Tag Archives for Rhode Island General Assembly

Rhode Island Nursing Homes Scramble to get Dental Coverage for Residents

Published in Pawtucket Times on March 3, 2003

According to Alfred Santos, executive director of the Rhode Island Health Care Association (RIHCA), one company’s business decision has left Rhode Island nursing homes scrambling to bring dental coverage to thousands of nursing home residents.

Over the last two months, Santos has met with state regulatory officials to inform them of this latest health-care access problem.

Here’s the scoop:

Access Dental Care, a major provider of dental services to nursing facilities, announced in a Nov. 4 member to its 40 nursing home clients that it would no longer offer onsite dental care, beginning Jan 1, 2003. The brief memo cited the extreme physical challenge to dental staff who provided dental services to residents outside the normal dentistry setting as the rationale for dropping onsite dental care.

But a nursing home trade group says that there may be a bigger issue behind Access Dental Care’s decision to not provide onsite dental services to nursing home residents.

RIHCA’s Dental Services Committee believes the actual reason for this business decision may well be tied to a low Medicaid reimbursement for dental care services, said Chair john Gage, who also serves as the trade group’s vice-president. Currently, Gage is the administrator at Riverview Heatlh Center in Coventry.

Gage said 80 percent of nursing home residents rely on Medicaid to pay for their dental services. Access Dental Care’s decision to not perform dental services on site will force m any frail, bedridden residents to be transported outside the facility for treatment, causing needless pain and suffering to them, he said.

“With a severe staffing shortage facing many facilities it will be even more difficult to assign a staff person to accompany the resident,” Gage noted.

According to Gage, it’s not so easy for nursing homes to find other providers to deliver onsite dental services. Complicating this health care access issue, Geage said, is HealthDrive’s policy not to contract with any nursing home to only provide dental services.

At press time, state officials from the Department of Health and Human Services were unavailable for comment about this payment issue.

State Sen. H. Elizabeth Roberts

(D-Cranston), who is chairing a subcommittee of the state’s Long-Term Care Coordinating Council (LTCCC) is currently looking at Medicaid issues, said Access Dental Care’s decision to not provide treatment to Medicaid recipients in the nursing home setting only exacerbates an ongoing problem. That Is, low Medicaid reimbursement  keeps low income seniors from receiving the appropriate preventative and restorative dental care they need.

Roberts said, “inadequate Medicaid rates make it hard for dentists to see residents, because the rates are so far below their costs. When combined with the medical complexity of nursing home patients, the low reimbursement is even more of a barrier, she said.

Robert’s LTCCC subcommittee plans to turn their attention to investigating the obstacles that keep dental care from being provided to Medicaid-eligible seniors in nursing homes and in their homes.

Bringing dental services to low-income children and seniors became an important issue to Roberts when care to a young constituent in the Rlte Care program required the use of an operating room for dental work because of severe tooth decay.

This operation could have been prevented with ongoing dental care, she said, noting that it “took the attention of state government to locale a provider who would accept the low Medicaid provider rate.”

Roberts is working to ratchet up the Medicaid reimbursement for dental care and to streamline the payment process through legislation she has recently introduced. The senator intends to bring together the state’s Dental Society and nursing homes to develop a plan to bring dental care to facilities that no longer received onsite dental service.

Robert Hawkins, state ombudsman and executive director of the Alliance for Better Nursing Home Care, agreed with Roberts’ assessment that there has been limited access to dental services in nursing homes over the past couple of years.

Hawkins has been pushing for appropriate dental treatment for nursing home residents for more than 25 years.

“Medicaid-eligible seniors who are mobile can more easy travel to dental clinics, if they can find treatment, especially with the low Medicaid rates,” Hawkins said. “For the old, sick and feeble, why should they have to go to through the turmoil of leaving the facility to get their dental care?

“Lack of access to dental care is a form of discrimination for those unfortunate to be lower-income and on Medicaid, Hawkins charged.

The Medicaid system has always been “penny wise and pound foolish,” Hawkins said. “When you don’t treat a dental problem early, residents don’t eat, they lose weight, develop bed sores, ultimately requiring costly hospital care.

“Can any one remember having a tooth ach all night long with no where to go?,” Hawkins asked.

Susan Sweet, a consultant to nonprofit groups and a longtime elder rights advocate, added there is also a lack of dental care for low-income seniors that extends into the community as well.

“For some reason, dental care is treated in the health care community as less important as other medical care,” she said, adding that reimbursement for dental care has lagged behind reimbursement for other medical care.

So where do we go from here?

Roberts’ plans to bring the state’s Dental Society together with nursing homes to craft a short-term solution is the first step in removing the obstacles of providing dental services to Medicaid-eligible residents. But a more permanent solution is needed.

With Gov. Don Carcieri poised to shortly release his budget, I hope he and the General Assembly counter Medicaid’s traditional “penny wide and pound foolish,” philosophy by increasing Medicaid payments for dental services. An inadequate reimbursement rate will ultimately reduce the needless pain and suffering that dental problems cause in nursing homes across the state.

Inaction on RIPAE Proposals Would Be a State Tragedy

Published in the Pawtucket Times on May 20, 2002

Lawmakers are rushing to finalize the state’s business, hoping to adjourn as early as the end of May.

With thousands of proposals in the legislative hopper, each representative was directed by House leadership to choose three of their own sponsored bills to push for in the Senate.

All legislative proposals that do not make the “priority” lists are as good as dead for the year.

At press time, one proposal, Pharmaceutical Assistance for the Elderly Program (RIPAE) moves closely to passage.

The House Finance Committee has put the proposal (H 7291) into the state budget article. Susan Sweet, a consultant and aging advocate said she expects full House passage of the state budget article by the end of the week.

Once passed by the House, the state budget article goes to the Senate for their consideration and approval. Sweet told All About Seniors that she believes that the Senate will quickly pass the budget, too.

With passage, the final state budget will be  forwarded to Governor Lincoln Almond.

Under H 7291, the state Department of Human Services would seek a waiver from the federal government, allowing Rhode Island to use Medicaid funding to pay for prescription drugs for low-income seniors with incomes up to $ 17,720 and couples with incomes up to $ 23,880.

The legislative proposal, authored by Lt. Governor Charles Fogarty and sponsored by Rep. Constantino and House Finance Chairman Gordon Fox, would enroll about 90 percent of the 37,000 seniors now enrolled in RIPAE. Because seniors would now qualify for prescription drug coverage under Medicaid all U.S. Food and Drug Administration (FDA) drugs would be covered not just those currently covered by RIPAE.

Seniors would pay a small copayment rather than the 40 percent co-payment currently charged.

With the passage of the state budget article, then “cleanup” begins on all legislative proposals, Sweet noted, adding that the two other RIPAE proposals have not been acted upon yet.

These legislative proposals would make prescription drugs more affordable to seniors and persons with disabilities who are not covered by the Medicaid waiver.

One bill (H 7290) would allow seniors enrolled in the RIPAE program to buy prescription drugs not currently covered by RIPAE at the discounted state price.

The other (H 7524) would allow low-income disabled persons on Social Security Disability Income who are between ages of 55 and 65 to become members of RIPAE and purchase prescription medications at the state discounted rate. Under booth, the state would be able to obtain the manufacturer’s rebate available through RIPAE.

Sweet along with other aging advocate groups, has called on the Rhode Island General Assembly to pass the three RIPAE proposals, which don’t cost the state one penny.

Not acting on them will continue a tragic trend that is well-documented in Rhode Island and nationwide.

That is, the high cost of prescription drugs forces many seniors on fixed incomes into not taking their prescribed medications at all or using only partial doses.

Moreover, noncompliance can lead to unnecessary hospitalization, nursing home admission and premature death.

Even in the shadow of a huge state budget deficit, lawmakers have the opportunity to lower the spiraling out-of-pocket costs of costs of prescription drugs, at no cost to the state.

The Ocean State is now posed to enact sound public policy that will result in no fiscal impact to state coffers.

If Congress is not ready to tackle this aging policy issue through the creation of a Medicare pharmaceutical benefit, then the Rhode Island General Assembly must take the lead and pass the three RIPAE proposals.

Simply put, it is the right thing to do on behalf of older and disabled constituents.

Adequate Medicaid Payments Can Bring High Quality Health Care

Published in the Pawtucket Times on January 21, 2002

Like clockwork each year, Robert Hawkins, the state’s best-known consumer advocate for quality nursing home care and the state’s nursing facility industry, came to Smith Hill, calling on the General Assembly to adequately fund long-term care.

While representing different constituencies, both Hawkins and the nursing home industry were on the same page regarding this policy issue. Both groups strongly urged the Rhode Island General Assembly to adequately fund the state’s Medicaid program. For its Medicaid dollars, the Rhode Island Department of Human Services got: 24-hour nursing care; three meals per day with dietary supplements; other care services like grooming, personal care, bathing and assistance with eating; medical supplies, such as beds and wheelchairs; social services and activities.

Some years were better than others, especially last year. Responding to a serious statewide nursing assistant shortage, Rhode Island lawmakers gave an additional $9 million to pay for nursing facility direct care staff. However, the Rhode Island Health Care Association said that those funds did not cover the spiraling costs of operating a facility.

Liability insurance has doubled, energy costs have risen by approximately 25 percent and Providence-based facilities have been hit with tax increases with some facilities being assessed close to $ 100,000, noted the state’s largest nursing facility trade group.

Now, a recently released national study supports nursing facility and consumer concerns that the Rhode Island Medicaid program has not paid the “real” cost of providing care to Medicaid patients.

According to an independent analysis of the nation’s Medicaid pr.0ogram by the accounting firm of BDO Seidman, the Ocean State’s Medicaid program underfunds its nursing facility industry by more than $25 million annually or about $10.04 per patient day.

According to the national study, most states fail to adequately account for escalating Medicaid costs. They do this by using cost inflators that are not reflective of actual nursing facility cost increases and by using extremely outdated data.

For instance, Rhode Island uses data using 1991 costs in setting rates for most nursing facilities.

“The most disturbing finding of this study is that the state is reimbursing senior’s long-term care for substantially less than the acknowledge cost of that care,” says Alfred Santos, executive vice president of the Rhode Island Health Care Association (RIHCA). “Medicaid pays just slightly more than $4 per hour per patient, less than most people pay a teenage babysitter,” Santos charges.

Adds Hugh Hall, administrator of the Cherry Hill Manor, the cost of care in his facility is higher than most because of the acuity of his residents. Being under paid by Medicaid by $40 dollars per day significantly impacts the operation of his Johnston-based 172-bed skilled nursing facility, Hall says, noting that it forces the facility to look for other sources of payment to compensate for the state’s shortfall.

Hall called for a national commitment to adequately pay for care provided to the elderly and the younger subacute care population coming in nursing facilities.

“In Rhode Island, we’re working to educate the General Assembly so they understand the shortfall of the current Medicaid system, says Hall, specifically noting that the negative impact of not keeping up with annual cost changes affecting nursing facilities and not recognizing more immediately the capital costs required to maintaining a physical plant.

Hawkins, executive director of the Alliance for Better Long-Term Care and the state’s ombudsman brings the Medicaid payment issue down to a personal level: “How would any person like to have their salary level based on 1991 costs?”

“As a society, all of us are responsible for the care being provided to nursing facility residents. IF we don’t provide the best of care, we are partially responsible for that care not being provided,” says Hawkins.

“While we are demanding the highest quality of care to be delivered in Rhode Island facilities, we are not ensuring that the facility is being paid adequately to reach the quality that we are demanding from them,” adds Hawkins.

“While there may be areas where a facility can save money, it should certainly not come from a facility’s budget to ensure appropriate staffing levels or to pay for qualified nursing staff,” notes Hawkins.

“Nursing facilities are between a rock and a hard shell because they cannot recruit staff because of low wages that result from the current Medicaid reimbursement system, and they cannot hire additional staff either,” says Hawkins.

Lt. Governor Charles J. Fogarty, who heads the state’s Long-Term Care Coordinating Council, states that the General Assembly is now working to address the concerns of consumers and providers over the state’s inadequate Medicaid reimbursement policy.

Fogarty stated that he serves on a work group, administered by the state’s Department of Human Services with members from the House and Senate, to review the state’s current reimbursement Principles for Nursing Homes and other components of the long-term care system. The state-level work group has been meeting for several months and came into existence as a result of lawmakers confronting the severe certified nursing assistance shortage in nursing facilities, the Lt. Governor said.

Fogarty states the work group is in the process of considering the hiring of a consultant to ultimately shape the state reimbursement policy on Medicaid.

“This issue will not go away,” he said, noting the state’s growing aging population. “Nursing facility residents are now sicker and require more intensive care than they did 14 or 20 years ago, noted Fogarty.

Jane Haywood, director of the state’s Department of Human Services, says that her agency recognizes there is a myriad of issues relating to nursing facilities and the long-term care continuum the state must address. The legislatively mandated workgroup is expected to develop proposals of reforming the state’s Medicaid system and entire long-term care system by spring, Hayward adds.

When something is broke fix it.

No Rhode Island company can not survive for long with their revenues not covering their operating costs.

Now it is time for the state to follow this longtime sound business principle when it revamps its ailing Medicaid program. With adequate state funding, Rhode Island regulators can rightfully better demand quality from nursing facilities. With more money in their coffers, facilities had better produce that quality of care, too.

The message should be clear to the nursing home industry – it’s now time to get the gang for the buck.