Elder Law Prof Blog

Call for papers: deadline

Australian Guardianship and Administration Council
2009 National Conference
Social Inclusion: The Future of Ageing, Disability
and Substituted Decision-Making

BRISBANE : 19-20 MARCH 2009
Hilton Hotel

FIRST & FINAL CALL FOR ABSTRACTS
Closing date for receipt of abstracts: Tuesday 30 September, 2008

Abstracts for papers that address these and related issues are invited and may include a consideration of:
Please note that the acceptance of papers etc.
is contingent on registration for the Conference.

• Assessing capacity
• Use of enduring powers of attorney, advance health directives and
family agreements
• Guardianship, including protection of rights and developing best practice
• Responding to challenging behaviour,
mental illness, personality disorders and homelessness
• Administration and financial protection of the vulnerable
• Medical treatment decisions including end of life
decision-making
• Tribunals - structure, fact finding, confidentiality and procedural fairness
• Promoting human rights
• Engaging with Indigenous Communities
• Responding to the needs of our vulnerable aged

Please ensure that you comply with the following and forward (details below)
no later than 30 September 2008.
Abstracts must be:
• typed in Microsoft Word
• no more than 300 words
• submitted by email as an attachment or by post on a CD or floppy disk
(faxes will not be accepted)
Abstracts should include:
• Name of conference
(“AGAC Conference”)
• Title of presentation
• Author/s name(s), with name of presenting author underlined:
• Authors’ affiliations
• Main author’s address and contact details (postal and email addresses, phone and fax numbers)
Please forward abstracts by email to:
[email protected]

or on a CD to:

AGAC Conference
c/- The Congress Organiser
146 Leicester Street
Carlton, Victoria 3053
AUSTRALIA

Receipt of all abstracts will be
acknowledged by email.

GAO says CMS should audit Part D sponsors due to fraud and abuse

Summary: 

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit, known as Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) contracts with private companies to serve as Part D sponsors and administer the Part D prescription drug benefit plans. To protect beneficiaries and the fiscal integrity of the program, the MMA requires Part D sponsors to implement programs to control for fraud and abuse in Part D. Subsequent regulations and guidance from CMS contain requirements and recommended measures for these programs.

This report examines (1) the extent to which certain Part D sponsors have implemented programs to control fraud, waste, and abuse and (2) the extent of CMS’s oversight of Part D sponsors’ programs to control fraud, waste, and abuse. GAO conducted on-site reviews of five of the largest Part D sponsors’ fraud and abuse programs. GAO also interviewed officials from CMS and reviewed CMS documents.

What GAO Recommends

To help safeguard the Medicare Part D program from fraud, waste, and abuse, GAO recommends that CMS conduct timely audits of Part D sponsors’ fraud and abuse programs. CMS disagreed that its oversight has been limited, but GAO found that CMS has not audited sponsors’ fraud and abuse programs. CMS concurred with GAO’s recommendation.

Get the GAO report.

Upcoming conference--A Jewish Approach to End-of-Life

Sent to me by Neil Hendershot, PA Elder, Estate, and Fiduciary Law Blog:

"On Sunday, September 14, 2008, from 9 a.m. to 3 p.m., Yeshiva University, in New York City, will conduct a seminar entitled "The Sanctity of Life: A Jewish Approach to End of Life Challenges."

This is the purpose of the conference:     The conference will provide a unique opportunity to interact with rabbis and physicians who are leaders in this area of medical ethics.     By enriching our education, raising our awareness, and deepening our sensitivities, the YU Student Medical Ethics Society hopes to promote continued discussion, thus enhancing the community’s ability to deal with these issues in an effective manner that holds true to the highest moral standard. * * * The conference speakers will address the medical, psychological, social, & religious (under Jewish law) issues arising in end-of-life situations..."

More here.

Professor Kenny Heglund:: End of life conversations video now online

A new video on intensive care, hospice and the value of candid family conversations is available online. It will be part of a continuing series on elder law topics designed for the general public, and it is based on the book written by Professor Kenney Hegland and Robert Fleming, CELA: Alive and Kicking: Legal Advice for Boomers. The video is designed to be helpful to clients facing, but mostly ignoring, end-of-life matters.

www.law.arizona.edu/boomerlaw

Call for book reviews: Pace Law Review, Women and the Law

Call for Book Reviews: Women and the Law

Proposals Due September 25, 2008

The editors of Pace Law Review invite proposals from scholars, researchers, practitioners and professionals for contributions to a special book review issue to be published in Winter 2008.  We seeks proposals for reviews of any book published in 2008, 2007 or 2006 that contributes to the understanding of women’s experiences with the law.

Pace Law School has a longstanding commitment to both the study of women and the law and the development of women as lawyers and leaders. The Pace Women’s Justice Center was founded in 1991 as the first academic legal center in the country devoted to training attorneys and others in the community about domestic violence issues.  Pace is a vibrant and intellectual community that contains several nationally-recognized scholars of women’s, children’s and LGBT rights.

A law review volume devoted to books concerning women and the law promotes an ongoing discourse on women and the law, justice and feminist jurisprudence.

Please submit book review proposals of no more than 500 words by attachment to [email protected] by September 25, 2008.  Proposals should include (a) the intended reviewer’s name, title, institutional affiliation and contact information; (b) the title and publication date of the book proposed for review; (c) a description of the importance of the book to the general topic; and (d) any other information relevant to the book or proposed review (e.g., the proposed reviewer’s expertise or any relationship with the author).  Authors are welcome, but not required, to submit a CV as well.  We expect to make publication offers by October 1, 2008.

Complete manuscripts from authors of accepted proposals will be due November 1, 2008.  Completed book reviews should not exceed 8,500 words.

Not elder law: eBay insect fossil is new species

A scientist who bought a fossilised insect on the web auction site eBay for £20 has discovered that it belongs to a previously unknown species of aphid.

Dr Richard Harrington, vice-president of the UK's Royal Entomological Society, bought the fossil from an individual in Lithuania.

He then sent it off to an aphid expert in Denmark, who confirmed the insect was a new species, now extinct.

The bug has been named Mindarus harringtoni after the scientist.

Source:  BBC, http://news.bbc.co.uk/2/hi/science/nature/7572052.stm

CMS Part D website is confusing and almost useless for most seniors

About three-fourths of older adults with basic computer skills could not find the most beneficial prescription drug plan on the Medicare Web site, and could not take the necessary steps to enroll to receive home health care services, according to a study published on Wednesday in the Journal of the American Medical Association, the South Florida Sun-Sentinel reports.  The study -- conducted by Sara Czaja, co-director of the Center on Aging at the University of Miami Medical School, and colleagues -- included 112 adults ages 50 and older from Broward and Miami-Dade counties in Florida, each of whom had at least 14 years of education and basic computer skills.

Study participants received brief training on the Medicare Web site before researchers asked them to find the most beneficial prescription drug plan among various plans listed on the site. Researchers analyzed the computer activity logs of participants and found that they often could not understand the technical language or navigate the pages of the Web site. In addition, some participants did not search the Web site adequately to find the information that they needed to select a prescription drug plan, the study found. Some participants ended their searches before they visited the 10 or more pages needed to find the information, according to the study.

Czaja said, "There are some problems ... some design features with the site that make it difficult for people to use, and they can't get the maximum value out of it," adding, "Some of them just gave up trying."

In a response to the study, Jeff Nelligan, a CMS spokesperson, said that the Web site receives more than one million visitors daily and that the agency conducted focus groups before the launch of the site in 2005. Nelligan said, "We've worked hard to organize and format our quality 'compare' tools ... in a consumer-friendly manner by conducting both qualitative and quantitative research of the Web site tools with multiple audiences," adding, "More research is probably needed to assess the usability of the site, and should be performed by people who have a basic understanding of the size and complexity of the program" (LaMendola, South Florida Sun-Sentinel, 8/20).

Source:  KFF Daily Health Policy Report, http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54056

Editor's note:  I just tested the plan finder tool to see how it works.  Now, I am one of the most Web-savvy people I know.  I have no idea whether I picked the best plan for me, but what I do know is that even though I chose what I thought was the cheapest plan, I ended up with a montly total premium cost plus drug co-pays that is approximately more than double what I currently pay for the medications I listed.  Hmmmm.  That's not good, is it?

GAO Report recommends stronger oversight of PBGC

Summary of the report: 

The Pension Benefit Guaranty Corporation (PBGC) insures the retirement future of over 44 million people. As a federal guarantor of private defined benefit plans, PBGC finances its operations through insurance premiums, investment income, and funds from terminated pension plans. PBGC is governed by a board of directors comprised of the Secretaries of Commerce, Labor, and Treasury, who are responsible for providing policy direction and oversight but often rely on board representatives. In 2004, PBGC began reviewing its investment policy biennially and recently decided to broaden the range of asset classes in which it invests.

GAO reviewed PBGC’s procedures for developing and implementing its investment policies, and examined PBGC’s most recent investment policy. To address these issues, GAO reviewed and analyzed PBGC policies and data, assessed the analysis informing the recent policy change, and interviewed agency officials and other experts.

What GAO Recommends

GAO recommends (1) improvements to the way that PBGC’s board monitors progress in achieving investment policy goals, and (2) additional analyses on the new investment policy. In response, PBGC’s board stated its informal guidance is appropriate oversight. GAO states this type of guidance is not strong enough for investing $68 billion. Further, PBGC is conducting additional analysis on the new policy.

Get the report.

SSA continues to over-withold Part D premiums

  Some Medicare beneficiaries still are having incorrect amounts withheld from their Social Security checks for Medicare Advantage and Medicare prescription drug benefit premiums, but the programs have made significant improvements since 2006 in matching their databases to deduct the correct amounts, according to a recent GAO report, CQ HealthBeat reports. MA and the drug benefit -- known as Medicare Parts C and D, respectively -- were created by the 2003 Medicare law and broadened private insurers' role in the Medicare program.

The report states that the introduction of MA and the drug benefit added about 800 different contracts with more than 6,000 plans and multiple payment options. This confusion led to some beneficiaries having too much money taken out of their Social Security checks, while others having too little taken out. According to the report, monthly premiums for Medicare Part B "is a standard amount for most [beneficiaries] and is based on a standard calculation for others," while "the monthly premium amounts for Parts C and D vary widely by plan." GAO found that Medicare and Social Security have improved their collaboration on deductions since 2006, but SSA still rejects about 5% of Medicare's premium deduction requests. The Social Security Administration in 2006 rejected 44.5% of Medicare's requests for premium deductions, according to the report.

Senate Finance Committee Chair Max Baucus (D-Mont.) on Wednesday said, "Paying Medicare premiums directly from Social Security benefits should be an easy way to make sure seniors don't have to deal with a bill in the mail and to save taxpayer dollars on administrative costs. But the way it's set up now, the withholding process is a mess that discourages Medicare recipients from signing up for it" (Reichard, CQ HealthBeat, 8/13).

Source:  KFF, http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53964
Full report: http://www.gao.gov/docsearch/abstract.php?rptno=GAO-08-816R

States don't notify CMS of Medicaid provider sanctions as require by law and regs

States regularly fail to notify the HHS Office of Inspector General when they have expelled health care providers from their Medicaid programs for incompetence, fraud and other reasons that would prohibit them from receiving federal reimbursements, according to federal investigators.  The lack of notice keeps the providers off OIG's reimbursement exclusion list, making it easier for barred providers to work in other areas of the country and continue to receive federal funds, according to the report.

Federal investigators surveyed states to determine how often Medicaid programs sanction a provider in a way that would place them in OIG's exclusion database. Reasons for exclusion include fraud convictions, patient abuse, licensing board sanctions and default on federal education health loans. No federal payments can be made for any services that an excluded provider performs, orders or prescribes, according to federal law. Forty-seven states responded to the survey.

OIG found that 61% of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005 were not on the federal list. States that had taken action against more than 100 providers tended to have high federal match rates with the list. Alabama, Louisiana and Texas had the highest match rates, with more than 80% of the providers suspended from their state Medicaid programs listed on the national database. New York and Florida, the two states that sanctioned the largest number of providers, had the lowest matching rates of 21% and 9%, respectively. About a dozen states, including California and Michigan, submitted incomplete data or reported not sanctioning any health care providers in 2004 and 2005.

Many state officials expressed uncertainty about the kind of information that was supposed to be forwarded to OIG. CMS spokesperson Jeff Nelligan said the agency will "strive to reduce the barriers that may currently exist" in order to increase the number of referrals from the states. 

Kuchinich bill would replace Part D with new program

Rep. Dennis Kucinich (D-Ohio) recently introduced a bill (HR 6800) that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries. In addition, the bill would limit the price of prescription drugs developed through publically funded research and allow the purchase of medications from an approved list of foreign nations.

More here from KFF.

GA) report addresses Indian Health Service/CMS relationship

Indian Health Service (IHS) may retain reimbursement from Medicare and Medicaid without an offsetting reduction in funding. Ensuring that IHS-funded facilities enroll individuals in—and obtain reimbursement from—Medicare and Medicaid can provide an important means of expanding the funding for health care services for the population served by IHS. The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers Medicare and oversees states’ Medicaid programs, is required by Executive Order and HHS policy to consult with Indian tribes on policies that have tribal implications. This requirement is in recognition of the unique government-to-government relationship between the 562 federally recognized Indian tribes and the federal government.

GAO was asked to (1) describe interactions between CMS and IHS, (2) examine mechanisms CMS uses to interact and consult with Indian tribes, (3) examine mechanisms that selected states’ Medicaid programs use to interact and consult with Indian tribes, and (4) identify barriers to Medicare and Medicaid enrollment and efforts to help eligible American Indians and Alaska Natives apply for and enroll in these programs. GAO reviewed documents, interviewed federal and state officials, and visited a judgmental sample of Indian tribes and IHS-funded facilities in six states.

Read the report.

Cool new teaching resource: 1000 Voices Video Archive

The 1000 Voices Archive, www.1000VoicesArchive.org, is a new online teaching resource for law educators.  Recently launched, this is a national collection of video stories created by filmmakers and communities across the country that helps to put a human face on the policy issues that your audience may find useful in their classrooms and clinical practice.  Each video story is accompanied by a set of "social dialogue" and advocacy tools, which help demonstrate to students how personal testimonial stories can be presented and leveraged for policy impact.

By 2009, the 1000 Voices Archive will contain the selected stories of 1000 Americans as they evoke the values they cherish most.  Focus issue areas for 2008 include health care, immigration, human rights, and racial justice. Please feel free to share the availability of this resource with your readers, and view some of the videos as well. 

Check out this site at http://1000voicesarchive.org/

My favorite so far:   http://www.1000voicesarchive.org/video/102/Julie-Winokur-and-family-Montclair-NJ

Spotlight on: The Elder Law Clinic at Wake Forest University School of Law

Wake Forest's Elder Law Clinic provides free legal assistance to moderate income seniors, and serves as a resource center for lawyers and other professionals. In a partnership with the School of Medicine, the E-Clinic offers law students a unique opportunity to learn about medical and health law issues of older clients. To learn more, read "Ideals and High Heels" in the N.C. State Bar Journal and check out this video from the N.C. Bar Foundation.

The Clinic's Newsletter is available on line. 

The Clinic is directed by elder law goddess Kate Mewhinney.

Walgreen expands drug plan

Walgreen recently announced that it has expanded its Prescription Drug Savings Plan to include 90-day prescriptions of generic drugs for $12.  The program was launched last year and offers reduced prices on more than 5,000 brand-name and generic drugs. The $12 prescriptions are available for more than 400 generic drugs. People who are not enrolled in drug coverage through Medicare or Medicaid can enroll in the program for $20 per year for an individual or $35 per year for a family.

Source:  KFF/the Chicago Tribune.

Prof. Kaplan (IL) on planning for retirement

Dick Kaplan's article entitled “A Guide to Starting Social Security Benefits,” has just appeared in the Journal of Retirement Planning (July-Aug. 2008) and is available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1192902

Abstract:  When a person should begin taking Social Security retirement benefits is a critical question for planning one’s retirement. This article explains the various factors at play in determining the optimum starting point, including: longevity considerations; spousal implications, whether for a previously employed or a previously unemployed spouse; the impact of post-retirement employment; the availability of health insurance prior to Medicare eligibility for the worker and the worker’s spouse; alternative sources of retirement income, including distributions from retirement savings plan assets and lifetime liquidation of nonretirement assets (and the pertinent income tax ramifications); and anticipated investment strategies.

Dick rules!