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January 1, 2008
Advocacy Medicare Package is almost a reality The Medicare package was approved by the Senate on December 18, 2007 and by the House on December 19th. President Bush is expected to sign the legislation. Congress will have to address the issue again in mid-2008 to avoid yet another payment cut for doctors from taking effect July 1, 2008. The bill would stop a scheduled cut in Medicare physician payments; place a moratorium on the addition of new "special needs plans" in the Medicare Advantage program through Dec. 31, 2009; extends the authority of specialized Medicare Advantage plans to target enrollment through 2009; and provides $5 million to Area Agencies on Aging Disability Resource Centers for beneficiary outreach and assistance. The good news is that there is no freeze on home health payments. There were also no cuts to Medicare Advantage plans. A Medicaid program that helps low-income seniors and individuals pay their Medicare premiums would be extended through June 30, 2008. The bad news, there was no provision for the eight state adult day services to remain a Medicaid state option and to preserve the Medicaid spousal protection for HCBS provisions. With the 0.5 percent payment hike to doctors due to expire June 30, and the 10.1 percent cut due to kick in then, lawmakers will again be looking at cuts to Medicare Advantage plans and other health care sectors in order to pay for an extension preventing the doctor cuts. So we will be discussing another Medicare/Medicaid bill in February or March. Contact: Peter Notarstefano, 202 508-9406 Omnibus bill still needs President's signature House appropriators released an omnibus spending bill that complies with the total spending levels on which the President has insisted, but which reshuffles spending priorities to funnel more money than the President had requested into housing and other domestic programs. This bill still needs the President's signature to become law. Supportive Services and Centers that fund adult day services, in-home services and senior centers; and the Older American's Act nutrition programs received funding above the FY2007 levels. Programs, such as the Alzheimer's Disease Demonstration and the Preventive Health Services had received no funding under the President's budget, but were funded in the omnibus. The Family Caregiver support program that funds adult day services took a 1.7% cut. The Lifespan Respite bill received no funding in the omnibus bill. Also, in the omnibus was funding for specific local projects, such as Naturally Occurring Retirement Communities, technology projects, in-home services in rural areas and respite services for people with dementia. To read the omnibus bill. Contact: Peter Notarstefano 202 508-9406. Targeted Case Management rule for Medicaid defined The Government Accountability Office reported "inappropriate" billing of Medicaid for Targeted Case Management Services under Medicaid optional state plan. The Center for Medicare & Medicaid Services (CMS) clarifies that case management does not include the actual direct services provided for the individual. CMS said that this clarification of benefits would save the Medicaid program $1.2 billion over the next five years. For more information on targeted case management. Submit comments on the final rule. Peter Notarstefano, 202-508-9406 MedPAC writes draft recommendations Tightening Requirements on Special Plans The Medicare Payment Advisory Commission on December 6 wrote draft recommendations to put in place strict new requirements for Medicare Advantage special needs plans (SNPs). Unless it is reauthorized, the SNP program is set to expire at the end of 2008. One of the concerns about the SNP program are that many of the new entrants have no specialized experience, leading to the question of whether they are interested just in marketing or making a real investment in the populations they are targeting. Another concern is the lack of a requirement that the dual SNPs coordinate benefits with Medicaid. Still another problem is that SNPs can obtain a waiver to ease the requirement that they enroll a disproportionate share of special needs beneficiaries and may then choose who else they want to enroll. The following draft recommendations were given:
AoA Announces Participation in Medicare Senior Risk Reduction Demonstration. HHS Assistant Secretary for Aging Josefina G. Carbonell has announced participation in a demonstration designed to help seniors stay healthy. Nine Aging and Disability Resource Center (ADRC) programs and an Administration on Aging (AoA) Older Americans Act Information and Referral (I&R) program will participate in the Medicare Senior Risk Reduction Demonstration. The CMS Medicare Senior Risk Reduction Demonstration is designed to evaluate whether health promotion and disease prevention programs currently offered by national private insurers and employers can be delivered by the Medicare program to encourage beneficiaries to engage in healthy lifestyles and practices that can help them maintain and improve their health and reduce the need for health care services for preventable illnesses, injuries, or complications. For more information about the Senior Risk Reduction Demonstration. Evaluation of Special Needs Plans The National Committee for Quality Assurance (NCQA), funded by the Centers for Medicare & Medicaid Services (CMS), has been developing recommendations for evaluating SNPs. In March of 2007, NCQA proposed a potential list of evaluation measures for SNPs. These recommendations included thirteen HEDIS measures, and a set of Structure and Process measures. On December 12, 2007 NCQA posted the measures and supporting documents for public comment. The public comment period will be open until January 15, 2008. The measures will be finalized in March/April 2008. To view the recommendations and submit a comment. Veteran's Administration funds 8 Pilot Programs for Caregiver Assistance On December 6, 2007, the Department of Veterans Affairs (VA) announced that it will provide nearly $4.7 million for caregiver assistance pilot programs to expand and improve health care education and provide needed training and resources for caregivers who assist disabled and aging veterans in their homes. The pilot program will support eight caregiver projects across the country. These programs will provide caregiver education, telehealth, improved respite, and an innovative foster home model of care. For more information on the individual pilot programs. Technology Date Set for Senate Technology Demonstration CAST will organize a limited technology demonstration for U.S. Senators and their staff on Jan. 30. The event will be held in conjunction with the Senate Special Committee on Aging's staff briefing about S. 908, a bill to create the Consortium on the Impact of Technology in Aging Health Services. Please urge your senators and their staff members to attend these important events. Read more about the events. Using Technology to Help Older People Stay Independent Researchers at the Quality of Life Technology Center in Pittsburgh are working to develop home-monitoring systems and invent robotic devices that will help people with disabilities remain independent for longer. The center, a collaboration of the University of Pittsburgh and Carnegie Mellon University, is supported by a $15 million grant from the National Science Foundation. To read the article. Seniors Welcome Some Home Monitoring Research on home monitoring conducted by CAST Director Majd Alwan was featured recently in a Wall Street Journal article. Alwan, who conducted his research at the University of Virginia, told the newspaper that older people object to some kinds of monitoring, such as the presence of video cameras. However they are more accepting of less-invasive technology, especially when that technology can help them delay nursing home admission. Read more. Quality First joins with Technology for the future growth of Home & Community-based Services AAHSA Quality First is a philosophy of quality and a framework for earning public trust in aging services. We believe we can dramatically improve our field, and that technology is an important component of quality in aging services across the continuum. Learn more about how technology works with Quality First. Home Health Care Home Health Agency's Free Videos Not a Kickback Risk, Advisory Opinion Says A home health agency that distributes free educational videos to prospective patients does not risk civil monetary penalties or kickback violations because of the program, the Department of Health and Human Services Office of Inspector General said in an advisory opinion (No. 07-16) posted Dec. 13. The OIG determined that the value of the free educational videos to prospective patients was nominal and that the provision of the videos had minimal influence over patients' choices of home health agencies. The referring surgeons have no financial interest in the agency and are not employed by the agency, the OIG noted. Furthermore, the agency reminds patients in the initial phone call that they can choose another home health provider for post-operative care. To read the advisory opinion. MedPAC recommends freeze on home health payments The Medicare Payment Advisory Commission met on December 7th and recommended to keep home health payments at 2008 levels. Regarding home health, the commission estimated that industry profits on Medicare patients averaged 15.4 percent in 2006 and that in 2008 they would average 11.4 percent. It unveiled a draft recommendation that would freeze 2009 payments at 2008 levels. MedPAC calculations are for freestanding home health agencies and do not take into account the many home care agencies that are affiliated with hospitals and have higher costs and lower profit margins. MedPAC margin calculations also do not include such costs as those associated with the use of dietitians, respiratory therapy, telehealth services and marketing. According to industry experts, when all types of payments are taken into account, the profits of home health agencies average just three percent. In addition agencies face a number of payment cuts in the next few years because of the "case mix creep" and the new home health prospective payment system. Peter Notarstefano, 202 508-9406. Billing information on new HH PPS available CMS is providing guidance to home health agencies (HHAs) on two issues related to the implementation of the refined HH PPS effective 1/1/2008: 1) Billing options for HHAs whose systems are not ready to bill, based on the refined HH PPS, on 1/1/2008; 2) Upcoming revisions to the HH PPS Grouper, which may result in underpayments to HHAs, and the options available to HHAs on how to handle those potential underpayments. CMS will be releasing the revised grouper, HAVEN and associated pseudo code as soon as possible in 2008. To read the guidance document. News from the States Maryland: Appeals Court rules Medicaid Eligibility Criteria too strict A state appeals court ruled on November 27, 2007 that the state's Department of Health and Mental Hygiene used a standard for eligibility that was stricter than that was allowed under the Medicaid Act when it determined that a person with Alzheimers disease was ineligible for benefits under the state's Community Waiver for Older Adult's Program. The person with Alzheimer's disease did not require skilled care, but needed "intermediate care" in a home setting. The standard states that the applicant needs "health related care and services" that are provided on a regular basis at least 5 days during a seven day period. Read the court's decision. Pennsylvania: Home Health Agency to pay for travel expenses A Pennsylvania home health care company has agreed to pay more than $2 million to eligible employees for time spent traveling between the homes of clients. On November 26th, Judge Gary Glazier of Pennsylvania Court of Common Pleas in Philadelphia gave preliminary approval to the settlement for violations of the Pennsylvania Wage Payment and Collection Law and the Pennsylvania Minimum Wage Act. The agreement would apply to 3000 home health workers employed by Total Health Home Care Corp during a five year period. There are four similar lawsuits in Pennsylvania that have been filed. Travel time is non-reimbursable, and it is common for agencies not to pay for travel time. Contact: P. Notarstefano or 202 508-9406. New York: Statewide Study on Rate of Elder Abuse Initiated Lifespan of Greater Rochester, Inc., Cornell University and the New York City Department for the Aging will be conducting a statewide study on the prevalence of elder mistreatment in New York State. Investigators intend to survey 4000 participants aged 60 and over. The study will also include a review of data on incidences of elder abuse submitted by Adult Protective Services, Law enforcement, district attorney offices and other agencies that deal with this problem. This study is funded in part through the New York State Children and Family Trust Fund. For more information on the study. Resources and Publications Long-Term Service and Supports: The Future Role and Challenges for Medicaid This new report from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured examines the structure and impact of Medicaid's role in long-term care. The report outlines seven problems faced by states on long=term care: 1. coordination of acute and long-term care services, housing and other social services; varying state disability criteria on who meets "need for institutional care" requirements; income and asset considerations in light of a needs assessment; access to home and community-based services where there is increasing waiting lists; creation of flexible benefit designs; monitoring HCBS and nursing homes for quality; and finding financing alternatives other than the Medicaid program for long-term care services. Read the report. New report on SNP's and high risk beneficiaries released An analysis of six not-for-profit Medicare managed care health plans across the country that entered the Special Needs Plan (SNP) insurance market over the last two years was released in November 2007 by Avalere Health. The report was commissioned by the Association of Community Affiliated Plans, a group whose members cover more than 4 million Medicare and Medicaid beneficiaries. The report concludes that if benefits are tailored to meet specific needs of high-risk beneficiaries, Medicare's special-needs plans hold the promise of improving health care and reducing costs. The analysis also states that these six plans provide benefits that the report said go beyond traditional models of insurance for dual-eligible beneficiaries. The number of SNPs grew to 477 plans operating in 2007 from 276 in 2006, according to Avalere. Authorization of the program sunsets Dec. 31, 2008, and Congress will need to reauthorize the program for it to continue. To read the report. U.S. Department of Health and Human Services releases 5 year plan The U.S. Administration on Aging is pleased to inform you of the publication of the HHS Strategic Plan FY 2007-2012. This document provides a comprehensive overview of the U.S. Department of Health & Human Service's priorities and activities for the next five years, and highlights the significant role the U.S. Administration on Aging is playing within the department to improve the health and well-being of older people and their family caregivers. To read the plan. NIH offers free information on Making Your Printed Health Materials Senior Friendly Making Your Printed Health Materials Senior Friendly is a new publication from the National Institute on Aging, part of the National Institutes of Health. The tip sheet offers suggestions for how to write and design health information to accommodate cognitive and physical changes that often accompany old age. It provides specific examples and includes resources for more information. Print copies of Making Your Printed Health Materials Senior Friendly Transportation options for Older Adults brochures available The National Association of Area Agencies on Aging (n4A) in conjunction with the National Center on Senior Transportation (NCST) developed a brochure that describes the various types of transportation services for older adults, and the availability of these services. To download the brochure. UPCOMING MEETINGS 2008 AAHSA Leadership Summit Jan. 16, 2008 New Orleans, La. Join your peers from across the country at AAHSA's 2008 Leadership Summit. During this exclusive educational event, best-selling leadership author and executive coach Marshall Goldsmith will help you and your team find the tactics your organization needs to achieve the next stage of success. For more information. AAHSA Future of Aging Services Conference March 31 - April 2, 2008 Marriott Wardman Park Hotel Washington, DC January is National Glaucoma Awareness Month January is National Glaucoma Awareness Month. Glaucoma is the leading cause of preventable blindness. Among African-American and Hispanic populations, glaucoma is the leading cause of blindness. Over 3 million Americans, and nearly 70 million people worldwide, have glaucoma. For more information about this disease. View past issues of the HCBS Report. AAHSA · 2519 Connecticut Ave. NW · Washington DC 20008 · www.aahsa.org
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