Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – January 17, 2019

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  1. Improve and Expand Medicare: Oral Health
  2. Center for Medicare Advocacy is Honored to Welcome Judith Feder, Ph.D as President of our Board of Directors
  3. Registered Nurses Are the Key to Reducing Hospital Readmissions of Nursing Home Residents
  4. Hot off the Press: 2019 Medicare Handbook
  5. Nursing Home Residents at Risk: Advocates Submit Briefing to Congress

Improve and Expand Medicare: Oral Health

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations for Medicare, now and in the future, is the need to expand and Improve Medicare for all current and future beneficiaries, not just those in private Medicare plans. One of the key issues faced by beneficiaries in the traditional Medicare program is the lack of coverage for oral health benefits.

As noted in last week’s CMA Alert, one of the Center for Medicare Advocacy’s top priorities is to expand Medicare coverage to include oral and dental care for all beneficiaries.  We have also long advocated for coverage of medically necessary oral health care, which we believe is currently supported by the Medicare statue but is, unfortunately, significantly limited in practice due to Medicare policy.

The Medicare statute specifically excludes payment for services “in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth…” (Section 1862(a)(12) of the Social Security Act [42 U.S.C. § 1395y(a)(12)]).  The provision bars payment when the primary purpose of the dental work is to address the teeth and supporting structures.

Importantly, the plain language of the statutory provision does not prohibit payment for dental services needed “in connection with” treatment of medical issues that extend beyond the teeth and supporting structures. For example, clinical standards and protocols for certain covered medical procedures (e.g., some organ transplants, cardiac surgeries, chemotherapies) require that dental infections be treated to reduce the risk of serious and costly complications.

As we work toward the development of a comprehensive Medicare oral health benefit, the Center for Medicare Advocacy will continue to fight against the over-broad use of the dental exclusion to preclude coverage for dental procedures in all circumstances.  This was not the legislative intent. Appropriate interpretation also aligns with Medicare’s fundamental, remedial purpose to help beneficiaries access and afford treatment for major medical problems.

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Center for Medicare Advocacy is Honored to Welcome Judith Feder, Ph.D as President of our Board of Directors

The Center for Medicare Advocacy is thrilled to announce that Judy Feder has been elected President of our Board of Directors.

Ms. Feder is a professor of public policy and, from 1999 to 2008, served as dean of what is now the McCourt School of Public Policy at Georgetown University. A nationally-recognized leader in health policy, Ms. Feder has made her mark on the nation’s health insurance system, through both scholarship and public service. A widely published scholar, Ms. Feder’s health policy research began at the Brookings Institution, continued at the Urban Institute, and, since 1984, flourished at Georgetown University. In the late 1980s, Ms. Feder moved from policy research to policy leadership, actively promoting effective health reform as staff director of the congressional Pepper Commission (chaired by Sen. John D. Rockefeller IV) in 1989-90; Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services in former President Bill Clinton’s first term; a senior fellow at the Center for American Progress (2008-2011) and, today, as an Institute Fellow at the Urban Institute.

Ms. Feder matches her own contributions to policy with her contributions to nurturing emerging policy leaders. As dean from 1999 to 2008, she built Georgetown’s Public Policy Institute into one of the nation’s leading public policy schools, whose graduates participate in policymaking, policy research, and policy politics, not only throughout Washington but throughout the nation and the world.

Ms. Feder is an elected member of the Institute of Medicine, the National Academy of Public Administration, and the National Academy of Social Insurance; a former chair and board member of AcademyHealth; a member of the Center for American Progress Action Fund Board, the Board of the National Academy of Social Insurance, and the Hamilton Project’s Advisory Council; and a senior advisor to the Kaiser Commission on Medicaid and the Uninsured. In 2006 and 2008, Ms. Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district. Ms. Feder is a political scientist, with a B.A. from Brandeis University, and a master's and Ph.D. from Harvard University.

Ms. Feder replaces outgoing President Bess Brewer, Esq.  We thank them both for their work on behalf of the Center for Medicare Advocacy.  We are honored to be associated with two such wonderful thought-leaders and advocates.

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Registered Nurses Are the Key to Reducing Hospital Readmissions of Nursing Home Residents

States Whose Nursing Facilities Employ Few Registered Nurses Are More Likely To Be Penalized for Readmissions of Their Residents to Hospitals

In 2014, as part of the Protecting Access to Medicare Act, Congress created the Skilled Nursing Facility Value-Based Purchasing Program, whose financial incentives are intended to reduce rehospitaliations of nursing home residents.  In December 2018, for the first time, the Centers for Medicare & Medicaid Services assigned financial bonuses and penalties to specific skilled nursing facilities, judging performance on the rehospitalization rates of their residents within 30 days of discharge.[1] 

Kaiser Health News reports that 85% of nursing facilities in Arkansas, Louisiana, and Mississippi had payment reductions, while more than half the facilities in Alaska, Hawaii, and Washington State received bonuses.

On January 9, 2019, the Center for Medicare Advocacy looked at the nurse staffing levels for the six states, as reported on the federal website Nursing Home Compare.  Federal nurse staffing data, which are now based on data derived from payroll, documented that registered nurses (RNs) are the key to reducing readmissions of nursing facility residents to acute care hospitals.

All three states that had payment reductions have lower RN staffing levels than the national average.  All three states that received bonuses have higher RN staffing levels than the national average. 

Other licensed nurses are not correlated with reduced hospitalizations.  In fact, all three states with payment reductions have higher licensed practical nurse (LPN) rates than the national average and their total licensed nurse staffing levels are either just below or just above national levels.

Moreover, all three states receiving bonuses have lower LPN rates than the national average.  These states have higher total licensed nurse staffing levels, although for two of them (Hawaii and Washington), the licensed nurse staffing rates are between 11 and 15 minutes higher than the national average.

The key staffing factor appears to be having adequate numbers of RNs on staff.

State

State’s RN staffing

National RN staffing

State’s LPN staffing

National LPN staffing

State’s Total Licensed Nurses

National Total Licensed Nurses

States with Penalties

 

 

 

 

 

 

Arkansas

20 min.

41 min.

1 hr. 3 min.

53 min.

1 hr. 23 min.

1 hr. 34 min.

Louisiana

17 min.

41 min.

1 hr. 9 min.

53 min.

1 hr. 27 min.

1 hr. 34 min.

Mississippi

37 min.

41 min.

1 hr. 5 min.

53 min.

1 hr. 41 min.

1 hr. 34 min.

States with Bonuses

 

 

 

 

 

 

Alaska

2 hr. 2 min.

41 min.

41 min.

53 min.

2 hr. 43 min.

1 hr. 34 min.

Hawaii

1 hr. 28 min.

41 min.

21 min.

53 min.

1 hr. 49 min.

1 hr. 34 min.

Washington State

1 hr.

41 min.

45 min.

53 min.

1 hr. 45 min.

1 hr. 34 min.

The correlation of higher RN staffing levels with reduced rates of hospitalization is consistent with prior studies that have directly tied appropriate staffing levels with improved resident outcomes.[2] 

CMS has acknowledged the importance of appropriate staffing in meeting residents’ care needs. In an April 2018 memorandum, CMS states, “[r]esearch shows the presence of an RN is strongly related to the quality and outcomes residents experience.”[3]  The memorandum includes a chart showing how nursing homes perform on three claims-based quality measures (30-day readmissions, emergency room transfers, and successful discharge to community) based on the decile of RN hours.[4]  As the chart demonstrates, nursing homes with higher RN hours have better outcomes on all three measures.[5]

[1] Jordan Rau, “Medicare Cuts Payments To Nursing Homes Whose Patients Keep Ending Up in Hospital,” Kaiser Health News (Dec. 3, 2018), https://khn.org/news/medicare-cuts-payments-to-nursing-homes-whose-patients-keep-ending-up-in-hospital/.
[2] More Nurses in Nursing Homes Would Mean Fewer Patients Headed to Hospitals, (CMA Alert, Mar. 10, 2011).
https://www.medicareadvocacy.org/more-nurses-in-nursing-homes-will-mean-fewer-patients-headed-to-hospitals/.
[3] CMS, Transition to Payroll-Based Journal (PBJ) Staffing Measures on the Nursing Home Compare tool on Medicare.gov and the Five Star Quality Rating System, QSO-18-17-NH (Apr. 6, 2018), Questions & Answers, p. 2, https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO18-17-NH.pdf.
[4] Id.
[5] Id.

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Hot off the Press: 2019 Medicare Handbook

The Center for Medicare Advocacy’s comprehensive Medicare Handbook is now available from Wolters Kluwer.

The Medicare Handbook is a complete resource for attorneys, advocates, policy experts and health care providers.  It is the indispensable resource for clarifying Medicare's confusing rules and regulations.

Prepared by the experts at the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning, advice, research or advocacy.  It includes extensive discussion and examples of how Medicare rules apply in the real world, case citations, checklists, worksheets, practice pointers and other tools to help in obtaining access to Medicare coverage.

Order Online Now
or Call Wolters Kluwer at 1-800-638-84377

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Nursing Home Residents at Risk: Advocates Submit Briefing to Congress

The Center for Medicare Advocacy, the Long Term Care Community Coalition, the National Consumer Voice for Quality Long-Term Care, Justice in Aging, and California Advocates for Nursing Home Reform recently submitted a briefing to members of Congress addressing ongoing concerns regarding the health and safety of nursing home residents.

The Nursing Home Reform Law requires every nursing home to provide residents with the services they need to attain and maintain their “highest practicable physical, mental, and psychosocial well-being.” Unfortunately, the Centers for Medicare & Medicaid Services (CMS) has been rolling back resident rights and protections, often at the request of the nursing home industry, for the purpose of reducing so-called provider “burdens.”

CMS’s efforts are even more dangerous because they exacerbate existing problems in nursing homes. Multiple reports from the HHS Office of the Inspector General (OIG) and the Government Accountability Office (GAO) document persistent and widespread problems facing nursing home residents. The Center for Medicare Advocacy and our partners continue to pursue the opportunity to work with members of Congress to address the needs of this exceptionally vulnerable population.

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