Category Archives for Rhode Island General Assembly

Statehouse Rally Calls for Passage of Nursing Home Payment Reforms

Published in Pawtucket Times on June 9, 2003

In the final days of this year’s legislative session, the Coalition to Ensure Funding for Quality Long-Term Care rallied its troops at the Statehouse rotunda to push for the passage of two legislative proposals that would fix an ailing Medicaid reimbursement system.

The goal of last Wednesday’s rally was to keep the Coalition’s two legislative proposals on the radar map of the Rhode Island General Assembly, which has been bogged down with a multitude of heated legislative issues – separation of powers , fire code changes, smoking bans in restaurants to name a few.

Even with an expected $ 225 million budget deficit for fiscal year 2004, the long-term care advocates, including provider groups, consumer advocates, state policy makers and legislators, urged lawmakers to pay a fair Medicaid rate for nursing facilities, required by state and federal law to provide quality of care to 9,000-plus vulnerable Rhode Island seniors who need intensive, 24-hour-a-day care.

Rally supporters gave a thumbs-up to two legislative proposals ( H 5803/ S 0899). The companion bills, if enacted would revise the state’s Principles of address the inadequate funding of the state’s nursing facilities.

The two legislative proposals, still in the House and Senate Financial Committee, reflected the findings of an 18-month study of B.D.O. Seidman, a consulting firm hired by the state Department of Human Resources to re view and recommend fixes to the state’s flawed reimbursement system.

A major finding of this state-financed study found that the state was underpaying facilities in excess of $ 29 million annually.

These bills call for an additional $ 14 million to state funding for Medicaid reimbursement to nursing facilities. With the infusion of state dollars, the federal government would then kick in $ 16 million for a total increase of $ 30 million.

Eighty percent of the state’s nursing facility residents rely on the Medicaid program to pay for their care, John Gage, administrator of the Coventry-based Riverview Health Care Community and a Coalition member, told those who intended the rally.

Many facilities are left struggling to remain open because Medicaid does not pay for the actual cost of care, he said, noting a number of Ocean State nursing facilities have already filed for bankruptcy of receivership, and some are even closing their doors.

An inadequate reimbursement rate continues to fuel Rhode Island’s critical nursing shortage, too, said Gage. Due to the current  reimbursement system, facilities are hard-pressed to come up with the necessary funds for increases in salaries and benefits to retain nursing staff.

Lt. Gov. Charles Fogarty, who chairs the state’s Long-Term Care Coordinating Council, warned the crowd that Rhode Island’s nursing home industry “is on verge of a meltdown.”

He- along with Sen. Stephen D. Alves (D-West Warwick) and Rep. Steven M. Costantino (D-Providence), sponsors of the Coalition’s nursing home payment reform bills – urged Gov. Donald Carcieri and House and Senate leaders to include funding in the fiscal year 2004 budget to begin the steps needed for Medicaid reform.

Throughout the afternoon rally, until 6:00 p.ml, the Coalition gathered hundreds of signatures to support efforts to increased Medicaid reimbursement to nursing facilities.

Meanwhile, posters strategy placed outside the House and Senate chambers illustrated the rally supporters point that the state is not paying enough for care  of family members in nursing facilities.

At one poster site, piles of dirt were placed on a 6-foot table.  A  poster said: “Did you know this mulch topsoil costs more than $ 5.63 – that’s more than the Medicaid system’s pay for an hour’s worth of nursing facility care for your loved one.  Isn’t your grandmother’s care worth more than the cost of a pile of dirt.”

In a previous All About Seniors column, this writer called for lawmakers to fix the state’s flawed Medicaid reimbursement system once and for all.

The legislative session will soon be ending, and immediate action must be taken now by lawmakers to pass the Coalition’s two legislative proposal, with Gov. Carcieri hopefully signing the bills into laws.

State policy makers must no longer use a Band-Aid approach to fix  broken Medicaid payment system, especially with the graying of the Ocean State’s population. A growing number of Rhode Islanders will soon require this level of intensive care.

It’s time for lawmakers to ratchet up the Medicaid rates to pay for actual costs of care, allowing facilities to deliver quality services.

Lawmakers to Consider Funding for Vaccine Immunizations for Seniors

Published in Pawtucket Times on May 12, 2003

Even with a state budget deficit looming, sometimes putting a little money into a statewide initiative can ultimately save big dollars.  It’s just the right thing to do.

For the second year, the Ocean State Adult Immunization Coalition (OSAIC) has approached the Rhode Island General Assembly for funding to promote the group’s efforts to get the word out about the importance of Rhode Island seniors  getting influenza and pneumococcal vaccinations.

OSAIC’s message is quite simple: “Avoid a Hospital Stay: Get Your Flu Shot Now!”

According to OSAIC, pneumonia and influenza deaths together are considered the six-leading cause of death in the nation.

Since 1999, there have been 300 deaths and 6,800 hospitalizations that were attributed to influenza and pneumococcal disease in the Ocean State.

OSAIC said vaccinations are a cost-effective way to prevent these unnecessary hospitalizations and deaths.

OSAIC, a coalition of 40 agencies, including hospitals, nursing facilities, vaccine manufacturers, medical societies, managed care groups, the Rhode Island Department of Health, Rhode Island Quality Partners, the Visiting Nurses Association, and Blue Cross Blue Shield of Rhode Island, call on Gov. Don Carcieri and lawmakers to see the big picture – preventative medicine care can ultimately save tax dollars.

Anne Marie Beadsworth, OSAIC’s chair, said the cost of a flu shot is $ 15 and a pneumonia shot is $ 30.

On the other hand, she added that the average length of stay for an older person with influenza is five days, costing $ 12,000.

Since OSAIC was established in 1997, Beadsworth has seen a steady progress in the coalition’s efforts to get more older Rhode Islanders immunized to prevent the influenza and pneumonia.

“The immunization coverage rates for those age 65 and over has increased by eight precent (from 67 percent to 75 percent) for influenza vaccine and 24 percent (from 43 percent to 67 percent) for pneumococcal vaccine,” she noted.

Beadsworth said OSAIC is working to reach the Healthy People 2010 goal of a 90 percent immunization rate for influenza and pneumococcal  for people age 65 and over.

“Through promotional efforts in five languages in 2002, more than 350 flu clinics were conducted throughout Rhode Island with the guarantee that any person age 65 and older, regardless of insurance status, could get a flu shot without any out-of-pocket expenses,” she said.

Furthermore, OSAIC’s gains have propelled the Rhode Island-based initiative into top 10 standings in the United States, says Beadsworth.

“We rank number seven for both flu and pneumococcal vaccination rates,” she added.

Beadsworth said that during last year’s legislative session, OSAIC’s efforts for the state funding fizzled because of state funding fizzled because of state budget cuts. The coalition was just not effective in getting its message out to lawmakers, she added.

During this year’s legislative session, OSAIC is pushing for $ 103,169 in new funding in Fiscal Year 2003-2004 to expand the coalition’s educational outreach efforts and to hire a part-time staffer to oversee its ongoing programs to improve the state’s immunization rates.

Currently, OSAIC is a volunteer-driven organization with its $ 50,000 working budget coming from member organizations and from the community.

It seems things may be different this year at the Rhode Island General Assembly. Support among lawmakers is growing for OSAIC’s ongoing preventative medicine initiatives.

“Quite a few advocates are coming to the Senate asking for funding,” said Sen. Stephen D. Alves (D-West Warwick), who said there is now growing support for OSAIC’s funding request.

Alves, who serves as chair in the Senate Finance Committee, told All About Seniors the funding request will be brought up during the chamber’s budget debates.

“Everyday, we talk about preventative medicine – funding this program is a step in the right direction,” said Alves.

Rep. Steven M. Costantino (D-Providence), who sits on the House Finance Committee, told me he sees the value of OSAIC’s efforts, too, and plans to call for funding OSAIC’s initiative during House budget deliberations.

Health Director Patricia A. Nolan also sees the positive benefits of OSAIC’s prevention campaign.

“Adults need their shots, too – especially people aged 50 and older or people with chronic health conditions. Vaccinations are one of the easiest and most effective ways to stay healthy,” she says.

As state revenue estimators meet to determine the breath and scope of the state’s budget deficit, Gov. Carcieri’s staff continue their ‘Big Audit” to identify ways to save taxpayer dollars.

When the dust settles, even with a projected budget deficit, it may be time for the governor and the General Assembly to view preventative medicine as a worthy cost containment approach for reining in skyrocketing health care costs. Even though state dollars have to be allocated up front, large savings might be realized down the road.

As the state’s final budget is being crated, we must not be “penny wise but pound foolish” when determining what bills live or die in the 2004 legislation hopper. Taxpayers will ultimately lose if this happens.

Fix the Nursing Facility Problem Once and For All

Published in Pawtucket Times on April 28, 2003

Forty-years ago, the Senate Aging Committee hearings put the spotlight on the poor care provided in the nation’s nursing facilities.

This month, the April 2003 special issue of “the Gerontologist” sends the troubling message that nationwide improvement in nursing facility care is not likely.

Despite substantial regulatory oversight, Joshua Wiener, of the Urban Institute said “quality of care in nursing homes remains problematic. Quality of care in nursing facilities remains a problem for which there are not simple solutions.”

Before this national crisis can e directly confronted, increased staffing and raising the wages of nursing facility workers appear to be necessary preconditions for improving care quality and should receive high priority, said Weiner. (Rhode Island nursing facility providers hold similar beliefs and have called on Gov. Don Carcieri and state lawmakers to provide the necessary funding to raise facility worker’s wages.

The article’s written by 14 prominent policy experts in this special issue – “The Challenges in Nursing Home Care” – address central concerns in nursing facility care and help provide answers to questions, such as how these facilities can be financed and how care can be delivered.

The articles in this issue are the result of a conference held at Florida State University that was sponsored in part by the National Institute on Aging.

Dr. Quadagno and Dr. Stahl, guest editors of this special issue, believe a major challenge at both the national and state levels concerns the effective recruitment, training and retention of certified nursing aides.  Nursing aides, they pointed out provide about 60 percent of total nursing hours to residents (Again, this observation has been delivered to lawmakers at numerous legislative hearings on Smith Hill).

Many experts who wrote articles in this special issue contend the overall quality of nursing facility care in America still remains poor.  There are serious ongoing quality problems.

And like the rest of the nation, Rhode Island’s facilities are having problems recruiting and retaining certified nursing aids and providing higher wages to them as they receive inadequate Medicaid reimbursement.

What can be done about it?

Simply put, improving the quality of care in Rhode Island nursing facilities is directly linked to getting adequate Medicaid funding. The state must pay a fair rate when facilities are required  to provide quality care to 10,000-plus vulnerable Ocean State seniors who require intensive 24-hour-a-day care.

“The Principes of Reimbursement for nursing facilities are grossly underfunded,” charged Hugh Hall, president of the Rhode Island Health Care Association (RIHCA), a state-wide trade group representing nursing facility providers.

Hall, who is the administrator of the Cherry Hill Manor Nursing & rehabilitation Center in Johnston, estimated only two percent of the state’s nursing facilities are receiving adequate Medicaid reimbursement to cover their true costs of care.

Hall said that unless reimbursement is addressed swiftly, the quality of care delivered by facilities will begin to suffer the effects of the continued lack of attention of state policy makers.

“There is always another need for state tax dollars to be spent elsewhere,” Hall said, recognizing the growing number of special interest groups, who approach the General Assembly each year.

“Hopefully, it will be spent on where it is needed most, on the state’s frailest citizens,” he said, noting that “if the state does not spend it on them, who will?”

According to Alfred Santos, RIHCA’s executive director, the General Assembly is considering legislation (H 5803/S 0901) that would revise the state’s Principles of Reimbursement. Passage would begin to address the inadequate funding of the state’s nursing facilities, he said.

The legislative proposals, referred to the House and Senate Finance Committees, reflect the findings of an 18-month study of B.D.O Seidman, a consulting firm hired by the Department of Human Services to review and recommend fixest to the state’s flawed reimbursement system. Santos said one of the findings of this study was the state was underpaying facilities in excess of $ 30 million annually.

It’s time to fix the state’s flawed Medicaid reimbursement system once and for all. A Band-aid solution is not the appropriate approach considering the growing number of Ocean State seniors who will require higher levels of intensive care.

At an AARP  debate in gubernatorial candidates last September, this writer asked Carcieri if he would budget $ 15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing facility residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million for a total of $ 30 million. This funding would allow Rhode Island facilities to provide quality care.

Candidate Carcieri acknowledged it would be difficult to find $ 15 million to fix the system because of the state’s looming budget deficit.

But there may be a light at the end of the tunnel. When the dust settles on the governor’s “Big Audit,” state funds may be identified and targeted toward ratcheting up the state’s inadequate reimbursement rate.

Combine these newly discovered funds with new tx revenues generated from the Lincoln greyhound track and you might just have the $15 million in state funds required to bring in millions of federal dollars.

For those Rhode Island seniors who are currently in nursing facilities, and for their children and grandchildren who may unfortunately require that intensive level of care, lawmakers must fix the payment problem once and for all.

Hopefully, Carcieri, along with the General Assembly, will not allow the B.D.O. Seidman report’s recommendations on fixing the state’s Medicaid payment system to sit on the dusty shelf in the Department of Human Services.

If that happens, what a waste of taxpayer money.