NASUA Members

NASUA Health Care Reform Update

2009-06-22T10:02:00.000-07:00

June 22, 2009

WASHINGTON, DC – The Senate Health Education Labor and Pensions (HELP) Committee began hearings on health care reform last week amid reports of preliminary cost estimates by the Congressional Budget Office (CBO). Senator Edward Kennedy’s (D-MA) bill, the “Affordable Health Choices Act” was estimated to cost $1 trillion and cover only 16 million out of 47 million uninsured Americans. The Senate Finance Committee’s bill was estimated to cost $1.5 trillion. Neither of those proposals was complete when scored.

Finance Committee Chairman Max Baucus (D-MT), who was planning to release his draft legislation last week, delayed the release of that committee’s proposal to look for further savings. The Senate Finance Committee’s markup will also be delayed until possibly after the July 4 recess. The Senate HELP Committee, led by Senator Chris Dodd (D-CT) in ailing Chairman Kennedy’s absence, will continue its daily hearings beginning at 3 p.m. today through the end of the week. The committee’s archived hearings are available at: http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

House Democratic leaders from three committees of jurisdiction released an 852-page draft bill last week. It excluded provisions on how to pay for the bill due to divisions between House and Senate Democrats. Some revenue proposals include taxing employer sponsored health benefits, increasing the Medicare payroll tax, adding a “value-added” tax, and taxing soda and alcoholic beverages. The House bill includes a mandate on consumers to carry health insurance, and a mandate on employers to provide a health insurance benefit. It also provides for a public insurance option that would compete with private insurance plans.

The House Energy and Commerce Health Subcommittee will hold hearings on health reform on Tuesday and Thursday. The House Ways and Means Committee, which oversees taxes, Medicaid and Medicare, will hold a hearing on Wednesday morning in which it is expected to release some of the first revenue details for the House Democratic approach.

The President has said he would like to sign health care legislation by October, setting an ambitious timeline for Congress. To have a bill to the President by October, Democratic leaders in Congress aim to complete their committee work and vote on the bills in their respective chambers before the August recess. Differences between the final House and Senate bills – on how to fund the measure and what a public option would look like, for instance – could then be worked out in a conference committee in September. With timelines slipping in both chambers, that is proving to be an elusive goal.

NASUA will provide ongoing information about the health reform debate, the evolving health reform proposals, and instructions for advocacy efforts in upcoming email alerts. Please also check out the Project 2020 blog for updates on our legislation and health care reform.

Surface Transportation Act of 2009

2009-06-18T13:51:00.000-07:00

House Committee on Transportation and Infrastructure Chairman James L. Oberstar (D-MN) has released a white paper to outline plans for the new surface transportation authorization bill. The authorization bill is currently being drafted and will replace the current authorization, SAFETEA-LU, which is due to expire on September 30. Oberstar has promised that the new authorization will transform the way the federal government invests highway, safety, and transit funds.

The Surface Transportation Act of 2009 redefines the Federal role and restructures the Federal surface transportation by consolidating or terminating more than 75 programs. The consolidation creates Highway and Transit funding, each of which have four program categories.

Within transit funding, one of the program categories is providing mobility and access to transit-dependent individuals. Many of the current programs that assist aging Americans and individuals with disabilities are slated for consolidation into the access and mobility program or termination.

Programs slated for consolidation into the mobility and access program include:
• ADA Project Action
• Elderly Individuals and Individuals with Disabilities Program Section 5310
• Human Services Transportation Coordination
• Job Access and Reverse Commute Program
• National Technical Assistance Center for Senior Transportation
• New Freedom Program

Programs slated for termination include:
• Growing States and High Density States program
• Contracted Paratransit pilot program
• Elderly Individuals and Individuals with Disabilities pilot program
• Medical Transportation Demonstration Grants
• Over-the-Road Bus accessibility program

The news conference, originally set for Wednesday, June 17, occurred instead late in the afternoon on Thursday, June 18 at in the Rayburn House Office Building.

To view the executive summary of the white paper:
http://transportation.house.gov/Media/file/Highways/HPP/Surface%20Transportation%20Blueprint%20Executive%20Summary.pdf

To view a full list of the programs slated for consolidation or termination:
http://transportation.house.gov/Media/file/Highways/HPP/Surface%20Transportation%20Blueprint%20Program%20Consolidation.pdf

To view a video of the news conference:
http://transportation.house.gov/

2009 Social Security and Medicare Boards of Trustees Annual Reports

2009-05-13T12:12:00.000-07:00

The Trustees of the Social Security and Medicare trust funds have released their annual report summarizing the financial situations of both Medicare and Social Security. The 2009 report demonstrates that both the Social Security and Medicare programs remain in challenging financial situations as costs are not sustainable given the current program parameters.

Social Security's annual surpluses of tax income over expenditures are expected to fall significantly this year and to remain steady in 2010 due to the recession. They are expected to rise for a brief period before declining again. Cash flow deficits are projected beginning in 2016 as baby boomers become beneficiaries. The deficits will be alleviated by redeeming trust fund assets until reserves are exhausted (projected in 2037), at which point tax income would be sufficient to pay about three fourths of scheduled benefits through 2083.

Medicare's financial status is worse, and will become a problem before Social Security, as its problem is exacerbated by the rising costs of health care. In 2008 and again in 2009, Medicare's Hospital Insurance (HI) Trust Fund will pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. The difference will be addressed by redeeming trust fund assets. Growing annual deficits are projected to exhaust HI reserves in 2017, after which the percentage of scheduled benefits payable from tax income would decline from 81 percent in 2017 to about 50 percent in 2035 and 30 percent in 2080. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays provider fees and prescription drug costs will continue to require increases in costs for beneficiaries and the Federal government.

The Trustee reports concluded that both programs are facing serious financial challenges that need to be addressed quickly. Secretary Sebelius’ statement reads “this isn’t just another government report. It’s a wake up call for everyone who is concerned about Medicare and the health of our economy. And it’s yet another sign that we can’t wait for real, comprehensive health reform.”

The 2009 Trustees are:

Timothy F. Geithner, Secretary of the Treasury
Hilda L. Solis, Secretary of Labor

Kathleen Sebelius, Secretary of Health and Human Services
Michael J. Astrue, Commissioner of Social Security

There are two other currently vacant Trustee positions that are public representatives appointed by the President, subject to confirmation by the Senate.

To view a summary of the reports:

http://www.socialsecurity.gov/OACT/TRSUM/index.html

To view Secretary Sebelius’ statement on the reports:

http://www.hhs.gov/news/press/2009pres/05/20090512a.html

2009-05-12T13:21:00.000-07:00

Senate Finance Committee – Roundtable Discussion on Financing Comprehensive Health Care Reform

Today the Senate Finance Committee held the last of three scheduled roundtable discussions on health reform. Today’s discussion focused on financing. There will be a closed-door Committee walk-through of this third element of tentative legislation on May 20.

The major themes of the financing discussion were:

• Extensive discussion of the current exclusion from income tax of employer sponsored health care. Senator Baucus stated that the exclusion would not be repealed but that modifications should be discussed. Some of the ideas for modification included capping the exclusion or linking it to income level. Some witnesses advocated phasing it out. There was some agreement that no single mechanism exists that will finance all of health reform.
• Another issue raised in the context of using the tax code to finance reform was geographic variation in health costs and whether geographic variation in the tax burden would be constitutional.
• There was some discussion of the reasons for geographic variation in health care costs and that the adherence of physicians to evidence-based guidelines is quite low. The need for developing compliance incentives was highlighted. The existence of integrated systems (Washington, Oregon, Minnesota) was noted as a mechanism that can make a difference in controlling costs.
• Comparative effectiveness research was discussed and a number of witnesses stated that it had an important role to play in ensuring that the care paid for is of high value and results in good outcomes.
• Bundled payments to hospitals, Medicare physician payment reform, and health information technology were all highlighted as areas where reforms can improve care, health outcomes, and result in savings.
• Employers do not want to abdicate their historic role in providing health insurance to their employees. Employers do want better alignment between cost and quality. Critically important to build on employer-sponsored system.

The participants in today’s roundtable are listed below. Their written statements may be accessed at http://finance.senate.gov/sitepages/hearing051209.html
Stuart H. Altman - Professor of National Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass.
Joseph R. Antos - Scholar in Health Care and Retirement Policy, American Enterprise Institute
Katherine Baicker - Professor of Health Economics, Harvard School of Public Health
Leonard Burman - Director, Tax Policy Center, Urban Institute
Robert Greenstein - Executive Director, Center on Budget and Policy Priorities
Jonathan Gruber - Professor of Economics, Massachusetts Institute of Technology
Michael F. Jacobson - Executive Director, Center for Science in the Public Interest
James A. Klein - President, American Benefits Council
Edward Kleinbard - Chief of Staff, Joint Committee on Taxation
Gerald M. Shea - Assistant to the President, Governmental Affairs, AFL-CIO
John Sheils - Senior Vice President, The Lewin Group
Gail Wilensky - Senior Fellow, Project HOPE
Steven Wojcik - Vice President, Public Policy, National Business Group on Health

Senate Hearing on Medicare and Medicaid Fraud

2009-05-07T08:24:00.000-07:00

On Wednesday, May 6 the Senate Special Committee on Aging convened a hearing titled Catch Me If You Can: Solutions To STOP Medicare and Medicaid Fraud From Hurting Seniors and Taxpayer. The hearing was convened by Chairman Herb Kohl (D-WI) and Senator Mel Martinez (R-FL), Ranking Member of the Senate Special Committee on Aging. The hearing featured five expert witnesses from across the country to testify about their experiences with Medicare and Medicaid fraud, as well as their ideas for solutions. The major themes of the hearing included:

· A focus on prevention; identifying fraud when claims are made, before payments occur

· Implementation of stricter penalties for fraud

· Improved screening of enrollees

· Improved screening of providers

· Increased transparency in Medicare and Medicaid spending

· Increased transparency of reimbursements received by providers

The witnesses were:

R. Alexander Acosta, US Attorney for the Southern District of Florida, US Department of Justice, Miami, FL

Daniel R. Levinson, Inspector General, US Department of Health and Human Services, Washington, DC

James Frogue, Project Director, The Center for Health Transformation, Washington, DC

Robert A. Hussar, First Deputy Inspector General, Office of the Medicaid Inspector General, State of New York, Hauppauge, NY

Stephen C. Horne, Vice President, Master Data Management and Integration Services, Dow Jones Business and Relationship Intelligence, Edgewater, NJ

Senator Martinez and John Cornyn (R-TX) have introduced two efforts targeted at detecting and preventing Medicare and Medicaid waste, fraud, and abuse. The Seniors and Taxpayers Obligation Protection or "STOP" Act (S.975) will work to reduce the estimated loss of more than $60 billion every year by creating fraud prevention and detection systems. The Medicaid Accountability through Transparency or "MAT" Act (S.974) will require transparency in billing for services and medical equipment.

The STOP Act would require the Secretary of HHS to implement changes to the current system of using Social Security Numbers as the Medicare Beneficiary Identifier (MBI) on Medicare cards, seeking to reduce fraud and identity theft among seniors. In addition, the STOP Act will also help to improve HHS's detection methods and place billing statements under increased scrutiny. Items such as durable medical equipment are notoriously known to be falsely billed at taxpayer expense - often by fake companies with nothing more than a P.O. Box.

The MAT Act seeks to reduce the prevalence of fraud in the Medicaid program by requiring HHS to publicly disclose the Medicaid payment data it already collects. Under the language, the Secretary shall establish a publicly-accessible Web site containing non-aggregated Medicaid claim payment data which has been fully de-identified according to HIPAA law. This information must be provided in a format that is easily accessible, useable and understandable to the public and shall be updated at least once per calendar quarter.

To view the full testimony:

http://aging.senate.gov/hearing_detail.cfm?id=312599&

To view the legislation, search the bill number (S.974, S. 975) on www.thomas.gov

2009-05-05T05:43:00.000-07:00

Friday, May 1, 2009

LCAO Supports Increased Funding for OAA

On April 30, the Leadership Council of Aging Organizations (LCAO) sent a letter to the Hill, supporting increased funding for Older Americans Act programs. NASUA is one of the organizations that signed on to the letter. You can review the letter on NASUA's website at
http://nasua.org/issues/federal_policy/documents/Letter-LCAO-ComServ-OAAApril09FINAL.pdf

2009-05-05T11:04:00.000-07:00

Senate Finance Committee Holds Second Roundtable on Health Care Reform

Today, May 5, 2009, the Senate Finance Committee held the second of three planned roundtable discussions on health care reform. The topic today was “Expanding Health Care Coverage.”

While there was agreement that the individual market needs reform and that all individuals should have health care coverage, there was no agreement about how these things should be accomplished.

There was some discussion of whether a public plan should be part of reform. Those opposed to a public plan expressed concern about whether there could be a level playing field for private plans and whether a public plan could effectively coordinate care and serve those with chronic illnesses. Those in favor of the public plan option stated that they believed such a plan could be fair and that the same set of rules could be designed to apply to both public and private plans.

Expansion of existing public programs was also discussed. Expansion of Medicaid to at least 100% of the federal poverty level was supported by many of the witnesses, including those opposed to a public plan. Senator Hatch noted that in his view, such an expansion, as well as a Medicare buy-in component, equated to a public plan. He expressed concerns about crowd out, additional stresses on these programs, as well as increased costs.

There was some discussion of long term care and the need to have the reformed system reflect the desires of individuals to receive services in their homes rather than in institutions. Senator Kerry mentioned his sponsorship of the Empowered at Home Act while Senator Cantwell talked about the efficiencies that could be realized if states have incentives to focus more on providing home care.

Other topics of discussion included: Small business and its ability to offer insurance to its employees; the importance of including oral health care in health plans, and addressed cost and provision of end of life care.

The list of witnesses and links to their written statements are available on the Senate Finance Committee’s website at:

http://finance.senate.gov/sitepages/hearing050509.html

2009-04-21T12:11:00.000-07:00

Senate Finance Holds First Roundtable On Health Care Reform

Today the Senate Finance Committee held the first of three scheduled roundtable discussions on health reform. The first topic area considered was delivery system reform. The second roundtable will address coverage expansion and will be held on May 5. The third and final roundtable on financing will take place on May 14. Committee walk-throughs of tentative legislation will follow each roundtable with a mark-up expected in June.

After brief opening remarks from Senator Max Baucus and Senator Charles Grassley, the roundtable discussion began and was moderated by John Iglehart, founding editor of Health Affairs.

The major themes of the delivery system reform discussion were:

- Discussion of integrated systems like Geisinger Health System and tested care coordination models for adults with chronic conditions (such as the Advance Practice Nurse Transitional Care Model)

- Reforms of current payment system including bonus payments for primary care physicians, bundling of payments, revise process for setting relative values in Medicare, paying for outcomes

- Reform CMS to remove silos; should be a source of innovation and the best place in government to work; less prescriptive legislation with latitude to make decisions, subject to proper oversight; ability to implement successful pilots and demonstrations more quickly without having to seek additional authorization; public-private partnerships; leverage Medicare and Medicaid

- Health IT: electronic medical records, use data to educate providers about how they compare to their peers (e.g., hospital readmission data)

- Workforce: increase use of advance practice nurses, overcome barriers that prevent academic medical centers from valuing primary care as a specialty; possibly create commission to study workforce shortage and make recommendations to Congress

- Patient-centered model; medical home

-Individual choice, supported with information so that patients can make informed, evidence based choice; importance of comparative effectiveness research; provide incentives for patients to make healthy choices (Safeway example: financial incentives to lose weight, quite smoking)

- Importance of care coordination and availability of home and community based services (Washington state was the example cited and discussed by Senator Cantwell and Mark McClellan as a model that could save billions if implemented nationwide)

- Prevention of fraud and abuse: scrutinize providers and suppliers before enrollment; establish payment methodologies that are reasonable and reflect the marketplace; require compliance plans; vigilant monitoring (better data systems); respond quickly to detected fraud

The participants in today’s roundtable are listed below. Their written statements may be access at http://finance.senate.gov/sitepages/hearing042109.htm:

Allan M. Korn, M.D., Senior Vice President, Chief Medical Officer, Office of Clinical Affairs, Blue Cross Blue Shield Association, Washington, DC

Glenn M. Hackbarth, J.D., Chairman, Medicare Payment Advisory Commission, Washington, DC

Peter V. Lee, J.D., Executive Director, National Health Policy, Pacific Business Group on Health, San Francisco, CA

Mark B. McClellan, M.D., Director, Engelberg Center for Health Care Reform, Brookings Institute, Washington, DC

Lewis Morris, J.D., Chief Counsel to the Inspector General, Office of Counsel to the Inspector General, Washington, DC

Mary D. Naylor, Ph.D., FAAN, RN, Marian S. Ware Professor in Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA

Debra Ness, President, National Partnership for Women and Families, Washington, DC

Frank G. Opelka, M.D., FACS, Vice Chancellor for Clinical Affairs, Professor of Surgery, Office of the Chancellor, Louisiana State University, Health Science Center, New Orleans, LA

Glenn Steele Jr., M.D., PhD, President, Geisinger Health System, Danville, PA

John Tooker, M.D., MBA, FACP, Executive Vice President/Chief Executive Officer, American College of Physicians, Philadelphia, PA

Richard J. Umbdenstock, FACHE, President and CEO, American Hospital Association, Washington, DC

Ron Williams, Chairman and CEO, Aetna Inc., Hartford, CT

Paul J. Diaz, J.D., President and CEO, Kindred Healthcare Inc., Louisville, KY

2009-04-30T10:47:00.000-07:00

Congress Approves Budget Resolution

On Wednesday, April 29, the Senate voted 53 to 43 to approve the Conference Committee Report for Senate Concurrent Resolution 13. The day before the House voted 233 to 193 to approve the same budget resolution conference report. The measure received no Republican support. Seventeen Democrats in the House and three in the Senate voted against it. The compromise includes $3.4 trillion in budget authority and $3.5 trillion in outlays for 2010, and $17.783 trillion in budget authority and $18.031 trillion in outlays over 2010-2014. The compromise also includes reconciliation provisions that will limit debate.

Budget Resolution Explanation
The budget resolution provides the overall framework of anticipated costs, revenues, surplus or deficit for the federal government. The budget resolution sets spending limits for annual discretionary spending, places limits on the amount of spending the authorizing committees can approve and establishes revenue targets for the tax writing committees. The resolution represents the agreement between the House and the Senate concerning the overall size of the federal budget and the makeup of the budget by functional categories. Twenty functional categories make up the budget without regard to the agencies that may oversee the individual programs. Amounts in the functional categories result in allocations to committees with jurisdiction over the spending.

Separate Process for Appropriations
Appropriations is a separate process and restrictions on appropriations include limits in the authorizing legislation as well as constraints on discretionary spending caps and budget allocations from the concurrent budget resolution. The House and Senate Appropriations Committees subdivide the amounts allocated under the budget resolution to their subcommittees. The sub-allocations are to be made as soon as practicable following this after agreement on the concurrent resolution.

Budget Resolution Not Law
Budget resolutions do not have the force of law. Spending, revenue and public debt laws necessary to implement decisions agreed to in the budget resolution are enacted subsequently and separately. The budget includes direction both for discretionary spending (spending that is not mandated by existing law and is made available through annual appropriations) and mandatory spending (spending that is mandated in laws other than appropriations). Legislation must be consistent with the allocations and aggregate levels of spending and revenue. These are enforceable by points of order made during floor consideration of legislation.

Reconciliation
Reconciliation instructions in budget resolutions identify committees that must recommend changes to laws affecting revenues or direct spending (mandatory spending) programs within their jurisdiction. Reconciliation includes limitations on debate and on the types of amendments that may be considered.

Health Care Reform
The compromise budget resolution contains the principles of the President’s health care reform agenda as well as the health care reform reserve fund. The reconciliation process that would place limits on debate could be used if key committees (Senate Finance, Senate Committee on Health Education, Labor and Pensions, House Energy and Commerce, House Ways and Means, House Education and Labor) submit their recommendations to their respective chamber budget committees by October 15. The key elements of the President’s health reform include: (1) protect families' financial health including restraining the growth of health premiums and other health-related costs;(2) make health coverage affordable to businesses (in particular to small business and individuals who are self-employed), households, and governments, including by reducing wasteful and inefficient spending in the health care system with periodic reports on savings achieved through these efforts, and by moving forward with improvements to the health care delivery system, including Medicare;(3) aim for quality, affordable health care for all Americans;(4) provide portability of coverage and assurance of coverage with appropriate consumer protections;(5) guarantee choice of health plans and health care providers to Americans;(6) invest in prevention and wellness and address issues of health disparities;(7) improve patient safety and quality care, including the appropriate use of health information technology and health data, and promote transparency in cost and quality information to Americans; or (8) maintain long-term fiscal sustainability and pays for itself by reducing health care cost growth, improving productivity, or dedicating additional sources of revenue; by the amounts provided in such legislation for those purposes, provided that such legislation would not increase the deficit over the period of the total of fiscal years 2009 through 2019.

LIHEAP
The conference agreement includes the President’s request of $3.2 billion for LIHEAP in 2010. The agreement also includes a discretionary cap adjustment for an additional $1.9 billion if the President’s funding level of $3.2 billion is in an appropriations measure.

Community Development Block Grant
The conference agreement includes increased funding which could include full funding for CDBG.

Social Security
The Social Security Administration funding level in the conference agreement assumes the President’s full request for an adjustment for program integrity efforts including SSI redeterminations and SSI asset verification. It also reflects the President’s full request for more resources to address the backlog of disability claims and hearings.

To view the budget resolution visit http://thomas.loc.gov and search by bill number (SCR 13). The conference committee report is also available at the same site.

Spending in 2010 Concurrent Budget Resolution
In billions
Budget authority = BA
Outlays = OT

Mandatory Spending

Agriculture BA 17.559
OT 17.734

Commerce & Housing Credit BA 50.984
OT 75.553

Transportation BA 56.715
OT 2.233

Community & Regional BA 0.378
Development OT 2.399

Health BA 325.753
OT 324.079

Medicare BA 444.068
OT 444.228

Income Security BA 472.062
OT 470.879

Social Security BA 697.336
OT 695.343

Veterans Benefits BA 53.102
OT 52.994

Discretionary Spending

Agriculture BA 6.131
OT 6.217

Commerce & Housing Credit BA 13.391
OT 13.459

Transportation BA 31.436
OT 93.462

Community & Regional BA 17.930
Development OT 26.904

Health BA 58.556
OT 64.806

Medicare BA 5.600
OT 5.570

Income Security BA 64.778
OT 69.323

Social Security BA 6.072
OT 6.057

Veterans Benefits BA 53.396
OT 52.584

Leadership Council of Aging Organizations Sends Health Reform Recommendations

2009-04-29T09:27:00.000-07:00

The Leadership Council of Aging Organizations(LCAO), of which NASUA is a member, has sent recommendations to Congress on key elements of upcoming health reform initiatives. While we are encouraged that the principles of Project 2020 are included under Chronic Care Supports & Services, because of the unfunded mandates throughout, NASUA abstained from supporting the recommendations as a whole. The recommendations focus on the following five areas:

Under-65 Population

Recommendations include offering a nationwide plan, setting premiums by community, keeping health care affordable, and elimination of the two year waiting period for SSI and Medicare

Medicare

Recommendations include addressing gaps in coverage, maintain choice of providers, expand access, improve prescription drug coverage, align payments to Medicare Advantage, and provide enhanced coverage for low-income beneficiaries

Medicaid

Recommendations include expanding eligibility to a simpler, more uniform system; incentivize states to cover more people; provide permanent additional federal funding; create an automatic trigger for FMAP increases; and reverse punitive DRA asset transfer provisions of the DRA

Chronic Care Supports & Services

Recommendations include expanding access to home based services; expand access and eligibility to Medicaid and non-Medicaid Home and Community based services to reach parity with institutional care, including Project 2020 principles; and improve the quality of life for nursing home residents

Systemic Reform

Recommendations include instituting care coordination, supporting a well trained workforce, improving caregiver support programs and employing Health information technology

The actual document can be viewed on the LCAO page of the NASUA website:

http://www.nasua.org/issues/federal_policy/LCAO_materials.html

Health Care Reform Newsmakers Series

2009-04-16T12:37:00.000-07:00

The Kaiser Family Foundation, Families USA and the National Federation of Independent Business are sponsoring a series of “reporters only” briefings regarding health care reform. Wednesday, April 15, Nancy-Ann DeParle, Director of the White House Office of Health Care Reform was the featured guest. Ms. DeParle was administrator of the Health Care Financing Administration - what is now the Centers for Medicare and Medicaid Services - during the Clinton administration. She also worked at the Office of Management and Budget and in the private sector.

In introductory remarks, Ms. DeParle noted that unlike the health care reform efforts of the ‘90s, this time more groups are at the table and no one wants the status quo. Every group wants to lower costs for businesses and for families. Reporters quizzed Ms. DeParle on a number of aspects of reform. Some of the questions and answers are summarized below.

1. Does the administration support taxing health benefits? Ms. DeParle responded that the president wants to build on the current employer based plans.

2. What options are being considered to lower Medicare costs? Ms. DeParle replied that options for lowering costs to Medicare include more equitable payments to Medicare Advantage Plans, bundling payments to hospitals to create incentives to reduce readmissions, promoting comparative effectiveness so that physicians and patients are able to make better decisions that will reduce costs in the long run, encouraging health information technology to improve care, lower costs and reduce errors, and emphasizing wellness and prevention to reduce utilization.

3. How do you respond to questions that have been raised about the public plan option? Ms. DeParle related that confusion exists about what a public plan is. She mentioned that often the concern is not whether a public plan should be available but the details of how a public plan will work. Some concerns have been raised about payment rates and options available. She noted that examples already exist including the state health plans that administer health coverage for state employees and use private health plans.

4. Will the administration support continuation of fee for service plans? Ms. DeParle reminded the audience that the president wants to strengthen fee for service and change incentives such as the bundling of payments to hospitals to avoid readmissions. She said that the emphasis on health information technology (HIT) assumes a robust private fee for services system. She noted that HIT is not a silver bullet but thinks that HIT will provide overall improvements to care and will lower administrative costs.

5. How does the concept of a medical home fit into the reform plan? Ms. DeParle noted that the idea is to create a less fragmented health care experience for patients with a medical clinician coordinating care so that patients are referred to the right specialists and are prescribed the right medications.

6. How will we pay for the reform? Ms. DeParle said that some “game changers” are included in the plan such as HIT and emphasis on wellness and prevention that will generate savings.

7. What strains do you foresee for the health care system if the 45 million uninsured suddenly have health care coverage? Ms. DeParle reminded the reporters that when Medicare began in July of 1966 millions of older adults were added to the health care system without overwhelming it. She also noted that different parts of the country have different capacities and that we need to make additional investments in the health care workforce.

In closing, Ms. DeParle reiterated that health care reform is one of the most important issues we are facing as a nation. It is clear that we all want better health care outcomes and stability in costs.

GIVE Act Ready for Vote

2009-03-20T14:25:00.000-07:00

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

Fiscal Year 2010 Health Care Proposals

2009-03-13T06:22:00.000-07:00

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.

Designing a High Performing Healthcare System

2009-03-12T08:36:00.000-07:00

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

Senate Special Committee on Aging Hearing: Health Care Reform in An Aging America

2009-03-06T11:16:00.000-08:00

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.

National Coalition on Mental Health and Aging Meets

2009-03-04T14:02:00.000-08:00

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.

House passes measures regarding missing older adults

2009-02-18T06:07:00.000-08:00

The House of Representatives has passed two bills relating to missing older Americans.

H.R.908 Missing Alzheimer’s Disease Patient Alert
Representative Maxine Waters (D-CA) sponsored this legislation that amends the Violent Crime Control and Law Enforcement Act of 1994 to reauthorize the Missing Alzheimer's Disease Patient Alert Program. The bill was received in the Senate, read twice and referred to the Committee on the Judiciary.

The Missing Alzheimer’s Disease Patient Alert Program directs the Attorney General, through the Bureau of Justice Assistance and in consultation with the Secretary of Health and Human Services, to award competitive grants to nonprofit organizations to assist such organizations in paying for the costs of planning, designing, establishing, and operating locally based, proactive programs to protect and locate missing patients with Alzheimer's disease and related dementias and other missing elderly individuals.

The legislation authorizes appropriations of $5 million for each year 2010 through 2016. The funds must be appropriated before the grants will be available.

H.R.632 National Silver Alert Act 2009
The National Silver Alert Act 2009 sponsored by Representative Lloyd Doggett (D-TX) would encourage, enhance, and integrate Silver Alert plans throughout the United States, and authorize grants for the assistance of organizations to find missing adults. The bill was received in the Senate, read twice and referred to the Committee on the Judiciary.

The legislation directs the Attorney General to: (1) establish a national Silver Alert communications network within the Department of Justice (DOJ) to assist regional and local search efforts for missing seniors; (2) assign a DOJ officer to serve as the Silver Alert Coordinator to coordinate the network with states; and (3) award grants to states for support of Silver Alert plans and the network. The bill defines "missing senior" as any individual who is reported as missing to or by a law enforcement agency and who meets state requirements for designation as a missing senior. It further directs the coordinator to: (1) establish minimum standards for the issuance and dissemination of alerts issued through the network; and (2) make available to states, local governments, law enforcement agencies, and other concerned entities network training and information.

The bill also includes the Kristen's Act Reauthorization of 2009 directing the Attorney General to make competitive grants to public agencies or nonprofit private organizations to: (1) maintain a national resource center and information clearinghouse for missing and unidentified adults; (2) maintain a national, interconnected database to track missing adults endangered due to age, diminished mental capacity, or the circumstances of disappearance, when foul play is suspected or circumstances are unknown; (3) coordinate public and private programs that locate or recover missing adults; (4) provide assistance and training to law enforcement agencies, state and local governments, and other agencies involved with missing adults; (5) provide assistance to families in locating and recovering missing adults; and (6) assist in public notification and victim advocacy related to missing adults.

These bills have been read in the Senate and assigned to committee. More information about these issues will be provided when the Senate takes action.

To read more about these bills go to http://www.thomas.gov/ and search for the bills by number.

Funding available for Social Innovators in Your Communities

2009-02-03T13:20:00.000-08:00

Social entrepreneurs John Gardner and Marc Freedman founded Civic Ventures in the late 1990s as a think tank and an incubator, generating ideas and inventing programs to help society achieve the greatest return on experience. Civic Ventures promotes redefining the second half of life as a source of social and individual renewal. Through research, publishing, conferences, and media outreach, Civic Ventures reports on the growth of the experience movement. Through programs and consulting, Civic Ventures brings together older adults with a passion for service and helps stimulate opportunities for using their talents to advance the greater good helping America realize an experience dividend.

Civic Ventures awards the Purpose Prize and applications are currently being accepted. The Purpose Prize® provides five awards of $100,000 each to people over 60 who are taking on society’s biggest challenges. It’s for those with the passion and experience to discover new opportunities, create new programs, and make lasting change. The deadline for applications is March 5, 2009. Read more about it at http://www.purposeprize.org/

Secretary of HHS confirmation process begins

2009-01-09T06:35:00.000-08:00

Former Senator Tom Daschle appeared before the Senate Health Education Labor and Pensions Committee as a first step in the confirmation process for his appointment as Secretary of Health and Human Services. In his remarks, Senator Daschle noted that the problems in our current health care system are “pervasive and corrosive.”

In referring to health care reform efforts in the 1990s he remarked that criticisms were “it took too long, the process was too opaque, the plan was too hard to understand and the change was too dramatic.” He noted that these are not good reasons for failing to act. Further, he quoted Nelson Mandela “Some things seem impossible until they are done.” Senator Daschle asserted that health care reform doesn’t have to be impossible. However, he noted that health care change must include input from the grass roots and community level and that President-elect Obama has received many suggestions from Americans at the website change.org.

He went on to say that high value preventive care is needed and currently the US health system has experienced a failure of preventive care. In addition, studies show that every $1 of prevention results in $5.60 in savings. Disparities in health care access must be addressed as well as the shortage of primary care physicians. Having represented a rural state he mentioned that rural communities often lack sufficient health care resources. Senator Daschle affirmed that health care reform must be guided by evidence and effectiveness. Public health should be strengthened and long-term care for the elderly must be part of health care reform.
Senator Daschle mentions that cost, access and quality are the three big components of health care. He says that we need a framework that provides for more efficiency and more transparency.

Other topics discussed at the hearing included:
1. improving communication among the component agencies and offices of HHS
2. evaluation of Medicare C, Medicare generally and Medicaid to identify efficiencies
3. dental services as an essential component in health care and lack of access must be addressed
4. mental health as a part of health care reform and lack of coverage and access
5. needs of individuals with disabilities must be included in part of health care reform
6. ong-term care including care in the least restrictive environment must be included
7. more emphasis on wellness in our communities including school based programs, community based wellness programs and mental health recognizing that physical ailments are related to stress, depression, etc.
8. transportation, education, workplace issues that don’t squarely fall within HHS but are part of health care reform
9. view health care as a pyramid with primary care as a base and heart transplants and more intensive tests like MRIs at the top
10. make wellness “cool” and integrate wellness in all aspects of our lives
11. transparency from HHS in providing data
12. pay for prevention and wellness services
13. vigorous top down review of HHS to cut duplication and waste
14. take ideology out of decisions and allow scientists to conduct the science to find the new medicines and treatments
15. prevention can be intervention in chronic disease to keep the disease from progressing,
16. senior centers are in every community and could be a place to relate the prevention and compliance strategies recommended by health care providers
17. integration of health care providers in care settings
18. promote health IT
19. review Medicare part D for negotiation of drug prices and fixing the “donut hole”
20. encourage more primary care providers and start with funding primary care providers including nurses, pharmacists, therapists, etc.
21. importance of National Institutes of Health.

To view the Senate Health, Education, Labor and Pensions Committee confirmation hearing visit http://www.cspan.org/ and follow the links to the Daschle confirmation hearing.

GAO Report Regarding Traumatic Brain Injury and the VA

2009-02-03T11:36:00.000-08:00

Government Accountability Office Report
Released January 29, 2009

TRAUMATIC BRAIN INJURY: Better DOD and VA Oversight Can Help Ensure More Accurate, Consistent, and Timely Decisions for the Traumatic Injury Insurance Program

In 2005, Congress created a traumatic injury insurance benefit program, known as TSGLI, to help service members with traumatic brain injury and other serious injuries with the financial burdens that they and their families face. The Department of Veterans Affairs (VA) administers the program, in collaboration with the Department of Defense (DOD), while the branches of service are responsible for deciding service members’ claims. GAO examined (1) the TSGLI approval rate for traumatic brain injury claimants, and whether DOD and VA have assurance that claims are processed accurately, consistently, and in a timely manner and (2) any challenges service members with traumatic brain injury may have faced in accessing TSGLI benefits, and the extent to which DOD and VA have taken steps to address such challenges. GAO analyzed program data and interviewed DOD and VA officials, service members, and medical professionals.

What GAO Recommends
GAO recommends that DOD and VA (1) implement a quality assurance review process to help ensure that decisions are accurate and consistent within and across the services and (2) take steps to ensure the data required to assess the approval rate for traumatic brain injury and timeliness of the claims process are reliable and comprehensive. DOD and VA generally agreed with our recommendations.
To view the full report visit http://www.gao.gov/new.items/d09108.pdf

Kennedy Statement on the Role of States in Keeping Americans Healthy

2009-02-03T11:09:00.000-08:00

EXCERPTS FROM STATEMENT BY SENATOR EDWARD M. KENNEDY ON THE ROLE OF STATES IN KEEPING AMERICANS HEALTHY
United States Senate Health, Education, Labor and Pensions Committee Hearing

At a January hearing of the Senate Health, Education, Labor and Pensions Committee, Senator Edward M. Kennedy (D-MA) provided a statement in which he noted that the United States spends two trillion dollars a year on care, yet one in two Americans suffer from chronic diseases that decrease quality of life and increase health costs. Estimates indicate that close to 200 million Americans alive today will have a chronic illness, and that one in four dollars will soon be spent on health care.

He noted that many factors lead to chronic disease, but much of the health care expenditures associated with these conditions are preventable. “For every dollar spent on initiatives to increase physical activity, improve nutrition and prevent smoking, a total of $5.60 can be saved in health costs” his statement reported. Even though a great deal is known about the power of prevention, less than five percent of all health expenditures are spent on prevention.

The statement noted that economic, social and physical issues often make it difficult for people to make healthy choices. In response, states are exploring innovative prevention initiatives to combat the effects of chronic illness on their residents. In particular he highlighted the Massachusetts Office of Health and Human Services initiative “Mass In Motion,” a multi-faceted program that includes promoting healthy eating and physical activity, grants to cities and towns to make wellness initiatives a priority, and a new website to give residents advice on how to make healthy eating and physical activity part of their daily lives.

He went on to say that the power of prevention is an essential element of health reform and that prevention must be one of the principal pillars of overall health reform.

Leadership Council of Aging Organizations meets

2009-01-09T12:43:00.000-08:00

Debra Whitman, from the Senate Special Committee on Aging, addressed the Leadership Council of Aging Organizations (LCAO) January 7th and urged continued advocacy for aging issues. Looking back to the 110th Congress, she noted that Elder Justice and Criminal Background Check bills had strong support and expects that both will be introduced in the 111th Congress. She also mentioned watching for reintroduction this year of legislation to increase reimbursement for volunteers, improve nursing home care, support caregivers, address the need for a larger health care workforce, improvements to Medicare and reform for long-term care.

Health care reform must include the integration of long term care she said, but cautioned not to expect a large scale revamping of long-term care as a part of the overall health care reform. She suggested that components of long-term care reform may have a chance of being included in health care reform package. She encouraged continued advocacy for the issues about which we are most concerned.

Steve McConnell from Atlantic Philanthropies also spoke to the members about the foundation and its goals. Some of the areas of focus are on aging, disadvantaged youth and human rights. The fund’s goal is to grant several billion dollars to organizations over the next 8-9 years and exhaust the fund. Atlantic Philanthropies is non-partisan but is interested in funding advocacy to influence public policy and providing support that will have a lasting effect.

In other business LCAO is planning for hill briefings in the next few months with new and returning members of Congress to garner support for aging legislative and budget priorities.

Older Worker Demonstration Grants

2008-12-30T05:17:00.000-08:00

The U.S. Department of Labor (DOL), Employment and Training Administration (ETA) announced December 19th the availability of approximately $10 million in funds for Older Worker Demonstration Grants. The grants will be awarded though a competitive process as a part of the High Growth Job Training Initiative (HGJTI).

The grants are intended to address the workforce challenges facing older individuals by developing models for talent development in regional economies that recognize older workers as a valuable labor pool and include employment and training strategies to retain and/or connect older workers to jobs in high growth, high demand industries critical to the regional economy. Grants awarded under the Older Worker Demonstration should focus on providing training and related services for individuals age 55 and older that result in employment and advancement opportunities in high growth industries and economic sectors. The proposed strategies must take place in the context of regional talent development efforts designed to contribute to a strong regional economy, and must be developed and implemented by a strategic regional partnership.

The preferred eligible applicants for this solicitation are entities that represent the local workforce investment system, but other entities may apply. It is anticipated that the number of awards will range from 10 to 13, with award amounts ranging from $750,000 to $1,000,000.

Issue Date: December 19, 2008 Closing Date: February 19, 2009
For full announcement visit: http://www.doleta.gov/grants/pdf/SGA-DFA-PY-08-06.pdf

Call for National Day of Service Events

2008-12-29T07:55:00.000-08:00

The Leadership Council of Aging Organizations convened a conference call December 22nd with members of the Presidential Inaugural Committee (PIC) to learn about a special opportunity for a day of volunteer service tied to the inauguration of our new president. State Units on Aging, local Area Agencies on Aging and other aging network members may wish to participate. Below is an excerpt from the message from a PIC representative about how to use the PIC website to publicize your event and link volunteers with your project. Please distribute this information to those in the aging network in your state as you determine appropriate.

The Presidential Inaugural Committee (PIC) encourages organizations of all sizes and focus to get involved in planning, organizing and staging non-partisan volunteer community service events all across the country to be held on January 19, 2009 -- Martin Luther King Day.

The PIC is currently conducting outreach to national, regional and local organizations to encourage participation and to begin organizing volunteer events. These initial events will populate a new website dedicated to promoting and organizing this day of service.

Americans in every state will be able to go to the website, enter their zip code, and signup for events in their community.

The website is scheduled to launch after the New Year. Once the website launches, additional national, regional and local groups – as well as individual volunteers – will be able to sign on and help grow the list of service opportunities by creating more ways for every American to get involved.

Here is how your organization can begin getting active right away, and be a part of the initial website launch:

1) Pledge Your Organization’s Involvement Today: PIC is seeking national
participants to plan volunteer service events in multiple states, which will serve as a starting point for the launch of the new interactive website.

2) Schedule and Begin Organizing Events Right Away: Organizations committed to being a part of this national day of service, should immediately begin compiling a list of:
a. Sponsored events;
b. Location of these events;
c. Local contact on the ground for each event (a PIC field representative
will follow-up with them directly);
d. Description of the community service opportunity;
e. How many volunteers each event has the capacity to support.

3) Upload Scheduled Events: Beginning December 17, 2008, participating
organizations will be able to upload their planned events to the new website
before it launches. All events which are to be included in the initial launch of the website must be posted by December 31, 2008. To post an event before the
website launches, please go to http://www.pic2009.org/page/s/DS2.

4) Join with PIC to Help Promote Volunteer Opportunities in the Press: In
addition to direct outreach to potential volunteers, the PIC wants to work with
participating organizations to promote events across the country in the media.
Once the website is launched, PIC will work with participating organizations to
raise awareness around these events and drive additional volunteers to the
web.

From the Senate Special Committee on Aging

2008-12-22T06:52:00.000-08:00

12-18-08 Excerpts from Statement by Special Committee on Aging Chairman Herb Kohl (D-WI)

“When it comes to nursing home quality and transparency, I firmly believe two things. First, that Americans should have access to as much information about a nursing home as possible. This information should include the results of independent safety inspections; the health status of residents, which is closely tied to the quality of services provided; the number of direct care staff responsible for providing hands-on care; and basic information about a home’s management and ownership. Second, I believe that the federal government has a responsibility to ensure that consumers can readily obtain this information in a clear manner, so that it can be used to help in making the best possible decision about which home is right for their loved one.

“CMS meets the first obligation fairly well, posting much of this data on the government’s website Nursing Home Compare. And with the implementation today of their five-star rating system for nursing homes, they are getting closer to meeting the second.

“Finally, I agree with (CMS) Administrator Weems that it is critical that families understand that the very best way to choose a nursing home is to visit it – more than once, with and without an appointment. Invaluable information can be gleaned by simply speaking with residents, their family members, administrators, and the state long-term care ombudsman’s office.

To view the 5 star rating systems visit www.medicare.gov/NHCompare

Related Legislation

If you are interested in the rating system for nursing homes, you may also be interested in three bills introduced in the 110th Congress regarding nursing home transparency.

The bill introduced in the Senate is S. 2641 sponsored by Sen. Charles Grassley (R-IA)

Highlights of the Nursing Home Transparency and Improvement Act of 2008

Increases Transparency of Nursing Home Ownership and Operations
Enables the residents and the government to know who actually owns the nursing home
Strengthens accountability requirements for individual facilities and nursing home chains including annual independent audits for nursing home chains
Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of homes in the Special Focus Facility program, and links to inspection reports
Provides more transparency on a nursing home’s expenditures by requiring more detail about staffing expenditures in cost reporting
Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines
Provides for improved reporting of payroll-based nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

Strengthens Enforcement
Equips the Secretary with tools to address corporate-level quality problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains
Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents
Requires a study on the role that financial issues play in poor-performing homes
Requires a study on best practices for the appointment of temporary management for nursing homes
Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

Improves Staff Training
Improves staff training to include dementia management and abuse prevention training as part of pre-employment training
Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Similar bills were also introduced in the House including H.R.5799 Sponsored by Rep. Eddie Bernice Johnson (D-TX) and H.R. 7128 sponsored by Rep. Pete Stark (D-CA). To view the bills visit http://www.thomas.loc.gov/