July 3, 2007

CARIE Policy Update and Meeting Cancellation

Quote of the Month
“No one could make a greater mistake than he who did nothing because he could do only a little.” – Edmund Burke

Assisted Living in Pennsylvania
After years of little action in regard to assisted living on the part of the Pennsylvania legislature, it appears that an assisted living bill is being positioned to pass quickly. Even though the current primary focus and need of the General Assembly is to pass a budget that is past due as of July 1, assisted living legislation is being identified for possible passage sometime in July.

Four assisted living bills have been introduced thus far. There are three House Bills (HB) including: HB 375, introduced by Representative Watson; HB1213, introduced by Representative McIlvaine Smith; and, HB1583, introduced by Representative Mundy which is the Rendell Administration’s bill.  In the Senate, Senator Vance has introduced Senate Bill (SB) 704.  The Office of Long Term Living has been in negotiations with Senator Vance and Representative Mundy both respective Chairs of the Senate and House Aging Committees. SB 704 is the bill that will be amended for passage. Unfortunately at this time, SB 704 doesn’t include many key provisions that consumer advocates have long fought for.

A benefit to Pennsylvania’s being slow to enact assisted living legislation is that we can learn from the successes and failures of other states. Unfortunately, the fast track the current bill is on seems to be excluding lessons learned in other states. For example, “negotiated risk” is a practice that can be categorized as a failure and as being quite harmful for consumers. Negotiated risk is like the proverbial wolf in sheep’s clothing whereby it sounds as if it enables consumer choice but in actuality has been used by providers to avoid providing quality care, prevent regulatory action, and evade litigation. CARIE and other advocacy groups have advocated that policy prohibit negotiated risk agreements in Pennsylvania. Senate Bill 704 was amended to include “informed consent agreements” that are essentially negotiated risk agreements. CARIE recommends looking at the federal Nursing Home Reform Law as a model alternative to define and utilize the concept of negotiated risk. This federal law requires residents to be given the right to make choices, including the right to refuse medical treatment, provided that this choice does not jeopardize another resident’s health or safety. Facilities are required to “promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.” CARIE strongly recommends that the term and any reference to negotiated risk or informed consent agreements be removed from any legislation.

SB 704 passed the Senate by 46-3 on June 30, 2007 and already passed with amendments from the House Aging and Older Adult Services Committee by 28-0 on July 1, 2007. It has been temporarily removed from the table. If passed by the House, the bill will need to be sent back to the Senate to concur on the amendments. Advocates are encouraged to contact their respective state Representatives and ask that they vote against SB 704 at this time.  

Pennsylvania Budget Update
The Senate is forming a conference committee to negotiate Pennsylvania’s $27 billion 2007-08 budget with House conference committee members and Governor Rendell. For a look at the differences between the House and Senate versions of the budget, read this fact sheet prepared by the Pennsylvania Budget and Policy Center.  If the new budget is not signed by July 9, over 24,000 “non-essential” state employees will be furloughed until a budget is passed. Rendell is insisting that the legislature act on his policy priority proposals for transportation funding, energy programs and health care before he will sign a budget. This strategy is angering elected Republican policy makers who have stated they would not consider Rendell’s proposals until after a budget is passed, although it seems there is agreement on transportation funding among lawmakers of both parties in the House and Senate now. Since Pennsylvania ended its 2006-07 fiscal year with about $650 million over projections, it helps to narrow a projected $800 million budget gap for 2007-08.  

Update on Older Americans Act (OAA) Funding 
Thank you to those of you who supported the advocacy request from the National Council on Aging’s (NCOA) Support Our Seniors (SOS) campaign to push for increased Older Americans Act (OAA) funding. The following is a status report from NCOA:
In the Senate: The Appropriations Committee completed its Labor-HHS-Education bill, boosting spending for the Administration on Aging (AoA) for OAA programs by 4.2 percent or $58.6 million. The bill now heads to the full Senate, where a floor vote could occur in July, with no change expected in the OAA figures.

The Senate bill includes an increase of $38.5 million in OAA nutrition programs (5.2 percent), increases for Titles VI and VII, and $28 million for the “Choices for Independence” initiative. However, the Senate bill provides no increase for the important Supportive Services and Senior Centers line (Title IIIB), nor does it increase funding for the Senior Community Services Employment Program (SCSEP or Title V), despite the fact that next year’s mandatory federal minimum wage increase will require higher wages for program enrollees.

In the House: An appropriations subcommittee completed its version of the same bill, which is expected to go to both the full committee and House floor in July, with no change expected in the OAA numbers. The total increase for AoA spending is 2.3 percent or $31.4 million.

In many ways the House bill is not as good as the Senate bill on OAA. The House bill increases nutrition programs by only $23.5 million (3.2 percent), increases Title VI by less than the Senate, and provides only $16.5 million for “Choices.” However, it is preferable in two places: it increases Supportive Services and Senior Centers by $7 million (2 percent) and provides $47.3 million for SCSEP enrollees’ minimum wage increase.

After both chambers complete their bills, a conference committee will meet to resolve the differences—probably in September. NCOA will press for the higher number for every OAA program and title. The Support Our Seniors campaign will go on a temporary hiatus until there is another opportunity to press for the higher number for every OAA program and title. All campaign information will remain on NCOA’s website.”   

Dual Eligibles Experience Delays in Getting Part D Benefits
At a June 21 House Ways & Means Health Subcommittee hearing “Hearing on Beneficiary Protections in Medicare Part D” ongoing Medicare Part D beneficiary issues and possible legislative changes were discussed. Vicki Gottlich from the Center for Medicare Advocacy presented testimony and made recommendations about how to streamline the Medicare Part D appeals process. According to testimony by Kathleen King from the Government Accountability Office (GAO), it takes CMS up to five weeks to enroll a new dually eligible beneficiary. During this time, beneficiaries often have difficulty getting their medications because pharmacies do not have the information needed to bill a prescription drug plan (PDP). Neither CMS nor PDPs notified beneficiaries in the past about their ability to be reimbursed for out-of-pocket drug costs that were covered but the pharmacy was not able to bill a PDP. CMS now has letters that CMS and PDPs use to alert these beneficiaries about their PDP enrollment and their ability to make a claim with the PDP for any prescription drugs they paid for out-of-pocket. Please contact the CARIE LINE at 215-545-5728, if you are experiencing any problems or have questions about Medicare Part D.

SEPTA Shared Ride Rate Change
Effective July 9, 2007 the one-way fare for the Shared Ride program will be $4.00 and must be paid in cash.  For question or problems related to SEPTA's shared ride program, please contact CARIE's transportation advocate, Allison Givhan at 215-545-5728. 

Just the Links.....
The following are links to potential resources or documents of interest:

• The Administration on Aging has a new online gateway to the Older Americans Act (OAA) amendments with detailed information about the new provisions of the OAA.
• Two recent Office of Inspector General reports were issued. “Quality Concerns Identified Through Quality Improvement Organizations Medical Records Review” found that Quality Improvement Organizations (QIOs) are too lenient on nursing facilities.  The second report, “Consecutive Medicare Stays Involving Inpatient and Skilled Nursing Facilities,” made CMS acknowledge that it needs to improve its monitoring to help improve quality care.
• The GAO issued a new report encouraging QIOs to target low-performing nursing facilities, “Federal Actions Needed to Improve Targeting and Evaluation of Assistance by Quality Improvement Organizations.”
• The MedPAC issued a study about the impact of Medicare Part D on Nursing Homes, “Medicare Part D, Nursing Homes, and Long-Term Care Pharmacies” and its June 2007 "Report to the Congress: Promoting Greater Efficiency in Medicare.”
• The Congressional Research Service issued a report, “Social Security Administration Budget Issues.”
• The Georgetown University Long-Term Care Financing Project released nine documents to explore innovative ways to finance long term care and an issue brief, “Community-based long-term services financed by Medicaid: Managing resources to provide appropriate Medicaid services.”
• The National Center for Policy Analysis issued a study, “Medicare: Past, Present and Future.”    
• The Center for Medicare Advocacy released an alert, “The New Medicare Hospital Notice: Insight and Guidance for Beneficiaries.”
• The Pennsylvania Department of Aging has updated its website to include “Care Plan Worksheet – Train the Trainer Materials.” 

CARIE News
CARIE is pleased to announce that Tiffany Lombardi has returned to CARIE and is now the new CARIE LINE Coordinator.

CARIE is getting a new computer server which means staff will not be able to receive or respond to email messages for a few days later this month. The CARIE OnLINE service will also be affected temporarily as well. The dates of our server conversion are tentatively scheduled for July 25 to July 31, 2007. Any messages sent during this time are expected to be delivered once the new server is fully operational. If you need a more timely response to your inquiry during this time, please contact us by phone at 215-545-5728.

Just for Fun 
For those of you who enjoyed listening to The Zimmers singing “My Generation,” a group of older adults aged 73 to 92 called the Young@Heart Chorus is entertaining young and old alike with their renditions of famous rock songs. This Massachusetts-based group has performed not only in the US but also around the world in locations such as Australia and Norway. To learn more about the Young@Heart Chorus, visit their website or listen to their rendition of Sonic Youth’s “Schizophrenia” and other covers on YouTube.  Enjoy!

July and August Meeting Cancellation
Just a reminder that the Legislative Committee meetings for July and August have been cancelled! We expect to resume our normal meeting schedule in September. As always, don't hesitate to contact me if you have any questions.  Have a happy and safe July 4th holiday!
Kathy