Public Transportation on Indian Reservations Program

The Federal Transit Administration (FTA) announces the selection of projects to be funded under Fiscal Year (FY) 2008 appropriations for the Public Transportation on Indian Reservations Program; Tribal Transit Program (TTP), a program authorized by the Safe, Accountable, Flexible, and Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU).

This announcement contains a list of grantees and the amounts awarded.

Older Worker Demonstration Grants

The U.S. Department of Labor (DOL), Employment and Training Administration (ETA) announces the availability of approximately $10 million in funds for Older Worker Demonstration Grants. These grants will be awarded though a competitive process as a part of the High Growth Job Training Initiative (HGJTI). The grants are intended to address the workforce challenges facing older individuals by developing models for talent development in regional economies that recognize older workers as a valuable labor pool and include employment and training strategies to retain and/or connect older workers to jobs in high growth, high demand industries critical to the regional economy.

Grants awarded under the Older Worker Demonstration should focus on providing training and related services for individuals age 55 and older that result in employment and advancement opportunities in high growth industries and economic sectors. The proposed strategies must take place in the context of regional talent development efforts designed to contribute to a strong regional economy, and must be developed and implemented by a strategic regional partnership. The preferred eligible applicants for this solicitation are entities that represent the local workforce investment system, but other entities may apply. It is anticipated that the number of awards will range from 10 to 13, with award amounts ranging from $750,000 to $1,000,000.

Election Assistance Commission: Request for Public Comment on Proposed Strategic Plan

The EAC seeks public comment on a ``U.S. Election Assistance Commission Draft Strategic Plan Fiscal Years: 2009 Through 2014.'' The EAC developed a strategic plan that lays out an approach to create a receptive and productive agency fully capable of the unique leadership role it has been given as a national clearinghouse, a manager of Federal financial assistance, a certifier of voting systems, and a resource for election officials throughout the country regarding the administration of Federal elections. EAC issues this notice according to a policy adopted on September 18, 2008 that requires EAC to provide notice and an opportunity for public comment on, among other things, advisories being considered for adoption by the U.S. Election Assistance Commission.

DATES: Comments must be received by 5 p.m. EST on January 20, 2009.

Disproportionate Share Hospital Allotments and Disproportionate Share Hospital Institutions for Mental

This notice announces the final Federal share disproportionate share hospital (DSH) allotments for Federal fiscal year (FFY) 2007 and the preliminary Federal share DSH allotments for FFY 2009. This notice also announces the final FFY 2007 and the preliminary FFY 2009 limitations on aggregate DSH payments that States may make to institutions for mental disease and other mental health facilities. In addition, this notice includes background information describing the methodology for determining the amounts of States' FFY DSH allotments.

CMS Data Collection Proposals

New collection - Disclosure of Financial Relationships Report - The DFRR collection instrument will be used by CMS to (1) identify arrangements that potentially may not be in compliance with the physician self-referral statute and implementing regulations; and (2) to identify examples and areas of non-compliance that may assist us in any future rulemaking concerning the reporting requirements and other physician self-referral provisions.

Revision of a currently approved collection - Transmittal and Notice of Approval of State Plan Material and Medicaid State Plan--Base Plan, Attachments and Supplemental Pages - The Medicaid State plan is comprised of ``pages'' and organized by subject matter which includes Medicaid eligibility services, payment for services, and general, financial and personnel administration. When States seek to change selected pages of their State plans, the page(s) are transmitted to CMS for review and approval by the CMS Central and Regional Offices prior to amending its State plan.

State Option To Establish Non-Emergency Medical Transportation Program

This final rule implements section 6083 of the Deficit Reduction Act of 2005, which provides States with additional State plan flexibility to establish a non-emergency medical transportation (NEMT) brokerage program, and to receive the Federal medical assistance percentage matching rate. This authority supplements the current authority that States have to provide NEMT to Medicaid beneficiaries who need access to medical care, but have no other means of transportation.

Effective date: These regulations are effective January 20, 2009.

Medicaid Program; Disproportionate Share Hospital Payments; Final Rule

This final rule sets forth the data elements necessary to comply with the requirements of Section 1923(j) of the Social Security Act (Act) related to auditing and reporting of disproportionate share hospital payments under State Medicaid programs. These requirements were added by Section 1001(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Effective Date: This rule is effective on January 19, 2009.

SSA: Clarification of Evidentiary Standard for Determinations and Decisions

Final Rule

We (Social Security Administration) are amending our rules to clarify that we apply the preponderance of the evidence standard when we make determinations and decisions at all levels of our administrative review process. These rules do not change our policy that the Appeals Council applies the substantial evidence standard when it reviews a decision by an administrative law judge (ALJ) to determine whether to grant a request for review. We are also adding definitions of the terms ``substantial evidence'' and ``preponderance of the evidence'' for use in applying these rules.

DATES: These final rules are effective on January 20, 2009.

State Long-Term Care Partnership Program: Reporting Requirements for Insurers

This final rule sets forth reporting requirements for private insurers that issue qualified long-term care insurance policies in States participating in the State Long-Term Care Partnership Program established under the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171). Section 6021 of the DRA requires that the Secretary of Health and Human Services (the Secretary) specify a set of reporting requirements and collect data from insurers on qualified long-term care insurance policies issued under the program and the subsequent use of the benefits under these policies. Under a State Long-Term Care Partnership Program, an amount equal to the benefits received under the long-term care insurance policy is disregarded in determining the assets of an individual for purposes of Medicaid eligibility and estate recovery.

Effective Date: This final rule is effective on April 17, 2009.

FTA Fiscal Year 2009 Apportionments, Allocations, and Program Information

SUMMARY: Division A of the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009, (Pub. L. 110-329) signed into law by President Bush on September 30, 2008, continues to fund the Federal transit programs of the Department of Transportation (DOT) at the same levels that were available under Division K of the ``Consolidated Appropriations Act, 2008'' (Pub. L. 110-161) until a DOT Appropriations Act for Fiscal Year (FY) 2009 is enacted or March 6, 2009, whichever occurs first. This notice provides information on funding amounts that are currently available for the Federal Transit Administration (FTA) assistance programs; provides program guidance and requirements; and provides information on several program issues important in the current year. The notice also includes tables that show certain discretionary programs unobligated (carryover) funding from previous years that will be available for obligation during FY 2009.

SSDI: Collection of Medical Evidence Could Be Improved

What GAO Found

Obtaining timely and complete medical records is a challenge to DDSs in promptly deciding disability claims, and DDSs have responded with additional provider contacts and adjustments to their payment procedures. Although DDSs pay most medical providers for medical records and SSA pays the DDSs to cover these expenses, 14 of 51 DDSs reported the percentage of requests for which they did not receive records was 20 percent or more in fiscal year 2007. In response to this challenge, all DDSs conduct follow-up with providers and claimants to urge them to provide records. Over half of the DDSs (34 of 51) have also implemented more timely payments for records and six increased the amount they pay. Although SSA evaluates DDS collection of medical records, it does not compile key data necessary to identify and share promising collection practices.

SSA has made progress moving to electronic collection of medical records, but faces challenges in fully implementing electronic retrieval and analysis of medical evidence. SSA now uses electronic images instead of paper copies of new claimants' records. Though SSA seeks to obtain all records electronically and provides options for online submission of records, only one large provider accounts for most of the records submitted online, and about half of all records received are on paper. To date, SSA has taken only limited action to identify and analyze the barriers providers face in using current electronic record submission options, and has not developed a strategy to address them. In the long run, SSA is participating in an advanced prototype to collect medical records in formats that can be searched and analyzed by electronically querying a hospital’s records database and directly retrieving the claimants’ records.

What GAO Recommends

GAO recommends SSA identify DDS evidence collection practices that may be promising, evaluate their effectiveness, and encourage implementation of successful practices in other states, as applicable. To do so, SSA should cost-effectively compile and assess additional data on the collection process. SSA should also work to identify and address barriers to expanded use of its online medical evidence submission options.

Updated Data on State Health Facts

December 17, 2008
Data Update
Statehealthfacts.org has recently added new and updated data on Demographics and the Economy, Medicaid & SCHIP, Medicare, Providers & Service Use, Health Status and Women’s Health.

Demographics & the Economy

• Unemployment Rate The latest data from the Bureau of Labor Statistics on unemployment rates have been added for all states and the nation, showing the growth from October 2007 to October 2008.
• Cost of Living VariationNew data on cost of living variation for families living in selected urban areas across the states are now available for 2008. Data are based on Kaiser Commission on Medicaid and the Uninsured (KCMU) analysis of the Council for Community and Economic Research’s ACCRA Cost of Living Index (COLI).
• Income TaxesUpdated data from the Internal Revenue Service (IRS) and the Census Bureau on tax collections in 2007 are now available for all states and the nation. Data on total gross state collections, state government tax collections, and state collections per capita have been added.
• State Fiscal DistressThe latest information on projected state budget shortfalls for state fiscal year 2009 from the Center on Budget and Policy Priorities is now available for all states and the nation.
• Food Stamp ProgramUpdated state-by-state data from the United States Department of Agriculture (USDA) on monthly food stamp enrollment are now available for September 2008.
  

Medicaid & SCHIP

• SCHIP Allotments and Projected Shortfalls New data are now available from the Congressional Research Service (CRS) on FY2008 SCHIP and FY2009 SCHIP projected financing and funding shortfalls. Data are available for all states and the nation and include states' own projected federal spending, federal SCHIP allotments, and projected shortfall amounts under current law.
  

Medicare

• Medicare Prescription Drug Plan (PDP) PenetrationUpdated data on Medicare Prescription Drug Plan (PDP) penetration rates from Kaiser’s Medicare Health and Prescription Drug Plan Tracker have been added for all states and the nation for 2008.
  

Providers & Service Use

• Medical MalpracticeUpdated 2007 data from the Kaiser Family Foundation’s analysis of the National Practitioner Data Bank (NPDB) are now available on the number of paid medical malpractice claims and total malpractice payments for all states and the nation.

Health Status

• Disability Prevalence New data based on Cornell University’s analysis of the American Community Survey (ACS) on the percentage of adults with disabilities are available for all states and the nation for 2007.
• Teen DeathsThe latest data from the Annie E. Casey Foundation on teen death rates are now available for all states and the U.S. for 2005.

Women’s Health

• Breast and Cervical Cancer DeathsUpdated data from the National Cancer Institute (NCI) on deaths caused by breast cancer and cervical cancer have been added for 2005. Breast cancer and cervical cancer death rates by race/ethnicity are also available for all states and the nation.

Statehealthfacts.org, from the Henry J. Kaiser Family Foundation, provides free, up-to-date, and easy-to-use health and health policy data on all 50 states. Statehealthfacts.org has data on more than 600 health topics including Medicaid and SCHIP, Medicare, health coverage and the uninsured, health costs and budgets, providers and service use, minority health, women’s health, and HIV/AIDS

Senator Tom Daschle - What's He Said About Long Term Care

Steve Gold's Information Bulletin # 273 (12/08)

President-elect Barack Obama has nominated former Senator Tom Daschle to be Secretary of the U.S. Department of Health and Human Services. His book "CRITICAL - What We Can Do About the Health-Care Crisis," (Thomas Dunne Books, St. Martin's Press, 2008) is quite important for advocates of the disability and elderly communities. Below are some relevant portions of the book.

The book starts out with the following quote: "Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection."

Whom did he quote? Clinton? No. President Harry Truman, 1945. Daschle writes that both Truman in 1945 and Clinton in 1993 "underestimated the strength of the forces arrayed against them. Special-interests lobbyists...." He asks "Why have we failed to solve a problem that is such a high priority for so many citizens?... the limitations of our political system, and the power of the interest groups...."

Here's what he writes about "long-term care," which he recognizes as a"troubling area - and the only one in which we spend less compared to peer nations." Medicaid "is fundamentally geared toward institutional care,even though most elderly people prefer to receive care at home or in more personalized community settings."

Daschle quotes Professor David Mechanic who calls "long-term care' the stepchild of our health-care system'," which "vividly exhibits our system's inability to deal with chronic conditions in an integrated way."

"I believe that our health-care system must cover these vital services[i.e., long-term care].... We should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now."

OK. Now let's see if he will walk-the-walk, and not just talk-the-talk.

Will Daschle and Obama have both the will and fortitude to stand up to the"power of the interest groups" that have forced people with disabilities and elderly Americans to go into nursing facilities instead of receiving care at home?

Will he take the initiative and make sure Medicaid provides every elderly and disabled American the choice of where they wish to receive long-term care?

We know that the "interest groups" will not roll over. Our challenge is to hold Daschle and Obama to their statements. "Yes we can." We have the power!!!! Write letters to your local newspapers and opinion pieces,quoting Daschle. Tell stories of real people.

A Hidden Cost in Medicare Drug Benefit: ‘Reference-Based Pricing’

Posted by Jacob Goldstein in the Wall Street Journal Health blog

Seniors who insist on getting a brand-name drug when a generic version is available may wind up paying a high price. That seems fair enough: Why should the Medicare drug benefit pay extra because someone refuses to take a generic?

The problem, this morning’s WSJ suggests, is a lack of transparency that may leave seniors unaware they’ll be on the hook for the higher price of the branded drug. “I am concerned that beneficiaries could find themselves paying far more out-of pocket than they expected,” Rep. Pete Stark (D., Calif.) recently wrote in a letter to the Centers for Medicare and Medicaid Services.

Today, the AARP is going to issue a warning to seniors and send a letter to CMS complaining about the lack of disclosure around the practice, known as reference-based pricing.

The Medicare Ponzi Scheme

By Eric Novack in the Health Care blog

Just today, our next President spoke out against the largest investment swindle in US history. The alleged behavior of Bernard Madoff may have cost investors up to $50 billion.

What did Madoff do? He lured investors with big returns, and used the "profits" as a means to encourage additional investment by investors, while luring new ones.

The only problem is he was using the new money to pay off the old investments. And when current investors asked to redeem their shares, there was no money left. The whole scheme was a sham.

Which brings us to Medicare.

When you hear about "unfunded liabilities"—insert the phrase "Ponzi scheme."

How much is Medicare’s unfunded liability?

Adding up Medicare Part A, Part B, and Part D ... $85 trillion

Let’s make this even simpler. To meet the obligations "promised" to Medicare current and future recipients — that is how much would need to be in the bank today.

There is zero difference between the promises made by Madoff and those made by elected officials of both parties on Medicare.

Anyone want to consider whether the new administration or the Republican minority will use the same language that President-elect Obama used today to describe the Medicare system?

Medicaid and Entitlement Reform

The commentary by John Holahan of the Urban Institute Health Policy Center responds to a recent report from the Centers for Medicare and Medicaid Services (CMS) on future Medicaid spending growth. Medicaid spending growth will in fact be high but not probably as high as the CMS actuaries have forecast (7.9% per year). The evidence on Medicaid spending growth suggests that spending per enrollee in the Medicaid program has been held down to levels consistent with the medical care CPI and increases in GDP. The main cost driver has been enrollment growth – hard to address when the number of uninsured is rising. Further spending restraint could come from more efficient care for Medicaid's dual eligibles.

Full Commentary

To Stimulate the Economy, Defeat Health Care Reform

Posted by Michael F. Cannon in the Cato@Liberty blog

The Church of Universal Coverage is telling us that national health insurance will stimulate economic growth.

• Senate Finance Committee chairman Max Baucus (D-MT) says universal health insurance coverage is the key to a healthy economy.
  
• MIT economist Jonathan Gruber says “health care reform is good for our economy.”
  
• Business Week columnist Chris Farrell writes, “Universal coverage would stimulate the economy [and] boost the financial security of ordinary Americans.”

That seems to contradict their usual spiel — which happens to be correct — that America’s health care sector is wasteful and inefficient. Americans spend twice the amount that other advanced nations spend on medical care, yet we’re not noticeably healthier. Researchers estimate that one third of U.S. medical spending produces nothing at all — that’s about $700 billion wasted per year. How is pumping more money into such an inefficient economic sector supposed to stimulate growth?

THE LONG-TERM FISCAL OUTLOOK IS BLEAK

Restoring Fiscal Sustainability Will Require Major Changes to Programs, Revenues, and the Nation’s Health Care System - By Richard Kogan, Kris Cox, and James Horney in the Center on Budget and Policy Priorities blog

This report updates the Center on Budget and Policy Priorities’ projections of federal spending, revenues, deficits, and debt through 2050. These projections — like the projections the Center issued in January 2007 and the projections by other institutions such as the Congressional Budget Office (CBO), Government Accountability Office, and Office of Management and Budget — show that without changes in current policies, federal deficits and debt in coming decades will grow to unprecedented levels that will threaten serious harm to the economy.
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This conclusion should not be surprising. The costs related to the recession will have only a small budgetary impact on the long-term deficit problem, because they are temporary. Temporary costs — even if very large in the short run — add much less to the long-term fiscal gap than permanent costs (such as extending the tax cuts) because their total costs are small relative to the total size of the economy over the long-run. Also, short-term economic weaknesses have little impact on the major drivers of the long-term fiscal imbalance: rising health care costs and the aging of the population.

Nevertheless, policymakers should keep the long-term budget problem in mind as they take the necessary steps to stabilize financial markets and the economy. While the long-term problem should not deter policymakers from dealing with the short-term crisis, policymakers will need to demonstrate to the public and the lenders who finance our short- and longer-term borrowing needs that they are prepared to move the budget toward a sustainable long-run path when the economy improves.

In addition, in designing policies to deal with the short-term problems, policymakers should consider policies that could serve “double duty” by helping to spur the economy in the short term while also laying the groundwork for measures to restore fiscal responsibility in the longer term. This includes measures such as investments in health information technology that hold promise for contributing to efforts to stem the rapid growth of health care costs over time.
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Rising health care costs are the single largest cause of rapidly rising expenditures.
The main sources of rising federal expenditures over the long run are rising costs throughout the U.S. health care system (both public and private) and the aging of the population. Together, these factors will drive up spending for the “big three” domestic programs: Medicare, Medicaid, and Social Security. Health care costs are by far the biggest single factor. For the past 30 years, costs per beneficiary throughout the health care system have been growing approximately 2 percentage points faster per year than per-capita GDP, and our projections assume this pattern will continue through 2050. Limiting health care cost growth to 1 percentage point faster than per-capita GDP growth would shrink the fiscal gap by more than one-third (to 2.7 percent of GDP). If health care costs could be constrained to grow only at the same rate as per-capita GDP — a daunting and probably unachievable goal — the fiscal gap would shrink by more than two-thirds, to just 1.2 percent of GDP.

Fundamental health care reform must be part of any solution.
Rising costs throughout the health care system exacerbate the long-term budget problem in two ways. They increase federal spending by raising the per-person cost of providing health care through Medicare and Medicaid. (Per-person costs are rising in these programs at about the same rate as in the health care system as a whole, including the public and private sectors.) In addition, rising health care costs shrink federal revenues by increasing the share of the nation’s income that is exempt from taxation. Employer-provided health benefits are excluded from taxable income, and various other provisions of the tax code allow individuals to pay some health care costs from pre-tax income. Thus, when health care costs grow faster than the economy, the share of total income that is exempt from taxation increases.

A major effort is needed to expand our currently limited knowledge about ways to reduce the rate of growth in heath care costs in the public and private sectors alike, while improving the quality of care system-wide. Medicare can play an important role in these efforts, and policymakers should promote initiatives that both restrain cost growth in Medicare and serve as a model for reforms applicable to the system as a whole. Examples include eliminating the large overpayments that Medicare makes to private insurance companies that participate in the Medicare Advantage component of the program, altering Medicare’s payment systems to reward quality and efficiency, and strengthening primary care and care coordination.

Full Report

LOUISIANA’S MEDICAID WAIVER PROPOSAL- Is it the Right Fit for Louisiana?

By January Angeles and Judith Solomon in the Center on Budget and Policy Priorities blog

The Department of Health and Hospitals is seeking approval from the legislature to submit a proposal for a section 1115 Medicaid waiver to the U.S. Department of Health and Human Services (HHS). The state claims that the proposal would establish a medical home system like that described in the Health Care Reform Act. However, there are serious questions about whether the design of the Department's plan is appropriate or even possible for Louisiana, because Louisiana lacks the type of managed care organizations on which the plan primarily depends.
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In considering how to move the state forward toward its goal of a medical home system of care, the Louisiana legislature and other policy makers should give careful consideration to alternative approaches, which may be a better fit for Louisiana. In particular, Louisiana's current CommunityCARE program could be enhanced in ways that have been shown to improve outcomes and save money in other states. This alternative approach would be more suited to the state’s current health care environment and infrastructure, and have a higher likelihood of success.

A New Health Care Quality Improvement Resource: WhyNotTheBest.org

The Commonwealth Fund has launched a new Web site, WhyNotTheBest.org, that allows health care providers, researchers, and professionals to easily conduct side-by-side comparisons of 4,500 hospitals nationwide, track performance over time against numerous benchmarks, and download tools to improve health care quality.

WhyNotTheBest.org allows you to:

• Find the top-performing hospitals in the country on 24 nationally recognized measures of health care quality, including care provided for heart attack, heart failure, and pneumonia, and prevention of surgical infection
• Compare a hospital against its peers
• Learn how to improve the quality of care delivery and patient satisfaction.

On the Web site, users can search publicly reported Centers for Medicare and Medicaid Services performance data by a number of hospital characteristics--including region, ownership, and size--and measure performance against top performers and state and national averages.

WhyNotTheBest.org provides more than data. Case studies of high-performing hospitals and a library of tools offer lessons and strategies on ways to improve care. Featured tools include materials created by the Institute for Healthcare Improvement, the Agency for Healthcare Research and Quality, the American Heart Association, and top hospitals around the country.

"There are many report cards that measure quality of care, but WhyNotTheBest.org is unique in that it allows providers to benchmark performance against leaders and track improvements, and it provides credible tools to help providers achieve better performance," said Anne-Marie Audet, M.D., Vice President, Quality Improvement and Efficiency, at The Commonwealth Fund.

All information, including tools, can be saved to a "My Profile" page for later use. Over time, new measure sets and functionality, such as an Improvement Calculator to track progress toward benchmarks, will be added. IPRO, a not-for-profit health care evaluation and quality improvement organization, conducted all data analysis and Web development for the site.

CDC: Public Health Conference Support Program

CDC’s Procurement and Grants Office has published a program announcement entitled, “Public Health Conference Support Program.” Approximately $2, 600,000 will be available in fiscal year 2009 to fund approximately 70 to 100 awards. The purpose of the program is to provide partial support for specific non-Federal conferences in the areas of health promotion and disease prevention, educational programs, and applied research. For complete program details, please see the full announcement on the CDC website at http://www.cdc.gov/od/pgo/funding/FOAs.htm . The estimated funding dates vary.


Eligible Applicants
State governments
County governments
City or township governments
Special district governments
Public and State controlled institutions of higher education
Native American tribal governments (Federally recognized)
Native American tribal organizations (other than Federally recognized tribal governments)
Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education
Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education
Private institutions of higher education
For profit organizations other than small businesses
Small businesses

AHRQ Health Services Research Demonstration and Dissemination Grants

-Support improvements in health outcomes. Drawing from literature on variations in clinical practice and associated outcomes, the documented increase in the prevalence of chronic disease, and growing interest in the impact of different delivery modalities and financing arrangements on the outcomes of care, AHRQ seeks to support research to understand and improve decision-making at all levels of the health care system, the outcomes of health care, and, in particular, what works, for whom, when, and at what cost.

-Strengthen quality measurement and improvement. AHRQ is interested in a broad array of research topics, including studies to develop valid and reliable measures of the process and outcomes of care, causation and prevention of errors in health care, strategies for incorporating quality measures into programs of quality improvement, and dissemination and implementation of validated quality improvement mechanisms.

-Identify strategies to improve access, foster appropriate use, and reduce unnecessary expenditures. This area focuses on issues pertaining to the types of health care services Americans use, the cost of these services and sources of payment, determinants of access to care, and whether particular approaches to health care delivery and financing, or characteristics of the health care market, alter behaviors in ways that improve access and promote cost-effective use of health care resources.


Eligible Applicants
County governments
Native American tribal governments (Federally recognized)
Public housing authorities/Indian housing authorities
Public and State controlled institutions of higher education
State governments
Independent school districts
Special district governments
City or township governments
Native American tribal organizations (other than Federally recognized tribal governments)
Private institutions of higher education

SSA: Use of Date of Written Statement as Filing Date

SUMMARY: We (Socical Security Administration) propose to revise our rules for protective filing after we receive a written statement of intent to claim Social Security benefits under title II of the Social Security Act (the Act). Specifically, we propose to revise from 6 months to 60 days the time period during which you must file an application for benefits after the date of a notice we send explaining the need to file an application. We are proposing this revision to make the time period used in the title II program consistent with the time period used in other programs we administer under the Act. We believe that eliminating the difference between the time periods in the programs we administer would make it easier for the public to understand and follow our rules.

DATES: To be sure that your comments are considered, we must receive them by February 17, 2009.

National Council On Disability Quarterly Meeting

DATES AND TIMES:
January 12, 2009, 8:30 a.m.-3 p.m.
January 13, 2009, 8:30 a.m.-5 p.m.
January 14, 2009, 8:30 a.m.-5 p.m.

LOCATION:
Chaparral Suites Resort, 5001 N. Scottsdale Road, Scottsdale, AZ.

STATUS:
January 12, 2009, 8:30 a.m.-5 p.m.--Open.
January 13, 2009, 4:00 p.m.-5 p.m.--Open.
January 14, 2009, 8:00 a.m.-8:30 a.m.--Closed Executive Session.
January 14, 2009, 8:30 a.m.-5 p.m.--Open.

AGENDA:
Public Comment Sessions; Emergency Preparedness Panel; and Employment; Healthcare; Reports from the Chairperson, Council Members, and the Executive Director; Strategic Planning; Unfinished Business; New Business; Announcements; Adjournment.

ADVERSE EVENTS IN HOSPITALS: OVERVIEW OF KEY ISSUES

The DHHS Office of the Inspector General has released a new report examining the key issues regarding adverse events in hospitals.

SUMMARY
The extensive range of entities involved in researching and addressing adverse events shows that reducing the incidence of adverse events is a high priority. Stakeholders described the current environment among hospitals and policymakers as being on the threshold of accelerated progress. They point to a large body of research as improving understanding, including recognition of the critical role of hospital systems in guarding against adverse events. Additionally, new policies, such as denying hospitals higher payment for admissions complicated by certain adverse events and public disclosure of events, strengthen hospital incentives to develop safer practices. These advancements in clinical understanding, combined with heightened controls, hold promise for reducing the incidence of adverse events in hospitals and improving the quality of care.

KEY ISSUES
Issue 1: Estimates of adverse event incidence vary widely
Issue 2: Nonpayment policies are gaining prominence
Issue 3: Hospitals rely on staff to report adverse events
Issue 4: Hospitals report adverse events to oversight entities
Issue 5: Public disclosure has benefits but raises concerns
Issue 6: Hospitals may be slow to apply practices
Issue 7: Interviews and literature reveal strategies

Link to Full Report

Arkansas coroner sees ‘deterrent effect’ at nursing homes

By DEAN OLSEN, THE STATE JOURNAL-REGISTER, Posted Dec 07, 2008

A 1999 state law that requires all Arkansas nursing homes to notify the local coroner whenever a resident dies has reduced the number of bedsores and accidental deaths in the facilities, according to the coroner in Arkansas’ largest county.

CMS Medicare Prescription Drug Benefit Manual

CMS has published online its Medicare Prescription Drug Benefit Manual.

Table of Contents

Chapter 1 - Introduction and General Provisions (v09.26.08) [PDF, 97KB]

Chapter 2 - Part C and D Marketing Guidelines (v07.25.06) [PDF, 838KB]

Chapter 4 - Creditable Coverage Period Determinations/Late Enrollment Penalty (v06.27.06) [PDF, 210KB]

Chapter 5 - Benefits and Beneficiary Protections (v07.03.08) [PDF, 629KB]

Chapter 6 - Part D Drugs and Formulary Requirements (v07.18.08) [PDF, 901KB]

Chapter 7 - Quality Improvement and Medication Therapy Management (v09.15.08) [PDF, 173KB]

Chapter 9 - Fraud, Waste and Abuse (v04.25.06) [PDF, 543KB]

Chapter 12 - Employer/Union Sponsored Group Health Plans (v11.10.08) [PDF, 278KB]

Chapter 13 - Premium and Cost-Sharing Subsidies for Low-Income Individuals (v11.21.08) [PDF, 406KB]

Chapter 14 - Coordination of Benefits Guidelines (v.09.26.08) [PDF, 742KB]

Related Links Inside CMS

Chapter 3 - PDP Enrollment and Disenrollment Guidance [PDF, 250KB]

Chapter 18 - Part D Enrollee Grievances (v01.01.08) [PDF, 305KB]

GAO: Medicare Advantage Characteristics, Financial Risks, and Disenrollment Rates of Beneficiaries in Private Fee-for-Service Plans

What GAO Found

In April 2007, beneficiaries in PFFS plans tended to be healthier and generally younger than beneficiaries in other MA plans and Medicare FFS. Specifically, projected health care expenditures for PFFS beneficiaries were 7 percent less than the projected average for beneficiaries in other MA plans and 10 percent less than the projected average for beneficiaries in Medicare FFS. Beneficiaries in PFFS plans also generally were more likely than beneficiaries in other MA plans and Medicare FFS to reside in rural areas where fewer other MA plans were available. In addition, about 81 percent of beneficiaries who were new enrollees in PFFS plans were in Medicare FFS before enrolling in their plan, compared to 65 percent in other MA plans.

PFFS beneficiaries may have faced certain financial risks if they did not contact their plan before receiving services. These risks were generally not assumed by beneficiaries in other MA plans and Medicare FFS. Specifically, if beneficiaries or their providers did not contact their PFFS plans before obtaining a service to make sure it would be covered, beneficiaries unexpectedly may have had to pay for the entire cost of the service if coverage was later denied by their plan. CMS officials told GAO they did not have data on the extent to which PFFS beneficiaries were faced with such costs. Furthermore, some beneficiaries likely experienced higher out-of-pocket costs for covered services if they did not contact their plan before obtaining the services. For example, one sponsor of PFFS plans increased the share of the cost for which beneficiaries were responsible from 30 percent to 70 percent if the beneficiaries did not contact the plan before obtaining certain durable equipment. GAO found that some PFFS plans were inappropriately using the term prior authorization, which can involve denying service coverage if prior plan approval is not obtained, in their informational materials. CMS officials stated that PFFS plans should not have used this term because these plans were not permitted to deny service coverage due to lack of prior plan approval. However, CMS guidance on this issue has been inconsistent and sometimes incorrect.

From January through April 2007, beneficiaries in PFFS plans disenrolled at an average rate of 21 percent compared to 9 percent for other MA plans, and GAO concludes that CMS has not complied with statutory requirements to mail disenrollment rates to Medicare beneficiaries. Disenrollment rates can reflect factors such as beneficiary satisfaction and CMS is required by law to mail this information to Medicare beneficiaries to help them compare available MA plans in their area. Although CMS has not mailed disenrollment rates to beneficiaries since 2000, the agency did provide disenrollment rates through Medicare’s Web site. However, this information was based on disenrollment in 2004 and 2005 and, given the enrollment growth since then, may not accurately reflect plans available to beneficiaries in 2008.

What GAO Recommends

GAO recommends that CMS
(1) investigate the extent to which PFFS beneficiaries face unexpected costs for not contacting their plan before receiving care,
(2) ensure that CMS guidance on prior authorization reflects CMS policy, and
(3) mail MA plan disenrollment rates to beneficiaries, as required by statute, and update rates on Medicare’s Web site.

CMS outlined the steps it was taking to respond to all three recommendations, but did not address how it would distribute disenrollment rates.

Future of the Internet III: How the Experts See It

by Janna Quitney Anderson, Director, Imagining the Internet, Elon University and Lee Rainie, Director, Pew Internet & American Life Project December 14, 2008

A survey of internet leaders, activists and analysts shows they expect major technology advances as the phone becomes a primary device for online access, voice-recognition improves, artificial and virtual reality become more embedded in everyday life, and the architecture of the internet itself improves.

Here are the key findings in a new report based on the survey of experts by the Pew Internet & American Life Project that asked respondents to assess predictions about technology and its roles in the year 2020:

• The mobile device will be the primary connection tool to the internet for most people in the world in 2020.
• The transparency of people and organizations will increase, but that will not necessarily yield more personal integrity, social tolerance, or forgiveness.
• Voice recognition and touch user-interfaces with the internet will be more prevalent and accepted by 2020.
• Those working to enforce intellectual property law and copyright protection will remain in a continuing "arms race," with the "crackers" who will find ways to copy and share content without payment.
• The divisions between personal time and work time and between physical and virtual reality will be further erased for everyone who is connected, and the results will be mixed in their impact on basic social relations.
• "Next-generation" engineering of the network to improve the current internet architecture is more likely than an effort to rebuild the architecture from scratch.

Screening: Not All Blood Pressure Tests Are Equal

By NICHOLAS BAKALAR - Published: December 16, 2008 - New York Times

A new report suggests that only ambulatory blood pressure can predict a future heart problem.

Researchers report that only ambulatory blood pressure, readings taken with a portable device that measures pressure at regular intervals over 24 hours, can predict a future heart problem.

Studies Try to Tease Apart the Links Between Depression and Heart Disease

By NICHOLAS BAKALAR - Published: December 16, 2008 - New York Times

Three new studies have tried to explain the link between cardiovascular disease and depression and have arrived at subtly different conclusions.

A review of hospital discharge data in California revealed that interruptions in Medicaid coverage increased the risk of hospitalization for ambulator

By GINA KOLATA -Published December 16, 2008 - New York Times

For years, many doctors and patients thought colonoscopies, the popular screening test for colorectal cancer, were all but infallible. Have a colonoscopy, get any precancerous polyps removed, and you should almost never get colon cancer.

Then, last spring, researchers reported the test may miss a type of polyp, a flat lesion or an indented one that nestles against the colon wall. And now, a Canadian study, published Tuesday in the journal Annals of Internal Medicine, found the test, while still widely recommended, was much less accurate than anyone expected.

In the new study, the test missed just about every cancer in the right side of the colon, where cancers are harder to detect but about 40 percent arise. And it also missed roughly a third of cancers in the left side of the colon.

Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care-Sensitive Conditions

Andrew B. Bindman, MD; Arpita Chattopadhyay, PhD; and Glenna M. Auerback, MPH
Annals of Internal Medicine 16 December 2008 Volume 149 Issue 12 Pages 854-860

A review of hospital discharge data in California revealed that interruptions in Medicaid coverage increased the risk of hospitalization for ambulatory care–sensitive conditions such as heart failure, diabetes, and chronic obstructive pulmonary disease, which can often be managed in an outpatient setting. Hospital admissions for these conditions may signal a decline in health status among patients who no longer have access to preventive and primary care services because of an interruption in their health care coverage.

The Institute for Geriatric Social Work Receives Five-Year Continuation Grant from The Atlantic Philanthropies to Strengthen Workforce in Aging

The Institute for Geriatric Social Work (IGSW) at Boston University School of Social Work has just announced receipt of a five-year, $3.1 million grant from The Atlantic Philanthropies (AP) to continue IGSW's path-breaking efforts in preparing the social services workforce for an aging society. Since it was established with initial funding from AP in 2002, IGSW has become a national leader in provision of post-professional training in aging, improving the practice of social workers and others who care for older people and their families.

S. 3730: ‘Retooling the Health Care Workforce for an Aging America Act of 2008’

Sponsor: Sen. Herbert Kohl [D-WI]
Dec 10, 2008: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

TITLE I--AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT

Subtitle A--Health Professions Education Related to Geriatrics
Sec. 101. Geriatric education centers.
Sec. 102. Improving geriatric training for physicians, dentists, and behavior and mental health professionals.
Sec. 103. Geriatric academic career awards.
Sec. 104. Geriatric Career Incentive Awards.
Sec. 105. National Center for Health Workforce Analysis.

Subtitle B--Improved Nursing Services
Sec. 121. Comprehensive geriatric education nursing grant program.

TITLE II--AMENDMENTS TO THE WORKFORCE INVESTMENT ACT OF 1998
Sec. 201. Core services.
Sec. 202. Individual training accounts.
Sec. 203. Collaboration between State boards and the veterans agencies of the States.
Sec. 204. Collaboration between Department of Labor and Department of Veterans Affairs.
Sec. 205. Training opportunities for direct care workers.

TITLE III--AMENDMENTS TO THE OLDER AMERICANS ACT OF 1965
Sec. 301. Family caregiver training.
Sec. 302. Redesignations in provisions for multigenerational and civic engagement activities.
Sec. 303. National Resource Center on Volunteers, Students, and Seniors.

TITLE IV--AMENDMENTS TO THE SOCIAL SECURITY ACT
Sec. 401. Demonstration program for personal or home care aides, nurse aides, and home health aides in long-term care settings.
Sec. 402. Medicare family caregiver information and referral.
Sec. 403. Medicaid assessment of family caregiver support needs.

TITLE V--STUDIES AND REPORTS
Sec. 501. Studies and reports.
(a) IOM Study and Report on Mental Health Workforce Needs
(b) GAO Study and Report on the Needs of the Aging Network

(c) GAO Study and Report on the Direct Case Workforce in Long-Term Care Settings
(d) GAO Study and Report on NIH Spending and Grants

A Lifeline for Families Faces Cuts

By Robin Shulman - Washington Post Staff Writer - Sunday, December 14, 2008

In N.Y., Caregivers Grapple With Likely Loss of Programs for Dementia Patients

Sometimes it seems as though all Doreen Tiseo does is care for her 87-year-old father, who has memory loss from Alzheimer's disease. She supervises him in the shower and gives him reminders, such as "pick up the soap" and "wash your face." In the morning, she helps him dress and slips a handkerchief into his pocket. At night when he wanders, she tells him, "It's dark out, time to sleep."

But during the day, she gets a respite to go to her job as her father attends a city-funded program. It offers people with dementia and Alzheimer's art and music therapy, lunch, physical activities, and guided discussions and socializing -- critical, Tiseo says, to keeping her father alert, happy and relatively healthy.

Now, because of a budget crisis, New York City plans to eliminate funding for all 12 of these adult day-care programs at the end of this month, saving $1.2 million before the next fiscal year begins in July. The programs, which receive most of their funding from the city, are facing immediate closure unless they can raise fees dramatically or find new donors -- in a climate in which other government agencies, corporations and individuals are also cutting back. Even then, they may be able to remain open only a few days a week.
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Faced with the need to make cuts, it seemed better to "surgically eliminate" these small adult day programs, said Edwin Mendez-Santiago, who recently resigned as commissioner of the city's Department for the Aging, rather than programs such as home-delivered meals, which reach 17,000 people daily, or senior centers, which serve 20,000 each day.

Mendez-Santiago said the department's staff would help redirect the 300 or so people who attend these programs to state-funded, Medicaid or private-pay day-care programs, or to home-care options. But he acknowledged that only a portion will qualify for Medicaid and that state budgets are also facing reductions.

A City Looks To Its Moral Compass in Lean Times

By Michael Laris - Washington Post Staff Writer - Sunday, December 14, 2008

Faced with painful choices about who will suffer most from looming budget cuts, Alexandria officials have taken the unusual step of paying a professional ethicist to help them grapple with the moral issues involved.

Just a few of the vexing decisions his advice helped Alexandria policymakers confront in recent weeks: They took apartments being built for the mentally ill and temporarily turned them into housing for the disabled. They cut a parenting counselor for jailed minors with kids but preserved aid for belligerent preschoolers. They scaled back drug prevention but kept the methadone pills available to ease the cravings of withdrawal.