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HHS Expands Aging & Disability Resource Centers to all States
June 22, 2009

The Department of Health and Human Services wants to extend the Aging and Disability Resource Center Program (ADRCs) to all states.

ADRCs are a collaborative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS). Since 2003 AoA and CMS have jointly funded ADRC pilot programs in 45 states and territories. The new funding will build on and expand the existing pilots and ensure that every state can offer this program and its services.

The funding opportunity will make it easier for older people, younger adults, and their families to learn about and access health and long-term care options through ADRCs, HHS said.

The funding availability includes two opportunities:

1) AoA-funding opportunity for ADRC development or expansion in up to 50 states over a three-year period. The maximum award for the ADRC opportunity will be $600,000; total funds available are $10 million.

2) CMS-award opportunity to programs in California, Hawaii, Maryland and North Carolina to strengthen ADRC partnerships with hospitals so that more people who are being discharged and need post-acute care receive that care at home rather than in a nursing home facility. The award amount per state is $1,167,000.

States applying for ADRC grants must involve a variety of agencies, organizations and consumers representing seniors and people with physical, developmental and mental health disabilities in the design and implementation of their ADRC programs. ADRCs also partner with State Health Insurance Counseling Programs to help people with their Medicare benefits

Applications are due Aug. 3, 2009; letters of intent are due July 1, 2009. The notice is in the June 22 Federal Register. Go to: http://edocket.access.gpo.gov/2009/pdf/E9-14559.pdf.

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Cantwell, Kohl Introduce Long-Term Care Services Reform Bill
June 11, 2009

Legislation to encourage states to implement home and community-based health care programs was introduced June 11 by Sens. Maria Cantwell (D-WA) and Herb Kohl (D-WI).

The Home and Community Balancing Incentives Act (S.1256) would reform long-term care systems by offering enhanced federal Medicaid matching rates to states that are willing to implement home and community-based health care programs. In recent years, Medicaid payments have shifted from primarily funding nursing home care, to funding more home and community-based care for older and disabled Americans.

“Home and community based services provide people the care they need in non-institutional settings, which in addition to saving a significant amount of money allows patients to maintain their independence,” said Cantwell. “This bill would reform long-term care services by providing states with resources to improve their long-term care delivery systems. If we gave just 5% of those who go into nursing homes now the ability to receive care in their own homes and communities the federal government would see a net savings of more than $10 billion over 5 years. This significant savings can be achieved while simultaneously providing better care; a truly win-win situation.”

The Cantwell-Kohl bill will provide states with resources and financial incentives to broaden the range of Medicaid services offered to people in their homes and communities, allowing more of them to live as independently as possible and still receive the care they need. The legislation will assist states in expanding their range of long-term care services, while also controlling costs.

S. 1256 would:

Improve case management to help people stay out of nursing homes;

Allow consumers to be in charge of their own home care;

Provide a coordinated system that assists in transitioning seniors and people with disabilities from nursing homes back to the community;

Create a standardized, state-wide assessment program to monitor home and community based enrollees’ eligibility status;

Develop a services and information clearinghouse so people can have one easy-to-use point of contact to learn about their home and community based options;

Require providers to submit data on the services they provide so agencies and states can create a standardized method for tracking and charging home and community based services, and;

Collect data on home and community-based patient outcomes

Project 2020
Meanwhile, Sen. Maria Cantwell (D-WA) and Debbie Stabenow (D-MI), and Reps. Bruce Braley (D-IA) and John Sarbanes (D-MD) introduced Project 2020: Building on the Promise of Home and Community-Based Services (S. 1257), which would amend the Social Security Act to build on the aging network to establish long-term services and supports through single-entry point systems, evidence based disease prevention and health promotion programs, and enhanced nursing home diversion programs.

The National Association of Area Agencies on Aging and National Association of State Units on Aging, which worked to get the bill introduced, Project 2020 is estimated to reach over 41 million Americans and will reduce federal Medicaid and Medicare costs by approximately $2.8 billion over the first five years, resulting in a net savings to the federal government of nearly $250 million. The program would also generate significant savings for state governments. Financial performance is expected to improve in years five through 10 of the program, as all systems reach full scale operations nationally, with the net federal savings over 10 years reaching $1.1 billion.

The groups said Project 2020 builds on best practices in community-based long-term care that have been demonstrated to reduce the need for more expensive institutional care and prevent or at least delay “spend down” to Medicaid for elderly and disabled adults. The legislation embraces three proven strategies as requirements for infrastructure development and participation in this program. The key elements of the approach include:

1. Person-Centered Access to Information: Services would be made available to help anyone interested in accessing long-term care obtain counseling and assistance regarding long-term care services and supports.

2. Evidence-Based Health Promotion and Disease Prevention: Scientifically-proven wellness programs for seniors would be provided through Area Agencies on Aging.

3. Enhanced Nursing Home Diversion Services: Specific care plans targeted at allowing lower-income individuals to stay in the community and stay off Medicaid.

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New Analysis Reveals Rising Costs for Medicare Part D Enrollees Over Time
June 11, 2009

For many beneficiaries enrolled in Medicare Part D prescription drug benefit plans, the coverage provided by Medicare’s private drug plans has eroded as premiums and cost-sharing requirements have increased over time, with shrinking options for low-income beneficiaries, according to new trend analysis from the Kaiser Family Foundation. The analysis from a new summary of the Foundation’s 2009 Medicare Part D Data Spotlights series reveals a pattern of beneficiaries paying more for less over time, on average:

Premiums. Between 2006 and 2009, the weighted average premium paid by beneficiaries for stand-alone Part D coverage has increased by 35%, from $25.93 per month in 2006 to $35.09 in 2009. Between 2008 and 2009 alone, the average enrollee paid 17% more in premiums – the largest one-year premium increase to date.

Cost sharing. Since 2006, the median cost sharing for a 30-day supply of “non-preferred” brand-name drugs in stand-alone PDPs has increased by 35%, from $55 to $74.75, while cost sharing for “preferred” brand drugs increased by 32%, from $28 to $37. Cost sharing for generic drugs in PDPs has remained fairly stable.

Specialty tier. In 2009, 87% of PDP enrollees and 98% of Medicare Advantage enrollees are in a plan with a specialty tier (up from 82% and 69%, respectively in 2006). The majority of Part D plans with specialty tiers currently charge 33% coinsurance for these drugs; in contrast, relatively few plans charged more than 25% coinsurance for specialty-tier drugs in 2006.

Coverage gap. In 2009, as in 2006, the majority of Part D plans offer little or no coverage in the so-called “doughnut hole,” where enrollees pay 100% of total drug costs before catastrophic coverage begins. Since 2006, the share of plans offering coverage of mostly generic drugs in the gap has increased, while full coverage of brand-name drugs in the gap has virtually disappeared.

Utilization management. While the share of drugs covered by plans has changed little in recent years, plans are increasingly placing utilization management restrictions on their use. In 2009, 28% of brand-name drugs have such restrictions, up from 18% in 2007. These restrictions include requiring step therapy, prior authorization, or a limit on the quantity covered.

Plans available to low-income beneficiaries. In 2009, fewer plans are available without a premium to low-income beneficiaries eligible for additional subsidies than in any previous year. As a result, over 1.6 million low-income subsidy recipients were assigned to new Part D plans, and another two million who remained in their same plan between 2008 and 2009 are now paying premiums for their drug coverage.

The spotlights were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation and are available online at http://www.kff.org/medicare/med110608pkg.cfm.

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Centers for Disease Control and Prevention
47,000 Older Adults Treated in Emergency Departments Annually for Fall Injuries Related to Walkers and Canes
June 29, 2009
From 2001 to 2006, an average of 129 Americans ages 65 and older were treated in emergency departments each day—a total of more than 47,000 each year—for injuries from falls that involved walkers and canes, according to a Centers for Disease Control and Prevention study published this month in the Journal of the American Geriatrics Society.
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Department of Justice
Eight Miami-Area Residents Charged in $22 Million Medicare Fraud Scheme Involving Home Health Care Agencies
June 26, 2009
Eight Miami-Dade County, Fla., residents have been indicted in connection with an alleged $22 million Medicare fraud scheme operated out of Miami businesses purporting to specialize in home health care services, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida, and Daniel R. Levinson, Inspector General of the Department of Health & Human Services.
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Administration on Aging
Kathy J. Greenlee Confirmed as U.S. Assistant Secretary for Aging
June 26, 2009
The Administration on Aging (AoA) is proud to announce that on Thursday, June 25, 2009, Kathy J. Greenlee was unanimously confirmed by the United States Senate as Assistant Secretary for Aging at the Department of Health and Human Services.
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Health Affairs
A New Center For Comparative Effectiveness Research Should Leave Cost-Effectiveness Analysis To Others, Wilensky Says
June 25, 2009
If Congress establishes a new center for research on the comparative effectiveness of drugs and medical devices, the center should not include calculations of cost and cost-effectiveness in its analyses, a former administrator of the Health Care Financing Administration (HCFA) argues
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American Geriatrics Society
Innovative Educational Program Designed to Improve Care for Growing Number of Older Adults Expands to Three More Schools
June 25, 2009
A highly successful and innovative training program that prepares chief residents at medical schools to diagnose and treat health problems common to older adults -- and to prepare the medical students and residents who they help train to do the same -- will include three additional medical schools, the Association of Directors of Geriatric Academic Programs has announced.
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Rep. Linda Sánchez
Introduces Legislation to Make Adult Day Care Available
June 25, 2009
Today, Rep. Linda Sánchez (D-CA) introduced the Medicare Adult Day Care Services Act which would allow seniors, people with disabilities, and their families by including adult day care as a covered service in Medicare.
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Department of Health and Human Services
Medicare Fraud Strike Force Operations Lead To Charges Against 53 Doctors
June 24, 2009
Fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and FBI Director Robert Mueller announced today. The Strike Force in Detroit is the third phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.
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FBI
Medicare Fraud Strike Force Operations Lead to Charges Against 53 Doctors, Health Care Executives, and Beneficiaries for More Than $50 Million in Alleged False Billing in Detroit
June 24, 2009
Fifty-three people have been indicted for schemes to submit more than $50 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Detroit, Attorney General Eric Holder, Department of Health and Human Services Secretary Kathleen Sebelius and FBI Director Robert Mueller announced today. The Strike Force in Detroit is the third phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.
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Department of Health and Human Services
HHS Announces Advanced Development Contract for New Way to Make Flu Vaccine
June 23, 2009
HHS Secretary Kathleen Sebelius announced today that the department will pursue advanced development of new way to make influenza vaccine. The work will be done by Protein Sciences Corporation, Inc., of Meriden, Conn., under a new $35 million contract. The contract could be extended up to five years at a total cost of approximately $147 million.
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FBI
Eight Miami Residents Charged in Five-State $100 Million Medicare and Medicare Advantage Fraud Scheme
June 23, 2009
Jeffrey H. Sloman, Acting United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, Daniel W. Auer, Special Agent in Charge, Internal Revenue Service, Criminal Investigation Division, and Al Lamberti, Broward County Sheriff, announced that defendants … were indicted on June 18, 2009, on Medicare and other fraud-related charges.
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Gerontological Society of America
Researchers to Reveal Aging’s Origins on Global Stage
June 23, 2009
Four of the biologists who described the underlying causes of aging will soon share their findings with an international audience during a symposium at the upcoming World Congress of Gerontology and Geriatrics, taking place from July 5–9, 2009, in Paris, France.
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Census Bureau
Census Bureau Reports World’s Older Population Projected to Triple by 2050
June 23, 2009
The world's 65-and-older population is projected to triple by midcentury, from 516 million in 2009 to 1.53 billion in 2050, according to the U.S. Census Bureau. In contrast, the population under 15 is expected to increase by only 6 percent during the same period, from 1.83 billion to 1.93 billion.
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America’s Watchdog
The Nursing Home Complaint Center Intends To Team Up With Personal Injury Law Firms To Stop Nursing Home Abuse & Medicare Fraud In Each State
June 22, 2009
The Nursing Home Complaint Center has been created to be the premier advocacy group in the nation, for senior citizens suffering wrongful death, abuse and neglect, by teaming up with personal injury law firms in every state, or major metro area in the US. At the same time the Nursing Home Complaint Center will focus on Medicare-Medicaid fraud, class actions, and wage and hour investigations in most major US cities.
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White House
Remarks by the President on the Medicare Part D "Doughnut Hole" and AARP Endorsement
June 22, 2009
THE PRESIDENT: Thank you. Well, first of all, I want to thank Barry Rand for the introduction, but also AARP, the organization he so ably represents, for coming together with us on this critical issue today.
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Census Bureau
Older Population in the United States: 2007 and 2008
June 22, 2009
Census Bureau releases a series of detailed tables with data on a wide range of demographic and socioeconomic characteristics of people 55 and older.
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