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May 1, 2008
Advocacy House Passage Sends Battle Over Medicaid Payment Cuts to Senate The effort to block Bush administration rules designed to reduce federal Medicaid costs now moves to the Senate, after House passage April 23, 2008, of a measure that would delay implementation of the rules. The Senate has moved to fast-track the legislation (bypassing the Senate Finance Committee). The bill is expected to move straight to the Senate floor within the next few days. House lawmakers easily defied administration veto threats and passed the bill (HR 5613) on a 349-62 vote, a margin large enough to overcome a presidential veto. The question now is whether supporters in the Senate can muster sufficient votes in that chamber and follow suit. The federal government now pays 57 percent of the program's costs - an estimated $204 billion in fiscal 2008. The seven proposed Bush administration regulations would narrow certain services provided by Medicaid, limit others eligible for federal reimbursements and end some Medicaid accounting maneuvers used by the states. Congress has overridden a veto by President Bush only once. The Congressional Budget Office estimates that the bill's one-year delay of the regulations would cost about $1.8 billion over five years. That cost would be offset in part by anticipated savings from a provision to require electronic verification of the assets of people applying for Medicaid. Senator Rockefeller has introduced a related measure (S 2819). In addition to the rules targeted by the House-passed legislation, Rockefeller's measure would postpone two others: one involving a board that hears appeals of Health and Human Services policies and another regarding the State Children's Health Insurance Program. For more information, please contact Morgan Gable at 202-508-9427. Baucus to Introduce Medicare Legislation By Mid-May A CQ HealthBeat News article states that Senate Finance Committee Chairman Max Baucus, D-Mont. intends to have Medicare legislation on the Senate floor in mid-May, and payment reductions to Medicare Advantage (MA) plans remain in play as a way to pay for the bill. Finance members are working to put together a package that would prevent a scheduled 10.6 percent cut in Medicare physician payments scheduled for July 1. Baucus favors an 18-month fix and he met with physician specialty and other clinician groups on April 11 "to relay his priorities" for the Medicare package. For more information, please contact Morgan Gable or 202-508-9427. Lawmakers Introduce Bills To Delay Hospice Repayments to Medicare Lawmakers earlier in April introduced bills in the House and Senate that would place a three-year moratorium on retroactive repayments from hospice providers to Medicare and authorize a comprehensive study of Medicare hospice benefits. In the last five years, the use of hospice by patients with less predictable life expectancies, such as those with Alzheimer's disease, has increased substantially. According to MedPAC, the average stay for an Alzheimer's patient is 86 days, compared with 44 days for lung cancer patients. Congress in 1998 removed limits on how long a person could receive Medicare hospice services but did not remove a cap on the aggregate amount that hospices could be reimbursed each year. CMS has begun asking hospices for millions of dollars in repayments from facilities that exceed Medicare reimbursement limits. A recent MedPAC analysis projected that 220 hospices, or about one in every 13 providers, in 2005 received repayment demands totaling $166 million. Please read the entire report. Falls Legislation Heads to the President Senator Barbara A. Mikulski (D-Md.) announced that legislation that she introduced to prevent falls among older adults has passed both the U.S. Senate and House of Representatives, and is headed to President Bush for his signature. The Safety of Seniors Act of 2007 (S. 845) authorizes new programs to help prevent falls among older adults through public education, research and demonstration projects. Falls are the leading cause of injury deaths among persons over 65. Specifically, the bill focuses on the following four components: public education campaigns, research initiative legislation, demonstration projects, and studies on effects of falls on health care costs. Review the entire article on Senator Mikulskis' bill for senior safety. Medicaid and Medicare News New Rule Will Increase Availability of Home & Community-Based Services Through the 1915 (i) Waiver The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide home-and-community based services. The proposed rule provides guidance to states on how to implement this provision of the DRA. Under this option, states will now be able to set their own eligibility or needs-based criteria for providing HCBS. The DRA provision eliminates the skilled need requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level. and who satisfy the needs-based criteria. The proposed rule emphasizes "person centered" care, giving individuals an active role in developing their care plans, and the "self-direction" option in which states can allow individuals to take charge of their own services. States may include under this benefit case management, homemaker, home health aide, personal care, adult day health, habilitation, and respite care. The DRA also allows states to provide special services to individuals with chronic mental illness, including day treatment or other partial hospitalization, psychosocial rehabilitation, and clinic services. Under the proposed rule, states would no longer have to apply for a waiver to provide HCBS to Medicaid beneficiaries. Under the DRA, states only need an approved state plan amendment (SPA) satisfying the DRA criteria. Once approved by CMS, the SPA does not need to be renewed nor is it subject to some of the same requirements of waivers such as budget neutrality. One state, Iowa, has since been granted an HCBS SPA. Three additional states, Colorado, Nevada, and Georgia, have requests pending under CMS review. The proposed rule was published in the Federal Register on April 4, 2008, and there is a public comment period through June 3, 2008. Read the rule or for more information please contact Peter Notarstefano or 202-508-9427. Real Choice Systems Change (RCSC) and Aging and Disability Resource Center/Area Agencies on Aging (ADRC) Grants for Fiscal Year 2008 On April 17, 2008, the Centers for Medicare & Medicaid Services (CMS) released the Real Choice Systems Change/Aging and Disability Resource Center Grant Solicitation. Applications are due no later than July 17. CMS has available approximately $8 million in funding to continue to support States' efforts to address complex issues in long-term care reform. In addition, CMS was also awarded $5 million for Aging and Disability Resource Center /Area Agencies on Aging grants. Base Grant Category: Development and Implementation of a Person-centered Hospital Discharge Planning Model. Only one grant per State will be awarded. In addition to this base grant, two additional options are offered. States may apply for only the base grant funding, or funding under one additional option. A state may not apply for both options. This grant solicitation builds upon the successes and direction of earlier RCSC and ADRC grant opportunities by providing targeted assistance to states in their efforts to improve hospital discharge planning through collaboration with Aging and Disability Resource Centers, Area Agency on Aging and the Centers for Independent Living. Specifically, this grant opportunity is designed to: promote the development and implementation of enhanced Person-centered Hospital Discharge Planning Models that meaningfully engage Medicaid-eligible, and potentially Medicaid-eligible individuals with disabilities (and their informal caregivers) to increase their opportunity to receive home and community-based services. Also, these grants will increase the capacity of existing, or develop new single entry points (including ADRCs) to provide critical linkages to available long-term care services in the community and much needed supports for informal caregivers themselves. The two additional options are: Option #1, Enhancing or Expanding Aging and Disability Resource Centers/ Single Entry Point Programs (ADRC/SEP). Option #2, Development of a New Aging and Disability Resource Center/ Single Entry Point Program. Please visit the CMS website for more information on ADRC and RCSC. CMS Durable Medical Equipment Update If you order, refer or supply certain medical equipment and supplies, such as oxygen or power wheelchairs, you should know about a new Medicare program that may change the suppliers your patients will need to use. The new program will begin July 1 in 10 geographic areas around the country, including Charlotte-Gastonia-Concord, NC-SC; Cincinnati-Middletown, OH-KY-IN; Cleveland-Elyria-Mentor, OH; Dallas-Fort Worth-Arlington, TX; Kansas City, MO-KS; Miami-Fort Lauderdale-Miami Beach, FL; Orlando-Kissimmee, FL; Pittsburgh, PA; Riverside-San Bernardino-Ontario, CA; San Juan-Caguas-Guaynabo, PR. The program will expand to 70 additional areas in 2009 and to additional areas thereafter. If your clients live in or travel to one of the 10 designated areas and you order, refer or supply any medical equipment or supplies that fall within the 10 product categories (see links below), please discuss the new program requirements with your clients, and provide them with the Medicare fact sheet entitled "What You Should Know if You Need Medicare-covered Equipment or Supplies." Please review the fact sheet. For the latest provider information on this new program, CMS has released 3 MLN Matters educational articles, which can be found on the CMS webiste: MLN Matters articles:SE0805 MLN Matters articles:SE0806 MLN Matters articles:SE0807 Adult Day Services Marketing Adult Day Services to Physicians It can be difficult to increase referrals from physicians. Many times they are not aware of what services are available in Adult Day Services, and how these services benefit their patients, as well as the family caregivers. The key to marketing to physicians is to:
Home Health Care Joint Commission and Home Health Accreditation The Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) has again granted the Joint Commission deeming authority for home health organizations. The CMS designation means that home health agencies accredited by The Joint Commission will be "deemed" as meeting Medicare and Medicaid certification requirements. Home health agencies choosing this option achieve "deemed status" by virtue of their successful achievement of Joint Commission accreditation. CMS found that the Joint Commission's standards for home health meet or exceed those established by the Medicare and Medicaid programs. Get more information on Joint Commission and Home Health Accreditation. CMS Says Another Payment Cut Will Come Lori Anderson, CMS Acting head of home health and hospice said, "As laid out in the 2008 PPS rule, CMS will repeat this year's 2.75% cut in 2009." Anderson hinted that while another case-mix change will not occur this year, another change could be in store for 2010, but she stated that it will be nowhere as drastic as the changes that took effect this year. For more information, please contact Peter Notarstefano or at 202-508-9406. OASIS Revisions Expected Late 2009 According to Home Health Line, the new proposed OASIS data set, OASIS-C, which includes the addition of 30 new process measures, won't be finalized until late 2009 at the earliest. Preview the newly revised OASIS from the CMS website and click on "CMS-10238." For more information, please contact Peter Notarstefano or at 202-508-9406. Avoid Errors in Medicare Home Health Claims According to a new CMS article, you may need to make changes in your billing systems to prevent erroneous low utilization payment adjustment (LUPA) add-on payments for claims that are not eligible for the add-on. The article describes the necessary changes and clarifies that add-on payments are made only on the first or only episode of care in a sequence of adjacent episodes. The article also stresses that CMS will adjust all claims received between January 1 and July 6, 2008 which received an inappropriate LUPA add-on. This article clarifies current policies in which there have been no changes. More detailed information regarding errors in medicare home health claims or contact Iara Woody (202) 508-9429. Hospice/End of Life Care MedPAC Releases For-Profit Versus Non-Profit Hospice Report MedPAC has released a report that highlights an 11.8% profit margin for for-profit hospices and a 2.8% profit margin for non-profit hospices. The report also found that average length of hospice stays rose 30% from 2000 to 2005, and that for-profit hospices have accounted for 90% of the 1,000 new hospices that have been opened since 2000. MedPAC will issue recommendations later this year, but one of the main recommendations is expected to attempt to reform the hospice payment system. For more information, please contact Morgan Gable or 202-508-9427. New Hospice Study Released More than a third of Americans now die under the care of a hospice service, a huge increase from just a decade ago and a major advance in end-of-life care. But a new University of Michigan study reveals major gaps in the availability of hospice care across the country - gaps that the researchers attribute directly to the way hospice care is currently funded in America. Most strikingly, the study finds that communities with lower average incomes and education levels, and areas with large concentrations of elderly people, are far less likely to be served by a hospice than communities with wealthier, more educated and younger populations. Analyses to date have not shown that hospice saves money overall, but it does result in lower hospitalization, resuscitation and treatment costs. Despite hospice's benefits, previous research has shown that elderly people, members of minority groups and people in rural areas are far less likely to use hospice. The new analysis probes the reasons why, by looking at hospice availability using mapping technology. View more on the new hospice study released. Aging in Place New Aging in Place Reports Released Two reports, one from AARP and the other from the Center for Aging Service Technologies (CAST) of the American Association of Homes and Services for the Aging, concluded that seniors want to use technology to age safely in place. The studies also found that caregivers believe some challenges can be eased through technology. The reports also found that both seniors and caregivers raised concerns that factors associated with the technology such as installation and maintenance costs act as barriers to the use of these new products. "Our study shows that we can create a network of technology-driven services to help elders stay at home and achieve better outcomes," said Majd Alwan, Ph.D., director of CAST. To find out more about CAST and to read its reports, please visit the CAST website as well as review the entire article. News from the States Alabama Over 1,500 Alabama Department of Human Resources (DHR) adult clients may lose their homemaker and/or day care services unless the department gets a budget increase from the state's general fund this year,. Alabama, like so many other states, is in a budget crunch and spends $3.6 million annually on homemaker and adult day care services. Many adult day health care centers in the state may be forced to close their doors if their funding is cut and if they do not receive an increase in their state funding. For more information on Alabama (DHR) cuts. California Pharmacists, medical equipment suppliers and senior-care providers say delays in Medi-Cal treatment approvals are causing hardships for them and their patients. Also expected is a 10 percent cut in Medi-Cal reimbursement that takes effect July 1 and an expected one-month delay in reimbursements this summer. Some patients are being declined services, mostly being denied prescription drugs, because required authorizations have not yet been received. Read the full article, "Medi-Cal faces delay in treatment approvals" . The California legislature has also voted to delay the cost-of-living adjustment for 1.3 million poor and near-poor elderly and disabled people who receive state supplementary payments to their Supplemental Security Income (SSI) benefits. Florida The Florida Legislature's plans to cut hundreds of millions of dollars from Medicaid programs for the elderly, disabled and poor will put lives at risk and will negatively impact all Floridians, the leaders of Florida's safety net hospitals warned. The proposed cuts in state Medicaid spending will also wastefully forfeit as much as $280 million in federal matching funds and will lead to higher health care costs for all Floridians, the hospital leaders said. One of the main programs that will face a serious cut is "The Aged and Disabled program." This program serves low-income residents who are 65 or older, or are totally or permanently disabled. Many recipients receive institutional care, hospice services, or home- and community-based services. The state Senate wants to totally eliminate this program. If the Senate succeeds, 24,000 elderly and disabled people whose annual incomes fall below 88 percent of poverty guidelines -- that's $9,152 a year -- will lose their Medicaid coverage. Find out more information regarding Florida legistation. Iowa The Iowa Senate voted Monday to give the state more regulatory authority over assisted living homes and adult day care centers. Current law does not allow the Department of Inspection and Appeals to investigate the facilities the way the department investigates traditional nursing homes. If the bill is signed by the governor, consumers would be able to search for reports on adult day and assisted living facilities in order to find the best one, similarly to what is only currently available for nursing homes. Read the entire article from Radio Iowa. New York The new Home Health and Hospice website will provide New York State residents with accurate and reliable information about state-certified home health agencies, long-term home health care programs, hospice programs and licensed home care services agencies in New York State. The Web site enables the public to search for providers, look at the services they offer, find contact information, compare quality measures and review complaint and investigation history and DOH enforcement actions. View website and learn more about New York Home care. New York's budget threatens to cut $100 million from home care funds. Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver are trying to stop the cuts by submitting pro-home care budget proposals. Advocates and State legislators are hoping that newly installed Governor David Paterson will reject the cuts. Please read the entire article on New Yorks' budget. Attorney General Andrew Cuomo Thursday announced that his industry-wide Medicaid fraud probe of the home health care industry has expanded upstate with the issuance of 27 subpoenas to western and central New York home health care providers. The investigation, known as "Operation Home Alone," has resulted in the conviction of a Buffalo area home health agency employee, Rochester area nurse, and Syracuse area licensed practical nurse. "Operation Home Alone" is the Attorney General's long-term and statewide investigation into fraud in the home health care industry, which is one of New York's fastest growing industries. Thus far, "Operation Home Alone" has resulted in charges against more than 80 defendants, including patients, aides, nurses, instructors, and the administrators of licensed and certified home health agencies. Defendants convicted during the investigation have been ordered to repay nearly $14 million in restitution. This week the Attorney General issued 27 subpoenas to certified home health agencies in the Buffalo, Rochester, and Syracuse regions. Read the full article on Operation Home Alone. Rhode Island According to a report by the Center on Budget and Policy Priorities (CBPP), Rhode Island low-income elderly people now must pay higher rates for subsidized adult daycare. This is estimated to affect more than 1,200 people with incomes below $20,000. The state is also considering cutting meals-on-wheels. Tennessee The Tennessee Health Insurance Assistance Program will get $793,699 from the Centers for Medicare & Medicaid Services to help Medicare beneficiaries in Tennessee get more information about their health care choices. The programs will use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics. Review the article on the Tennessee program. Vermont Governor James Douglas has announced a freeze on home health rates for fiscal year 2009. It is reported that in fiscal year 2006, the home care agencies in Vermont lost $6.1 million providing services under state programs. Proponents for more funding are advocating for $400,000 in state funds and the related matching federal funds in order to adequately fund home health services for fiscal year 2009. Without this funding, the provision of home health services to residents of Vermont may suffer. Read the entire article on squeeze due to Govoners budget on home health rates on 2009. Vermont is having a hard time coping with a shortage of home care providers. The number of Vermont residents 65 and older will jump almost 25% from now until 2030. A recent study was completed to understand more about the direct care worker shortage. Two of the major reasons for the shortage were low wages and a lack of benefits, mainly healthcare coverage. Read more about the study on shortage of home care providers. Virginia Virginia ranks 47th in the nation in Medicaid funding of home care. Unlike states that have tried to shift funding toward home care and away from nursing homes, Virginia spends just 27 percent of its Medicaid budget on home health and personal care. By comparison, it spends 42 percent on nursing facilities, according to the National Center on Caregiving. Because Virginia's reimbursement rate for home care doesn't cover all the costs of providing it, many home-care companies opt out of accepting Medicaid patients altogether. The companies that do accept Medicaid are plagued by worker shortages. Because of low reimbursements, service providers say they have a hard time paying their aides a living wage and covering mileage. In Virginia's rural areas especially, providers report that many Medicaid-eligible seniors simply go without home care because there's no one willing to provide it for such low pay locally. Read the entire article regarding low ranks in funding of home care. Washington MSNBC featured an article on ElderHealth Northwest, an adult day care center located in Seattle, Washington. The article focused on how ElderHealth Northwest provided valuable caregiver respite to families with loved ones who are suffering from Alzheimer's disease. Nora Gibson, the executive director of ElderHealth Northwest and an AAHSA HCBS Development Cabinet member, gave great tips on what to look for in a quality adult day care center. Get more information by reading the entire article. News, Resources, and Publications AAHSA Insurance Programs Now Open to HCBS Providers We are proud to announce the recent expansion of the AAHSA Insurance Programs into the home and community based services field. The AAHSA Insurance Programs, administered by Aon Association Services and underwritten by CNA HealthPro, have expanded to include HCBS providers including: Adult Day Care, Home Health Care, Meals Services, and PACE providers. Working together we continue to provide members with broad, competitive insurance products and free, online risk management education. Our ability to serve even more of the AAHSA membership is unprecedented and unmatched in the industry. For more information, go to our website or have your broker contact Maria Moreno at Aon Association Services at 1-800-865-7307 ext. 8553. New Devices Help Ensure Medications Compliance With 32 million Americans taking three or more medications a day, technology researchers are working overtime to make it easier for consumers with multiple health conditions to manage their prescriptions. For example, a small device called Med-eMonitor beeps, displays a large-print message and uses a voice recording to announce when it's time to take a pill. Another device, called MagneTrace is a necklace that senses and records when a pill passes through a person's esophagus. In-Home Monitoring: Benefits and Challenges In-home remote monitoring technologies could provide consumers with many health benefits, but getting insurers to pay for those technologies could be challenging, according to two reports. A study by Deloitte Center for Health Solutions of New York suggests that in-home technologies could help increase medication adherence, reduce post-acute complications and improve management of chronic conditions. In another report, Dallas-based research firm Parks Associates maintains that insurers would be less resistant to remote monitoring if they could see independently verifiable trial results that demonstrate the benefits of this technology. New Report on HCBS Policy from Rutgers Center for Health Policy A new report has been written by Paula Acosta and Leslie Hendrickson entitled, "Advancing Medicaid HCBS Policy: From Capped Consumer to Consumer-Directed." This report features sections on the past, present, and future of HCBS and also discusses issues related to the Deficit Reduction Act of 2005. Read the entire document from the HCBS website. Reports Key on Quality in Consumer-Directed Care Forty-two states had Consumer Directed-Personal Assistance Services programs available in 2006, and the four states profiled reported participation rates of about 10 percent among those eligible for the program. Two reports released March 24 by the Kaiser Family Foundation stated that enrollees in consumer-directed personal assistance services (CD-PAS) are pleased with the flexibility and independence, but better customer service, improved training for enrollees and workers, and better pay and benefits for workers are needed to improve the program. One report, Consumer Direction of Personal Assistance Services in Medicaid: A Review of Four State Programs reveals how consumer direction has worked in California, Colorado, New York, and Virginia. A second report, Consumer Direction of Personal Assistance Services in Medicaid: Insights from Enrollees in Four States, is based on focus group responses from CD-PAS participants and those receiving care from a traditional program in the federal-state Medicaid system. Review the report on Medicaid. Trustee Report Details Social Security's and Medicare's Financial State While many believe that Medicare and Social Security are in serious and immediate financial trouble, the Trustee report has stated that Social Security will be able to pay out 100% of its benefits through 2041, and according to the Center on Budget and Policy Priorities (CBPP), the program "is structurally sound and does not require drastic changes." However, the news for Medicare is not quite as good. The Trustee report states that the Medicare Hospital Insurance (HI) Trust fund will begin running a deficit as early as 2010. CBPP believes that Medicare's problems are a direct result of overall sky-rocketing healthcare costs, not because of a structural problem with the program. Once again, the overpayments to Medicare Advantage programs have been cited as a possible reform effort. Read a more detailed analysis of the report. May is Older Americans Month The U.S. Administration on Aging (AoA) has made materials that can be utilized by organizations available online. The theme for Older Americans Month 2008 is "Working Together for Strong, Healthy and Supportive Communities." Materials include logos, posters, a sample proclamation and a sample article. You must download information in order to obtain materials for Older Americans Month. Don't miss your chance to be a part of the Leadership AAHSA Class of 2009! Leadership AAHSA offers a challenging and engaging year-long learning experience, designed to help aging services professionals accelerate their leadership development. Fill out our online application form. Application Deadline: May 15, 2008 (tuition waivers are available). Grant Opportunities/Funding Sources Weinberg Foundation to Award Caregiver Grants The Harry and Jeanette Weinberg Foundation, one of the nation's largest private philanthropies has announced an innovative program to provide $9 million in grants to assist caregivers nationwide. Grant applications will be accepted by The Weinberg Foundation until June 12, 2008. Complete application details and additional information is available online, by calling (410)654-8500, or by emailing. Community College Caregiver Training Initiative Grants Available The Caregiving Project for Older Americans, a project housed within the International Longevity Center-USA (ILC-USA), has released a Request for Proposals (RFP) and will award up to twelve $25,000 grants to community colleges to establish new caregiver training programs or to build upon existing programs. Program requirements include: Care of Older Adults-the training must prepare students to care for older people, either exclusively or in addition to other groups; Care in the Home-the training must prepare students to provide care in home settings, either exclusively or in addition to institutional care; and Family Caregivers-while the overall program may be for the training of professional caregivers, some components must address family caregivers. The RFP can be downloaded. The deadline for submissions is May 15, 2008. Questions should be emailed. Major funding was made available by the MetLife Foundation. MetLife offers numerous, major grants for many health-related projects. Get more information from the Metlife website. UPCOMING MEETINGS 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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