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February 26, 2008

CARIE Policy Update and Meeting Cancellation

Quote of the Month
“Even if you are on the right track, you’ll get run over if you just sit there.” – Will Rogers

Federal Budget Update
President Bush’s proposed $3.1 trillion budget for fiscal year (FY) 2009 that begins October 1 would significantly cut Medicare and Medicaid budgets as well as discretionary spending for government health programs. This is the first budget in U.S. history to exceed $3 trillion. Bush proposes cutting Medicare spending by $12.1 billion in FY 2009 and by $182.7 billion over five years. Federal Medicaid expenditures would be cut by $1.8 billion in FY 2009 and by more than $17 billion over five years. Much of the Medicare cuts would come from reductions in payments to hospitals, nursing homes, home health agencies, physicians, and other providers. For example, nursing homes would receive the same Medicare payment in FY 2009 as they do now and home health agencies would be reimbursed at their current rate through 2013. Hospitals would receive their current rate through 2011. Discretionary spending for government health programs would be cut by over $2 billion. The only two increases in the Health and Human Services budget are for the Food and Drug Administration and for programs designed to counteract bioterrorism and plagues. The president would cut funding for the Low Income Home Energy Program (LIHEAP) and mental health services. However, Bush’s proposed budget has not been well received by Congress so it isn’t likely they will use his budget as the basis for debate.

Click here to review federal FY 2009 budget related information for Health and Human Services, including Medicare and Medicaid.  

Medicare News and Resources
The Medicare Modernization Act of 2003 requires the Medicare Trustees to estimate whether general revenues will exceed 45% or more of total Medicare spending in a particular year. If, in two consecutive years, the trustees project the 45% point will be reached within the next seven years, they are required to issue a Medicare funding warning. They issued such a warning last April. As a result of the warning, the law requires the President to propose changes to decrease general revenues below 45% of total Medicare spending and Congress to consider the President’s proposal in an expedited way. The Administration released its proposal last week.

The Center on Budget and Policy Priorities issued a policy brief, "The President's Budget and the Medicare Trigger."  The Center for Medicare Advocacy released an alert, “The Medicare 45% Trigger: What It Is and Why It Matters.”  The Congressional Research Service released two related reports, “Medicare: FY 2009 Budget Issues” and “Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007.”

The 2008 model Explanation of Benefits (EOB) that Medicare Part D sponsors should use to explain benefit and formulary change information to enrollees was updated by the Centers for Medicare and Medicaid Services (CMS).  The new EOB includes more information about the prescription drug claims processed, a record of total out-of-pocket costs and total drug payments transferred from previous plans, and contact information for numerous questions. CMS issued a memo clarifying that enrollees should receive their revised EOB in August 2008.  CMS also wants sponsors to send a cover letter explaining the EOB changes to enrollees.

The GAO issued a report, “Medicare Part D: Plan Sponsors' Processing and CMS Monitoring of Drug Coverage Requests Could Be Improved.” 

Finally, the Medicare Payment Advisory Commission (MedPAC) posted testimony, “Private Fee-for-Service Plans in Medicare Advantage.” 

Nursing Home Update 
NCCNHR has posted an updated list of nursing home staffing standards for every state. “Nursing Home Staffing Standards in State Statutes and Regulations” provides information such as the minimum required state staffing standards for nursing facilities and the estimated variance from the federal standard for a facility with 100 beds. 

For the first time, the Centers for Medicare and Medicaid Services (CMS) released lists of nursing facilities and hospitals from across the nation that have fallen below quality benchmarks set for high-risk pressure ulcers, the use of physical restraints, and surgical infections. Responding to concerns from the Institute of Medicine, the Government Accountability Office, and Congress, CMS released this information as part of its 9th Statement of Work for Medicare’s 53 Quality Improvement Organizations (QIOs). QIOs will be required to provide better oversight of the facilities and hospitals listed. There are 112 nursing facilities listed for Pennsylvania. Click here to view a CMS fact sheet and here to view the lists of nursing facilities. (Please be aware this is a huge file that takes a while to download.) 

As discussed in last month’s CARIE Connection, CMS compiled a list of Special Focus Facilities (SFF), nursing homes that continually have problems with regulatory compliance. However, as of November, CMS only released the names of 54 of these facilities to the public.  CMS has finally released the complete list of deficient nursing homes that failed to meet safety and quality standards for care.

The Center for Medicare Advocacy posted an alert “The New CMS Tool for Assessing Nursing Facility Penalties Assures They Will Remain Low,” and last month the Department of Health and Human Services released a report, "Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." 

Be sure to see CARIE News below to learn more about new postings on CARIE’s website including an ethics concept paper, “Relationship, Responsibility and Commitment: Cornerstones for an Ethics of Long Term Care” as well as an updated order form that includes training resources for the “Universal Core Curriculum for Direct Care Workers in Long Term Care” and “Ethical Decision-Making in the Changing Culture of Long Term Care.”

New 2008 Public Benefit Figures
The federal poverty levels have been updated for 2008 and so eligibility limits have increased for many public benefits. AARP Foundation’s National Legal Training Project released its January 2008 version of “Annual Update of Public Benefit Figures” that includes charts of figures for "Social Security Retirement and Survivor's Benefits; Supplemental Security Income (SSI); Social Security Disability; Medicare; Medicaid; Food Stamps; Railroad Retirement; Medicare Savings Programs: QMB, SLMB, QI and QDWI, and Veterans Connected Pensions."  The Center for Medicare Advocacy posted “New 2008 Poverty Levels Will Affect Eligibility for Many Federal Health Programs.” 

Pennsylvania Budget Update
Governor Rendell released his proposed $61.3 billion budget for FY 2008-09 that begins July 1, 2008 and includes $28.3 billion for General Fund spending.  Medical Assistance would receive 20% of the General Fund Budget and other Department of Public Welfare programs would receive 17%. The total of federal and state funding for Medical Assistance would be $5.68 billion, an increase of about $455 million. Click here to view a copy of Secretary Richman’s budget briefing PowerPoint presentation.  In terms of positive news in the budget proposal for older Pennsylvanians, there is proposed funding for an additional 2,100 new slots in the Aging Waiver, nursing home transition services, and expanding adult day services and Dom Care statewide. There is funding proposed to begin to license and inspect assisted living facilities. The bad news is that there are no additional funds proposed for Options services or the Family Caregiver Support Program.  There is no cost of living increases for Area Agencies on Aging (AAAs), or other service providers such as home care or nursing facilities.  There is no funding proposed for senior centers’ capital improvement projects. The Department of Aging is basically flat funded, although there is a proposal that would allow 3 additional staff to be hired for protective services. Funding for the general operations for the Department of Aging moved this current fiscal year from the General Fund to the Lottery Fund and FY 2008-09 continues general operational funding for the Department through lottery funds. Governor Rendell proposed once again to transfer about $248 million of Lottery Funds to the Medical Assistance long term care budget, most of which will be used to make up for the loss of Intergovernmental Transfer funds. The House Democratic Committee on Appropriations released a budget overview and a Tobacco Settlement Fund overview.  The website is also providing daily summaries of the House budget hearings held.

Of major concern is the sudden projected loss in the fiscal year end balance of the Lottery Fund. The fiscal year end balance amounted to $476.5 million on June 30, 2007 and it is projected to decrease to $301 million by the end of June 2008 and to $34.7 million by the end of June 2009.  The Governor is proposing to spend $366 million more from the Lottery Fund than what is expected in revenues.  Both the Senate and House Appropriations Committees' budget hearings have begun. During the Department of Aging’s House budget hearing, Secretary Dowd Eisenhower responded to inquiries about the Lottery Fund by emphasizing that lottery revenues are stable and older Pennsylvanians do not need to be worried about getting lottery funded services in the future. She was not able to explain why such significant decreases in year end balances were projected nor could she state where the surplus dollars were being spent. She deferred these questions to Secretary Wolf from the Department of Revenue. Tom Snedden responded to questions about the anticipated savings to the PACE program in FY 2007-08 from Medicare Part D. In sum, he replied that it is really “offsetting costs” as opposed to “savings” but the total amount is about $6 million a week. The average fluctuates when more beneficiaries are in their deductible or donut hole coverage periods of their Part D benefit. In calendar year 2007 about 55% of the PACE benefit costs were transferred to Part D plans. PACE never paid these costs since the switch occurs at the point of sale and the Part D plans pay first. He added that he doesn’t expect Medicare Part D to provide as much savings in the future since the PACE program will have to compensate for federal changes to Medicare Part D. Mike Hall responded to questions as to why about $76 million that was appropriated for the Aging Waiver program wasn’t spent. He replied by explaining that there was an “over correction” in policies and procedures implemented to better manage the program. There is proposed funding for an additional 2,100 Aging Waiver slots in FY2008-09 budget to "get back on target" with the program.

Secretary Wolf from the Department of Revenue responded to questions about the Lottery Fund and the projected loss of the surplus at a separate House budget hearing. In sum, he stated that the surplus was originally planned to be eliminated in FY 2004-05 budget but was put back in. The plan is once again to eventually eliminate the surplus. Secretary Wolf tried to assure the legislators that there is no longer a need for high reserves since the lottery has been stable for so long. He continued by explaining the plan to ensure the profitability of the lottery. The plan includes continuing to expand the retail base; try to change the matrix of the Powerball game to ensure jackpots grow (there is a huge increase in sales once the jackpot rises above $200 million); ensure new technology/machines are in place by calendar year 2009; and, provide new instant games. He was not able to answer questions as to how funds from the lottery are being spent since the Department of Revenue is only responsible for revenues or what is coming into the budget.  He deferred questions regarding spending to Secretary Masch.  Secretary Wolf also argued that although he only has preliminary data regarding the impact of casinos on lottery sales, he doesn’t believe that slots have, or will, hurt the lottery. He describes slots as a “venue product” and lottery tickets as an “impulse item.”  He attributed the slight decrease in lottery sales to the current economy and the lack of a big Powerball jackpot.  The budget hearings continue and can be viewed on cable television on PCN or their website.  (Click on "Streaming.") 

About 52,000 state retirees received notice that their health care benefit is changing.  Approximately 39,000 state retirees currently receive traditional Medicare benefits but are now being forced to choose a Medicare Advantage plan that are operated by private insurers.  They must choose by March 21 or they will be automatically transferred to Advantra Freedom, a private fee-for-service plan. Click here to read another article about this change for state retirees.

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

CARIE News
There is new information posted on CARIE’s website!  Michele Mathes, JD, CARIE's Director of Education and Research, has written an ethics of long term care concept paper, "Relationship, Responsibility and Commitment: Cornerstones for an Ethics of Long Term Care," that describes a framework about how to make ethical decisions in long term care settings. The ethics concept paper also provides background information about CARIE's newest training offering, "Competence with Compassion™: Ethical Decision-Making in the Changing Culture of Long Term Care."  An updated order form has been posted for this training curriculum that also includes training resources for the “Universal Core Curriculum for Direct Care Workers in Long Term Care.” 

In Pennsylvania, the Aging Waiver and the Attendant Care Waiver are scheduled to expire on June 30. The Office of Long Term Living held a series of listening sessions to obtain stakeholder input for the renewal document for each Waiver. Click here to read CARIE’s testimony.

CARIE will be relocating to the 15th Floor of the Land Title Building at 100 S. Broad Street in Philadelphia effective March 3. When visiting CARIE at our new location, it will be best to enter the building entrance off of Chestnut Street next to the FYE store. These elevators will take you right outside our entrance. If you enter off of Broad Street, you will need to walk along a hallway to get to our entrance. CARIE’s mailing address will be: 100 S. Broad Street, 1500 Land Title Building, Philadelphia, PA 19110-1088. Our phone and fax numbers will remain the same. However, CARIE will be utilizing a new phone system that will require a short transition on Friday, February 29 in the late afternoon when our telephone service will be switched to the new office. You won’t reach a live person during this time but you may leave a Voicemail message and someone will return your call on Monday, March 3 when our telephone service will be back to normal.

CARIE is seeking donations to our auction fundraiser and cocktail party scheduled for Wednesday April 16, 2008 and hosted by the Independence Foundation in their offices. Last year’s auction donors included leaders of business, cultural, and sports venues like the Pennsylvania Ballet and the Daily Show with Jon Stewart. If you have any items to donate or are aware of civic-minded businesses that may want to make a donation, please contact Cathy Schiman. CARIE will also publish ads in its program book for the event. You may also contact Cathy Schiman for information about rates and specifications for copy. Click here to send your name and address to receive an invitation to the event.  

Just for Fun 
This month’s “Just for Fun” features two websites helping visitors enjoy the English lexicon. Test your vocabulary and help end world hunger. For every word you get right, FreeRice  will donate ten grains of rice through the United Nations food program.

Word Spy “is devoted to lexpionage, the sleuthing of new words and phrases. These aren't "stunt words" or "sniglets," but new terms that have appeared multiple times in newspapers, magazines, books, Web sites, and other recorded sources."  

March Meeting Cancellation
The March Dorothy S. Washburn Legislative Committee meeting is CANCELLED! We will meet again on April 3 at CARIE’s new location.

February's edition of CARIE Connection is longer than usual since it was delayed and so much is happening.  Hopefully you found some useful information.  As always, don't hesitate to contact me if you have any questions.

Thanks,   
Kathy 
 

Kathy Cubit
Director of Advocacy
Initiatives
cubit@carie.org
Call CARIE
100 North 17th St, Suite 600 Philadelphia, PA 19103 T: 215.545.5728 F: 215.545.5372
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