December 3, 2008

CARIE Policy Update and Meeting Announcement

Quote of the Month
"It is in giving that we receive.” – Saint Francis of Assisi  

Medicare Open Enrollment 
Medicare’s open enrollment for prescription drug and Medicare Advantage plans began on November 15 and will continue through December 31, 2008. Even consumers who are satisfied with their current Medicare Part D prescription drug plan (PDP) should make sure that understand any changes to the plan for 2009. Any changes to their existing plan were explained in the Annual Notice of Change letter sent in October. Click here for a brief overview of the national PDPs available in each state.  The Centers for Medicare & Medicaid Services (CMS) issued a new consumer publication, “Use Medicare’s Information on Quality to Help You Compare Plans,” to describe the plan rating information available through the Medicare Plan Finder at www.medicare.gov. However, the Center for Medicare Advocacy has released an issue brief, “When Is The Lowest Cost Prescription Drug Plan Not The Lowest Cost Prescription Drug Plan?” that points out the problems with the Medicare Plan Finder.

CMS announced the updated Low Income Subsidy (LIS) resource and cost sharing limits for 2009. CMS is required by statute to update the Part D resource limits, income standards and cost sharing amounts on an annual basis. The 2009 resource limits are $8,100 for individuals ($12,910 if married) for the full low income subsidy and $12,510 for individuals ($25,010 if married) for other low income subsidies. CMS will announce the 2009 LIS income standards in early 2009 once the federal poverty levels are released. According to the National Senior Citizens Law Center (NSCLC), about 25% of LIS recipients are enrolled in fully subsidized plans whose premiums will no longer be below the benchmark amount next year. Over 2 million LIS recipients will need to change plans to avoid paying a premium. Most will be re-enrolled in a new plan by CMS. The NSCLC released a report, “Musical Chairs: An Analysis of the Part D Annual Reassignment Process,” that describes the issues facing LIS recipients and making policy recommendations. It also provides state specific information about 2009 Medicare Part D plan changes for full subsidy LIS recipients.

The Medicare Rights Center is hosting free monthly webinars on Medicare topics. The next webinar, “Changes to Medicare in 2009” is scheduled for December 11, 2008 at 1 PM Eastern Time. Click here for more information and to register.   

Medicaid News
According to the “2008 Actuarial Report on the Financial Outlook for Medicaid” recently released by the U.S. Department of Health and Human Services, Medicaid spending is projected to increase much faster than the economy and may reach $4.9 trillion over 10 years. The report forecasts Medicaid expenditures and enrollment for the next ten years and the data are organized by enrollment groups and service categories. This inaugural report is expected to be produced annually and is similar in intent to the annual reports produced by the Social Security and Medicare trustees. More specifically, the report predicts that Medicaid benefits spending will increase 7.3% from 2007 to 2008, reaching $339 billion, and will grow at an annual average rate of 7.9% over the next 10 years, to $674 billion by 2017.

AARP’s Public Policy Institute also posted a fact sheet, “Myths about the Medicaid Program and the People It Helps,” to address some of the most common misperceptions about Medicaid. 

Nursing Home Information   
On November 7, 2008, CMS released a report “Freedom from Unnecessary Physical Restraints: Two Decades of National Progress in Nursing Home Care.”  This report includes information about initiatives to reduce the use of physical restraints in nursing facilities as a result of 1987 Nursing Home Reform Act. The report describes the reduction in restraint use as one of the greatest accomplishments resulting from the Act. The cover memo states, “Because of the hard work of practitioners, providers, advocates, and government agencies, the percentage of nursing home residents physically restrained daily substantially declined from 21.1 percent in 1991 to less than 5.0 percent in 2007.”

CMS also posted an updated Special Focus Facility Initiative and List on November 21, 2008. 

Highlights from a Commonwealth Fund supported study, “Variation in the Use of Federal and State Civil Monetary Penalties for Nursing Homes,” found that civil monetary penalties are underused and the wide variation in use among states indicates a lack of standardize enforcement and limited federal oversight of the enforcement process. 

Some of the Spousal Impoverishment and SSI figures for 2009 have been announced by CMS.  (Also see page 1 of the "1998-2009 Spousal Impoverishment, Resource Limits.") Effective January 1, 2009, the Minimum Community Spouse Resource Allowance is $21,912 and the Maximum Community Spouse Resource Allowance is $109,560. The Maximum Community Spouse Monthly Income Allowance is $2,739. The SSI 2009 Federal Benefit Rate is $674/month for individuals and $1,011/month for couples. 

Assisted Living Update 
The purpose of the Assisted Living Disclosure Collaborative is to provide assisted living consumers and their families with information about various aspects of assisted living care to compare facilities such as services available; pricing information; admission and discharge criteria; staffing information; and resident rights. The wide variation among state requirements as well as services provided by individual assisted living providers make it difficult for consumers to decide which provider best meets their needs. Workgroups consisting of stakeholders (providers, consumers, clinicians, and policy experts) are collaborating to develop the information with the goal of creating tools that help consumers and their families make better choices. Beginning in FY 2009, Phase II of the project will test the tools with consumers and providers. In late 2010, Phase III of the project will include dissemination of the materials.

CARIE is pleased to be a member of the PA Assisted Living Consumer Alliance (PALCA), an alliance 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. PALCA is gathering stories from consumers and people working in the field about assisted living or personal care facilities and associated issues and challenges presented. Some examples may be related to discharge, ill equipped facilities, poor quality of care, lack of staff or staff training or not receiving assistance in obtaining prescriptions, healthcare, or transportation to medical appointments. One can submit their story directly on PALCA’s website or contact Jennifer Habeeb via email and she will draft you story for the website. Please understand that these personal experiences are very valuable and will help achieve PALCA’s goals. 

Elder Economic Security lnitiative 
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.

WOW is seeking personal stories from older adults or their caregivers to post on their website. They are looking for older consumers who are having trouble making ends meet and may even find themselves skipping meals or splitting medications. Perhaps their heating bills will be too high to afford this winter. If you know an older adult or a caregiver struggling financially that is willing to share their story with WOW, it will be featured on the WOW website along with other seniors, baby boomers and family caregivers who are struggling to get by. The personal stories will help support advocacy efforts to raise awareness and promote policy and program change to assure the economic well-being of elders and their families. The stories will be used to help educate policy makers and the media about how difficult it is to afford nutritious food, prescription medications and utilities in today’s economy. Email Stacy Sanders or call her at (202) 464-1596 to share a story or find out more.

In Pennsylvania, Pathways PA partnered with CARIE, the United Way of Southeastern PA and others to develop the EESI Index for PA. Even thought the report was completed before the economic downturn, 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. Once again, 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 for Advocates (fact sheet)

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

• AARP’s Public Policy Institute posted a report, “Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update.”    
• In one year, the legislation that decides how the federal government funds transportation will end. The American Association of State Highway and Transportation Officials (AASHTO) is seeking online comments and videos from anyone with ideas on how to improve public transit and roads etc. (Please be sure to provide information about the transportation needs of older adults!)    
• The Centers for Medicare & Medicaid Services (CMS) has released a MLN Matters article, “Changes in Medicare Payment for Oxygen and Oxygen Equipment,” that emphasizes important information on Medicare payment and supplier requirements for oxygen and oxygen equipment and an updated article, “Update to Medicare Deductible, Coinsurance and Premium Rates for 2009.”   
• The Department of Health and Human Services (HHS) released its first inventory of quality measures used by its agencies and operating divisions to improve public and private sector quality performance measurement efforts. The HHS measure inventory is available on the National Quality Measures Clearinghouse website.   
• The 2008 Best Health Plans guide provides comprehensive rankings and consumer information for almost 700 commercial, Medicare, and Medicaid health plans. 
• The Kaiser Family Foundation has updated two primers, “Medicaid: A Primer” and “Medicare: A Primer,” that explain the role of Medicaid and Medicare in providing health coverage to more than 90 million Americans.
• The U.S. Department of Commerce announced a new government interagency website EconomicRecovery.gov that includes an interactive online forum, “Ask the White House,” and the latest information from government agencies about America’s economic recovery to help people “keep their homes, find jobs and protect their savings.”
• The National Governors Association (NGA) and the National Conference of State Legislatures (NCSL) released a joint press release to request that Congress and the Administration take swift action to stabilize the nation's economy. Twenty states have already cut $7.6 billion from their current budgets and 30 states have identified additional shortfalls totaling more than $30 billion. The press release includes additional links such as for a white paper, “Economic Recovery: A Federal and State Partnership” further outlining their recommendations.    
• The Government Accountability Office (GAO) issued a report – “State and Local Fiscal Challenges: Rising Health Care Costs Drive Long-Term and Immediate Pressures,” (GAO-09-210T)       
• The Center on Budget and Policy Priorities issued a brief, “Recession Could Cause Large Increases in Poverty and Push Millions into Deep Poverty.”
• A new Harvard research paper, Transforming the Fight Against Poverty: The Internet & Anti-Poverty Strategies, “addresses how the Internet has enhanced productivity in government run anti-poverty programs and bridged physical and market isolation gaps prevalent in poor populations."  
• The Federal Trade Commission announced that it developed a new booklet and website to help provide reliable sources of health information to seniors, their family members, and caregivers. Who Cares: Sources of Information About Health Care Products and Services, “urges older consumers to discuss their health-related decisions with doctors and other trusted health care providers and helps them find links to agencies and organizations that provide reliable information about generic drugs, hormone therapy, caregiving, surgery to improve vision, alternative medicine, hearing aids, Medicare fraud, and medical ID theft” among other information. Copies of the Who Cares booklet can be downloaded or ordered from the FTC’s Consumer Response Center at: 1-877-FTC-HELP.
• Four national legal organizations including: the American Bar Association, Legal Services Corporation, National Legal Aid & Defender Association and Pro Bono Net launched a new website to help victims of disasters find critical legal information and assistance. It includes information about lawyers who want to volunteer to help and serves as a vehicle to recruit as well as mobilize pro bono lawyers in the aftermath of a disaster. 
• The “Unified Agenda, November 2008 Edition,” also known as the Semiannual Regulatory Agenda, summarizes the rules and proposed rules that each Federal agency expects to issue during the next year. You can search by agency or department such as the Department of Health and Human Services.
• The Congressional Research Service issued a report: “Federal Civil Rights Statutes: A Primer.”
• The Partnership to fight Chronic Disease has posted an “Almanac of Chronic Disease 2008 Edition: Statistics and Commentary on Chronic Disease Prevention.” 
• The Metlife Mature Market Institute posted an updated report: "The MetLife Market Survey of Nursing Home & Assisted Living Costs."  

CARIE News 
CARIE has a job opportunity for a full time long term care ombudsman. Applicants must have a college degree. Click here for more information about the position and how to apply.

CARIE and the Bryn Mawr Graduate School of Social Work and Social Research are sponsoring ethics workshops for social work professionals. This workshop will focus on professional standards and values in relation to aging and health care and will offer a process for resolving ethical dilemmas in social work practice. Issues include: client self-determination and cognitive impairment, confidentiality in the health care environment, client advocacy/client best interests, end-of-life decisions, and professional boundaries and conflicts of interest. This half-day workshop offers 3 Social Worker CEUs. Click here for more information including how to register.  

Are you planning to shop online this holiday season? If so, please go to www.igive.com and choose Center for Advocacy for the Rights and Interests of the Elderly (CARIE) as your cause. It’s free to join and there are no hidden costs to you. Participating merchants automatically donate a portion of your total purchase to your chosen cause when you shop through iGive. Over 700 of the web's best stores like Barnes & Noble, Amazon and QVC participate in the iGive program, and a portion of each purchase can benefit CARIE. Be sure to check iGive’s "Specials & Coupons," "Free Shipping," and "Distinctive Donations." CARIE will not know what you bought. In fact, we don’t even know who designates us. (Thanks to all of you who do shop for CARIE!) We simply receive a check a few times a year from iGive based upon the purchases made from those who identify CARIE as their cause. So next time you plan to shop online, please consider using iGive and help CARIE with just the click of your mouse. It’s free and for a good cause!

Just for Fun 
This month's "Just for Fun" item features two amazing collections found on the web.  You can now step back in time and view some of LIFE magazine’s iconic images and never seen photographs. LIFE magazine and Google have partnered to make millions of photographs available from the LIFE photo archive, dating back to the 1750s to today. Most were never published but are now accessible for the first time online at the Google LIFE photo archive. 

“The Encyclopedia of Life (EOL) is an ambitious project to organize and make available via the Internet virtually all information about life present on Earth. At its heart lies a series of Web sites—one for each of the approximately 1.8 million known species. Each site is constantly evolving and features dynamically synthesized content ranging from historical literature and biological descriptions to stunning images, videos and distribution maps.”   

December Legislative Committee Meeting Announcement
The Dorothy S. Washburn Legislative Committee meeting will be held from 9:30 to 11:30 on December 4, 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