Quote of the Month
“For age is opportunity no less than youth itself, though in another dress, And as the evening twilight fades away the sky is filled with stars, invisible by day.” – H.W. Longfellow
(Please be sure to join us at CARIE’s Cavalcade of Stars. More information in “CARIE News” below.)
“Doc Fix” Update
There is bipartisan agreement in Congress that the Medicare Sustainable Growth Rate (SGR) formula, which was passed by Congress in 1997 to control physician spending, does not work. It has required 17 temporary fixes by Congress to prevent significant Medicare rate cuts to physicians. Medicare payments to doctors were scheduled to be cut by 21% on April 1, but the Department of Health and Human Services is holding off processing claims at the lower rate until April 15 with the hope that Congress will once again act to avert this cut. The SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 1470) is now part of a larger package as it was added to H.R. 2, The Medicare Access and CHIP Reauthorization Act of 2015, which also funds the Children’s Health Insurance Program (CHIP) and extends all of the Medicare extenders (including therapy caps) and funding for Community Health Centers through 2017. The legislation would permanently extendthe Qualifying Individual (QI) program that pays Part B premiums for low-income beneficiaries. This bipartisan legislation would offer a permanent solution to the SGR by restructuring the provider payment system under Medicare Part B. The Congressional Research Service issued a related report, H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015. President Obama stated he would sign the bill and the Senate is expected to take up the legislation when it returns on April 13.
While the bill solves some major problems, half of the $70 billion needed to pay for it would come from increases in beneficiaries’ out-of-pocket costs. According to the Consumer Voice, “The bill also includes an extremely harmful provision for nursing home residents, a “standard of care” provision that would make it more difficult for violations of important federal quality of life and quality of care standards – such as residents’ rights, nurse staffing, or assessment and care planning- to be used to establish a legal case of negligence against a facility.” Advocates are being asked to contact their Senators to support an amendment to make the bill more balanced and to exclude nursing homes from the standard of care provision.
The Consumer Voice has set up an online system to communicate with your Senators to ask them to remove nursing homes from this provision in H.R. 2. “It is quick and easy – just enter your zip code and information here, and a letter will be provided for you to send.” NCOA has also set-up an online system to help you contact your Senators “to support a modest, bipartisan amendment to make the bill more balanced by improving low-income protections and outreach, repealing arbitrary therapy caps, and extending ADRC funding.”
Resources for Medicare’s Complaint and Appeal Processes
Each state has a Beneficiary and Family Centered Care Quality Improvement Organization (BFF-QIO) to respond to Medicare beneficiaries’ complaints about the quality of their care and appeals related to a health care provider’s decision to discharge them from the hospital or nursing home, or to stop other types of services. The two regional BFCC-QIOs are KEPRO and Livanta. Both of these BFCC-QIOs recently created online tools to make it easier for Medicare beneficiaries and providers to check the status of patients’ discharge appeals. Up to now, this information was only available over the phone through the BFCC-QIOs’ call centers. Livanta’s tool also provides the status of quality of care complaints in addition to appeals. Click hereto determine whether KEPRO or Livanta is the BFCC-QIO in your state. Each website will have more information about the complaint and appeal processes including toll free numbers and forms. Click on the following links to view the online tools KEPRO, Livanta Area 1, andLivanta Area 5.
In addition, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Quality Improvement Organization (QIO) Program Progress Report.
The Pennsylvania Department of Human Services (DHS) announced a 30-day public comment period for the transition plan for the Health Choices Medicaid Expansion. The plan addresses the steps DHS is taking to transition from the Healthy PA alternative Medicaid waiver expansion program to a traditional Medicaid expansion. The public notice, transition plan, samples of notices being sent to Medicaid consumers, and other resources can be viewed at HealthChoicesPA.
Webcasts and Videos
The Dementia Action Alliance posted a 7-minute video, “Person-Centered Matters,” that is “an extraordinary video based in hope and possibility about living fully with dementia through meaningful engagement and person-centered dementia care and service.”
On April 9, 2015 from 1:00-2:30 pm ET, the CMS National Training Program will be highlighting new and updated Medicare-covered preventive services and will demonstrate 2 Medicare tools: MyMedicare.gov and The Blue Button. Click here to join the webinar, dial 1-877-267-1577, and enter meeting number 998 275 879 for the audio.
The Institute on Medicine released a new PSA this week on having the conversation about end-of-life care, as a companion to its recent report on the topic. The video, and other resources for the conversation, are at www.iom.edu/theconversation.
Just the Links
The Medicare Payment Advisory Commission (MedPAC) issued its March 2015 report to Congress.
The Alzheimer’s Association’s released its 2015 Alzheimer’s Disease Facts and Figures that includes a special report on disclosing a diagnosis of Alzheimer’s Disease.
The March issue of AHRQ’s Health Care Innovations Exchange features resources and three programs that used innovative strategies to support caregivers of patients with dementia.
The NIA’s Alzheimer’s Disease Education and Referral Center postedAlzheimer’s and Dementia Resources for Professionals.
The Families and Work Institute released The Older Adult Caregiver Study. It had a surprising finding that in the last five years, of those employed, slightly more men (51%) than women (49%) provided 20 hours or more of elder care a week.
The Huffington Post rounded up the top eight aging in place ideas.
The National Institute for Health Care Reform (NIHCR) posted an issue brief, Bridging the Disconnect Between Patient Wishes and Care at the End of Life.
The Institute of Medicine report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life finds that most people are unable to make their own decisions about care when they’re nearing the end of life.
The Long Term Care Community Coalition released a new primer on nursing home quality standards for managed care organizations.
The Administration for Community Living (ACL) has created outreach materials to help celebrate Older Americans Month this May and the 50th anniversary of the Older Americans Act. The theme for Older Americans Month 2015 is Get into the Act.
The Pennsylvania Department of Human Services recently posted a mapshowing the availability and cost of MA nursing facility services, home and community-based services, Living Independence for the Elderly (LIFE) and demographics on a county basis.
Just for Fun
Whoever said you’re too old to go for a ride in a red wagon never met these retirees from Wasilla, Alaska.
Please plan to attend CARIE’s annual auction to be held on Thursday, April 30, 2015 from 5:30 PM – 8:30 PM at WHYY – 150 North 6th Street, Philadelphia. This year’s theme is CARIE’s Cavalcade of Stars – Celebrating older loved ones and friends who inspire! The event will honor two outstanding advocates as recipients of this year’s Spirit of CARIE award. Terry Roth, a public interest attorney, has been an effective advocate for the rights of people with disabilities of all ages for three decades. Dr. Norma Thomas, a professor and director of the Master of Social Work Program at California University of Pennsylvania, has effectively advocated on behalf of vulnerable elder members of minority communities and advanced education in the field of aging. CBS 3’s Jim Donovan returns as the evening’s Master of Ceremonies. Auction items include exciting vacations, artwork, jewelry, event tickets, services, fun activities and much more! New this year – silent auction online bidding. Please visit our event website to purchase tickets, register for online bidding, and for sponsorship opportunities. For more information contact Michele Mathes at (267) 546-3436 or email@example.com.
On March 20, CARIE submitted comments to the Pennsylvania Department of Human Services (DHS) Office of Long Term Living regarding its most recent proposed Home and Community-Based Settings Transition Plan. The draft transition plan outlines the steps the Department of Public Welfare (DPW) proposes to take to comply with the Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services Final Rule.
CARIE Connection Archives
Are looking for a past issue of CARIE Connection? Click here to access past newsletters.
Public Policy Meeting Announcement
The next Dorothy S. Washburn Legislative Committee meeting will be held from 9:30 to 11:30 on Thursday, April 9, 2015 at CARIE’s office at Two Penn Center – Suite 1500. Here is the agenda. All are welcome. Hope you can join us.
As always, please contact me if you have any questions.
267-546-3438 or 1-800-356-3606, ext. 3438