Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – Tax Cuts will Hurt, Not Help; Sherman Fairness Hearing Set; “Homebound” Settlement Objections Due; More

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  1. Words Matter. Tax Cuts Will Hurt, Not Help America
  2. Final Week in Health Care Sabotage – 2017 ACA Open Enrollment Over in Most States
  3. Social Isolation Among Older Medicare Beneficiaries
  4. Reminder: Objections to "Homebound" Settlement Due December 28, 2017
  5. Settlement on Lower-Level Home Health Appeals Preliminarily Approved – Fairness Hearing Set for February 26, 2018

Words Matter. Tax Cuts Will Hurt, Not Help America

The tax bill has passed, providing entitlements for large corporations and rich people – as evidence-based data shows.  As a consequence of the tax cuts, vulnerable families and individuals will be harmed, from the unborn fetus, to transgender people and elders. Diversity of tax benefits for wealthier people will dramatically increase. The deficit will explode, leading to cuts to programs that help diverse, vulnerable populations. This is science-based, not conjecture; Speaker Ryan is on record confirming this is the plan. Everyday people and advocates for vulnerable people need to take heed and reject permanent damage to Medicare, Medicaid, Social Security and other key, longstanding components of the national social compact.

Final Week in Health Care Sabotage – 2017 ACA Open Enrollment Over in Most States

The time to enroll in a health insurance plan on www.healthcare.gov has come to an end. Unfortunately, but not surprisingly, the Administration has sided against consumers by not extending the deadline. Extending the deadline would have given consumers more time to choose a plan and gain fair access to quality care. An extension would have also eased the harm done to consumers by the administration’s reckless acts to sabotage the Affordable Care Act.      

The Administration was clear from the beginning that its goal was to let the Affordable Care Act (ACA) “fail, collapse and explode,” as the president stated on various occasions. To achieve this purely political goal, they took a series of actions that undermined the ACA, caused confusion and made it harder for consumers to get covered. We believe these actions were meant to undermine public confidence in the ACA in order to make it easier to repeal. In spite of these actions, public support for the ACA remains high and enrollment beat many expectations. 

Throughout the year, we have called attention to actions taken by the Administration such as cutting the enrollment period in half; slashing funding for enrollment assistance, refusing to participate in enrollment events; making plans to shut down www.healthcare.gov during critical times; refusing to pay cost-sharing reductions and issuing an Executive Order allowing the sale of junk plans. Although enrollment beat many expectations, these harmful actions took their toll. Politico reported that a survey from Public Policy Polling shows that only 43% of consumers even knew about the December 15th deadline.  
    
Even as the Administration sought to depress enrollment, many states stepped up and have extended their enrollment deadlines. Consumers in the below states can still enroll.   

It is also important to note that consumers adversely affected by recent natural disasters may qualify for a Special Enrollment Period through www.healthcare.gov.

Everyone who needs coverage and still has the opportunity to enroll should get covered.

As an organization that advocates for older people and people with disabilities, we will continue to watch and hold policy makers accountable in the New Year for any actions that bar fair access to quality health coverage. 

Social Isolation Among Older Medicare Beneficiaries

As we prepare to spend the holidays surrounded by family and friends, we want to bring attention to the many older people who may be spending the holidays alone and isolated.  Social isolation can have a harmful impact on an older person’s health and well-being. Isolation has been linked to higher mortality rates, chronic disease, dementia and depression. A report from the AARP Foundation described research showing isolation as having the same impact on health as smoking 15 cigarettes a day.

In the first study of its kind, AARP analyzed the impact of isolation on health care spending among older adults. The study found that isolation costs the federal government about $6.7 billion a year. Using Medicare spending data, the report showed that Medicare spent about $1,608 more annually for each social isolated beneficiary. This additional spending is described in the report as being close to what Medicare spends on chronic conditions like hypertension and arthritis.

An infographic from the National Association of Area Agencies on Aging (n4a) shows that isolation is also linked to higher use of emergency services and admission to nursing homes. Unfortunately, there are instances where isolation can even occur in a nursing home setting.  

The Nursing Home Reform Law requires each nursing home to “provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”[1] In order to participate in Medicare and Medicaid, nursing homes must adhere to the Nursing Home Reform Law and the minimum standards of care set out in the Requirements of Participation. One such standard of care requires every certified nursing home to “provide activities to meet the interests and needs of each resident.”[2] Unfortunately, when nursing homes are deficient in meeting this standard of care, residents can become isolated.

For example, state surveyors cited a Michigan nursing home in August 2017 for failing to ensure that residents were engaged in dignified and meaningful activities, which resulted in “boredom, and the potential for feelings of worthlessness and the promotion of loneliness.”[3] The Statement of Deficiencies (inspection record) for this nursing home noted that one resident only left his room for an hour and a half when the staff needed to clean his room. After expressing his frustration with being “there with nothing to do,” the resident communicated his desire to commit suicide.[4] Another nursing home in California was cited in September 2017 for failing to provide activities for a resident who was in contact isolation, which “had the potential to affect the psychosocial well-being” of the resident.[5] The Statement of Deficiencies in this case noted that the resident was observed staring at a wall because there was no television, radio, or reading materials in his room. The resident told surveyors that “no one visits me except when they feed me.”[6]

Unfortunately, these resident experiences likely reflect a large portion of the over two thousand deficiencies currently listed on Nursing Home Compare for this standard of care. Still, given that many reports indicate that state surveyors under-cite deficiencies, there are likely many more instances of isolation in nursing homes left in the dark.[7]

We can all work to alleviate the loneliness and isolation of older people in our communities. Our nation’s greatest generations deserve no less.  

Resources:

[1] 42 U.S.C. § 1395i-3(b)(2).
[2] 42 C.F.R. § 483.24(c)(1).
[3] Statement of Deficiencies for Brookcrest, CMS (Aug. 3, 2017), https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=235039&SURVEYDATE=08/03/2017&INSPTYPE=STD&profTab=1&state=MI&lat=0&lng=0&name=Brookcrest&Distn=0.0.
[4] Id.
[5] Statement of Deficiencies for Casa De Modesto, CMS (Sept. 14, 2017), https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=555898&SURVEYDATE=09/14/2017&INSPTYPE=STD&profTab=1&state=CA&lat=0&lng=0&name=
CASA%2520DE%2520MODESTO&Distn=0.0.
[6] Id.
[7] See, e.g., Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses, GAO (May 2008), https://www.gao.gov/assets/280/275154.pdf.

Reminder: Objections to "Homebound" Settlement Due December 28, 2017

As previously announced, a settlement in Ryan v. Hargan, a case about the Medicare agency’s failure to apply a policy that was helpful to beneficiaries seeking coverage of home health services, was preliminarily approved, and any objections from class members must be received by December 28, 2017.  A fairness hearing on the settlement will be held in Rutland, Vermont on January 11, 2018. The notice to class members, with instructions on submitting objections, and a copy of the proposed settlement agreement can be found here. The settlement will apply to Medicare beneficiaries in the northeast United States whose home health appeals were denied on the basis of not being homebound, and who had previously received a favorable appeal decision determining that they were homebound. More details on the class definition can be found in the notice to class members. The agreement will allow class members to have their eligible claims for home health services re-reviewed.

Settlement on Lower-Level Home Health Appeals Preliminarily Approved – Fairness Hearing Set for February 26, 2018

On December 13, 2017, a federal court preliminarily approved a settlement agreement in Sherman v. Hargan, 3:15-cv-1468 (JAM) (D. Conn.). The lawsuit alleged that Medicare was denying beneficiaries meaningful review of their home health claims until they reached the third level of appeal: a hearing with an Administrative Law Judge (ALJ). The beneficiary bringing the lawsuit on behalf of a nationwide class cited statistics in support of his claim showing that it was virtually impossible to be successful at the first two levels of appeal (called “redetermination” and “reconsideration” for appeals with standard timeframes).  

The proposed settlement applies to all Medicare beneficiaries whose appeals for coverage of home health services have been or will be denied at the first two levels of review and who received an initial determination or notice of termination of coverage for those services dated on or after January 1, 2012. Under the agreement, the Medicare agency will transmit four memoranda containing important principles for deciding home health appeals to the Medicare contractors that handle those decisions at the first and second levels of review. The Center for Medicare Advocacy, as class counsel, believes that the principles expressed in the transmittals are key to fair decision-making and will reinforce compliance with beneficiaries’ due process protections in the administrative appeal system.

A Fairness Hearing on the settlement will be held in New Haven, CT on February 26, 2018. Any class member wishing to object must follow instructions listed in the Notice to Class (below), and all objections must be received by class counsel by February 5, 2018. The proposed Settlement agreement and Notice to Class are below.

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