- Medicare Annual Enrollment Period Ends December 7th
- Updated – COVID-19: An Advocates Guide to Beneficiary Related Medicare Changes
- Nursing Home Residents and COVID-19: Staffing and Quality of Care Matter
- COVID-19 and Teeth
- Utah Removes Age Discrimination from its “Crisis Standards of Care”
- Free Webinar – Skilled Nursing Facility Updates – Rescheduled to January 6, 2021
Medicare Annual Enrollment Period Ends December 7th
The Medicare Annual Coordinated Election Period (AEP) – the period during which individuals with Medicare can make coverage choices for the coming year – ends next Monday, December 7th. During this time, people can enroll in, switch, or get out of Medicare Advantage (MA) and Part D prescription drug plans. They can also retain, or leave an MA plan, and enroll in traditional Medicare. Elections made during the period will be effective January 1st.
People who begin 2021 enrolled in an MA plan have an additional opportunity to switch MA plans or disenroll from an MA plan and return to traditional Medicare with a Part D plan during the first 3 months of the calendar year. This enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is not available to individuals who are in traditional Medicare and enrolled in a stand-alone Part D plan. As discussed in a recent CMA Alert, there is unequal access to different coverage options in Medicare, and there are flaws in several means of comparing such options.
In addition, there are certain rights to use a Special Enrollment Period (SEP) to change or get out of a plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents). For a full list of available SEPs, see, e.g., for MA SEPs: Medicare Managed Care Manual, Chapter 2 (2021 update available here) and Title 42, Code of Federal Regulations §422.62(b); for Part D SEPs see Medicare Prescription Drug Manual, Chapter 3 (2021 update available here) and Title 42, Code of Federal Regulations §423.38.
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Updated – COVID-19: An Advocates Guide to Beneficiary Related Medicare Changes
The global COVID-19 crisis has led to many changes in health care rules, including in the Medicare program. Most of the Medicare changes are slated to be temporary, but advocates will need to watch which provisions do and do not remain after the crisis. While a many of the changes affect health care providers, including payment and waivers of certain requirements, our Advocates Guide, updated December 1, 2020, focuses on Medicare COVID changes that relate to beneficiaries and their access to covered care. Note: This Advocates Guide describes, but does not analyze or critique these changes.
- See more and download the full guide at https://medicareadvocacy.org/covid-19-an-advocates-guide-to-medicare-changes/
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Nursing Home Residents and COVID-19: Staffing and Quality of Care Matter
Despite the nursing home industry’s ongoing insistence that location/zip code is the primary factor determining whether residents infected with coronavirus,[1] evidence mounts that higher nurse staffing levels are correlated with fewer COVID-19 cases in nursing facilities.[2]
Prompted by Bloomberg Law’s finding that the five nursing facilities within 25 miles of Nashville, Tennessee that were operated by the New Jersey-based CareRite Centers “suffered an infection rate more than three times that of the metro area’s 26 other homes,”[3] the Center for Medicare Advocacy took a closer look at the 31 nursing facilities in the Nashville area – five CareRite facilities and 26 facilities with other ownership.
Coronavirus cases and deaths are considerably higher in the five CareRite facilities than the other 26 Nashville-area nursing facilities, according to cumulative information self-reported by facilities and reported through Nursing Home Compare, as of November 15, 2020.
5 CareRite and 26 Non-CareRite Facilities
Nashville, Tennessee Area
Self-Reported Data (Nov. 15, 2020)
Recognizing that larger facilities may be more likely than smaller facilities to have COVID-19 infections and that CareRite’s facilities are generally larger than other facilities, the Center controls for facility size by showing below total coronavirus cases and deaths per 1000 residents for CareRite and non-CareRite facilities. As of November 15, 2020, CareRite’s Nashville facilities reported almost double the number of COVID-19 cases per 1000 residents, compared to non-CareRite facilities.
5 CareRite and 26 Non-CareRite Facilities
Nashville, Tennessee Area
Covid-19 Cases/1000 Residents
As shown in the below chart, as reported on Nursing Home Compare (data not updated since March 2020),the five CareRite facilities in the Nashville area have lower overall star ratings, lower health inspection ratings, and considerably lower staffing ratings than the 26 non-CareRite facilities. CareRite facilities reported higher ratings only in the quality measure domain than non-CareRite facilities. Quality measures are based largely on self-reported information and are the most inaccurate part of publicly-reported data.
5 CareRite and 26 Non-CareRite Facilities
Nashville, Tennessee Area
Nursing Home Compare
More recent staffing data continue to show that CareRite facilities in Nashville provide residents with much less care by registered nurses, compared to non-CareRite facilities.
In March 2020, as part of the Blanket Waivers for Health Care Providers, the Centers for Medicare & Medicaid Services (CMS) waived the requirement that nursing facilities report staffing data, using the Payroll-Based Journal (PBJ) system.[4] On June 25, 2020, CMS announced that it was ending that waiver, effective with the second calendar quarter 2020 (April –June 2020), although staffing information publicly reported on Nursing Home Compare (now Care Compare) would continue to be held constant and to report data for the fourth calendar quarter 2019 (October-December 2019).[5]
The New York-based Long Term Care Community Coalition published staffing data for the second quarter, 2020, as reported on data.cms.gov.[6] This information, based on PBJ data, shows that CareRite’s Nashville facilities provide less RN care than non-CareRite facilities – 0.38 hours per resident per day, compared to 0.52 hours per resident per day.
5 CareRite and 26 Non-CareRite Facilities
Nashville, Tennessee Area
Long Term Care Community Coalition
PBJ Data, data.cms.gov (2d quarter 2020)
CareRite’s low staffing levels and high rates of COVID-19 infections and deaths are not limited to the company’s Nashville facilities. CareRite’s nine Tennessee nursing facilities have 4% of the state’s nursing home beds, but 10% of the state’s COVID-19 cases and 11% of the deaths. Moreover, two of Tennessee’s three largest COVID-19 outbreaks are in CareRite facilities.
Bloomberg Law reports similar COVID-19 cases and deaths in CareRite facilities in other states. At least 499 resident and staff members have died from COVID in CareRite’s 29 facilities in four states. The company’s 15 facilities in New York, with 3000 beds, have had 336 COVID-related deaths, representing “a fatality rate that’s 75% higher than the average for nursing homes in the state.” CareRite’s four Florida facilities have seen 73 fatalities, “also above the average.”
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[1] American Health Care Association President and CEO Mark Parkinson, “We Won’t Back Down” (Jun. 2020), https://files.constantcontact.com/64f0b60b701/f86b03a3-a859-4098-b6d0-3866c56672d5.pdf. See Center for Medicare Advocacy, “Nursing Facilities and Covid-19 – it’s not Inevitable” (CMA Alert, Oct, 8, 2020), https://medicareadvocacy.org/nursing-facilities-and-covid-19-its-not-inevitable/.
[2] Center for Medicare Advocacy, “Nursing Facilities and COVID: Staffing Matters” (CMA Alert, Nov. 5, 2020) (discussing Bloomberg Law’s report about Nashville nursing facilities), https://medicareadvocacy.org/nursing-facilities-and-covid-staffing-matters/; Center for Medicare Advocacy, “Studies Find Higher Nurse Staffing Levels in Nursing Facilities Are Correlated With Better Containment Of Covid-19” (CMA Alert, Aug. 13, 2020) (discussing four studies finding facilities with more nurses are more successful in containing COVID-19 cases and death), https://medicareadvocacy.org/studies-find-higher-nurse-staffing-levels-in-nursing-facilities-are-correlated-with-better-containment-of-covid-19/.
[3] Ben Elgin, “Cost-Cutting at America’s Nursing Homes Made Covid-19 Even Worse,” Bloomberg Law (Oct. 31, 2020).
[4] CMS, “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” (issued Mar. 2020, updated Dec. 1, 2020), https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.
[5] CMS, “Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency,” QSO-20-34-NH (Jun. 25, 2020), https://www.cms.gov/files/document/qso-20-34-nh.pdf.
[6] https://nursinghome411.org/nursing-home-data-information/staffing/.
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A recent New York Times article, “Their Teeth Fell Out. Was It Another Covid-19 Consequence?” raised the possibility that tooth loss could be another result of COVID-19 infection, although the article stated that there are currently limited examples on the topic. According to the article, some medical experts think that it is possible that the infection could aggravate existing dental conditions.
Currently there is mostly anecdotal evidence of tooth loss being associated with the infection. Some of the individuals cited in the article lost teeth even though they did not have any underlying dental problems. Many of the individuals lost the tooth without any blood loss or pain. This description could point to a connection to the COVID-19 infection’s known ability to attack blood vessels.
The article quoted an expert on this issue:
“Teeth falling out without any blood is unusual, Dr. Li said, and provides a clue that there might be something going on with the blood vessels in the gums. The new coronavirus wreaks havoc by binding to the ACE2 protein, which is ubiquitous in the human body. Not only is it found in the lungs, but also on nerve and endothelial cells.”
Therefore, Dr. Li says,
‘it’s possible that the virus has damaged the blood vessels that keep the teeth alive in Covid-19 survivors; that also may explain why those who have lost their teeth feel no pain. It’s also possible that the widespread immune response, known as a cytokine storm, may be manifesting in the mouth.”
Some other medical research has also pointed to the possibility that COVID-19 could worsen or even initiate oral health problems, although the research is limited. More research is needed to definitively establish a correlation between COVID-19 and tooth loss.
Another area requiring more extensive research is whether existing oral health conditions could increase severity of illness. The Center for Disease Control and Prevention has highlighted that populations at higher risk for many of the chronic diseases that have been linked with worse COVID-19 outcomes are similar to those at increased risk for developing oral health conditions. Over the summer, Nature’s British Dental Journal also raised the possibility of a link between oral hygiene and severity of illness, and called for additional examination of the subject. “[T]he connection between the oral microbiome and COVID-19 complications should be investigated in the process of better understanding the outcomes of COVID-19 disease.”
Additional research on COVID-19 and oral health is necessary. Current concerns underscore what advocates for expanded oral health coverage have long stated: oral health is part of overall health.
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Utah Removes Age Discrimination from its “Crisis Standards of Care”
In October the Center for Medicare reported about Utah’s inclusion of an age-based “tie-breaker” in its “Crisis Standards of Care.” These standards guide medical providers when they are forced to ration life-saving treatment, such as the use of ICU care or ventilators. At the time, Utah hospitals were becoming overwhelmed by a surge of COVID-19 patients. Now, they have been stretched even thinner, with “informal rationing” of care already starting.
The Center for Medicare Advocacy joined Justice in Aging’s efforts to oppose the inclusion of an unlawfully discriminatory “tie-breaker,” based solely on the patient’s age, in Utah’s Crisis Standards of Care. We are pleased that the state has now removed that arbitrary provision and revised its “tie-breaker” guidelines.
Resources are now to be triaged based on clinical factors that emphasize prospects for short-term survival, followed by random allocation if necessary. The revised standards also expressly prohibit discrimination based on age and other factors such as race, disability, or sex. While it is tragic that these crisis standards may have to be used, Utah’s revisions help ensure the equitable treatment of COVID-19 patients. This is particularly important for older adults, who have borne the worst effects of the pandemic and should not be devalued based solely on their age.
Other resources on COVID-19 care rationing and opposition to age- or disability-based discrimination:
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Free Webinar – Skilled Nursing Facility Updates – Rescheduled to January 6, 2021
Skilled Nursing Facility Updates will now take place Wednesday January 6, 2021 at 2:00 PM EST.
Right now, quality nursing facility care matters more than ever. Join us for an overview of nursing home quality of care & quality of life standards from a consumer perspective.
- When: Wednesday, JANUARY 6, 2021 2:00 PM – 3:00 PM EST
- Presented by: Center for Medicare Advocacy Senior Policy Attorney Toby Edelman and Health & Aging Policy Fellow Cinnamon St. John.
Prior registrants should have received notification of the date-change in a separate email. If the date change affects your ability to attend, please note that this presentation will be recorded for later viewing. If you are able to attend on January 6, 2020 your original registration link will work for that session. If you were not able to attend the December date, but can make January 6th, register now at medicareadvocacy.org/webinars.
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