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ISSUE BRIEF

Fighting Improper Billing of Dual Eligibles: New Strategies

By | ISSUE BRIEF, REPORTS | No Comments

Doctors, hospitals, and other providers often bill dual eligible Medicare beneficiaries and Qualified Medicare Beneficiaries (“QMBs”) for services that should be covered under Medicare or Medicaid. This practice of improper billing is illegal and can cause low-income beneficiaries to go into debt, skip needed medical care, or end up without sufficient funds to pay for necessities like food and rent.

Justice in Aging has created several new resources that advocates can use to stop providers from billing their clients improperly. Today we’re releasing all of our improper billing resources together as a toolkit on our website. In the Improper Billing Toolkit, you’ll find a new issue brief including a chart of improper billing regulations organized by state, several model provider letter templates, including California-specific letters, all of the trainings we have presented on the topic, as well as resources from CMS on improper billing.

Improper billing of QMBs has been a persistent problem across the country that Justice in Aging and other advocates have been working to stop. We’ve worked with CMS to improve its provider education efforts and internal processes, and provided advocates with previous trainings and resources. We’ve made progress but more remains to be done.

That’s why we created this robust toolkit for you to use to help your clients and to share broadly with other advocates.

Medicaid Funding Caps Would Harm Older Americans

By | Health Care, ISSUE BRIEF, Medicaid, REPORTS | No Comments

Recent months have seen increased discussion of proposals to cap federal Medicaid spending. Under these proposals, the federal government would provide limited funding through either block grants or per capita payments to states, and states would have broad discretion to set their own Medicaid standards.

A new issue brief from Justice in Aging explains how these proposals would harm older Americans. The caps would result in a dramatic reduction in federal funding for Medicaid, and these crippling cuts would be exacerbated by the loss of longstanding federal protections. Potential consequences include loss of services, cutbacks in eligibility, unaffordable health care costs, and diminished quality of care.

The issue brief provides careful analysis of both the “cap” proposals and the protections of existing Medicaid law. Many of the proposals tout the “flexibility” of giving almost complete discretion to states. As the issue brief highlights, however, consumer protections in current Medicaid law are vital to older Americans’ health and financial security.

Section 1557: Strengthening Civil Rights Protections in Health Care

By | Affordable Care Act, Health Care, ISSUE BRIEF, REPORTS | No Comments

So many health care protections are at risk in the months ahead, including Section 1557, the provision in the Affordable Care Act (ACA) that specifically applies civil rights protections to health care settings.

This ACA provision has already been targeted, as a nationwide preliminary injunction issued on December 31 by a Federal District Court in Texas prohibits the Department of Health and Human Services (HHS) from enforcing the provisions in the implementing regulations that pertain to transgender discrimination and discrimination based on termination of pregnancy. The temporary order leaves the rest of Section 1557 intact, although some in the new administration and the new Congress would like to go further, seeking to repeal Section 1557 as part of a broader ACA repeal effort.

Justice in Aging has prepared a brief summary of the extent to which the injunction is likely to impact programs that affect older adults.

Justice in Aging also created an issue brief that discusses how Section 1557 and the HHS implementing regulations affect programs that serve older adults. The brief looks at discrimination protections around language access for beneficiaries with limited English proficiency, sex and gender discrimination, disability discrimination and discrimination based on age and race, with examples of how those provisions could play out for older adults using the Medicare or Medicaid benefit.

Medicaid Non-Emergency Medical Transportation (NEMT): An Overlooked Lifeline for Older Adults

By | ISSUE BRIEF, REPORTS | No Comments

Low-income older adults depend on Medicaid’s non-emergency medical transportation (NEMT) benefit for transportation services to and from medical services. Nearly 7.1 million Americans rely on it. Yet, every year, an estimated 3.6 million Americans miss or delay health care because of difficulty accessing these critical services.

With our partners at Community Catalyst’s Center for Consumer Engagement in Health Innovation, we created an issue brief, Medicaid Non-Emergency Medical Transportation: An Overlooked Lifeline for Older Adults.

The brief outlines the importance of NEMT for older adults and people with disabilities, details the challenges faced by users, and offers a series of recommendations based on promising state practices.

For a quick overview of the full brief, visit our blog. You can also view the accompanying webinar here.

 

How SSA Can Improve the Representative Payee Program to Protect Vulnerable Seniors

By | ISSUE BRIEF, REPORTS | No Comments

Social Security’s Representative Payee Program is crucial to protecting the resources and economic security of vulnerable older adults who cannot manage their own finances. It is also inadequate to meet the growing needs of older adults and has a number of problems in both its capability determination process and in the way the overall program is administered. This Issue Brief, How SSA Can Improve the Representative Payee Program to Protect Vulnerable Seniors is the final paper in a series that Justice in Aging has produced with the support of a fellowship grant from the Borchard Foundation on Law and Aging.

You can access the full toolkit of publications on the Representative Payee Program here.

Voluntary Means Voluntary: Coordinating Medicaid HCBS with Family Assistance

By | ISSUE BRIEF, REPORTS | No Comments
Family caregivers in the U.S. provide billions of hours of care worth billions of dollars. This care should be voluntary, and, for older adults and people with disabilities receiving the care under a Medicaid service plan, federal law requires it.

Under federal Medicaid regulations, Medicaid service plans for older adults and people with disabilities who receive Home and Community-Based Services (HCBS) cannot compel family members to provide unpaid assistance. However, state Medicaid programs (often through managed care organizations) frequently violate federal law by basing service levels on the availability of unpaid care by family members, effectively compelling family members to provide this care, often at the expense of their jobs and their own health.

In this Issue Brief, Voluntary Means Voluntary: Coordinating Medicaid HCBS with Family Assistance, multiple examples from Florida illustrate this systemic national problem and point the way toward the advocacy needed to solve it.

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Ways to Meet Growing Need for Rep Payees

By | ISSUE BRIEF, REPORTS | No Comments
As the population of older Americans increases in the coming years, and the prevalence of cognitive impairments also increases, the need for Representative Payees to manage individual’s Social Security and SSI benefits will grow. However, the Social Security Administration (SSA) does not have reliable mechanisms for determining who is in need of a Representative Payee. Additionally, the agency will be unable to meet the growing need for representative payees without a sustainable program for the recruitment of new payees.

A new policy issue brief by Justice in Aging, Ways to Meet the Growing Need for Representative Payees, explores the issue and poses some possible solutions.

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The Duals Demonstration: A First Glimpse at Lessons Learned

By | DUAL DEMONSTRATIONS, ISSUE BRIEF, Medicaid, Medicare | No Comments

In January 2016, the Centers for Medicare and Medicaid Services (CMS) released the first ever evaluation of the Financial Alignment Initiative (FAI) known as the dual eligible demonstration.

Since the first dual eligible demonstrations rolled out in August 2013, Justice in Aging has followed the process both through the advocates on the ground who counsel clients directly, through the plans we’ve worked closely with, and through our work directly with the state agencies that administer the demonstrations. As national experts on the issues facing dual eligibles we’ve been both an information hub for advocates and feedback loop for policymakers. As such, we’ve been awaiting the release of the first formal evaluations of the demonstrations to see if they match the information we’ve been receiving. They have been released and we’ve analyzed them and published an issue brief on the findings.

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The Dual Eligible Demonstrations at Five: Justice in Aging Toolkit on Design and Implementation

By | DUAL DEMONSTRATIONS, DUAL ELIGIBLES, ISSUE BRIEF, REPORTS | No Comments

States and CMS are in the early stages of evaluating the demonstrations and also looking at mid-course corrections and improvements based on experiences to-date. At the same time, advocates and policymakers are contemplating future health care delivery system reforms, as part of a broader reform effort to pay for value and outcomes, instead of volume.

To contribute to these efforts, Justice in Aging has created a toolkit of design and implementation resources. The toolkit consists of:

  • A new tool for advocates comparing different state outreach and enrollment materials to highlight effective models to use when reaching vulnerable populations. The new tool includes two appendices: Appendix 1, a working chart with links to outreach materials in different states. Appendix 2, accessible from the Outreach and Notices tab on this page, includes examples of notices currently in use in states, and our comments on strengths and areas of improvement.
  • Resources on appeals procedures, designing enrollment notices, care continuity, and ensuring consumer protections in integrated models. These resources were developed earlier by Justice in Aging to influence the demonstration’s design to ensure consumer protections were a focus of new managed care delivery systems. They are assembled together for the toolkit and linked from this page.

ADA at 25: Aging Advocates Celebrate Partnership and Progress

By | ISSUE BRIEF, REPORTS | No Comments
On July 26, disability and aging advocates will celebrate the 25th anniversary of President George H.W. Bush signing the Americans with Disabilities Act (ADA) into law. This celebratory time offers an opportunity to commemorate the ADA’s history and its future potential.

In Justice in Aging’s new issue brief, ADA at 25: Aging Advocates Celebrate Partnership and Progress, we reflect on twenty-five years of the ADA and its progress for people with disabilities, including older adults with disabilities. One in three older adults lives with some type of disability and the law’s protections continue to shape and improve the lives of older Americans.

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