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  • 18May

    2015 marks the 50th anniversary of Medicare, Medicaid, and the Older Americans Act, as well as the 80th anniversary of Social Security. It also marks the year of the next White House Conference on Aging. These conferences provide an opportunity to recognize these these key programs and to look ahead at the issues and solutions to help create a healthy landscape for older Americans for the next decade.

    In the past, conference processes were determined by statute with the form and structure directed by Congress through legislation authorizing the Older Americans Act. While Congress has not yet reauthorized the Older Americans Act, the White House is still committed to hosting a White House Conference on Aging (WHCoA) in 2015 (date for the in person part of the conference in D.C. has not yet been set). WHCoA is also hosting several regional forums (such as the one held in Seattle on April 2) and intends to seek broad public engagement and use web tools and social media to encourage as many older Americans as possible to participate. (See the Get Involved section of the WHCoA website to sign up for their email updates and share your story, concerns and ideas.)

    The 2015 White House Conference on Aging has picked 4 top areas of concern and innovation for our country’s older adults. These areas are: healthy aging, long-term services and supports, elder justice, and retirement security. Below is a short excerpt from the WHCoA website on a policy brief on each topic with a link to the full report.

    Healthy Aging Policy Brief

    Older Americans are calling for a shift in the way we think and talk about aging. Rather than focusing on the limitations of aging, older adults across the nation want to focus instead on the opportunities of aging. Older adults are seeking ways to maximize their physical, mental, and social well-being to remain independent and active as they age.


    Long-Term Services & Supports Policy Brief

    Despite efforts to stay healthy and prevent disease, many older adults will eventually develop some degree of limitations and need additional paid or unpaid help with basic daily living activities.

    Long-term services and supports help older adults and people with disabilities accomplish everyday tasks such as bathing, dressing, preparing a meal, or managing money. These services include health and social services that may be needed to maximize the independence and well-being of an individual. Individuals of all ages may have functional limitations, but these limitations are most prevalent among adults age 65 and older.


    Elder Justice Policy Brief

    As Americans live longer and technology becomes increasingly sophisticated, older Americans face new challenges and opportunities. While technology is helping individuals to live longer and healthier lives, older Americans may be susceptible to financial exploitation and other forms of elder abuse.

    Elder abuse is a serious public health problem affecting millions of older Americans each year, with some studies suggesting that as few as one in 23 cases is reported to authorities. Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm to an older person (whether or not harm is intended). Elder abuse encompasses physical abuse, neglect, financial exploitation, sexual abuse, as well as emotional and psychological abuse.

    Retirement Security Policy Brief

    Americans are living longer than ever before. In 2012, life expectancy at birth in the United States reached a record high of 78.8 years. A 65 year-old man can expect to live another 17 years and a 65 year-old woman another 20 years. As a result, older Americans have more time to help grow the economy, enrich their communities, and enjoy their families. But longer lives can also challenge older Americans’ financial security, increasing the risk of outliving their assets.

  • 20Feb

    Earlier this month the President released his Fiscal Year 2016 budget. With respect to Medicare, it is similar to last year’s budget, with both good provisions and not-so-good provisions that shift more costs onto beneficiaries. Below are some brief highlights of both the proposals we support and those we are concerned about. For a more full analysis and overview of the President’s budget, see the Kaiser Family Foundation’s summary.

    Proposals we support

    • Increased Part D drug discounts and closing the Part D donut hole gap 3 years early by 2017: The proposed budget would increase manufacturer discounts for brand-name drugs in the Part D coverage gap to 75% (up from 50%), thus closing the gap for brand-name drugs by 2017. This is 3 years earlier than it’s currently scheduled to close.
    • Prevent “pay to delay”: Would prohibit the common practice of brand name drug makers from paying other companies to delay introducing their generic equivalents into the marketplace, thus delaying more affordable medication options. It would also shorten the length of exclusivity for biologics from 12 years to 7 years.
    • Prescription drug rebates: Would require drug manufacturers to provide rebates on behalf of beneficiaries with the Part D Extra Help (low-income subsidy) that are at least equal to Medicaid rebate levels, and to provide an additional rebate for brand-name and generic drugs whose prices grow faster than inflation, beginning in 2017.
    • Elimination of 190-day cap on inpatient psychiatric care: Would eliminate the 190-day lifetime limit on inpatient psychiatric facility services.
    • Extension of Qualified Individual program: Would extend the QI program to pay Part B premiums for qualified individuals (QIs) through 2017. The QI program is currently authorized through March 31, 2015.
    • Expanded dialysis services: Would expand Medicare’s coverage of short-term scheduled dialysis services for those with acute kidney injury.
    • Improved accuracy of payments to Medicare Advantage plans: Would improve monitoring system to prevent upcoding of making patients look more sick than they are.

    Proposals we’re concerned about

    • Increased income related premiums under Medicare Parts B and D: Under Medicare Parts B and D, certain beneficiaries pay higher premiums based on their higher levels of income. Beginning in 2019, this proposal would restructure income-related premiums under Medicare Parts B and D by increasing the applicable percent for calculating the lowest income related premiums by five percentage points, from 35% to 40% of program costs, and creating new tiers every 12.5 percentage points until capping the highest tier at 90%. The proposal maintains the current income thresholds associated with these premiums until 25% of beneficiaries under Parts B and D are subject to these premiums. This proposal claims it would help improve the financial stability of the Medicare program by reducing the federal subsidy of Medicare costs for those who need the subsidy the least.
    • Increased Medicare costs and Part B premiums: Would introduce a Part B premium surcharge for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, starting in 2019. Other Medigap plans that meet minimum cost-sharing requirements would be exempt. The surcharge would be equivalent to approximately 15% of the average Medigap premium (or about 30% of the Part B premium).
    • Increased Part B deductible: Would apply a $25 increase to the Part B deductible in 2019, 2021, and 2023 respectively for new beneficiaries beginning in 2019. Current beneficiaries or near retirees would not be subject to the revised deductible.
    • Increased Part D copayments for some people with Part D Extra Help: Would double the copayment amounts for brand name drugs that have generic equivalents as a way to encourage the use of lower cost generic drugs. With a successful appeal, a beneficiary could get the copayment back to current amount. This policy would exclude low-income beneficiaries receiving institutional care.
    • Introduction of Home Health copayments for new beneficiaries: Would create a copayment for new beneficiaries of $100 per home health episode, starting in 2019. This copayment would apply only for episodes with 5 or more visits not preceded by a hospital or inpatient post-acute stay.
  • 11Feb

    Below is a New York Times commentary on Steven Brill’s book, America’s Bitter Pill, a thought provoking and provocative view on some of the more hidden reasons how and why this legislation came about.

    Anatomy of a Health Care Mess

    Never sign up for a tour of the sausage factory, not if you want to keep eating sausage. In the case of health care, unfortunately, no one gets to abstain. Journalists and legislators, doctors and nurses, reformers and reformed alike, all eventually land on the conveyor belt that feeds those grinding gears.

    Is it better to go through the machinery with some understanding of how it works (or doesn’t)? Individual preferences will vary. For those who believe forewarned is forearmed, the veteran journalist Steven Brill has put together a comprehensive and suitably furious guide to the political landscape of American health care circa 2014 — a tour de force inspection of both sausage and factory.

    Mr. Brill began his muckraking early in the rollout of the Affordable Care Act, with a comprehensive indictment of American health care costs that occupied an entire issue of Time magazine in early 2013. He continued to comment in the pages of Time on the disastrous debut of the act’s health insurance marketplaces that fall and the widespread repair work that still continues.

    All this reporting reappears in the book, sometimes verbatim, reframed by several new sections. At the beginning comes a long back story detailing the years of politicking that created the new legislation. At the end, Mr. Brill offers a series of personal insights provoked in large part by his recent, unexpected detour from reporter to patient, and suggestions for how it might all be fixed.

    Full disclosure here:  It became clear early in the creation of the Affordable Care Act that my definition of the word “reform” differed substantially from that of our political leaders.  After that, I stopped paying a lot of attention to the political Kabuki — a disgraceful if all too common reaction among us beleaguered sausage-makers.

    Hence, I cannot assess the accuracy of Mr. Brill’s account of the negotiations that created Obamacare, but I found it persuasive, shocking and very sad. It is not an easy story to follow, a little like plowing through a long description of every can of paint flung onto a Jackson Pollock canvas. Still, the difficulty and occasional tedium of the narrative themselves inform the subject.

    As Mr. Brill tells it, the legislation was from the very beginning all about profit, with all the relevant industries, from insurers to drug makers to hospitals, methodically seduced aboard with promises of big returns. The politicos spoke of broader insurance coverage, but what they actually meant was more health care dollars to spread around. The nonprofit “public option” never had a chance, and vanished.

    The final legislation was a truly remarkable triumph of fiscal diplomacy. No wonder the act’s political parents were so exhausted by its creation that implementation took second place. The initial result: a deeply flawed federal enrollment website and phone banks of confused people diligently dispensing misinformation. Mr. Brill details these mishaps in full, along with the months of mopping up required.

    He revisits the sick people he came to know across the country to examine the legislation’s effects. In Kentucky, a state with a great deal of chronic illness and a seriously underinsured population, the new insurance options were deployed smoothly, and have clearly improved life for many residents. Elsewhere, confusion reigns on.

    For unintentional comic relief, Mr. Brill also details the 2013 creation of a cool New York insurer, Oscar, named after the great-grandfather of one of its founders. Devised by hipsters for their peers, Oscar aced all the start-up tasks that bedeviled the feds, with smoothly functioning technology and appealing branding. Its young proprietors were jazzed when the premiums started pouring in, then more than a little taken aback when they actually had to start paying some gigantic medical bills.

    That’s the health business for you — totally awesome till someone goes and gets sick. Mr. Brill’s own perspective took a similar lurch when in the spring of 2014 he underwent repair of an aortic aneurysm, an expensive and complicated procedure. As a patient, he writes, “I was anything but the well-informed, tough consumer with lots of options that a robust free market counts on. I was a puddle.”

    That is the fatal flaw in market-based medical care: Patients and their relatives simply cannot be savvy shoppers. Their attentions are elsewhere.

    Mr. Brill’s solution is born in large part from his gratitude that his surgery at one of New York’s premier teaching hospitals went very well. He suggests: Why not allow these giant academic medical centers, most of them smoothly run by physician-executives, to insure themselves, sweeping up smaller nearby facilities into networks of care? The plan would cut out some middlemen, reduce some bureaucratic expense, and the medical background of those in charge would ensure a patient-centered ethos. These would be “regulated oligopolies,” in Mr. Brill’s phrase, with heart and soul.

    His idea has some precedent in nonacademic insurer-provider organizations like California’s Kaiser Permanente. Some large teaching centers are already headed in this direction. Whether a more humane, less pricey marketplace will result remains to be seen, one obvious caveat being that, for all of Mr. Brill’s illusions, physician-executives are hardly immune to corruption, hubris and greed.

    As for that other definition of the word “reform,” the one that would transform American health care into a tightly controlled nonprofit commodity funded by a single payer, Mr. Brill emphatically sounds its knell, providing 500 pages of convincing evidence that it is never going to happen.

    See our Health Care Reform news articles and blogs for more info on the Affordable Care Act and how it relates to Medicare.

  • 12Jan

    Below is a notice from the Centers for Medicare and Medicaid Services (CMS) regarding taxes and Obamacare health coverage tax credits for those who purchased a plan in the Marketplace in 2014.

    Consumers may need help making the connection between Marketplace premium tax credits and filing their taxes.

    Many are unaware that they:

    1. Must reconcile their tax credits or claim tax credits for the first time
    2. May have to pay a fee if they are uninsured, or
    3. May qualify for an exemption from the fee.

    It’s important for people to know that If anyone in their household enrolled in a health plan through the Health Insurance Marketplace in 2014, they’ll get a new Form 1095-A — Health Insurance Marketplace Statement.  The form will be mailed in early February for them to use to file their 2014 federal income tax return.

    Remind them to keep this form with their other important tax information, like W-2 forms and other tax records.  They’ll get a Form – 1095-A even if a member of their household only had Marketplace coverage for part of 2014.  They won’t get this form if no one in the household is enrolled in a Marketplace Qualified Health Plan.

    Visit to learn more about how health coverage affects your 2014 federal income tax return.

  • 11Dec

    Health Insurance Explained is Kaiser Family Foundation’s newest release of their YouToons cartoons. It helps the public understand and navigate the new health coverage available through the Affordable Care Act, also referred to as Obamacare. In a short 5 minutes, viewers are both entertained and taken through various scenarios that cleverly demonstrate factors to consider when choosing a plan. They remind viewers that low premiums can be deceptive as those plans often have high deductibles. They also encourage people to know: what your plan covers and what you pay; what providers/facilities are considered in-network with your plan and what aren’t; and the price difference between brand name and generic drugs.

    While people with Medicare don’t need to purchase this insurance, many people approaching Medicare age without other insurance may need to purchase new coverage through the Marketplace. For additional resources, see:

    • 300 FAQs for consumers about the ACA
    • a short 10-question quiz, and
    • a Health Insurance Marketplace Calculator (updated with 2015 premium data).

    All of these tools are written and produced by the Kaiser Family Foundation to help consumers across the U.S. better understand health insurance. They are also all available in Spanish.

    For those of you on Medicare with questions about Medicare and the Covered California (the health insurance marketplace in our state), see our article: Medicare & Covered California ~ Get Your Questions Answered.

  • 24Apr

    The Centers for Medicare and Medicaid Services (CMS) will be phasing in fingerprint-based background checks this year for certain providers as a way to slow and prevent rampant fraud. These background checks will initially be applied to those durable medical equipment, prosthetics, orthotics and supplies providers and home health agencies trying to enroll in Medicare and will remove the “fraudsters” already enrolled. In the future, CMS will also apply the fingerprint-based background check requirements to those providers considered to be “high-risk.” These efforts stem from the Affordable Care Act’s provisions to augment Medicare’s enrollment screening.

    recent article in Fierce Health Payer Anti-fraud’s online newsletter states:

    CMS will send notification letters to affected providers with contact information for the fingerprint-based background check contractor. Providers will be required (generally just once) to pay for and undergo fingerprinting.

    The contractor will collect fingerprints and send them to the FBI for processing. Within 24 hours of receipt, the FBI will compile a background history. CMS will assess the data and either approve the provider application or exercise authority to deny the application or revoke Medicare claims filing privileges.

    For more information on this new background check requirement, see CMS’ Medicare Learning Network Matters notice: Implementation of Fingerprint-Based Background Checks (pdf).

  • 07Apr

    In this 22-minute video below, the Office of Inspector General’s (OIG) leadership discuss their priorities in 2014, including how the OIG will fight fraud, waste and abuse, promote quality, safety and value while ensuring the future of Health and Human Services programs.

    OIG oversees the complex world of the government’s health care programs, and their 2014 work plan provides the blue print of their oversight and enforcement efforts. As it is a time of great transition, a good portion of oversight is focused on the new health care market places, particularly on:

    • Payment accuracy
    • Eligibility controls
    • Contracting oversight and
    • Privacy and security issues

    In the short video, the OIG elaborates on their goals for 2014 and beyond, including:

    • Fighting fraud waste and abuse — such as prescription drug fraud and fraud in home and community-based services.
    • Promoting quality, safety and value. A key focus is on the quality of care in nursing homes and addressing the unacceptable reality of how often beneficiaries are injured or harmed during their nursing home stays.
    • Securing the future of Health and Human Services programs, of which Health IT is big priority.

    See the video below and read the OIG’s 2014 Work Plan (pdf) for more information.

  • 02Apr

    The infographic below effectively highlights some of the failures of our own health care system. While the U.S. has some of the highest health care costs, it is not even ranked in the top 50 countries for life expectancy. This begs the important question of: “If all this money being spent is not being used to increase quality of life or life expectancy, then where is it going?”  The infographic, contributed by Best Nursing Masters, concludes with identifying some of the common traits found in the residents of countries with the highest life expectancy, and encourages people to turn away from looking for a “cure” for symptoms, and instead to focus on developing healthy lifestyles.

    Healthcare Spending

  • 22Jan

    As of January 1 of this year, Medicare pays the same amount for outpatient mental health care treatment as it does for other covered medical services. Medicare pays 80% of the approved amount for care, and the beneficiary or his/her supplemental insurance pays the other 20%. This is a significant improvement from the 50% coverage Medicare provided in the past, and is great news for many elders seeking treatment for depression, anxiety and other mental health conditions.

    Since the program’s inception, Medicare had paid a smaller portion of the bill for treatment from psychiatrists, psychologists or clinical social workers than it did for medical services. It has also imposed strict lifetime limits on psychiatric hospitals stays (no more than 190 days – and this restriction still stands), though it has no such limits to medical care received in inpatient facilities.

    In 2008, however, Congress passed the Medicare Improvements for Patients and Providers Act. This law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time. In 2008, Medicare covered only 50% of the bill, last year Medicare covered 65%, and as of January 1, 2014, Medicare now covers 80% of bill for covered treatment (after the annual deductible of $147 is met).

    This Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.

    For more info on the Mental Health Parity Act, see the article: Sebelius Releases Final Rules for 2008 Mental Health Parity Act. Also see the article: Medicare Requires Mental Health Parity.

  • 13Dec

    The federal government is giving people enrolled in the Pre-existing Conditions Insurance Plan (PCIP) an extra month, until January 31, 2014, to sign up for coverage through the health exchange, or Covered California in our state. This transitional month of coverage allows people more time to review Marketplace plan options and enroll in the coverage that best meets their needs. The government will notify PCIP enrollees by mail of this extended coverage offer, along with details about cost-sharing. Eligible enrollees can purchase this 31-day PCIP transitional coverage by sending in a January premium payment. The premium rate is the same as what they paid for December 2013.

    California has the highest number of PCIP enrollees out of all all 50 states: 16,060 or 15%. The next state is FL at 10,402. Here’s the enrollment numbers from the Centers for Medicare and Medicaid Services.

    For more information, see Kaiser Health News’ article: Thousands in Obamacare’s High-Risk Pools Get Month’s Reprieve.

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