Aug-08

AGS Members Make More Than 70 Visits to Congressmen During Society’s “Congressional Visits Program;” 13 Lawmakers Endorse Key Legislation Following Visits

More than 150 AGS members met with nearly 80 legislators to urge support for legislation aimed at improving older Americans’ access to quality healthcare during the Society’s 2008 Annual Scientific Meeting in Washington, DC, in May.

Members urged legislators to support the Geriatric Assessment and Chronic Care Coordination Act (GACCCA), the bipartisan Caring for an Aging America Act, and the Geriatricians Loan Forgiveness Act, and to adequately fund Title VII Health Professions Programs, the NIA, and the VA. In addition, they alerted lawmakers and their staffs to the findings and recommendations in the Institute of Medicine’s Retooling for an Aging America: Building the Health Care Workforce.

Within hours of the visits, 13 additional congressmen endorsed the GACCCA, the Caring for an Aging America Act of 2008, and the Geriatricians Loan Forgiveness Act.

AMA House of Delegates Approves AGS Resolution on the IOM's Retooling for An Aging America Report

An AGS resolution calling on the American Medical Association (AMA) to join specialty societies in reviewing the Institute of Medicine’s Retooling for an Aging America: Rebuilding the Health Care Workforce won approval of the AMA’s House of Delegates (HOD) earlier this summer. The April IOM report recommends immediate action to prepare the U.S. workforce for the coming age boom. Proposed during the HOD meeting in Chicago, the AGS resolution also calls on the AMA to work with specialty societies to draft suggestions this year for supporting and helping implement key recommendations in the IOM report.

The resolution was cosponsored by the American College of Physicians, the American Academy of Physical Medicine and Rehabilitation, the American Academy of Family Physicians, the American Association for Geriatric Psychiatry, the American Academy of Home Care Physicians, the American Academy of Hospice and Palliative Medicine, the American Medical Directors Association, and the American Psychiatric Association. The AGS looks forward to continued work with the AMA and other supporting organizations to advance the IOM’s recommendations.

President Threatens Veto of Legislation to Block 10.6% Medicare Pay Cut

President Bush was threatening to veto legislation—newly approved by veto-proof margins in the House and Senate—that would rescind a mandated 10.6% cut in Medicare payments to physicians as this issue of Annals of Long-Term Care went to press July 15.

In a recent AMA survey, 60% of physicians indicated that the cut would make caring for Medicare beneficiaries so financially untenable that they would be forced to limit the number of new Medicare patients they saw. Mandated by Medicare’s controversial Sustainable Growth Rate formula, the pay cut was slated to take effect July 1. On June 30, however, the Administration moved to delay processing of Medicare claims through July 15.

Should the President—who, with other Republicans, has balked at provisions in the bill that would offset the costs of rescinding the cut by trimming payments to private Medicare Advantage plans—veto the legislation, both chambers of Congress would have to override the veto with a two-thirds majority. “Rest assured that we will make very sure that this bill becomes law through a veto override,” House Speaker Nancy Pelosi (D-CA) promised.

In an initial vote on June 26, the Senate was able to muster just 59 of the 60 votes needed to pass the Medicare legislation with a veto-proof margin. A 355 to 59 June 24 vote in favor in the House, however, encouraged Senate Majority Leader Harry Reid (D-NV) to continue pressing for approval. On July 9, roughly two weeks after the overwhelming, bipartisan House vote, the Senate passed the legislation in a veto-resistant 69-30 vote. Sen. Edward Kennedy (D-MA) (who returned to Congress to vote for the first time since undergoing treatment for cancer in early June) cast the needed 60th “Aye” for the legislation. Following Sen. Kennedy’s vote, another nine legislators reversed themselves to approve the measure.

Senate Committee Approves 2009 Appropriations Bill That Would Fund Title VII Geriatrics Health Professions Programs at Current Levels; House Appropriations Still Uncertain

The 2009 Labor, Health and Human Services and Education appropriations bill that the Senate Appropriations Committee approved earlier this summer would allocate $31 million for Title VII Geriatrics Health Professions Programs in fiscal year (FY) 2009—the same amount they received this fiscal year. The Senate measure would appropriate a total of $195.5 million for all Title VII Health Professions Programs, $1.58 million more than this year. Title VIII Nursing Workforce Development Programs would get $167.6 million under the spending plan—a $11.6 million increase over current levels.

The House Appropriations Committee was scheduled to mark up its version of the Labor, Health and Human Services and Education appropriations bill as well, but the markup session was abruptly adjourned in late June after House Republicans attempted to modify Interior Department legislation to allow for expanded offshore oil and gas drilling. After Republicans tried to force consideration of the modification, the committee session adjourned.

Under the House spending proposal, Title VII Geriatrics Health Professions Programs would get $31 million in funding for FY 2009—the same amount appropriated by the Senate Appropriations Committee. The House measure would allocate a total of $244.1 million for all Title VII Health Professions Programs, a $50.2 million increase over FY 2008. Title VIII Nursing Workforce Development Programs would receive $174.4 million, an $18.4 million increase over this year’s allocation.

CMS To Start Rating Nursing Homes on 5-Star Scale This Year, Require All Homes to Have Sprinklers by 2013

The Centers for Medicare and Medicaid Services (CMS) will start rating the nation's nursing homes on a five-star scale this year, and will require all facilities to install fire sprinklers by 2013.

The ratings, which will base nursing homes' ratings on their government inspection results, staffing data, and quality measures, should be posted on the CMS website by year's end, The Wall Street Journal reported in mid-June.

Older adults and their loved ones often find it difficult to get information about the quality of care in nursing homes, including information concerning staffing levels and violations, for example. "Despite government oversight, some nursing homes repeatedly violate regulations, and lawmakers and patient advocates have been raising questions about care at some investor-owned nursing homes," according to the Journal.

Only new nursing homes and those under renovation currently are required to have sprinklers. About 20% of nursing homes in the United States lack these.

Legislation Extends Medicaid GME Moratorium

President Bush signed legislation this summer delaying implementation of a CMS regulation that would eliminate federal Medicaid spending for graduate medical education (GME). The legislation defers this action until April 1, 2009. The legislation, known as the Supplemental Appropriations Act of 2008 (HR 2642), also includes $150 million for scientific research at the National Institutes of Health.

Revising Rules Last Updated 25 Years Ago, CMS Adopts New Regulations Expanding Rights of Medicare Hospice Patients

Hospices must meet new regulations for terminally ill Medicare patients under a policy issued by the CMS in June. The rule revises the Conditions of Participation (CoP), last updated in 1983, that hospices must meet to participate in the Medicare and Medicaid programs. Effective December 2, the new CoP includes detailed specifications regarding patient rights that were not part of previous regulations.

Among other things, the rule stipulates that patients who choose hospice, or palliative care, instead of curative treatment are entitled to participate in their treatment plans and have the right to effective pain management, the right to refuse treatment, and the right to choose their own physicians.