- Congress Sets the Stage for Important Medicare Improvements
- Senators Introduce Nursing Home Legislation to Improve Quality of Care
- GAO Issues New Report on Nurse Staffing in Nursing Facilities
- Medicare Advantage Costs and Coverage Concerns
- Article | Making hearing aids affordable isn’t enough. Older adults also need hearing care services
- American Bar Association Adopts Resolution on Nursing Home Size and Density Vaccination
- Still Time to Comment on Proposed Rules that Would Diminish Access to Medicare Home Health Care
Earlier this week, the Senate passed a $1 trillion bipartisan infrastructure bill, followed by a party-line approval of a $3.5 trillion budget blueprint for a reconciliation bill. According to Politico, the budget blueprint, or framework, instructs various committees to draft portions of the reconciliation proposal by September 15. The House of Representatives plans to take up the infrastructure bill and a reconciliation package – which is outlined in the budget blueprint but not yet in the form of a bill – together.
As noted by the New York Times, “[t]he blueprint sets in motion a perilous legislative process aimed at creating the largest expansion of the federal safety net in nearly six decades.” If taken up by the House, “committees in both chambers can begin work fleshing out [the Democratic party’s] vision for what would be the greatest change to social welfare since the 1960s’ Great Society.”
Among the health-related provisions of the topline budget blueprint are plans to add oral health, hearing, and vision coverage to Medicare – goals that the Center for Medicare Advocacy has long sought and supported. As noted by Inside Health Policy (Aug. 9, 2021), a memorandum from Senate Leader Schumer to Senators states that the list of items in the budget framework are “not final and not exclusive” meaning more proposals may be added as the package takes shape.
As outlined in a recent CMA Alert, the Center joined several other consumer advocacy organizations in sending a letter to Congress and the Administration recommending our priorities for strengthening Medicare, including:
- Add an Out-of-Pocket Cap to traditional Medicare
- Add a Comprehensive Oral Health Benefit
- Add Hearing Coverage (see related Alert this week)
- Expand Vision Coverage
- Reduce Prescription Drug Prices and Out-of-Pocket Costs
- Improve the Medicare Savings Programs’ (MSPs) Low-Income Protections
- Strengthen the Home Health Benefit
- Improve Chronic Care
- Improve Medigap enrollment options and coverage
The Center has issued an Action Alert urging individuals to contact their members of Congress to push for many of these goals, as well as a separate Oral Health Action Alert focusing specifically on adding an oral health benefit. We encourage you to contact your legislators as momentum builds for Medicare improvements.
The Nursing Home Improvement and Accountability Act of 2021, introduced by Senate Finance Committee Chair Ron Wyden (D-OR), Senate Aging Committee Chair Bob Casey (D-PA), and Senators Richard Blumenthal (D-CT), Michael Bennet (D-CO), Sheldon Whitehouse (D-RI), and Sherrod Brown (D-OH) on August 10, 2021, includes multiple provisions to improve the quality of care for residents and the oversight system. Among the proposed changes addressing staffing, survey and enforcement, the federal website Care Compare, and many other issues for nursing homes that receive reimbursement from the Medicare and Medicaid programs for providing care to residents, the bill:
- Requires 24-hour a day registered nurse coverage in all facilities;
- Requires the Secretary of the Department of Health and Human Services to study, submit periodic reports to Congress, and implement nurse staffing ratios, and requires facilities to meet staffing ratios;
- Requires all facilities to have an infection preventionist at least 40 hours per week;
- Requires the Secretary to review and improve survey and enforcement practices to ensure their effectiveness, appropriate classification of deficiencies, timely correction of deficiencies, timely investigation of complaints and reported allegations of abuse and neglect, the ability of state survey agencies to hire, train, and retain surveyors, and more;
- Provides enhanced Medicaid funding to support staffing (higher wages and benefits) and quality of care, with independent evaluations of and reports to Congress about the increased funding;
- Enhances the accuracy and reliability of nursing home data, requiring audits and financial penalties for the submission of inaccurate data;
- Prohibits pre-dispute arbitration agreements;
A companion House bill is expected to be introduced after the August recess.
For additional information: “Wyden, Casey Unveil comprehensive Bill to Improve Nursing Homes for Residents and Workers” (News Release, Aug. 10, 2021), https://www.finance.senate.gov/chairmans-news/wyden-casey-unveil-comprehensive-bill-to-improve-nursing-homes-for-residents-and-workers, which includes links to the legislative text, a summary of the bill, and a section-by-section summary of the bill.
The Government Accountability Office (GAO) has issued a new report describing nurse staffing levels in nursing facilities and analyzing the relationship between nurse staffing levels, critical incidents (defined as incidents that lead to rehospitalizations or emergency room visits), and Medicare spending for hospital care for nursing home residents who are rehospitalized. The GAO reports, among other findings, that:
- Staffing by registered nurses (RNs) decreases more than 40% in skilled nursing facilities (SNFs) on weekends;
- Less than half of SNFs adjust nurse staffing levels based on resident acuity and need (although required to do so by the “annual facility assessment,” 42 C.F.R. §483.70(e));
- About 24% of SNFs “frequently” (defined as 80% of the time) meet staffing levels identified in a 2001 CMS staffing study; another 26% of SNFs meet those staffing levels “infrequently” (defined as 19% or fewer days); and
- Important staffing information, such as weekend staffing hours and use of agency nurses, is not reported on the federal website Care Compare.
The GAO also finds that although facilities with low RN staffing levels have higher rates of critical incidents, current federal financial penalties for rehospitalizations of residents are too small to encourage higher staffing levels. The GAO writes, “the additional staffing costs they would have to incur (particularly for RN staff) could outweigh the 2 percent reduction in payments” under the federal penalty program.
Facilities with the lowest rates of RN coverage are likely to be for-profit facilities and to be located in the South.
For more information, please go to: GAO, Medicare: Additional Reporting on Key Staffing Information and Stronger Payment Incentives Needed for Skilled Nursing Facilities. GAO-21-408 (Jul. 2021), https://www.gao.gov/assets/gao-21-408.pdf.
On August 11, 2021, Axios published an article by reporter Bob Herman entitled “Medicare has become more of a private marketplace — and it’s costly”. The article is available here.
Herman’s article opens as follows:
Medicare’s open enrollment will kick off in two months, leading to the health insurance industry’s annual marketing blitz that entices seniors with Medicare Advantage plans that tout capped out-of-pocket costs, vision and dental benefits, and fitness classes.
Why it matters: Medicare Advantage continued to grow during the pandemic, and it’s increasingly likely a majority of all Medicare enrollees will be in private plans in a few years despite Medicare Advantage’s deep, longstanding problems.
In the article, Herman touches on a number of important concerns relating to the Medicare Advantage (MA) program, including increased and wasteful payment to MA plans. Herman notes that the federal government paid “almost $350 billion to MA insurers” for 2021, a 10% increase from last year. “Every year since 2015” the article states, “annual spending growth on MA plans has outpaced annual enrollment growth.” This is despite the fact that “promises of saving taxpayer dollars have not panned out.” Herman quotes the Medicare Payment Advisory Commission’s (MedPAC) June 2021 report that states “No iteration of private plan contracting has yielded net aggregate savings for the Medicare program”. Herman documents how MA plans “are overcharging the government by exaggerating how sick their members are” and that the “giant pot of taxpayer funding is a big reason why venture capitalists have backed new insurers”.
In addition to noting that enrollment in MA plans is growing, and that more employers are shifting retirees into MA plans, Herman cites to the latest evidence that many people who are more sick tend to disenroll from MA plans. In June 2021, the Government Accounting Office (GAO) released a report entitled “Beneficiary Disenrollments to Fee-for-Service in Last Year of Life Increase Medicare Spending” which found that “MA beneficiaries in the last year of life disenrolled to join Medicare fee-for-service (FFS) at more than twice the rate of all other MA beneficiaries” and “disproportionate disenrollment by MA beneficiaries in the last of year life may indicate potential issues with their care.”
Herman concludes his article:
“The bottom line: Medicare Advantage is consuming more membership and more of the Medicare trust fund, but many enrollees are not sticking with their plans until the end” [emphasis in original]. After citing to the GAO report, he asks: “Why? As those people get sicker, they need more care, and their plans’ networks limit access to the doctors, hospitals, nursing homes and hospice care they want.”
It is long past time for Congress and the Department of Health and Human Services to address these Medicare Advantage problems, including wasteful spending and higher rates of disenrollment of those who are more sick. More broadly, policymakers must right the growing imbalance between the MA program and traditional Medicare.
By Frank Lin, Charlotte Yeh, and Christine Cassel Aug. 6, 2021
This article was originally published by STAT on www.statnews.com.
When Anne Madison noticed her hearing was declining at age 66, she struggled. She had always prided herself on being a savvy health care consumer, but when it came to hearing loss, what were her options? Ads for hearing aids seemed predatory, visits to an audiologist for objective professional advice about how to address hearing loss weren’t covered by Medicare, and since Medicare also didn’t cover hearing aids, the price tag was far out of her reach.
This story, which Anne told one of us (F.L.), is a common one. Hearing loss affects more than 40 million Americans, including two-thirds of all adults over age 70, and is understood to be the leading risk factor contributing to the development of dementia. Because a pair of hearing aids costs a prohibitive $4,700 on average, less than 20% of people who would benefit from hearing aids actually have them. Millions of Americans could potentially improve their health and lead better lives if hearing aids and related hearing care services were more affordable and easily accessible.
There’s good news: In 2017, Congress passed a bipartisan bill instructing the Food and Drug Administration to make certain hearing aids available over the counter, and the White House recently issued an executive order instructing the FDA to release the long-delayed regulations for these new aids within the next 120 days. Once finalized, these regulations will encourage consumer technology companies already producing innovative hearing technologies such as Bose and Apple to enter the hearing aid market, increasing competition in a stagnant marketplace currently dominated by just five manufacturers and making these life-changing devices drastically more accessible.
But there’s also bad news: While consumers may soon be able to directly purchase more affordable hearing aids, many still won’t have access to the audiological support services needed to ensure they can fully benefit from these devices. Such support services are often essential to help individuals overcome a poor understanding of their hearing loss (a common refrain from such individuals is “My hearing is fine! My wife just mumbles at me all the time.”) or without the technological savvy to learn how to use a hearing aid on their own.
At present, Medicare provides coverage for hearing tests but not for such hearing treatment or hearing aid-related services, leading to the sad paradox that an older person could see an audiologist to be diagnosed with hearing loss but not receive the hearing aids or essential treatment services needed to address it.
Current efforts in Congress spurred by President Biden’s budget request for the 2022 fiscal year calling for Medicare coverage for hearing services — along with coverage for vision and dental services — would address this anachronism. That would be important not only for seniors with traditional Medicare but also for anyone with private health insurance or Medicare Advantage plans, which often follow the cues of Medicare policy.
Click here to read the complete article on STAT.
The impact of COVID-19 on the nation’s nursing homes has been devastating. Since the pandemic began, COVID has killed over 135,000 residents and staff and infected another 1.2 million within the walls of these facilities.
In response to this unparalleled crisis, policymakers are evaluating a number of potential solutions aimed at protecting vulnerable long-term care residents and staff. The American Bar Association (ABA) is now also weighing in by adopting a resolution calling for smaller nursing home facilities with single occupancy rooms. Specifically, the ABA:
- “Urges the U.S. Congress and Department of Health and Human Services to institute a review of the advisability and feasibility of phasing in size and design standards for nursing homes that would require small, household model facilities with single rooms and private baths, given their safety and infection control advantages.”
- “Urges Congress and the executive branch to provide financial incentives for the development and operation of nursing homes meeting size and design standards pursuant to this review” including such avenues as “restructuring the Section 202 Supportive Housing for the Elderly Program of the Department of Housing and Urban Development (HUD), tax incentives under the Internal Revenue Service, or actions by other executive branch agencies to provide or encourage low cost financing for redesign, remodeling, building and rebuilding of nursing homes meeting these standards.”
- “Urges the Centers for Medicare and Medicaid Services to change Medicare and Medicaid regulations and payment policies to pay for single private rooms and bathrooms for all residents, with reasonable reimbursement rates for such rooms.”
The director of the ABA Commission on Law and Aging, Charles Sabatino, recently co-wrote an article with Dr. Charlene Harrington, Professor Emeritus, at the University of California, San Francisco, “Policy Change Putting the Home Back into Nursing Homes” that provides the background and reasoning for this resolution.
 Centers for Medicare & Medicaid Services. COVID-19 Nursing Home Data. CMS Data. (Updated July 25, 2021). Available at: https://data.cms.gov/covid-19/covid-19-nursing-home-data
Public comments on the Centers for Medicare and Medicaid Services (CMS) notice of proposed rulemaking (NPRM) are due to CMS by Friday, August 27th. As you write your own comments, feel free to from borrow from the Center’s comments, and share them with others. If you would prefer not to write your own comments, you are welcome to sign-on to our comments.
Please let us know by Friday, August 20th if you have any questions or would like to sign-on by contacting firstname.lastname@example.org.