AGS Urges Appropriators to Increase Funding for OAA Programs in 2006

The AGS joined members of the Leadership Council of Aging Organizations (LCAO) in urging House appropriators to increase spending on Older Americans Act (OAA) programs next year. Programs funded under the OAA provide a variety of home- and community-based services, including home care, caregiver support, congregate and home-delivered meals, adult day care, transportation, protection against abuse and neglect, senior centers, case management, and state long-term care ombudsman services. By helping older Americans remain independent in their homes and communities, these programs save money, LCAO members explained in a June 7th letter.

“OAA funding, however, has not kept pace with inflation and population growth—effectively being frozen for the past several years,” the letter noted. As a result, “older adults in communities across the nation are on waiting lists for many essential services, such as home-delivered meals and transportation. These gaps in services have been exacerbated in the last several years by cutbacks in state Medicaid and community services programs as a result of the fiscal problems states have faced.”

CMS Announces Medical Adult Day Care Demonstration

The Centers for Medicare & Medicaid Services (CMS) recently announced plans for a demonstration project that will allow some Medicare beneficiaries to receive medical adult day care services under the home health benefit. “This demonstration will permit Medicare to assess whether providing medical adult day care services through the home health benefit will improve patient outcomes and provide the opportunity for some respite for beneficiaries’ caregivers,” said CMS Administrator, Mark B. McClellan, MD, PhD.

Authorized by the Medicare Modernization Act, the demonstration will provide an opportunity for home health agencies to partner with medical adult day care facilities. Together, they would provide medical adult day care services to Medicare beneficiaries—as a substitute for a portion of health services that would otherwise be provided in the home, according to an agency release. The project is limited to five sites selected by CMS and will run for three years. As many as 15,000 beneficiaries will be able to enroll in the demonstration, which begins in February 2006.

More information is available at: http://www.cms.hhs.gov/researchers/demos/MADCS/default.asp.

Key House Committee Examines Post-Acute Care

A key House Committee is examining ways to improve coordination in the clinical assessment of post-acute care and in payment for this care. Rep. Nancy Johnson (R-CT), Chair of the Ways and Means Health Subcommittee, convened a hearing on the subject on June 16. “In light of the rapid growth in payments in post-acute settings, the development of a common patient assessment tool and the creation of a more rational post-acute payment structure—one that is tied to the services required by the patients, rather than the institutional setting in which patients are placed—should be a high priority for the Congress and the Medicare program,” Johnson explained.

Medicare currently pays for post-acute care in four separate settings: long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and the home. Medicare reimburses for these services in these settings according to four separate payment methodologies, Johnson noted. In addition, each setting uses a different patient assessment instrument to evaluate the level of care a patient requires.

The subcommittee heard testimonies from CMS, the Medicare Payment Advisory Committee (MedPAC), and the Government Accountability Office, as well as from industry representatives. Herb Kuhn, Director of the Center for Medicare Management at CMS, told lawmakers that the agency would begin testing a patient assessment tool for all post-acute care services under Medicare this spring. “An approach that relies on a single comprehensive assessment of a patient’s needs and clinical characteristics could ensure that payments are at levels consistent with high-quality, cost-effective care, regardless of setting,” he said. Kuhn pointed to the Medicare Advantage (MA) program as an example of an existing model “of seamless care that may serve as a good example for post-acute care payment and assessment systems.”

Testifying on behalf of MedPAC, Chairman Glenn Hackbarth outlined the Commission’s recommendations for improving payment systems for post-acute sectors. According to MedPAC, existing patient assessment tools “measure the same broad aspects of patient care—functional status, diagnoses, co-morbidities, and cognitive status.” Nevertheless, “the timeframes covered, the scales used to differentiate patients, and the definitions of the care included in the measures vary considerably, [making it] very difficult, if not impossible, to compare the quality of care and patient outcomes across all settings.”

Report from WHCoA Mini-Conference on Long-Term Care Available

There have been several official White House Conference on Aging (WHCoA) mini-conferences on important health issues, including long-term care. One, “Creating a Comprehensive National Long-Term Care Policy,” was held in April. Its purpose was to provide the full WHCoA Policy Committee with recommendations specific to long-term care that could be considered for incorporation into its final policy recommendations to the President and Congress.
The final recommendations and report submitted to the WHCoA are available at: http: //www.ahca.org/brief/whcoa_ltcmc_050603.pdf.

YOUR HELP IS CRUCIAL
AGS encourages all members to engage in grassroots activities. Lawmakers ultimately are accountable to the constituents who elect them. That is why your participation at the grassroots level is such an essential component of the American Geriatrics Society’s government relations’ efforts in Washington. Get involved today by:

• E-mailing Julie Zaharatos at jzaharatos@americangeriatrics.org to join our key contacts database.

• Registering for “MyAGS” at http://www.americangeriatrics.org/myAGS/login.asp and accessing the legislative tool kit to learn more about how to become a grassroots advocate.

• Bookmarking www.americangeriatrics.org/policy/key_contact.shtml and visiting it often to learn about the current hot issues in AGS advocacy efforts.

AGS understands that there are many demands on your time; however, your participation is extremely important. Remember, you only need to work with three people: your Representative and the two Senators from your state.