Tuesday, February 25, 2014

Pennsylvania to Apply for Medicaid Balancing Incentive Program

Pennsylvania Department of Public Welfare Secretary Bev Mackereth testified on February 24, 2014 before the PA Senate Appropriations Committee.
Of particular note was her testimony that the Department is ready to submit an application to participate in the Affordable Care Act’s Balancing Incentive Program.
The Balancing Incentive Payments Program was created by the Affordable Care Act of 2010 (Section 10202) to encourage states to keep Medicaid funded care recipients at home rather than in more expensive institutions.
Participation in the program will get Pennsylvania a 2% enhancement in federal Medicaid matching funds (FMAP) on home and community based services. That would amount to $75 million according to the Secretary.
In return, Pennsylvania will need to commit to make structural reforms to increase nursing home diversions and to rebalance so that by September 30, 2015 it spends 50% of its total Long Term Services and Supports (LTSS) expenditures on non-institutionally based LTSS.
Pennsylvania must agree to use the enhanced FMAP only to provide new or expanded home and community-based LTSS. The program requires states to create a standardized set of eligibility assessments for everyone regardless of age or type of disability. Participating states must also provide affected consumers with an independent case manager who is not conflicted due to ties to a nursing home or other health provider.

However the federal government is unlikely to impose any penalties on states that fail to meet the goals or fully comply with the mandates of the program. And Pennsylvania seems unlikely to attain the 50% goal by September of 2015. But these are additional funds that Pennsylvania can use in support of its ongoing efforts to re-balance its LTSS system.   
More information on the Balancing Incentives Program is available on the Medicaid.gov website at the following link: http://tinyurl.com/al479us

Thursday, February 20, 2014

Plan Addresses Alzheimer’s Epidemic

The Pennsylvania Alzheimer's Disease Planning Committee issued its Pennsylvania State Plan for Alzheimer's Disease and Related Disorders on February 7, 2014.   
The plan provides recommendations for Pennsylvania to address the epidemic of Alzheimer's disease and related disorders occurring in the commonwealth.  
The report contains seven recommendations which involve increasing awareness, the need for private/public partnerships, brain health, care and early diagnosis, family and caregiver support, healthcare delivery, workforce and research. Click here to download a copy of the plan.
Dire Circumstances
The report lays out the dire circumstances faced by Pennsylvania in confronting what it refers to as an epidemic.
An estimated 400,000 Pennsylvanians are living with Alzheimer’s disease and related disorders (ADRD). (The plan suggests that use of the term ADRD is more respectful and less stigmatizing than the word dementia). Included under the ADRD umbrella are Alzheimer’s disease itself, Vascular Dementia, Dementia with Lewy Bodies, Frontotemporal Lobal Degeneration, and mixed dementias. 
Older age is the greatest risk factor for ADRD. Approximately 5% of Americans who are between ages 65 and 74 have ADRD. About 1/3rd of persons over age 85 suffer from some form of dementia. This means that the number of people with ADRD is expected to skyrocket over the next fifteen years with the aging of the U.S. population.
Pennsylvania has the fourth highest percentage of elderly in the nation with 2.7 million residents over age 60. By 2030 that number is projected to rise to 3.6 million.  
In 2012, the cost of health care, long term care, and hospice care for people with ADRD was estimated nationally at $200 billion. In addition, unpaid caregivers bear a tremendous financial burden. It is estimated that in 2012 more than 15 million Americans provided 17.5 billion hours of unpaid care to people with ADRD.
Approximately 70 percent of Pennsylvania residents with ADRD live at home. An estimated 667,000 Pennsylvanians provide unpaid care for people with ADRD. The toll on family caregivers is enormous, emotionally, financially, and on their overall health. One in 12 Pennsylvania families is affected by ADRD.
The cost of care for individuals with ADRD tends to be much higher than for individuals with other chronic health problems because they tend to be older, have other coexisting conditions and have more severe functional impairments that limit their ability to care for themselves.
Providing support to persons with ADRD and their caregivers is more difficult in rural areas. Pennsylvania is the second most rural state in the nation. Nearly 3.5 million people resided in the commonwealth’s 48 rural counties in 2010.
Plan Recommendations
The committee developed seven overall recommendations for Pennsylvania’s response to the ongoing increase in the prevalence of ADRD.
Recommendation 1 - Improve awareness, knowledge, and sense of urgency about medical, social, and financial implications of ADRD across the commonwealth.
Recommendation 2 - Due to the magnitude of the ADRD epidemic, identify and, where possible, expand financial resources to implement this plan through federal, state, foundation, private, and other innovative funding mechanisms and partnerships.
Recommendation 3 - Promote brain health and cognitive fitness across the life cycle from birth onward.
Recommendation 4 - Provide a comprehensive continuum of ethical care and support that responds to social and cultural diversity, with services and supports ranging from early detection and diagnosis through end of life care.
Recommendation 5 - Enhance support for family and non-professional caregivers and those living with ADRD.
Recommendation 6 - Build and retain a competent, knowledgeable, ethical, and caring workforce.
Recommendation 7 - Promote and support novel and ongoing research to find better and effective cures, treatments, and preventive strategies for ADRD.
Plan Goals and Strategies
Section VI of the Plan presents much of the meat of the report: the committee’s recommendations for goals and strategies to be implemented by the commonwealth and its partners to confront the growing ADRD epidemic. Specific goals and strategies to achieve them are provided for each of the report’s recommendations.
The goals and strategies are too lengthy to summarize here – the reader is directed to the report itself:  Click here to download a copy. I’ll only comment on a few of the areas that struck me as I read the report. 

  • Alzheimer’s disease is among the most feared diseases in the United States, yet most people know little or nothing about it. This lack of awareness and understanding results in stigmatization of those affected as well as their caregivers, and prevents people from getting a diagnosis, planning for the future, and getting the help they need. In response the plan proposes raising awareness and knowledge of ADRD among health care and aging service providers and inclusion of ADRD training in the curricula for health professionals. It also suggests promotion and support of the development of dementia friendly communities. 

  • The report notes that research suggests that about half of ADRD risk is linked to seven modifiable lifestyle factors: diabetes, hypertension, obesity, smoking, depression, education, and physical activity. Goal 3A is to potentially delay to onset of ADRD by promoting brain health and cognitive fitness.

  • The report recommends expanding the availability of and access to care management services in order to coordinate services for individuals living in settings across the continuum of care. (Goal 4C)  

  • The report recognizes the devastating impact of caregiving on the caregiver. Goal 5B is to provide resources and support that will better enable informal caregivers to care for both their loved ones and themselves. This would include training and education for non-professional caregivers and those living with ADRD. (Goal 5D).  

  •  Recommendation 2 is to expand financial resources to implement the plan. Given the limited resources currently available it argues that there is an urgent need to identify innovative, non-traditional funding sources for ADRD research and care.

Unfortunately, the funding sources suggested in Recommendation 2 are hard to identify. It’s clear to this writer that a more significant public sector financial response will be required to implement the Plan’s recommendations. ADRD is expensive, and the toll will be paid one way or another by our society. 
However politically inconvenient it may be, more public money for increased research, caregiver support, workforce development etc. is needed if we are to respond effectively to the epidemic. To me, a plan that does not shout out for greatly increased public funding misses a key element needed to address the ADRD crisis.   
Creation of the Pennsylvania Plan was a notable early step towards a more effective response to the reality of ADRD. The swelling crisis facing aging Pennsylvania is fateful. Hopefully, the Plan’s recommendations, goals and strategies won’t be disregarded.     

VA Offers Free Webinar on its Fiduciary Program for Veterans

Pennsylvania has well over 1 million residents who are veterans. Many of these veterans are eligible for at least some benefits through the Department of Veterans Affairs (VA). VA benefits can provide significant assistance to help veterans meet their daily living, health-care, and long-term care needs.
VA appoints fiduciaries to assist veterans who, due to injury, disease, or due to age, are unable to manage their financial affairs. VA will only determine an individual to be unable to manage his or her financial affairs after receipt of medical documentation or if a court of competent jurisdiction has already made the determination.
Upon determining that a beneficiary is unable to manage his or her financial affairs, VA will appoint a fiduciary. Generally, family members or friends serve as fiduciaries for beneficiaries; however, when friends and family are not able to serve, VA looks for qualified individuals or organizations to serve as a fiduciary.
VA is hosting a free one hour webinar on February 28, 2014 at 9:30 AM ET and 1:30 PM ET on the fundamentals and benefits of the VA Fiduciary Program. The hour long presentation will be followed by a thirty minute question and answer session for participants. Click on the following links to learn more about the webinar and reserve your place.
9:30am session: goo.gl/HNkSRi
1:30pm session: goo.gl/yBn05F
Information regarding the VA Fiduciary Program is also available on the VA website: http://benefits.va.gov/fiduciary/beneficiary.asp.


Saturday, February 15, 2014

Pennsylvania eases income limits on drug programs for Seniors

Pennsylvania has enacted a law that makes it easier for lower income seniors to qualify for help with prescription drug costs.  Thousands of Pennsylvania residents who are over age 65 should benefit. 

House Bill 777 was unanimously passed by both houses of the Pennsylvania legislature and signed into law as Act 12 of 2014 on February 7. It takes effect immediately. 

PACE and PACENET are Pennsylvania's income limited prescription assistance programs for older adults, offering low-cost prescription drugs to low income residents who are over age 65.  Over 300,000 Pennsylvanians receive prescription drug benefits through the programs.

To be eligible for PACE or PACENET, Pennsylvania residents must be at least 65, cannot have prescription coverage through Medicaid, and must meet program income requirements. Eligibility is determined based on the applicant’s previous calendar year income.
For PACE, a single person cannot have countable income of more than $14,500. For a married couple, the combined income limit is $17,700. For PACENET, the income limit is between $14,500-$23,500 for a single person and $17,700-$31,500 for couples.

The new law allows seniors who would lose prior eligibility due to Social Security cost-of-living adjustments (COLA) to stay on the PACE and PACENET programs. This continues a policy that expired on December 31, 2013. The law extends that Social Security COLA moratorium until December 31, 2015
Significantly, Act 12 also permanently removes Medicare Part B premiums from countable income. This disregard should allow thousands of additional seniors to qualify for PACE and PACENET.
As noted by the legislation’s primary sponsor, Representative Seth Grove, seniors never really receive the “income” for the Medicare Part B benefit since it is deducted directly from their Social Security checks. In 2014 most people pay $104.90 each month in Part B premiums or over $1,250 per year. The Pennsylvania Department of Aging estimates that this change will provide nearly 8,200 additional seniors with prescription drug coverage.
For more information on Pennsylvania’s pharmaceutical assistance programs for the elderly, call 1-800-225-7223. Local assistance is available through your Area Agency on Aging and from local pharmacies.

Friday, February 14, 2014

A Modern Love Story

One of the rewards of aging is being able to watch the stories that develop in the lives of people we love.
Sometimes, we get to be small participants in those lives. This summer I was blessed to be part of the wedding of my youngest daughter, Jessie.    
Jessie is a teacher and a writer who lives far away from me on the Big Island of Hawaii. That is where she met her husband, James. 
Jessie has written a piece that tells about meeting her husband to be and their early romance. It is being published in the New York Times “Modern Love” column.  
Jessie’s story will be out this weekend in the “Sunday Styles” section of the Times print edition. But the Times has already uploaded it to its online edition along with a “Valentine's Animation Special” that was created to go with the article.
The story, “Learning to Silence My Inner Editor,” and the animation are available now here: http://nyti.ms/1gvxwGh.
I’d wanted to share Jessie’s article with my readers this Valentine’s Day. It’s a good day to spread some love if you can.