December 18, 2012

US Senate Finance Committee Holds Hearing on Services for Dual Eligibles

On Thursday, December 13th, the U.S. Senate Finance Committee held a hearing on the progress of state proposed care models that would integrate services for the dually eligible population. This population is made up of roughly 9 million Americans that qualify for both Medicare and Medicaid coverage and consists of a diverse group of beneficiaries, including younger individuals with disabilities and elderly individuals with low-incomes. Dually eligible individuals account for a disproportionate amount of spending in both Medicare and Medicaid, roughly totaling $300 billion in expenditures during 2011 and States have begun to look at ways to better integrate care for these individuals that may potentially lead to a reduction of costs. Melanie Bella, representing the Center for Medicare & Medicaid Innovation housed within the Centers for Medicare & Medicaid , spoke of the progress of states in implementing new integrated care ‘demonstrations’ for dually eligible individuals and the role of CMS in overseeing and assisting states with these proposed models. Ms. Bella emphasized that, in providing states the opportunity to implement such models, CMS’s priority was to improve care for dually eligible individuals, not to contain costs (although cost-savings would be expected to occur under such models.)

Following Ms. Bella’s testimony, three representatives from Washington, Arizona and Ohio spoke about each of their states’ efforts in creating models to better integrate and improve care amongst the dually eligible population; these states’ demonstrations are set to launch in 2013 and 2014. Committee members raised a number of concerns regarding these proposed models, and Senator Rockefeller expressed unease about the rights and choices of beneficiaries being upheld under state integrated care models. As we await the implementation of these demonstrations in the coming years, the Consumer Voice will remain a vocal advocate for consumers in this process and will closely monitor any additional developments that may affect the dually eligible population.

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Recording Available from Consumer Voice's Virtual 25th Anniversary Celebration of the Nursing Home Reform Law

The Consumer Voice hosted a virtual 25th Anniversary party to celebrate the Nursing Home Reform Law (NHRL) on Friday, December 14th, 2012! Our entire network was invited to participate in this free event. Speakers discussed how the NHRL has made a difference and where we still need to go, and we had other fun and informative activities.

• Introductions (Sarah Wells, Executive Director, and Bill Lamb, President-Elect)
• How the Nursing Home Reform Law Came to Be (Sarah Burger, RN,C., MPH, FAAN, Coordinator Coalition of Geriatric Nursing Organizations, Hartford Institute for Geriatric Nursing)
• Nursing Home Reform Law: How It's Made a Difference (Penny Shaw, Nursing Home Resident and Consumer Advocate)
• Nursing Home Reform Law: What it Means for Advocates (Esther Houser, Oklahoma State Long-Term Care Ombudsman)
• Nursing Home Reform Law: Where We Go From Here (Robyn Grant, Director of Public Policy & Advocacy)

If you weren’t able to participate last Friday, a free recording of the call is available here.

ACR Elder Decision-Making and Conflict Resolution Section Provides Long-Term Care Training Objectives for Mediators

The Association for Conflict Resolution (ACR) Elder Decision-Making and Conflict Resolution Section has completed a set of Long-Term Care Training Objectives, intended as guidance for training mediators to handle disputes related to long-term care. Mediation offers people in a dispute an opportunity to have a productive conversation with the aid of a mediator who facilitates the discussion and search for resolution. Elder care disputes present special challenges to even the most experienced mediators. These challenges include the presence of multiple parties or stakeholders; potential concerns about (and the need for sensitivity and accommodation regarding) the capacity of participants – especially in situations involving mediation as an alternative to formal guardianship or conservatorship; challenging long-standing family dynamics; generational power shifting; and the presence and roles of a range of advocates. The training objectives developed by ACR are meant to aid mediators in long-term care settings.

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National Center for Health Statistics Encourages NSLTCP Participants to Respond

The National Center for Health Statistics is currently conducting the 2012 National Study of Long-Term Care Providers (NSLTCP). We would like to thank the many of you who have already participated. The information you provided will be invaluable in planning for long-term care in the future.   For those of you who have received a FedEx packet of information and/or a phone call indicating that you have been selected for the study, but have not yet responded, we strongly urge you to please do so now.   Your participation is voluntary but is needed to make this study a success. By law, all data collected and released will be kept in strict confidence and used only for statistical purposes and no individual provider, staff or individual can be identified. Results from this study are expected to be released late 2013. To learn more about NSLTCP, please visit the website.

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GAO Releases Report on OAA Title III & VII Funding Formulas

This week, the Government Accountability Office (GAO) released a report, “The Older Americans Act: Options to Better Target Need and Equity.” Requested by Ranking Member of the Senate Special Committee on Aging, Sen. Bob Corker (R-Tenn.), the report seeks to assess the current formula used to allot Older Americans Act (OAA) funds to the states, and explore options to better ensure that the needs of the growing older adult population are met.

Nursing Home Residents Can Leave for the Holidays

As the holidays are rapidly approaching, please keep in mind that you can leave the nursing home. Nursing home residents often want to join in family festivities and visit with children and grandchildren, but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. This is not true.

The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, "an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care."

Residents receiving Medicaid may also be eligible to leave for overnight visits and still have their bed paid for if their state has a therapeutic leave or bed hold policy. Each state’s rules are different so residents and families need to have all the facts before planning an overnight visit. Get more information on this fact sheet.

For more information, review the Center for Medicare Advocacy’s Spring 2012 Update.

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