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Vanessa Barrington

Medicare Patients Placed Under “Observation Status” Win Right to Appeal, Federal Court Orders

By | IN THE NEWS, LITIGATION, NEWS, Newsroom, PRESS RELEASE

Media Contact: Vanessa Barrington 510-256-1200 vbarrington@justiceinaging.org

March 24, 2020—Medicare beneficiaries who have been denied coverage for nursing facility services after transferring from hospitals because the hospital changed their status from “in patient” to “observation status” now have a right to appeal their classification and a chance to receive reimbursement from Medicare for the uncovered nursing facility charges. Read More

Nursing Homes Scramble to Enable Televisits Amid Coronavirus

By | ASSISTED LIVING, IN THE NEWS, Long Term Care, Nursing Homes

AARP: Nursing Homes Scramble to Enable Televisits Amid Coronavirus, (March 30, 2020)

Federal restrictions barring visitors to nursing homes — except in cases of compassionate care, such as end-of-life care — because of the coronavirus are frustrating relatives and friends of nursing home residents across the country. The author spoke with Justice in Aging attorney, Eric Carlson, who has  heard mixed reviews of how effectively nursing homes have embraced the use of mobile devices.

“I hear that in some facilities, they’re making a good faith effort,” he said. “But in others, due to staffing shortages and priorities or the lack of technology, in those facilities making these connections falls by the wayside.

Llegar a la tercera edad como inmigrante, sin pensión y sin seguro médico

By | Health Care, Health Disparities, Health Equity, IN THE NEWS, Language Access, SENIOR POVERTY, Uncategorized

La Opinion: Llegar a la tercera edad como inmigrante, sin pensión y sin seguro médico, (March 28, 2020)

This article talks about how difficult it is for older adult immigrants who have no pension or health care to meet their basic needs during the COVID-19 pandemic, especially if they lost their jobs due to the pandemic. Justice in Aging attorney, Denny Chan, was interviewed for this article.

Se estima que de 2.2 millones de personas sin documentos que viven en California, el 2% son mayores de 65 años, según un informe del UC Berkeley Labor Center. “Muchos trabajadores inmigrantes han perdido su trabajo y están luchando para satisfacer sus necesidades para vivir; una catástrofe como una hospitalización de un miembro de la familia, los podrá en dificultades económicas”, agregó. “Un seguro médico protege a los estadounidenses de los costos médicos altos e inesperados, pero sin esos beneficios, las familias inmigrantes enfrentan altos riesgos de muerte y desesperación”. Denny dijo que, “en estos momentos la comunidad inmigrante, documentados o no, viven situaciones muy complicadas por las políticas antiinmigrantes por parte de la administración Trump.”

Leaving Seniors to Fend for Themselves During Pandemic Has Cost Lives

By | IN THE NEWS, NEWS

Los Angeles Times Leaving Seniors to Fend for Themselves During Pandemic Has Cost Lives (March 24, 2020)

Despite early data showing that older adults were most at risk of complications and death from COVID-19, many companies were slow to put in measures that could help older adults stay safe. For example, in the beginning of the pandemic, drug stores were charging older adults delivery fees instead of encouraging them to stay home and safe by waiving fees. Later, many drugstores did begin waiving fees. “It’s taken way too long,” said Kevin Prindiville, executive director of the advocacy group Justice in Aging. “Our failure to create systems early on to help older people social distance has cost lives.”

Why the New “Public Charge” Rule Could Hit Immigrants Hard

By | IN THE NEWS, Newsroom

Next Avenue: Why the New “Public Charge” Rule Could Hit Immigrants Hard (February 24, 2020)

Since 1999, federal immigration law has had a public charge test in place to deny people admission to the United States if the government identifies them as ones who may be “primarily dependent” on the government for support, either through cash assistance programs or long-term institutional care. The Trump administration altered the definition of public charge in ways that unfairly target older adult immigrants. “This will have a ripple effect on their families who are here in the United States, as well as our communities in general,” said Justice in Aging attorney Natalie Kean. Denny Chan was also interviewed for this article.

Americans with Million Dollar Salaries Stop Paying Into Social Security Before March While Everyone Else Continues

By | Economic Security, IN THE NEWS, Social Security

Newsweek: Americans with Million Dollar Salaries Stop Paying Into Social Security Before March While Everyone Else Continues (February 19, 2020)

Social Security, which provides retirement, disability, and survivor benefits to one fifth of the U.S. population, is funded by a payroll tax capped at the first $137,700 of earned wages, and excludes income from other sources such as capital gains. The burden of sustaining Social Security is not being carried fairly by the rich. One simple fix is put forth in the The Social Security 2100 Act ,which would apply the payroll tax to wages above $400,000 and adjust the benefits to rising costs of living Justice in Aging Executive Director, Kevin Prindiville said, such a move is, “a key step in combating senior poverty in our country.”

 

 

 

Some Assisted-Living Residents Don’t Get Promised Care, Suit Charges

By | ASSISTED LIVING, IN THE NEWS, Uncategorized

New York Times: Some Assisted-Living Residents Don’t Get Promised Care, Suit Charges (February 14, 2020)

It’s common in Assisted Living facilities to regularly assess individual residents to determine whether a resident needs help bathing or dressing, for example, or suffers from dementia. But often the results of those assessments are used to show increasing need, and to justify increased costs, but not to make staffing decisions to reflect the greater needs and costs. Now a group of law firms is suing California assisted living facilities. There are several ongoing suits. Justice in Aging attorney, Eric Carlson, was interviewed for this story. About the lawsuits and what they uncover he said, “It gets at internal systemic issues. When facilities disclose information like how much time staff members spend on tasks, it gets at what’s happening behind closed doors.”

In AEP Home Stretch, CMS Grapples With Plan Finder ‘Glitches’

By | Medicare

Reprinted with AIS Health permission from the December 5, 2019, issue of RADAR on Medicare Advantage

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period ending on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs. In a blog post responding to the reports, CMS said it stands by the accuracy of the tool, but it acknowledged that it has been making updates to the MPF as issues are flagged, giving weight to consumer advocates’ concerns that CMS did not allow enough time for testing the tool before rolling it out.

With the goal of offering a more streamlined and personalized shopping experience at Medicare.gov, the MPF this year underwent a major makeover that reportedly cost $11 million. Sources such as the Consumer Assessment of Health Plans Survey, the “Modernizing Medicare Plan Finder” report from the National Council on Aging and RAND research had raised multiple navigability issues with the tool and prompted CMS to take on the redesign. But after promising consumer advocacy groups that the new version would be available to use alongside the legacy MPF for “much of the summer,” CMS dropped the new plan finder on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.

“The Medicare Plan Finder is a critical tool for beneficiaries to make plan selections — and even more so this year in which Medicare beneficiaries on average have the choice of 28 different [stand-alone Part D] plans to enroll in,” says Amber Christ, directing attorney with Justice in Aging, referring to a recent Kaiser Family Foundation analysis.

“At the outset, CMS did not provide enough time to test the functionality of the tool, which has led to ‘testing in real time’ with real ramifications to Medicare beneficiaries and their ability to access care,” laments Christ. Shortly after the MPF’s late August unveiling, Justice in Aging joined with the Center for Medicare Advocacy, the Medicare Rights Center and the National Council on Aging to issue a letter to CMS arguing that it did not give counselors enough time to familiarize themselves with the tool, and criticizing the decision not to allow them to fall back on the legacy MPF, which was retired at the end of September.

Meanwhile, a key feature of the tool was missing: the ability to sort Part D plans based on a beneficiary’s total out-of-pocket drug costs for the rest of the year.

CMS explained to AIS Health in September that the feature was always meant to be included in the new plan finder but couldn’t be completed in time for the late August launch. And the agency did indeed add it by the start of the AEP, when it also began enabling consumers to compare expected drug costs in stand-alone Part D plans and MA plans with prescription drug coverage and automatically load their current prescription drug list (if they are existing Medicare beneficiaries and provide their Medicare ID number).

Reports Suggest Emphasis on Premiums

But a recent Health Affairs article observed that the new MPF “explicitly emphasizes the monthly plan premium over arguably more relevant information — estimated total drug costs — which also account for expected out-of-pocket costs.” Meanwhile, total drug costs are “displayed in a small font amidst other information,” and the tool lists available plans starting with the lowest premiums, potentially steering users toward plans with low premiums when previous research has suggested this leads beneficiaries to spend more than necessary on yearly drug expenses, observed the article.

Other news reports offered detailed accounts from users around the country. When using the MPF to compare three drug plans for a client, a Medicare consultant in Wisconsin found that the summary page indicated that one of her client’s medications would not be covered — but upon clicking on “plan details” was informed that all of them would be covered, according to a Nov. 25 article from ProPublica. Further research on the plans’ websites revealed that coverage depended on which version of the same high blood pressure medication the member was taking.

In North Carolina, officials with the state’s Seniors’ Health Insurance Information Program told North Carolina Health News that costs for enrollees who receive low-income subsidies were not accurately reflected in the plan finder, and another not-for-profit agency reported that beneficiaries who entered their new Medicare ID numbers saw their forms automatically repopulate with their Social Security numbers, which were supposed to be removed from the process. And an administrator in Nebraska’s Dept. of Insurance told ProPublica that she’d flagged about 100 errors with the new tool since Oct. 1.

CMS: Information Is ‘Current,’ ‘Accurate’

“Distressed” by “the media coverage talking about ‘glitches’ or ‘malfunctions’” in the MPF, a CMS blog post dated Nov. 27 with no byline said the new tool “displays the most current and accurate information on premiums, deductibles and cost sharing that Medicare Advantage and Prescription Drug Plans provide.” That information, added CMS, “changes frequently because plans regularly update drug formularies and renegotiate drug prices,” which is “good for beneficiaries.”

CMS also reported that traffic on the plan finder website is 14% higher than last year and that the agency is already “seeing high percentages of plan switching, likely because new supplemental benefits are appealing.” However, the agency is not done improving the tool and has incorporated additional changes during the AEP as it receives feedback from users and stakeholders, including beneficiaries, caregivers and State Health Insurance Program counselors who have provided “meaningful suggestions,” added the blog post. “As we’ve said, the Plan Finder redesign is an iterative project, and in the coming months we’ll be scoping out additional improvements that we can implement based on lessons we learn this year.”

“We appreciate that CMS is working diligently to address problems that come up,” says Christ. “Our concern is that many people have already made decisions based on inaccurate plan finder information.”

Advocates Want More Flexible SEP

To ensure that beneficiaries do not experience harm, Justice in Aging has asked CMS to make the Special Enrollment Period (SEP) more flexible and to widely advertise its availability, she adds. The SEP applies when beneficiaries receive inaccurate or misleading information from the government, but it is generally narrow and requires burdensome documentation by beneficiaries, according to Justice in Aging.

That’s not to be confused with the three-month Open Enrollment Period, which starts in January and allows individuals who made an MA plan choice to switch. While that period may “help a subset of individuals who early on realize their plan selection is harmful…many won’t encounter a problem until later in the year, and they too need a way to fix a mistake that was based on erroneous or misleading plan finder information,” suggests Christ. Furthermore, the three-month open enrollment period only applies to MA, and not to PDP enrollment, she points out.

Even with MPF glitches, the AEP appears to be robust, with overall year-to-date enrollment up 7.2%, according to Credit Suisse. “The big ‘wait and see’ question will be if and when enrollees depending on Plan Finder realize they received incorrect information,” says Lindsay Resnick, executive vice president at Wunderman Thompson Health, in an email to AIS Health. “Given that the vast majority of beneficiaries complete their purchase through a licensed Medicare Advantage agent or directly with the health plan, we may not see major issues. That said, for the integrity of the MA program, the onus is on CMS to get in front of this issue with consumer facing communications about Plan Finder issues as well as clear and simple explanations of OEP rules.”

Meanwhile, private shopping platform Connecture — which prides itself on using pharmacy-specific drug pricing data (not just regional averages) collected from the largest number of carriers in the country — says it has seen significant growth in enrollments this AEP through all channels (broker, call center and direct-to-consumer) via its PlanCompare solution.

Connecture: Calculating Drug Costs Is Key

“This AEP, especially, has afforded Connecture the opportunity to educate on the importance of collecting (and saving) drug lists, knowing accurate drug costs and understanding why $0 premium plans can end up costing more if consumers don’t understand their total annual out-of-pocket estimates,” says Bill Keyes, senior vice president of sales and marketing with Connecture. “Our total cost calculators take multiple Medicare plan factors into consideration (such as the donut hole) all of which ultimately drive consumers to finding their best fit plans.”

View the Health Affairs article at https://bit.ly/2R8WK7L and the CMS blog post at https://go.cms.gov/2qYbEmJ.

Contact Christ via Vanessa Barrington vbarrington@justiceinaging.org, Keyes via Connecture Marketing Director Kara Tarantino at ktarantino@connecture.com or Resnick at lindsay.resnick@wunderman.com.

By Lauren Flynn Kelly

Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem

By | Health Equity, IN THE NEWS, Medicare, Oral Health, Uncategorized

Miami Herald: Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem (December 20, 2019)

Spotty coverage — combined with high oral health costs — means many older adults like Domínguez and Morejón, the two people discussed in this story, have no path to getting dental care. According to Justice in Aging, a national non-profit legal advocacy organization, only half of all 60 million Medicare beneficiaries saw a dental provider in the past year. “When we speak with older adults, lack of access to dental care is very much top of mind for them,” said Jennifer Goldberg, Justice in Aging’s Deputy Director. “And that lack of access to dental coverage has a disparate impact on populations of color.”

Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds

By | IN THE NEWS, Medicaid, Nursing Homes

Reveal from The Center for Investigative Reporting: Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds (December 14, 2019)

This story is the fourth in an investigative series about wage theft and worker exploitation in Medicaid-funded board and care homes in California, Florida, Oregon, and Wisconsin. Companies may be prohibited from collecting Medicaid if they have been convicted of Medicare or Medicaid fraud or patient abuse or neglect, among other offenses. However, the federal agency that administers Medicaid – the Centers for Medicare & Medicaid Services – does not police whether senior care-home operators comply with wage and hour laws. “Medicaid certification is a privilege, not a right, and payment should depend upon complying with relevant laws,” said Eric Carlson, a directing attorney at Justice in Aging. “Underpaying employees is a red flag for health care quality.” This story also appeared in The New York Times, Washington Post, Minneapolis Star Tribune, Seattle Times, US news and World Report, and the San Diego Union Tribune.