State Lawmakers Ok Many Senior Initiatives  

Published in Pawtucket Times on July 7, 2003

 As this year’s legislative session came to an end, even the widely publicized tight state budget did not keep aging advocates from seeing some of their legislative proposals get passed by the House and Senate.

With the passage of companion legislative proposals (H 5841/ S 876), the state’s long-term care ombudsman law will be revised to reflect federal law, expanding the scope and authority of the state’s ombudsman program.

The new statute changes will require the state ombudsman to represent the interests of nursing facility residents or clients of service providers before governmental agencies.

The state ombudsman will also be charged with seeking administrative, legal and other remedies to protect the health, safety, welfare and rights of Ocean State seniors.

Another legislative proposal also got the thumbs-up from lawmakers. With the passing of companion proposals  H 5418/ S 506, new state funds totaling $ 300,000 will pay for nursing facility care of legal immigrant Rhode Island seniors who ae not eligible for Medicaid.

Meanwhile, the Rhode Island General Assembly provided that it sees the value in preventative medicine and how it can ultimately save health care dollars.

The Ocean State Adult Immunization Coalition requested $ 103,000 in new state funding to expand the coalition’s efforts to get the world out about the importance of seniors getting influenza and pneumococcal vaccinations.  While not receiving the whole loaf, lawmakers gave a half loaf instead – about $ 50,000.

With state dollars now allocated up front, large savings will be realized down the road. The cost of a flu shot is $ 15 and a pneumonia shot is $ 30.

If a senior is hospitalized, the average length of stay for an older person with influenza is five days, costing $ 12,000.  That’s a huge savings.

Lawmakers also passed legislation to make pharmaceutical drugs more affordable to Rhode Island seniors.

With the passing of companion proposals H 5237/S 374, persons eligible to participate in the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE) who also have prescription drug coverage through a health plan, will now be allowed to use RIPAE to pay for an individual prescription drug once they reach the maximum level of coverage for that drug.

Also, companion measures H 5239/ S378 passed, expanding RIPAE to allow persons age 55 to 61 on Social Security Disability Insurance to receive a 15 percent RIPAE co-payment in addition to their RIPAE drug discount rate.

As previously reported in All About Seniors, an 18-month study of .B.D.O. Seidman, a consulting firm hired by the state Department of Human Services, found that Rhode Island was underpaying its nursing facilities in excess of $ 30 million annually.

It seems that the General Assembly agreed with that report’s assessment and made a partial allocation of new Medicaid dollars to overhaul the state’s ailing Medicaid system.

With the passage of the state’s budget, nursing facilities will receive a total of $ 18.8 million in state and federal dollars – a three-year phase in will bring the total federal and state dollars to $30 million.

On the other hand, some aging agenda items went down in flames.

Aging advocates called on Gov. Don Carcieri and state lawmakers to allocate taxpayer dollars in the FY 2004 budget to allow more low-and moderate-income persons to choose Medicaid waiver-funded assisted living.

Although the federal government has already approved an additional 180 units in the state’s Medicaid assisted living waiver program, state funding of this initiative is required.

No funding in this year’s budget ensures that low-and- moderate income seniors will continue to be denied an option of choosing a less restrictive level of care, an option that higher income seniors have.

Additionally, lawmakers chose not to pass companion proposals (H 5478/ S 299) which would have allowed Rhode Island residents to buy prescription drugs from Canadian pharmacies, where they are routine cheaper.

Finally, in the aftermath of the tragic Station nightclub fire, the General Assembly and governor moved quickly to tighten regulations and to hire additional staffing at the Fire Marshal’s office to protect the patrons of bars and restaurants from fire.  However, beefing up the state Department of Health’s regulatory oversight of the Ocean State’s assisted living facilities, where 3,700 plus seniors reside, did not receive one dime in funding in the FY 2004 budget.

An assisted-living provider group, aging advocates, the Long-Term Coordinating Council, the state ombudsman and officials at the state Department of Health, have all called for new state dollars to fill one full-time surveyor position ( a nurse) to ensure that assisted living residences across Rhode Island are inspected on a timelier basis.

Last year, state lawmakers passed legislation to protect frail Rhode Island seniors who receive assisted-living services.

As this legislative session ends, the governor and General Assembly have failed to allocate the necessary funding in the FY 2004 state budget to fully implement state law that would result in the inspection of the state’s 72 assisted-living facilities and 155 assisted-living beds in nursing facilities in a timely manner.

According to the state’s Department of Health, another seven assisted-living projects are expected to be up and running over the next 18 months.

The ball now moves to Carcieri’s court to either use contingency funds in his office budget or to take administrative action to hire more assisted-living inspectors.

While it has been reported that the governor is amenable to using funds flushed out by his “fiscal fitness program” to pay for a new surveyor position, the time to act is now, rather than later.

Acting now to fix this policy glitch is sound public policy.  I am sure that Rhode Island seniors and taxpayers will agree.

Congress is Close to Passing Prescription Drug Legislation

Published in Pawtucket Times on June 23, 2003

Within days of the July 4th congressional recess, the House and Senate continue their debates on enacting legislation to lower the cost of pharmaceuticals for the nation’s elderly.

The AARP will kick off a media blitz to get a point across to lawmakers that while they may take a short break during recess, the nation’s elderly don’t get a break when it comes to affording the costly medications they need.

“There’s no recess [for seniors] from high prescription drug costs,”  AARP declares in a press release sent to the nation’s media outlets.

In a written statement, Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, calls on Rhode Island’s congressional delegation to pass meaningful Medicare drug benefits, rather than the legislative proposals being debated in the House and Senate chambers.

“While it is nice that after many years of promises Congress has finally taken on this issue these proposals will cause nothing but heartburn and headaches for seniors if passed,” said Fogarty, noting that many seniors will pay more for the program than they will get back in benefits. He charged that others will even be left without prescription drug coverage when they need it the most.

Under the Senate proposal, seniors would pay a $ 35 monthly premium and then have to meet a $275 deductible before Medicare starts to kick in to pay for half of the drugs costs.  Once senior’s reach a cost cap of $ 4,500 for the last year, they would then have to pick up the entire cost until they reach yet another cap of $ 5,800 in total drug spending. At this point, Medicare would then pay 90 percent of the covered drug costs.

Fogarty noted the Congressional Budget Office found that one-third of seniors would pay more money to enroll in the plan than they would actually get back in benefits.

That’s because a senior with $ 1,000 in annual drug costs would actually end up

$ 1,057 annual for the benefits ($420 in premiums, a $ 275 deductible and half of the drug costs).  A senior with $ 2,000 in drug costs would pay $ 1,557 out-of-pocket for the benefits.

Fogarty also called attention to the major gap in coverage for those whose costs exceed the $ 4,500 limit until they reach that $ 5,800 mark.

Furthermore, Fogarty, who authored the state’s expanded prescription drug program, said a study by Columbia University found that only those annual drug costs about $ 1,100 would benefit through the plan.  

In the House chamber, the Republican proposal also calls for monthly premiums of $ 35 along with a lower annual deductible of $ 250 with Medicaid paying 80 percent of the cost of drugs up to $ 2,000.

There is a gaping hole in coverage (in this legislative package).” Fogarty warned “Seniors would then have to spend at least another $ 1,500 depending on their income, on medications before coverage would again begin.”

According to Fogarty, Consumer Union, the publisher of the widely-read magazine, Consumer Reports, noted the “skimpy benefits [in the House and Senate proposal] and the historically high growth of prescription drug costs means that most who lack coverage today would wind up paying more for prescription drugs in four years than they do now.”

Will seniors see a prescription drug proposal enacted this year?

Probably, said Jason Ormsby, director of policy at the Washington, D.C.-based Allilance for Health Reform.

“There is a tremendous drive that I have not seen in the last there years [to enact a prescription drug bill],” said Ormsby.

He noted the House passed a legislative proposal to assist seniors in paying for costly pharmaceuticals, but it died in the Senate.

“The somewhat similar House and Senate bills will have a good change to pass by the July 4th recess,” Ormsby predicted.  Once passed, the legislative proposal will go to conference committee to iron out the differences between the 600-page House and 350-pshr Senate bills,” he said.

The prescription drug benefits are just a small portion of these massive legislative proposals, he noted.

Robert Greenwood, vice-president of public affairs for the National Pace Association, added: “Many Democrats see the limitation of these bills.  This legislation passed presents a historic opportunity to get this law on the book so it can be amended and improved in future years.”

While not a meaningful drug prescription proposal, it’s the first step in the right direction.

Once enacted into law, the Rhode Island congressional delegation must begin their efforts to improve the law – improve access for all: make out-of-pocket costs and cost sharing affordable; lessen gaps in coverage; more important, put the breaks to the steady increase in high-cost drugs.

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.