Monday, June 26, 2017
This week is a big one for the Senate as they consider the Republican version of a health care bill to "repeal" the Affordable Care Act. Now I confess that I've only skimmed portions of it, and I suspect that there will be some "deal making" going on to amend the proposal in an attempt to gather the necessary votes for it to pass. I don't intend this to be a political post, although the title probably makes you think I do. But depending on what happens, couldn't a crisis be looming as a result, at least for those individuals in nursing facilities whose stays are covered by Medicaid? Whether per capita caps or block grants, the potential remains that there may be less money to cover long term stays in nursing homes, right?
What got me thinking about this post was an article in the New York Times on June 24, 2017. Medicaid Cuts May Force Retirees Out of Nursing Homes asks the question, what happens if Medicaid cuts are enough to affect coverage for long term nursing home care? "Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage." One expert interviewed for the story suggested that even if the ACA isn't repealed, Medicaid is still an attractive target for cuts and don't forget that long term nursing home care makes up a significant amount of Medicaid spending, "long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them." The article considers the possibilities of cuts and the impact both on the facilities and the residents.
Justice in Aging released a blog post, issue brief and fact sheet focusing on the impact the Senate version of the bill will have on elders. The Fact Sheet, discussing Caps lists 5 downsides to the states and 3 ways elders will be harmed. Since the Times article was focused on nursing facility coverage, here's what the Justice in Aging Fact Sheet says about that: "Losing Coverage for Nursing Home Care. 62% of nursing home residents rely on Medicaid. For the vast majority of these 850, 000 nursing home residents, Medicaid coverage is provided through an eligibility category that is "optional" under federal Medicaid law. As states face insufficient funding, they will look for optional categories to cut, putting nursing home residents at particular risk." Both the Issue Brief and the Fact Sheet fail to take into account the aging of America by tethering the cap to "baseline years". As the Brief notes
[T]he fourth problem is that the Senate bill’s per capita cap fails to recognize how increasing age corresponds to a greater need for health care. In 2011, for example, persons aged 85 and over incurred average Medicaid costs that were 2.5 times higher than the average costs incurred by beneficiaries aged 65 to 74.35
Assume that a state currently has a large percentage of Medicaid beneficiaries in their early 70s. The base rate for that state will be weighted heavily towards the average health care needs of persons in their 70s, and that weighing will affect the cap amounts imposed in 2027, when the large group of beneficiaries will be in their early 80s — with different and more extensive needs for health care. Notably, such a shift in population from the young-old to the old-old is more likely than not, given the overall aging of America’s population. From 2025 and 2035, approximately two-thirds of the states will experience a rise in the share of seniors who are 85 and older. In most cases, the increase will be at least 25%. (citations omitted).
If these folks in nursing homes need a level of care that can't be provided by their families (if they even have families) and Medicaid is cut, what's the answer? Right now, all we can do is wait and see what happens with the Senate this week. Right now, the vote is projected to take place on Thursday.
Wednesday, June 21, 2017
According to a recent article in the Washington Post, not all family caregivers of vets are treated equally. Law makes VA treat some family caregivers better than others explains that for "veterans injured on duty, Uncle Sam pays more attention to some of their caregivers than others. The law allows the government to provide caregiver services for vets injured on Sept. 11, 2001, or after, but not those injured before that ...." On June 19, 2017, the Disabled American Veterans (DAV) organization released a report about its efforts, the "Unsung Heroes Initiative" to change the law. The DAV describes this, according to the article, as “a national campaign to raise awareness about the service and sacrifice of caregivers to America’s severely disabled veterans as well as the inequities of supports available, particularly for those injured before 9/11.” Bills are before Congress to change the law "that would make all veterans, no matter when they served, eligible for the caregiver support." The article also references a recent Veterans' Affairs Committee hearing on budgets, with testimony, etc. available here.
Tuesday, June 20, 2017
Consider those who need home health care but say no. Kaiser Health News recently ran a story on this very topic. Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems explain that the percentage of those who want to be left alone is higher than you may think. "As many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services, according to a new report." The report is from a roundtable that was sponsored by the Alliance for Home Health Quality & Innovation and United Hospital Fund. The report, I Can Take Care of Myself: Patients' Refusals of Home Health Care Services runs 23 pages.
Here are highlights of the report (found on page 1):
Medical care is moving from hospitals and other institutions into the community, which for most people means care at home, where they want to be. With shorter hospital stays and more complex post-discharge needs, the importance of home health care services, including skilled care and personal care, in discharge planning and transitional care is increasing.
Some studies show that patients who receive home health care after hospital discharge are less likely to be readmitted. Other studies show that patients who receive home health care report better quality of life.
Although data are limited, approximately 6-28 percent of patients eligible for home health care refuse these services, for a variety of reasons.
Even less is known about the process by which hospital staff identify patients for referral to home health care, how they explain these services, and how well they address the full range of patients’ and family caregivers’ transitional care needs.
Patients and their family caregivers have similar goals but may have different needs and attitudes about home health care.
Policy and system barriers to accessing services include inflexible criteria for eligibility, inadequate payment for home health care agencies’ services for patients with complex conditions, and shortages of trained workforce.
Recommendations from Roundtable participants include interventions that improve communication about care challenges and home health care services, qualitative and quantitative research on all aspects of home health care refusals, policy changes to increase access and coordination, and continuity across providers and care settings.
Thursday, June 15, 2017
When thinking about Social Security for retirement purposes, we know that recipients can be confused about when to draw benefits. But it may also be unclear what type of benefits are available for certain beneficiaries. So Kiplinger's Social Security quiz is a quick and easy way to test your Social Security knowledge. The 10 multiple choice questions covers topics such as early retirement, spousal benefits, the effect of divorce, dependent benefits, the trust fund and the future of Social Security. Check it out!
Wednesday, June 14, 2017
According to a recent story in Investment News, FINRA is going to provide brokerages with more guidance on dealing with "rogue brokers." Finra CEO Robert Cook promises to give brokerages more guidance on overseeing rogue brokers explains that "[FINRA] intends to help brokerages better identify and supervise brokers with checkered disciplinary histories who may pose risks to investors. In coming months, the broker-dealer self-regulator will delineate [FINRA's expectations]...." The article relates pressures on FINRA to do something about brokers that move from firm to firm.
At its May meeting, Finra's board advanced proposals that would allow tougher penalties for brokers with certain past infractions, enable disciplinary hearing panels to restrict the activities of brokers and firms while a case is on appeal, and require firms to strengthen supervision while a "disqualification request" is under review or a broker is appealing a hearing decision.
There's a working group on this issue and FINRA is considered other measures, with any final regs needing SEC approval.
Monday, June 12, 2017
Parts of the Department of Labor Fiduciary Rule is finally in effect, but whether the rule with stay or be repealed remains to be seen. Investments News ran a recent article, DOL fiduciary rule takes effect, but more uncertainty lies ahead. The article explains that "[t]wo provisions of the measure, which requires financial advisers to act in the best interests of their clients in retirement accounts, become applicable [June 9th]. One expands the definition of who is a fiduciary, and the other establishes impartial conduct standards." According to the article, the entire rule is scheduled to go into effect January 1, 2018, but that may be delayed since the agency is undertaking regulatory reviews as part of the mandate from the administration. As far as the 2 regs in effect, the article explains that those "will govern adviser interactions with clients in retirement accounts. Under those provisions, advisers must give advice that is in the best interests of their clients, charge reasonable compensation and avoid "misleading statements" about investment transactions and what they're being paid." There is a grace period until July 1, 2018 regarding advice being given to clients, as long as the "fiduciaries who are working diligently and in good faith to comply with the fiduciary duty rule."
The article also mentions that the SEC has asked for comments regarding fiduciary duty.
Friday, June 9, 2017
Kiplinger's ran an article about less noticed veterans benefits. Vets, Don't Miss Out on 'Hidden Benefits' discusses life insurance, hearing aids, spouse and dependent benefits (DIC), health insurance, directed care, Agent Orange benefits, Aid & Attendance, home modification and coverage for conditions from the water at Camp Lejeune to name a few. The article offers information about eligibility, where to get help, how to apply for benefits and more.
Monday, June 5, 2017
I'm just going to start off with my opinion on this latest action by CMS: bummer. Now I'll tell you what CMS is doing and you can decide if you agree with their course of action, or not. As you may recall, last fall CMS issued the revised nursing home regs (which we've blogged about before-you can search the archives for them, if you want). One of the regs getting a lot of attention was the reg that prohibited the use of pre-dispute arbitration clauses in nursing home admission contracts. Now CMS has announced they are reversing course. They will no longer prohibit pre-dispute arbitration clauses under the proposed amendment to the rule. Instead the proposed rule allows the use of arbitration clauses if certain notice requirements are met. The summary explains that CMS
would revise the requirements that Long-Term Care (LTC) facilities must meet to participate in the Medicare and Medicaid programs. Specifically, it would remove provisions prohibiting binding pre-dispute arbitration and strengthen requirements regarding the transparency of arbitration agreements in LTC facilities. This proposal would support the resident’s right to make informed choices about important aspects of his or her health care. In addition, this proposal is consistent with [CMS] approach to eliminating unnecessary burden on providers.
The specific amendments to 42 C.F.R. 483.70(n) appear on pages 20-21 of the notice. The notice is scheduled to be published in the Federal Register on June 8 and the comment period closes 60 days thereafter.
Wednesday, May 31, 2017
Let's start June off with some good news, shall we? Some time ago we let you know that Medicare was going to remove Social Security Numbers from beneficiaries' Medicare cards (can you say identity theft?). I saw a progress report about this. Medicare plans to replace Social Security numbers on cards reports an announcement from Medicare on May 30, 2017 that they are on schedule to have the cards revised with a randomly generated number replacing a beneficiary's SSN. Mail outs are planned to being in April of 2018. The final design of the card is still unknown, according to the article. The new numbers will be known as "MBI, which stands for Medicare Beneficiary Identifier." To read the press release from CMS, click here.
Thursday, May 18, 2017
Social Security is a popular social insurance program administered by the Social Security Administration. It provides critical resources and economic security to many workers who are retired or have a disability, as well as to their survivors and dependents. This webinar is designed for legal services and other advocates who are just getting started in the field and others who want to learn more about the essentials of the program. This Legal Basics: Social Security webinar will cover the basics of the Social Security program and the rules surrounding it, including general information on how the program works and who is eligible to claim benefits (including spouses and children). We will also discuss other basic information such as timing considerations when applying for benefits, how benefits are calculated, and suggestions on where to find further information.
To register for this free webinar, click here.
Wednesday, May 17, 2017
Earlier this month Kaiser Health News (KHN) ran a story about Ombudsman volunteers. Volunteers Help Ombudsmen Give Nursing Home Residents ‘A Voice’ In Their Care discusses the local ombudsman volunteers and their importance regarding a resident's quality of care.
Ombudsman’s offices, which operate under federal law in all 50 states, Washington, D.C., Puerto Rico and Guam, investigated 200,000 complaints in 2015, according to the Administration on Aging, a part of the Department of Health and Human Services.
Of those, almost 117,000 were reported to have been resolved in a way that satisfied the person who made the complaint, and about 30,000 were partially resolved. At the top of the list were problems concerning care, residents’ rights, physical environment, admissions and discharges, and abuse and neglect.
Ombudsmen volunteers have a right to enter a long term care facility and talk to residents or anyone else. They investigate complaints and can find issues on their own, and maintain confidentiality. The article emphasizes the importance of volunteer ombudsmen to the success of the programs. There's more involved than putting your name on a list. Ombudsmen volunteers go through training, must pass background checks, are supervised on a few first visits and attend monthly meetings. The article notes the spectrum of experience held by the volunteers but identifies one commonality, "an abundance of compassion."
Monday, May 15, 2017
The Commonwealth Fund has released a new issue brief regarding Medicare out of pocket costs. Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status examines the out of pocket costs faced by Medicare beneficiaries" "Fifty-six million people—17 percent of the U.S. population—rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs." The issue brief concludes that
More than one-fourth of all Medicare beneficiaries—15 million people—spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.
The Commonwealth Fund used 2 "indicators" in doing the research, the "High total cost burden" and "underinsurance". The issue brief notes that lower-income beneficiaries may have significant out of pocket costs. "When premiums, cost-sharing, and spending on uncovered services are included, more than one-fourth of all beneficiaries (27%)—an estimated 15 million people—and two of five beneficiaries with incomes below 200 percent of the federal poverty level spent 20 percent or more of their income on health care and premium costs in 2016." As far as the other indicator, the Commonwealth Fund found "that one-fourth of beneficiaries are underinsured—that is, they spend at least 10 percent of their total annual incomes on medical care services, excluding premiums. Of beneficiaries with incomes below the poverty level, one-third spent 10 percent or more... Despite having Medicare or supplemental coverage, these people are effectively underinsured." (citations omitted).
The brief concludes with these observations:
Despite the substantial set of benefits that Medicare provides, many beneficiaries are left vulnerable because of financial burdens and unmet needs. As Medicare enters its sixth decade and the baby boom population becomes eligible, the costs of the program will increase, likely placing it on the policy agenda. Despite Medicare’s notable recent success in controlling costs per beneficiary, total spending will increase as the program covers more people.
The high financial burdens documented in this brief illustrate the need for caution. Half of Medicare beneficiaries have low incomes; one-third have modest incomes (200% to 399% of poverty). Any potential policy should first consider the impact on beneficiaries.
Access and affordability remain key concerns. In any discussions of potential Medicare reform, it will be important to pay particular attention to consequences for those vulnerable because of poor health or low income. Indeed, the findings point to the need to limit out-of-pocket costs and enhance protection for low-income or sicker beneficiaries.
As the single largest purchaser of health care in the country, Medicare policies directly influence insurance and care systems across the country. With a projected one-fifth of the population on Medicare by 2024, keeping beneficiaries healthy and financially independent is important to beneficiaries, their families, and the nation. (citations omitted).
Monday, May 8, 2017
The Elder Justice Initiative (EJI) has announced the release of a guide and toolkit for creating Multi-Disciplinary Teams (MDT). The EJI has an MDT Technical Assistance Center (or MDT TAC). EJI is also offering a free webinar to help users get started creating an MDT. The email announcement explains how to get started:
The Elder Justice Initiative (EJI) is pleased to announce the launch of the new Multidisciplinary Team Guide and Toolkit. The Toolkit is designed for anyone looking to create or grow a local elder abuse MDT, regardless of their experience with MDTs. The web-based Toolkit is enhanced for use on mobile devices and contains easy-to-download PDF sample documents and citations.
On May 30, take a live walk through the Toolkit. The EJI webinar will cover many aspects of the Toolkit, including:
Layout and usability
Highlights from each chapter
Questions and feedback
Justice in Aging, the Center for Medicare Advocacy and the National Consumer Voice for Quality Long-Term Care have issued another in the series of issue briefs about the revised nursing home regulations. Return to Facility After Hospitalization covers several important topics including notice, bed holds, right to return and appeal rights. Here is the executive summary:
Bed hold rights are set by state law. Federal law complements state law by requiring facilities to notify residents of those rights. Notice of bed hold rights must be provided at two separate times: in advance of a hospitalization, and at the time of transfer to a hospital. The advance notification must include the resident’s right to a bed hold, whether the state’s Medicaid program pays for a bed hold, and the facility’s bed hold policies (which must be consistent with state and federal law). The time-of-transfer notification must describe the resident’s bed hold rights under the facility’s policy.
Federal law also establishes a resident’s right to return to the facility even if a bed hold period has been exceeded, or if the resident did not have a bed hold. The resident can return to her previous room if available, or to the next available room if the previous room is not available. The regulations specify that the resident can request a transfer/discharge hearing if the facility refuses to accept her back.
Wednesday, May 3, 2017
Justice in Aging announced the release of two additional issue briefs concerning the revised nursing home regs. One brief concerns quality of care and the other, grievances and resident/family councils.
The executive summary for the quality of care issue brief explains
The substantive requirements for quality of care are retained in the revised regulations, and the Centers for Medicare & Medicaid Services (CMS) affirms the regulations’ overriding goals: supporting person-centered care and enabling each resident to attain or maintain his or her highest level of well-being. Finding all of the requirements presents a challenge, however. CMS has significantly reorganized the quality of care provisions, moving some provisions to other regulatory sections, expanding the standards of the prior regulations, and adding several entirely new requirements.
The executive summary for the grievances and resident/family councils issue brief explains:
Residents have the right to file grievances and the facility must work to resolve those concerns promptly. A grievance official at the facility is responsible for complaint handling. Each facility must have a grievance policy and provide residents with information about how to file a grievance, how to contact the grievance official, a time frame for complaint review, a written decision, and information about other entities with which grievances can be filed. Written decisions must include, but are not limited to, the steps the facility took to investigate the complaint, the findings, whether the complaint was confirmed or not, and the action the facility has taken or will take to correct the problem.
The resident has a right to: form and participate in a resident council; have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents; and participate in the family council. There must be a staff person assigned to assist both resident and family councils and the council, along with the facility, must approve this person. The councils must be given a private space in which to meet and no one outside of a resident or family member can attend without invitation. The facility must act upon council concerns and recommendations and provide a reason for its decision, although it does not have to implement all that the councils request.
All of the issue briefs are available here.
Monday, May 1, 2017
Late last week I learned that CMS may be reversing course on prohibiting pre-dispute arbitration clauses in nursing home admission contracts. I couldn't decide if my response should be "say it isn't so" or "you have got to be kidding me". Nevertheless, Justice in Aging reported in their weekly newsletter, This Week in Health Care Defense that:
CMS Backtracks on Nursing Home Arbitration Prohibition
As part of last year’s revision of nursing facility regulations, CMS prohibited federally-certified nursing facilities from obtaining arbitration agreements at the time of admission. CMS concluded that it was unfair to have residents and families waive legal rights during such a difficult and chaotic time. Now, however, CMS has reversed course and has filed language that would revise the regulation to allow facilities to obtain arbitration agreements at admission. For more on the revised regulations, see the series of issue briefs developed by Justice in Aging in partnership with the Center for Medicare Advocacy and the National Consumer Voice for Quality Long Term Care.
Wednesday, April 26, 2017
Justice in Aging has announced a free webinar for May 17th, 2017 from 2-3 edt on Elder Financial Abuse & Medicaid Denials. Here is a description of the webinar
Financial exploitation can devastate low-income older adults, especially those who rely on Medicaid for their health and long-term care. For example, older adults who are victims of financial abuse may be denied eligibility for Medicaid because their abuser won’t turn over their bank records. Without Medicaid eligibility, the older adult may be threatened with eviction or involuntary discharge from a nursing home because of nonpayment. Legal services are critical to helping older victims of financial exploitation receive the medical care and services to which they are entitled. Join us for Elder Financial Abuse and Medicaid Denials to learn how to identify victims of elder financial abuse, what problems this exploitation can cause for Medicaid eligibility, and how legal services attorneys can help their older clients receive the benefits they need and prevent future problems accessing Medicaid.
To register for the webinar,https://attendee.gotowebinar.com/register/5875005469626032643?source=SALSA. Did I mention, it's free!
April 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)
Sunday, April 23, 2017
Justice in Aging has released a new fact sheet, New Guidance from SSA on Spousal & Survivors Benefits for Married LGBT Individuals. "On March 1, 2017, the Social Security Administration (SSA) announced it would reopen any decision to deny spousal or survivors benefits to a same-sex spouse based on a discriminatory marriage ban, which resulted in a loss of benefits to the individual who filed the claim." The fact sheet notes an SSA ruling and POMS. "This policy change applies to applications for spousal or survivors benefits that SSA denied prior to the Windsor and Obergefell decisions because it did not recognize their marriages. Even those who began receiving SSA benefits following the Supreme Court decisions may be due retroactive benefits for the period between when they first applied (and were denied) and when SSA finally recognized their marriage." The fact sheet also explains who is not affected as well as who might be. The fact sheet concludes explaining that SSA is in the process of reaching out to 800 beneficiaries whose benefits were denied to tell them their applications are being reopened.
Click here to read the full fact sheet.
Monday, April 17, 2017
Register now for Justice in Aging's latest webinar, Older Adults & Immigration. The webinar is set for Friday April 21, 2017 from 2 p.m. to 3 p.m. edt. Oh, and did I mention, it is free! Here's a description of the webinar
Are your immigrant senior clients coming to you with immigration-related questions? Recent events may leave your immigrant senior clients understandably confused. Need clarification on an immigrant older adult’s eligibility for safety net programs like Medicaid or SSI? Join Justice in Aging as we host a special immigration law webinar with our partners from the National Immigration Law Center. Intended for an audience who work with low income seniors but who are not familiar with immigration law, this webinar will cover basic topics, like:
• Different types of immigrants in our communities;
• Rights and protections for immigrant seniors;
• Immigrant senior eligibility for SSI, Social Security, Medicare, and Medicaid; and
• Resources for individual assistance
This free webinar will also highlight some of the recent events affecting immigrant seniors and how they may be affected by changes in government policies.
To register, click here.
Thursday, April 13, 2017
Registration is now open for Stetson's annual Fundamentals of SNT Administration webinar. This half-day webinar is scheduled for May 5, 2017 from 1-5 p.m. The 4 speakers will cover topics on how to become a SNT administrator, Tax issues when making distributions, services and products a SNT administrator can provide, and an update on the laws, regs and POMS. The agenda is available here and registration is available here. (you can register online and fill out and submit a pdf).
Full disclosure, I'm the conference chair. Hope to see you virtually at this webinar!