The Senate is poised to vote on Monday, March 23, on a cloture motion setting the stage for passage of H.R. 1388 the Generations Invigorating Volunteerism and Education Act referred to as the GIVE Act sponsored by Representative Carolyn McCarthy (D-NY) and 37 co-sponsors. The bill amends the National and Community Service Act of 1990 (NSCA) and the Domestic Volunteer Service Act of 1973 (DVSA).
The bill provides for service from individuals of all ages. Some aspects of the bill relate specifically to service opportunities and programs for older Americans. Among other features, the legislation requires states to develop comprehensive plans for volunteer and paid service by Baby Boomers and older adults.
It also establishes within the Investment for Quality and Innovation program: (1) a ServeAmerica Fellowships program providing fellowships to individuals chosen by states to participate in service projects addressing certain areas of national need; (2) a Silver Scholarship Grant Program providing scholarships to individuals age 55 or older who complete at least 500 hours of service in a year in an area of national need; and (3) an Encore Fellowships program providing one-year fellowships to individuals age 55 or older who serve in areas of national need and receive training to transition to public service employment. ServeAmerica fellows will be eligible for national service educational awards.
The bill makes revisions to components of the DVSA including: (1) the VISTA program; and (2) the Senior Corps, including the Retired and Senior Volunteer program (RSVP), the Foster Grandparent program, and the Senior Companion program.
The GIVE Act also prioritizes VISTA participant selection to include disadvantaged youth and retired adults of any profession along with prioritizing RSVP projects in specified areas. Anyone 55 years of age or older is eligible to be a Senior Corps volunteer. Under the Senior Corps demonstration program incentive matching grants will be available to Senior Corps programs that exceed specified performance measures, enroll most of their volunteers in outcome-based service programs, and increase their enrollment of Baby Boomer volunteers. Congress intends that the number of AmeriCorps, VISTA, and NCCC participants should reach 250,000 by 2014.
For the full text of the bill visit http://www.thomas.loc.gov/ and search for bill number H.R. 1388
Friday, March 20, 2009
Friday, March 13, 2009
Fiscal Year 2010 Health Care Proposals
The Senate Finance Committee held a hearing Tuesday, March 10 on the President’s Fiscal Year 2010 Health Care Proposals. Chairman Max Baucus (D-MT) opened the hearing by saying that comprehensive health reform is “an imperative. If we delayed, the problems that we face today would grow even worse. If we delayed, millions more Americans would lose their coverage. If we delayed, premiums would rise even further out of reach. And if we delayed, Federal health care spending would soak up an even greater share of our nation’s income.” He related the schedule for Congressional action including mark up of a comprehensive health care reform bill in June and a bill on the President’s desk by July 4. To view his statement follow this link: http://finance.senate.gov/hearings/statements/031009mb.pdf
The ranking member of the committee, Senator Charles Grassley (R-IA), also made an opening statement. He said, “The American health care system – if you can even call it a system -- is in desperate need of reforms. We spend twice as much on health care as other developed countries. But even with all this spending, our health outcomes are often half as good. “ He also noted that the schedule to which he has committed with Senator Baucus is “ambitious but achievable” and that the Congress has “a long way to go and a lot of heavy lifting ahead of us. “ Senator Grassley related his four principles for reform: (1) reform should be accomplished through regular order in a fiscally responsible way, (2) health care costs must be brought under control, (3) reform must assure that individuals are allowed the choice to keep their existing coverage, and (4) any change must assure that individual health care decisions are made by the physician and the patient and not by a bureaucrat. To view Senator Grassley’s full statement follow this link: http://finance.senate.gov/hearings/statements/031009cg.pdf
Peter R. Orszag, Director of the Office of Management and Budget, was the only witness to testify before the committee. Director Orszag began his remarks noting that all options should be considered. He said that escalating health care costs result in crowding out of other areas in state budgets. Furthermore, high health care costs often reflect that more procedures were performed but do not necessarily mean that better outcomes were achieved. He went on to relate that affordable, quality health care must be available to all Americans.
Several reforms he mentioned included implementation of health information technology. With all of the information technology that is part of our everyday life, it is stunning that health information is still routinely recorded and stored on paper. Comparative effectiveness research is a tool that will provide health care professionals and their patients with better tools to weigh treatment options. Changing our payment system to provide efficient, effective care, not just more care, must be part of reform. Prevention and wellness are key components for a healthier America. To view his testimony you may follow this link: http://finance.senate.gov/hearings/testimony/2009test/031009potest.pdf .
Chairman Baucus, Ranking Member Grassley and the committee members made comments and asked questions about Medicare, prescription drug purchasing from other countries, biologics and generic drugs, the process for implementing comparative effectiveness, public and private health insurance plans, reforms to the health insurance market, personal responsibility, coordination of care, health care payment and incentive reforms, long-term care, access to care, improper payments, prevention and coverage for immigrants in the country illegally, among others. Director Orszag reiterated that the president believes all options should be on the table as Congress takes action to reform the health care system.
The ranking member of the committee, Senator Charles Grassley (R-IA), also made an opening statement. He said, “The American health care system – if you can even call it a system -- is in desperate need of reforms. We spend twice as much on health care as other developed countries. But even with all this spending, our health outcomes are often half as good. “ He also noted that the schedule to which he has committed with Senator Baucus is “ambitious but achievable” and that the Congress has “a long way to go and a lot of heavy lifting ahead of us. “ Senator Grassley related his four principles for reform: (1) reform should be accomplished through regular order in a fiscally responsible way, (2) health care costs must be brought under control, (3) reform must assure that individuals are allowed the choice to keep their existing coverage, and (4) any change must assure that individual health care decisions are made by the physician and the patient and not by a bureaucrat. To view Senator Grassley’s full statement follow this link: http://finance.senate.gov/hearings/statements/031009cg.pdf
Peter R. Orszag, Director of the Office of Management and Budget, was the only witness to testify before the committee. Director Orszag began his remarks noting that all options should be considered. He said that escalating health care costs result in crowding out of other areas in state budgets. Furthermore, high health care costs often reflect that more procedures were performed but do not necessarily mean that better outcomes were achieved. He went on to relate that affordable, quality health care must be available to all Americans.
Several reforms he mentioned included implementation of health information technology. With all of the information technology that is part of our everyday life, it is stunning that health information is still routinely recorded and stored on paper. Comparative effectiveness research is a tool that will provide health care professionals and their patients with better tools to weigh treatment options. Changing our payment system to provide efficient, effective care, not just more care, must be part of reform. Prevention and wellness are key components for a healthier America. To view his testimony you may follow this link: http://finance.senate.gov/hearings/testimony/2009test/031009potest.pdf .
Chairman Baucus, Ranking Member Grassley and the committee members made comments and asked questions about Medicare, prescription drug purchasing from other countries, biologics and generic drugs, the process for implementing comparative effectiveness, public and private health insurance plans, reforms to the health insurance market, personal responsibility, coordination of care, health care payment and incentive reforms, long-term care, access to care, improper payments, prevention and coverage for immigrants in the country illegally, among others. Director Orszag reiterated that the president believes all options should be on the table as Congress takes action to reform the health care system.
Thursday, March 12, 2009
Designing a High Performing Healthcare System
The House Committee on Energy and Commerce, Subcommittee on Health held a hearing on March 10, kicking off a series of hearings on “Making Health Care Work for American Families.” The first hearing, entitled “Designing a High Performing Healthcare System,” explored options for designing a high performing healthcare system. In his opening statement Chair of the subcommittee, Congressman Frank Pallone (D-NJ), said that having the hearing “implies that our current system is underperforming.” Each committee member had a chance to express concerns and raise issues about improvements needed in the American healthcare system.
The major themes of the hearing included:
· Health information technology- the costs, benefits and implementation
· Care coordination- access to primary care, utilization of other providers, incentives
· Primary care physician shortages
· Health disparities- minorities, low income, rural
· Physician reimbursement- bundled payments, physician payment equity
· Public vs. private health insurance- one payer system, rationing of services, quality
The following witnesses testified:
· Doug Elmendorf, Director, Congressional Budget Office
· Glenn Hackbarth, Chairman, Medicare Payment Advisory Commission (MedPAC)
· Jack C. Ebeler, Vice Chair, Committee on Health Insurance Status and Its Consequences, Institute Of Medicine
· Alan Levine, Secretary, Louisiana Department of Health and Hospitals
· Atul Gawande, M.D., Assoc. Prof., Dept. Health Policy & Management., Harvard School of Public Health
· M. Todd Williamson, M.D., President, Medical Association of Georgia
The written testimony of each witness and Congressman Pallone, as well as video coverage of the hearing is available on the Committee’s website:
http://energycommerce.house.gov/index.php?option=com_content&task=view&id=1524&Itemid=95
The major themes of the hearing included:
· Health information technology- the costs, benefits and implementation
· Care coordination- access to primary care, utilization of other providers, incentives
· Primary care physician shortages
· Health disparities- minorities, low income, rural
· Physician reimbursement- bundled payments, physician payment equity
· Public vs. private health insurance- one payer system, rationing of services, quality
The following witnesses testified:
· Doug Elmendorf, Director, Congressional Budget Office
· Glenn Hackbarth, Chairman, Medicare Payment Advisory Commission (MedPAC)
· Jack C. Ebeler, Vice Chair, Committee on Health Insurance Status and Its Consequences, Institute Of Medicine
· Alan Levine, Secretary, Louisiana Department of Health and Hospitals
· Atul Gawande, M.D., Assoc. Prof., Dept. Health Policy & Management., Harvard School of Public Health
· M. Todd Williamson, M.D., President, Medical Association of Georgia
The written testimony of each witness and Congressman Pallone, as well as video coverage of the hearing is available on the Committee’s website:
http://energycommerce.house.gov/index.php?option=com_content&task=view&id=1524&Itemid=95
Friday, March 6, 2009
Senate Special Committee on Aging Hearing: Health Care Reform in An Aging America
Wednesday, March 4, the Senate Special Committee on Aging, chaired by Sen. Herb Kohl (D-WI), held a hearing on Health Care Reform in an Aging America, with a specific focus on long term services and supports. Two panels provided testimony to the hearing. The first panel included Thomas Hamilton, Director, Survey and Certification Group, Centers for Medicare & Medicaid Services; Karen Timberlake, Secretary, Wisconsin Department of Health Services; and Holly Benson, Secretary, Florida Agency for Health Care Administration. The second panel consisted of Henry Claypool, Washington Liaison, PHI, New York, New York; Melanie Bella, Senior Vice President for Policy, Center for Health Care Strategies, Hamilton, New Jersey; and Judy Feder, Senior Fellow, Center for American Progress, Washington, D.C.
Aging advocates and advocates for individuals with disabilities filled the hearing room.
Senator Ted Kennedy (D-MA), who is leading the health care reform effort in the Senate along with Sen. Max Baucus (D-MT), issued the following statement at the hearing: "A major goal of health reform must be to give our citizens the chance to lead full and independent lives. That means that reasonable health care should include services to help individuals maintain their function and prevent deterioration of their condition --- just as it should cover services for acute illness and injury. So I join Senator Kohl in expressing the importance of including long-term services and supports in any health care reform initiative and applaud him for holding this hearing today."
Each of the witnesses provided insights into long-term services and supports and the importance of including long-term care issues in reforms to health care.
Panel One
Mr. Hamilton noted that Medicare and Medicaid together “comprise the single largest purchaser of long-term care.” He highlighted the partnership role that the federal government plays with states for financing long-term care, with families through Medicaid waiver home and community based services programs, with individuals with disabilities in the cash and counseling programs, with the private sector that employs the direct care workers, and with other federal agencies such as the Administration on Aging. He described the integral part that long-term services and supports plays in health care.
Secretary Timberlake related innovative programs in Wisconsin that manage care utilizing care teams to support nursing home eligible individuals who want to live in the community. She mentioned the cost savings associated with their long-term care programs. She particularly highlighted the Aging and Disability Resource Centers providing person centered access to information. “Long-term care must be a central issue of health care reform and entitlement reform,” she said.
Secretary Benson shared information about long-term care programs in Florida including Cash and Counseling, Medicaid Nursing Home Diversion and the Program of All-Inclusive Care for the Elderly. She provided some ideas for actions that Congress could take to help Florida’s efforts to improve long-term care including promoting coordination of long-term care services, investing in preventative services, and directing the Centers for Medicare and Medicaid Services (CMS) to develop a methodology to share savings with state Medicaid programs.
Panel Two
Henry Claypool urged the Senators to “move beyond making improvements in access to acute care services and embrace interventions that improve access to on-going services and social supports that allow individuals with limitations in activities of daily living to lead better and healthier lives.” As an example, he related that the cost to the Medicare program from treating the needs of those with functional limitations is three times that of a beneficiary without long-term care needs. “If we do not include this population – which consumes a significant share of our nations’ health care resources – Congressional efforts to address the growth rate of medical costs is likely to fall far short of its goal.” He recommended strengthening Medicaid and creating a new public insurance option.
Melanie Bella mentioned two major areas of opportunity: fully integrated care for dual eligibles and coordinated patient-centered home and community based services. Fully integrated care would combine acute care and long-term services and supports with one entity responsible for the financial and programmatic aspects of the program. She pushed for CMS to be encouraged to support fully integrated care models that states are testing.
Judy Feder urged broadening of Medicaid coverage of community based long-term services and supports, coordination of acute and long-term services and supports for those who are dually eligible for Medicare and Medicaid, adding a long-term care benefit to Medicare and establishing a voluntary public long-term care insurance program. Her advice was to act now to improve long-term care financing. “Assuring efficient, adequate and equitable long-term care financing is part and parcel of building our nation’s economic future,” she said.
Aging advocates and advocates for individuals with disabilities filled the hearing room.
Senator Ted Kennedy (D-MA), who is leading the health care reform effort in the Senate along with Sen. Max Baucus (D-MT), issued the following statement at the hearing: "A major goal of health reform must be to give our citizens the chance to lead full and independent lives. That means that reasonable health care should include services to help individuals maintain their function and prevent deterioration of their condition --- just as it should cover services for acute illness and injury. So I join Senator Kohl in expressing the importance of including long-term services and supports in any health care reform initiative and applaud him for holding this hearing today."
Each of the witnesses provided insights into long-term services and supports and the importance of including long-term care issues in reforms to health care.
Panel One
Mr. Hamilton noted that Medicare and Medicaid together “comprise the single largest purchaser of long-term care.” He highlighted the partnership role that the federal government plays with states for financing long-term care, with families through Medicaid waiver home and community based services programs, with individuals with disabilities in the cash and counseling programs, with the private sector that employs the direct care workers, and with other federal agencies such as the Administration on Aging. He described the integral part that long-term services and supports plays in health care.
Secretary Timberlake related innovative programs in Wisconsin that manage care utilizing care teams to support nursing home eligible individuals who want to live in the community. She mentioned the cost savings associated with their long-term care programs. She particularly highlighted the Aging and Disability Resource Centers providing person centered access to information. “Long-term care must be a central issue of health care reform and entitlement reform,” she said.
Secretary Benson shared information about long-term care programs in Florida including Cash and Counseling, Medicaid Nursing Home Diversion and the Program of All-Inclusive Care for the Elderly. She provided some ideas for actions that Congress could take to help Florida’s efforts to improve long-term care including promoting coordination of long-term care services, investing in preventative services, and directing the Centers for Medicare and Medicaid Services (CMS) to develop a methodology to share savings with state Medicaid programs.
Panel Two
Henry Claypool urged the Senators to “move beyond making improvements in access to acute care services and embrace interventions that improve access to on-going services and social supports that allow individuals with limitations in activities of daily living to lead better and healthier lives.” As an example, he related that the cost to the Medicare program from treating the needs of those with functional limitations is three times that of a beneficiary without long-term care needs. “If we do not include this population – which consumes a significant share of our nations’ health care resources – Congressional efforts to address the growth rate of medical costs is likely to fall far short of its goal.” He recommended strengthening Medicaid and creating a new public insurance option.
Melanie Bella mentioned two major areas of opportunity: fully integrated care for dual eligibles and coordinated patient-centered home and community based services. Fully integrated care would combine acute care and long-term services and supports with one entity responsible for the financial and programmatic aspects of the program. She pushed for CMS to be encouraged to support fully integrated care models that states are testing.
Judy Feder urged broadening of Medicaid coverage of community based long-term services and supports, coordination of acute and long-term services and supports for those who are dually eligible for Medicare and Medicaid, adding a long-term care benefit to Medicare and establishing a voluntary public long-term care insurance program. Her advice was to act now to improve long-term care financing. “Assuring efficient, adequate and equitable long-term care financing is part and parcel of building our nation’s economic future,” she said.
Wednesday, March 4, 2009
National Coalition on Mental Health and Aging Meets
The National Coalition on Mental Health and Aging held its first quarterly meeting of 2009 in February at the American Psychological Association in Washington, D.C. The featured speaker was Dr. Marie Bernard, Deputy Director for the National Institute on Aging (NIA) at the National Institutes of Health. By way of background, Dr. Bernard related that NIA was established in 1974 to support and conduct research on aging. The divisions at NIA include the Division of Aging Biology, Division of Behavioral and Social Research, Division of Neuroscience and the Division of Geriatrics and Clinical Gerontology. $63 million is budgeted for mental health studies at NIA.
Several topics are currently being studied at NIA including aging and mental health; cognitive function and psychosocial factors; caregiver stress; stress, aging and the immune system; and midlife, menopause and depression.
Dr. Bernard discussed current NIA efforts including the Resources for Enhancing Alzheimer's Caregivers Health (REACH) project. The project has helped improve the quality of life and lower the prevalence of clinical depression. The research shows that even one additional hour of free time for caregivers resulted in positive outcomes.
Dr. Bernard related some other NIA research findings:
- Nearly 18 percent of those 65 and older experience depressive symptoms.
- Lack of sleep, an issue for many caregivers, increases blood pressure, increases blood sugar, increases appetite, depresses mood and impairs cognition.
- Caregivers often experience a reduction of white blood cells which inhibits the ability to fight infection.
- Physical activity for older adults is beneficial for a number reasons including obvious ones such as maintaining a healthy weight, improving bone and muscle strength, improving outlook and reducing caregiver stress. Two of the less obvious benefits are that physical activity is more beneficial for preventing diabetes than medication and physical activity improves cognition.
For more information about NIA visit http://www.nia.nih.gov/
Also noted at the meeting Older Americans Mental Health Week will be May 24 – 30, 2009.
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