Tag Archives for Rhode Island General Assembly

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.



Confronting the Long-Term Care Dilemma in Uncertain Times

Published in the Pawtucket Times on January 14, 2002

 Aging advocates are about to find out how many slides you can cut the Rhode Island budgetary pie, especially when lawmakers are predicting that the state’s deficit could soar to hundreds of millions.

With the backdrop of a recession, pushing to keep funding at current levels for existing programs and services this legislative session may be their only hope as advocates for affordable health care and housing, education, disabled persons, seniors, and low-income families call for their fair share, too.

Meanwhile, CHOICES, a broad-based coalition of provider organizations and advocate organizations, will push this legislative session for more funding to keep Rhode Island seniors in their homes.

The coalition representing home care agencies, assisted-living facilities, adult day care, housing, senior center, disabled and senior advocates and Meals on Wheels, will continue its efforts to urge the General Assembly for reforms to Rhode Island’s long-term care system, said Paula Parker, Executive Director of Rhode Island Partnership of Home Care and a CHOICES member.

“Consumers must have options to choose programs and services that can provide them with greater independence in familiar surroundings,” Park told ALL About Seniors, adding that this is an underlying principle of CHOICE’S philosophy.

During the state’s prosperous years, Rhode Island’s allocation for home and community-based services slowly inched up from seven to eight percent of the state’s total long-term care budget.  Parker noted, however, that General Assembly funding for long-term care services continued to be heavily weighted toward funding institutional facility care.

“The challenge today is to continue the momentum of increasing state support for home and community-based services in less prosperous times,” Parker said, because the start’s rising elderly population creates a need to expand options in long-term care.

Susan Sweet, a consultant, long-time consumer advocate and CHOICES member, added that the seven-year-old coalition plans to continue its education efforts to inform legislators and the public about the cost savings of home and community care for elders as opposed to institutional care.

For example, Sweet stated that full-time adult day care five days a week may cost up to $ 10,000 annually as compared to an average $38,000 bill for nursing facility care.

Options in the state’s continuum of care include assistance with the costs of pharmaceutical drugs, community-based programs, rehabilitation facilities and nursing facility care. Sweet said, “A menu of available choices allows seniors and their families to seek out and receive the most appropriate and cost-effective care for their current situation. That’s what CHOICES is all about.”

Can long-term care options assist lawmakers in controlling the state budget while providing needed services for seniors?

Yes, said Sweet. “Not only is the quality of life greatly enhanced for elders and their families when institutionalization is delayed or eliminated, but also individual assets and state contributions to care through the Medicaid program are greatly reduced or eliminated,” she said.

Recognizing that lawmakers must work within severe budgetary constraints. Sweet said she believes it should be fiscally short-sided not to recognize the significant budgetary savings that home and community-based care- and preventative care- bring to situations that, without intervention, would lead to costly health care such as hospitalization and protracted institutional stays.

“The challenge for Rhode Island is to continue progress on creating less restrictive and less expensive community services while continuing funding for needed acute and long-term care,” Sweet said, stressing that in a tie of decreasing revenues, this will not be an easy task.

Lawmakers must either conform the long-term care crisis now for today’s seniors in the shadow of the state’s current budget deficit or in later years, when the state’s demographic time bomb I ready to explode. For today’s seniors and for the aging baby boomers who follow in their footsteps, lawmakers, state agencies, providers and seniors  must cooperate in crafting a seamless long-term care system with options that enhance quality of life and provide independence. This may take years.

But until then, amid competing interests for limited state dollars, advocates for better long-term care will have to roll up their shelves with the support of senior and disabled constituents to get this year’s slice of the state budget pie.