Sunday, September 24, 2017

The Newly Redesigned Medicare Card

Some time back we told you that the Medicare card would be redone so beneficiaries' Social Security numbers no longer appeared on the cards. CMS has released the design for the new Medicare cards.  Still sporting the red, white and blue design, you will see that the Medicare number is different now-no more Social Security number!!! New Medicare Card Banner Image

Issuing new cards may sound like a simple thing, but it really is a big deal, when you stop and think about it, especially given the number of folks on Medicare.

Here is an excerpt from CMS to health care providers: 

Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. We’ll start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

You may even notice a commercial or two about the change. For more information about the changes, click here

 

 

 

September 24, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Elder Law Attorney Uses Her Experiences to Explain Why Graham-Cassidy Repeal of ACA Isn't Right Answer

Texas Elder Law Attorney Jennifer Coulter explains how the Affordable Care Act has affected her clients -- and herself -- in a positive way.  She makes a principled, compelling case for why "getting it right" on health care is far more important than political sound bites and rushed repeal measures.  

 

September 24, 2017 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Social Security | Permalink | Comments (0)

Thursday, September 21, 2017

Embrace Aging

Do you consider yourself to be old? Well, if you are over 37, statistically you are old, according to an article in the New York Times, Feeling Older? Here’s How to Embrace It.  However, "S[s]udies show that people start feeling old in their 60s, and a Pew Research Center survey found that nearly 3,000 respondents said 68 was the average age at which old age begins." The article offers tips to embrace your aging, including having perspective about aging, be friends with various generations (helps with loneliness), and make decisions about "good" aging (for example, "[c]hoices about lifestyles and behaviors can influence the effects of so-called secondary aging.")  Aging is organic, but don't just let it happen-plan for it and make appropriate decisions! The article also offers these tip:s welcome the positives (identify activities that are enriching for you) and reject ageist notions. Age is a great equalizer-everyone ages, even without realization. For example, say it took you two minutes to read this post. You are now two minutes older. 

Various milestones — birthdays, changes in careers and the deaths of siblings and peers — are reminders of the passage of time, but you should not lose focus on finding meaning and quality in life, Mr. Kaplan ["assistant professor of social work at Adelphi University in Garden City, N.Y."] wrote.

“For many people, old age creeps up slowly and sometimes without fanfare or acknowledgment,” he wrote. “While most people enjoy relative continuity over the decades, being able to adapt to the changing context of our lives is the key to success throughout life.”

September 21, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Retirement | Permalink | Comments (0)

Wednesday, September 20, 2017

Coming Changes to Medigap Policies

The Chicago Tribune ran a story on changes to Medigap policies, Why Seniors Should Choose Wisely When Selecting Medigap Supplement Insurance. The article explains that

In 2020, people who are on Medicare and don't already have what's known as Plan F or Plan C Medigap insurance won't be able to buy it because the federal government will close those plans to new participants. That means that when people go onto Medicare at 65, or if they switch Medicare-related insurance during the next couple of years, they are going to have to be diligent about scrutinizing insurance possibilities before some of those doors start to close.

If you are wondering why this is newsworthy, given that there are a number of other Medigap plans available, the story explains the popularity of Plan F.

In the past, people have tended to veer toward Plan F Medigap insurance when they wanted all retirement medical costs covered. Plan F is the most popular of the many Medigap insurance plans because it is the most comprehensive. It doesn't cover dental, vision, or medicine, but if retirees pay their monthly premiums they shouldn't have to pay anything else for doctors, tests or hospitals. Even medical care overseas is partially covered.

The article notes that over half of beneficiaries purchase Plans C or F. Then why would Congress do away with these popular plans? Well, according to the article, "the popularity of Plans F and C made them unpopular with federal lawmakers and brought about the change that will happen in 2020. In 2015, Congress decided to shut the doors on Plan F and C in 2020 to reduce government spending on Medicare. Although Medigap plans are purchased from private insurance companies, people use them along with Medicare provided by the government. Critics argue that Plan F makes it too easy for people to go to the doctor without thinking twice about the cost."

Even if a beneficiary has Plan F, after 2020, the beneficiary may see a rise in premiums  "because the plan won't be taking in any more young, healthy people. As those in Plan F grow older and sicker, the insurance companies may go to government regulators and request the right to raise rates." The article notes that some advisers are suggesting beneficiaries take a hard look at Plan G. Of course, if Plan G becomes the new Plan F in terms of popularity, then it's likely that Plan G premiums will increase. One expert quoted in the article suggests that a Medigap policy be viewed as a lifetime choice and the beneficiaries need to be sure that the policy purchased is portable.

 

September 20, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, State Statutes/Regulations | Permalink | Comments (0)

Call for Papers: Seton Hall Law's 2d Annual Health Law Works-In-Progress Retreat on 2/9/18

We just received the good news that Seton Hall Law School's Center for Health and Pharmaceutical Law & Policy will hold a second (now second annual!) "Regional Health Law Works-in Progress Retreat" in early 2018.  The purpose of the retreat is to give area health law scholars an opportunity to share their work and exchange ideas in a friendly, informal setting.  The retreat is open to anyone with an academic appointment in health law (including professors, fellows, and visitors) in any institution of higher education in the Northeast area (broadly defined to include Washington D.C. and all points north).

The retreat will take place on February 9, 2018 at Seton Hall Law in Newark, New Jersey, offering an opportunity for in-depth discussion of approximately 5-6 draft papers.  Professor Carl Coleman  explains:  "For each paper, a commentator will provide a 10-15 minute overview, as well as his or her reactions.  The author will then have 5 minutes to respond, after which the floor will be opened for a general discussion among all retreat participants."

For those interested in participating they should submit a preliminary draft or a detailed abstract to Professor Coleman at carl.coleman@shu.edu by November 17, 2017.  So, plan ahead!  Professor Coleman says that those with submissions accepted for presentation will be notified by December 15. Final drafts are due by January 19, 2018.

By the way, while looking at the interesting materials on Seton Hall Law School's website, I noticed an timely program on "Consumer Financial Protection in Health Care," on the evening of Tuesday, October 24, 2017.  Seton Hall invites interested persons to join them "for a discussion about the growing body of financial protections under federal and state law for health care consumers and how we can work to protect all health care consumers from medical-billing abuses."  

 

September 20, 2017 in Consumer Information, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Monday, September 18, 2017

"Barn Door" Rule-Making and Disaster Response

Over the weekend, Florida Governor Rick Scott announced he was "directing" state agencies to "issue emergency rules to keep Floridians safe in health care facilities during emergencies."  Arguably, this an example of  locking the barn door after the horses have escaped.  On the other hand, especially with another hurricane already looming, certainly no political leader wants to be seen as doing nothing.

There are some important questions -- that can perhaps be translated into lessons -- emerging from the most recent tragedy with eight nursing home residents perishing from heat related complications in Broward County Florida after Hurricane Irma.  

1. Should States Mandate Specific Equipment?  For example, Governor Scott is seeking a rule that mandates "ample resources" including a "generator and the appropriate amount of fuel, to sustain operations and maintain comfortable temperatures for a least 96-hours following a power outage."   It should be clear, certainly after Katrina (2005), Harvey (2017) and Irma (2017), that some of the biggest dangers of extreme weather events ares not just the wind or rain or fire or other immediate impact, but the consequences of loss of power or other critical resources.  

2. Can Inspectors Better Assure Compliance with Safeguards?  Governor Scott's demands focus not just on the care facilities' obligations, but on the role of state and local officials to have a system of checks and balances to increase the likelihood the safeguards are actually in place and operable, and not "just" a written plan for the future.

3.  What Safeguards Were Effective At Similarly Situated Facilities?  News articles report some push back from providers to Scott's measures, who seem to be arguing feasibility and cost. But, certainly there were providers, faced with the same challenges as the Broward County nursing home, who were successful in protecting their residents.  Perhaps the more important lesson to learn -- and learn quickly -- is what was affordable and effective?  

Also, I think that there are some questions that can be raised about whether and how family members and the larger community might be able to help as part of a plan for disaster preparedness.  Certainly not all, and perhaps not even most, families will be able to help in providing post-disaster assistance including temporary shelter.  But, I think at a minimum, families would want to know what steps they might take to be part of the safety plan and post-event response. 

 

September 18, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Doctors in Older Age: Should They Be Evaluated on Their Fitness?

I've heard a few times about concerns regarding doctors in their 70s and 80s who continue to practice medicine. The implication is that their age might somehow make them less fit to practice medicine. I've also heard the same concerns expressed about attorneys. Do we concern ourselves with professional fitness just based on age for any other profession? Not for us law profs.  So I was interested in reading this article from the Philadelphia Inquirer, More doctors are practicing past age 70. Is that safe for patients? 

The article opens with the story of one pediatrician who at 76, was required by his hospital to be evaluated. This hospital "is among the growing number of hospitals that are reevaluating doctors simply because they are old. Their age puts them at higher risk for physical and cognitive changes that could imperil patients." Other doctors quoted in the article oppose such actions, arguing the lack of "scientific evidence correlating such test results with physician performance. They have, however, grudgingly accepted physical testing and peer review."  The article notes a trend of sorts on this issue

In 2015, the American Medical Association called for guidelines to evaluate aging doctors, although it did not specify what they should be.  It also said doctors have a “professional duty” to self-assess.  The American College of Surgeons last year said surgeons should voluntarily undergo testing by their personal physicians and  disclose any problems to their employers.

There are likely more older physicians still practicing then you might think. To some extent, the article notes, that taking action now internally is preemptive.   There's a two-day challenging testing program, "[t]he  Aging Surgeon Program, which is available to doctors from anywhere,  involves extensive cognitive and physical testing as well as evaluation of balance, reaction time, and fine motor skills."  Penn Medicine has implemented cognitive testing for all of their doctors who are 70 or older. The article looks at what other medical facilities in the area are doing. 

I suspect this is an issue we will hear more about in the future.

September 18, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Health Care/Long Term Care | Permalink | Comments (1)

Friday, September 15, 2017

Is Hospice Care Misunderstood?

Hear the word hospice and what do you think? The patient is close to dying, right? Kaiser Health News did a story about hospice care that explains the patient doesn't have to be on the edge of dying. Shedding New Light On Hospice Care: No Need To Wait For The ‘Brink Of Death’ examines the misconception about hospice care.

Although hospices now serve more than 1.4 million people a year, this specialized type of care, meant for people with six months or less to live, continues to evoke resistance, fear and misunderstanding... “The biggest misperception about hospice is that it’s ‘brink-of-death care,’” said Patricia Mehnert, a longtime hospice nurse and interim chief executive officer of TRU Community Care, the first hospice in Colorado.

People who have some time left may find that using hospice gives them a better quality of life.  "New research confirms that hospice patients report better pain control, more satisfaction with their care and fewer deaths in the hospital or intensive care units than other people with similarly short life expectancies." (The article referenced in the quote requires purchase or subscription).  The KHN article explains the differences in the four levels of care offered by hospice, including respite care, routine care, general inpatient care and continuous care. Routine care is the most typical, with visits by aides and an RN, the frequency of which is dictated by the patient's condition.  One of the biggest misconceptions, according to the article, the family thinks hospice folks will be in the home with the patient continuously.  As a result, the family or patient may need to hire aides or companions to get the needed help.  The article discusses provision of medications, choice of doctors,  medication concerns, discharge and care of the patient in the last few days of life.

September 15, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, September 14, 2017

Women Who Are Older--Financial Fears?

How well-prepared are you for financing your retirement? Do you know your family's finances?  The New York Times examined the situations that may be faced by women who are older who are not involved in the handling of their family's finances. Helping Women Over 50 Face Their Financial Fears covers a lecture series, Women and Wills, designed specifically for women over 50 that cover a variety of topics, including estate planning. health care, insurance, long term care, business succession planning and more. The founders are well aware that some women may not be up to speed on their family's finances, or other circumstances such as a spouse's illness, may present challenges for them. The founders plan to take their lecture series on the road, nationwide, and publish a book on the importance of planning.

Thanks to Professor Naomi Cahn for sending a link to the article.

 

September 14, 2017 in Books, Consumer Information, Current Affairs, Estates and Trusts, Health Care/Long Term Care, Property Management, Retirement, Social Security | Permalink | Comments (0)

Wednesday, September 13, 2017

The Critical Importance of A.C. for Emergency Preparedness

A couple of years ago, I was present when my father's dementia care facility -- a licensed assisted living community -- was doing a test of part of their emergency preparedness plan.  The staged "emergency" for that particular test was "loss of air-conditioning," which for most of the year in Arizona and other locations in the south and southwest is a serious concern.  With climate change, heat and air-conditioning systems are going to be even more critical in the future.

I was impressed that even without back-up generators, the facility had both a short-term and long-range plan. The long-term plan required staged evacuation to other locations.  Of course, to be effective, any evacuation would depend on the "other" locations having working power systems, something that can't be certain in a large scale weather or similar emergency.  

Sadly, as reported in the New York Times on September 13, following the damage caused by Hurricane Irma, there were several deaths at a long-term care facility near the coast in southeastern Florida.  The rapidly developing story suggests that as many as eight deaths were tied to loss of air-conditioning, although not a complete loss of power to the facility. It is too early to know all of the relevant facts.  But, what about the law?  The NYT article notes that:  

Florida requires nursing homes to have procedures to ensure emergency power in a disaster as well as food, water, staffing and 72 hours of supplies. A new federal rule, which comes into effect in November, adds that whatever the alternative source of energy is, it must be capable of maintaining temperatures that protect residents’ health and safety.

Does the federal regulation mandate emergency sources of air-conditioning? Although the highlighted language in the NYT article suggests the new federal rule "comes into effect" in November of this year, my read of the regulation says the effective date was November 15, 2016 -- in other words, last year.

***

9/14/17 Correction to above paragraph:  It was bothering me that I saw more than one news article describing the Emergency Preparedness rule as not taking effect until November of this year.  The "effective date" of the Rule is clearly November 15, 2016 -- but, the New York Times is correct -- Long Term Care facilities have "until" November 15, 2017 to "implement" their preparedness plans, including any plan for maintaining safe temperatures.   The implementation deadline was in a previous version of the rule, not the version of the rule actually made "effective" on November 15, 2016.  Another lesson for me in the need for careful reading of regulations!

***

Perhaps more importantly, here's the language of the federal regulation, at 42 C.F.R Section 483.73, governing emergency preparedness at LTC facilities:

The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:
 
(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:
    (i) Food, water, medical, and pharmaceutical supplies.
    (ii) Alternate sources of energy to maintain
        (A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;     
        (B) Emergency lighting;
        (C) Fire detection, extinguishing, and alarm systems; and
        (D) Sewage and waste disposal.
Does this regulation require alternative sources of air-conditioning or heat -- as necessary to "protect resident health and safety" -- or does it merely require a "policy and procedure"?  I suspect this language might be a legal issue in any post-Irma proceedings.  
 
This is still a developing story, with state authorities conducting investigations.  For more, see this NPR story

September 13, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 12, 2017

Disaster Planning and Services on Our Minds

With Irma in Florida's rear view mirror (and not a moment too soon), many are focused on what, if anything, should be done differently  next time.

For us as attorneys, we should be sure to tell our clients about the importance of having a disaster plan. For clients living elsewhere, whether a long-term care facility or housing specifically for elders, they should be advised to ask a lot of questions. Does the facility have a disaster plan? Get a copy of it.  What services does the facility provide to help residents evacuate? In what evacuation zone is the facility located? Does the facility have a back-up generator in the event of a power outage? How does the facility balance having adequate staff on site before, during and after the disaster while simultaneously allowing staff to prepare for the disaster?  Does the facility's insurance policy cover property of residents? What services does the facility provide to help residents return after the disaster? What happens if the facility is now uninhabitable?  Does the admissions contract provide for any return of the resident's money (this may be more applicable to a CCRC than a SNF or apartment). Will the facility help residents find other suitable housing? What other items would you add to the list?

As part of the news coverage surrounding Irma, the Washington Post ran a story about the risks of evacuating elders. Moving Florida’s many seniors out of Irma’s path has unique risks discusses the research that has been done on the stress of evacuations on elders, noting that some evacuees will die from the stress of evacuation.  Whether to go or stay is akin to rolling the dice. On the one hand, those in the path have plenty of advance notice of the approaching storm, but as seen with Irma, the track can (and does) change, so no one knows where it will hit. 

If you stay you have risks. If you go, you have risks.  As one person quoted in the Washington Post article noted, "[t]his is one of those classic cases of damned if you do, damned if you don’t. It’s a very difficult decision: When you evacuate, there is an inherent body count for frail, older adults...”   Because these folks are frail, they need to be evacuated earlier than others might, and based on lessons learned from Andrew and Katrina, there may be more pressure from officials for facilities to evacuate their residents rather than to stay put to weather the storm.  Speaking from personal experience, the wait is stressful. It seems to take a long time for the storm to pass over once the go-no go time has passed. Then afterwards, there's the issue of utilities, clean up, services and supplies.

The media aren't the only ones focused on the issues of elders in the path of disasters. The Senate Committee on Aging has scheduled a hearing for September 20, 2017 at 9:00 a.m. on "Disaster Preparedness and Response: The Special Needs of Older Americans"  

Stay tuned.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

CMS Issues ABLE letter to State Medicaid Directors

CMS released State Medicaid Director Letter #17-002, Implications of the ABLE Act for State Medicaid Programs. The letter is designed to give guidance to state Medicaid programs on implementing ABLE. The letter includes background on the ABLE Act, explains who is eligible to have an ABLE account (including an explanation about the use of the word "qualified" in the statute)), how funds in the ABLE account are treated, contributions by the beneficiary or a 3rd party, distributions, post-Medicaid eligibility treatment of income  and transfers of ABLE money to a state and estate recovery.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Frustrated Expectations and Costs-of-Care in Assisted Living

We often write on this Blog about concerns or even scandals in "nursing home" care for seniors. But, increasingly senior care spans a wide spectrum of formats and identities, and the SNFs of old, both good and bad, are increasingly outnumbered by newer names.  "Assisted Living" facilities -- traditionally positioned somewhere between skilled care and independent living -- are now often the target of concerns and lawsuits.

Reading the complaint in the latest suit, a class action filed in federal court in July 2017 in California against Brookdale Senior Living Inc. and Brookdale Senior Living Communities, Inc., I can see a central frustration, regardless of any issue of poor or negligent care.  Brookdale is one of the largest, if not the largest providers of assisted living, especially after it acquired another large assisted living operator, Emeritus.  The named individual plaintiffs, who describe their extensive impairments, including physical and mental disabilities, also describe their expectations about receiving appropriate care in "assisted living" at an affordable rate.  They allege, for example:

Assisted Living facilities are intended to provide a level of care appropriate for those who are unable to live by themselves but who do not have medical conditions requiring more extensive nursing care.

 

In recent years, [Defendant] has increasingly been accepting and retaining more residents with conditions and care needs that were once handled almost exclusively in skilled nursing facilities.  This has allowed [Defendant] to increase not only the potential resident pool but also the amounts of money charged to residents and/or their family members.

The plaintiffs complain that rates charged, alleged to range between "approximately $4,000 to $10,000 per person per month," increased at a rate of  6% to 7% percent per year in each of the last two years, at the same time that staffing levels dropped to a critical, allegedly unsafe level.  

At the core of the complaint is the frustration that residents are not being provided the services they need.  The legal theories include violation of the Americans with Disabilities Act, state civil rights and consumer protection laws, unfair trade practices laws, and California's Elder Financial Abuse laws, all leading to what I see as a fundamental question:  

Can Assisted Living operators be held liable for failure to provide skilled care to residents they allegedly "know" need such care, or is the less-than-skilled label and license to operate a defense against such liability?

The Brookdale defendants deny the allegations of fault.    For more, see  Largest Assisted Living Chain in U.S. Sued for Poor Care of Elderly from California Healthline.

 

September 12, 2017 in Consumer Information, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 11, 2017

Hurricane Irma and Florida: How Will Elders Fare?

Sitting at home watching the storm tracker, and being right in the path of Irma, I wondered what efforts are being taken to protect Florida's elders, so we don't see a picture similar to that we saw from Harvey. I'm not the only one wondering about this. The New York Times ran an article the day before Irma made landfall on the continental US. Long a Refuge for the Elderly, Florida is Now a Place of Danger  describes the demographics, 20% of South Florida's residents are over 65 and in some counties, a significant number are over 75.  The numbers, as well as the variations in health, makes evacuation and care for this part of Florida's population especially challenging when a hurricane arrives.  Add to that the fact that many elders who retire to Florida don't have  support of friends or family in Florida.  Not every elder will evacuate and don't forget that the caregivers need to take care of their own homes and families at some point. As well, first responders notice everyone that once winds reach a certain speed, they will not respond to calls for help.  Then once the storm passes, getting services and utilities restored becomes another challenge. For some, delays in having power can be life-threatening.  Stay tuned and wish all of us down here well.

 

 

September 11, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

Thursday, September 7, 2017

Jimmo v. Sebelius-Is the End in Sight?

CMS has released a new webpage as part of its settlement of the Jimmo case. The Center for Medicare Advocacy press release explains that "[t]he Jimmo webpage is the final step in a court-ordered Corrective Action Plan, designed to reinforce the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities/Hospitals."

The CMS Jimmo website

 reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).  Specifically, the Jimmo Settlement Agreement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient's clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program.  Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program. 

The Jimmo Settlement Agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.  The Jimmo Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

The website provides links to added resources, FAQs and pdfs of resources. 

September 7, 2017 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

NYT: Would an End to DACA Cause Problems for the LTC Industry?

We're seeing specific industries report on the expected impact from termination of the DACA program for otherwise undocumented workers.  Broadly speaking, long-term care (LTC)  is already experiencing a worker-shortage, as we've reported here in the past.  From the New York Times:

Mr. Sheik is the chief executive and founder of CareLinx, which matches home care workers with patients and their families. The company relies heavily on authorized immigrant labor, making the looming demise of the program — which has transformed around 700,000 people brought to this country as children into authorized workers — a decidedly unwelcome development. The move, Mr. Sheik said, would compound an already “disastrous situation in terms of shortages of supply.” He added, “This is a big issue we’re focusing on.”

 

***

Surveys of DACA beneficiaries reveal that roughly one-fifth of them work in the health care and educational sector, suggesting a potential loss of tens of thousands of workers from in-demand job categories like home health aide and nursing assistant.  At the same time, projections by the government and advocacy groups show that the economy will need to add hundreds of thousands of workers in these fields over the next five to 10 years simply to keep up with escalating demand, caused primarily by a rapidly aging population.

 

“It’s going to have a real impact on consumers,” Paul Osterman, a professor at the Sloan School at MIT and author of a new book on long-term care workers, said of the DACA move.

For more, read What Older Americans Stand to Lose if  "Dreamers" Are Deported.

September 7, 2017 in Consumer Information, Discrimination, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, September 6, 2017

Medicaid 101 Webinar

The National Center on Law & Elder Rights  has announced an upcoming free webinar on Medicaid 101.

Here is the info about the webinar

Understanding Medicaid is a key to understanding the health and long-term care delivery system for older adults. Every year, over 6 million older Americans rely on Medicaid every year to pay for necessary health services. Over two-thirds of all older adults who receive long-term care at home or in a nursing facility, participate in the Medicaid program.

This free webinar, Legal Basics: Medicaid 101, will provide participants with a basic primer on the Medicaid program. It will explain the formation of Medicaid, Medicaid funding, key Medicaid protections, and Medicaid’s role in paying for health and long-term care for older adults.

The webinar is set for September 12, 2017 at 2:00 p.m. edt. To register, click here.

September 6, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)

Tuesday, September 5, 2017

Dual Eligibles and Medicare Coordination of Benefits

The National Center of Law & Elder Rights has announced an upcoming free webinar on Managed Care for Dual Eligibles and Medicare Coordination Programs on September 20, 2017 at 2:00 p.m. edt.  Here's a description of the webinar

Dual eligible individuals, those with both Medicare and Medicaid coverage, represent the most medically needy and costly population for both Medicare and Medicaid. In an effort to improve health outcomes and reduce healthcare spending, the Centers for Medicare and Medicaid Services (CMS) has been testing  financial alignment demonstrations in thirteen states to better coordinate and integrate care for dual eligibles.

What has been learned from these demonstrations so far? What are the take-aways for states that did not participate? This webinar will provide an update on these dual eligible demonstrations and review early evaluations of the programs. The webinar will also cover other recent efforts by CMS to address issues unique to dual eligible including issues around access to durable medical equipment.

Following the training, the audience will have a better understanding of the two models being tested in the demonstration, the fully capitated model and the managed fee-for-service model. They will also know about challenges and innovations during the almost four years since the demonstrations were launched and what further evaluation is being planned.

This is an advanced webinar. Legal service attorneys and aging and disability network professionals who work with dual eligibles are encouraged to attend.

Click here to register.

September 5, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, Programs/CLEs, Webinars | Permalink | Comments (0)

Sunday, September 3, 2017

Early Alert from CMS-SNF Abuse

Here's something to give you pause. The HHS Office of Inspector General has released an early alert. The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements (A-01-17-00504)  dated August 24, 2017, 

alert[s] [the CMS administrator about] ... the preliminary results of our ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the Office of Inspector General (OIG) to detect and combat elder abuse. The objectives of our audit are to (1) identify incidents of potential1 abuse or neglect of Medicare beneficiaries residing in SNFs and (2) determine whether these incidents were reported and investigated in accordance with applicable requirements.

The 14 page letter provides a lot of detail about the situation and offers a number of recommendations, including immediate action: "implement procedures to compare Medicare claims for [ER] treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this analysis to the Survey Agencies for further review and ... continue to work with ... HHS ... to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of section 1150B." Longer term the alert suggests new regulations among other ideas.

 

September 3, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 31, 2017

The Eyes Have It? A New Tool To Detect Alzheimer's?

USA Today ran a story, Can this eye scan detect Alzheimer's years in advance? This short article explains that according to scientists "early indicators of Alzheimer's disease exist within our eyes, meaning a non-invasive eye scan could tip us off to Alzheimer's years before symptoms occur... It turns out the disease affects the retina — the back of the eye — similarly to how it affects the brain, notes neuroscience investigators at Cedars-Sinai Medical Center in California. Through a high-definition eye scan, the researchers found they could see buildup of toxic proteins, which are indicative of Alzheimer's." The study on which this article is based was published in the Journal of Clinic Investigation.  Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease is downloadable as a pdf by clicking here. The 19 page article offers this intriguing statement. "Such retinal amyloid imaging technology, capable of detecting discrete deposits at high resolution in the CNS, may present a sensitive yet inexpensive tool for screening populations at risk for AD, assessing disease progression, and monitoring response to therapy." (Warning-there are a lot of detailed photos of eyes in this article).

 

August 31, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)