Friday, October 31, 2008
Summary: The Medicare Part D benefit was first available in January 2006, and that year it provided federally subsidized prescription drug coverage for nearly 28 million beneficiaries at a cost of $47.4 billion—almost 12 percent of total Medicare spending.
The Centers for Medicare & Medicaid Services (CMS), part of the Department of Health and Human Services (HHS), manages and oversees the Part D program. Part D sponsors—entities that enter into contracts with Medicare2—administer the benefit and compete for beneficiary enrollment. To provide coverage, the sponsors often enter into contractual relationships with pharmacy benefit managers (PBM),3 drug manufacturers, and retail pharmacies, among others. The Part D program relies on sponsors to generate prescription drug savings, in part through their ability to negotiate price concessions, such as rebates and discounts, with these entities. Sponsors must report the price concession amounts to CMS and pass price concessions on to the program.4 CMS uses the reported data to calculate final plan payments, so accurate data are necessary to ensure accurate payments. CMS is responsible for ensuring that the reported price concessions data are reliable.
We and others have reported challenges to the oversight of federal prescription drug programs that rely on privately reported data, noting significant financial consequences for the federal government resulting from inaccurate reporting.5 You asked us to provide information on the price concessions data CMS collects. Specifically, we examined how CMS ensured the reliability of the 2006 price concessions data, the most recent complete year of data for which CMS had conducted oversight activities.
Findings: CMS conducted checks of the reported price concessions data prior to reconciling the 2006 payments to identify certain potential problems, and has initiated about half of its planned financial audits to examine the data in more detail. According to CMS officials, they conducted data checks prior to payment reconciliation to identify potential problems such as outliers and questionable data. Where officials identified problems with the data, they contacted sponsors and resolved most problems before payment reconciliation. CMS officials said they do not expect the data checks to identify all possible problems, but they rely on them as a vital step to ensure a certain level of confidence in the data in the absence of sufficient time to fully review or audit them before payment reconciliation. The officials said that the financial audits, which occur after payment reconciliation, allow them to more fully evaluate the accuracy and validity of the data. CMS intends to complete 169 financial audits of Part D contracts for program year 2006. Officials expect to complete about half of the planned audits by October 2008—within CMS’s targeted timeline for conducting all of the audits of 2006 data. According to CMS officials, the remaining audits were delayed due to financial constraints and CMS, therefore, funded the audits from two program year budgets. The officials expected to complete the delayed audits by October 2009 and did not expect that audits of program year 2007 data would be similarly delayed. In addition, officials noted that variation in defining and reporting price concessions data, such as variation in how sponsors allocate manufacturer rebates between their Part D plans and other business, would likely create oversight challenges. We received written comments on a draft of this report from HHS. HHS stated that the draft correctly characterized the financial audit program, but did not adequately emphasize the robustness of CMS’s other oversight activities. We revised the draft to reference further detail about CMS’s data checks and clarified our characterization of their purpose.
Get full report here: http://www.gao.gov/new.items/d081074r.pdf?source=ra
Oct issue available here: http://www.abanet.org/srlawyers/publications/enewsletter/home.shtml
Upcoming conference, Senior Lawyers' Division:
Providing Persons with Disabilities and the Elderly with Equal Access to Justice
Sponsor: ABA Tort, Trial & Insurance Practice Section
Co-sponsor: ABA Senior Lawyers Division
December 5, 2008
Stetson University College of Law
NHeLP has issued a new fact sheet that answers the most commonly asked questions about Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. EPSDT provides early health screenings, preventive care, comprehensive treatment, and health education to children and young adults who are Medicaid beneficiaries. The fact sheet is located on NHeLP’s website under the “What’s New” section at www.healthlaw.org.
Wednesday, October 29, 2008
The Shriver National Center on Poverty Law has just published
"What You Need to Know About Advocacy for Limited-English-Proficient Elders"
Growing numbers of limited-English-proficient senior citizens frequently encounter language barriers when attempting to access government services and programs. Older people have a number of language-access rights under both federal and state law as well as under legal services program policies. Advocates should be aware of these rights and specific language-access problems related to the largest government agency regularly used by the elderly: the Social Security Administration.
Tuesday, October 28, 2008
The Economic Crisis Webcast
Thursday, October 30, 2008 at 2:30 PM - 4:00 PM EDT / 11:30 AM - 1:00 PM PDT
- How we got into this mess.
- What we as a nation and as advocates can do about it.
Financial meltdown, credit crunch, the burst housing bubble, rising unemployment: the economic situation is tumultuous and scary. Between the finance jargon and the finger-pointing about blame, it is pretty hard to understand what's going on and, most important, how to evaluate the solutions being proposed. This webcast is for people who care about rebuilding our economy in a way that includes low- and moderate-income people, both protecting them and recognizing that the only sustainable prosperity is shared prosperity.
You'll learn from experts what you need to know about the current crisis in the economy and in housing, and what Congress and a new Administration may do about it.
Jared Bernstein, Economic Policy Institute, author of Crunch: Why Do I Feel So Squeezed? (And Other Unsolved Economic Mysteries)
Jared is famous for plain-English explanations and wit. His quotes and advice are widely sought out by press, candidates, and public officials.
Barry Zigas, Consumer Federation of America
Barry is Housing Policy Director at the Consumer Federation of America, and is a leading expert on low-income housing policy, with previous experience at Fannie Mae and the National Low Income Housing Coalition.
Deborah Weinstein, Coalition on Human Needs
Debbie is Executive Director of CHN. What Congress is considering; practical suggestions about how you can help shape the agenda.
We're Trying Something New!
This event will be webcast live from the Economic Policy Institute in Washington, DC. DC-based advocates will attend. Advocates not based in DC can tune in and watch on their computers. We will leave plenty of time for questions, taking them both from those in the room and from participants watching from undisclosed locations all around the country.
If you can join us in person: please RSVP to Maricela Donahue at
Economic Policy Institute
1333 H Street, NW
For online participation, click here to register.
Register here! https://www1.gotomeeting.com/register/254313901%3E
Are the following statements true or false?
"Assisted living is a social model of care, so health care standards don't belong."
"Nursing homes don't work well because they've been overregulated -- we don't want to make those same mistakes with assisted living."
"Enforcement actions are counterproductive; government inspection should be replaced with technical assistance."
We respectfully submit that these statements are false, and invite you to join the Assisted Living Consumer Alliance for a timely evaluation of public policy and government enforcement. The session will discuss both advocacy for individual residents, and statewide advocacy on statutes and regulations.
The speakers are Eric Carlson of the National Senior Citizens Law Center, and Toby Edelman of the Center for Medicare Advocacy. Both serve on ALCA's Board of Directors.
The training will start at 3 p.m. Eastern, 2 p.m. Central, 1 p.m. Mountain, and noon Pacific, on Wednesday, November 19.
You have two options for calling in. If you think you might want to ask a question, you can call in at 703-259-9001, code 348-083-395. Don't use a cell phone, and it would be best if you have the technology to mute your phone when you're listening. If for some reason you cannot be connected, call in as a listen-only attendee, following the instructions in the next sentence.
If you expect to listen only, call in as an attendee at 703-259-9001, code 658-630-183 You will be able to submit questions with your computer keyboard through the Question and Answer feature of the Webinar program.
With any questions, please contact us at email@example.com.
Title: Advocacy and Enforcement in Assisted Living
Date: Wednesday, November 19, 2008
Time: 12:00 PM - 1:00 PM PST
REGISTER HERE: https://www1.gotomeeting.com/register/254313901%3E
After registering you will receive a confirmation email containing information about joining the Webinar.
Monday, October 27, 2008
October 21, 2008 -- With a massive Baby Boomer population approaching retirement age and the current economic squeeze impacting American wallets, advanced long-term care planning is now more crucial than ever. To help educate families on these senior issues, the National Academy of Elder Law Attorneys (NAELA) and AARP have joined forces to present a free Webcast on Oct. 30 at 1:00 pm ET entitled "Aging in America - How to Plan for it."
AARP's William Stoner will moderate the discussion, featuring insight
from NAELA members Ronald Fatoullah and Bernard A. Krooks on what
families should do now to prepare for the future. During the program,
attendees will also have the opportunity to ask their own questions of
"Aging in America" will be Webcast "live" from 1:00 to 2:00 p.m. ET. All public attendance is via the Internet. To attend, visit www.NAELA.org and click on the "Aging in America" Webcast registration button. There is no charge to attend, but attendance is limited.
Replacement rates are common and useful tools used by individuals and policy analysts to plan for retirement and assess the sufficiency of Social Security benefits and overall retirement income. Because the calculation and meaning of replacement rates differs depending on the definition of preretirement earnings, this article examines four alternative measures: final preretirement earnings, constant income payable from the present value of lifetime earnings (PV payment), wage-indexed average of lifetime earnings, and inflation-adjusted average of lifetime earnings (CPI average). The article also calculates replacement rates for Social Security beneficiaries aged 64–66 in 2005.
The Windfall Elimination Provision (WEP) is a method of computing benefits for some workers who receive a pension based on non-Social Security covered work. At the end of 2006, about 970,000 beneficiaries, mainly retired workers, were affected by the WEP. This article provides a brief legislative history, describes the WEP computation, and presents statistical data about beneficiaries affected by the WEP.
The Railroad Retirement program was established in the 1930s. It provides retirement, survivor, unemployment, and sickness benefits to individuals who have spent a substantial portion of their career in railroad employment, as well as to these workers' families. This article describes the history, benefit structure, and funding of the Railroad Retirement program.
Canada's Public Pensions System is widely applauded for reducing poverty among the elderly. This article reviews benefits provided to Canada's older people and compares the Canadian system to the U.S. Supplemental Security Income program. Although Canada's system would probably be judged prohibitively expensive for the United States, the authors argue that there are nevertheless lessons to be learned from the Canadian experience.
Since its inception in 1981, Chile's system of mandatory individual retirement accounts has become a model for pension reformers around the world. A March 2008 comprehensive pension reform law made major changes that address some key policy challenges including worker coverage, gender equity, pension adequacy, and administrative fees. The cornerstone of the new law sets up a basic universal pension as a supplement to the individual accounts system.
Access full bulletin: http://www.ssa.gov/policy/docs/ssb/v68n2/index.html
Friday, October 24, 2008
As in the rest of the nation, the rural United States is facing increasingly expensive health care options. With an aging population of farmers and ranchers, those in the agriculture sector are watching premiums rise and, often, making hard choices about preventative treatment. Seeking to bring attention to what farmers and ranchers are facing, a recent survey — titled “Health Care in the Heartland: 2007 Health Insurance and Survey of Missouri Farm and Ranch Operators” — was released by the Missouri Rural Crisis Center, a farmer advocacy group.
“A big finding is that farm families are being forced to go off-farm to take a job for the health insurance,” says Tim Gibbons, who has been with the MRCC for three years. “In some cases, they don’t even need the job except for the health benefits.” While current conditions are difficult for many farm families, the future is also a huge concern. Farmers are “really worried about what could happen in the next 10 years. Will health care insurance be even more expensive? Will the farm be under even more pressure? Will farmers be forced to choose between exorbitant health care coverage and a piece of needed equipment or land?”
Richard Williams, a red Angus rancher from Tipton, Mo., says his situation “is standard around here for self-insured farmers.” Shown Williams’ claims, several Mid-South insurance agents say his situation is also not an outlier for the Delta. “We’ve got darned high deductibles,” says Williams, whose state has 104,000-plus farm operations — second only to Texas. “There are many farmers whose wives have to go out and get a job just for the insurance — maybe a job with the state, or something.” With both spouses working on the farm, the Williamses spend about 15 percent of their budget on health care. “That’s give-or-take, of course. Being on a farm, it’s difficult to say exactly what you’ll make.”
Source/more: Delta Farm Express, http://deltafarmpress.com/news/healthcare-insurance-1024/
Thursday, October 23, 2008
University of Missouri law student Julie H. (last name withheld as a matter of her personal preference) launched the Missouri Elder Law Blog a few months ago. Not sure how I missed it, but check it out:
I met Julia this evening at the NAELA opening reception. Pay attention--she definitely has a future in elder law!
Saturday, October 18, 2008
Update: Dick Kaplan, U.Ill., reports to me:
My daughter the EMT informs me that CPR can be also performed appropriately to the song, "Another One Bites the Dust" by Queen. For obvious reasons, using the song “Stayin Alive” is better public relations."
Thanks for the tip!
US medics have found the Bee Gees' 1977 disco anthem, Stayin' Alive, provides an ideal beat to follow when performing CPR on a victim of a cardiac arrest. A University of Illinois medical school study said it contained 103 beats per minute, close to the recommended rate of 100 chest compressions per minute.
Dr David Matlock said many people were put off performing CPR as they were not sure about keeping the correct rhythm. He said CPR could triple cardiac arrest survival rates when performed properly. The study by the University of Illinois College of Medicine saw 15 doctors and students performing CPR (cardiopulmonary resuscitation) on mannequins while listening to Stayin' Alive. They were asked to their time chest compressions with the beat.
Five weeks later, they did the same drill without the music, but were told to think of the song while doing compressions.
The average number of compressions the first time was 109 per minute; the second time it was 113 - more than recommended by the American Heart Association, but better than too few, according to Dr Matlock.
"It drove them and motivated them to keep up the rate, which is the most important thing," he told the Associated Press.
Source/more: BBC, http://news.bbc.co.uk/2/hi/health/7678371.stm
Friday, October 17, 2008
The nearly 56,000 older Australians who receive help at home through community aged care packages will get a greater say in the provision of their services - under the Rudd Labor Government.
The Minister for Ageing, Mrs Justine Elliot today announced the Australian Government was developing a Charter of Rights and Responsibilities for community care and flexible care packages.
There will be consultation with consumers, aged care providers and other interested groups. The formal consultation will begin today at the Ageing Consultative Committee in Canberra. A draft Community Care Charter has been prepared.
“Home care packages help older Australians continue to live in their own homes and remain independent and active,” Mrs Elliot said.
Australians now have the world’s second longest life expectancy – at 81.4 years after the Japanese. By 2060, an Australian woman can expect to reach the age of 90 and by mid-century, most Australians can expect – on average – to reach the mid-to-late 80s.
Over the next four years, the Rudd Labor Government is investing a record $40 billion in nursing homes and hostels and community care services.
In 2008-2009, $2.2 billion of that will be spent on community care alone.
Community care packages complement the nearly 3,000 nursing homes and hostels in Australia providing more than 170,000 beds.
“As our population ages, growth in demand for home and community care will also increase – and with that care recipients and their carers should get a bigger say in the delivery of their own care,” Mrs Elliot said.
“At the moment, there is a charter for nursing homes and hostels, but none for community care.
“Put simply, this is about giving older Australians a greater say in the services they receive,” Mrs Elliot said.
Mrs Elliot said people should have real choice in the community care packages, they receive and a say in the arrangements for the delivery of that care.
“The Community Care Charter will clearly spell out the rights and responsibilities of consumers of home care services funded by the Australian Government,” Mrs Elliot said.
The Australian Government funds three community care packages. They are:
- Community Aged Care Packages (CACPs), which provides support services for older people who would otherwise require low-level residential aged care;
- Extended Aged Care at Home (EACH), for people who need high-level care; and
- the specialised Extended Aged Care at Home Dementia packages (EACH Dementia), which provide the equivalent of high-level residential care in the home for people with dementia.
Mrs Elliot said the charter would clearly explain the flexibility older Australians have in making decisions about their care and their ability to negotiate their package of services.
Once developed, the charter would be provided to each recipient of packaged community care programs when their care package is being negotiated.
The draft Community Care Charter says each recipient of a community care service funded by the Australian Government has the right to:
- Full and effective use of his or her personal, civil, legal and consumer rights;
- Quality care appropriate to his or her needs;
- Be treated and accepted as an individual, and to have his or her individual preferences taken into account and treated with respect;
- Maintain his or her personal independence;
- Maintain control over, and continue making decisons about, the personal aspects of his of her daily life, financial affairs and possessions;
- Complain and to take action to resolve disputes;
- Have access to advocates and other avenues of redress; and
- Be free from reprisal, or well-founded fear of reprisal, in any form for taking action to enforce his or her rights.
From the Social Security Administration:
Monthly Social Security and Supplemental Security Income benefits for more than 55 million Americans will increase 5.8 percent in 2009, the Social Security Administration announced today. The 5.8 percent increase is the largest since 1982.
Social Security and Supplemental Security Income benefits increase automatically each year based on the rise in the Bureau of Labor Statistics' Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W), from the third quarter of the prior year to the corresponding period of the current year. This year's increase in the CPI-W was 5.8 percent.
The 5.8 percent Cost-of-Living Adjustment (COLA) will begin with benefits that over 50 million Social Security beneficiaries receive in January 2009. Increased payments to more than 7 million Supplemental Security Income beneficiaries will begin on December 31.
Some other changes that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $106,800 from $102,000. Of the estimated 164 million workers who will pay Social Security taxes in 2009, about 11 million will pay higher taxes as a result of the increase in the taxable maximum.
Information about Medicare changes for 2009 can be found at www.medicare.gov.
Thursday, October 16, 2008
After years of personal experience, the staff of CERA believe that senior legal helplines are an effective, low-cost mechanism to serve the senior populations throughout the nation. We also believe that helplines are most effective when they are an integrated part of the legal and aging services delivery systems. It is CERA's goal to support and promote efforts to further these beliefs through the collaborative efforts of the National Legal Resource Center.
The CERA staff have many years of experience in all aspects of setting up and running a senior legal helpline. While many of you may already know us, here is a brief introduction of who we are:
Shoshanna Ehrlich, Program Specialist. I have been involved in elder law and legal hotline/legal service delivery for almost two decades: as Supervising Attorney at a statewide Senior Legal Hotline in Florida and for the past 12 years, as the head of the Legal Hotline Technical Support Project at AARP Foundation. As part of the Technical Support Project, I developed a website devoted to legal hotlines, moderated egroups for hotline managers and legal assistance developers, developed workshops on legal delivery topics, and provided individual consultation and site visits to legal hotline developers. The work of that project now rests with CERA, and I am delighted to be participate in this exciting new program.
David Godfrey, Program Specialist. As the Managing Attorney at Access to Justice Foundation in Kentucky, I am responsible for the development and operation of the Legal HelpLine for Older Kentuckians and implementation of a model approaches to legal service development work plan. I started as the first staff attorney for our HelpLine nearly 10 years ago and grew the program from a handful of calls a month to a stable program with a carefully managed case volume. I am in my second year of the work plan on a Model Approaches to Legal Service Development project in partnership with the state department for aging and independent living and our legal assistance developer aimed at improving access to legal assistance through the aging services network focusing on the aging and disability resource centers. I have presented training on issues in law and aging and legal service delivery in 24 states over the past 7 years. I have an extensive background in organizational communication and marketing with over 15 years work in affordable housing prior to attending law school.
Keith Morris, Project Manager. As the Director of Operations and Legal Services at Elder Law of Michigan, I have run the Legal Hotline for Michigan Seniors--one of the largest in the nation--for the last five years. I have extensive experience in operations, nonprofit management, fundraising, volunteer management, and effectively using new technology. I also have a strong background in data analysis and marketing because before going to law school, I was a marketing analyst in the private sector for seven years.
If you have an established helpline or are thinking of starting one, we are ready to provide you with assistance on most operational and procedural issues, including technology, personnel, case management, and outreach.
The U.S. Census Bureau, in partnership with 31 states, has launched a series of reports on older workers that presents a detailed picture for people 55 and older in the work force. Individual reports will present data at the county and metropolitan area levels for 2004, based on data from the Local Employment Dynamics (LED) program. "The retirement of baby boomers will have a huge impact on the work force,” said Census Bureau Director Louis Kincannon. “Businesses and planners need a better understanding of labor force trends, the loss of experienced workers and the payout of retirement benefits.”
Reports are now available for 19 of the partner states at
Wednesday, October 15, 2008
The Elder Law Study Group, a group of legal academics and elder law experts brought together by the Borchard Foundation Center on Law and Aging and the Institute for Laws of Health and Aging at Pacific McGeorge School of Law, is conducting a survey on the field of elder law. If you teach or write in the field of elder law and have not yet completed the survey, you can download a copy here: www.law.syr.edu/ninakohn/survey. Any questions can be directed to Nina Kohn, Associate Professor at Syracuse University College of Law (firstname.lastname@example.org).
NOTE: As a member of the Study Group, I strongly encourage you to complete the on-line study if you haven't already submitted the paper version! Help increase our knowledge of elder law as an academic speciality in law.
Monday, October 13, 2008
Source: New Scientist
It's official: the oldest human footprints ever found are 345,000 years old, give or take 6000. Known as the "devils' trails", they have been preserved in volcanic ash atop the Roccamonfina volcano in Italy. The prints were first described to the world by Paolo Mietto and colleagues of the University of Padova in Italy in 2003 after amateur archaeologists pointed them out. At the time, the team estimated that the prints were anywhere between 385,000 and 325,000 years old, based on when the volcano was thought to have last erupted. Now, Stéphane Scaillet and colleagues at the Laboratory of Climatic and Environmental Sciences, France, have used argon dating techniques to verify the prints' age. "Their more rigorous methods confirm that these are the oldest human footprints ever found," says Mietto. The new findings also confirm that the owners of the footprints were Homo heidelbergensis.
Mietto is setting off next week to excavate a second site, some 3 kilometres away. Early visits have convinced him that there are more human footprints, and he says it is highly likely that they are the same age. The excavations should help reveal a trail that was used by early humans.
NAELA Advanced Institute
Kansas City, MO
Canadian Conference on Elder Law,
Nov. 13-15, 2008
National Aging and the Law Conference
Dec. 3-6, 2008
A new report from the Census Bureau provides a detailed analysis of the uninsured population in the U.S., providing breakdowns by state, county, and demographic groups, the Denver Rocky Mountain News reports. For the study, researchers at the bureau's Small Area Health Insurance Estimates division used 2005 data from all states across gender, age and income. According to the Rocky Mountain News, the report is the most wide-ranging estimate the Census Bureau has published on the rates of uninsured U.S. residents.
According to the report, about 16% of U.S. residents did not have health insurance in 2005. Nationally, Minnesota and Hawaii had the lowest uninsured rates in 2005 at 9.5% and 9.7%, respectively, followed by Wisconsin at 10.3%. The study also found Florida, New Mexico and Texas had the three highest rates of uninsured residents younger than age 65. In addition, the report found that states have wide variances between racial-ethnic groups, the Miami Herald reports. Mississippi and Texas had greater shares of uninsured Hispanic residents, while Montana and Oklahoma had higher rates of uninsured white residents.
The Census Bureau noted that previous data gathered in 2000 were not applicable because the researchers used a different method to gather the data in 2005.
Source/links: Kaiser Daily Health Policy Report, http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54920
Recent CRS reports of interest
Income and Poverty Among Older Americans in 2007
October 03, 2008
Military Construction, Veterans Affairs, and Related Agencies: FY2009 Appropriations
September 27, 2008