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February 1, 2008
Advocacy Medicare legislation is a temporary fix The Medicare package was signed into law by President Bush. 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 Senate Finance Committee is planning a markup of a Medicare bill in February with a tentative goal of conferencing with the House in June. The bill stops a scheduled cut in Medicare physician payments; places 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. 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. There is a possibility that the provisions that were in the CHAMP Act, such as the freeze on Home Health, the provision for the eight state adult day services to remain a Medicaid state option, the preservation of the Medicaid spousal protection for HCBS, and the 5% add on for rural home health agencies will be resurfacing again in February. Contact: Peter Notarstefano, 202 508-9406. CMS Proposes Standards for Self-Directed Personal Assistance Care The Centers for Medicare & Medicaid Services Jan. 14 released a proposed rule providing guidance to state Medicaid officials who want to administer self-directed personal assistance services (PAS). CMS said the proposed rule would implement Section 1915 (j) by setting forth the requirements of the self-directed PAS delivery model and defining how individuals may qualify to participate in a self-directed PAS state plan option. CMS said individuals would be allowed to exercise decision-making authority in identifying, accessing, managing, and purchasing their PAS. That decision-making authority would include, at a minimum, "the purchase of PAS and support for PAS, recruiting workers, hiring and discharging workers, specifying worker qualifications, determining worker duties, scheduling workers, supervising workers, evaluating worker performance, determining the amount paid for a service, support, or item, scheduling when services are provided, identifying service workers, and reviewing and approving invoices." States choosing this self-directed care option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants. States also must train potential participants in ways to manage their budgets and assess their personal care needs. The notice of proposed rule-making will be published in the Jan. 18 Federal Register and the 30-day comment period expires Feb. 19. To read the regulations on Self-directed PAS. Prevent State Medicaid Cuts Congress will consider an economic stimulus package to counteract the downturn in the nation's economy. AAHSA is concerned that states experiencing falling revenues will feel pressured to cut their Medicaid spending, since the program is one of the largest items in state budgets. States can only reduce Medicaid spending by cutting benefits covered, cutting eligibility for coverage, or cutting payments to providers, any or all of which could have a severe impact on frail elders who depend on Medicaid for their long-term care. We therefore are urging Congress to include an increase in the federal Medicaid match in whatever economic stimulus legislation is considered, similar to the temporary FMAP increase that was provided during the recession in 2002 and 2003. We hope that the members will contact their legislators on this issue as well. We have posted an alert and sample letter on Contact Congress. House Energy & Commerce Committee holds a hearing on HCBS Panelists at a Jan. 16, 2008 House Energy and Commerce Committee hearing said they support legislation for state Medicaid programs to cover home and community-based services (HCBS) for people with disabilities, but were concerned about reducing Medicaid reimbursements for agencies that help people transition from nursing homes. It was reported that up to 300,000 people currently in nursing homes have "expressed a preference for home and community-based services," allowing them to get personal care attendants in their own homes instead of having to live in a nursing home or another institutional setting. Legislation introduced by Rep. Danny Davis (D-Ill.) last March, the proposed Community Choice Act of 2007 (H.R. 1621), would give people the choice to use attendants. There is also a concern about the Centers for Medicare & Medicaid Services rule to change the number of days that qualify for Medicaid reimbursement for agencies that help people transition from nursing homes to home and community-based settings. For more information on the House Energy and Commerce Committee hearing. Targeted Case Management Interim Final Rule AAHSA submitted a letter to C.M.S. opposing the Targeted Case Management Interim Final Rule (TCM IFR) (CMS-2237-IFC) that was published in the Federal Register on December 4, 2007. The Interim Final Rule (IFR) limits the role of the case manager, and is a barrier to the implementation of successful Disease Management programs and Long-term Home Health Care programs, that have proven to be successful in promoting quality outcomes, and contain costs. Case management is the foundation of the structure of the home and community-based service delivery system. Single Point of Entry systems, Money Follows the Person and Nursing Home Transition programs utilize the expertise of staff from Aging and Disability Resource Centers, Area Agencies on Aging, providers and agencies that specialize in case management for clinically complex populations, such as HIV, Mental Health, Dementia and Developmentally Disabled. TCM IFR reduces the communication among these organizations by focusing on a single case manager for a consumer in a targeted group. The change of the transition time noted in the TCM IFR could have a negative impact on the Money Follows the Person programs and some state HCBS waivers. Some nursing home residents will require more case management service time, especially if there are shortages in affordable housing and home care staff. The TCM IFR removes the care planning process, functional eligibility assessment and the ability to approve services from the responsibilities of the case manager. The removal of these key responsibilities will diminish the effectiveness of the case manager. Many states have case management as part of their administrative function. The IFR changes this important function, which could lead to a fragmentation of service delivery. For more information contact Peter Notarstefano, 202 508-9406 Ohio and Pennsylvania to Raise Awareness about Long-Term Care Planning Ohio and Pennsylvania, will join the federal Own Your Future campaign created to increase the public's awareness about the importance of long-term care (LTC) planning. The "Own Your Future" initiative, administered by HHS' Centers for Medicare & Medicaid Services (CMS), Administration on Aging (AoA), and Office of the Assistant Secretary for Planning and Evaluation (ASPE), is designed to help Americans take an active role in planning ahead for their future long-term care needs. To date, over 11 million letters signed by governors in 16 states have been mailed to households with individuals in the target audience and from those letters more than 550,000 Long-Term Care Planning Kits have been mailed. Ohio and Pennsylvania were two of 11 applicants to join the current 16 states participating in the "Own Your Future" initiative. The other participating states are Arkansas, Georgia, Idaho, Kansas, Maryland, Michigan, Missouri, Nebraska, Nevada, New Jersey, Rhode Island, South Dakota, Tennessee, Texas, Virginia and Washington. The Deficit Reduction Act of 2005 provides funds, $3 million in 2008, to fund the National Clearinghouse for Long-Term Care Information and Own Your Future Campaign. The Clearinghouse, hosted by AoA, is a collaborative effort among AoA, CMS, and ASPE that provides comprehensive information about long-term care planning, services and financing options, along with tools to help people begin the planning process. For more information about LTC planning in various states. Opportunity to Participate in a CMS Post-Acute Care Assessment Instrument Demonstration If you are located in one of ten geographic regions selected by the Centers for Medicare and Medicaid Services (CMS), you may volunteer to participate in the demonstration of the Medicare Continuity Assessment Record and Evaluation (CARE) tool. The ten regions are: Boston; Chicago; Dallas; Lakeland/Tampa, Florida; Lincoln, Nebraska; Louisville, Kentucky; Rapid City, South Dakota; Rochester, New York; San Francisco/Bay Area; and Seattle/Tacoma, Washington. Skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals are eligible to participate in the demonstration. Those that participate will use the uniform patient assessment form (CARE tool) to assess patients during their post-acute care stays. Contact Karyn Downie (202) 508-9410. To be considered for the demonstration, you may contact the CMS contractor at RTI International. Please review the CMS press release. Adult Day Services Article on Adult Day Services highlights increased demand for Adult Day Services The Wall Street Journal on January 10, 2008 featured an article on how baby boomers are using adult day services as a means for their parents to remain at home. Adult children and the spouses of individuals with chronic diseases seek quality care and relief from the care they're providing around the clock. Some caregivers want an option that lets them go to work but is more affordable, reliable and stimulating than hiring a home health-care aide. National data are sketchy, but individual facilities around the country report demand is growing at between 5% and 15% a year, depending on location. Metropolitan Life Insurance Co. found that the national average cost for adult day care is about $61 a day. The hourly rate for a home health aide -- who generally provides custodial care -- is $19, or $114 to $152 for a six- to eight-hour day. The article also mentions some positive preliminary results of the Medicare Adult Day Health pilot project. At Landmark Home Healthcare, in Allison Park, Pa., one of five Medicare pilot sites, hospital readmission rates for participants in the pilot project are less than half that for the population not participating. It is important that adult day services not be compared to a sitter service. Adult day is a cost effective program that offers everything from medication management and physical therapy, to nursing care, exercise and grooming. See the article on Adult Day Services. Dementia-specific Adult Day Center: A model for the future More than 5 million Americans have Alzheimer's disease. This disease has progressive symptoms that are a major challenge for caregivers. Many times, the purpose of Adult Day Centers is misunderstood by caregivers and sometimes healthcare professionals. Some people may equate adult day with a child-day or child sitting service. This false understanding of adult day has been a barrier for developing these cost-effective, quality community services. Specialization in Adult Day services has been an effective way of demonstrating how adult day services can make a difference in preventing nursing home placement for people with chronic diseases, such as Alzheimer's. Recreational activities, nursing services and even the building design of the adult day center can be specifically designed to deal with the symptoms of memory loss, short attention span and wandering. In an article in The Providence Journal, the reporter tells about the specialized program at Hope Alzheimer's Center. The Center has used fundraising and creative programming to combat limited state and federal funding. More on this specialized adult day services program. Home Health Care Home Care Aides: Nation's Fastest Growing workforce The ProAging Information Network newsletter on January 4th cited U.S. Department of Labor Statistics on occupational projections that found that home health aides, personal and home care aides outnumbered nursing aides, orderlies and attendants. The number of home health aides from 2006 to 2016 is projected to increase by 56%, and personal care and home care aides by 41%. For more details, read the newsletter. MedPAC Approves Array of Medicare Payment Recommendations The Medicare Payment Advisory Commission (MedPAC) on January 10, 2008 approved recommendations concerning a freeze on 2009 payments to home health agencies at 2008 rates. According to MedPAC, the recommendation would result in no major implications for beneficiaries and providers and would decrease federal spending by $250 million to $750 million in 2009 and between $1.5 billion and $5 billion over the next five years. "Even a freeze seems to result in an extraordinarily generous payment level," said commissioner Jack Ebeler, who at the panel's December meeting suggested that MedPAC discuss a five percent reduction to home health agencies due to their profit margins, projected to hit an estimated 11.4 percent in 2008. Peter Notarstefano, 202 508-9406. Hospice/End of Life Care New report focuses on PACE and End-of-Life Care The United States General Accounting Office (GAO) released a report on End-of-Life Care: Key Components Provided by Programs in Four states, and it highlights PACE in Florida, Oregon and Wisconsin. To view more information on the report. VA is key provider of hospice services Nearly 9,000 veterans were treated in designated hospice beds at VA facilities in 2007, and thousands of other veterans were referred to community hospices to receive care in their homes. The number of veterans treated in VA's inpatient hospice beds increased by 21 percent in 2007. In addition, the average daily number of veterans receiving hospice care in their homes paid for by VA increased by 30 percent this past year. To date, the VA has partnered with community hospice programs in 35 states to promote hospice services that are not provided directly by VA staff. To read the article on the Veteran's Administration's extensive hospice and palliative services. Hospice/End of Life Care 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 on Medicaid Eligibility Criteria. 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 New York study. Aging in Place Community Membership to Age in Place The Harvard Magazine in its January-February 2008 issue featured the article, Aging Gracefully at Home to highlight the emergence of "intentional communities" for older adults. Beacon Hill Village in Boston pioneered this village concept in independent living six years ago. Older adults in a community pay an annual membership fee to receive services, such as transportation, help with errands, recreation, information and referral and home care. Some of these services are free or offered at a discount price. These communities are being developed in NY State, Massachusetts, New Hampshire, Vermont, Connecticut, Virginia and D.C. To read the article from the Harvard Magazine. News from the States California Budget crises in CA impacts services for seniors There is a $14 billion California state budget crisis, and there will be a negative financial impact on our Adult Day Health Care (ADHC) and other home & community-based programs. Governor Schwarzenneger is proposing immediate mid-year and FY 2008-09 cuts including reducing the ADHC rate by 10%, effective March 1, 2008, reducing the Adult Day Center beneficiary population by 10% to generate savings, plus deferring Medi-Cal payments for five weeks this summer. It is also possible that our state Treasury will run out of cash in June. Read the article in the San Francisco Chronicle. Connecticut Report says there is "no place like home" A recent report on long-term care issues compiled by the Center on Aging at the University of Connecticut Health Center reported that older adults living in Connecticut would prefer to stay in their own homes, rather than living in a nursing facility. The report also showed that senior citizens underestimate the cost of services associated with getting adequate nursing care in the home and overestimate how much insurance and government programs will cover. By the state's projections, there are now about 188,000 Connecticut residents requiring long-term care, a number expected to reach at least 240,000 by 2030 as the boomers age. Only about 32 percent of Connecticut's Medicaid spending goes for home and community-based services. Get more information on the LTC report issues. Iowa The Hospice of Siouxland has been awarded $12,000 through the Siouxland Community Foundation's Special Impact grant to help in their efforts to develop a Program of All Inclusive Care for the Elderly. This program will be the first P.A.C.E. in Iowa and one of the first rural P.A.C.E. The grant funds will be used to create a therapeutic garden for the P.A.C.E. Center. More on this innovative project in Iowa. Kentucky More than 14,000 older adults in Kentucky are on waiting lists for services that will help them remain in their own homes. 4000 of these older adults are waiting to receive home-delivered meals. Read the article in the Kentucky Post. Missouri Backlog on Background checks impacts home care KSDK TV news in St. Louis on January 8th reported that Missouri state officials say that there is a backlog on background checks on home care workers. It was reported that it takes 30 to 60 days for home care agencies to receive the background check information on a new employee. Some agencies are employing independent companies to expedite the check. The report sites a robbery case that is alleged to have resulted from this delay in obtaining a criminal background check. Read more details regarding background checks on home care workers. First N.O.R.C. in Missouri takes off The Jewish Fereration of St. Louis has helped organize its first Naturally Occurring Retirement Community in Missouri. In a three square mile section of St. Louis 1100 residents age 65 plus have taken advantage of the St. Louis NORC services. The success of this NORC may lead to additional NORC projects throughout Missouri. Read more on the Missouri NORC projects. Pennsylvania Nursing Home Transition in action The January 6th edition of the Pittsburgh Post-Gazette places a human face on moving from a nursing home back into the community. The Nursing Home transition program out of the Allegheny Area Agency on Aging paid for $2000 for furnishings, household supplies and a security deposit for a one bedroom apartment for a 70 year old woman with chronic illnesses. To read more on this Nursing Home transition program. Pennsylvania has new emphasis on HCBS The Pittsburgh Post-Gazette reported on January 15th that Pennsylvania is taking steps to implement a "state strategy to shift more individuals into home and community care". Gov. Ed Rendell (D) has "beefed up funding of home-assistance programs intended to keep people out of nursing homes" and is "preparing financial incentives to encourage nursing homes to eliminate skilled-care beds." In addition, new assisted-living regulations "are being developed that will add government financing for people who require only some supervision." The state also has offered financial assistance to nursing homes that are willing to shift their focus to alternative types of care. Michael Hall, state deputy secretary of long-term living, said that the shift to home- and community-based care will save the state money. "If we're spending $70,000 or $80,000 a year on a nursing home bed, and I can take that bed off line, I can buy a heck of a lot of home- and community-based services and help a lot more people," Hall said, adding, "It's about rebalancing the system and services so we have a healthier array of more cost-effective services that do better in meeting consumer preferences." Read the article on the new emphasis on HCBS in PA . Rhode Island The Rhode Island Department of Elderly Affairs is proposing to substantially increase the copays for older adults who utilize subsidized adult day services and home care in Rhode Island. Clients would pay an increase of 27 to 50% more on co-payments to receive these needed services. 362 seniors were on the subsidized program for adult day and 969 for home care. This proposal would also eliminate the state subsidy completely for many older adults. These services help prevent nursing home placement. These increases will be a hardship for many older adults and caregivers. More information on the proposal in RI of increasing copays for the elderly. Resources and Publications Kaiser issues reports on Special Needs Plans The Kaiser Family Foundation has updated its interactive online resource, the Medicare Health and Prescription Drug Plan Tracker, with new 2008 data. The Tracker provides local, regional and national information about Medicare Advantage plans, including HMOs, regional and local PPOs, private fee-for-service plans, and special needs plans. It also includes current information on stand-alone prescription drug plans offered, along with updated 2007 enrollment data for Medicare Advantage and stand-alone prescription drug plans. The online tool can be used to monitor changes in Medicare Advantage enrollment over time within counties, states and nationally. Also,the Foundation has released a new report examining special needs plans. Prepared for the Foundation by researchers at Mathematica Policy Research, the report describes the history of these plans, how they fit into the larger Medicare Advantage marketplace, and how to assess whether special needs plans are performing differently from other Medicare Advantage plans. Read the report, "Do We Know If Medicare Advantage Special Needs Plans Are Special?". New Quality First Guidelines Now Available This month, AAHSA Quality First will release new guidelines every week to help you move forward on your journey to put quality first. This week's guidelines focus on developing partnerships and implementing evidence-based practices to improve your work for older adults. Use them to expand on the quality characteristics laid out in the Aging-Services Providers' Checklist for AAHSA Quality First. Contact: Bruce Rosenthal, (202) 508-9499. View all of the available Guidelines. Check out the Most Popular Tools and the Top Viewed Resources on the Quality First Web site. Adult Day Center in Oklahoma succeeds with Quality First AAHSA and the Oklahoma Association of Homes and Services for the Aging are proud of the achievements of the Daily Living Centers in Oklahoma for their successful implementation of Quality First. Quality First made a difference at Daily Living Centers (DLC). Their Quality First efforts resulted in a positive environmental change at this Adult Day Services program. It impacted everything from their day to day operations to their vision for the future. To read the letter from Bill Weaver, President/CEO of the Daily Living Center. Home Health PPS Fact Sheet available The Home Health Prospective Payment System Fact Sheet, which provides information about coverage of home health services and elements of the Home Health Prospective Payment System, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To review the Home Health PPS Fact sheet. Major fears of Older Adults A study by the Clarity and EAR Foundation found that 89% of American seniors want to age-in-place, and 26% rated loss of independence as their greatest fear. Death was only reported as a fear by 3% of older adults who responded to the survey. The article also reports that 63% of boomers surveyed said that they are providing some support to their parents to age-in-place. To read the article on the fears of American seniors. Is your community on track for the aging of America? Mature Markets.com completed a survey of 10,000 local governments to determine if they were ready for the "Maturing of America". The survey found that local governments generally offer basic health and nutrition programs, but have not developed policies, programs or services to promote quality of life for their older citizens. Some of services include job retraining, flex time, home chore services, home modification, affordable senior-friendly housing, roadway design, public transportation assistance, volunteer opportunities, and affordable transportation services. To read more on the survey about aging America. February is American Heart Month Cardiovascular diseases, including stroke, are our nation's No. 1 killer. To urge Americans to join the battle against these diseases, since 1963 Congress has required the president to proclaim February "American Heart Month." The American Heart Association works with the administration to draft and sign this annual proclamation. During American Heart Month, thousands of our volunteers visit their neighbors. Their goal is to raise funds for research and education and pass along information about heart disease and stroke. To see what you can do to help older adults and your employees battle heart disease. UPCOMING MEETINGS AAHSA Future of Aging Services Conference The Future of Aging services Conference (FASC) on March 31 - April 2, 2008 at the Marriott Wardman Park Hotel in Washington, DC will offer the following educational sessions on home and community-based services:
AAHSA Annual Meeting October 12th to October 15, 2008 Philadelphia, PA View past issues of the HCBS Report. AAHSA · 2519 Connecticut Ave. NW · Washington DC 20008 · www.aahsa.org
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