Mary Agnes Carey, associate editor of CQ [Congressional Quarterly] HealthBeat spoke about the FY 2007 budget, the FY 2006 budget reconciliation, and Medicare’s prescription drug program. (Medical News Today)

Under the FY 2007, Medicare spending would be cut by $36 billion. Medicare payments would be reduced for certain long term care providers, including home health agencies. Carey also discussed a clerical error found in the FY 2006 budget reconciliation bill after it was passed in the House of Representatives and Senate. To learn more details about the error, see this story.

The audio and transcript of Carey’s comments are available at the Kaiser Network.

Despite the time, energy, and money spent discussing and debating the drug benefit, only 1.4 million people have signed up for the plan. Eight million people are eligible. From the Washington Post:

At this rate, by some calculations, the government is on track to spend about $250 for each person it enrolls, and even then it would have only 2 million poor senior citizens taking advantage of what is perhaps the most generous government benefit available today.
…

But as in earlier efforts to register low-income Americans in programs such as food stamps or children’s health insurance, officials have encountered myriad challenges. The group of seniors eligible for the subsidies dubbed “extra help” tend to move often, may not speak English, sometimes suffer from mental impairments or do not want what they perceive to be a government handout.

Across the nation, the administration has turned to hundreds of community groups to help sign people up.

Follow the link to see samples of drug plans.

The generation born during a period of high birth rates between 1946 and 1964 has influenced the culture in many ways. The oldest members of the “baby boomers” are around 60, and in a few years many of them will retire. As this generation ages, the demand for long term care services will increase.

Rose Marie Fagan, executive director of the Pioneer Network, which “advocates and facilitates deep system change and transformation in our culture of aging,” says baby boomers are already influencing long term care as they provide for their parents. Writing in the Rochester Democrat & Chronicle about a movement to promote alternatives to traditional, institutional care, Fagan says:

In the last decade, the movement has grown to be a force in long-term care, influencing key public policy decision-makers and modifying the regulatory system in important ways. Yet crossing the next frontier requires that the consumer’s voice be heard in ever greater numbers in order to raise expectations of what we want for our loved ones and for ourselves.

The new culture of aging is about something much broader than changing nursing homes into true homes. It is about people coming together to define what aging means in our community. And it is about transforming what it means to be an older person in our society. As a microcosm, the traditional nursing home mirrors societal attitudes about aging, death, dying and what we value and devalue in our society. The Pioneer Network and Almost Home ask us to bear witness to the pervasive denial of aging in our society, and to recognize the possibility for new growth and relationships among the frailest and least advantaged among us, elders and caregivers alike.

The Pioneer Network site is worth a look, although I’m a little fuzzy on exactly what they advocate. Thinking about long term care services for aging baby boomers now will help solve problems in the long run.

The Centers for Medicare and Medicaid Services seeks to deny coverage for an artificial spinal disk called Charite. Lack of evidence that the surgery required to implant the disk is “reasonable and necessary” is the reason, says CMS.

From Kaiser Network’s report:

The proposal to deny Medicare coverage for Charite could prompt private health insurers to take similar actions. According to the Journal, such actions would represent a “rare setback” for J&J, which has “excelled at persuading insurers to pay for new technology.”

As baby boomers age and technological advancements improve existing medical devices and create new ones, expect similar clashes between the health care industry, private insurers, and government insurers like Medicare. We should encourage innovation, but the question will always be, “Who is going to pay for it?”

Here is some important news for providers and good news for abdominal aneurysm sufferers: next year Medicare will begin coverage for ultrasound screening for abdominal aortic aneurysms for high-risk beneficiaries, according to the Kaiser Network.

“High-risk” groups include:

• Beneficiaries with a history of aneurysms in their family
• Males who’ve smoked more than 100 cigarettes in their lifetimes

Beneficiaries currently in the Medicare program will not receive coverage for ultrasounds. From the report:

Robert Zwolak, a Dartmouth Medical School vascular surgeon who campaigned for the new coverage, said the move is “a tremendous step forward and a great victory for patients at risk.” According to the Journal, AAAs kill 15,000 U.S. residents each year, although the number could be higher because the causes of sudden deaths often go undetermined. Supporters of the bill estimate that roughly 58,000 U.S. beneficiaries could be screened during the first year (Burton, Wall Street Journal, 2/10).

I have been doing some research into the issue of Nurse Aide Training Waivers in New Mexico. Given that many facilities in New Mexico are located in small rural communities, losing Nurse Aide Training due to survey issues is a huge problem for some of those facilities.

What can such a facility do when there is an urgent need for Nurse Aide Training during the time period the facility is disallowed from the program? The Federal Regulations allow waivers in some instances.

Note that 42 USC 1396r(f)(2)(C) holds that a waiver (to its general prohibition of state approval of NATCEP programs at noncompliant facilities) is available for programs offered

IN but not BY

noncompliant facilities if the State:

(i) determines that there is not other (sic) such program offered within a reasonable distance of the facility,
(ii) assures, through an oversight effort, that an adequate environment exists for operating the program in the facility, and
(iii) provides notice of such determination and assurances to the State long-term care ombudsman.

I could not locate a New Mexico regulation regarding the logistics of such a program in the New Mexico Administrative Code. However, I spoke with the knowledgeable folks at the Department of Health and was told that a facility wanting such a waiver should make a written request to the Department of Health. The facility must contract with an outside entity to come onto its premises to hold the training. The facility, should include the information referred to above in the CFR, as well as the name of the outside entity and a preview of the training program so that DOH can determine its sufficiency.

If the DOH determines that there is good reason to allow the facility to hold a Nurse Aide Training program by the separate entity on its premises, and the proposed program is sufficient, the DOH can approve the waiver and allow the training. The request for the waiver should be directed to David Rodriguez or Sandra Cole at the New Mexico Department of Health.

DADS has posted Provider Letter #05-50 - Safe Resident Handling and Movement Practices. The letter is a result of Senate Bill 1525 (SB 1525), which is codified in Texas Health & Safety Code, Chapter 256. What the statute requires is that a facility’s Quality Assurance Comittee, shall adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. This policy must include the following:

• Analysis of the risk of injury to both residents and nurses posed by the resident handling needs of the resident populations served by the nursing facility and the physical environment in which resident handling and movement occurs;

• Education of nurses in the identification, assessment, and control of risks of injury to residents and nurses during resident handling;

• Evaluation of alternative ways to reduce risks associated with resident handling, including evaluation of equipment and the environment;

• Restriction of the use of equipment and aids to manually move the resident’s weight except in emergencies or life threatening or exceptional circumstances;

• Collaboration with the nurse staffing committee, and submission of an annual report;

• Procedures for nurses to refuse to perform or be involved in resident handling or transfers that the nurse believes in good faith will expose a resident or nurse to an unacceptable risk of injury;

• Submission of an annual report to the QAAC on activities related to the identification, assessment, and development of strategies to control risk of injury to residents and nurses associated with the lifting, transferring, repositioning, or movement of a resident; and

• For nursing facilities that are newly constructed or remodeled, consideration of the feasibility of incorporating resident handling equipment or the physical space and construction design needed to incorporate that equipment at a later date should be included in the development of architectural plans.

You can find the provider letter by clicking here. The online Health & Safety Code does not appear to be updated with the new chapter. I had to find it through Lexis. However, the wording of the bill can be found by clicking here.

Several politicians weighed in on the new Medicare prescription drug benefit in The Hill, a Capitol Hill newspaper. (Medical News Today)

Senator Chuck Grassley (pictured), the lone Republican in the group, says although some claim the new drug benefit program is complex, having choices will ensure that beneficiaries will get the best plan for their needs. Grassley added that the Medicare call center is available 24 hours a day.

Senator John Kerry, the Democrat from Massachusetts, says:

America’s senior citizens deserve a comprehensive and affordable healthcare system — and that includes a guaranteed, simple and affordable prescription-drug benefit. The Bush plan fails to meet that standard. In fact, the Medicare prescription-drug law is doing more harm than good. America’s seniors can attest to that.

Kerry makes a convincing case that the plan is indeed confusing and offers suggestions to make it simpler.

I’m interested in hearing from providers and Medicare beneficiaries. Is the plan as complicated as some say it is?

In a move that will likely be the subject of many angry letters and op-eds, Nissan, the Japanese car manufacturer, has announced it will cut health insurance and pension benefits for U.S. employees to “remain competitive.”

From Medical News Today:

Nissan informed workers with manufacturing jobs that, starting at age 65, they will receive an annual stipend to supplement Medicare coverage instead of receiving supplemental health care coverage from the company. A Nissan spokesperson said that once changes are made, a qualifying retired couple could receive $5,000 in addition to annual 3% increases.

Nissan’s decision serves as a warning to American workers in any industry. As the retirement age is pushed higher, companies are burdened with expensive health care supplements. Companies like Nissan provide an incentive for employees to seek additional insurance coverage outside the employers plan and put more money toward tax-deferred 401(k) investment plans. Many workers won’t like it, but in the end it may save the American auto industry.

No, this is not a new legal standard or regulation, and the Guideline does not create new legal obligations for employers. But if you have home health or other employees driving as a part of their job, you will want to check out the Occupational Safety and Health Administration’s (OSHA) new Guidelines. OSHA joined the National Highway Traffic Safety Administration and the Network of Employers for Traffic Safety to develop a 32-page document offering help to employers designing an effective driver safety program in their workplaces. The document features a 10-step program outlining what an employer can do to improve employee driving while minimizing the risk of motor vehicle accidents and includes several sample policies.

You can find the Guideline by clicking here.

The EEOC has announced final approval of the new EEO-1 Report (Employer Information Report) to go into effect for 2007. The new form is the first major change to the employer survey in four decades and will be required for the 2007 survey, which is due by September 30, 2007.

What is the EEO-1 Report, you ask? The Report is a government form requiring many employers to provide a count of their employees by job category and then by ethnicity, race and gender. The EEO-1 report is submitted to both the EEOC and the Department of Labor, Office of Federal Contract Compliance Programs (OFCCP). The EEO-1 report, submitted annually to the EEOC by September 30, must be filed by:
• Employers with federal government contracts of $50,000 or more and 50 or more employees; and
• Employers who do not have a federal government contract but have 100 or more employees.

The EEO-1 report must be. It must use employment numbers from any pay period in July through September of that year.

And in case you were wondering — yes, the Commission is required by law to keep individual employer EEO-1 reports strictly confidential.

The revised form with instructions can be found at: www.eeoc.gov/eeo1/index.html. Employers are expected to use the current format for their 2006 EEO-1 submissions (still available on the EEOC’s website here).