PHInational.org

Kathy Greenlee, Assistant Secretary for Aging, HHS

Assistant Secretary of Aging Kathy Greenlee, who heads up the CLASS Office, announced in a September 28 blog post that the U.S. Department of Health and Human Services (HHS) would be releasing a report and recommendations in mid-October about how to proceed with the CLASS program.

This announcement came after a week of media coverage on the CLASS program left many people in doubt as to whether the voluntary long-term care insurance program created under the Affordable Care Act (ACA) would be implemented in 2012 as planned.

HHS tried to counter reports that the CLASS office was closing, after an actuary from the program disclosed this information in an email that was picked up by the press.

HHS said the staff at the CLASS office was being “reduced,” and reiterated that they were still determining whether the program was “fiscally solvent and self-sustaining into the future,” as the law requires.

Greenlee says in her blog that “we are looking at the CLASS program from every angle.”

She said that a report from the program’s actuaries that provide an “actuarial analysis of a number of potential CLASS benefit plans” would be part of a “comprehensive review of our work on CLASS over the last 18 months.”

Personal Care Attendants Workforce Advisory Panel

The future of the Personal Care Attendant (PCA) Workforce Advisory Panel, which was mandated by a provision in the ACA under the CLASS Office, is still unknown.

The members of the panel were to be announced one year ago. The panel is responsible for advising Congress on the adequacy of the number of personal care aides, their wages and benefits, and access to their services.

– by Deane Beebe

President Obama signing health reform into law, March 23, 2010

March 23 marks the first anniversary of the passage of the health reform law.

The Patient Protection and Affordable Care Act (PPACA) and its companion legislation, the Health Care and Education Act of 2010, have already begun to make health coverage more accessible and change how health care is delivered in the United States.

Dozens of organizations throughout the nation, including the National Council on Aging, National Partnership for Women and Families, and Small Business Majority, are sponsoring events to celebrate the anniversary. The events will highlight the many protections afforded under health reform to people with low incomes, women, children, the elderly, people with pre-existing health conditions, and small businesses.

The “Moving Forward” events will be organized around the following themes:

• March 21: Protecting Small Business’s Care
• March 22: Protecting Seniors’ Care
• March 23: Protecting Patients’ Rights
• March 24: Protecting Women’s Care
• March 25: Protecting Young Adults’ Care

Details of the events will be released before each day. Contact Carol Regan, PHI director of government affairs and the Health Care for Health Care Workers campaign, for event information.

Health Reform and Direct-Care Workers

While the health reform law contains many general provisions that benefit direct-care workers, some of the items specifically address community-based long-term care services and support the direct-care workforce, including:

• Demonstration grants to develop and pilot competency-based training curricula for personal and home care aides.
• Establishment of a Personal Care Attendant Advisory Panel at the Department of Health and Human Services (HHS) as part of the creation of the new voluntary long-term care insurance program called the CLASS Act.
• Additional demonstration provisions to extend the Money Follows the Person rebalancing demonstration, Independence at Home demonstration program, and community-based collaborative care networks and transition programs (pdf).
• Grants to provide career ladders for new and incumbent workers and to help state develop comprehensive health care workforce development strategies (pdf).

Health Reform Law Resources

Visit the PHI Health Reform Resource Center and Health Care for Health Care Workers websites for more information about the law, including the Health Reform Fact Sheet series and a complete PHI summary of direct-care workforce and long-term care provisions (pdf).

– by Deane Beebe

The Friday Morning Collaborative is hosting the second webinar in its series to provide information and resources that may assist state advocates in preventing cuts to home and community-based services (HCBS), while promoting the adoption of new options in the Affordable Care Act.

“Cost Effectiveness of Home and Community Based Services” will take place on March 25 from 2:00 to 3:30 PM EST.

Speakers will include:

• Stephen Kaye, Center for Personal Assistance Services, University of California San Francisco;
• Lisa Alecxih, The Lewin Group;
• K. Charlie Lakin, Research and Training Center on Community Living, University of Minnesota; and
• Dee Mahan, Families USA.

Due to limited space, anyone interested in participating should register early and share lines when possible. The webinar will also be recorded and made available for viewing following the event.

A recent AARP Public Policy Institute report documents how state budget cuts caused by the economic recession pose a serious threat to long-term care services for elders and individuals with physical disabilities.

The webinar series was kicked off in February with “State Budgets: Challenges and Opportunities for Home and Community Based Services.” The series is made possible with support from The Scan Foundation.

The Friday Morning Collaborative — of which PHI is a member — is a national coalition of aging and disability organizations working together to protect and strengthen Medicaid Home and Community Based Services (HCBS).

– by Deane Beebe

The House Committee on Energy and Commerce is holding a hearing on the CLASS Act entitled “The Implementation and Sustainability of the New, Government-Administered Community Living Assistance Services and Supports (CLASS) Program.”

Here are the details on this public event:

Thursday, March 17
9:30 am EST
2322 Rayburn House Office Building
Independence Avenue and South Capitol Street
Washington, DC

Kathy Greenlee, assistant secretary, Administration on Aging, and William Minnix, Jr., chair of Advance CLASS and CEO of LeadingAge, are among the witnesses testifying in support of the CLASS Program.

Advanced CLASS Executive Director Connie Garner issued a statement noting that “HHS is still working on the program design and the group hopes that critics will reserve judgment until the work is complete.”

Advocates are encouraging supporters of the CLASS Program to attend the hearing.

Additionally, Families USA (pdf) is providing a toll-free telephone number, 888-876-6242, that CLASS supporters can call to let members of the House Committee on Energy and Commerce know that 1) CLASS will be invaluable to people with disabilities and older adults in need of long-term services and supports, and 2) according to law, the program will be self-sustaining.

– by Deane Beebe

Many governors are requesting a repeal of the Affordable Care Act‘s maintenance of effort (MOE) provisions, which prohibit states from making changes in Medicaid and State Children’s Health Insurance Program (CHIP) eligibility requirements until 2014 for adults and 2019 for children.

Consumer advocates across multiple constituencies, however, support the MOE provisions and are mobilizing to keep them in place and to counter other efforts to cut Medicaid services.

At The Consequences of Obamacare: Impact on Medicaid and State Health Care Reform, a hearing held by the House Energy and Commerce Committee on March 1, governors Haley Barbour (R-MS) and Gary Herbert (R-UT) requested that the federal government eliminate the MOE provisions.

In contrast, Governor Deval Patrick (D-MA) highlighted (pdf) the success of his state’s health care reform law, which is similar in many ways to the Affordable Care Act.

Mobilizing to Keep MOE Intact

Dozens of advocates, including PHI, voiced opposition to weakening the MOE provisions in a letter (pdf) to the U.S. House of Representatives.

During economic downturns like the current recession, Medicaid and CHIP play a critical role in maintaining access to health care and long-term services and supports for millions of children, elders, and people with disabilities, the advocates wrote. Although state budget problems are serious and warrant attention, advocates say that reducing access to critical services is the wrong response.

More information about why the MOE provisions are important to elders and people with disabilities has been provided by Families USA (pdf) and the Center for Budget and Policy Priorities (pdf).

Tackling Medicaid State Budget Cuts

Advocates are also working to scale back proposed state budget cuts to Medicaid services.

As many as 350 advocates from 48 states participated in the first of a series of webinars hosted by the Friday Morning Collaborative, a network of aging and disability advocates in which PHI participates, on February 25.

The webinar, State Budgets: Challenges and Opportunities for Home and Community Based Services (registration required), featured presentations by Judy Solomon, Center on Budget and Policy Priorities; Wendy Fox-Grage, AARP Public Policy Institute; Jerry Reilly, Eldercare Alliance–Washington State; and Diane Justice, National Academy for State Health Policy.

The Friday Morning Collaborative, which is led by the National Council on Aging and funded by The SCAN Foundation, just launched an online community to share resources (registration required). Medicaid cuts are a serious concern for aging and disability advocates and providers, especially as waiting lists for Medicaid home and community based long-term services and supports grow.

– by Gail MacInnes, PHI National Policy Analyst

Elder abuse is a growing and largely unnoticed problem in the U.S., according to a report (pdf) by the Government Accountability Office (GAO).

The report was the focus of a March 2 hearing by the Senate Special Committee on Aging.

Elder abuse can take many forms, including physical, sexual, or psychological abuse; neglect; and financial exploitation. It has been linked to shorter life spans, depression, and other health problems.

An Under-the-Radar Problem

The most recent study on the subject found that 14.1 percent of elders had been abused in the last year. The GAO’s report, however, determined that this figure almost certainly underestimates the problem, since the vast majority of elder abuse cases go unreported.

The GAO report further states that “as the American population ages, the extent of abuse will likely grow.”

The March 2 hearing included testimony (pdf) from actor Mickey Rooney, who said that his “daily life became unbearable” due to abuse he experienced at the hand of his wife and stepson.

Rooney said that they took control of his finances without his consent, leaving him feeling “trapped, scared, used, and frustrated.”

Elder Protection Programs Face Challenges

While there are state and federal programs in place to prevent elder abuse, they “may not be able to meet the needs of the increasing number of older Americans,” the GAO report suggests.

The report identifies numerous problems with the current elder protection programs. One major issue is a lack of funding. In FY 2009, only $11.9 million in federal funding was allotted to elder justice activities; state Adult Protective Services (APS) programs received a small fraction of that money.

The report also points out that the Administration on Aging has been lax in establishing federal guidelines for collecting data on elder abuse. “Without these data, states cannot benefit from their collective experience in this area,” the report’s authors write.

Training Materials in Development

National health reform is likely to have a positive impact on the issue of elder abuse, however.

Included in the legislative package signed into law by President Obama in March 2010 is the Elder Justice Act — which, among other things, will fund the design and development of training resources addressing elder abuse.

These resources will eventually be distributed to all Medicare- and Medicaid-certified nursing homes in the U.S.

Abuse Prevention Curriculum Already Available

A free curriculum on preventing elder abuse and neglect, geared toward employees in all long-term care settings, is already available at the PHI Training and Organizational Development Services website.

“Proper education is essential to eradicating elder abuse from long-term care settings,” said Peggy Powell, PHI National Director of Curriculum and Workforce and Development. “This curriculum provides trainees with the tools necessary to recognize, report, and ultimately prevent elder abuse.”

This training was developed through a grant from the Centers for Medicare & Medicaid Services (CMS) to the Michigan Department of Community Health. Partners in its development included Michigan State University, the Michigan Office of Services to the Aging, BEAM (a wholly owned subsidiary of MPRO, Michigan’s federally designated quality improvement organization), and PHI.

– by Matthew Ozga