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The National Consumer Voice for Quality Long-Term Care

March 11, 2014

New Executive Director Message: He's Joined the Team!

I have been at Consumer Voice only a little more than a week, but I wanted to reach out to the organization’s stakeholders, members, partners, volunteers and contributors.  Many of you have sent welcoming notes and messages and I have so greatly appreciated receiving them.  Your messages have made me feel that I am already part of the team.

All nonprofit organizations are a “team sport,” but none more than our shared goal of ensuring that everyone requiring long-term services and supports receives quality care.  Why is our cause different and one that requires more teamwork than others?  You who have labored in this field know the answer better than I, but to me there are at least two reasons.  First, quality care is not a sometimes focus; it is a commitment for 24 hours a day, seven days a week, 365 days a year.  There is no backing off.  The second reason is that with so much vigilance required and addressing so many aspects of a person’s well-being, it is easy to become tired and overwhelmed, or feel that what you’re doing doesn’t make a difference.   This reaction is sometimes called “burnout.”

The best antidote to this experience is respite and also team support, encouragement, and connection.  That can also include additional education, training and coaching to develop new ways to achieve our commitment to excellence and to re-charge our batteries.

It’s clear even from my short time here that there is a very committed team made up of the Consumer Voice network of staff, stakeholders, members and others. We have a big job to do, but I am confident that by working together and working smart, we can build on the legacy of NCCNHR and further expand our movement and its influence so that support for quality long-term care surrounds every consumer and every caregiver – and serves the interests of our communities and society as well.  

I know that I am going to continue to need your encouragement and support to help you and Consumer Voice achieve our goals.  I look forward to working with you all in this critical endeavor.  You can reach me any time here at Consumer Voice or at rgelula@theconsumervoice.org.

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Connecticut Considers Stronger Nursing Home Staffing Law

On March 4th, Brian Capshaw, a member of the Consumer Voice Leadership Council, testified in support of stronger nursing home staffing laws in Connecticut.  Capshaw spoke at a hearing held by the Connecticut Legislature’s Human Services Committee in support of H.B. 5322. The legislation would raise the state’s current staffing ratio from 1.9 to 2.7, a change which Capsaw described as an important first step toward better care in nursing homes in the state. Capshaw also noted in his testimony the fact that at the national level, the Federal government has made a payroll data collection system for nursing home staffing a priority by including it in the Affordable Care Act, but has yet to implement the provision.  The Consumer Voice also submitted testimony in support of the staffing legislation proposed in Connecticut.  

Brian Capshaw’s testimony can be found here

The link to Consumer Voice testimony can be found here.

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Upcoming Paid Webinar on Medicare Observation Status and Improvement Standard in Skilled Nursing Facilities: What Advocates and Consumers Need to Know

When: Thursday, March 13, 2014 • 3:00pm - 4:30pm EST

Speaker: Toby S. Edelman, Senior Policy Attorney, Center for Medicare Advocacy, Inc.

After briefly reviewing requirements for Medicare coverage of a stay in a skilled nursing facility, this webinar will discuss in depth how to overcome two obstacles to coverage – observation status and the myth of medical improvement. Observation status occurs when hospitals label patients as “outpatient” when they are hospitalized, often for multiple days, depriving them of the three-day inpatient status that is necessary for Medicare coverage in a SNF. Regarding the improvement standard, the settlement in the Vermont lawsuit Jimmo v. Sebelius confirms that Medicare pays for “maintenance” nursing and therapy for nursing home residents, dispelling the myth that Medicare pays for care only when a resident will “improve.” Learn how to advocate effectively for Medicare beneficiaries, and where advocates and consumers can get help.

This webinar is open to all!

Cost: $50.00 Registration for Live Webinar (includes mp3 recording) • $15.00 Webinar recording only (mp3, by email).

Register Today

Questions? Contact Alia Murphy, Associate, Long-term Care Ombudsman Program and Policy.

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OIG Releases Report on Adverse Events in SNFs; Consumer Voice Responds

The Office of the Inspector General recently released a report entitled "Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries." This study estimates the national incidence rate, preventability, and cost of adverse events (defined as harm resulting from medical care) in SNFs by using a two-stage medical record review to identify events for a sample of 653 Medicare beneficiaries discharged from hospitals to SNFs for post-acute care. The study found that an estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays.  An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Read the report.

In response to this report, the Consumer Voice called for more staffing in nursing homes.  In a statement, the Consumer Voice called on federal legislators to pass a law requiring minimum staffing standards in nursing homes.  Read the Consumer Voice's response.

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Financial Exploitation Webinar Recording and Materials Now Available

The webinar recording, PowerPoint slides, fact sheets and additional materials from last week’s Consumer Voice webinar titled, "Tips and Tools for Preventing and Responding to Financial Exploitation in Long-Term Care Facilities” are now available on the Consumer Voice website and the National Long-Term Care Ombudsman Center (NORC) website.
The webinar discussed financial exploitation in long-term care facilities and provided tips and resources for preventing, detecting and reporting financial abuse. Naomi Karp, Policy Advisor, Consumer Financial Protection Bureau (CFPB) Office of Older Americans, explained CFPB’s role in the financial protection and education of older adults and shared new resources attendees can use with residents, family members and providers to increase financial literacy and prevent financial exploitation. Ann-Maria Beard, Deputy Director, Office of Supplemental Security Income and Representative Payment Policy of the Social Security Administration discussed the Representative Payee Program, providing an overview of the responsibilities and oversight of representative payees and how attendees can support the rights of Social Security and Supplemental Security Income (SSI) beneficiaries and report suspicion of misuse of benefits by a representative payee. Additionally, webinar participants discussed a scenario involving potential financial exploitation and shared challenges and best practices related to responding to allegations of financial exploitation. New consumer facts sheets regarding the prevention, detection and reporting of financial exploitation in nursing home and assisted living facilities produced by the National Consumer Voice for Quality Long-Term Care (Consumer Voice) for the National Center on Elder Abuse (NCEA) were introduced.

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Consumer Voice Webpage Features Resources on Nursing Home Quality

The Consumer Voice has debuted a new webpage on nursing home quality. The page provides resources for finding and advocating for quality nursing home care. On February 26th, U.S. News & World Report released its 2014 guide to the best nursing homes in Americas.  While the U.S. News & World Report rankings are a helpful beginning resource for consumers seeking to make decisions regarding nursing home care, it is important for consumers to be aware of the shortcomings of the Nursing Home Compare data used for these rankings.  In response to this report, the Consumer Voice sent a letter to the editor of the U.S. News & World Report describing the importance of staffing when it comes to quality care and how the staffing numbers used in these rankings are widely recognized to being inaccurate.

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Consumer Voice Submits Comments to CMS on Proposed Rule for Changes to Medicare Part D Prescription Drug Program

On Friday, March 7th, Consumer Voice submitted comments on a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that put forward a series of policy and technical changes to the Medicare Part D prescription drug program. While we supported a number of the proposed changes because they would aid in strengthening the program and improving services and safeguards for consumers, we strongly opposed a proposed change in the rule that would result in the removal of immunosuppresants, antipsychotics, and antidepressants from the six protected drug classes in Medicare Part D. Currently, Part D plans are required to provide coverage for all medications in the immunosuppressant, antipsychotic and antidepressant categories, but this proposed change would rescind this requirement in 2015 for immunosuppresants and antidepressants and in 2016 for antipsychotics. Consumer Voice expressed concern that the removal of these drugs from protected class status at this time would negatively impact the health and well-being of consumers reliant upon these medications. We commended CMS for its acknowledgement of the ongoing misuse of antipsychotic drugs among long-term care residents with dementia, but stressed that there were other ways in which this issue could be addressed.  Our comments discussed several recommendations on how to combat this problem without endangering access to these medications for beneficiaries with serious mental illness. You can read Consumer Voice’s full comments on the proposed rule here.

After receiving comments from the public, CMS announced yesterday that it would not currently be moving forward on certain provisions of the proposed rule, such as the suggested changes to the six protected classes. For more information the agency's decision, click here.

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OIG Releases Medicaid Fraud Control Units Fiscal Year 2013 Annual Report

The Office of the Inspector General released a report that found in FY 2013, Medicaid Fraud Control Units (MFCUs) nationwide reported a total of 1,341 criminal convictions in cases involving Medicaid fraud and patient abuse and neglect, and criminal recoveries reached nearly $1 billion. Criminal convictions involved a variety of provider types, most notably home health agencies. MFCUs also obtained 879 civil settlements and judgments in FY 2013, and civil recoveries totaled over $1.5 billion. Civil settlements and judgments involved a variety of provider types, most notably pharmaceutical companies. MFCUs are an important source of referrals to the OIG for purposes of provider exclusions; for over 1,000 Medicaid providers convicted in MFCU cases, OIG took further action to exclude them from all Federal health care programs, including Medicare, in FY 2013.

The study found that a lack of fraud referrals to MFCUs from Medicaid managed care organizations (MCOs) presents challenges; Unit officials expressed concern that some MCOs may not have incentive to refer providers suspected of fraud. We also found that recent provider payment suspension rules enacted by the Patient Protection and Affordable Care Act (ACA) require more coordination between MFCUs and State Medicaid agencies. Finally, in its oversight role during FY 2013, OIG conducted 10 onsite reviews of Units, published 8 reports on onsite reviews, issued regulations to allow data mining by MFCUs, and proposed additional authorities for Units to investigate allegations of patient abuse and neglect.

Read the report.

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About The Gazette

The Gazette is a weekly e-newsletter, published by the National Consumer Voice for Quality Long-Term Care and the National Long-Term Care Ombudsman Resource Center. If you do not wish to continue receiving this publication, please unsubscribe. Your contributions and comments are welcome and should be sent to info@theconsumervoice.org. Copyright © 2014.

The Consumer Voice is the leading national voice representing consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves. We are a primary source of information and tools for consumers, families, caregivers, advocates and ombudsmen to help ensure quality care for the individual. The Consumer Voice's mission is to represent consumers at the national level for quality long-term care, services and supports.

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