Quote of the Month
“History is merely a list of surprises. … It can only prepare us to be surprised yet again.” – Kurt Vonnegut
New Nursing Home Regulations
On October 4, 2016, the final regulations for nursing homes participating in the Medicare and/or Medicaid programs were published in the Federal Register. The National Consumer Voice for Quality Long-Term Care, along with Justice in Aging and the Center for Medicare Advocacy, created a brief overview of the regulations, including positive and negative effects for nursing home residents. The regulations are being phased in over four years – PHASE 1 – November 28, 2016; PHASE 2 – November 28, 2017 and PHASE 3 – November 28, 1019.
Some of the highlights include:
- Improvements to eviction protections including effective in Phase 1, nursing homes must cc the ombudsman on all discharge letters.
- Facilities cannot require or request a third-party financial guarantee.
- More emphasis on person-centered planning and discharge planning; a baseline care plan is required within 48 hours of admission and a comprehensive plan within 7 days.
- It is now easier to challenge arbitration agreements ad financial guarantees.*
- Visitation rights are strengthened i.e. if a guardian wishes to limit visitation by family, they need to file for a court order.
*While the new regulations do not allow pre-dispute arbitration agreements, the American Health Care Association (AHCA) has filed a legal challenge and the court granted an injunction pending appeal.
Observation Status (MOON)
The Medicare Outpatient Observation Notice (MOON) informs all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or critical access hospital (CAH). Effective 2-21-17, the MOON must be delivered to beneficiaries in Original Medicare (fee-for-service) and Medicare Advantage enrollees who receive observation services as outpatients for more than 24 hours. The hospital or CAH must provide the MOON no later than 36 hours after observation services begin. This includes beneficiaries who do not have Part B coverage (as noted on the MOON, observation stays are covered under Medicare Part B), beneficiaries who are subsequently admitted as an inpatient prior to the required delivery of the MOON, and beneficiaries for whom Medicare is either the primary or secondary payer. For more information visit the Center for Medicare Advocacy.
How will repealing the Affordable Care Act impact Medicare?
Bundled within the Affordable Care Act (ACA) of 2010 are provisions that both directly assist Medicare beneficiaries and strengthen the long-term solvency of the Medicare program. Indeed, Medicare beneficiaries saw substantial decreases in their payments for preventative measures such as wellness visits, and mammograms. In addition, the ACA significantly lowered the cost of prescription drugs, especially for low income beneficiaries, and those with high prescription drug burdens. The ACA also extends the solvency of the Medicare program. First, the ACA has provided for programs, and measures designed to cut waste, and fraud in the Medicare program. Secondly, by expanding the Medicaid program, an additional 12 million Americans now have access to quality health care, increasing the likelihood of positive long-term health outcomes. The Congressional Budget Office projects that the savings provided by these aspects of the ACA will allow Medicare to remain solvent 11 years longer than prior to the law’s enactment.
The passage of the Affordable Care Act of 2010 has been met with consistent Republican opposition. Emboldened by current majorities in both houses and a new Republican administration in the White House, Republicans have redoubled their efforts by passing legislation in January to begin dismantling parts of the ACA. Although there is currently no consensus on what would replace the law if repealed, a significant number of Americans, including Medicare beneficiaries, stand to be effected. Firstly, Medicare beneficiaries could lose many of the preventive and prescription drug benefits they have come to rely upon. Secondly, many of the measures designed to contain Medicare fraud and waste are threatened. Thirdly, repealing the ACA threatens the 12 million Americans who now receive health insurance through the law’s Medicaid expansion. Without, adequate healthcare, it is possible that these individuals will be considerably sicker by the time they reach Medicare age, which is likely to increase the burden on the Medicare program. This, along with the loss of programs designed to combat fraud and abuse, could have devastating consequences on the long term financial health of the program. A Special Report by the Center for Medicare Advocacy provides information about the need to renew rather than repeal the ACA.
Medicaid Block Grants: What does this mean and how will it impact Older Adults?
House Republican leaders have incorporated a revision to the federal funding support to states for Medicaid in their Affordable Care Act (ACA) repeal and replacement plan. Currently, Medicaid costs are shared between federal and state governments, with the federal government paying more than 54% of Pennsylvania Medicaid costs. The proposed reform would change federal Medicaid spending from percentages based on cost to either block grant or per capita cap models. Under the block grant model, the federal government would give states a yearly set lump sum of money, while the per capita cap would provide a set sum of money per person per year. Proponents of the revision see this change as an opportunity to curb federal spending and give more flexibility to the states to manage their own Medicaid programs.
The risks, however, far outweigh any benefits proposed. 6.9 percent of adults over 65 rely on Medicaid for long term care services including home and community based services, help in paying Medicare premiums and copays, and filling in coverage gaps from Medicare. The block grant model and per capita caps would greatly reduce funding for Medicaid, leaving states with few options other than to limit eligibility, reduce or eliminate services, or pay providers less. All such options would result in serious access problems, leaving older adults and people with disabilities the most vulnerable to not receiving the care they need.
In addition, with block grants and per capita caps, funding across states would vary, resulting in health disparities across the nation. Federal funding would be allocated to states based on historical spending not on current need, therefore locking states into possibly low allotments solely based on what they have spent in the past. This would eliminate the critical need for spending flexibility to accommodate contingencies such as recessions, natural disasters, and the changing healthcare needs of the growing aging population.
The majority of Medicaid spending is used for older adults and people with disabilities. These proposed reforms would shift costs to states, providers, and the beneficiaries themselves, leaving many people without the needed access to coverage and care they depend on every day. For more information on how Medicaid works for older adults and the proposed reforms please use these links:
Medicaid Financing: The Basics
Straight Talk for Seniors: Medicaid
Justice in Aging Policy Brief: Medicaid Funding Caps Would Harm Older Americans
Urban Institute: Block Grants and Per Capita Caps, the Problem of Funding Disparities among States.
Senate Special Committee on Aging
Pennsylvania’s Senator, Bob Casey is now the Ranking Member of the Senate Special Committee on Aging. He and Chair, Senator Susan Collins of Maine have made fighting Financial Exploitation, Fraud and Scams a priority establishing a Fraud Hotline – 1-800-855-9470. The Committee’s investigators have experience in fraud concerning retirement savings, identity theft, phone scams, Medicare, Social Security, and a variety of other consumer issues important to seniors and the elderly. Due to the nature of the fraud that has been committed or is suspected, individuals often do not know where to turn for assistance. The hotline is staffed by a team of committee investigators weekdays from 9 a.m. to 5 p.m. EST.
CARIE’s Executive Director, Diane Menio was invited to speak at the first hearing held since Senator Casey became Ranking Member. The hearing, “Stopping Senior Scams: Developments in Financial Fraud Affecting Seniors” was held on February 15, 2015 and also featured, Philip Hatch, an IRS Impersonation scam victim from Maine, Lois Greisman, Associate Director, Division of Marketing Practices, Bureau of Consumer Protection, Federal Trade Commission, and Tim Camus, Deputy Inspector General for Investigations, Treasury Inspector General for Tax Administration.
Fiscal Year 2018 Budget
It’s budget season again and Pennsylvania is facing a $2.3 billion budget deficit. At his budget address on February 7th, Governor Wolf outlined his budget for Fiscal Year 2018. As expected, the budget does not include new taxes but does cut expenses. Many of the cuts are realized through consolidation of agencies, the largest of which is the merger of four agencies into a single agency, the Department of Health and Human Services. The agencies included are: the Department of Aging, the Department of Drug and Alcohol Programs, the Department of Health, and the Department of Human Services. This new agency will account for nearly one-half of all spending in the Commonwealth. We shared our concerns in a letter to the Governor, the Secretaries and the chairs of the House Aging and Adult and the Senate Aging and Youth Committees.
Managed Long-Term Supports and Services – Community Health Choices Implementation
After issuing an RFP and reviewing proposals the Department of Human Services chose AmeriHealth Caritas, Pennsylvania Health and Wellness (Centene), and UPMC for You for negotiations to cover all regions in the state.
The timeline for the introduction of Community Health Choices, the name for Pennsylvania’s Managed Long Term Care Services and Supports program, has been pushed back. The new effective dates are as follows: Southwest PA: January 1, 2018; Southeast PA: July 1, 2018; and the remaining zones January 1, 2019.
The change in the timeline is the result of delays related to four bid protests by managed care organizations (MCOs) that were not chosen in the Commonwealth’s bidding process. This has prevented required steps in the implementation process, including the readiness reviews required of the MCOs. Three of the protesters filed appeals but the courts found that the process could move forward pending the resolution. So, it seems that readiness reviews can begin at any time – we have been told that this process takes at least six months. Information about Community Health Choices is archived and updated on the web.
Independent Enrollment Broker
The Office of Long Term Living (OLTL) is in the process of gathering detailed data related to the timing of processing applications for the Aging waiver and other home and community based waiver services. Specifically, OLTL is working to identify factors contributing to lags in time between participant application and eligibility determination and between eligibility determinations and service provision. There was a large increase in December, 2016. The department considers this an anomaly, attributed anecdotally to provider agencies heavily marketing in the Southeast. The RFP for a permanent enrollment broker was developed and sent for comment. OLTL last announced that they expected to provide an update in January. No word yet. On February 19, 2017, the Chairpersons of the House Older Adult Services and the Senate Aging and Youth Committees recently sent a letter to Secretaries Ted Dallas and Teresa Osborne CHC and the Independent Enrollment broker urging the department to make more information public on its website including public comment.
Impact on Pennsylvania if the Affordable Care Act is repealed
On February 22, 2017 Insurance Commissioner Teresa Miller, Secretary of Health Dr. Karen Murphy, and Secretary of Human Services Ted Dallas joined Pennsylvania consumers to discuss the implications of repealing the Affordable Care Act for consumers around the commonwealth. More than 1.1 million Pennsylvanians currently receive coverage through the Affordable Care Act’s health insurance exchange and Medicaid expansion.
If the ACA were to be repealed, Pennsylvania could lose 137,000 jobs in 2019, almost all in the private sector and would reduce gross state product by $76.5 billion and state and local tax revenue by $2.4 billion between 2019 and 2023. Over the next 10 years, ACA repeal is estimated to result in nearly $36 billion less federal funding for health care for Pennsylvanians and $7.8 billion more in state spending. A press release with information about how ACA repeal will impact Pennsylvania has been prepared by the Pennsylvania Health Funders Collaborative. A full report and data book with facts for the state, each Congressional district, and Philadelphia, Allegheny, Montgomery and Delaware counties is available on the Collaborative’s website.
Webinars and Conferences
New Rules for Medicare Appeals 2017, Webinar – Thursday, March 9, 2017, 3:00-4:00 PM EST
On March 20, 2017, new Medicare appeals regulations will take effect. This webinar will include a discussion of key changes made to the Medicare appeals regulations with a focus on how the changes will impact Medicare beneficiaries and those who represent Medicare beneficiaries and advocacy tips shared by attorneys who have collectively appealed thousands of Medicare denials.
PCA’s 6th annual Senior Education Day “Engage Your Body and Brain” will feature Dr. Dan Gottlieb, host of WHYY radio’s Voices in The Family. Enjoy 60-minute classes, free parking and a healthy snack! March 18, 2017 at PCA 642 N. Broad St. Philadelphia, PA. Tickets are $5. Register here to buy tickets online or call 215-765-9000, ext. 5055.
American Society on Aging, Aging in America Conference (AiA17) March 20-24, 2017 in Chicago, IL. More than 3,000 professionals attend AiA17 to learn, network and participate in the largest multidisciplinary conference covering issues of aging and quality of life for older adults.
The 2017 National Voices of Medicare and Senator Jay Rockefeller Lecture will be held in Washington, DC on March 30th. Senator Sherrod Brown will give the Senator Jay Rockefeller Lecture and Senator Rockefeller will be present to introduce him and join in a Q&A session after the Lecture. The Summit will also feature personal stories from beneficiaries and families interspersed throughout a day filled with valuable information, insights, and best practices from the following experts and national leaders.
Just the Links
Medicare: Time to Renew Not Retreat, an issue brief by the Center for Medicare Advocacy provides a compelling case for why we need to strengthen Medicare. As one Pennsylvania beneficiary noted, “Privatized Medicare to seniors that are already on a fixed income would be a disaster for senior citizens who are already having to choose between food and medical care and prescriptions.”
Families USA, in partnership with the DentaQuest Foundation, has launched an intensive, multi-faceted advocacy campaign, Oral Health for All, to expand access to oral health coverage to the more than 130 million Americans who currently lack coverage. They plan to achieve this ambitious goal through a series of strategic policy changes to be enacted on the federal and/or state level including adding an oral health benefit to Medicare and Medicaid, including oral health coverage in subsidized marketplace health insurance plans; and improving access to oral health care for children in Medicaid and the Children’s Health Insurance Program (CHIP).
There is a new and particularly disturbing form of elder abuse happening in nursing homes and other long-term care settings. ProPublica identified 47 instances since 2012 in which workers have shared inappropriate, dehumanizing, and unauthorized digital content of residents (Ornstein & Huseman, 2015). The National Center for Elder Abuse has released a fact sheet presenting the findings from this report as well as resources and ideas for action.
The National Council on Aging’s Elder Economic Security Standard™ Index (Elder Index) offers a tool to increase our understanding of the costs of growing older in the US. The Elder Index present local expenses, savings requirements, and what incomes are needed to achieve economic security by family type, and at the city, county, and state levels. Anyone can use the database to find out how much is needed to be economically secure, by location and family type, compare expenses across locations and family types, download national, state, county and city index data, and access additional information on elder economic security.
Carol Netzer, a psychologist, is a 90-year-old resident of an assisted living facility in New York City. Before she made the decision to leave her home, she and her daughter did a lot of research on what it would be like to live in such a facility from a resident’s perspective. They found nothing. Carol’s book, Assisted Living: An Insider’s View aims to fill that void. In addition, she maintains a blog where you can read excerpts from her book and Carol’s regular posts.
Kaiser Family Foundation recently talked to Trump voters covered by the Affordable Care Act about what they want in a health plan, Listening to Trump Voters with ACA Coverage: What They Want in a Health Care Plan.
February 22, 2017 – Governor Wolf visited Wilson Park Senior Center in Philadelphia to announce $2m in grants to Pennsylvania’s Senior Centers for Fiscal Year 2016-2017.
An op-ed was published February 8, 2017 in Newsworks by Philadelphians Against Bed Bugs (PHABB). PHABB is a collective of advocacy and legal organizations, including CARIE, asking the City of Philadelphia to adopt a comprehensive policy to address the rising rate of bed bug infestations. CARIE understands not just the physical and psychological toll a bed bug infestation can have on older consumers, but the barriers in place in exterminating the problem. PHABB is calling for the adoption of policy recommendations from the Philadelphia Bed Bug Task Force which convened in 2015. It includes implementing code enforcement for property owners who neglect serious bed bug infestations, educating the city about best practices to combat infestations, and implementing policies to keep homes, places of work, social gathering, and schools safe from potential bed bug problems. The policy recommendations can be found on PHABB’s website.
Services & Advocacy for GLBT Elders (SAGE) https://www.sageusa.org/ is the country’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual and transgender (LGBT) older adults.
Just for Fun
Flo Meiler, of Shelburne, Vermont is a pole-vaulting, hurdle-jumping track and field star. At 82, she’s also a grandmother to five and a great-grandmother to two. Meiler has set 25 world records, 19 American records and has won more than 750 medals since she began her track and field career at age 60.
While CARIE is, and always will be non-partisan, we believe it is our responsibility to acknowledge that some of the changes happening at the federal level have the potential to dramatically impact the quality of life of the consumers that we serve. CARIE’s work will always be guided by the best interests of the people we serve, and we will continue to have a seat at the table as a voice for consumers.
SHARE IN THE CELEBRATION OF CARIE’S 40 YEARS OF ELDER ADVOCACY! Please join us on the evening of April 20, 2017 for a wonderful reception and auction supporting CARIE and celebrating CARIE’s 40 years of advocacy on behalf of elders throughout our communities! The event will be held at WHYY studios, 150 N. 6th Street, Philadelphia, PA 19106 from 5:30 – 8:30 PM on April 20th. In addition to great food, drink and company, the evening will include both silent and live auctions offering exceptional (and much sought after!) silent and live auction items, including fantastic vacation destinations, evenings on the town, art, jewelry, home entertainment, sporting and cultural events and many other items. We are honored also to be recognizing at the event two outstanding advocates and long-time friends of CARIE with the Spirit of CARIE award: Ray Landis, AARP Pennsylvania’s Advocacy Manager and Bill Benson, Principal, Health Benefits ABCs, LLC. You can purchase tickets to join CARIE’s 40th anniversary celebration and bid on your favorite auction items at our dedicated event website. And – coming soon! -even if you are not able to join us on April 20th, you can participate in the fun of the auction online. Please check our event website in the coming days as wonderful auction items will be added. Thank you so much for supporting CARIE and helping to ensure our next 40 years! For more information contact Michele Mathes at (267) 546-3436 or email@example.com.
CARIE establishes a new project, Providing Advocacy for Victimized Elders in Long Term Care
CARIE’s is expanding its victim advocacy program to long term care consumers including those living in nursing homes and personal care homes who have fallen victim to a crime. Physical disabilities, language barriers and mental health issues already contribute to a vulnerability to crime and can make the criminal justice process overwhelming. If an older adult experiences physical violence or sexual assault, they face an uphill battle of ensuring the crime is properly reported and often are unaware of available services.
The Long-Term Care Advocate will ensure that residents are educated about their rights to report a crime to law enforcement, ensure that victims receive assistance navigating the process, offer to accompany them to court, assist them in filing for Crime Victim Compensation and help to develop a victim impact statement. The advocate will also ensure that there is a stay away order in place against perpetrators who threaten a resident’s safety if needed. With assistance from project partner, Community Legal Services, the PAVE Advocate will address additional legal issues a victim may encounter related to receiving long term care. This project is funded by the Pennsylvania Commission on Crime and Delinquency. To learn more, please contact Juliane Holz at 267-546-3061 or firstname.lastname@example.org.
CARIE is hiring
Long Term Care Ombudsman. The Ombudsman serves as an advocate for long term care consumers by handling complaints and educating residents and families about their rights. Responsibilities of position include investigating complaints made by and on behalf of residents, responding to calls providing information and advocacy about issues related to long term care, making regular visits to long term care facilities to observe safety, cleanliness, staff/consumer interaction etc., outreach, and public policy analysis. For a full job description please visit: https://www.carie.org/contact/careers/. Send resume with cover letter and salary requirements to Lori Walsh, Program Manager at email@example.com. No phone calls please. CARIE is an Equal Opportunity Employer.
CARIE Connection Archives
Are you 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, March 2, 2017 at CARIE’s office at Two Penn Center – Suite 1500. Please click here for March’s agenda. All are welcome. Hope you can join us.