Some Highlights From the Governor’s 2012 Budget Submission

• The Governor’s budget level-funds most of the Elder Affairs line items at the level of the FY 2011 budget as it finally ended up after the restorations of federal matching funds (FMAP) and the supplemental budget.
• One notable exception, however, is the home care purchased services account (1630), which drops from $101.68 million to $96.781 million, a loss of $4.9 million (the FMAP restoration and supplemental funding was removed), or a drop of -4.8%. This line item is one of the more popular on Beacon Hill, and we hope to lift it back to at least the FY 2011 level.
• The Prescription Advantage program (1455) lost the most money: $9.88 million in funding. But EOEA indicates that current benefits levels in the program should be maintained, because more coverage under the donut hole is being picked up by the federal government. In FY12, the Prescription Advantage program will receive considerable cost relief from provisions in the Affordable Care Act (ACA). Despite a 31% (9.9m) decrease from FY11 funding levels, the FY11 Prescription Advantage Benefit design remains fully intact. There are no changes being made to the Prescription Advantage program.
• The protective services/elder abuse account is level funded at $15.25 million. Mass Home Care has made this elder abuse line item its top funding priority for the spring budget session. 53 new reports of elder abuse are received every day, and spending on child abuse and domestic violence is 31 times greater than elder abuse.
• The Enhance Community home care Program (ECOP) and care management accounts are also level-funded.
• The meals on wheels, supportive housing, Councils on Aging, and supportive housing line items are all level funded at 2011 levels.
• In the MassHealth accounts, the Adult Day Health programs are going to be restructured so that only “complex” clients are accepted into the program. This is a serious change that may require legislative advocacy to restore.

“In general, we appreciate the Governor’s commitment to home care for the elderly expressed in this budget,” Mass Home Care Executive Director Al Norman said. “We were braced for the worst---so we can live with these numbers.”

Administration Cuts $15.5 Million From Key MassHealth Elderly Services

Just hours before a major snowstorm hit the State, the Patrick Administration released a blizzard of cuts to MassHealth programs targeted to poor people and the elderly.

At a short meeting on the afternoon of January 11, 2011, the Patrick Administration announced a series of rate cuts in several key MassHealth programs. The rate reductions come with more than half the current fiscal year already over. A total of roughly $3.25 million will be cut from key programs in the remaining months of FY 2011, plus another $12.3 million will be cut from the FY 2012 budget as a result of rate cuts that will take effect on the Ides of March.

Here are the impacts of several of the major cutbacks announced.

Adults Foster Care: AFC is a program that provides daily assistance with personal care and case management oversight by the provider in caregivers home on a 24/7 basis. The proposed amendments decrease the payment rates for all adult foster care (AFC) services by 6.2% effective March 15, 2011.

• the proposed rate for AFC Level I services will decrease from $47.13 to $44.21
• the rate for AFC Level II services will decrease from $83.09 to $77.94
• the rate for Alternate Placement Level I services will decrease from $37.47 to $35.15
• the rate for Alternate Placement Level II services will decrease from $74.93 to $70.28
• the rate for Intake and Assessment services will decrease from $242.38 to $227.35

The Division of Health Care Policy and said it was proposing these amendments “to ensure that the payment rates are consistent with efficiency, economy, and quality of care, while maintaining access to services.” DHCFP estimates that the AFC rate cuts will result in aggregate annual expenditure reductions in FY 2012 by MassHealth of approximately $4 million or 6.2% as a result of this proposal. Since the cuts begin on March 15th, they will be in effect for three and a half months in FY 2011, and will reduce payments to AFC providers by $1 million this fiscal year.

In May of 2008, when the Patrick Administration proposed cutbacks in AFC rates, Mass Home Care testified against the rate cuts. “The fact remains,” Mass Home Care said, “that at the end of the day, the core of this program---the caregivers---are making $9,281 per year for level I, and $18,137 per year for level II. When caregivers apply for this program, it will not take them long to calculate these annual rates.” Mass Home Care said two things were certain: “These caregivers are enormously undervalued compared with people doing similar work in state agencies, and the new rates will not be enough to attract the caregivers needed to expand this program, and the ultimate losers from this situation will be the state’s taxpayers, who will foot the bill for more costly placements.”

Mass Home Care concluded in 2008: “Adult Foster Care holds the promise of becoming one of the critical growth programs under Governor Patrick’s “Community First” initiative. Yet today, this program is still largely unknown, and marginally utilized. AFC will become more important because it is a 24/7 residential alternative, and as such, is highly targeted towards those who are in need of significant personal assistance. The level II program in fact, is targeted to those who would otherwise need expensive institutional care. However, if this program continues to remain obscure, with rates that do not reflect the level of care and attention required by its clients, then the Commonwealth will lose the opportunity to keep people in the least restrictive setting, and pay the price for that loss.”

Adult Day Health: ADH is a community based day program providing nursing and therapeutic services and oversight for members in an effort to postpone nursing facility placement. Services provided include nursing, therapy, nutrition, dietary counseling, case management, activities, and assistance with activities of daily living. The proposed amendments decrease the payment rates effective March 15, 2011 for adult day health (ADH) services by an average of 7.8%. The proposed rate for Basic ADH services will decrease from $53.93 to $49.98 per day (7.3%); the rate for Complex ADH services will decrease from $68.68 to $62.95 per day (8.3%); and the rate for Health Promotion and Prevention (HPP) services will decrease from $27.86 to $25.69 per day (7.8%). Rates for ADH services are calculated based upon the median of industry unit costs as reported by ADH providers, to which efficiency standards for productivity and administrative costs, and a cost adjustment factor are applied. The proposed rates for Basic and Complex ADH services are based on 2009 reported costs. The proposed rate for HPP services decreases the current rate by 7.8%.

The Division estimates that aggregate annual expenditures by MassHealth in FY 2012 for ADH will decrease by approximately $3.32 million or 7.49 % as a result of this proposal. Because these rate cuts will take effect for 3.5 months in FY 2011, the cuts are projected to save roughly $968,000 in the current fiscal year. In October of 2009, Mass Home Care testified before DHCFP against cuts in Adult Day Health rates. “ADH is helping almost 7,000 individuals to remain living in the community,” Mass Home Care said, “saving state and federal taxpayers millions of dollars annually. If 7,000 people had to be institutionalized due to lack of ADH services, the cost would be roughly $408.8 million annually. The entire spending for the ADH program for FY 2009 is $90.49 million (including transportation). It is clearly more cost effective to keep people in the community, even when you combine ADH with other in-home supports that these individuals may be receiving.”

Group Adult Foster Care: GAFC is a program providing daily assistance with personal care services and case management oversight by the provider in an elderly/disabled housing complex, or Assisted Living Residence. Because this program does not operate with a set of regulations, it does not have to go through the same public hearing, rate setting process. The Administration has proposed cutting GAFC rates by 7.6%, which will reduce program expenditures in the remaining months of FY 2011 by $1.25 million, and cut FY 2012 expenses by $5 million.

In addition to these listed services, the Administration has proposed cuts to MassHealth dental services, day habilitation, and other services targeted to low-income people.

“Cutting community based services for the elderly is fiscally wrong-headed,” said Mass Home Care Executive Director Al Norman. “Day care and foster care programs keep seniors out of more expensive institutions. At a time when revenues are limited, it makes sense to invest in programs that save taxpayer’s money. As budget strategy, these cuts are inexplicable. On a human level, these cuts are indefensible.”

U.S. Alters Rule on Paying for End-of-Life Planning

By ROBERT PEAR

New York Times,
January 4, 2011

Entire Article Can Be Read Here!

WASHINGTON - The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.

The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.

Many doctors and providers of hospice care had praised the regulation, which listed "advance care planning" as one of the services that could be offered in the "annual wellness visit" for Medicare beneficiaries.

While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.

In a recently published article by Arthur Caplan, Ph.D, msnbc.com contributor, 'Death panels' alive - and that's good news for all of us, he says, ...Washington, D.C., is not the place to talk about end-of-life care - your doctor's office is.

Death Panels' Alive — And That's Good News For All Of Us!

Washington is not the place to talk about end-of-life care — your doctor’s office is
By Arthur Caplan, Ph.D. msnbc.com contributor

Watch out! The "death panels" are back. They are going to be used by Obama and his horde of federal health reformers to make sure that if you are old, very sick and go into a hospital, you will never return. So goes the line of utter malarkey put forward with a straight face and Twitter finger last year by Sarah Palin, who notoriously and ridiculously coined the term "death panels" to vilify efforts to legislate paying doctors to talk with Medicare patients about their health care options if they become terminally ill. Her critique worked. The provision to pay doctors for the time involved to talk about end-of-life care for older Americans was dropped from the health reform bill.

But it has come back, this time in the form of regulations to be issued on Jan. 1 by the Department of Health and Human Services. If an elderly person is offered a chance to do advance care planning by their doctor and wants to do so, then Medicare will pay the doctor for the time involved.

Some conservatives and right-to-lifers see rationing afoot. They think encouraging these discussions is simply a way to get old folks to save the federal government money by slyly tricking them into saying that they don’t want a lot of medical care if they are terminally ill. Not only are they wrong, they are dead wrong. Talking with your doctor about what you want to happen and who you want to make decisions for you if you become terminally ill is something every American, young and old, should do.

If you want aggressive care to the very end then you need to say so. If you don’t want to be kept alive with technology should you have a deadly cancer that does not respond to treatment then you need to let your doctor and your family know.

Story: Obama enacts end-of-life plan that drew 'death panel' claims

Few people are comfortable with the topic of death. Some, like Sarah Palin, seem to think that if they pull the covers over their head the Grim Reaper will go away. Not so. Each of us will face end-of-life decisions if not for ourselves then for our family or friends.

Anything, including Medicare money, that can encourage doctors, many of whom do not want to have this conversation with their reluctant patients, to do so is a sound, moral and prudent policy.

No one is telling you what you must say. No regulation says that you cannot insist that everything possible be done. No bureaucrat is whispering in your doctor’s ear to spin the conversation toward insuring your premature demise.

You can change your mind at any time about your views and wishes including during your time in a hospital, nursing home or hospice. Nothing is locked in stone by having this initial conversation about what you want and who you want to make decisions for you if you cannot do so.

If Terri Schiavo taught us anything, it was that you need to specify to your doctor and family who should make decisions for you about your medical care if you are unable to communicate.

If the political conversation over death panels and advance care planning has taught us anything, it is that Washington, D.C., is not the place to talk about end-of-life care — your doctor’s office is.

Article courtesy of MSNBC, contributed by By Arthur Caplan, Ph.D.