Last week, the New York Times ran an extremely troubling story about Long Term Care Insurance. Apparently, some Long Term Care Insurance companies are using bureacratic tactics to delay payment of claims until the insured dies, or is outright denying them.
In depositions conducted on behalf of angry policyholders, Conseco employees described bureaucratic obstacles that prevented payment of claims. Those depositions were sealed in settlement agreements but were obtained by The Times.
In a 2006 deposition, a Bankers Life and Conseco claims adjuster, Teresa Carbonel, testified that she denied claims because of missing records but was prohibited from calling nursing homes or physicians to request the documents. She also testified that when a claim was denied, she was forbidden to phone a policyholder, but instead used a time-consuming mailing system.
Ms. Carbonel’s testimony, recorded during lawsuit on behalf of a 94-year-old policyholder, Rhodes K. Scherer, also disclosed that if policyholders did not mail requested documents within 21 days, Conseco might abandon their claim, sometimes without informing them.
In the case of Mr. Scherer, who was institutionalized after a bathroom fall, it was difficult to obtain a response, Ms. Carbonel said, because the company’s requests were mailed to his home address, rather than the nursing center where the company had been notified that he had moved. Ms. Carbonel, who is no longer with the company, did not return calls. Conseco declined to comment on her testimony.
Long term care insurance is supposed to help alleviate pressure on Medicaid. Yet, if some companies persist in the kind of conduct described in the article, that certainly won’t happen.
And–what does this mean for providers accepting admissions of people with insurance from these companies?
(HT Wesley J. Smith)
The Health and Human Services Commission (HHSC) adopted an amendment that would allow it to update legacy agency references and outdated citations related to legacy agencies rule references. According to the Texas Register, HHSC didn’t receive comments on the proposed rule during the comment period.
For more information, see the relevant section of the March 23 Texas Register.
On Friday, March 23, 2007, the Centers for Medicare and Medicaid Services (CMS) broadcast a two-hour presentation on improving nursing home quality and payments via satellite and the Internet. The presentation was shown on the CMS digital network channel 712.
Providers interested in seeing the presentation can watch it via webcast for up to 12 months at CMS’s webcast page. For more information about topics discussed, download the memo here.
The Texas Department of Aging and Disability Services (DADS) has released four new letters addressed to the following providers:
Home Health Agencies (HHAs): DADS notified HHAs seeking Medicare certification that the Centers for Medicare and Medicaid Services has asked DADS to stop scheduling Medicare certification surveys of HHAs. For more information, download the seven-page letter here.
Medicaid-certified HHAs: DADS reminded Medicaid-certified HHAs that effective May 23, 2007, they must begin entering the doctor’s National Provider Identification number in Outcome and Assessment Information Set (OASIS) Item M0072 – Primary Referring Physician ID. For more information about this requirement, download the letter here.
Nursing Facilities (NF) and Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) Providers: DADS reminded NF and ICF/MR providers about the federal mandate to allow patients receiving Medicaid to keep a portion of their monthly income to cover personal needs. Providers must notify the Social Security Administration and DADS if the payee’s name and address changes and if the resident’s address changes. For more information, download the letter here.
ICF/MRs: DADS directed ICF/MR providers to complete an online survey to offer input on joint training courses. The survey will be available for 30 days, effective April 1. You may complete the survey at http://www.dads.state.tx.us/providers/training/survey/. Download the letter here.
In an effort to extend federal subsidies for Medicare Part D to more low-income beneficiaries, Congressman Lloyd Doggett of Texas seeks to revise the asset test for receiving such subsidies. (Kaiser)
Doggett introduced a measure that would extend subsidies to about 3.27 million people currently qualified for but who don’t receive subsidies. One way the bill would accomplish this goal is to exclude certain financial assistance from adult children of recipients as “income” when determining eligibility.
Additionally, low-income Medicare beneficiaries would be allowed to build retirement savings and still qualify for subsidies.
The Kaiser Foundation has updated its issue module on financing long term care. According to Kaiser, about 9.5 million Americans need long term care, and with the first of the baby boomers ready to retire, the number will increase. By 2030, the number of long term care recipients will double.
Kaiser estimates that over $158 billion was spent on long term care in 2004, and the average yearly cost of nursing home care is $74,000. Medicaid pays for most long term care, but recipients pay out-of-pocket, too.
Long term care reform will be the focus of discussions and debates among lawmakers, policy analysts, and providers for years to come.
Visit Kaiser’s site for resources on long term care financing, including key data, policy research, webcasts and presentations, and key organizations.
The Texas Department of Aging and Disability Services (DADS) will present a nursing facility joint training conference titled “Understanding Nursing Facility Enforcement Processes.” The conference will be held at the J.J. Pickle Center in Austin, Texas, on April 3 from 9:30 a.m. to 5 p.m. and at the Arlington Convention Center in Arlington, Texas, on April 5 from 9:30 a.m. to 5 p.m. For more information about the conference, download the five-page brochure here.
Permanency Planning training is free and available to new and seasoned permanency planners, certain providers, CRCG members, relocation specialists, guardianship specialists, DFPS DD specialists, and local case workers. You’ll find a schedule for 2007 training sessions here and registration form here.
March 9
The Texas Health and Human Services Commission (HHSC) announced on behalf of the Texas Department of Aging and Disability Services (DADS) that it has adopted the repeal of §§7.301 - 7.311 and §§7.313 - 7.316 in Chapter 7. The repeal is intended to facilitate the consolidation of rules dealing with volunteer programs and donations to DADS by striking obsolete rules. For more information, see the relevant section in the March 9 Texas Register.
Additionally, HHSC will submit an amendment to the STAR+PLUS 1915(b) waiver, which will “phase in the capitation payments for inpatient behavioral health services made to Managed Care Organizations (MCOs) contracted with HHSC under the STAR+PLUS waiver program.” HHSC’s notice of intent to submit an amendment that appeared in the February 27 issue of the Texas Register misidentified the geographic areas to be affected. The correct areas and contact information for obtaining a copy of the proposed amendment can be found here.
March 16
HHSC adopted an amendment in compliance with the state legislature, intended to ensure that all Medicaid recipients in nursing homes are given information about end-of-life care. For more information, see the relevant section in the March 16 Texas Register.
In order to comply with the state legislature, HHSC submitted an amendment that will require DADS to “accept an accreditation survey of an assisted living facility…conducted by an accreditation commission instead of an initial or annual licensing survey of the facility conducted by DADS staff, under specified circumstances.” For more, see the relevant section of the March 16 Texas Register.
HHSC announced the adoption of an interim per diem reimbursement rate for small, state-operated Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR), including facilities operated by DADS, effective September 1, 2006: $188.30.
Additionally, HHSC will hold a public hearing to receive public comment on proposed Medicaid payment rates on April 10, 2007, at 1 p.m. in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas. See more details about the reimbursement rate and public hearing here.
Also see DADS Rules in Progress.
In a letter dated March, 6, the Texas Department of Aging and Disability Services (DADS) reminded nursing facilities of the state requirement that medications of deceased residents, expired medications, and discontinued medications must be disposed as instructed by government laws and rules. For more information, download the letter here.
DADS also issued a federal survey and certification letter (CMS) and a state memo. Download the federal survey letter, Clarification of Provider Number Nomenclature, and the state memo, Pandemic Influenza.
The Kaiser Network reports the release of two Medicare prescription drug studies. One study found that over 25 percent of Medicare drug plans increased copayments and prices for beneficiaries in 2006, despite the fact that beneficiaries were locked into the plans for the year.
According to the Consumers Union, which issued the study, some private insurance plans raised prices by 5 percent or more last year. One plan reportedly raised costs by almost 30 percent. From Consumers Union:
Beneficiaries also might be in for a shock in 2007. During the one-month period from January to February 2007 – right after beneficiaries locked into a plan for the calendar year – 95 percent of the sampled plans increased their costs by some degree for the package of five widely used prescription drugs. Of those, 21 percent hiked costs by 5 percent or more in that one-month period.
According to the Centers for Medicare and Medicaid Services acting administrator Leslie Norwalk, the study appears to be much ado about nothing. “Approximately 90% of Part D beneficiaries pay co-pays that do not fluctuate during the year. These consumers are generally shielded from any price changes.”
Download a PDF copy of the study here.
The second study, which examined language services, found that Medicare drug program beneficiaries with limited English proficiency received customer support in their primary language 55 percent of the time. You may download a PDF copy of the report here.