Tuesday, October 16, 2007
GAO report says required Medicare Advantage audits "of limited value" because of CMS delays and refusal to pursue sanctions
Before 2006, companies choosing to participate in the Medicare Advantage
program were annually required to submit an ACRP to CMS for review and
approval. In 2006, a bid submission process replaced the ACRP process. The
ACRPs and bids identify the health services the company will provide to
Medicare members and the estimated cost for providing those services. CMS
contracted with accounting and actuarial firms to perform the required audits.
According to our analysis, CMS did not meet the requirement for auditing the
financial records of at least one-third of the participating Medicare Advantage
organizations for contract years 2001-2005. CMS is planning to conduct other
financial reviews of organizations to meet the audit requirement for contract
year 2006. However, CMS does not plan to complete the financial reviews until
almost 3 years after the bid submission date each contract year, which will
affect its ability to address any identified deficiencies in a timely manner.
CMS did not consistently ensure that the audit process for contract years
2001-2005 provided information to assess the impact on beneficiaries. After
contract year 2003 audits were completed, CMS took steps to determine such
impact and identified an impact on beneficiaries of about $35 million. CMS
audited contract year 2006 bids for 80 organizations, and 18 had a material
finding that affected amounts in approved bids. CMS officials took limited
action to follow up on contract year 2006 findings. CMS officials told us they
do not plan to sanction or pursue financial recoveries based on these audits
because the agency does not have the legal authority to do so. According to
our assessment of the statutes, CMS had the authority to pursue financial
recoveries, but its rights under contracts for 2001–2005 were limited because
its implementing regulations did not require that each contract include
provisions to inform organizations about the audits and about the steps that
CMS would take to address identified deficiencies. Further, our assessment of
the statute is that CMS has the authority to include terms in bid contracts that
would allow it to pursue financial recoveries. Without changes in its
procedures, CMS will continue to invest resources in audits that will likely
provide limited value.
Read the full report: http://www.gao.gov/new.items/d08154t.pdf?source=ra
Monday, October 15, 2007
Insurance companies offering Medicare-funded prescription drug plans are costing U.S. taxpayers almost $15 billion a year in excess administrative fees and pharmaceutical costs, a congressional study found. The study released today also found insurers fail to pass on $1 billion a year in discounts from drugmakers to participants in Medicare, the U.S. health program for the elderly and disabled.``The use of private insurers to deliver Medicare drug coverage is driving up costs and producing only limited savings on drug prices,'' said Representative Henry Waxman, a California Democrat and chairman of the House Oversight and Government Reform Committee. The panel's Democratic staff prepared the analysis. The report reviewed administrative expenses, sales costs, profits, and drug rebates of the 12 largest insurers offering prescription drug plans through Medicare. Combined, the companies supply prescription coverage to more than 18 million elderly Americans, or about 75 percent of the plans' participants.
Source: Bloomberg, http://www.bloomberg.com/apps/news?pid=20601103&sid=aLucd6NvhBBU&refer=us
Get the report: http://oversight.house.gov/story.asp?ID=1536
Former students and associates of Igloolik, Nunavut, elder Lucien Ukaliannuk, who passed away more than a week ago, praised him for working tirelessly to preserve Inuit traditional law and justice. Ukaliannuk, 67, died peacefully on Sept. 29 in Iqaluit. He was born at Avvajja, a small Catholic mission station near Igloolik, on Jan. 18, 1940. While he worked in community politics, Ukaliannuk's main life work was preserving and recording Inuit traditional knowledge of societal values and Inuit laws. He was involved in 1982 in ensuring aboriginal rights were enshrined in the Canadian Charter of Rights and Freedoms. Igloolik MLA Louis Taparjuk, who is also Nunavut's minister of culture, languages, elders and youth, told CBC News that Ukaliannuk saw how quickly Inuit traditional law was disappearing, being replaced by the modern justice system that sometimes created conflict. Such conflict has led to tragedies like suicide, he said, driving Ukaliannuk to begin recording and writing down elders' knowledge of the past. "Even today, we are forced to live in a society that is not of our own making, and which causes a lot of social problems. And we spend millions of dollars trying to address these problems," Taparjuk said Wednesday. "But Lucien [found] other ways — that if we took control of our own problems, understanding our own culture, then we would own up to our own problems and try to solve it according to the knowledge of the elders." Ukaliannuk's work led him to become an elder-in-residence with Nunavut's first law school, the Akitsiraq Law program offered jointly by the University of Victoria and Nunavut Arctic College. There, he taught traditional Inuit law and the Inuktitut language, as well as acting as a counsellor and a mentor.
Source/more: CBC Canada, http://www.cbc.ca/canada/north/story/2007/10/11/nu-lucien.html
Sunday, October 14, 2007
Medicaid Citizenship Documentation Rule Cited As Main Cause of Medicaid Enrollment Drop
Medicaid application processing delays under new citizenship documentation requirements are the main reason for a 0.5 percent decrease in Medicaid enrollment in 2007, the first drop in a decade, according to a Kaiser Commission study released Oct. 10.
Birth certificates and other proof of citizenship documents required under the Deficit Reduction Act of 2005 are largely responsible for the enrollment decline, according to the study, 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
Lead study author Vernon Smith said the last time the Medicaid program experienced a reduction in enrollment was in 1998, when enrollment declined 1.9 percent.
Three-quarters of the states (37) said the new documentation requirements had a negative impact on enrollment, Smith said. Thirty- five states said the requirements increased the time it took to process Medicaid applications and renewals. The new requirements also increased administrative costs for 45 states, the study found.
More from KFF: http://kff.org/medicaid/kcmu101007pkg.cfm
NHeLP's Final Comments on Proposed Federal Rules governing Rehabilitation Service Coverage (Oct. '07) Date: 10/11/2007
Organization: National Health Law Program Submission Date: 10/11/2007
NHeLP's Final Comments on Proposed Federal Rules governing Rehabilitation Service Coverage. Our comments are attached in Word format. The proposed rules are attached in PDF format. Deadline for comments Friday Oct. 12, 2007.
See comments or proposed regs: http://tinyurl.com/2b7xm7 (may require login)
The second issue of the "Journal of International Aging Law and Policy" has recently been published under the hospice of Stetson U. Faculty of Law:
Volume 2 Summer 2007
A Softly Greying Nation: Law, Ageing and Policy in Canada Charmaine Spencer & Ann Soden
Law and Ageing in Israel: The Development of a New Field of Law Israel Doron
Law, Ageing and Policy in the United Kingdom Helen Meenan and Graeme Broadbent
Elder law in the United States: The Intersection of the Practice and Demographics Rebecca C. Morgan
International Elder Law Research: A Bibliography
Tuesday, October 9, 2007
National Accounts Statistics: Main Aggregates and Detailed Tables, 2005 Contains detailed national accounts estimates for most countries and areas of the world for the period 1994-2005. The national data for each country and area are presented in separate chapters using uniform table headings and classifications recommended in the United Nations System of National Accounts 1993 (SNA 1993). A summary of the conceptual framework of the SNA 1993 and definitions of important terms are also included. Based on availability of official data, the following sequence of tables is displayed for each country or area:
Table 1.1. Gross domestic product by expenditures at current prices Table 1.2. Gross domestic product by expenditures at constant prices Table 1.3. Relations among product, income, savings and net lending aggregates at current prices Table 2.1. Value added by industries at current prices Table 2.2. Value added by industries at constant prices Table 2.3. Output, gross value added and fixed assets by industries at current prices Table 3.1. Government final consumption expenditure by function at current prices Table 3.2. Individual consumption expenditure of households, NPISHs, and general government at current prices Table 4.1. Total Economy (S.1) at current prices Table 4.2. Rest of the world (S.2) at current prices Table 4.3. Non-financial Corporations (S.11) at current prices Table 4.4. Financial Corporations (S.12) at current prices Table 4.5. General Government (S.13) at current prices Table 4.6. Households (S.14) at current prices Table 4.7. Non-profit institutions serving households (S.15) at current prices Table 4.8. Combined Sectors: Non-Financial and Financial Corporations (S.11 + S.12) at current prices Table 4.9. Combined Sectors: Households and NPISH (S.14 + S.15) at current prices Table 5.1. Cross classification of Gross value added by industries and institutional sectors at current prices
The international law firm of Sidley Austin LLP has agreed to pay $27.5 million to 32 former partners who the U.S. Equal Employment Opportunity Commission (EEOC) alleged were forced out of the partnership because of their age, under settlement approved by a federal judge. The EEOC brought the suit in 2005 under the federal Age Discrimination in Employment Act (ADEA). A major issue in the case was whether partners in the law firm were protected as employees under the ADEA. The settlement provides that "Sidley agrees that each person for whom EEOC has sought relief in this matter was an employee with the meaning of the ADEA." The settlement also includes an injunction that bars the law firm from "terminating, expelling, retiring, reducing the compensation of or otherwise adversely changing the partnership status of a partner because of age" or "maintaining any formal or informal policy or practice requiring retirement as a partner or requiring permission to continue as a partner once the partner has reached a certain age." "This case has been closely followed by the legal community as well as by professional services providers generally," says Ronald S. Cooper, general counsel of the EEOC. "It shows that EEOC will not shrink from pursuing meritorious claims of employment discrimination wherever they are found. Neither the relative status of the protected group members nor the resources and sophistication of the employer were dispositive here." The $27.5 million will be paid to 32 former partners of the firm for whom the EEOC sought relief because they either were expelled from the partnership in connection with an October 1999 reorganization or retired under the firm's retirement policy.
Source/more: HR.BLR.com, http://hr.blr.com/news.aspx?id=77249
Elderly gay people living in nursing homes or assisted-living centers or receiving home care, increasingly report that they have been disrespected, shunned or mistreated in ways that range from hurtful to deadly, even leading some to commit suicide. Some have seen their partners and friends insulted or isolated. Others live in fear of the day when they are dependent on strangers for the most personal care. That dread alone can be damaging, physically and emotionally, say geriatric doctors, psychiatrists, and social workers. The plight of the gay elderly has been taken up by a generation of gay men and lesbians, concerned about their own futures, who have begun a national drive to educate care providers about the social isolation, even outright discrimination, that lesbian, gay, bisexual and transgender clients face. Several solutions are emerging. In Boston, New York, Chicago, Atlanta and other urban centers, so-called L.G.B.T. Aging Projects are springing up, to train long-term care providers. At the same time, there is a move to separate care, with the comfort of the familiar.
Read more in the New York Times: http://www.nytimes.com/2007/10/09/us/09aged.html?ex=1192593600&en=31488165b0295b95&ei=5070&emc=eta1
Thanks to Allison Crandall for the tip....
...such as 98 year old John Simplot....
Monday, October 8, 2007
SSA spent the $500 million in MMA funds from December 2003 through January 2006 to implement activities outlined in MMA. The majority of costs paid with MMA funds consisted of personnel-related expenses, contractors, and indirect costs. More than half of the funds were spent on payroll for staff hours used on MMA activities in SSA headquarters and field offices (see table). Once the $500 million was spent, SSA began to use its general appropriation to fund the remaining costs of implementing MMA activities. SSA used its cost analysis system to track the total costs of its implementation of MMA activities. As of February 20, 2007, SSA had completed implementation of 16 of the 22 tasks for the six provisions under the act.
SSA had agencywide policies and procedures in place for its cost tracking and allocation, asset accountability, and invoice review processes. It also established specific guidance to assign and better allocate SSA’s costs in implementing MMA. There were some instances though where SSA did not comply with these policies and procedures. SSA did not effectively communicate the specific MMA-related guidance to all affected staff. SSA subsequently identified and corrected at least $4.6 million of costs that initially were incorrectly allocated to MMA, but had not corrected approximately $313,000 misallocated credit card purchase transactions. In addition, GAO found instances where accountable assets purchased with MMA funds, such as electronic and computer equipment, were not being properly tracked by SSA in accordance with its policies and instances where purchase card transactions were not properly supported. Although purchase card transactions and accountable asset purchases represented a small percentage of total MMA costs, proper approval and support for these types of transactions is essential to reduce the risk of improper payments.
Source: GAO-07-986, SOCIAL SECURITY ADMINISTRATION: Policies and Procedures Were in Place over MMA Spending, but Some Instances of Noncompliance Occurred
Deteriorating health and declining incomes threaten the welfare and security of many people as they enter old age. Nearly 80 per cent of older persons living in developing countries (about 342 million people) lack adequate income security, a figure that could, according to the World Economic and Social Survey 2007 (http://www.un.org/esa/policy/wess), rise to 1.2 billion by 2050 if pension coverage does not keep pace with demographic changes. The Survey suggests that a minimal universal social pension provides the surest way to tackle the problem. Universal pensions would provide a floor below which nobody could fall. Moreover, they could provide the basis for a more comprehensive pension system which may consist of a mixture of public and private initiatives adapted in accordance with existing country practices, financial circumstances and equity considerations.
Tackling Insecurity in Old Age: The Challenge of Universal Pensions
Saturday, October 6, 2007
Health information technology (HIT) is a powerful tool for improving the quality of long-term care, but it must be implemented to interact with other segments of healthcare in order to be successful, according to a new report by BearingPoint, prepared for the National Commission for Quality Long-Term Care. The Commission is a nonpartisan independent body based in Washington but overseen by The New School in New York. The report examines long-term care within the broader healthcare context, addressing the steps that need to be taken so that information technology can help improve quality of life for all. Due to the shortage of available resources, a strong business case must be made for the adoption of HIT by many differing long-term care stakeholders, and clear incentives for improving efficiency and outcomes for consumers must be provided. The report concludes that technology in long-term care is much more fragmented than the rest of the healthcare system. It also involves a wider spectrum of issues; provides a wider range of services for seniors; faces greater workforce and financing challenges; and has been slower to adopt technology. To combat these barriers, the report suggests that policymakers and federal healthcare purchasers must understand that the full integration of HIT into long-term care will affect all other healthcare sectors because a disproportionate percentage of health care dollars are spent on the elderly. However, the origins of these expenditures often begin many years earlier. So the role of HIT in improving the health of seniors must focus on people of all ages. A more holistic approach to developing HIT-related solutions is required.
Source/more: PR Newswire, http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/10-04-2007/0004675877&EDATE=
Thursday, October 4, 2007
Via the Center for Medicare Advocacy/Elderbar Listserv:
PROGRAM UPDATES: QI PROGRAM EXTENDED AND MEDICARE PREMIUMS & DEDUCTIBLES ANNOUNCED FOR 2008
Qualified Individual (QI) Program Extended
The Congress has passed legislation that will continue the Qualified Individual (QI) program through the end of 2007. The President is expected to sign the legislation. This will assure the continued payment of Part B premiums for the approximately 1.5 million people who receive QI benefits. The Center for Medicare Advocacy is working with many other organizations for the passage of legislation, before the end of the year, which would make the QI program permanent, rather than subject to periodic sunset provisions. The QI benefit is doubly valuable to those who are eligible, as it pays the Part B premium (currently $93.50/month) and also entitles the beneficiary to the full Part D low income subsidy.
Cost-Sharing for Part A and Part B
On October 1, 2008 the Centers for Medicare & Medicaid Services (CMS) announced Part A and Part B premiums and deductibles for 2008.
Hospital Deductible: $1,024 / benefit period
Days 0-60: $0
Days 61-90: $256 / day
Days 91-150: $512 / day
Skilled Nursing Facility Coinsurance
Days 0-20: $0
Days 21-100: $128 / day
Part A Premium (for voluntary enrollees only)
With 30-39 quarters of Social Security coverage: $233 / month
With 29 or fewer quarters of Social Security coverage: $423 / month
Deductible: $135 / year
Standard Premium: $96.40 / month
Part B Income-Related Premium
* Individual tax return with income less than or equal to $82,000 or
Joint tax return with income less than or equal to $164,000
Income-related monthly adjustment amount: $0.00Total monthly premium amount: $96.40
* Individual with income greater than $82,000 and less than or equal to $102,000
Joint with income greater than $164,000 and less than or equal to $204,000
Income-related monthly adjustment amount: $25.80
Total monthly premium amount: $122.20
* Individual with income greater than $102,000 and less than or equal to $153,000
Joint with income greater than $204,000 and less than or equal to $306,000
Income-related monthly adjustment amount: $64.50
Total monthly premium amount: $160.90
* Individual with income greater than $153,000 and less than or equal to $205,000 or
Joint with income greater than $306,000 and less than or equal to $410,000
Income-related monthly adjustment amount: $103.30
Total monthly premium amount: $199.70
* Individual tax return with income greater than $205,000 or
Joint with income greater than $410,000
Income-related monthly adjustment amount: $142.90
Total monthly premium amount: $238.40
In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at some time during the taxable year are:
Beneficiaries who are married but file a separate tax return from their spouse:
* Income less than or equal to $82,000
Income-related monthly adjustment amount: $0.00
Total monthly premium amount: $96.40
* Income greater than $82,000 and less than or equal to $123,000
Income-related monthly adjustment amount: $103.30
Total monthly premium amount: $199.70
* Income greater than $123,000
Income-related monthly adjustment amount: $142.00
Total monthly premium amount:$238.40
Medicare Advantage Eligibility
* Must be enrolled in Medicare Parts A & B; enrollees are still in the Medicare program,
* Must continue to pay the Part B premium ($96.40 / month in 2008),
* Must live in the plan?s service area,
* Must not have end-stage renal disease (ESRD) at time of enrollment.
Standard Part D Cost-Sharing for 2008
On April 2, 2008 CMS issued information about Part D cost-sharing for 2008: Base Beneficiary Premium: $27.93
Initial Coverage Limit: $2,510.00
Out-of-pocket Threshold: $4,050.00
Total Covered Part D Drugs to Get to Catastrophic Limit: $5,726.25 Catastrophic cost-sharing: Generic/ Preferred Drug: $2.25
Low-Income Subsidy Co-Payments (LIS)
Full Benefit Dual Eligibles w/incomes <100% Federal Poverty Level
Generic/Preferred Drugs: $1.05
Above Catastrophic Limit: $0.00
Full Benefit Duals with Incomes >100% Federal Poverty Level & Other Full-Subsidy Eligible Beneficiaries
Generic/preferred drugs: $2.25
Above Catastrophic Limit: $0.00
Partial Subsidy Eligible Beneficiaries
Co-insurance to ICL: 15%
Generics above catastrophic limit: $2.25
Others above catastrophic limit: $5.60
CMS has also announced the elimination of the 2008 late enrollment penalty for any beneficiary who qualifies for the low-income subsidy and who enrolls in a drug plan through December 31, 2008.
Wednesday, October 3, 2007
Delegates to the Kansas Silver Haired Legislature spoke out in force during a debate Tuesday over whether to support a resolution in favor of a cost-of-living increase in state employees' retirement benefits. As one former Boeing employee stood in opposition, saying he didn't think the state employees benefits were the province of the Silver Haired Legislature, there was an immediate resistance. Members of the Silver Haired Legislature will convene again at 8 a.m. today when they will take final action on the items discussed Tuesday. Jim Miller, of Topeka, responded that seniors had to stand as a group in support of better retirement benefits in the face of current workers who might "resent" having to pay taxes for older Kansans. "We're going to be facing an intergenerational warfare," he said. Bette Ford, of Valley Falls, stood to tell the delegates that she had been a state employee, and in the 20 years since retiring she has had one incremental increase. Throughout the process, delegates clapped as speakers made points they liked. The proposal to support the retirement increase eventually was passed.
Source/more: Topeka Capital Journal, http://cjonline.com/stories/100307/sta_204848259.shtml
Warfare? Come now! That's inflammatory!!
University of California Irvine, School of Medicine
Program in Geriatrics Presents:
NATIONAL CONFERENCE ON
MEDICAL ASPECTS OF ELDER ABUSE
Save the Date: February 11 – 12,
2008 (ends at noon)
Location: Newport Beach, Orange County, California
Sample of Presenters
• Susan E. Kurrle, MB BS, PhD Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia
• Georgia Anetzberger, PhD Cleveland State University Health Care Administration Program, Ohio
• Maggie Baker, PhD, RN University of Washington School of Nursing, Seattle, Washington
• Bonnie Brandl, MSW Wisconsin Coalition Against Domestic Violence/National Coalition on Abuse in Later Life
• Marie-Therese Connolly, JD Woodrow Wilson Scholar
• Carmel Bitondo Dyer, MD, FACP, AGSF University of Texas Medical School, Houston, Texas
• Richard Harruff, MD, PhD Chief Medical Examiner, King County, Washington
• J. Frank Randolph, MD Arrowhead Regional Medical Center, California
• Diana Schneider, MD University of Southern California, Los Angeles County Elder Abuse Forensic Center, LAC + USC Medical Center Adult Protection Team
• Laura Mosqueda, MD University of California, Irvine, Facilitator
Sample of Topics
• Self Neglect
• Abuse of Medications
• Forensic Markers of Abuse
• Elder Abuse as a Human Rights Issue
Who should attend
Physicians, Registered Nurses, Social Workers, Marriage and Family Therapists, Psychologists, Lawyers, Judiciary, Law Enforcement
CME to be offered
More information: www.centeronelderabuse.org or email: firstname.lastname@example.org
Made possible through a grant from the Archstone Foundation and supported by a grant from UniHealth Foundation.
Tuesday, October 2, 2007
Major U.S. long-term care insurers, including Genworth Financial Inc., and Manulife Financial Corp are being asked about "troubling data" showing a sharp jump for the industry in claims-related complaints, a senior Republican lawmaker said on Monday. Iowa Sen. Charles Grassley sent letters on Thursday to U.S. insurance providers "to learn more about how effectively the sector is meeting the needs of Americans who have purchased such policies," he said in a statement. Grassley, the top Republican on the Senate Finance Committee, said he made the request after learning about industry trends from the National Association of Insurance Commissioners (NAIC). The group reported a 92 percent jump in long-term care complaints nationally from 2001 to 2006 and "a steady increase in the number of complaints regarding claim denials," he said. It also identified a 74 percent increase in claim denial related complaints between 2003 and 2006. "While this may be explained by the increasing number of people purchasing LTCI (long-term care insurance), the relationship remains unclear," Grassley said in the letter, which also went to Conseco Inc MetLife Inc Penn Treaty American Corp., Unum Group, Prudential Financial Inc ,and others. The Senate Finance Committee oversees the federal government's Medicare and Medicaid health care programs. Grassley said in his letter that any increase in rejected long-term care insurance claims could place "a substantial and perhaps unnecessary financial burden ... on Medicaid."
Source/more: Reuters UK, http://uk.reuters.com/article/governmentFilingsNews/idUKN0134070220071001
Costly diseases, many of them related to obesity and smoking, are more prevalent among aging Americans than their European peers and add as much as $100 billion to $150 billion a year in treatment costs to the U.S. healthcare tab, a new study says. The study by researchers at Emory University's Rollins School of Public Health found higher rates of several serious diseases -- including cancer, diabetes and heart disease -- among Americans 50 and older as compared with aging Europeans. For example, heart disease was diagnosed in nearly twice as many Americans as Europeans 50 and older. More than 16% of American seniors had diagnosed diabetes, compared with about 11% of their European peers. And arthritis and cancer were more than twice as common among Americans as Europeans.
The study published on the Web today by the journal Health Affairs found that Americans were nearly twice as likely as Europeans to be obese (33.1% versus 17.1%), and they also were more likely to be current or former smokers (53% versus 43%). "We expected to see differences between disease prevalence in the United States and Europe, but the extent of the differences is surprising," said lead author Kenneth Thorpe, a public health professor at Emory and former deputy assistant secretary of the U.S. Department of Health and Human Services.
Elderly and disabled people will see their Medicare premiums rise 3.1 percent next year to $96.40 a month. But the formula used to calculate the premium assumes that physicians will take a 10 percent cut in their reimbursement rates next year, an unlikely occurrence. If, as expected, Congress acts to offset some of that pay cut or to eliminate it, premiums in future years would go up to reflect the additional expense. Another factor in the lower-than-usual premium increase was the fixing of an accounting error that otherwise would have added $2.50 to beneficiaries' monthly premiums in 2008. The program's expenses have soared in recent years as health care costs go up faster than most other segments of the economy and as more people join the program.
Source/more: Houston Chronicle/AP, http://www.chron.com/disp/story.mpl/ap/politics/5179304.html