both cheap viagra online improve treatment rates and optimise antibiotic stewardship. This study investigated the performance of the Visby Medical Sexual Health Test, a POC PCR-based NAAT for rapid (30 m) detection of CT, NG and Trichomonas vaginalis (TV).4 The analysis used self-collected vaginal samples from 1535 women who attended 10 clinics in seven US states over an 11-month period. Results were compared with those of clinician-collected samples tested using cheap viagra online gold-standard laboratory-based NAATs.

Specificity and sensitivity of the POC test were 98.3% and 97.4% for CT, 97.4% and 99.4% for NG and 99.2% and 96.9% for TV. These results highlight the potential utility of easy-to-use POC NAATs in clinical practice.Point of care HIV-1 RNA testing facilitates the same-day confirmation of HIV and leads to rapid viral suppression when cheap viagra online followed by immediate antiretroviral treatmentMSM with primary HIV (PHI) and those with established but undiagnosed can be an important source of onward transmission. This study cheap viagra online from Amsterdam evaluated a strategy comprising.

(i) an online media campaign to increase awareness about PHI among MSM and promote self-referral for testing, (ii) qualitative POC HIV-1 RNA testing for same-day confirmation of and delivery of results and (iii) immediate referral of newly diagnosed men to a treatment centre to initiate antiretroviral therapy (ART within 24 hours.5 Time to viral suppression was only 55 days for MSM who benefitted from the strategy and shorter than previous strategies that deferred ART initiation and/or did not employ HIV-1 RNA POC testing. The approach proved feasible in Amsterdam and should be investigated in other settings.Pre-exposure prophylaxis, HIV incidence and risk behaviour among MSM in West AfricaThis prospective cohort study investigated the use of pre-exposure prophylaxis (PrEP) among MSM in Côte D’Ivoire, Mali, Togo and Burkina Faso as an extension of CohMSM, a prevention study that did not include PrEP.6 Participants were free to choose between daily or event-driven PrEP, change between the two and cheap viagra online stop and restart PrEP. Among 598 MSM cheap viagra online followed for 743.6 person years, HIV incidence was 2.3 per 100 person-years (95% CI 1.3 to 3.7) and lower than in CohMSM (adjusted incidence rate ratio 0.21.

95% CI 0.12 to 0.36). There was cheap viagra online no evidence of an increase in risk behaviour since reports of condomless anal sex and prevalence of STIs remained stable, whereas the number of male sexual partners and of sex acts with casual male partners decreased. PrEP is an effective prevention tool for MSM in West Africa.Ethics statementsPatient consent for publicationNot required..

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Shutterstock The Delaware Department of Health how long should you wait after eating to take viagra and Social Services plans to offer a training program on treating opioid use disorder (OUD) among Medicaid recipients. The program is open to medical providers and how long should you wait after eating to take viagra practice managers in psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups from March 23 through Sept. 23. Participants will learn about the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be taught by addiction-medicine experts and will be offered how long should you wait after eating to take viagra in two phases.OBOT involves prescribing safe, effective, Food and Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov.

John Carney said how long should you wait after eating to take viagra. €œEquipping our medical providers to manage the treatment of these patients is an important part of this effort.”The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services supports the program through a $3.58 million grant awarded to the state.Shutterstock Pennsylvania’s Senate Labor and Industry Committee recently advanced legislation that aims to reduce opioid dependency.Senate Bill 147 would amend the Workers’ Compensation Act of 1915 to require employers who have a certified safety committee to provide how long should you wait after eating to take viagra employees with information about the consequences of addiction, including opioid painkillers.Under Pennsylvania’s Workers’ Compensation Law, employers receive a 5 percent discount on their workers’ compensation insurance premium if they establish a certified safety committee. The bill would require employers to incorporate addiction risks to receive certification and the discount.

The Department of Labor and how long should you wait after eating to take viagra Industry would develop and make available the information.State Sen. Wayne Langerholc (R-Bedford and Cambria counties) how long should you wait after eating to take viagra introduced the bill. It was one of five bills approved by the committee addressing workplace issues.“Pennsylvanians face a much greater risk of mental health challenges during the erectile dysfunction treatment viagra, so combatting the addiction crisis has never been more important than right now,” state Sen. Camera Bartolotta (R-Carroll), committee how long should you wait after eating to take viagra chairwoman, said.

€œThese bills accomplish the key goals of providing a pathway for individuals in recovery to find quality jobs to rebuild their lives, while also making sure more Pennsylvanians do not fall victim to addiction.”The bill was originally introduced in May 2020..

Shutterstock The Delaware Department of Health and Social Services plans to offer a training program on treating cheap viagra online opioid use disorder (OUD) among Medicaid recipients. The program is cheap viagra online open to medical providers and practice managers in psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups from March 23 through Sept. 23. Participants will learn about the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be taught by addiction-medicine experts and will be offered in two phases.OBOT involves prescribing safe, effective, Food and cheap viagra online Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov.

John Carney said cheap viagra online. €œEquipping our medical providers to manage the treatment of these patients is an important part of this effort.”The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services supports the program through a $3.58 million grant awarded to the state.Shutterstock Pennsylvania’s Senate Labor and Industry Committee recently advanced legislation that aims to reduce opioid dependency.Senate Bill 147 would amend the Workers’ Compensation Act of 1915 to require employers who have a certified safety committee to provide employees with information about the consequences of addiction, including opioid painkillers.Under Pennsylvania’s Workers’ Compensation Law, employers receive a 5 percent discount on their workers’ compensation insurance premium cheap viagra online if they establish a certified safety committee. The bill would require employers to incorporate addiction risks to receive certification and the discount.

The Department cheap viagra online of Labor and Industry would develop and make available the information.State Sen. Wayne Langerholc (R-Bedford and Cambria counties) introduced the bill cheap viagra online. It was one of five bills approved by the committee addressing workplace issues.“Pennsylvanians face a much greater risk of mental health challenges during the erectile dysfunction treatment viagra, so combatting the addiction crisis has never been more important than right now,” state Sen. Camera Bartolotta (R-Carroll), cheap viagra online committee chairwoman, said.

€œThese bills accomplish the key goals of providing a pathway for individuals in recovery to find quality jobs to rebuild their lives, while also making sure more Pennsylvanians do not fall victim to addiction.”The bill was originally introduced in May 2020..

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Credit http://calldrewfirst.com/?p=570 generic viagra coupon. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia generic viagra coupon in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated generic viagra coupon with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence generic viagra coupon of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings generic viagra coupon translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause generic viagra coupon of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other generic viagra coupon disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A generic viagra coupon. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England generic viagra coupon Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class generic viagra coupon of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used generic viagra coupon to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the visit the site same way that it would fight an . These medicines generic viagra coupon have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational generic viagra coupon burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has generic viagra coupon on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients generic viagra coupon with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be generic viagra coupon explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of generic viagra coupon those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell generic viagra coupon cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a viagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help generic viagra coupon guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a viagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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An increase in viagra stories Medicare Part B premiums means “America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” generic viagra online for sale — The headline of a press release from Sen. Rick Scott (R-Fla.) [UPDATED at 4:15 p.m. ET] Republicans blame President Joe Biden for this year’s historic surge in inflation, reflected in higher prices viagra stories for almost everything — from cars and gas to food and housing. They see last month’s 6.2% annual inflation rate — the highest in decades and mostly driven by an increase in consumer spending and supply issues related to the erectile dysfunction treatment viagra — as a ticket to taking back control of Congress in next year’s midterm elections. A key voting bloc will be older Americans, and the GOP aims to illustrate how much worse life has grown for them under the Biden administration.

Sen. Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and some drug costs and other outpatient services. €œSen. Rick Scott.

America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S. Seniors “paying HUNDREDS more for the care they need.” We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?. We reached out to Scott’s office for more detail but received no reply.

Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums. What’s the Status of Medicare Premiums?. Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending. The U.S. Inflation rate, for years held at bay, has been above 4% since April, hitting 6.2% in October, the highest rate in decades.

On Nov. 12, the Centers for Medicare &. Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history. Scott’s press release refers to the CMS report.

CMS cited three main factors for the increase. Rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the viagra, and the need to raise money for a possible unprecedented surge in drug costs. Inflation was not on that list. In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for the drug for one year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?. The Part B premium is typically subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums. Some Medicare beneficiaries won’t face a 14.5% increase, however, because a “hold-harmless” provision in federal law protects them from a decrease in their Social Security payments. But that rule won’t apply for most enrollees in 2022 because the increase in their monthly benefit checks will cover the higher monthly premium, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF.

What Role Does Inflation Play?. Several Medicare experts said the spike in the general inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors. €œThis is so false that it is annoying,” Paul Ginsburg, a professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation is behind the premium increase. €œThe effect of the inflation spike so far on prices is zero because Medicare controls prices.” Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs.

€œPremiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. €œI can’t see that the administration really had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug and make up for the reduced increase last year, he said. Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he said, such an increase would have to occur for more than a few months to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022.

€œThe claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said. CMS faced the challenge of trying to estimate costs for an expensive drug not yet covered by Medicare. €œIt is a very difficult projection to make, and they want to have enough contingency reserved,” said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund. Our Ruling Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying the price for Biden’s inflation crisis.” Though his statement contains a sliver of truth, Scott’s assertion ignores critical facts that create a different impression. For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums.

CMS said the increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for congressional action last year that held down premiums. We rate the claim Mostly False. SOURCES:Telephone interview and emails with Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, Nov. 24, 2021.Telephone interview with Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute, Nov. 19, 2021.Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov.

18, 2021.Telephone interview with Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund, Nov. 18, 2021.Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov. 18, 2021.Sen. Rick Scott’s press release, Nov. 16, 2021.Statista, monthly inflation rates, accessed Nov.

19, 2021.Centers for Medicare &. Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov. 19, 2021.Medicareresources.org fact sheet about high earners not subject to the hold-harmless provision, accessed Nov. 19, 2021.Social Security blog about the hold-harmless provision, accessed Nov.

19, 2021.AARP blog about the biggest-ever increase in Medicare Part B premiums, accessed Nov. 18, 2021.Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.CMS’ “2022 Medicare Parts A &. B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov. 12, 2021.

[Correction. This article was corrected at 4:15 p.m. ET on Nov. 24, 2021. A previous version of this story misstated the effect of a hold-harmless provision in federal law.

That measure protects people from a reduction in Social Security payments caused by higher Medicare premiums in years when the cost-of-living adjustment to Social Security is not enough to cover the premium hike. The earlier story’s reference to 70% of Medicare beneficiaries being protected in 2022 was incorrect. The rating remains the same.] Phil Galewitz. pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story TipThe decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated the last one?.

Should she continue eating, although it’s getting difficult?. Should she take more painkillers, even if she ends up heavily sedated?. Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine. Since then, doctors have found cancer in her colon and pancreas, too.

Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual concern, not hers alone. Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.” Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s or 70s and have known one another a long time.

Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy. Massad ended up saying “no” to that option in September after weighing the team’s input and consulting with a physician who researches treatments on her behalf. Several weeks ago, she stopped eating — a decision she also made with the group. A hospice nurse visits weekly, and an aide comes five hours a day. Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions.

It’s about “wellness” much more broadly defined. Massad, a primary care physician, first embraced the concept of a “health team” in the mid-1980s, when a college professor she knew was diagnosed with metastatic cancer. Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed loner, the professor said she wanted deeper connections to other people during the last stage of her life. Massad joined with the woman’s social therapist and two of her close friends to provide assistance.

(Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone. As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months to a few years. Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved. €œMost health teams have been organized around people who have fairly serious illness, and their overarching goal is to help people live the most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups.

Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and her partner, Sandy Friedman, were fighting often and “that was bad for the health of the whole house,” she told me. €œSo, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help. And it’s much better for us now.” Dr. Susan Massad first created a “health team” to help a professor she knew who was dying of cancer.

Today, she relies on a similar team to guide her through the end of life. (Janet Wootten) Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example. After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley consulted could tell her what was wrong, and she felt enormous stress as a result. €œMy team asked me to journal and to keep track of what I was eating and how I was responding.

That was helpful,” Fridley told me. €œWe worked on my not being so defensive and humiliated every time I went to the doctor. At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t just me. Other people shared what was going on for them as well.” Dr.

Hugh Polk, a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered care long before it became a buzzword. €œShe would tell patients, ‘We’re going to work together as partners in creating your health. I have expertise as a doctor, but I want to hear from you. I want you to tell me how you feel, what your symptoms are, what your life is like,’” he said. As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me.

And asking for help. Those aren’t things that come easy,” she told me by phone conversation. €œIt’s very challenging to watch her dying,” said her daughter Jessica Massad, 54. €œI don’t know how people do this on their own.” Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing. €œIt is a very intimate experience, and Susan feels loved so much,” said Henselmans.

For Massad, being surrounded by this kind of support is freeing. €œI don’t feel compelled to keep living just because my friends want me to,” she said. €œWe cry together, we feel sad together, and that can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Judith Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story TipCan’t see the audio player?. Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. President Joe Biden’s “Build Back Better” social spending bill passed the House last week, but the legislation faces a new and different set of hurdles in the Senate, where it will need the support of every single Democrat, plus approval by the Senate parliamentarian.

Meanwhile, erectile dysfunction treatment is surging again in Europe as well as in many parts of the United States, just as travel picks up for the holidays. And the Supreme Court prepares to hear oral arguments in an abortion case out of Mississippi that could lead to the weakening or overturning of Roe v. Wade — and could upend the political landscape in the U.S. This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN. Among the takeaways from this week’s episode.

There are roadblocks ahead in the Senate for the social spending plan. Some moderate Democrats may want to make changes, and parts of the bill could be challenged under tight Senate rules that require bills being passed using the budget reconciliation procedures — which prohibit filibustering — to show that the provisions have an effect on the budget.Among the health provisions that could be affected are paid family leave and the restrictions on drug price increases for plans outside of the Medicare program.As the bill passed by the House gets scrutinized, some of the smaller provisions that may not have garnered attention initially are now targets of debate and industry lobbying. Among them. A decision to tax vaping products, which some opponents suggest will lead users to continue to use cigarettes instead. Another is a mandate for nursing homes to have registered nurses in place 24/7, even though industry officials say they can’t recruit enough staff, which might lead some homes to close.If Congress does approve the bill, it’s good to remember that passage is not the final word.

Industry and advocates will continue to lobby the administration on regulations to implement the legislation, and those who are distressed by the law could take their grievances to court.With the decision last week by the Food and Drug Administration and the Centers for Disease Control and Prevention to authorize erectile dysfunction treatment boosters for all adults, public health messaging on the shots has shifted. While officials were much more nuanced when boosters first became available, they are now pushing hard for everyone to get the extra doses.Public attitudes about erectile dysfunction treatment also appear to be shifting, perhaps a result of viagra fatigue. Where once Americans looked to treatments to release them from the drudgeries of avoiding erectile dysfunction treatment, many now acknowledge the viagra will be around for a long time and are struggling to figure out how to return to a more normal life. Also this week, Rovner interviews Mary Ziegler of the Florida State University College of Law about the Supreme Court’s upcoming oral arguments in the Mississippi abortion case. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Julie Rovner. The Wall Street Journal’s “Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say,” by Stephanie Armour and Robbie Whelan. Margot Sanger-Katz. The New York Times’ “Everything in the House Democrats’ Budget Bill,” by Alicia Parlapiano and Quoctrung Bui. Joanne Kenen.

Politico’s “VA Stats Show Devastating erectile dysfunction treatment Toll at Vets’ Nursing Homes,” by Joanne Kenen, Darius Tahir and Allan James Vestal. Mary Agnes Carey. KHN’s “A erectile dysfunction treatment Head-Scratcher. Why Lice Lurk Despite Physical Distancing,” by Rae Ellen Bichell. To hear all our podcasts, click here.

And subscribe to KHN’s What the Health?. on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. Related Topics Contact Us Submit a Story TipIn the middle of a rainy Michigan night, 88-year-old Dian Wurdock walked out the front door of her son’s home in Grand Rapids, barefoot and coatless. Her destination was unknown even to herself. Wurdock was several years into a dementia diagnosis that turned out to be Alzheimer’s disease.

By luck, her son woke up and found her before she stepped too far down the street. As the Alzheimer’s progressed, so did her wandering and with it, her children’s anxiety. €œI was losing it,” said her daughter, Deb Weathers-Jablonski. €œI needed to keep her safe, especially at night.” Weathers-Jablonski installed a monitoring system with nine motion sensors around the house — in her mother’s bedroom, the hallway, kitchen, living room, dining room and bathroom and near three doors that led outside. They connected to an app on her phone, which sent activity alerts and provided a log of her mother’s movements.

€œWhen I went to bed at night, I didn’t have to guess what she was doing,” Weathers-Jablonski said. €œI was actually able to get some sleep.” New monitoring technology is helping family caregivers manage the relentless task of looking out for older adults with cognitive decline. Setting up an extensive monitoring system can be expensive — Weathers-Jablonski’s system from People Power Co. Costs $299 for the hardware and $40 a month for use of the app. With scores of companies selling such gear, including SentryTell and Caregiver Smart Solutions, they are readily available to people who can pay out-of-pocket.

But that’s not an option for everyone. While the technology is in line with President Joe Biden’s plan to direct billions of dollars toward helping older and disabled Americans live more independently at home, the costs of such systems aren’t always covered by private insurers and rarely by Medicare or Medicaid. Monitoring also raises ethical questions about privacy and quality of care. Still, the systems make it possible for many older people to stay in their home, which can cost them far less than institutional care. Living at home is what most people prefer, especially in light of the toll the erectile dysfunction treatment viagra took on nursing homes.

Technology could help fill a huge gap in home care for the elderly. Paid caregivers are in short supply to meet the needs of the aging population, which is expected to more than double in coming decades. The shortage is fueled by low pay, meager benefits and high rates of burnout. And for the nearly 1 in 5 U.S adults who are caregivers to a family member or friend over age 50, the gadgets have made a hard job just a little easier. Passive surveillance systems are replacing the “I’ve fallen and I can’t get up” medical alert buttons.

Using artificial intelligence, the new devices can automatically detect something is wrong and make an emergency call unasked. They also can monitor pill dispensers and kitchen appliances using motion sensors, like EllieGrid and WallFlower. Some systems include wearable watches for fall detection, such as QMedic, or can track GPS location, like SmartSole’s shoe insoles. Others are video cameras that record. People use surveillance systems like Ring inside the home.

Some caregivers may be tempted to use technology to replace care, as researchers in England found in a recent study. A participant who had visited his father every weekend began visiting less often after his dad started wearing a fall detector around his wrist. Another participant believed her father was active around the house, as evidenced by activity sensor data. She later realized the app was showing not her father’s movement, but his dog’s. The monitoring system picked up the dog’s movements in the living room and logged it as activity.

Technology isn’t a substitute for face-to-face interaction, stressed Crista Barnett Nelson, executive director of Senior Advocacy Services, a nonprofit group that helps older adults and their families in the North Bay area outside San Francisco. €œYou can’t tell if someone has soiled their briefs with a camera. You can’t tell if they’re in pain, or if they just need an interaction,” she said. In some instances, people being monitored changed their habits in response to technology. Clara Berridge, a professor of social work at the University of Washington who studies the use of technology in elder care, interviewed a woman who stopped her usual practice of falling asleep on the recliner because the technology would falsely alert her family that something was wrong based on inactivity deemed abnormal by the system.

Another senior reported rushing in the bathroom for fear an alert would go out if they took too long. The technology presents another worry for those being monitored. €œA caregiver is generally going to be really concerned about safety. Older adults are often very concerned about safety too, but they may also weigh privacy really heavily, or their sense of identity or dignity,” Berridge said. Charles Vergos, 92 and living in Las Vegas, is uncomfortable with video cameras in his house and wasn’t interested in wearing gadgets.

But he liked the idea that someone would know if something went wrong while he was alone. His niece, who lives in Palo Alto, California, suggested Vergos install a home sensor system so she could monitor him from afar. €œThe first question I asked is, does it take pictures?. € Vergos recalled. Because the sensors don’t have a video component, he was fine with them.

€œActually, after you have them in the house for a while, you don’t even think about it,” Vergos said. The sensors also have made conversations with his niece more convenient for him. She knows he likes to talk on the phone while he’s in his chair in the den, so she’ll check his activity on her iPad to determine whether it’s a good time to call. People making audio and video recordings must abide by state privacy laws, which typically require the consent of the person being recorded. It’s not as clear, however, if consent is needed to collect the activity data that sensors gather.

That falls into a gray area of the law, similar to data collected through internet browsing. Then there is the problem of how to pay for it all. Medicaid, the federal-state health program for low-income people, does cover some passive monitoring for home care, but it’s not clear how many states have opted to pay for such service. Some seniors also lack access to robust internet broadband, putting much of the more sophisticated technology out of reach, noted Karen Lincoln, founder of Advocates for African American Elders at the University of Southern California. The relief monitoring devices bring caregivers may be the most compelling reason for their use.

Delaine Whitehead, who lives in Orange County, California, started taking medication for anxiety about a year after her husband, Walt, was diagnosed with Alzheimer’s. Like Weathers-Jablonski, Whitehead sought technology to help, finding peace of mind in sensors installed on the toilets in her home. Her husband often flushed too many times, causing the toilets to overflow. Before Whitehead installed the sensors in 2019, Walt had caused $8,000 worth of water damage in their bathroom. With the sensors, Whitehead received an alert on her phone when the water got too high.

€œIt did ease up a lot of my stress,” she said. Sofie Kodner is a writer with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. The IRP reported this story through a grant from The SCAN Foundation. Sofie Kodner. katherine_kodner@berkeley.edu, @KodSof Related Topics Contact Us Submit a Story Tip.

An increase cheap viagra online in Medicare Part B premiums means “America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” — The buy viagra connect usa headline of a press release from Sen. Rick Scott (R-Fla.) [UPDATED at 4:15 p.m. ET] Republicans blame President Joe Biden for this year’s historic surge in inflation, reflected in higher cheap viagra online prices for almost everything — from cars and gas to food and housing.

They see last month’s 6.2% annual inflation rate — the highest in decades and mostly driven by an increase in consumer spending and supply issues related to the erectile dysfunction treatment viagra — as a ticket to taking back control of Congress in next year’s midterm elections. A key voting bloc will be older Americans, and the GOP aims to illustrate how much worse life has grown for them under the Biden administration. Sen.

Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and some drug costs and other outpatient services. €œSen.

Rick Scott. America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S.

Seniors “paying HUNDREDS more for the care they need.” We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?. We reached out to Scott’s office for more detail but received no reply.

Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums. What’s the Status of Medicare Premiums?. Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending.

The U.S. Inflation rate, for years held at bay, has been above 4% since April, hitting 6.2% in October, the highest rate in decades. On Nov.

12, the Centers for Medicare &. Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history.

Scott’s press release refers to the CMS report. CMS cited three main factors for the increase. Rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the viagra, and the need to raise money for a possible unprecedented surge in drug costs.

Inflation was not on that list. In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for the drug for one year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?. The Part B premium is typically subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums.

Some Medicare beneficiaries won’t face a 14.5% increase, however, because a “hold-harmless” provision in federal law protects them from a decrease in their Social Security payments. But that rule won’t apply for most enrollees in 2022 because the increase in their monthly benefit checks will cover the higher monthly premium, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF. What Role Does Inflation Play?.

Several Medicare experts said the spike in the general inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors. €œThis is so false that it is annoying,” Paul Ginsburg, a professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation is behind the premium increase.

€œThe effect of the inflation spike so far on prices is zero because Medicare controls prices.” Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs. €œPremiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. €œI can’t see that the administration really had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug and make up for the reduced increase last year, he said.

Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he said, such an increase would have to occur for more than a few months to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022.

€œThe claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said. CMS faced the challenge of trying to estimate costs for an expensive drug not yet covered by Medicare. €œIt is a very difficult projection to make, and they want to have enough contingency reserved,” said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund.

Our Ruling Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying the price for Biden’s inflation crisis.” Though his statement contains a sliver of truth, Scott’s assertion ignores critical facts that create a different impression. For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums. CMS said the increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for congressional action last year that held down premiums.

We rate the claim Mostly False. SOURCES:Telephone interview and emails with Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, Nov. 24, 2021.Telephone interview with Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute, Nov.

19, 2021.Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov. 18, 2021.Telephone interview with Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund, Nov. 18, 2021.Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov.

18, 2021.Sen. Rick Scott’s press release, Nov. 16, 2021.Statista, monthly inflation rates, accessed Nov.

19, 2021.Centers for Medicare &. Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov.

19, 2021.Medicareresources.org fact sheet about high earners not subject to the hold-harmless provision, accessed Nov. 19, 2021.Social Security blog about the hold-harmless provision, accessed Nov. 19, 2021.AARP blog about the biggest-ever increase in Medicare Part B premiums, accessed Nov.

18, 2021.Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.CMS’ “2022 Medicare Parts A &. B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov.

12, 2021. [Correction. This article was corrected at 4:15 p.m.

ET on Nov. 24, 2021. A previous version of this story misstated the effect of a hold-harmless provision in federal law.

That measure protects people from a reduction in Social Security payments caused by higher Medicare premiums in years when the cost-of-living adjustment to Social Security is not enough to cover the premium hike. The earlier story’s reference to 70% of Medicare beneficiaries being protected in 2022 was incorrect. The rating remains the same.] Phil Galewitz.

pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story TipThe decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated the last one?. Should she continue eating, although it’s getting difficult?.

Should she take more painkillers, even if she ends up heavily sedated?. Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine.

Since then, doctors have found cancer in her colon and pancreas, too. Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual concern, not hers alone.

Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.” Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s or 70s and have known one another a long time.

Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy. Massad ended up saying “no” to that option in September after weighing the team’s input and consulting with a physician who researches treatments on her behalf. Several weeks ago, she stopped eating — a decision she also made with the group.

A hospice nurse visits weekly, and an aide comes five hours a day. Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions. It’s about “wellness” much more broadly defined.

Massad, a primary care physician, first embraced the concept of a “health team” in the mid-1980s, when a college professor she knew was diagnosed with metastatic cancer. Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed loner, the professor said she wanted deeper connections to other people during the last stage of her life.

Massad joined with the woman’s social therapist and two of her close friends to provide assistance. (Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone. As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months to a few years.

Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved. €œMost health teams have been organized around people who have fairly serious illness, and their overarching goal is to help people live the most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups.

Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and her partner, Sandy Friedman, were fighting often and “that was bad for the health of the whole house,” she told me. €œSo, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help.

And it’s much better for us now.” Dr. Susan Massad first created a “health team” to help a professor she knew who was dying of cancer. Today, she relies on a similar team to guide her through the end of life.

(Janet Wootten) Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example. After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley consulted could tell her what was wrong, and she felt enormous stress as a result.

€œMy team asked me to journal and to keep track of what I was eating and how I was responding. That was helpful,” Fridley told me. €œWe worked on my not being so defensive and humiliated every time I went to the doctor.

At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t just me. Other people shared what was going on for them as well.” Dr.

Hugh Polk, a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered care long before it became a buzzword. €œShe would tell patients, ‘We’re going to work together as partners in creating your health. I have expertise as a doctor, but I want to hear from you.

I want you to tell me how you feel, what your symptoms are, what your life is like,’” he said. As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me. And asking for help.

Those aren’t things that come easy,” she told me by phone conversation. €œIt’s very challenging to watch her dying,” said her daughter Jessica Massad, 54. €œI don’t know how people do this on their own.” Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing.

€œIt is a very intimate experience, and Susan feels loved so much,” said Henselmans. For Massad, being surrounded by this kind of support is freeing. €œI don’t feel compelled to keep living just because my friends want me to,” she said.

€œWe cry together, we feel sad together, and that can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Judith Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story TipCan’t see the audio player?. Click here to listen on Acast.

You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. President Joe Biden’s “Build Back Better” social spending bill passed the House last week, but the legislation faces a new and different set of hurdles in the Senate, where it will need the support of every single Democrat, plus approval by the Senate parliamentarian. Meanwhile, erectile dysfunction treatment is surging again in Europe as well as in many parts of the United States, just as travel picks up for the holidays.

And the Supreme Court prepares to hear oral arguments in an abortion case out of Mississippi that could lead to the weakening or overturning of Roe v. Wade — and could upend the political landscape in the U.S. This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN.

Among the takeaways from this week’s episode. There are roadblocks ahead in the Senate for the social spending plan. Some moderate Democrats may want to make changes, and parts of the bill could be challenged under tight Senate rules that require bills being passed using the budget reconciliation procedures — which prohibit filibustering — to show that the provisions have an effect on the budget.Among the health provisions that could be affected are paid family leave and the restrictions on drug price increases for plans outside of the Medicare program.As the bill passed by the House gets scrutinized, some of the smaller provisions that may not have garnered attention initially are now targets of debate and industry lobbying.

Among them. A decision to tax vaping products, which some opponents suggest will lead users to continue to use cigarettes instead. Another is a mandate for nursing homes to have registered nurses in place 24/7, even though industry officials say they can’t recruit enough staff, which might lead some homes to close.If Congress does approve the bill, it’s good to remember that passage is not the final word.

Industry and advocates will continue to lobby the administration on regulations to implement the legislation, and those who are distressed by the law could take their grievances to court.With the decision last week by the Food and Drug Administration and the Centers for Disease Control and Prevention to authorize erectile dysfunction treatment boosters for all adults, public health messaging on the shots has shifted. While officials were much more nuanced when boosters first became available, they are now pushing hard for everyone to get the extra doses.Public attitudes about erectile dysfunction treatment also appear to be shifting, perhaps a result of viagra fatigue. Where once Americans looked to treatments to release them from the drudgeries of avoiding erectile dysfunction treatment, many now acknowledge the viagra will be around for a long time and are struggling to figure out how to return to a more normal life.

Also this week, Rovner interviews Mary Ziegler of the Florida State University College of Law about the Supreme Court’s upcoming oral arguments in the Mississippi abortion case. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too. Julie Rovner.

The Wall Street Journal’s “Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say,” by Stephanie Armour and Robbie Whelan. Margot Sanger-Katz. The New York Times’ “Everything in the House Democrats’ Budget Bill,” by Alicia Parlapiano and Quoctrung Bui.

Joanne Kenen. Politico’s “VA Stats Show Devastating erectile dysfunction treatment Toll at Vets’ Nursing Homes,” by Joanne Kenen, Darius Tahir and Allan James Vestal. Mary Agnes Carey.

KHN’s “A erectile dysfunction treatment Head-Scratcher. Why Lice Lurk Despite Physical Distancing,” by Rae Ellen Bichell. To hear all our podcasts, click here.

And subscribe to KHN’s What the Health?. on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. Related Topics Contact Us Submit a Story TipIn the middle of a rainy Michigan night, 88-year-old Dian Wurdock walked out the front door of her son’s home in Grand Rapids, barefoot and coatless.

Her destination was unknown even to herself. Wurdock was several years into a dementia diagnosis that turned out to be Alzheimer’s disease. By luck, her son woke up and found her before she stepped too far down the street.

As the Alzheimer’s progressed, so did her wandering and with it, her children’s anxiety. €œI was losing it,” said her daughter, Deb Weathers-Jablonski. €œI needed to keep her safe, especially at night.” Weathers-Jablonski installed a monitoring system with nine motion sensors around the house — in her mother’s bedroom, the hallway, kitchen, living room, dining room and bathroom and near three doors that led outside.

They connected to an app on her phone, which sent activity alerts and provided a log of her mother’s movements. €œWhen I went to bed at night, I didn’t have to guess what she was doing,” Weathers-Jablonski said. €œI was actually able to get some sleep.” New monitoring technology is helping family caregivers manage the relentless task of looking out for older adults with cognitive decline.

Setting up an extensive monitoring system can be expensive — Weathers-Jablonski’s system from People Power Co. Costs $299 for the hardware and $40 a month for use of the app. With scores of companies selling such gear, including SentryTell and Caregiver Smart Solutions, they are readily available to people who can pay out-of-pocket.

But that’s not an option for everyone. While the technology is in line with President Joe Biden’s plan to direct billions of dollars toward helping older and disabled Americans live more independently at home, the costs of such systems aren’t always covered by private insurers and rarely by Medicare or Medicaid. Monitoring also raises ethical questions about privacy and quality of care.

Still, the systems make it possible for many older people to stay in their home, which can cost them far less than institutional care. Living at home is what most people prefer, especially in light of the toll the erectile dysfunction treatment viagra took on nursing homes. Technology could help fill a huge gap in home care for the elderly.

Paid caregivers are in short supply to meet the needs of the aging population, which is expected to more than double in coming decades. The shortage is fueled by low pay, meager benefits and high rates of burnout. And for the nearly 1 in 5 U.S adults who are caregivers to a family member or friend over age 50, the gadgets have made a hard job just a little easier.

Passive surveillance systems are replacing the “I’ve fallen and I can’t get up” medical alert buttons. Using artificial intelligence, the new devices can automatically detect something is wrong and make an emergency call unasked. They also can monitor pill dispensers and kitchen appliances using motion sensors, like EllieGrid and WallFlower.

Some systems include wearable watches for fall detection, such as QMedic, or can track GPS location, like SmartSole’s shoe insoles. Others are video cameras that record. People use surveillance systems like Ring inside the home.

Some caregivers may be tempted to use technology to replace care, as researchers in England found in a recent study. A participant who had visited his father every weekend began visiting less often after his dad started wearing a fall detector around his wrist. Another participant believed her father was active around the house, as evidenced by activity sensor data.

She later realized the app was showing not her father’s movement, but his dog’s. The monitoring system picked up the dog’s movements in the living room and logged it as activity. Technology isn’t a substitute for face-to-face interaction, stressed Crista Barnett Nelson, executive director of Senior Advocacy Services, a nonprofit group that helps older adults and their families in the North Bay area outside San Francisco.

€œYou can’t tell if someone has soiled their briefs with a camera. You can’t tell if they’re in pain, or if they just need an interaction,” she said. In some instances, people being monitored changed their habits in response to technology.

Clara Berridge, a professor of social work at the University of Washington who studies the use of technology in elder care, interviewed a woman who stopped her usual practice of falling asleep on the recliner because the technology would falsely alert her family that something was wrong based on inactivity deemed abnormal by the system. Another senior reported rushing in the bathroom for fear an alert would go out if they took too long. The technology presents another worry for those being monitored.

€œA caregiver is generally going to be really concerned about safety. Older adults are often very concerned about safety too, but they may also weigh privacy really heavily, or their sense of identity or dignity,” Berridge said. Charles Vergos, 92 and living in Las Vegas, is uncomfortable with video cameras in his house and wasn’t interested in wearing gadgets.

But he liked the idea that someone would know if something went wrong while he was alone. His niece, who lives in Palo Alto, California, suggested Vergos install a home sensor system so she could monitor him from afar. €œThe first question I asked is, does it take pictures?.

€ Vergos recalled. Because the sensors don’t have a video component, he was fine with them. €œActually, after you have them in the house for a while, you don’t even think about it,” Vergos said.

The sensors also have made conversations with his niece more convenient for him. She knows he likes to talk on the phone while he’s in his chair in the den, so she’ll check his activity on her iPad to determine whether it’s a good time to call. People making audio and video recordings must abide by state privacy laws, which typically require the consent of the person being recorded.

It’s not as clear, however, if consent is needed to collect the activity data that sensors gather. That falls into a gray area of the law, similar to data collected through internet browsing. Then there is the problem of how to pay for it all.

Medicaid, the federal-state health program for low-income people, does cover some passive monitoring for home care, but it’s not clear how many states have opted to pay for such service. Some seniors also lack access to robust internet broadband, putting much of the more sophisticated technology out of reach, noted Karen Lincoln, founder of Advocates for African American Elders at the University of Southern California. The relief monitoring devices bring caregivers may be the most compelling reason for their use.

Delaine Whitehead, who lives in Orange County, California, started taking medication for anxiety about a year after her husband, Walt, was diagnosed with Alzheimer’s. Like Weathers-Jablonski, Whitehead sought technology to help, finding peace of mind in sensors installed on the toilets in her home. Her husband often flushed too many times, causing the toilets to overflow.

Before Whitehead installed the sensors in 2019, Walt had caused $8,000 worth of water damage in their bathroom. With the sensors, Whitehead received an alert on her phone when the water got too high. €œIt did ease up a lot of my stress,” she said.

Sofie Kodner is a writer with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. The IRP reported this story through a grant from The SCAN Foundation. Sofie Kodner.

katherine_kodner@berkeley.edu, @KodSof Related Topics Contact Us Submit a Story Tip.

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Bell and socket, smooth - flow type tubing and fittings should be used throughout the system. When system is used for vacuum cleaning of abrasive materials, schedule Nol40 pipe and cast iron drainage fittings, or heavier, should be used in place of tubing. From American Conference of Governmental terazosin viagra Industrial Hygienists (ACGIH®), Figure VS-40-20, Industrial Ventilation. A Manual of Recommended Practice, 23rd Edition. Copyright 1988 terazosin viagra.

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5 and pregnant women have how long do the effects of viagra last HIGHER LIMITS than shown viagra best price ESSENTIAL PLAN* For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $884 (up from $875 in 2020) $1300 (up from $1,284 in 2020) $1,482 $2,004 $2,526 $2,146 $2,903 Resources $15,900 (up from $15,750 in 2020) $23,400 (up from $23,100 in 2020) NO LIMIT** NO LIMIT 2020 levels are in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates and attachments here * MAGI and ESSENTIAL plan levels are based on Federal Poverty Levels, which are not released until later in 2021. 2020 levels are used until then. NEED TO KNOW PAST MEDICAID how long do the effects of viagra last INCOME AND RESOURCE LEVELS?.

WHAT IS THE HOUSEHOLD SIZE?. See rules here. HOW TO READ how long do the effects of viagra last THE HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 how long do the effects of viagra last on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R.

§ 435.4 how long do the effects of viagra last. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children age 1 - 19. CAUTION how long do the effects of viagra last.

What is counted as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, how long do the effects of viagra last based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad changes.

GOOD. Veteran's benefits, Workers compensation, and gifts from family or others no longer count how long do the effects of viagra last as income. BAD. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules.

For all of how long do the effects of viagra last the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the how long do the effects of viagra last "category" of the person seeking Medicaid.

Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article how long do the effects of viagra last. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household size will be determined using federal income tax rules, which are very complicated. New rule is how long do the effects of viagra last explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49.

Also seeLegal Aid Society and Empire Justice Center materials how long do the effects of viagra last OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See how long do the effects of viagra last 18 NYCRR 360-4.2, MRG p.

573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category how long do the effects of viagra last 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without how long do the effects of viagra last children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits.

It did not allow "spend down" how long do the effects of viagra last http://www.ec-cath-bischheim.site.ac-strasbourg.fr/documents-a-destination-des-parents/ of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit how long do the effects of viagra last is 138% FPL.

For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange. PAST INCOME &. RESOURCE LEVELS -- Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 how long do the effects of viagra last through 2019, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of how long do the effects of viagra last their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care. The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely transition back to the community with MLTC. Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes.

GIS 14/MA-017 Since you are allowed to keep more of your income, you may how long do the effects of viagra last no longer need to use a pooled trust. KNOW YOUR RIGHTS - FACT SHEET on THREE ways to Reduce Spend-down, including this Special Income Standard. September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet the other criteria below. "How nursing home administrators, how long do the effects of viagra last adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify.

"Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan. Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify for the special income standard. The special how long do the effects of viagra last income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community. Questions regarding the special income standard may be directed to DOH at 518-474-8887.

Who is eligible for this special income standard?. must be age 18+, must have been in a nursing home or an adult home for 30 days or more, must have had Medicaid pay toward the nursing home care, and must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home must have a how long do the effects of viagra last housing expense if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC. How much is the allowance?. The rates vary by region and change yearly.

Region Counties Deduction (2021) Central Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins $450 Long Island Nassau, Suffolk $1,393 NYC Bronx, Kings, Manhattan, Queens, Richmond $1,535 (up from 1,451 in 2020) Northeastern Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington $524 North Metropolitan Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester $1,075 Rochester Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates $469 Western Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming $413 Past rates published as follows, available on DOH website 2021 rates published in Attachment I to GIS 20 MA/13 -- 2021 Medicaid Levels and Other Updates 2020 rates published in Attachment I to GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates 2019 rates published in Attachment 1 to GIS 18/MA015 - 2019 Medicaid Levels and Other Updates 2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates. The guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 2017 rate -- GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards Attachment 12016 rate -- GIS 15-MA/0212015 rate -- Were not posted by DOH but were updated in WMS.

2015 Central $382 Long Island $1,147 NYC $1,001 Northeastern $440 N. Metropolitan $791 Rochester $388 Western $336 2014 rate -- GIS-14-MA/017 HOW DOES IT WORK?. Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo. Gross monthly income $2,575.50 DEDUCT Health insurance premiums (Medicare Part B) - 135.50 (Medigap) - 261.00 DEDUCT Unearned income disregard - 20 DEDUCT Shelter deduction (NYC—2019) - 1,300 DEDUCT Income limit for single (2019) - 859 Excess income or Spend-down $0 WITH NO SPEND-DOWN, May NOT NEED POOLED TRUST!.

HOW TO OBTAIN THE HOUSING DISREGARD. When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your local Medicaid program change your Medicaid budget to give you the Housing Disregard. See September 2018 NYS DOH Medicaid Update that requires MLTC plan to help you ask for it. The procedures in NYC are explained in this Troubleshooting guide.

In NYC, submit the application with the MAP-751W (check off "Budgeting Changes" and "Special Housing Standard"). (The MAP-751W is also posted in languages other than English in this link. (Updated 3-15-2021.)) NYC Medicaid program prefers that your MLTC plan file the request, using Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and Form MAP-3047B - MLTC/NHED Cover Sheet Form MAP-259f (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GOVERNMENT DIRECTIVES (beginning with oldest).

NYS DOH 12- ADM-05 - Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program Attachment II - OHIP-0057 - Notice of Intent to Change Medicaid Coverage, (Recipient Discharged from a Skilled Nursing Facility and Enrolled in a Managed Long Term Care Plan) Attachment III - Attachment III – OHIP-0058 - Notice of Intent to Change Medicaid Coverage, (Recipient Disenrolled from a Managed Long Term Care Plan, No Special Income Standard) MLTC Policy 13.02. MLTC Housing Disregard NYC HRA Medicaid Alert Special Income Standard for housing expenses NH-MLTC 2-9-2013.pdf 2018-07-28 HRA MICSA ALERT Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility and who Enroll into the MLTC Program - update on previous policy. References Form MAP-259f (revised 7-31-18)(page 7 of PDF)(Discharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept.

28, 2018 - this finally implements the most recent Special Terms &. Conditions of the CMS 1115 Waiver that governs the MLTC program, dated Jan. 19, 2017. The section on this income standard is at pages 26-27.

19 in school) cheap viagra online 138% FPL*** Children <. 5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN* For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $884 (up from $875 in 2020) $1300 (up from $1,284 in 2020) $1,482 $2,004 $2,526 $2,146 $2,903 Resources $15,900 (up from $15,750 in 2020) $23,400 (up from $23,100 in 2020) NO LIMIT** NO LIMIT 2020 levels are in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates and attachments here * MAGI and ESSENTIAL plan levels are based on Federal Poverty Levels, which are not released until later in 2021.

2020 levels are cheap viagra online used until then. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?. WHAT IS THE HOUSEHOLD SIZE?.

See rules cheap viagra online here. HOW TO READ THE HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People cheap viagra online in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.

42 cheap viagra online C.F.R. § 435.4. Certain populations have an even higher income limit - 224% FPL for pregnant women and babies <.

Age 1, 154% FPL for children age cheap viagra online 1 - 19. CAUTION. What is counted as income may not be what you think.

For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and cheap viagra online these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good changes and bad changes.

GOOD cheap viagra online. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD.

There is no more "spousal" or parental refusal for this population (but there still is cheap viagra online for the Disabled/Aged/Blind.) and some other rules. For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person.

HOWEVER, Medicaid rules about how to calculate the household cheap viagra online size are not intuitive or even logical. There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household cheap viagra online size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household cheap viagra online size will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.

See cheap viagra online slides 28-49. Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category.

Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility cheap viagra online. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007 CAUTION.

Different people in the same household cheap viagra online may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher cheap viagra online income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples.

This category had lower income cheap viagra online limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

Family Health Plus cheap viagra online - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.

PAST INCOME & cheap viagra online. RESOURCE LEVELS -- Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2019, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care. The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely transition back to the community with MLTC.

Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes. GIS 14/MA-017 Since you are allowed to keep more of your income, you may no longer need to use a pooled trust. KNOW YOUR RIGHTS - FACT SHEET on THREE ways to Reduce Spend-down, including this Special Income Standard.

September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet the other criteria below. "How nursing home administrators, adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify. "Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan.

Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify for the special income standard. The special income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community. Questions regarding the special income standard may be directed to DOH at 518-474-8887.

Who is eligible for this special income standard?. must be age 18+, must have been in a nursing home or an adult home for 30 days or more, must have had Medicaid pay toward the nursing home care, and must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home must have a housing expense if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC. How much is the allowance?.

The rates vary by region and change yearly. Region Counties Deduction (2021) Central Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins $450 Long Island Nassau, Suffolk $1,393 NYC Bronx, Kings, Manhattan, Queens, Richmond $1,535 (up from 1,451 in 2020) Northeastern Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington $524 North Metropolitan Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester $1,075 Rochester Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates $469 Western Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming $413 Past rates published as follows, available on DOH website 2021 rates published in Attachment I to GIS 20 MA/13 -- 2021 Medicaid Levels and Other Updates 2020 rates published in Attachment I to GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates 2019 rates published in Attachment 1 to GIS 18/MA015 - 2019 Medicaid Levels and Other Updates 2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates.

The guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 2017 rate -- GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards Attachment 12016 rate -- GIS 15-MA/0212015 rate -- Were not posted by DOH but were updated in WMS. 2015 Central $382 Long Island $1,147 NYC $1,001 Northeastern $440 N.

Metropolitan $791 Rochester $388 Western $336 2014 rate -- GIS-14-MA/017 HOW DOES IT WORK?. Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo. Gross monthly income $2,575.50 DEDUCT Health insurance premiums (Medicare Part B) - 135.50 (Medigap) - 261.00 DEDUCT Unearned income disregard - 20 DEDUCT Shelter deduction (NYC—2019) - 1,300 DEDUCT Income limit for single (2019) - 859 Excess income or Spend-down $0 WITH NO SPEND-DOWN, May NOT NEED POOLED TRUST!.

HOW TO OBTAIN THE HOUSING DISREGARD. When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your local Medicaid program change your Medicaid budget to give you the Housing Disregard. See September 2018 NYS DOH Medicaid Update that requires MLTC plan to help you ask for it.

The procedures in NYC are explained in this Troubleshooting guide. In NYC, submit the application with the MAP-751W (check off "Budgeting Changes" and "Special Housing Standard"). (The MAP-751W is also posted in languages other than English in this link.

(Updated 3-15-2021.)) NYC Medicaid program prefers that your MLTC plan file the request, using Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and Form MAP-3047B - MLTC/NHED Cover Sheet Form MAP-259f (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GOVERNMENT DIRECTIVES (beginning with oldest). NYS DOH 12- ADM-05 - Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program Attachment II - OHIP-0057 - Notice of Intent to Change Medicaid Coverage, (Recipient Discharged from a Skilled Nursing Facility and Enrolled in a Managed Long Term Care Plan) Attachment III - Attachment III – OHIP-0058 - Notice of Intent to Change Medicaid Coverage, (Recipient Disenrolled from a Managed Long Term Care Plan, No Special Income Standard) MLTC Policy 13.02.

MLTC Housing Disregard NYC HRA Medicaid Alert Special Income Standard for housing expenses NH-MLTC 2-9-2013.pdf 2018-07-28 HRA MICSA ALERT Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility and who Enroll into the MLTC Program - update on previous policy. References Form MAP-259f (revised 7-31-18)(page 7 of PDF)(Discharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard. GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept.

28, 2018 - this finally implements the most recent Special Terms &. Conditions of the CMS 1115 Waiver that governs the MLTC program, dated Jan. 19, 2017.