TOPIC No. 1:  AAHSA's Advocacy Agenda - CLASS Act, Adult Day Care Services, and other CCRC issues:

(See tab above, "HEALTH Mar 2010" for extensive special updates regarding 2010 federal legislation to this Topic) 

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The following is exerpted from a memo dated Friday, Oct. 30, 2009 from Sarah Mashburn of AAHSA to PARCR's Assistant Secretary and Legislative Committee member Julia Hix:

From: Sarah Mashburn <smashburn@aahsa.org>
To: juliahix1@yahoo.com
Sent: Fri, October 30, 2009 11:57:26 AM
Subject: Advocacy Materials from AAHSA

Hello Julia,

It was nice speaking with you this morning. I’ve included several resources that can help you get the latest on AAHSA’s advocacy agenda.

The first is the CLASS Act. Here’s a link to the question and answer fact sheet I mentioned:  http://www.aahsa.org/classact.aspx. There’s also an online letter you can send to your legislators:  http://www.capwiz.com/aahsa/issues/alert/?alertid=14042126&PROCESS=Take+Action.

I’ve also attached some information about the Adult Day Services bill I mentioned to you. Please urge your members to send the "dear colleague" letter to the following legislators:

Rep. Glenn Thompson Jr. (R-PA 5th District), Health LA, Matthew Brennan,  matthew.brennan@mail.house.gov

Rep. Jason Altmire, Health LA: Cara Toman,  cara.toman@mail.house.gov

Rep. Patrick Murphy, Health LA: Sara Schaumburg,  sara.schaumburg@mail.house.gov

Rep. Kathy Dahlkemper (D-PA 3rd District), Ivana Alexander,  ivana.alexander@mail.house.gov

Rep. Allyson Schwartz (D-PA 13th District), Health LA: Kelly Hall,   Kelly.hall@mail.house.gov

Rep. Mike Doyle (D-PA 14th District), Health LA: Kenneth DeGraff,   Kenneth.degraff@mail.house.gov

Rep. Tim Murphy (R-PA 18th District), Health LA: Brad Grantz,   brad.grantz@mail.house.gov

Here is a link to our an e-mail you can send to your legislators about the bill too: http://aahsa.capwiz.com/aahsa/issues/alert/?alertid=13627971  

I hope you were able to connect with Steve Maag about the CCRC issues. Please feel free to contact me with any questions. 

Sarah Mashburn
Manager, Communications, AAHSA
2519 Connecticut Ave NW
Washington, DC 20008

Phone: (202) 508-9492         E-mail:  smashburn@aahsa.org

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TOPIC No. 2:  AAHSA's "ACTION ALERT" regarding Medicare Reimbursement Freeze:  

Medicare: Payment Cuts Proposed in 2010
Tell Legislators: NO

June 15, 2009: President Obama has called for a freeze on Medicare payment rates for skilled nursing facilities in 2010 in addition to the home health care payment freeze included in his earlier budget proposal.

PLEASE FOLLOW THIS LINK TO READ AASHA's request for action from all affected organizations and individuals:

http://capwiz.com/aahsa/issues/alert/?alertid=13553841

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TOPIC No. 3:  AAHSA's "ACTION ALERT" CONCERNING THERAPY CAPS - update March 8, 2010

Good News!     On March 3, President Obama signed a temporary, retroactive extension of the exception to therapy caps, It is effective January 1 to March 31, 2010. Thus physicians can override the caps when necessary for a patient's health. If permanent repeal of the caps does not pass as part of a health reform bill. it is expected that another longer extension of the caps will be proposed. Thanks to all who responded to the alert on this!    (We can keep the information posted below as long as it is relevant, pending a more permanent resolution.)

ADVOCACY INFORMATION: A National Issue- Medicare Therapy Caps
                      from Sarah Hughes February 3, 2010

To: PARCR Advocacy Representatives

Please act upon the alert below. I hope you can get a good response from your residents this week. I held this up because Washington was shut down last week. Note request by PANPHA's Russ McDaid for personal stories (see email note below) about how the therapy caps harmed anyone you know. If each of us makes contact with one Senator or Representative that is good.    If you use the "Contact Congress" link in Russ McDaid's message, you will go to a letter that you can edit for e-mails to all three.  ( I revised the first sentence to indicate I was a senior, not a provider, and a similar phrase in the last sentence.)   It takes less than 5 minutes to do this. 

Here are the details.  Nick Luciano of the PANPHA staff informed me that an effort will begin in February to Marshall support to repeal the arbitrary limits on Medicare's reimbursement for physical, speech and occupational therapy. We hope you will inform interested residents about this issue, so that all who agree can act promptly when necessary. Such political action usually involves either phone calls to free 800 numbers or e-mails to Senators and Representatives. Since the anthrax scare several years ago, letters are often held up in the Congressional post office. Your responses in a lobbying campaign need not be long or complex – staff will basically count the number of supporters; although if you have a compelling personal story – for instance about how therapy restored you to a functional life – tell it briefly.

While much health reform legislation is complex and involves issues about which people have very different opinions, therapy caps are a relatively simple issue. One important point is therapy delivered in a hospital setting, especially an inpatient one, is usually more expensive. Allowing outpatient treatment is both economically efficient and more convenient for seniors.

A brief summary of the issue:  

In 1997 Congress passed a budget bill that put a dollar limit on the amount that Medicare could reimburse any individual in a calendar year for physical, speech, or occupational rehabilitation therapy that occurred outside a hospital setting. A patient must pay 100 percent of therapy costs above the cap. This therapy cap applies to Medicare Part B reimbursement. There are no similar limits on reimbursement for therapies given to patients in a hospital under Medicare Part A.

The gross unfairness of this policy to many, for instance a stroke victim, has led to 13 years of moratoriums or annual exceptions, in which a physician may certify that a patient needs additional reimbursed therapy. As of Jan 1, 2010, a cap on combined speech and physical therapy of $1,860 and a similar amount for occupational therapy is in effect. The House health reform bill has a two-year exception provision, while the Senate bill has a one-year exception. Two other bills, HR43 and S 46, would each repeal the outpatient therapy cap permanently. In mid-February there will active lobbying on this issue.

As every senior is only one fall from needing therapy, I hope many of you will respond to requests for advocacy on this issue. 
A longer press release from the American Physical Therapists Association (APTA) can be seen on the APTA web site; and choose "Medicare: Restore Access to Rehab Services"... or, click on the link below:   http://www.apta.org/AM/Template.cfm?Section=Media&CONTENTID=68709&TEMPLATE=/CM/ContentDisplay.cfm 

When AASHA organizes a call-in, they will usually supply a single Washington telephone number to call; otherwise you can contact your Senators.  Sen.Casey: 1-866-802-2833; Sen. Specter: 1-202-224-4254; Bill Shuster: 1-800-854-3035
You can look up any legislator using http://www.usa.gov/Contact/Elected.shtml .    A copy of email from Russ McDaid, PANPHA VP for Public Policy, is reproduced below.  It explains PANPHA's position further and provides valuable links, including one to the sample letter mentioned above:               

----- Email Original Message -----
From: Russ McDaid
To: Sarah Hughes
Cc: Nick Luciano ; Christopher Glen
Sent: Tuesday, February 09, 2010 4:48 PM
Subject: RE: legislative alert for PARCR

Sarah—

Sorry for the delay in responding, I’ve been out of the Office today following the Governor’s proposed FY 10-11 budget. The text of the AAHSA alert follows in case you haven’t seen it:

The therapy caps exceptions process is another issue left in limbo with the delay in health care reform. The exceptions process expired Jan. 1, so beneficiaries could soon begin exceeding the caps, which are $1,860 for physical and speech therapy combined and an additional $1,860 for occupational therapy. Please Contact Congress at http://capwiz.com/aahsa/issues/alert/?alertid=14621881 and tell your members to act quickly on restoring the exceptions process that ensures millions of older adults get full coverage for the therapy they need. Questions, Contact: Marsha Greenfield, (202) 508-9483.

I know that there are some groups out there who believe they may be able to get traction on a complete repeal of the Medicare Therapy Caps, but AAHSA has indicated their belief that this is unlikely. As a result, they are directing us to advocate for the exceptions process to be reinstituted—ideally on a permanent basis rather than the annual therapy cap cat and mouse game we play in advocacy.

I do think that PARCR’s voice on this issue would be helpful. We can also take any personal stories you have to our Congressional visits two weeks from today in D.C. if you receive any and share with Nick and/or I.

Thank you again for your tireless work in following advocacy issues for PARCR,

Russ
W. Russell McDaid, M.H.A.
Vice President, Public Policy, PANPHA 
1100 Bent Creek Blvd.
Mechanicsburg, PA 17050
russ@panpha.org
(717) 790-3949 Office
(717) 903-1031 Cell 
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TOPIC No. 4  PANPHA's "Center for Innovation"

PANPHA recently announced at their Annual Conference in Hershey, PA a pilot program for the creation of a Center for Innovation.   Throughout PANPHA member communities, there are a number of innovative programs occurring – some widely publicized, others not.

PANPHA’s goal for the Center for Innovation is to elevate the expertise and innovation of PANPHA members by cross-pollinating outstanding programs and actions to improve care.

The Center will:
· Be a repository of best practices and innovations for the provision of senior services, including: culture change; technology; workforce/talent development; and job enhancement.

· Coordinate visits with PANPHA members to learn about and share best practices.

· Develop and maintain information about innovation in senior services to include a website and an on-line community of practice or related list serves.

· Be a resource to PANPHA as the Association advocates to government and the public for the future of aging services for Pennsylvania.

In many ways, PANPHA’s Center for Innovation is a member driven project, relying on members to commit to sharing innovative practices and integrating new practices.

For more information about the PANPHA Center for Innovation and how you can contribute, please contact:

Ruth Bish
Kendal Outreach, LLC
Tel.: 610-335-1280
rbish@kendaloutreach.org -OR-

Janet Davis
Kendal Outreach, LLC
Tel.: 610-932-8002
jdavis@kendaloutreach.org
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TOPIC NO. 5:  "FREEZE THIEVES OUT"

(This topic was posted some time ago but is something every resident should consider current.)

"Freeze Thieves Out"

A new Pennsylvania state law gives consumers more control over their personal financial information in an effort to cut down on identify theft.  A law signed by Governor Edward Rendell in November 2006 allows consumers to place a freeze on their credit reports, preventing unauthorized access to the information.

Pennsylvanians can request a security freeze by certified mail or online and can lift the freeze - for example, when they want to apply for credit - by using a personal identification number or PIN.

Each of the three major credit reporting agencies can charge up to a $10 fee to place or lift a freeze, but consumers age 65 and older are exempt.

More than half of all states now have security freeze laws on the books. To learn more about Pennsylvania's law - and how to contact credit reporting agencies - go to www.aarp.org/pa.

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REPORTS  BY PARCR'S LEGISLATIVE COMMITEE: 

Special Report to PARCR Executive Committee March 8, 2010:

March 8, 2010 Legislative Report

Federal

On March 3, President Obama signed a bill extending exceptions to therapy caps, retroactive to January 1 and through March 31, 2010. Longer term provisions, possibly extending exceptions for two years, are part of the health care reform bills.

PANPHA and AAHSA lobbying in late February concentrated on four other issues as well.

These are 1) increased funding for Medicare and Medicaid, especially necessary because of the strain recession has placed on state budgets and because increased federal Medicaid matching funds under the stimulus bill expire on December 31, 2010;  (2) providing financial support for training the nurses and health care administrators who will be needed to staff long term care facilities; (3) revise the five-star rating system and develop better processes for surveying and certification of nursing homes;  (4) and require administrative review or amendment of a DEA action requiring that long term care pharmacies have a written, signed prescription from a physician for any controlled substance issued to a patient, instead of relying upon customary chart orders.

Nick Luciano has given me AAHSA Issue Briefs on these rather complex issues which I can share with anyone interested.

Pennsylvania

On March 5, Representative Dwight Evans introduced a series of budget bills in the House, but these do no more than establish numbers for the bills that will begin the legislative process for the fiscal year July 1, 2010 to June 30, 2011 state appropriations. Although the legislature is in session, day after day passes with no action in either branch. The Governor's budget speech gave little specific information about programs of interest to us; however, we should be aware that there may be a Medicaid reimbursement crisis for long term care facilities next year if there is inadequate federal funding to supplement state appropriations.

There is no news about the status of the Assisted Living regulations.

Advocacy

We still need to get representatives from several member communities.  I have tried to limit our advocacy requests to noncontroversial topics in this highly politicized period of debate over health care reform.  Material on gaining exceptions to Medicare therapy caps, or eliminating the caps, was distributed and I believe we had a good response.   On March 9th AASHA is sponsoring a call-in day for passage of provisions in health care reform bills; specifically, 1) the CLASS (long term care insurance) program; 2) Medicare payment schedules; and 3) Medicaid appropriations.  (At the direction of the Executive Committee, member community advocates were notified Mar. 8th and the PARCR web site updated to provide information and links to aid in communicating with legislators.)

Sarah Hughes, PARCR Legislative Committee Chair

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Report of the PARCR Legislative Committee, January 13, 2010, presented at the quarterly meeting of that date:

1. Pennsylvania General Assembly
Last week, on January 6, the legislature passed, then Governor Rendell signed the bill taxing licenses and profits of table games at casinos, which finalized the state budget for this fiscal year. Little else has happened in this long legislative session and little is expected to happen for the next two to three weeks. Through complex funding maneuvers medical assistance payments to long-term care facilities will receive essentially the same level of funding as last year

Michael Hall was confirmed as Secretary of Aging, but there has been no action in the Senate on HB 1152, which would move substantial parts of the Department of Public Welfare budget to a new Department of Aging and Long Term Care.

PANPHA's legislative director Nick Luciano expects little other legislative action soon, with the possible exception of HB 2192, a bill which would allow municipalities and counties to levy a tax on up to 25 percent of the assessed value of real property of tax-exempt charitable (non-governmental) properties in return for public services rendered.

2. Assisted Living Regulations
No final version of the regulations has been published by the Department of Public Welfare.

3. National Health Reform
The Senate and House health care reform bills are presently in conference for reconciliation. Of the many issues in those bills, I want to touch on only two: a long-term care insurance(or CLASS) program and limits on therapy payments under Medicare.

AAHSA strongly supports provisions for setting up a national long-term care insurance plan. Known as the CLASS Act, the program is included in both House and Senate health reform bills, though with slightly different provisions. It would encourage people to subscribe to the relatively affordable long-term care insurance at a young age, thus relieving eventual costs of Medicaid.

In 1997 Congress passed a budget bill that put a dollar limit on the amount that Medicare could reimburse any individual in a calendar year for physical, speech, or occupational rehabilitation therapy that occurred outside an inpatient hospital setting.
A patient must pay 100 percent of therapy costs above the cap. The gross unfairness of this policy to many, for instance a stroke victim, has led to 13 years of moratoriums or annual exceptions, in which a physician may certify that a patient needs additional reimbursed therapy. As of Jan 1, 2010, a cap on combined speech and physical therapy of $1,860 and a similar amount for occupational therapy is in effect. The House health reform bill has a two-year exception provision, while the Senate bill has a one-year exception. Two bills, HR43 and S 46, would each repeal the outpatient therapy cap permanently. In mid-February there will active lobbying on this issue. As every senior is only one fall from needing therapy, I hope many of you will respond to requests for advocacy on this issue. More information is available from the American Physical Therapy Association at www.apta.org.

Sarah Hughes, Legislative Chairperson

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Report of the PARCR Legislative Committee July 8, 2009 presented at the Quarterly Meeting of that date:

Recently you received a legislative alert from AAHSA - via NaCCRA and PARCR.  Hopefully you were able to share the alert with members of your community.  As this year progresses, there will be other urgent messages from legislative bodies that are of importance to seniors and especially to residents of CCRC's.  As we all know, legislators respond to well informed constituents.  Our aim is to keep you informed and provide the information you need in contacting your legislators.  Bothe PANPHA and AAHSA have been diligent in following legislation that concerns seniors.  Our job is to provide the network to get the messages and information out to members of our communities so that they can research the issues and respond.

We suggest that each community form a legislative committee to act as a network contact for local, state, and federal legislation, funneling information both to and from that community.  Please discuss this suggestion and if possible select/appoint one person from each community committee to be the contact person.

Send names to Sarah Hughes and Julia Hix.  We will work over the summer to establish a network and be ready to share information as issues develop.

Sarah Hughes
717-776-9436
 sbhughes@pa.net 
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 Report of the PARCR Legislative Committee January 14, 2009 presented at the January 14 meeting in Mechanicsburg:             
     Although both the Pennsylvania Legislature and the federal Congress have reconvened, there has been little substantive action. There are 33 new faces m the 2009-2010 Pennsylvanla legislature. Republicans are a majority in the Senate with 29 members to 20 Democrats; in the House, there are 104 Democrats and 99 Republicans. Senator Joseph Scarnati will serve as both President Pro Temp and Lt. Governor after the passing of Catherine Baker Knoll.                                                                              
     Early voting is not allowed in Pennsylvania, although it is practiced now in more than 30 other states. This difference in state practice created some confusion in the past national election. Some of my neighbors received absentee ballots in the mail with the suggestion that they could cast them if they wished. However, in this state absentee ballots may be legally used by those who will be out of town, hospitalized, or are disabled or incapacitated as verified by a physician. Several state lawmakers have announced that they plan to introduce legislation to allow voters to cast ballots prior to election day. Another possibility, practiced in some states is to allow anyone over a certain age, usually 60 or 65, to cast an absentee ballot if desired. Rep. Mike McGeehan of Philadelphia plans to sponsor a bill to do this. I have not been able to ascertain how much support there might be for such legislation. One of the main arguments for any form of early voting is that it helps avoid long lines at precincts, which are especially onerous for those of us who find standing painful. Does PARCR want to support either form of early voting? [If so, we request the Secretary to write a letter of support; I will supply the necessary information about bill sponsors and numbers.]
     Assisted Living regulations have not yet been issued by the Department of Public Welfare. In late October the Independent         Regulatory Review Commission returned the draft regulations to DPW, saying they needed to better distinguish the assisted living category from that of personal care homes; to better spell out how they came up with various rules; and what their impact would be.
     At about the same time, Gov. Rendell appointed Michael Hall as Secretary of Aging and gave him responsibility for coordinating and unifying all long term care services across the Aging and Public Welfare Departments. Hall, who had been Director of the Office of Long Term Living, came to Pennsylvania from Maine with a reputation for lowering costs of providing low-income senior health care by increasing community and home-based care and moving patients out of nursing homes. Secretary Hall announced that the final assisted living regulations will be published by January 31, 2009, but PANPHA does not expect the finalized version to be available before early March. Hall still hopes they will go into effect by July 1, 2009.
     One of the controversial issues that has delayed these new rules is the fact that younger disabled people are asking for larger rooms and tougher regulations, while advocates for facilities serving seniors have sought to qualify rooms smaller than 175 square feet for the assisted living license, as well as modifying other aspects of the rules that would make such a license very expensive for older buildings. A Department of Aging press release indicated that the "key challenge...is [to] sufficiently upgrade standards without making requirements so expensive for providers that few of them will enter the field." [10/22/2008]
     While it was originally thought that obtaining an assisted living license would enable any qualified resident of such a facility to obtain Medicaid, the number of slots allotted to assisted living facilities may be very small.
     For residents of CCRCs, and I would argue all seniors, it is important that there be a range of licensed assisted living facilities that are not priced out of budgets of providers or residents. It is not clear now what further opportunity we may have to comment. Watch our website in case we need to write letters of support on this issue. If that happens, we will post suggested drafts of letters that residents might choose to send to the appropriate authorities. If anyone is interested in working with me on this or other issues, let me know.

Sarah Hughes
717-776-9436
 sbhughes@pa.net 
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