August 5, 2008

CARIE Policy Update and Meeting Announcement

Quote of the Month
"Better to light one small candle than to curse the darkness." - Chinese Proverb 

Medicare Updates
On July 15, Congress overrode President Bush’s veto to pass HR 6331, the Medicare Improvements for Patients and Providers Act of 2008. Most of the press on this legislation related to a scheduled 10.6% cut in Medicare payments to physicians but it includes many additional provisions that benefit Medicare beneficiaries, especially those with low incomes.
Key provisions within the Act include:
• Improvements for low-income beneficiaries such as increasing the asset limits for Medicare Savings Programs (MSP) effective 2010 to the same standard resource limit for the Part D Low Income Subsidy (LIS) full subsidy levels ($6,290 per individual and $9,440 per couple in 2008) and indexes the MSP asset limits to inflation for the first time since the program’s inception. The law now excludes life insurance as an asset and in-kind support as a countable resource for LIS. The law also increases funding and reauthorizes the Qualified Individual (QI) program until December 31, 2009. Effective January 2009, the late enrollment penalty will be eliminated for LIS recipients. The Part D LIS application will also be simplified and Social Security is directed to provide LIS applicants with information about MSP. The model MSP application will be translated into at least 10 languages most frequently used by beneficiaries.  Estate recovery is eliminated for MSP benefits. 
• Extends the exceptions process to the $1,810 annual Medicare therapy cap effective July 1, 2008 until December 31, 2009.
• Adds preventive benefits to Medicare, and waives the deductable as well as extends the coverage from 6 months to one year for the “Welcome to Medicare Visit.”
• Reduces cost-sharing for mental health services over a 6 year period from the current 50% co-payment rate until the 20% co-payment rate is reached as for other outpatient medical care.
• Stops a scheduled cut in physician payments and includes a 1.1% increase in payments for physicians in 2009.
• Delays the competitive bidding program on Durable Medical Equipment (DME) for 18 months. Medicare beneficiaries in the 10 competitive bidding areas may use any Medicare approved supplier for DME even if they made a change when the program began on July 1.
• Permits Part D plans to cover benzodiazepines and barbiturates (for certain conditions) effective in 2012.
• Outlines new prohibitions and limitations on marketing activities under Medicare Advantage and prescription drug plans.

A summary of key provisions has been posted by the National Committee to Preserve Social Security and Medicare and the Center for Medicare Advocacy.  The Congressional Budget Office also completed a “Cost Estimate” of the Act." 

On June 19, the National Senior Citizen Law Center and the Center for Medicare Advocacy announced a settlement agreement with CMS in the class action lawsuit, Situ v. Leavitt, which will accelerate Medicare Part D auto-enrollment for dually eligible Medicare beneficiaries. CMS has agreed to process files it receives from states identifying new dual eligibles and deeming them eligible for LIS within one business day of receipt. States may also submit the files more frequently. The burden of proof is now on CMS to substantiate eligibility with the state, if the beneficiary does not provide documentation. The federal court will oversee the case for three years to monitor CMS’s implementation of the agreement. The Center for Medicare Advocacy has posted a summary of the settlement on their website. 

VA Now Offers Online Applications
The Department of Veterans Affairs (VA) now offers online applications for veterans, survivors and other claimants filing initial applications for disability compensation, pension, education, vocational rehabilitation and employment benefits. The VONAPP, Veterans ON Line APPlications, website will store an individual’s completed forms online for a year and incomplete forms for 30 days to allow claimants easy access to complete an application. While applicants no longer need to provide their signature, normal “rules of evidence” still apply. Veterans usually must meet requirements related to discharge and length of active duty. For more information about VA benefits, visit the VA’s website or review a recent Congressional Research Service report, "Veteran’s Benefits, An Overview."     

Elder Economic Index
Wider Opportunities for Women (WOW) and the Gerontology Institute at the University of Massachusetts Boston created the Elder Economic Security Initiative (EESI) program, a measure of income adequacy that attempts to reflect the amount of income older adults need to meet basic expenses. Currently, the Elder Economic Security Standard Index is available for California, Illinois, Massachusetts, Pennsylvania and Wisconsin on WOW’s website. 

In Pennsylvania, Pathways PA partnered with CARIE, the United Way of Southeastern PA and others to develop the EESI Index for PA. PA’s Index demonstrates that while one out of four older Pennsylvanians rely solely on Social Security, the average Social Security payment in Pennsylvania is not enough to support their basic needs. Housing costs consume between 19 to 45% of older adults monthly expenses. If an older Pennsylvanian needs home and community-based long term care, the cost can double and even triple their monthly expenses. The Index provides typical monthly expenses for an older adult as well as a couple specific to every county in Pennsylvania and includes a separate chart for home and community-based long term care costs by county.
Here are PA EESI related documents: 
Elder Economic Security Standard Index for Pennsylvania (full report)
Elders Living on the Edge: When Incomes Fall Short in Retirement (policy brief) 
PA EESI and the Family Caregiver Support Program (fact sheet) 
PA EESI for Advocates (fact sheet)  

PA Assisted Living Consumer Alliance
The PA Health Law Project has organized the PA Assisted Living Consumer Alliance (PALCA) comprised of consumers, caregivers, and advocates who want to ensure that the rights and needs of consumers are addressed in the assisted living regulations being developed in response to Act 56 of 2007. Click here for a press release.  CARIE is pleased to be a member of the PALCA and fully supports its goals. Act 56 created a new assisted living license that will be distinguished from personal care homes in that residents with higher level of health care needs will be able to “age in place” or be served in assisted living rather than being transferred to a nursing facility. PALCA has recently launched a website that includes links to news articles and will post information regarding the proposed assisted living regulations. 

The Department of Public Welfare (DPW) has submitted the proposed assisted living regulations to the Independent Regulatory Review Commission. Click here to review.  The official proposed regulations are expected to be published in the Pennsylvania Bulletin on August 9, 2008 which will mark the beginning of the 30 day public comment period that will end on September 8, 2008.

DPW’s regulatory analysis form states: “Currently, there is no regulation of assisted living residences in Pennsylvania. However, assisted living residences are a significant long-term care alternative which combines housing and supportive services. They are designed to allow people to age in place, maintain their independence and exercise decision making and personal choice. This regulation establishes the minimum standards for licensure of assisted living residences to allow individuals to age in place. The regulation protects consumers' health and safety, privacy and autonomy while at the same time balancing providers' concerns related to liability and individual choice.” DPW also estimates that 100 assisted living residences will be licensed in FY 2009-2010; 150 assisted living residences in FY 2010-2011; 200 assisted living residences in FY 2011-2012; and 250 assisted living residences in FY 2012-2013.

A preliminary review of the proposed regulations raises concerns that the needs and rights of residents may not be fully addressed. The PALCA is collecting personal stories, both positive and negative experiences with assisted living facilities as well as personal care homes in Pennsylvania. The stories can either reflect a personal experience or a professional observation. If you don’t have a story to tell, you can help by forwarding this link to those who may be able to help. The stories can be very brief or extensive; all will help in developing a response to the proposed regulations.

DPW has also begun to post personal care home inspection results online and later this year, plans to post its progress in inspecting the state’s 1,500 personal care homes. (Simply enter the name of the facility, the county, or zip code to find information about a particular facility.)  The Legislative Budget and Finance Committee has posted a report, “State Efforts to Fund Assisted Living Services.”   

Pennsylvania Budget Overview
Governor Rendell signed the FY 2008-09 $28.2 billion budget bill into law on July 4, 2008. The budget is $1.1 billion or 4% more than last fiscal year. Education received a boost and the Department of Public Welfare (DPW) spending increased by about $695 million while most budgets decreased by an average of 1.3%. Unfortunately, older Pennsylvanians in need of home and community based care did not fare well in this year’s budget.

Some positive aspects of the budget for older Pennsylvanians includes funding for an additional 2,100 Aging Waiver slots and an additional 24,000 older adults are expected to be served by the PACE program. The $247.6 million PENNCARE budget increased by $4.7 million to help fund individuals who are aging out of DPW’s attendant care program for people with disabilities transition to the PENNCARE funded attendant care program for people 60 and older. (The remainder of the $4.7 million increase is to fund the Office of Long Term Living’s (OLTL) initiatives previously supported by federal dollars.)

The Senior Supports Coalition, which CARIE is a member, fought for an increase to support home and community based services in the FY 2008-09 budget with no success. Older adults were hit hard in this budget as there was no Cost of Living Adjustment (COLA) for PENNCARE or the PDA Medicaid Waiver program, apparently the only Waiver program not receiving a 1% COLA. The Lottery Fund was also raided for $50 million out of a $66 million of an unanticipated surplus in the fund to help balance the General Fund budget (for long term care spending, mostly for nursing facility care) for this FY. The remaining $16 million went back into lottery reserves. The Administration and legislature did not recognize the overwhelming needs of the thousands of older adults currently on Options waiting lists throughout PA or the home and community based providers that have to manage without additional funds as the needs and cost of doing business rise. Advocates are extremely disappointed that not one dollar of the unexpected surplus was used to address the growing needs and costs of home and community based programs supported by lottery dollars.

The Senior Supports Coalition is already organizing for another advocacy effort for next fiscal year.  Future editions of CARIE Connection will provide information about how you may support future advocacy efforts.

On a related matter, the OLTL is now overseeing a number of programs previously managed by the Department of Aging such as: the Level of Care Assessment process, Options, the Family Caregiver Support Program, care management, adult day services, senior centers, nutrition and transportation.

For more information about the budget, the Senate Democratic Appropriations Committee has completed an analysis, the House Appropriations Committee has drafted two budget briefings – 2008/09 DPW Budget: Medical Assistance and 2008/09 Budget: Tobacco Settlement Fund – and numerous items are available on the Governor’s website.

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

• AARP’s Public Policy Institute issued a new report, “A Balancing Act: State Long-Term Care Reform,” that examines state government efforts to balance long term care options under Medicaid. Unfortunately, most states continue to spend the majority of their Medicaid LTC dollars for older people on institutional care.
• The National Association of Area Agencies on Aging’s (n4a) Senior Housing Locator, “SNAP for Seniors,” is now posted. It is a navigational tool that allows individuals to search a database of more than 60,000 senior housing listings, including all licensed senior housing in the nation such as nursing facilities, assisted living, residential care, and continuing care.  
• The n4a also released a survey, “Seniors Stranded: Escalating Costs Leave Aging Services Programs Struggling.”  
• The Alzheimer’s Association has published a statistical abstract about Alzheimer’s disease in the U.S., “2008 Alzheimer’s Disease Facts and Figures.”    
• The National Health Policy Forum published two new background papers: “The Fundamentals of Medicare Demonstrations” and “Shaping Medicaid and SCHIP through Waivers: The Fundamentals” that explore the history and policy context of Medicare demonstrations and Medicaid waivers.   
• The Department of Health and Human Services (HHS) has posted “Residential Care and Assisted Living Compendium: 2007” describing regulatory provisions and Medicaid policy for residential care settings in every state, including PA.    
• MedPAC recently posted, “A Data Book: Healthcare Spending and the Medicare Program.”    
• GAO issued the following reports: 'Medicare Part D: Complaint Rates Are Declining, but Operational and Oversight Challenges Remain" (GAO-08-719) and "Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices" (GAO-08-712).  
• CDC issued a report, “Disability and Health in the United States, 2001-2005,” that examines health-related differences between disabled and nondisabled noninstitutionalized adults aged 18 years and over using data from the National Health Interview Survey.     
• An Ernst & Young study, “Retirement Vulnerability of New Retirees: The Likelihood of Outliving their Assets,” finds most middle class retirees will outlive their retirement savings. Americans for Secure Retirement provides state specific data from the study.      
• On July 23, The Senate Special Committee on Aging held a hearing, “Person-Centered Care: Reforming Services and Bringing Older Citizens Back to the Heart of Society.”    
• The Corporation for National and Community Service released a report, “Volunteering in America: 2008 State and City Trends and Rankings.”  
• The New Old Age Blog has already created a major response from its readers. Jane Gross blogs about aging, retirement, and caregiving for The New York Times.   
• The Pennsylvania Legislative Budget and Finance Committee issued a report, "Feasibility of Requiring Shared-Ride Services During Evenings and Weekends and for Intercounty Travel."    
• The Office of Long Term Living has posted Pennsylvania’s Aging Waiver and Attendant Care Waiver renewal applications.     
• Save the date for Thomas Jefferson University’s September 17th event, “A New Age in Dementia Care: Turning Evidence into Practice.”  The program highlights evidence-based approaches that support culturally diverse persons with dementia and their families in the home and community. Participants will also have the opportunity to experience Jefferson's new virtual training center, “Living Laboratory for Elder Care.” For more information and to register (fee), visit: Jefferson’s Center for Applied Research on Aging and Health’s website.          

CARIE News
On May 15, 2008, the Philadelphia Corporation for Aging (PCA) held a pubic hearing entitled, "Meeting the Needs of Philadelphia's Elderly" related to its budget and draft area plan for 2008-2012. CARIE posted our testimony provided at the hearing.  CARIE also participated in a public hearing in Philadelphia on June 6th sponsored by the Pennsylvania Department of Aging about the draft state plan. CARIE’s testimony is now posted. 

The Office of Long Term Living (OLTL) sought feedback on its draft Nursing Facility Clinically Eligible (NFCE) clarification.  The OLTL also provided NFCE background information.  On May 22, 2008, CARIE posted the comments submitted concerning the draft document.  

Just for Fun
Summer is a great time to catch-up with reading and there are a number of websites designed for book lovers. Here are a few. Since 1984, every state has established statewide book centers affiliated with the Center for the Book in the Library of Congress to stimulate public interest in books and reading for people of all ages. The Center’s website provides links to every state center affiliate as well as many resources that promote books and reading. For example, PA has a link to a Literary and Cultural Heritage Map that allows you to glide your cursor over a map and learn about the best known literary figure for a particular county.

Some other “just for fun” websites for book lovers include:
• Bookcrossing.com – Want to become a “bookcrosser?" Simply register at bookcrossing.com to find where someone has left a book or sign-up to leave a trail for your books to be found. You can track how far your book travels, some travel the globe!
• Goodreads.com – Allows readers to post your own reviews, catalog what you have read, join a discussion group, start a book club, contact an author, and share recommendations with others in this online book club.
• Literature-map.com – Simply enter the name of your favorite author and you’ll get a graph listing other similar authors with your author in the middle. The closer the author is to your author on the graph, the more similar they are to each other.
• Meettheauthor.com – Provides video clips of authors describing their books. The site is updated daily.  

August Legislative Committee Meeting Announcement
The Dorothy S. Washburn Legislative Committee meeting will be held from 9:30 to 11:30 on August 7, 2008 at CARIE. Click here for the agenda.  Please feel welcome to join us.

As always, don't hesitate to contact me if you have any questions.

Thanks,
Kathy