Quote of the Month
“We will never have true civilization until we have learned to recognize the rights of others.” – Will Rogers
Managed Long Term Services and Supports
On June 1, the Centers for Medicare and Medicaid Services (CMS) published a 653 page long proposed rule to modernize regulations concerning Medicaid managed care and CHIP. It’s the first update since 2003. According to CMS, “the proposed rule would align the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implement statutory provisions; strengthen actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promote the quality of care and strengthen efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It would also ensure appropriate beneficiary protections and enhance policies related to program integrity. This proposed rule would also require states to establish comprehensive quality strategies for their Medicaid and CHIP programs regardless of how services are provided to beneficiaries.” CMS comments that managed care use has changed and grown substantially since the current regulations were released over a decade ago. As of FY 2011, almost 60% of Medicaid beneficiaries received benefits through a capitated managed care plan, and as of 2014, 20 states had implemented Medicaid managed long-term services and supports (MLTSS) programs. Click here for an article by Governing article, 5 of the Biggest Changes in New Medicaid Managed Care Rules. Public comments on the proposed rule are due to CMS by July 27 and more information can be found here, including summaries of key provisions, and here.
The newly proposed regulations regarding MLTSS are based on 10 essential elements in guidance CMS released to states for MLTSS programs implemented through Section 1115 demonstrations or 1915(b) waivers. These 10 components that CMS incorporated into the proposed managed care regulations include:
- Adequate Planning
- Stakeholder Engagement
- Enhanced Provision of Home and Community-Based Services
- Alignment of Payment Structures and Goals
- Support for Beneficiaries
- Person-Centered Process
- Comprehensive, Integrated Service Package
- Qualified Providers
- Participant Protections
On June 1st, the Pennsylvania Department of Human Services (DHS) made a major announcement about a new initiative to pursue Managed Long-Term Services and Supports (MLTSS) in Pennsylvania. DHS issued a discussion document which provides an outline of the components DHS wants to include in its MLTSS system. They also posted supporting documents including a summary fact sheet and a guide for submitting comments. Statewide public hearings are already scheduled starting June 10th in Erie and concluding June 26th in Philadelphia. Here is the fullschedule. To register to present verbal comments or attend the public input meeting, click here. Individuals may also register by calling (717) 783-8412 or (800) 654-5984 (TDD users). CMS posted a timelinefor states to use as a guide for “optimal planning and implementation of MLTSS programs.” This resource may prove useful to advocates during the stakeholder engagement process.
On May 21, the U.S. Senate Special Committee on Aging held a hearing,Challenging the Status Quo: Solutions to the Hospital Observation Stay Crisis. (Witness statements available in .pdf format and a video of the hearing is also available but scroll to the 20:22 mark to begin the hearing.) Observation status impacts Medicare beneficiaries who have Original Medicare coverage. Hospitals may either formally admit a patient or keep them under “observation” status. The care is the same for consumers; however, the out-of-pocket cost is very different especially if the consumer needs to be admitted to a skilled care facility after their hospital stay. In most states it’s up to the patient or family to ask about the patient’s status. However, Pennsylvania now has a law requiring hospitals to inform Medicare patients of their status. Senator Susan Collins, Committee Chair, expressed concern about the lack of communicating the status to Medicare patients and encouraged CMS to use its regulatory authority to require hospitals to give this notice.
Committee members also requested that CMS make changes to Medicare’s Recovery Audit Contractor (RAC) program, which some believe has caused the rise in observation stays in recent years. Mark Miller, Executive Director of the Medicare Payment Advisory Commission (MedPAC), testified that MedPAC recently backed recommendations for reforming the RAC program, including removing the divisive “two-midnight” payment rule and reducing the contingency fee for contractors with high overturn rates.
The hearing also focused on the impact of observation status on the cost of care in a skilled nursing facility. Currently, a Medicare beneficiary must be in a hospital for three nights as an inpatient to receive Medicare coverage for care at a skilled nursing facility. Senator Collins commented that the legislative process to remedy this problem has been slow.
Advocates are encouraged to contact members of the U.S. Senate Committee on Finance to approve the “Improving Access to Medicare Coverage Act of 2015” (S. 843). This measure would address one major problem with observation status and count any time that a Medicare beneficiary spends in a hospital toward the 3-night stay requirement. There is also a companion bill H.R. 1571 currently in the House Committee on Ways and Means and House Committee on Energy and Commerce’s Subcommittee of Health. Advocates may also contact members of these committees for action.
Please plan to attend the Disability Budget Coalition’s (DBC) rally at the Capitol to advocate for funding for home and community-based services on Monday, June 15. Make an appointment to see your State Representative and State Senator before or after the 11 a.m. rally and press conference. Here is a flyer with more information. You may also follow the DBC on Twitter @DBcoalitionPA and Facebook to stay current on these budget issues and the rally.
The Department of Human Services (DHS) released a discussion documenton its Home Modification Quality Improvement Program and wants your input. The overall goal of the program is to improve efforts to provide home modifications for individuals in certain Waivers, including the Aging Waiver, and increase the opportunity for them live in the community. If you have feedback, please submit your responses electronically to RA-PWPROGRAMREVIEW@pa.gov by close of business on July 2, 2015.
Video and Webinar
PBS NewsHour has a segment about how nearly one in six older Americans face the threat of hunger.
Justice in Aging is sponsoring a webinar Protecting Dual Eligibles from Balance Billing — What Advocates Need to Know on Wednesday, June 17 at 2:00 p.m. ET/11:00 a.m. PT. Click here to register.
Just the Links
The Administration on Aging posted A Profile of Older Americans: 2014.
The United Health Foundation released America’s Health Rankings: 2015 Senior Report
The 2015 White House Conference on Aging will take place on Monday, July 13th. For more information on the conference, including copies of issue briefs, links to the live stream and updates as the event draws closer, go to www.whitehouseconferenceonaging.gov.
The Washington Post wrote an article, How to build livable communities for older people: report that talks about a new report on livable communities for older adults.
GAO issued new reports including: “Domestic Food Assistance: Multiple Programs Benefit Millions of Americans, but Additional Action Is Needed to Address Potential Overlap and Inefficiencies,” GAO-15-606T, and “Older Adults: Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports,”GAO-15-190.
The National Foundation to End Senior Hunger (NFESH) released a study,State of Senior Hunger in America 2013: An Annual Report that shows 15.5% of seniors or 9.6 million individuals age 60 or older in the United States faced the threat of hunger an increase over the previous year’s findings. Click her for the Full Report, State Rankings, orSupplement.
CMS released guidance for Long Term Care (LTC) facilities regarding facility actions to disenroll beneficiaries from Medicare Advantage plans or plans that serve dual eligibles as part of the Financial Alignment Initiative. CMS identifies an unacceptable practice of LTC facilities disenrolling beneficiaries from these plans without the beneficiary’s or the representative’s knowledge or understanding. CMS clarifies that only a Medicare beneficiary, the beneficiary’s legal representative, or the party authorized to act on behalf of the beneficiary under state law can request enrollment or voluntary disenrollment from a Medicare plan.
The National Quality Forum released its Health and Well-Being, phase 2 project draft report containing the Steering Committee’s recommendations for endorsement on the measures submitted to the project. The comment period is open through June 29 at 6:00pm ET.
The Employee Benefits Research Institute (EBRI) released the results of their annual retirement confidence survey. The 2015 Retirement Confidence Survey also includes 7 topical fact sheets that highlight specific findings.
PEW posted an article, Elder Abuse a ‘Huge, Expensive and Lethal’ Problem for States.
The Consumer Financial Protection Bureau, together with the Securities and Exchange Commission, issued a consumer advisory and investor bulletin about diminished capacity.
CRS’ report, The Violence Against Women Act: Overview, Legislation, and Federal Funding, is now posted.
The Occupation Safety and Health Administration (OSHA) has issued a revised version of their Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. This publication updates OSHA’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers.
IdentityTheft.gov, a new website, offers step-by-step checklists of what to do right away, and what to do next, depending on the information that’s been stolen or exposed. It lists warning signs indicating your identity was stolen, and gives websites and phone numbers for organizations you’ll need to reach.
CARIE is a partner with the National Adult Protective Services Association (NAPSA), the National Center for Victims of Crime (the National Center), and the International Network for the Prevention of Elder Abuse (INPEA) to celebrate the First Global Summit on Elder Abuse, which is being held to commemorate the 10th Anniversary of World Elder Abuse Awareness Day (WEAAD). The Summit will take place on June 15th, 2015 at the Securities and Exchange Commission (SEC) in Washington, DC.
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, June 4, 2015 at CARIE’s office at Two Penn Center – Suite 1500. Here is the agenda. All are welcome. Hope you can join us. (Please be advised that July’s meeting is cancelled. We will meet on August 6.)
As always, please contact me if you have any questions.
267-546-3438 or 1-800-356-3606, ext. 3438