Medicare providers are prohibited from billing Qualified Medicare Beneficiaries (QMBs) for any Medicare co-payments or deductibles. This includes most dual eligibles. However, the problem of improper billing persists.
Proposals to expand the use of Health Savings Accounts (HSAs) have been raised repeatedly in the health care debate. This new issue brief looks at how expanding HSAs would impact the affordability of health care coverage for low and moderate income older adults by examining how HSAs would have functioned under one proposal, the Better Care Reconciliation Act (BCRA), had it become law.
The paper finds that the combination of HSA contributions and premium costs can easily reach 20% to 30% of an older adult’s income. It concludes that HSAs are not a path to affordable health care for older adults. Read the brief.
Inside Health Policy: Beneficiary Groups Concerned CMS’ Nursing Home Guidance Could Lower Penalties [Article unavailable online] (8/23/17) New nursing home guidance issued by CMS in July includes two major penalty exceptions that concern beneficiary advocates. The exceptions sanction per-instance, instead of per-day, penalties for facilities with good compliance histories and situations where a single isolated incident causes harm to a resident. According to Justice in Aging’s Eric Carlson, per-day penalties provide erring nursing home with incentive to correct compliance issues and reduce noncompliance issues. He expects that nursing homes, under the new guidance, will face more per-instance penalties, instead of large, accumulating per-day penalties. “I’ve certainly seen situations in the past where a facility is willing to pay the penalty as a fee for doing business,” Carlson said.
Two new fact sheets explain two facets of the In-Home Supportive Services (IHSS) program—Eligibility and the Application Process, and IHSS Services: Basics. These fact sheets provide a simplified starting place to understand how the eligibility and application process work, what services are available, and how the county determines eligibility for specific services.
In 2014, the Centers for Medicare and Medicaid Services (CMS) released regulations that set standards for the settings in which HCBS are provided. To implement these regulations, each state must have a transition plan approved by CMS by March 2019, with full compliance required by March 2022.
Monday, August 21 – To protect the rights of workers, Justice in Aging teamed up last week with leading civil rights law firms, The Impact Fund, the NAACP Legal Defense and Educational Fund, Inc. (“LDF”) and Cohen Milstein, to file an amicus brief on behalf of more than thirty civil rights organizations from across the country in a trio of cases pending in the U.S. Supreme Court.
The cases address the question of whether employment agreements that prevent workers from taking “concerted” action to challenge workplace violations conflict with protections in federal labor law. Such agreements undermine the fight for civil rights.
Focused on class members with open claims
When: August 10, 2017
Hart v. Berryhill (Colvin) is a Social Security and SSI disability class action that challenged the Social Security Administration’s continued use of medical reports from Dr. Frank Chen even after he had been disqualified from performing medical examinations for Social Security because of serious deficiencies in his reports. The settlement, which was approved on April 25, 2017, provides an opportunity for new disability determinations for many class members.
Decision in Alexander v. Price Means Medicare Patients Could Gain Right to Appeal Placement on “Observation Status” and Avoid Large Medical Bills
August 1, 2017 – Eighty-four-year-old Nancy Niemi of North Carolina was hospitalized for 39 days earlier this year after her doctor sent her to the emergency room. It took weeks to stabilize her blood pressure and she experienced serious complications. But unbelievably, Ms. Niemi was categorized as an outpatient on “observation status” for her entire hospitalization, and she therefore lacked the three-day inpatient stay Medicare requires for coverage of her subsequent, very expensive care at a nursing home. Ms. Niemi’s son tried to help her challenge her lengthy placement on observation status, but Medicare does not allow beneficiaries to appeal this issue. She still owes thousands of dollars to the nursing facility. However, due to the federal court decision issued July 31, 2017, she is now a member of a nationwide class of hospital patients who may gain the right to appeal their placement on observation status.
Below is a statement by Executive Director Kevin Prindiville of Justice in Aging
Today, the Senate took a reckless and irresponsible step towards gutting healthcare for older adults and others, and removing critical consumer protections that save lives. With Vice President Pence casting the tie-breaking vote, the Senate voted to begin a curtailed 20-hour debate on several bills that would drastically change our health care system, stripping coverage from millions of Americans and cutting over $750 billion from Medicaid. Any bill that emerges from such a chaotic process would have devastating effects on older Americans and their families.
Washington, DC—(July 19, 2017) 85-year-old Ortencia boils soup bones with vegetables she gets from the food bank to stretch her weekly food allotment and stay healthy. 61-year old Carey endures numerous aches and pains to carry groceries home from the bus, the cheapest form of transportation. Both struggle to survive on Supplemental Security Income (SSI), a need-based program administered by the Social Security Administration (SSA) that provides a very basic income to older adults and people with disabilities. Major provisions of the program haven’t been updated since it was created in 1972, and as the program fails to keep up with the cost of living, the 8.3 million people who rely on it to pay rent, buy food, and meet other basic needs keep falling further below the poverty line.
Representative Grijalva (D-AZ) introduced the SSI Restoration Act of 2017 in Congress today, with the support of 36 representatives and more than 80 organizations. The SSI Restoration Act puts forth solutions intended to help people like Ortencia and Carey make ends meet. The act increases the amount of money individuals can receive to supplement their income from both employment and non-employment sources; it increases the amount of assets individuals and couples can save for emergencies to a limit that’s more in line with today’s dollars; it repeals a provision that discourages people from seeking help from family; and removes the marriage penalty, among other adjustments.