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Status Report of Personal Care Homes and Assisted Living in PA - Posted May 1, 2007 

The Department of Public Welfare (DPW) recently released data indicating that 73% of Pennsylvania’s personal care homes are operating with expired licenses since DPW is behind in completing inspections. This means that 1,190 of Pennsylvania’s 1,589 personal care homes do not have a current license. Secretary Richman reported at a Senate Public Health and Welfare Committee hearing that she expects it will take until the end of the year for DPW to catch-up with this backlog. She recently announced plans to hire 30 retired workers as temporary, part-time inspectors to help address the backlog of annual inspections.  At a Senate Appropriations Committee hearing earlier this year, Secretary Richman announced plans to create a “QA unit” (quality assurance) that she hopes to be operational in the next few months.

It is expected that a number of bills regarding assisted living will be introduced this legislative session. Representative Watson has once again introduced her assisted living bill, House Bill 375.  Unfortunately, it still has not made needed improvements from last session to ensure consumer rights. Senator Vance recently introduced Senate Bill 704 and this bill also falls short in provided consumers with needed protections. The Bill passed the Senate Public Health and Welfare Committee on April 25.

An article in the April 30 Pittsburgh Post-Gazette describes the Rendell administration’s plans to introduce assisted living legislation in Pennsylvania. Representative Mundy is expected to be the primary sponsor of the bill.  The legislation will create a new licensing category whose regulations will be more involved than current personal care home regulations but less intensive than current nursing home regulations. The Department of Health would be charged with regulating assisted living. While the administration claims it would seek Medicaid Waivers to help cover the cost for older adults with income less than $1,870 per month, no funding has been proposed for assisted living because of doubts as to whether legislation could be approved.

On April 18, the Legislative Budget and Finance Committee released a report, “An Assessment and Cost Review of Personal Care Homes in Pennsylvania.” Unfortunately, the report misses the point that the recent closure of personal care homes has nothing to do with the change in regulations but rather these facilities would have closed under the enforcement of any regulations.

FY 2007 Federal Budget Highlights - Posted February 28, 2007

On February 15, President Bush signed the FY 2007 $464 billion budget bill, over four months into the fiscal year. The bill makes about $10 billion in cuts to 60 programs. Three Older Americans Act (OAA) programs received increases in funding including:
• $ 6.4 million increase for home delivered meals – from $181.9 million to $188.3 million
• $13.6 million increase for congregate meals – from $385.3 million to $398.9 million
• $51.3 million increase for Senior Community Service Employment Program (SCSEP) – from $432.3 million to $483.6 million.

All other OAA programs are funded at the FY 2006 levels throughout FY 2007. Funding for geriatric training programs under Title VII of the Public Health Service Act was also restored for FY 2007 at $31.54 million after Congress threatened to completely eliminate these important programs. The geriatric training programs include Geriatric Education Centers, Geriatric Health Professions Training and Geriatric Academic Career Awards.

Other funding increases include:
• VA medical care is funded at $32.3 billion, an increase of $3.6 billion from FY 2006.
• The National Institutes of Health received a $620 million increase from FY 2006.
• The Social Security Administration received a $146 million increase to avoid having to temporarily lay-off staff this fiscal year.
• The Centers for Medicare and Medicaid Services (CMS) received a $52 million increase to sustain the operation of the 1-800-MEDICARE call centers.

Pennsylvania 2007/08 Session Information - Posted January 30, 2007

Pennsylvania’s new legislative session began with one of the largest freshman class in many years. There were 56 new members elected, 51 in the House and 5 in the Senate. In a surprising development, Representative Dennis O’Brien (R., Philadelphia) was elected by a 105-97 vote to become the Speaker of the House in Pennsylvania. Even Rep. O’Brien did not anticipate his own nomination. Rep. Bill Deweese (D., Greene), the expected Democratic nominee, actually nominated Rep. O’Brien when he realized he wouldn’t have enough votes to defeat his Republican challenger, Rep. John Perzel (R., Philadelphia). For the first time in at least 100 years of Pennsylvania’s history, the Speaker won’t be from the majority party. Perhaps due to the chaotic situation, Rep. O’Brien did not officially vote. The Democrats hold a slim 102-101 lead in the House and the Republicans continue to hold the majority in the Senate.

Among the House leadership positions, there are two newly created posts. Rep. Perzel is now “Speaker Emeritus.” His new salary will be the same as rank-and-file members but he will have a staff of 3 or 4 aides as opposed to 1 or 2 provided for rank-and-file members. The duties of “Speaker Emeritus” were not released along with the GOP’s announcement of the new position. Rep. Joshua Shapiro (D., Montgomery) is the “Deputy Speaker” and was chosen for this new position by the new Speaker, Rep. O’Brien. Rep. Shapiro will receive the same salary as rank-and-file members but will be charged with promoting bipartisan cooperation on legislation.

Click here for House Committees’ membership listings. (To be posted soon) Some 2007-2008 key House Committee Chairs for older adult issues are as follows:
Democrats - Majority
Appropriations Rep. Dwight Evans – Philadelphia County
Aging & Older Adult Services Rep. Phyllis Mundy – Luzerne County
Health & Human Services Rep. Frank Oliver – Philadelphia County

Republicans - Minority
Appropriations Rep. Mario Civera – Delaware County
Aging & Older Adult Services Rep. Tim Hennessey – Chester County
Health & Human Services Rep. George Kenney – Philadelphia County

Click here for Senate Committees’ membership listings. Some of the 2007-2008 key Senate Committee Chairs for issues related to older adults are as follows:
Republicans - Majority
Appropriations Sen. Gib. Armstrong – Lancaster County
Aging & Youth Sen. Patricia Vance – Cumberland County
Public Health & Welfare Sen. Ted Erickson – Delaware County

Democrats - Minority
Appropriations Sen. Vince Fumo – Philadelphia County
Aging & Youth Sen. Leanna Washington – Philadelphia County
Public Health & Welfare Sen. Vincent Hughes – Philadelphia County

On January 24, Governor Rendell announced that Mike Hall is the new Deputy Secretary for the Long Term Living Council. Hall most recently served as Deputy Commissioner for Health, Integrated Access and Strategy in Maine. Mike Nardone, the current Council leader, has returned to the Department of Public Welfare as the Deputy Secretary for the Office of Medical Assistance Programs. Michele Hansarick has been appointed Executive Director of the Senate Public Health and Welfare Committee by Committee Chairman Senator Ted Erickson. She is replacing Scott Johnson. Hansarick has worked for Senator Jane Orie, ex-Senate GOP Leader Joe Loeper, and for Governor Dick Thornburgh in his Policy Office.

Governor Rendell will give his FY 2007/08 budget address on February 6, 2007. The House will hold budget hearings from February 14th through March 8th. Click here for the 2007/08 House budget hearing schedule. The Senate will hold budget hearings from February 26th through March 8th. Click here for the list of 2007/08 Senate budget hearing schedule.

Senate Appropriations Committee Budget Hearings of Interest to Older Adults
February 28th at 3:00 PM – Budget Secretary
March 1st at 10:30 AM – Department of Health
March 6th at 1:15 PM – Department of Aging
March 7th at 9:00 AM – Department of Public Welfare

House Appropriations Committee Budget Hearings of Interest to Older Adults
February 20th at 1:30 PM – Office of Health Care Reform
February 22nd at 10:00 AM – Department of Aging
March 1st at 2:30 PM – Department of Health
March 8th at 9:00 AM – Department of Public Welfare

Medicare Part D Update - Posted October 4, 2006

Medicare Part D insurers are permitted to begin marketing their 2007 plans in preparation for the six week open enrollment period that begins November 15. Even if beneficiaries are satisfied with their plan, they should take the time to review the 2007 policy to be sure their prescriptions will still be covered and that the tier hasn’t changed for any of the drugs they need. A change in tier could mean a significant increase in the monthly co-pay. Medicare has produced “Stand-Alone Prescription Drug Plans” for every state that lists the available plans and some basic information such as monthly premiums. To access the list of plans available in each state, go to http://www.medicare.gov/medicarereform/local-plans-2007.asp and click on the specific state. A relatively new website, http://partdoptimizer.com, provides information to help beneficiaries avoid or survive the infamous doughnut hole and lists comparative data about drug costs to help with price transparency.  

Medicare Part D and PACE - Posted September 5, 2006

PACE Plus Medicare became law on July 7, 2006 and went into effect on September 1, 2006. As a result of the law, Pennsylvania enrolled approximately 160,000 PACE and PACENET beneficiaries into Part D plans. (Click here for more information about Medicare Part D.) About 4,000 PACE and PACENET users refused to allow the state to enroll them into a Part D plan. While enrollment is voluntary, the Department of Aging will try again in the fall to convince them to enroll. PACE recipients who decided not to enroll will continue to receive PACE benefits as they always have. PACENET recipients who did not enroll in Part D will continue to receive their current benefits but will pay a premium that equals the current Part D benchmark premium, currently $32.54, instead of the PACENET deductible.

It is important to remember that beneficiaries will not lose their PACE and PACENET benefits. PACE Plus will fill the gaps in coverage from the Part D plans including the infamous doughnut hole gap. PACE and PACENET will continue to pay for medications not covered by the Part D plan’s formulary if the drug is currently covered by the PACE program. Some PACE beneficiaries may also have lower copayments. The Department of Aging has stated that cardholders should not experience any disruption in service and the change should be “seamless.”

Beneficiaries who opted to enroll in a Part D plan should bring both their PACE or PACENET card and their Medicare Part D card to their pharmacy when filling a prescription. If there are problems in filling a prescription, the pharmacist should contact PACE by phone at 1-800-225-7223.

The Department of Aging’s website has posted information about PACE Plus Medicare. If you or your clients experience any problems with PACE Plus, please contact the CARIE LINE at 215-545-5728. The CARIE LINE is also available to help those who need to select a plan or enroll in the Low Income Subsidy program.

"Take Action" on Medicare Part D - Posted September 5, 2006

The following information is from NCOA, the National Council on Aging.  Thank you for any contacts you can make to help with this advocacy effort.  Please urge your members of Congress to waive the Medicare prescription premium penalty and fund outreach and enrollment activities.

Medicare beneficiaries who wait until the November/December election period to enroll in a drug plan are subject to a 7% per month premium penalty for the rest of their lives.  Advocates should make their voices heard to encourage Congress to waive this penalty and provide additional funds for outreach and enrollment activities to State Health Insurance Programs (SHIPs), Area Agencies on Aging (AAAs) and others.

Urge your Senators to pass S. 2810 and your Representative to pass H.R. 5399: Waiving the premium penalty has broad bipartisan support. The Senate bill also includes an additional $13 million for State Health Insurance Assistance Programs (SHIPs) and $5 million for Area Agencies on Aging (AAAs) for outreach and enrollment efforts.   The House bill does not include this funding, but should.  NCOA is also working to increase the funding from $18 million to $22 million and give $100,000 to each of 20 Enrollment Benefit Centers around the country, which would focus on finding and enrolling low-income beneficiaries.  For more information on the bills and NCOA’s proposal to increase funding and target low-income beneficiaries, go to S. 2810 or H.R. 5399. 

Why should the Medicare prescription drug premium penalty be waived this year? 

1. Many seniors were unaware or confused about whether or how to enroll in the Part D benefit, and should not receive a lifetime 7% monthly penalty as a result.     
2. Waiving the penalty will encourage more people to enroll.  Many who did not initially sign up are taking few or no prescription drugs.  Enrolling healthier, less expensive beneficiaries will reduce costs for all participants. 
3. The Part D late enrollment penalty should not be more severe than the Medicare Part B late enrollment penalty, which is delayed for 12 months after the initial enrollment period has ended.

TAKE ACTION – Please contact your two Senators, in Pennsylvania Senators Specter and Santorum as well as your Representative immediately and urge them to pass S. 2810 and H.R. 5399 this year.  Urge them also to include funding for outreach and enrollment. 

You can call your two Senators as well as your Representative by contacting the U.S. Capitol switchboard at 202-224-3121 and asking for them by name.  You can also call their state or district offices.  To get local contact information, go to Congress Merge.  Please contact Kathy Cubit if you have any questions.  Thanks again for your help.

Pennsylvania Budget Update - Posted August 1, 2006

Licensing of Home Care Agencies and Registries - Posted August 1, 2006

House Bill 247, Act 69 of 2006, was signed into law on July 7.  For the first time, home care agencies and registries in Pennsylvania providing personal care services, approximately 600 agencies, must be licensed to provide personal care services.  Under the new law, consumer rights and protections have been established and agencies will need to complete criminal background checks on workers as well as provide training.  The Department of Health will promulgate regulations, license agencies and provide oversight.  Click here to read the bill.

Pennsylvania Budget Issues - Posted June 19, 2006

Pennsylvania begins a new fiscal year every July.  The legislature is in the process of finalizing the FY 2006-07 budget and will be scrambling the next two weeks to meet the June 30th Constitutional deadline for the enactment of Pennsylvania's budget.  It's interesting to note that no budget has been finalized by the deadline during the Rendell Administration.  This year could prove to be different since as of the end of May, Pennsylvania has an almost $723 million surplus which makes it easier than when dealing with a deficit.  The budget surplus coupled with the impact of last month's primary elections when an unprecedented 17 incumbent legislators were defeated, including the Senate majority leader and the Senate president pro tempore, could lead to a more timely resolution of contentious issues during an election year.  Currently, leaders from the four legislative caucuses are meeting and once they agree on a proposed budget, they will begin final discussions with the Rendell Administration.  House Majority Leader Sam Smith is quoted as saying that the leaders should have a proposal ready for Governor Rendell's staff to review by the end of the week.     

For the most part, there are no major funding cuts in Rendell's proposed budget that would impact programs and services directed to older adults.  However, the proposed relatively flat funding will cause waiting lists to grow as well as create barriers to needed care.  To complicate matters, the House Republican leadership ignored Rendell's proposed budget and is using the current budget as a starting point.  CARIE has joined a statewide campaign, coordinated by AARP of Pennsylvania, to advocate for the passage of Senate Bill 1188 (SB 1188).  SB 1188 would amend the State Lottery Law to allow the PACE/PACENET program to "wrap around" the Medicare Part D benefit and ultimately provide Pennsylvania savings of as much as $190 million annually.  In addition to the recommendations being made by the campaign to expand home and community based programs, CARIE is also advocating for "wrap around" coverage for dual eligibles, those eligible for both Medicare and Medicaid, as well as increasing reimbursement levels for the Family Caregiver Support Program.

CARIE sent a letter to every member of Pennsylvania's legislature to request that they pass SB 1188 and utilize the savings to benefit older Pennsylvanians.  (Editor's Note:  SB 1188 unanimously passed the Senate on June 21, 2006.)  Please click below to read CARIE's letter and the materials developed by the AARP campaign.  Want to learn how you can help with this advocacy effort?  Please click on the "Take Action" link.

CARIE's (Sample) Letter to Members of the Pennsylvania Legislature

"Support Home and Community Care Options" Flyer

"Talking Points for Expanding Pennsylvania's Home and Community Care OPTIONS"

"Give Older Pennsylvanians A Choice" White Paper

"Take Action" on the Pennsylvania Budget - Posted June 19, 2006

If you haven't already done so, please read the background information provided above about Pennsylvania's proposed FY 2006-07 budget.  Now is the time to call or fax your state senator and representative to ask for their support and leadership to ensure the following budget priorities to help older Pennsylvanians.  (Editor's Note:  SB 1188 unanimously passed the Senate on June 21, 2006.  The focus with the Senate should be about how the savings to the PACE program should be utilized.)

Please vote in favor of Senate Bill 1188 and use the savings to:

• increase funding for the Department of Aging's OPTIONS program by at least $30 million;
• increase funding for senior centers by at least $8 million;
• increase funding for shared ride transportation services by at least $5 million; and,
• provide $2 million for training direct care workers. 

(For the budget requests listed above, you may use a toll free hotline provided by AARP of Pennsylvania to contact your legislators at 1-800-515-8134.)

CARIE is also advocating for dual eligibles who have been negatively impacted with the implementation of Medicare Part D.  Please contact your state representative to ask that Senate Bill 1188 be amended or the Department of Public Welfare be mandated to provide dual eligibles with the same benefits and "wrap around" coverage being offered to PACE/PACENET beneficiaries. (The "benefits" include helping dual eligibles select the Medicare Part D plan that best meets their prescription drug needs as well as their preferred pharmacy and filing appeals with the Medicare Prescription Drug Plan, PDP.  "Wrap around" coverage would cover prescriptions on the PACE formulary that are not covered by the Medicare Part D plan formulary.)

Finally, the Family Caregiver Support Program has not seen an increase since the program's inception in 1990.  Request that the provisions in House Bill 566 (this bill unanimously passed the House last June) be supported to increase the maximum amount available to an eligible caregiver from $200 to $600 per month and the maximum amount for home modifications and assistive devices increase from $2,000 to $6,000. 

Click here to find the contact information for your state representative.

Click here to find the contact information for your state senator.

Don't know your state senator or representative?  Click here and go to the upper right hand corner of the page to search by zip code.

If you have any questions, please contact Kathy Cubit at CARIE.  In addition, if you have time please forward any response you receive from a legislator to Kathy.

Personal Care Home Litigation Update - Posted May 29, 2006

There is some good news to report on personal care homes in Pennsylvania!  As you know, personal care home providers filed a lawsuit in Commonwealth Court to try to stop the implementation of the new personal care home regulations.  On November 23, 2005, the Commonwealth Court issued a preliminary injunction that put a hold on a number of sections of the new personal care home regulations while the rest of the regulations were allowed to be implemented.  Among the areas put on hold were regulations relating to administrator qualifications and training, staffing requirements and training, and medication records.  On May 24, 2006, the Commonwealth Court issued their opinions and dismissed the petition.  Now all of the regulations put on hold have been reinstated.

Click here to read the Commonwealth Court's decision.

"Much To Do About Medstat" -  Posted May 2, 2006

At April’s Legislative Committee meeting, we distributed copies of the final Medstat report, “Home and Community Based Services Reform and Rebalancing Feasibility Analysis.”  The Pennsylvania Department of Public Welfare (DPW) contracted with Medstat to evaluate Pennsylvania ’s Home and Community Based Services (HCBS) waiver programs with a special emphasis on the structure, administration and delivery of waiver services in Pennsylvania .  The report briefly outlines information about Pennsylvania ’s eleven waivers as well as three state-funded HCBS programs, including OPTIONS.  Medstat also outlined a number of findings and recommendations under five major headings including:

1. “Misaligned Management Structures” – HCBS waiver programs in Pennsylvania are not being efficiently managed.
2. “Decentralized Administration of Waiver Programs” – The decentralization of HCBS waiver program administration has led to inconsistencies in the application of waiver services care plans and allocation of benefits.
3. "Waiver Program Policies and Procedures” – Medstat made a number of recommendations.

• “Develop Uniform Assessment Process”

·        “Streamline the Eligibility Process for Applicants at Most Risk of Institutional Services”

·        “Prioritize Waiver Services for Persons Most at Risk”

·        “Develop Residential Service Components in Waiver Programs”

·        “Provide Increased Continuity in Case Management Services”

·        “Separate Case Management Services from Direct Service Provision”

4.  “HCBS Waiver Consolidation and Target Population Changes” – Medstat recommends consolidating several existing 1915(c) waivers into one waiver and expanding two existing waivers in order to cover all individuals regardless of their disability.  It was recommended that the PDA Waiver continue as a separate waiver for older Pennsylvanians.

5.  “Feasibility of Section 1115 Independence Plus Waiver” – Medstat does not believe Pennsylvania needs to pursue a Section 1115 Independence Plus waiver at this time, but should reevaluate as various HCBS waiver programs need to be renewed.

According to DPW, stakeholders will be invited to provide input into the implementation of the recommendations included in the report through a series of meetings to be convened over the coming months.

Please click here to review a copy of the "Medsat" report.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long Term Care Integration Links - Posted May 2, 2006

In addition to the Medstat report, here are some recently released resources related to integrating long term care and rebalancing the long term care system.

• A draft document, “State Guide to Integrated Medicare & Medicaid Models,” from CMS dated March 1, 2006
• A draft CMS abbreviated report, “Rebalancing Long-Term Care Systems in Pennsylvania.” (Scroll down page to "State Specific Summary Reports" link.)
• The Executive Summary from a CMS report, “Management Approaches to Rebalancing Long-Term Care Systems in Eight States;” and,
• A National Health Policy Forum Background Paper, “Rebalancing Long-Term Care: The Role of the Medicaid HCBS Waiver Program.”