Leadership Council of Aging Organizations Consensus Statement on Older Americans Act Reauthorization

Introduction by LCOA on its consensus recommendations:

The Older Americans Act (OAA) is the major federal discretionary funding source for home and community-based services for older adults. Programs supported through the OAA include home-delivered and congregate nutrition services, in-home supportive services, transportation, caregiver support, community service employment, the long-term care ombudsman program, services to prevent the abuse, neglect, and exploitation of older persons, and other supportive services. These programs provide vital support for those older adults who are at significant risk of losing their ability to remain in their own homes and communities, or who need support and protection in long-term care facilities.

In addition, OAA funds resource centers that support the work of the aging services network, these resource centers address a variety of needs, including access to benefits, elder justice, multigenerational service and volunteering, legal services, financial literacy, long-term care ombudsman training, and targeted services to minority and special populations in need.

To develop and implement the wide array of OAA services, a system of federal, state and local agencies and organizations, known as the Aging Network, was established. The core of the Aging Network is the U.S. Administration on Aging (AoA), 56 State and Territorial Agencies on Aging (SUAs), 629 Area Agencies on Aging (AAAs), 246 Title VI Native American and Native Hawaiian aging programs, and more than 30,000 community-based service provider organizations. This critical aging infrastructure is the backbone of our nation’s home and community-based long-term services and supports system offering assistance to older adults. The Aging Network’s activities also benefit other populations such as people with disabilities and caregivers.

Supported by the OAA, the Aging Network has successfully served millions of older adults in the community and in long-term care facilities since 1965, and is positioned to assist the country’s growing aging population to remain healthy, active, and in their communities. With each reauthorization, the OAA has been adapted to meet the changing needs of this growing population, the changing role of family supports, and expanding research and technological advances, often with inadequate funding. Further, the Aging Network and its services have the potential to save the Medicare, Medicaid, and Veterans Administration programs billions of dollars each year by enabling older adults to stay in their homes and communities and out of hospitals and long-term care facilities.

This current reauthorization provides an opportunity to reassess the successes and shortcomings of the OAA’s ability to serve older Americans, particularly those with the greatest social and economic need. In these times of fiscal restraint, the Leadership Council of Aging Organizations (LCAO) offers in this document recommendations for improving the efficiency and effectiveness of the OAA in its delivery of core services and how it interacts and coordinates with other federal programs that serve older adults.

In order to maximize effectiveness, community-based services provided through the Aging Network must be coordinated and integrated with the various federal health care services that older adults receive. In addition, they must work hand in glove with other programs at the state and federal levels such as the Low-Income Energy Assistance Program (LIHEAP), fraud prevention programs, Senior Corps and other programs promoting community service, transportation programs, the State Health Insurance Assistance Program (SHIP), the Adult Protective Services Program and other elder abuse-related programs.

The goal of the following LCAO recommendations is to authorize the AoA, the Assistant Secretary, and the programs and staff across the nation to fulfill their promise by giving them the tools, direction and flexibility to provide the services that the aging population of our nation demands. Our focus is on person and family-centered care with local flexibility to serve the needs of unique communities and sub-populations. LCAO’s recommended improvements do not require major changes to the OAA’s core services or eligibility requirements. LCAO strongly believes that increasing the authorized funding for all titles of the OAA is necessary; however, provision of adequate funding is just one of the ways that we propose to improve and expand services. Additionally, any new programs added to OAA should be given specific authorization levels.

With the population of older individuals expected to grow exponentially in the coming years, the aging network faces incredible challenges associated with the influx of older individuals into OAA programs. The LCAO, which has played a significant leadership role in past reauthorizations, is committed to a reauthorization that will strengthen the OAA for both the older adults currently receiving services and for the boomers who, in 2011, have begun turning 65 years of age.

We urge Congress to update and improve the Older Americans Act, while providing the funding needed for OAA programs to keep older Americans independent and productive, thereby saving federal and state government resources. Therefore, the LCAO makes the following recommendations to strengthen and enhance the OAA.

Full Document

New York City Council Cuts Health Ombudsman Program - NYTimes.com

By ANEMONA HARTOCOLLIS

A program that for a decade helped New York City’s poor and elderly navigate their way through insurance problems — and that became a model for a similar federal program — has become a casualty of city budget cuts, an administrator of the program said on Thursday.

The $4 million program sent ombudsmen to 25 social service agencies across the city, including the Legal Aid Society and agencies serving Latino, Asian, Polish and Jewish communities across the city.
Those ombudsmen were trained to help people obtain insurance, get health services and contest claims that had been denied by insurance companies and hospitals. The program helped about 10,000 people a year, said David R. Jones, president of the Community Service Society, which administered it.

New York City Council Cuts Health Ombudsman Program - NYTimes.com

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

Medicare Counseling for Individuals

Do you need individual counseling? Call the Medicare Rights Center's consumer hotline at 800-333-4114, between 9 a.m. and 5 p.m., Eastern Time, Monday through Friday. A Medicare counselor will be happy to answer your question. You can also call your State Health Insurance Assistance Program (SHIP) for personal counseling on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare or applying for Extra Help!

Medical bills pinch elderly

Thomas Goldsmith, Staff Writer Raleigh News & Observer Costs not covered by Medicare can eat up their income, assets and even the house Jake Smith, a man who's good for what he owes, sold his paid-off home of 33 years recently to settle about $15,000 in medical debt that wasn't covered by Medicare. Smith, 80, a retired truck driver who volunteered for the Navy at age 17, is among the more than one in 10 older Americans whose only medical insurance is basic Medicare. The federal program pays a portion of doctor and hospital bills, but leaves the rest to patients. .... Jake Smith's wife, Christine, died of cancer last year. Selling the home they shared -- and moving to senior housing downtown -- was the only way he could catch up on the bills from doctors and Duke Hospital for her past care. ... Older people in North Carolina are increasingly faced with high out-of-pocket health-care costs even though they are covered by Medicare, the federal health-care insurance for seniors. State health-insurance counselors say the number of questions they receive about coverage under basic Medicare has more than doubled -- to more than 1,200 a month -- during the past three years.

H.R. 6331: Medicare Improvement for Patients and Providers Act of 2008

This bill has passed the House and Senate and is now awaiting the President's signature.

Medicare Improvements for Patients and Providers Act of 2008 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for coverage of additional preventive services.

• Provides for gradual elimination of copayment rates for Medicare psychiatric services.
• Places prohibitions and limitations on certain sales and marketing activities under Medicare Advantage (MA) plans and prescription drug plans.
• Requires offering of a range of Medicare supplemental policies.
• Extends the qualifying individual program.
• Provides for application of a full low-income subsidy assets test under the Medicare Savings Program.
• Eliminates Medicare part D (Voluntary Prescription Drug Benefit Program) late enrollment penalties paid by subsidy-eligible individuals.
• Directs the Secretary of Health and Human Services to make grants to states for state health insurance assistance programs, area agencies on aging, and aging and disability resource centers.
• Authorizes the Secretary to award grants to states for increasing the delivery of mental health services or other health care services to meet the needs of veterans of Operation Iraqi Freedom and Operation Enduring Freedom living in rural areas.
• Permits rebasing for sole community hospitals.
• Directs the Secretary to establish a demonstration project for development and testing of new community health integration models in certain rural counties.
• Amends the Tax Relief and Health Care Act of 2006, as amended by the Medicare, Medicaid, and SCHIP Extension Act of 2007, to extend through FY2009 the reclassification of certain hospitals.
• Increases physicians' payments. Revises requirements for and extends the quality reporting system, including incentive payments.
• Directs the Secretary to establish a Physician Feedback Program. Provides for: (1) incentives for electronic prescribing of medicine; (2) expanded access to primary care services; (3) extension of the floor on Medicare work geographic adjustment under the Medicare physician fee schedule; and (4) an accreditation requirement for advanced diagnostic imaging services.
• Revises requirements for Medicare anesthesia teaching programs.
• Makes permanent the exception to the 60-day limit on Medicare reciprocal billing arrangements between two physicians over a longer continuous period during all of which one of them is ordered to active duty as a member of a reserve component of the armed forces.
• Provides for coverage of pulmonary and cardiac rehabilitation.
• Extends increased Medicare payments for ground ambulance services.
• Amends the Public Health Services Act to direct the Secretary to establish pilot projects with respect to chronic kidney disease.
• Revises requirements for renal dialysis.
• Amends title XVIII (Medicare) of the Social Security Act to delay generally until after 2011 full implementation of the Medicare competitive acquisition program for the purchase of durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS).
• Revises such program, dividing its implementation into two rounds, and specifying covered item updates for 2009-2014.
• Directs the Secretary of Health and Human Services to provide for a competitive acquisition ombudsman within the Centers for Medicare & Medicaid Services to respond to complaints and inquiries by suppliers and individuals.
• Provides for phase-out of indirect costs of medical education from capitation rates.
• Revises requirements for MA private fee-for-service plans as well as MA plans for special needs individuals.
• Modifies requirements for quality improvement programs.
• Requires prompt payment of clean claims by prescription drug plans and MA-Prescription Drug plans under Medicare part D.
• Revises the definition of medically accepted indication for drugs.
• Directs the Secretary to: (1) contract with a consensus-based entity for certain activities relating to health care performance measurement; and (2) evaluate and report to Congress on approaches for the collection of data regarding health care disparities.
• Creates the Medicare Improvement Fund.
• Extends the transitional medical assistance (TMA), the abstinence education program, and allotments for disproportionate share hospitals (DSHs) under SSA title XIX (Medicaid).
• Amends the Deficit Reduction Act of 2005 to extend supplemental grants under SSA title IV part D (Temporary Assistance for Needy Families) (TANF).
• Amends the Public Health Service Act to extend special diabetes grant programs.

Revisions to Payment Policies for Physician Fee Schedule and Other Revisions to Part B for CY 2009; Amendment of the E-Prescribing Exemption

SUMMARY: This proposed rule would address proposed changes to Medicare Part B payment policy. We are proposing these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This proposed rule also discusses refinements to resource-based practice expense (PE) relative value units (RVUs); geographic practice cost indices (GPCI) changes; malpractice RVUs; requests for additions to the list of telehealth services; several coding issues; payment for covered outpatient drugs and biologicals; the competitive acquisition program (CAP); application of health professional shortage area (HPSA) bonus payments; payment for renal dialysis services; performance standards for mobile independent diagnostic testing facilities; and physician and nonphysician practitioners furnishing diagnostic testing services;

a proposed amendment to the exemption for computer-generated facsimile transmissions from the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard for transmitting prescription and certain prescription-related information for Part D covered drugs prescribed for Part D eligible individuals;

conforming and clarifying changes for comprehensive outpatient rehabilitation facilities (CORFs); revisions for rehabilitation agencies; therapy-related technical corrections; the physician quality reporting initiative; physician self-referral issues and anti-markup; beneficiary signature for nonemergency ambulance transport; the chiropractic services demonstration; educational requirements for nurse practitioners and clinical nurse specialists;

the expiration of provisions of the Medicare, Medicaid, and SCHIP Extension Act of 2007; bonus payments for long ambulance transports; update for clinical laboratory fees under the clinical laboratory fee schedule; physician certification/recertification for home health services; a prohibition concerning providers of sleep tests; organ retrieval; a revision to the ``Appeals of CMS or CMS contractor Determinations When a Provider or Supplier Fails to Meet the Requirements for Medicare Billing Privileges'' final rule; and, potentially misvalued services under the physician fee schedule.