Monday, May 13, 2013
Medicare officials have proposed changes in hospital admission rules that they say will curb the rising number of beneficiaries who are placed in observation care but are not admitted, making them ineligible for nursing home coverage.
“This trend concerns us because of the potential financial impact on Medicare beneficiaries,” officials wrote in an announcement last week. Patients must spend three consecutive inpatient days in the hospital before Medicare will cover nursing home care ordered by a doctor.
Observation patients don’t qualify, even if they have been in the hospital for three days, because they are outpatients and have not been admitted. They also have higher out-of-pocket costs than admitted patients while in the hospital, including higher co-payments and sometimes paying exorbitant charges for non-covered drugs.
Under the proposed changes, with some exceptions, if a doctor expects a senior will stay in the hospital for less than two days (or through two midnights), the patient would be considered an outpatient receiving observation care. If the doctor thinks the patient will stay longer, the patient would be admitted.
Setting deadlines for observation stays would also limit the growing length of time of observation visits, another trend officials said were troubling.
Reaction from patient advocates, doctors and hospitals has been swift and unanimous: It’s a bad idea.
The number of observation patients has jumped 69 percent in the past five years, to 1.6 million in 2011, according to federal records. They also are staying in the hospital longer, even though Medicare suggests that hospitals admit or discharge them within 24 to 48 hours. Observation visits exceeding 24 hours have nearly doubled, to 744,748.
Officials said extended observation stays occur because hospitals are not sure Medicare will pay if patients are admitted. The proposed changes are intended to address these questions.
The proposed admission changes are part of a 1,400-page annual hospital payment update released last Friday. If adopted, the new admission rules would apply to more than 3,400 acute-care hospitals, and Medicare estimates that the change would result in 40,000 more inpatient hospital stays.
To offset the expected additional cost of $220 million, Medicare would cut hospital payments by 0.2 percent.
Joanna Kim, vice president for payment policy at the American Hospital Association, called the time factor “somewhat arbitrary.” The association also objects to the pay cut, asserting that the projected inpatient increase is not certain.
“I can’t imagine anyone is going to like this proposed rule because it makes time the determining factor in whether the services are provided on an inpatient or observation basis,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy. “It is not about what the hospital is actually doing for you, what kinds of care you need and are receiving.”
Edelman said the proposal does nothing to help observation patients because it maintains the three-inpatient-days requirement, doesn’t require hospitals to tell patients when they are held for observation and doesn’t give patients a right to appeal their observation status. The center is representing 14 seniors who have filed a lawsuit against the government to eliminate the observation care designation.
A federal judge is holding the lawsuit’s first hearing Friday in Hartford, Conn., to consider the government’s request to throw out the case because the seniors should have followed Medicare’s lengthy appeals process before going to court. On Tuesday, government lawyers submitted the proposed rules change to the judge to bolster the argument for dismissal, claiming that it clarifies “when we believe hospital inpatient admissions are reasonable and necessary, based on how long beneficiaries have spent or are reasonably expected to spend, in the hospital.”
The American Medical Association is still reviewing the proposed changes, which don’t include steps it asked Medicare to take last year: either drop the three-day policy or count observation days toward the requirement.
“This policy is of great concern to the physician community because it has created significant confusion and tremendous, unanticipated financial burden for Medicare patients,” James Madara, the AMA’s executive vice president, wrote to Medicare. He also criticized a hospital’s ability to overrule the doctor’s decision to admit a patient, which creates more confusion when the doctor bills Medicare for inpatient services and the hospital bills for observation services.
Thursday, May 9, 2013
Google announced on April 11, 2013 that they would be offering a new feature specifically for users of Gmail, Google+, Google Drive, Picasa albums and YouTube. This opportunity allows you to decide what happens to your accounts after you pass away. You can appoint a "Google heir "or choose to have your data deleted after a certain time of inactivity. To learn more about this plan for your "Digital Afterlife" see the full article here.
In addition, there are websites and products that exist to help store your growing number of passwords such as myDucks.org and LastPass.com. If you are looking for an option like Google's "Inactive Account Manager" you may consider LegacyLocker.com.
Another resource for managing your "digital ducks" is a Virtual Asset Instruction Letter (VAIL). This valuable tool exists to identify and protect your virtual assets. To learn more about the topic of virtual assets and to download a free VAIL template click here.
Monday, April 22, 2013
A federal agency is calling on the president to raise the asset limit imposed on people with disabilities receiving Supplemental Security Income for the first time in decades.
In a letter to President Barack Obama this week, the chair of the National Council on Disability, Jeff Rosen, said significant updates to the SSI program are needed.
Currently, individuals receiving SSI benefits can have no more than $2,000 to their name at any given time, a limit that’s been in place since 1989. The council is asking the president to increase the amount to $10,000 with allowances for the figure to continue to rise with inflation. Additionally, the agency wants to see adjustments made to the way that SSI benefits are impacted when an individual earns money from a job, for example.
“SSI beneficiaries face the most severe levels of poverty of any group of Social Security beneficiaries,” Rosen wrote on behalf of the council, an independent federal agency charged with advising Congress and the president on disability issues. “We urge you to incorporate common-sense program reforms to SSI designed to improve beneficiary well-being and enhance the ability of SSI beneficiaries to participate in the workforce.”
The need for change is particularly urgent, Rosen said, with individuals who have disabilities disproportionately impacted by the sequester and other federal budget cuts.
“It is vital that current law be altered to allow SSI beneficiaries to save in order to blunt the impact of current and future cuts,” he wrote, calling the reforms “long overdue.”
Beyond SSI, the National Council on Disability also urged Obama to make it easier for people with disabilities to keep Medicaid coverage even as their income rises or if they move across state lines.
White House officials did not respond to requests for comment on the recommendations.
Author: Michelle Diament - disabilityscoop.com
Tuesday, April 2, 2013
Elder Abuse and Its PreventionHosted by the Institute of MedicineApril 17-18, 2013Live Two-Day Program in Washington DC with aLive-Streaming Webcast of the Entire ProgramA detailed agenda is available on the right hand side of the program website at
The workshop is free and open to the public. Please register online for in person and/or webcast attendance. The webcast will be provided with closed captioning.
Online registration is available at www.iom.edu/ElderAbusePreventionThe Keck Center of the National Academies500 Fifth St, NW, Room 100 Washington, DCApril 17-18, 2013
Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder abuse every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults aged 65 and older continues to grow, the implications of elder abuse for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem.The Institute of Medicine will hold a two-day workshop, illuminating the burden of elder abuse around the world and the evidence base for its detection and prevention. Occurrences and co-occurrences of different types of abuse, including physical, sexual, emotional violence; neglect; and financial exploitation, will be addressed. Promising innovative approaches to intervention and prevention will be explored, as well as opportunities for scalability and cross-sectorial collaboration.Excellent Agenda and World Class SpeakersNo CLE or CEU credits are available for this program.The NLRC e-lert is a publication of the National Legal Resource Center, a collaborative effort developed by the Administration on Aging, US Department of Health and Human Services. The NLRC e-lert is produced by the American Bar Association Commission on Law and Aging in tandem with it’s NLRC partners, The Center for Elder Rights Advocacy, the Center for Social Gerontology, National Consumer Law Center, and National Senior Citizens Law Center. For more information, contact NLRC e-lert editor David Godfrey at David.Godfrey@americanbar.org.David Godfrey
American Bar Association
Commission on Law and Aging
740 15th Street NW 202-662-8694 Washington, DC 20005
Tuesday, March 26, 2013
Recently, NBC News ran a piece highlighting some technological advances in the treatment of Alzheimer's Disease. Please visit this link to learn more.
Saturday, March 2, 2013
In the wake of the January 2013 repeal of the Community Living Assistance Services and Supports (CLASS) Act, Congress legislated the formation of a bi-partisan Commission on Long-Term Care to develop a plan to make long-term care services available to elderly individuals, individuals with substantial cognitive or functional limitations, and other individuals who require assistance.
By Morris Klein, CELA, CAP
According to the National Clearinghouse for Long-Term Care Information, 70 percent of us will need long-term care services at some point during our lives after turning age 65. The cost of such care continues to increase, squeezing middle-class families.
The 2012 Met-Lifesurvey of long-term care services reports the national average daily rate for a semi-private room in a nursing home is $222, up from $214 in 2011 (a 3.7 percent increase). This report also finds that average assisted living costs have risen to $3,550 per month from $3,477 (a 2.1 percent increase).
Medicare and private health insurance do not generally help pay for such expenses. Other options to pay for assisted living and nursing home care are as discouraging. The purchase of increasingly costly long-term care insurance is not feasible for many, and it is increasingly difficult to qualify for Medicaid benefits. Moreover, government benefits programs remain biased in favor of institutionalization, in contrast to what the AARP reports are the preferences of 9 out of 10 persons to age in place at home. Family members can sometimes be left with the exhausting task of serving as caregivers at the peril of their own health and financial security. As an Elder Law attorney, I see on a daily basis the heartache families face with the many variations of the long-term care crisis.
Why the CLASS Act Failed
Congress attempted to address these problems when it enacted the CLASS Act as part of the Affordable Care Act. CLASS was intended to allow persons who voluntarily paid monthly premiums to receive modest cash payments to help pay for their long-term care services if needed later in life. Planners soon realized that CLASS was designed to do the impossible: offer excellent benefits at low cost to an unknown pool of voluntary participants. The Obama administration suspended development of the program in 2011. Recognizing the program would not work without modifications, Congress repealed CLASS in the American Taxpayer Relief Act of 2012 (ATRA). The ATRA, which delayed the fall from the “fiscal cliff,” was passed on New Years Day 2013 and signed into law the next day.
Recognizing that the provision of long-term services and supports remains an important problem, however, Congress established in the same legislation a 15-member, bi-partisan Commission on Long-Term Care to “develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports...[for] elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance...” Once formed, the commission is to submit a report within six months with recommendations for legislative or administrative action. The report will be introduced as a Senate bill if approved by a majority of the commission members. The President and the minority and majority leaders of the House and the Senate will each appoint three commission members. This will result in six Republican appointments and nine Democratic appointments. All but the President’s three appointees have been named. Among the 12 individuals announced so far is Judy Stein, the Executive Director of the Center for Medicare Advocacy and Past President of NAELA.
Many Complex Challenges
Six months is a very short time to address such a complicated problem. Some will remember the “Pepper Commission” and its valiant effort to sort through the complexities of the gaping hole in our care for older and disabled individuals. Yet the persons appointed to the Commission on Long-Term Care embody experience and knowledge of the complexities and challenges involved. We hope that the commission report will:
Recognize that our current system of provision of services and payment structure needs improvement;
Seriously consider how to add fairness to the current system that, for example, pays for expensive heart bypass surgery but not care for victims of Alzheimer’s disease;
Consider the serious ramifications of the move by many states to force all Medicaid long-term care beneficiaries into private managed care;
Consider the roles government and the private sector can play in solving problems; and
Offer meaningful proposals.
We wish the commission success. NAELA stands ready to be a resource for information and assistance to the commission as it engages in its important work.
More on NAELA’s Public Policy position on long-term care is available online.
About the Author NAELA member Morris Klein, CELA, CAP, practices law in Maryland and Washington, D.C., concentrating in Elder Law, Special Needs Law, and Estate Planning. He is a NAELA Fellow, a member of the NAELA Public Policy Committee, and has served on the NAELA Board of Directors. He is a founding member and past president of the Maryland/DC Chapter of NAELA.