Tag Archives for CMS

Age beat writer gives us his most important columns in 2023

Published in Blackstone Valley Call and Times, on January 1, 2024

Over the years, like many of the nation’s news organizations, The Pawtucket Times, created an ‘Age Beat’ column in 2002 that allowed this writer for several years to cover a myriad of aging issues, including Social Security and Medicare, ethics, long-term care, consumer issues, spirituality, pop culture, health care and economics. Ultimately, I would return in July, 2012 to resume writing, also picking up other weekly commentaries.

As an ‘age beat’ journalist for over 44 years, I have penned more than 930 stories covering aging, health care and medical issues. These authored and coauthored pieces have appeared in national, state and trade publications.

In 2023, my articles appeared weekly in 52 issues of the Pawtucket Times and Woonsocket Call (now combined in one newspaper called the Blackstone Valley Call & Times), and RINewsToday.com, a statewide digital news publication.

As we celebrate the New Year and look forward to 2024, looking back, here are my top five favorite articles published in 2023:

“In the coming years, generations of older Veterans will be leaving us,” – RINewsToday, Nov. 13, 2023  

This commentary published before Veterans Day, had the Department of Veteran Affairs estimate that there will be a couple of hundred World War II veterans, over 1,600 Korean and 14,000 Vietnam veterans still alive in Rhode Island. In the coming years, frailty and health issues will keep these elderly veterans’ from attending Veteran Day celebrations and even at their reunions.     
 
As a generation of Civil War and World War I veterans vanish in 1956 and 2011, this writer urged readers to cherish the surviving older veterans. In the next thirty years, it was stressed that new generations of veterans who fought in World War II, Korea and Vietnam will pass away and these veterans were urged to share their personal stories and oral histories for the sake of America’s future generations. “They have so much to say, and America’s younger generations have much to learn from them,” noted the commentary. 

This commentary was dedicated to the writer’s father, Second Lt. Frank M. Weiss, who died in December 2003, in Dallas, Texas at 89 years old.

“Passages – Life and Times of Morris Nathanson,” RINewsToday, Oct. 7, 2023

Over two decades, this writer would visit Morris Nathanson on Saturday afternoons sitting in his living room drinking cups of freshly brewed coffee.  We would talk about Pawtucket, world events, and he would reminiscence about his amazing life’s journey from his childhood in Pawtucket, to the international world he lived in later in his life.

My friend, 95-year-old Morris Nathanson, a painter, illustrator and restaurant/hospitality designer died last September. My commentary was written to recognize and honor Morris’s incredible life, detailing his World War II experiences, fighting for civil rights, and his impact on the art and design scene.

Growing up poor during the depression in Pawtucket’s Pleasant View neighborhood, Morris, a spitting image of Mark Twine, or maybe Albert Einstein to me, would ultimately have a major impact on Rhode Island’s art and restaurant design scene. 

Morris brought the strategy of adaptive re-use of underutilized and vacant mills to city and state officials, a concept that he picked up from his years of working in New York City, watching the development and transformation of the industrial mills in SOHO.

Witnessing firsthand man’s biases and prejudices motivated him throughout seventy-five years of his long life to fight for the equal rights of all.  Morris participated in the Freedom Rides of 1961, Dr. Martin Luther King’s campaigns in Selma and Birmingham, Alabama, and the March on Washington for Jobs and Freedom.  

At age 24, Morris, head of the design team at Paramount, developed and designed the first franchise in American history, Dunkin Donuts. While working with Friedman he also designed restaurants in the pavilions of the 1964 World’s Fair in Flushing Meadows, New York.

When Morris left Paramount Restaurant Supply Co, his most notable design projects locally include Hemenway’s, Ruth Chris Steak House, 22 Bowen, restaurants and bars for the Inn at Castle Hill, Capital Grill, Pizzeria Uno, Joe’s American Bar & Grill, Mills Tavern, Waterman Grill, Red Stripe and for those who still remember, the beloved Ming Garden and McGarry’s Restaurant in downtown Providence.  He also had clients all over the world.

It would take pages to detail all of Morris’s professional accomplishments while serving on state, city and nonprofit organizations throughout his long-life.  Hopefully I whetted your appetite to learn more about his life by reading this commentary. 

“Will Magaziner fulfill call to reestablish House Aging Committee,” RINewsToday, Oct. 9, 2023.

As reported, with Congressman David Cicilline retiring from Congress, no House lawmaker has yet stepped up to reintroduce, H.R. 583, the Rhode Island lawmaker’s resolution to reestablish the House Select Committee on Aging (HSCoA). Without receiving a vote in the House Rules Committee at the end of the 117th Congress, the resolution was considered “dead.” On his way out Cicilline was not successful in passing the legislative baton and finding a new original sponsor.  The Rhode Island Congressman had introduced this resolution in four Congressional sessions.

The HSCoA was a permanent select committee of the U.S. House of representatives between 1974 to 1992.  The committee was initially created with the intent of not crafting legislative proposals, but of conducting investigations and holding hearings to put the Congressional spotlight on aging issues. Its purpose was to push for legislation and other actions, working with standing committees, through regular committee channels.

This writer asks who will ultimately pick up the legislative baton from Cicilline to become Rhode Island’s fiery aging advocate?  Will it be Congressman Seth Magaziner, or the newly elected Congressman Gabe Amo, from Rhode Island’s Congressional District 1 to step to the plate?

The article asks why shouldn’t a Rhode Island Congressman follow in the footsteps of former Rhode Island Congressman John E. Fogarty (dec.) and be the original sponsor of legislation that will have a major impact on national aging policy. The lawmaker would become a hero to America’s seniors.  

“Unique partnership creates Senior Fellows pilot program,” RINewsToday, Dec. 11, 2023

This commentary announced that the success of a pilot Senior Fellows Program, created by Leadership Rhode Island (LRI) and Age-Friendly Rhode Island (AFRI), the organizations are seeking funding to offer another session in the summer of 2024.

The unique initiative prepared 25 Senior Fellows to advocate for improvements that address age-related challenges in Rhode Island. The initial eight-week program was tuition-free. The first crop of Senior Fellows, residents of 13 different cities and towns in Rhode Island, ranged in age from 62 to 83. Nearly half were retired.

The idea to develop a senior advocates program came from Marianne Raimondo, a graduate of LRI’s Core Program, who made the connection between Leadership Rhode Island and James Burke Connell. Connell is the executive director of Age-Friendly Rhode Island, an initiative at Rhode Island College that represents a coalition of public and private agencies, organizations and individuals committed to healthy aging.

Connell proposed the pilot program because, he says, empowering seniors to become advocates, activists and champions of age-friendly thinking and practices “will result in a Rhode Island where older adults thrive and live their best lives.”  He was inspired by similar programs in Maine and New Hampshire.

Age-Friendly RI raised the funds for the pilot program, and relied on LRI’s “talented team” to handle recruiting, participant selection, curriculum planning, and guiding participants in the development of individual community commitments, Connell says.

Most session days were divided into two parts, with half focused on knowledge-building around relevant issues, such as housing, food insecurity, transportation needs, and health care. The other half focused on skill-building, such as writing persuasively, public speaking and network building, to enable the Fellows to develop and eventually execute their own Civic Commitments.

The Fellows took turns describing their Civic Commitments during their final session, held at the RI State House.  The presentations, which included several “poignant and pin-drop moments,” were well received.

“Increased funding must be tied to nursing home mandated minimum staffing“, RINewsToday, September 25, 2023

The commentary announced that the Centers for Medicare and Medicaid Services (CMS) had issued a proposed rule to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards. CMS officials said that the requirement would improve both safety and promote high-quality care in the nation’s 18,700 skilled nursing facilities delivering care to 1.2 million residents each day.

National and Rhode Island nursing home trade groups pushed back on the unfunded mandate requiring more staffing especially during a severe labor shortage forcing hundreds of facilities across the nation to close because of lack of workers.

​John E. Gage, President, and CEO of the Rhode Island Health Care Association, reported that six Rhode Island-based facilities have closed since the beginning of the pandemic in March 2020. Three others are currently in receivership. He warns that arbitrary federal staffing mandates will result in more closures, and residents will be displaced from their homes just as they were most recently when Charlesgate Nursing Center in Providence.

James Nyberg, president, and CEO of LeadingAge Rhode Island, with offices in East Providence, sees a staffing ratio mandate as a blunt enforcement tool that does not consider the numerous challenges facing providers, including Medicaid underfunding, lack of workforce, and the diversity of resident needs. Moreover, he charged that fining for being unable to meet a staffing ratio is counterproductive by siphoning off scarce resources that facilities need as they seek to address their workforce and resident care needs.

To review ALL of Herb’s articles published by RINewstoday, go to https://rinewstoday.com/herb-weiss/

Federal Court denies attempt to stop Medicare drug negotiation program

Published in RINewsToday on November 6, 2023

Over two months ago, as supporters of President Biden’s Inflation Reduction Act (IRA) celebrated the one-year anniversary of the passage of the historic legislation, the U.S. Chamber of Commerce, Pharmaceutical Research and Manufacturers of America (PhRMA), along with drugmakers filed multiple lawsuits to block the IRA’s drug price negotiation provisions.  The drug price negotiation program, created by IRA, allows Medicare to use its bargaining power to negotiate the prices of ten prescription drugs for the first time.

The multiple-filed legal suits came weeks before Sept. 1 when the for Centers Medicare & Medicaid Services (CMS) was scheduled to publish a list of the first 10 drugs that would be subjected to negotiations.  These lawsuits argued that the federal price negotiation program was unconstitutional because it violated the First and Fifth Amendments of the U.S. Constitution, as well as the separation of powers clause, by giving the U.S. Department of Health and Human Services (HHS) discretion over a maximum fair price for any given drug selected for negotiation.  These lawsuits also charge that CMS price controls would force drug makers to pull back on developing new drugs, jeopardizing medical breakthroughs for individuals with life-threatening and chronic illnesses. 

Among the nine lawsuits scheduled to go to trial, one was a motion filed on July 12, 2023 by the Chamber and several of its affiliates in Ohio. This motion requested the court to issue a preliminary injunction to halt the Medicare drug negotiation program from implementation. The ruling came before the Oct. 1, 2023 deadline requiring drugmakers whose pharmaceuticals were selected for negotiations to either sign agreements to participate or to face stiff penalties.  

The U.S. Department of Justice opposed the Chamber’s motion, filing a motion to dismiss its case.  On Sept. 15, 2023, the court held oral arguments giving the  Chamber and the DOJ an opportunity to present their legal arguments in greater detail.  

Overcoming a Major Legal Hurdle 

On Friday, September 29, 2023, U.S. District Judge Michael J. Newman for Southern District of Ohio, denied the Chambers request to block implementation of the newly established Medicare drug price negotiation program before the drug price negotiation talks began.  The ruling called on the Chamber to file an amended complaint by Oct. 13, 2023. DOJ would then have until Oct. 27, 2023 to renew its motion to dismiss.

According to Spencer Kimball of CNBC, legal experts say the pharmaceutical industry hopes to see conflicting rules from lawsuits filed in other federal appellate courts to bring this issue to the Supreme Court for final resolution. 

The Willimantic, Connecticut-based Center for Medicare Advocacy (CMA), a nonprofit group pushing for comprehensive Medicare coverage, health equity and quality of health care for seniors and people with disabilities, is encouraged by Judge Newman’s ruling, which assessed the drug manufacturer’s claims “to be weak in the face of clearly established laws.”

According to CMA, the 28-page court order found that the Chamber and other plaintiffs had demonstrated neither likelihood of success on the merits, nor irreparable harm, which are required for a preliminary injunction.  CMS noted that this case cited “clear” law that “participation in Medicare, no matter how vital it may be to a business model, is a completely voluntary choice.” The court also found that the price established by negotiations cannot be considered ‘confiscatory,’ as the Chamber charges or “a violation of due process, because drug manufacturers can opt out of Medicare entirely.”

Newman’s ruling noted that drugmakers are not compelled to sell drugs at the prices established by the Medicare program and that any economic harm, when the negotiated drug prices take effect in 2026, was too speculative to warrant immediate relief, reported CMS.  However, the court did deny the government’s motion to dismiss the lawsuit entirely, saying that more information on whether the plaintiffs have standing to sue would be beneficial and therefore the judge is allowing for limited discovery to clarify issues related to legal standing, after which the government may renew its motion to dismiss, noted the Medicare advocacy group.

With this ruling, Medicare may move forward with its implementation of its drug negotiation program as this case and others continue to proceed. 

Giving their two cents…

At press time, the Chamber did not respond to a request for comment about the court’s ruling.  But health care and aging advocacy groups issued statements expressing their thoughts about the impact of Newman’s ruling. 

“This is the first major blow to Big Pharma in its legal battles to block the drug price negotiation provisions under the Inflation Reduction Act, says Peter Maybarduk, Public Citizen’s director of the Access to Medicines program.

“The Chamber’s lawsuit lacks merit; the court made the right decision not to grant the injunction, which would have caused needless patient suffering and treatment rationing, notes Maybarduk, calling on drugmakers “to drop their lawsuits and drop their prices.”

“Now, drug companies should agree to participate in the negotiation program in good faith. The program is an important first step in ending the exorbitant prices charged to Medicare enrollees,” adds Maybarduk.

Frederick Isasi, Executive Director of Families USA, happily noted that the Medicare drug negotiation program continues, calling the ruling “a big win for seniors and their ability to purchase life-saving medications. The ability to afford medication is a matter of life and death for millions of older adults. That’s why we are fighting this David and Goliath battle – people deserve to pay a fair price for their drugs and Medicare price negotiation is a critical piece of this puzzle. And let’s not forget each drug subject to fair price negotiation is an old drug that millions of people need and doesn’t have competition,” he notes.

“It never ceases to amaze us that – on one hand – Big Pharma can cry poverty by saying that drug negotiations will hurt their bottom line, while recent earnings reports show they are raking in money hand over fist.  We are glad Judge Michael J. Newman, a Trump appointee in Ohio’s Southern District, saw through this hypocrisy by affirming the Biden administration’s power to begin negotiating the prices of 10 medications with drugmakers,” says Dan Adcock, Director of Government Relations and Policy, of the Washington, DC-based National Committee to Preserve Social Security and Medicare. (NCPSSM).

According to NCPSSM, Drug makers made a whopping $493 billion in revenue from ten drugs that are now subject to price negotiations between CMS and the manufacturer, which have accounted for more than $170 billion in gross Medicare spending, according to a report from the nonprofit, Protect Our Care.

“The court’s decision to allow Medicare drug price negotiations to move forward is welcome news, says William Alvarado Rivera, Senior Vice President for Litigation at AARP Foundation. “Pausing Medicare negotiations would have risked billions of dollars in savings for taxpayers – and countless lives. It is unconscionable that Americans face such high prescription drug costs that many people skip taking medication altogether or must ration it,” he said.

“We’re prepared to fight for as long as necessary to ensure big drug companies can’t charge excessive prices at the expense of patients’ health, says Rivera, noting that the new Medicare negotiation law would bring financial and medical relief to millions of older Americans and their families, and put drugs that treat life-threatening and chronic conditions, from cancer to heart disease, within their reach. Rivera says, “It must not be derailed.” 

Congress has put the breaks to the spiraling costs of pharmaceuticals by giving Medicare the authority to negotiate the price of popular drugs with drug makers.  America’s seniors will continue to suffer financial  hardships and many might even lose their lives by not choosing not to take their costly medications if courts rule in favor of drug companies.  Time will tell.   

U.S. Judge Michael J. Newman ruling denying the U.S. Chamber of Commerce’s request for a preliminary injunction, go to https://www.bloomberglaw.com/public/desktop/document/DaytonAreaChamberofCommerceetalvBecerraetalDocketNo323cv00156SDOh/5?doc_id=X3U600KOGG69QHQBPEU24OS1JMO

A listing of drugmaker revenues of the first ten negotiated drugs, go to https://www.protectourcare.org/by-the-numbers-the-ten-costly-drugs-that-are-now-eligible-to-have-lower-prices-negotiated-by-medicare/

Putting the brakes on CMS proposed minimum staffing for nursing facilities

Published in RINewsToday on October 23, 2023

In response to the Centers for Medicare and Medicaid Services (CMS) recent release of proposed rule to establish minimum federal staffing requirements, last week 97 members of Congress, mostly Republican, called on Health and Human Services (HHS) Secretary Xavier Becerrato put the breaks on CMS’s proposed rule issued on Sept. 1, 2023.

In September, CMS issued a proposed rule establishing minimum staffing requirements and standards for nursing facilities. But the proposed CMS rule notes that according to the Bureau of Labor Statistics, “there are roughly 235,900 fewer health care staff working in nursing facilities and other long-term care facilities compared to March of 2020.”  Furthermore, the proposed CMS rule notes that nursing facilities around the country would need to hire nearly 13,000 registered nurses and 76,000 nursing assistants. Safety thresholds could increase a modest 1% while costing between $1.5 to $6.8 billion to fully implement. Noncompliance with CMS’ proposed minimum staffing requirements would lead to citations for noncompliance with Medicare Conditions of Participation, potentially resulting in a variety of enforcement actions, including imposition of Civil Monetary Penalties, denial of payments for new admissions, and even termination from the Medicare program.

Congressional call to CMS to reconsider minimum staffing rule

Congressman Greg Pence (R-IN), along House colleagues Brett Guthrie (R-KY), Vern Buchanan (R-FL), Michelle Fischbach (R-MN), Jared Golden (D-ME), and Chris Pappas (D-NH), along with 91 of their Republican colleagues sent a bipartisan letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra, opposing minimum federal staffing requirements.

In this Oct. 20 letter, they charge that CMS’s rule would inevitably result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and most consequentially lead to widespread nursing facility closures. they urge the Secretary to reconsider the proposal to impose new federal staffing requirements on nursing facilities which would adversely hurt their ability to serve existing and prospective residents.

In the letter, the lawmakers expressed their concerns with CMS proposed rule issued at the direction of the Biden White House. This rule would establish minimum staffing requirements and standards for nursing facilities, which they warned would inevitably result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and most consequentially lead to widespread nursing home closures.

“At a time when nursing homes are already experiencing healthcare worker shortages and financial hardships, CMS and the Biden Administration should not be implementing a regulation that would only exacerbate this issue. If implemented, facilities throughout the country will have no choice but to deny access to our nation’s seniors who need nursing home care, especially in rural communities, like many of the ones I represent in Indiana’s sixth congressional district,” said Congressman Pence. “This one-size-fits-all regulatory requirement will result in many negative consequences, and I strongly urge Secretary Becerra to reconsider this proposal,” he said.

“There are workforce shortages all across rural America and healthcare workers are no exception. I’m committed to working with my colleagues to find ways to prevent otherwise avoidable closures of nursing homes in Maine,” said Congressman Golden.

Nonprofit provider group calls on Congress to stop CMS proposed rule

The Washington, DC-based LeadingAge, representing more than 5,000 nonprofit aging services providers, gave the thumb up to House lawmakers who are attempting to delay CMS’s proposed rule until there are enough qualified applicants and adequate funding to address staffing levels realistically throughout the long-term care continuum.

“We all want to ensure access to quality care for older adults, but federal leaders are getting it wrong right now,” said Katie Smith Sloan, president and CEO, Leading Age, the association of nonprofit providers of aging services, including nursing homes. “CMS’s proposed nursing home staffing mandate rule works against that shared goal, and would limit older adults’ and families’ access to care,” she said.

In a letter sent to Congressional leaders on Sept. 28, 2023 addressing the Centers for Medicare and Medicaid Services (CMS) September 1 proposed rule on nursing home staffing mandates, Sloan urged policymakers to focus on advancing real solutions to ensure quality nursing home care for older adults and families across America. 

Sloan’s letter lays out three main reasons why the proposed rule will be impossible to implement.  She notes that no federal funding has been allocated to cover the $7.1 billion price tag of CMS’s proposed regulation.  She warns that the mandate would require the hiring of 90,000 more workers, and there are simply not enough people to hire.  Finally, the mandating staffing requirements could decrease access to care across the continuum of care, says the top aging services executive.

The letter asks Congress to intervene to delay the proposed rule until there are enough qualified applicants and adequate funding to address staffing levels. Sloan provides her association’s independent cost analysis of the proposed rule, which projects implementation would be at least $7.1 billion—far higher implementation than CMS estimates.

“The costs of delivering quality care already far exceed Medicaid reimbursement levels, and this unfunded mandate will force nursing homes to consider limiting admissions or even closing their doors for good, depriving older adults and their families of care in their communities,” states the letter, noting that “the outcome is the opposite of what providers, lawmakers, the administration and the American people want.”

According to Sloan, nursing facilities aren’t the only part of the healthcare system that will be affected if the rule is implemented as proposed. Home health providers are already rejecting referrals and some face closure due to financial pressures and workforce shortages. There will be far fewer options for older adults and families to access care, and communities of color and less affluent individuals will feel the deepest impact, she says. 

“The current and highly fragmented approach to long-term care financing no longer serves the millions of older adults who require compassionate and highly skilled care,” writes Sloan, calling on Congress to work with the Administration on realistic solutions, including a “robust national workforce development strategy.” 

LeadingAge has put forward solutions to tackle the aging services workforce crisis including prioritizing immigration reform to help build the pipeline of workers; increasing funding and working with states to increase Medicaid reimbursement rates to cover the cost of care and increase wages; along with replicating existing successful training programs and expand opportunities for interested applicants to pursue careers as RNs, LPNs, and CNAs. 

“We need a holistic approach to real solutions to the workforce crisis. Let’s get this right,” said Sloan.

A Rhode Island perspective

“Unfortunately, a staffing ratio mandate, whether state or federal, is a blunt enforcement instrument that does not consider the numerous challenges facing providers, including Medicaid underfunding, lack of workforce, and the diversity of nursing homes and their resident needs,” says James Nyberg, president, and CEO of LeadingAge Rhode Island. “Moreover, the concept of imposing severe financial penalties for homes that are unable to meet a staffing ratio is counterproductive at best by siphoning off scarce resources that providers need as they seek to address their workforce needs and resident care needs,” he says. 

“We in Rhode Island can attest that there are numerous unintended consequences of a staffing ratio mandate, including the severity of fines, how compliance is measured and calculated, costs of compliance (or trying), backlogs of people in hospitals waiting for skilled nursing care, and other access-related issues, says Nyberg, noting that even homes that are currently able to comply with the staffing ratio are doing so at an unsustainable cost. 

According to Nyberg, a staffing ratio mandate without an adequate workforce supply, as well as financial resources, poses an existential threat to the industry. LeadingAge Rhode Island is working with state officials and other stakeholders to revisit some of the more onerous provisions of our mandate, mitigate its effects, and pursue other less punitive approaches to meeting collective goal of ensuring adequate staffing and quality of care while also working on various initiatives to develop a pipeline of workers, which will quite simply take time. 

For a copy of the Oct. 20 correspondence sent to HHS Secretary Xavier Becerra urging her to reconsider establishing minimum staffing in nursing facilities, go to https://drive.google.com/file/d/1RzhXgF2OQR-cbz8fA5I4yE0DWYn8fDJM/view.

To read LeadingAge’s Sept. 28 correspondence to Congress, go to https://leadingage.org/wp-content/uploads/2023/09/LeadingAge-Staffing-Mandate-Analysis-Congressional-Letter-9-28-2023.pdf.

For a copy of a CMS Fact Sheet on CMS’s proposed rules on minimum staffing, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid