CMA Alert – April 4, 2019

On November 28, 2019 – three years after the revised federal nursing home rules were issued – “Phase 3” requirements will go into effect. These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. This presentation will examine the Compliance and ethics program, infection prevention, trauma-informed care, the Quality assurance and performance improvement program, training time, and more.

Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman will join Justice in Aging Directing Attorney Eric Carlson and Robyn Grant, Director of Public Policy and Advocacy at National Consumer Voice for Quality Long-Term Care as presenters.

Overview of Phase 3 Nursing Home Regulations: A Look Ahead
Apr 9, 2019, 3:00 PM
Register now at: https://zoom.us/webinar/register/WN_JNFhIcF_SiKKNUAJlDxxjw

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Health Care Sabotage News:

Court Strikes Blow for Health Care

Last week, a federal district court judge put a stop to another effort by the Administration to sabotage the Affordable Care Act (ACA). The judge’s ruling halts an attempt by the Department of Labor to expand Association Health Plans and weaken the ACA. In past Alerts, we have highlighted the dangers of these plans and how they undermine our health care.

Expanding these Association Plans would make it easier for certain small employers to offer plans that don’t have ACA coverage protections. These plans could also weaken essential health benefits for people who need coverage and care the most. Others who still rely on ACA compliant plans would likely see a spike in their premiums. As CNN rightly reports, “these policies… could destabilize Obamacare by siphoning out younger and healthier Americans….” This would raise costs over time for people who are older and rely on the protections mandated by the ACA.

We stated in comments opposing the Association Plan rule that it “…will weaken the individual and small group markets that are critical sources of coverage for people with pre-existing health conditions. The effect of the rule will be lower costs and more choices for some small employers, but, conversely, increased cost and limited choice for others.” The judge who issued the ruling called it “clearly an end-run around the ACA.”

We call it health care sabotage.

• See CNN article about the ruling: https://www.google.com/amp/s/amp.cnn.com/cnn/2019/03/28/politics/trump-obamacare-courts/index.html
• See New York Times Article about the ruling: https://www.google.com/amp/s/www.nytimes.com/2019/03/28/us/politics/trump-judge-health-care.amp.html

Advocacy Groups File Amicus Brief in Texas ACA Case

This week the Center for Medicare Advocacy joined AARP and Justice in Aging in filing an amicus brief in Texas v. United States, urging the Fifth Circuit Court of Appeals to reverse the trial court’s December 2018 ruling that would nullify the entire Affordable Care Act (ACA). The three organizations highlight the ACA’s critical protections for older adults and the disastrous ramifications that would ensue if the law were to be struck down. The amicus brief was filed in support of the appellant states, which are led by California. Last week, the U.S. Department of Justice announced a new, more extreme position in the case, maintaining that the entire law must be invalidated.

• Read the brief at: https://www.medicareadvocacy.org/wp-content/uploads/2019/04/Fifth-Circuit-FINAL-ACA-brief-4-1-2019.pdf

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Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief

Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Kaiser Family Foundation recently released an issue brief, Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries that examines the state of oral health for Medicare beneficiaries, including use of dental services and out-of-pocket spending. Medicare currently does not cover routine dental care, and the majority of people with Medicare have no oral health coverage at all. This leads to high out-of-pocket costs and foregone oral health care. The issue brief also discusses the means of coverage, along with scope of coverage and costs, for those Medicare beneficiaries who have access to oral health coverage through Medicare Advantage plans, Medicaid or private plans. Some key findings from the issue brief:

• Almost two-thirds of Medicare beneficiaries (65%), or nearly 37 million people, do not have dental coverage.
• Almost half of all Medicare beneficiaries did not have a dental visit within the past year (49%), with higher rates among those who are black (71%) or Hispanic (65%), have low incomes (70%), and are living in rural areas (59%) (as of 2016).
• Almost one in five Medicare beneficiaries (19%) who used dental services spent more than $1,000 out-of-pocket on dental care in 2016.
• Older adults have high rates of untreated caries and periodontal disease, which negatively affect oral and overall health: more than 14% of older adults have untreated caries and about 2 in 3 (68%) have periodontal disease.
• In 2016, 60% of Medicare Advantage enrollees, or about 10.2 million beneficiaries, had access to some dental coverage. The remaining 40% of all Medicare Advantage enrollees, or almost 7 million beneficiaries, did not have access to dental coverage under their plan.
• Some Medicare Advantage plans charge an additional premium for dental benefits, and enrollees must pay that premium in order to receive the dental coverage. Overall, almost three in ten (29%) Medicare Advantage enrollees with access to dental benefits under their plan may be required to pay a monthly premium, averaging $284 per year in 2016, for the plan dental benefits.
• Of the 7 million Medicare Advantage enrollees in plans that offered both preventive and more extensive dental benefits, about four in ten (43%) are in plans with dollar limits on coverage, and most plans had limits around $1,000. In addition to dollar limits, Medicare Advantage plans typically limit the number of services covered.
• Among full dual eligibles, almost nine in ten (88%) lived in a state where they were eligible for some dental benefits from Medicaid, although the range in covered benefits varies significantly across states.
• Poor oral health is associated with potentially preventable and costly emergency department (ED) visits, with more than 2 million visits to the ED each year among people of all ages due to oral health complications.

The KFF Issue Brief available at: https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/ The Center for Medicare Advocacy’s oral health work: https://www.medicareadvocacy.org/medicare-info/dental-coverage-under-medicare/

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Center for Medicare Advocacy Hosts a Webinar
with Special Guests Medicare Rights Center & Justice in Aging

Medicare & Health Care Hot Topics
Wed, Apr 10, 2019 3:00 PM – 4:00 PM EDT

This presentation will examine several current issues facing Medicare beneficiaries. Topics include: ongoing barriers to care, including home health and observation status issues, Medicare outreach and education, transitions from other coverage to Medicare, prescription drug proposals, and various issues impacting low-income beneficiaries, including Dual-Eligible Special Needs Plans (D-SNPs) and improper billing of Qualified Medicare Beneficiaries (QMBs).

Presenters:

David Lipschutz, Associate Director/Senior Policy Attorney, Center for Medicare Advocacy
Lindsey Copeland, Federal Policy Director, Medicare Rights Center
Jennifer Goldberg, Deputy Director, Justice in Aging

Register now at:
https://attendee.gotowebinar.com/register/5911795139236030978

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