Balance Billing Toolkit for Advocates

By | Medicaid, Medicare, REPORTS, Toolkit

Recently, Justice in Aging released a toolkit of five model letters that advocates can use when their low income clients face illegal balance billing for Medicare co-pays, co-insurance or, deductibles.  Accompanying the letters is a webinar that explains balance billing protections for dual eligibles (people with both Medicare and Medicaid) and for people who are Qualified Medicare Beneficiaries (QMBs). The webinar and slide deck walk advocates through the basics of balance billing and the federal protections for beneficiaries. They provide examples of how the problem comes up and how to get it fixed. The toolkit gives advocates some simple letters that they can use as they work with providers to prevent erroneous bills.

Access all the materials here. The webinars, toolkit, and other materials are broken out in tabbed sections.

Balance billing occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for Medicare co-pays, co-insurance, or deductibles. Balance Billing is illegal under federal law, yet it is a common practice as some providers are confused about their obligations under the law.

New Toolkit to Help Advocates Push for Strong HCBS Rules

By | REPORTS, Toolkit
Justice in Aging, together with other disability and aging advocacy groups, issued a toolkit to help advocates push for strong implementation of the new Home and Community Based Services (HCBS) Settings Rules in their states. The new HCBS Settings Rules require all settings funded by Medicaid HCBS programs to, among other things, provide opportunities for participants to be integrated in and engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings. States have until March 2019 to transition their HCBS programs into full compliance with the new settings requirements.

This new toolkit provides advocates with detailed information about the HCBS Settings Rule and provides action steps for advocates to impact implementation of the new rules in their states. The toolkit contains six documents:

  1. The Medicaid Home and Community-Based Services Settings Rules:  What You Should Know;
  2. Home and Community-Based Services Regulations Q&A:  Settings Presumed to be Institution & the Heightened Scrutiny Process, and
  3. The Home and Community-Based Settings Rules:  How to Advocate for Truly Integrated Community Settings, as well as an abridged version of this resource.
  4. State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates
  5. Medicaid’s New Rule to Promote Independence and Choice: What Advocates Need to Know
  6. Applying the New Federal HCBS Rules to Adult Day Centers: What You Can Do

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New 50 State Survey of Dementia Training Requirements

By | REPORTS, Special Report, Toolkit
With more than 5 million people living with Alzheimer’s and other dementias, there’s a growing need for robust training standards for health care professionals in the special needs of people with cognitive impairment. For example, though 64% of nursing home residents have dementia, only 23 states have laws prescribing training requirements for direct care staff in nursing homes and, of those, only one state requires staff to pass competency examinations. Only ten states require dementia training for law enforcement.

These are among the findings of an in-depth 50-state survey of statutes and regulations that Justice in Aging conducted with the support of the Alzheimer’s Association. We looked at dementia training requirements for professionals in a variety of health care and community settings and found wide variation among states in both the amount and the content of required training. We compiled our findings in a five-paper series, Training to Serve People with Dementia: Is our Health Care System Ready?

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