Tag Archives for CMS

Bill Seeks to Soften Impact of Medicare Cuts

Published in Pawtucket Times on September 23, 2002

One week to go before the new federal Medicare cuts go into effect – cuts that will slash $1.7 billion in 2003 funding for the developmentally disabled and frail seniors in nursing facilities.

According to the American Health Care Association (AHCA), over the next two year’s cumulative Medicare cuts, called the “Medicare Cliff,” will total a whopping $5.2 billion.

Meanwhile, AHCA, representing 12,000 nonprofit long-term care providers, has been lobbying Congress for federal relief from the draconian reductions.

A new ad appearing in the Capitol Hill newspaper, Roll Call, reminds lawmakers that the upcoming cuts could lead to reduced nurse staffing and puts residents at risk.

In the upcoming November elections, voters might just get riled up too, over Medicare being cut by 10 percent, says AHCA.

The Roll Call ad notes a recent national survey of 800 persons found that 84.6 percent of the respondents opposed cutting Medicare funding for nursing facility care by 10 percent.

Additionally, 64.1 percent were less likely to vote for a candidate running for Congress if they knew that the candidate “voted to cut Medicare funding for nursing facility for nursing facility care by billions.”

Charles H. Roadman, II, M.D., AHCA’s president and CEO noted that a recent study by the University of North Carolina School of Public Health confirms the devastating impact of the impending Medicare cuts.

The study says that cuts could lead to reduced numbers of staff caring for seniors in nursing facilities, thus jeopardizing quality of care.

“At a time when the Centers for Medicaid and Medicare Services (CMS) and nursing care providers are actively pursuing efforts to improve the quality of care in nursing facilities throughout the nation, new federal cuts to Medicare are inconsistent with achieving this important goal,” says Dr. Roadman.

Roberta Hawkins, executive director of the Alliance for Nursing Home Care and state ombudsman agree with Roadman’s assessment.

“Huge Medicare cuts pull the carpet from under the federal quality initiatives that take effect across the country in October,” she tells All About Seniors. “The right hand of the federal government does not seem to know what the left hand is doing.”

According to Hawkins, the staffing shortage in Rhode Island is having a drastic impact on the quality of care delivered to more than 10,000 residentes.

“The upcoming Medicare cuts combined with an outdated Medicaid payment system will only further compromise patient care in the Ocean State,” she says.

U.S. Rep. James Langevin and House colleagues today announced a legislative fix that would delay scheduled cuts for nursing facilities and assisted living facilities in Rhode Island.

Langevin is co-sponsoring the Medicare Skilled Nursing Beneficiary Protection Act, sponsored by Congressman Tom Allen (D-ME), that would extend Medicare reimbursement add-ons for three years, through 2005, to allow the Bush administration more time to implement an adequate reimbursement formula for skill nursing facilities.

Langevin and the other bill sponsors hope this new timetable will obviate the need for further cuts in Medicare reimbursement rates, which would place severe financial burdens on nursing facilities.

Langevin stated that unless Congress acts this year, Medicare funding for skilled nursing care will be cut by 10 percent in 2003 and 19 percent in 2004 – translating to cuts of nearly $ 35 per patient per day in 2003 and $68 in 2004.

The Rhode Island congressman believes that in the Ocean State, the Medicare cuts will be even greater than the national average totaling $ 38.81 in 2003 and $ 76.90 in 2004.

“Difficult decisions were made in 1997 with passage of the Balanced Budget Act, and some of the changes were not implemented as Congress intended,” Langevin said. “The Medicare Skilled Nursing Beneficiary Protection Act will postpone further cuts and ensure that critical funding remains available for thousands of Rhode Islanders who rely on skilled nursing services.”

According to Langevin in mid-1998, the new Medicare prospective payment system (PPS) was implemented for skilled nursing care, as mandated in the 1997 Balanced Budget Act (BBA).

He noted that the new system resulted in cuts far deeper than intended by Congress.

In 1999 and 2000, Congress temporarily restored some of the unintended cuts as part of the Balanced Budget Refinement Act (BBRA) and the Benefits Improvement and Protection Act (BIPA).

These temporary add-ons helped restore beneficiary access to care, but overall Medicare funding levels for skilled nursing facilities continue to be below BBA projections, Langevin said.

“I am wholly committed to making the restorations of 1999 and 2000 permanent,” he said.

“We cannot turn our backs on a generation who built and defended the very foundation of this nation. They answered the call of our nation -now we must answer theirs.”

Fed’s Proposal to Confronting Nursing Shortage is Not Enough

Published in Pawtucket Times on April 1, 2002

Responding to the nation’s serious nurse staffing shortage, a new Federal proposal gives states flexibility to allow nursing facilities to use paid feeding assistants to supplement the services of certified nurse aides (CNAs). The specialty trained staff would help residents eat and drink.

With a growing number of frail elderly resident in the nation’s nursing facilities, today’s nursing staff must take care of residents who require a higher level of medical care. This leaves less time to ensure that residents eat their meals and drink enough fluids on a daily basis.

Oftentimes, both physical and psychological changes will interfere with a resident’s ability to eat and consumer a meal. Some residents may only need encouragement or minimal assistance with eating.

On the other hand, frail residents may require staff assistance with feeding .  Assistance would be needed for residents with cognitive impairment, impaired swallowing due to muscular weakness or paralysis, a tendency to aspirate or choke, poor teeth, ill-fitting dentures or partial plates, poor muscular or neurological control of their arms or hands, as with Parkinson’s disease.

Under the Centers for Medicare & Medicaid Services (CMS) proposal, trained feeding assistants are allowed to help residents eat and drink, especially at meal times.

The workers would be required to complete a state-approved course to quality to be hired for the new position.  Currently nursing facilities rely primarily on CNAs, registered or licensed practical nurses to assist residents with eating and drinking.  However, volunteers and family members also may assist with these tasks.

At this time, there is no provision in federal regulations for the employment of nursing facility workers to perform only a single task without competing 75 hours of nurse aide training.

The proposed rule change published in the March 29 issue of the Federal Register would allow facilities to hire workers to perform a single task with training on feeding techniques and some basic information that is currently part of CNA training requirements.

“Meal times can often be the busiest time in nursing facilities,” says CMS Administrator Tom Scully.

“Feeding residents is often a slow process and competes with m ore complex tasks, such as bathing, toileting and dressing changes, as well as urgent medical care,” he added.

“Trained feeding assistants will free nurses and nurse aides to focus on residents’ other health care needs. The result will be that residents will receive better nutrition and care,” Scully noted.

The American Health Care Association (AHCA), a Washington, D.C.-based trade group, that represents both profit and non-profit nursing facilities, gives the new federal rules a thumbs up.

‘Simple common-sense dictates that when our nation’s health care system is being undermined by a chronic nursing staffing shortage, and the greater needs of increasing sicker patients, we should do everything conceivable to better the lives of our patients,” stated Dr. Charles H. Roadman II, president and CEO of AHCA. “The rule will also help the overextended nurses and nursing aides already on the job cope with competing important tasks.”

Hugh Hall, executive director of the Johnston-based Cherry Hall Manor Nursing and Rehabilitation Center, supports the federal government’s approval of the single task workers who feeds nursing facility residents.

“The prior regulation was not logical or practical when prohibiting other nursing home workers other than registered nurses, licensed practical nurses and CNAs from feeding, but allowing volunteers and families to participate in the feeding process with little training,” he said.

Hall, the former president of the Rhode Island chapter of AHCA, said the health care community would prefer that the federal government develop long-term care programs to recruit fully trained certified nursing assistants and to financially support those initiatives.

Roberta Hawkins, who serves as the state’s nursing facility ombudsman and executive director of the Alliance for Better Long-Term Care agrees.

“The federal proposal is only a Band-Aid fix.” Hawkins says, calling on the federal government to put more funds into the nursing facility reimbursement system to enable facilities to pay better wages to hire permanent full-time staff and to create career ladders.

“Even though you may teach an aide to just feed residents, they are not trained to spot medical changes in the resident, Hawkins told Everything About Seniors.  More important, she said, “they will not be familiar with the specific needs of the residents.”

Hawkins believes that the Bush administration’s proposal can become an obstacle in providing continuity of care in nursing facilities.

A state commission, chaired by Human Services Director Jane Haywood, is currently looking at Rhode Island’s staffing shortage and how the existing Medicaid reimbursement system can be improved.

Recommendations for a new and improved system coming from Haywood’s group might just fix a long-time systemic problem, enabling nursing facilities to better recruit and retain CNAs.

Hopefully, Haywood’s long-awaited proposals will be seriously considered by the administration and General Assembly and won’t end up on a dusty shelf or a circular file.

While allowing the use of single-tax workers, proposed by the Bush administration, it is a step in the right direction. Gov. Lincoln Almond, state lawmakers and state policymakers must not lose sight of the real issue – inadequate Medicaid payments- which fuels an ongoing CNA shortage in many of the state’s nursing facilities.

Almond and the General Assembly are currently at odds over subsidized gambling in the Ocean State.

During this year’s budget debates, overshadowed by a projected $70 million plus budget deficit, let us not forget about Rhode Island’s 10,000 nursing facility residents or the growing elderly population who may ultimately require that level of care or community-based long-term care services.

If the General Assembly can easily find $ 15 million next year to keep the greyhound racing industry afloat, lawmakers might dedicate some time and a little energy and effort in finding state dollars to increase funding to Rhode Island’s long-term care delivery system.

For older constituents and the state’s aging baby boomers it is the right thing to do.

Kennedy Must Lead Fight Against Medicare HMO Rate Hikes

Published in The Pawtucket Times on November 19, 2001

Across the nation, seniors who have enrolled in Medicare HMOs are getting hit hard in the pocketbook.  Premiums and copays for hospital care, nursing services and prescription drugs are skyrocketing. Complaining about inadequate federal funding offered to provide health care services to seniors, a growing number of Medicare HMOs are opting out of the program, leaving their senior enrollees high and dry.

In Rhode Island, seniors are also seeing this alarming trend. Last year, United Healthcare discontinued its Medicare Plus Choice program, first in Newport County, then in Bristol County.  Now Blue Cross Blue Shield of Rhode Island (BCBS) informs its seniors that higher premiums and copays come next year for two of their three BlueCHiP for Medicare plans. The increases include prescription drugs, inpatient care, skilled nursing services, and more. The added out-of-pocket costs impacts about 41,000 seniors across the state.

However, Rep. Patrick Kennedy (D-RI) is not buying BlueCHiP’s request for a rate increases.

In a strongly worded letter Tom Scully, the administrator of the Centers for Medicare and Medicaid Services, the agency charged with overseeing the Medicare program, the Rhode Island congressman strongly protested the rate hikes.

He called on the federal official to investigate whether the current market for Medicare HMOs in Rhode Island has created a situation where the types of increases charged by BCBS are more likely to occur and be approved.

Furthermore, he requested a review to determine if the increases are actuarially sound.

Scott Fraser, BCBS spokesperson, acknowledges that the premium increases of the two BlueCHiP plans were the result of higher medical costs passed onto the BlueCHiP plans by hospital and other medical providers. “It’s medical inflation,” he quips, adding that even higher medication costs charged by drug companies has resulted in an increase in drug copays.

Even with next year’s increases, the BlueCHiP plans will not increase the premiums for the most commonly used services, specifically physician visits, laboratory tests and X-ray services, Fraser adds. “These co-pays have been the same for the last three years.”

CMS has reviewed BCBS’s application for the changes in rates and benefits over the summer, says Fraser, adding that the rate increase was given a thumbs up by the Feds.

Are BCBS’s rate increase actually sound thus justifiable?

CMS spokesperson Peter Ashkenaz told All About Seniors “the fact that the request has been approved by CMS speaks for itself. If the costs seem to be higher than what would be paid for in fee-service Medicare, we would have questioned them.”

Ed Zesk, president of Aging 2000, a non-profit consumer advocacy group. Believes that Rep. Kennedy has asked the right questions in his letter to CMS, specifically, “Are these premium and deductible increases justifiable?”

“Consumers just don’t have access to that type of information, Zesk said.

With Medicare reform now on the back burner as the nation gears up to fight terrorism, Rep. Kennedy must use his position on the House Appropriations Committee and Subcommittee on Labor, Health and Human Services and Education, to address the rising out-of-pocket healthcare costs for Medicare HMO enrollees. As the Congressional elections approach, seniors will want to see concrete congressional action leading to meaningful Medicare reforms.