Graves, Budzinski Introduce Save Rural Hospitals Act

Congressman Sam Graves (R-MO) and Congresswoman Nikki Budzinski (D-IL) reintroduced the bipartisan Save America’s Rural Hospitals Act to help struggling rural hospitals stay open and continue serving their communities. Rising costs and falling Medicare reimbursement rates have pushed many to the brink—this bill gives them the lifeline they need.

“Falling Medicare reimbursement rates have been hammering rural hospitals for years,” said Congressman Graves. “In the last 15 years, more than 150 rural hospitals have closed, and hundreds more are at risk. When these hospitals shut down, families lose access to care, good-paying jobs disappear, and entire communities suffer. I’m proud to reintroduce this bipartisan bill to make commonsense reforms, keep rural hospitals open, and ensure folks can get the care they need without having to drive hours to find it.”

“Rural hospitals are a lifeline for the folks they serve. But with healthcare costs rising and outdated Medicare repayment rules, many have been forced to close their doors,” said Congresswoman Budzinski. “The Save America’s Rural Hospitals Act offers a real solution to help rural hospitals become more financially solvent so they can continue to serve our communities. I’m proud to introduce this bipartisan legislation with Congressman Graves to make sure that every American can access quality care - no matter where they live."

Since 2010, more than 150 rural hospitals across the country have closed their doors—forcing patients to travel further to get the care they need and leaving others to put off necessary healthcare. Today, 453 rural hospitals are currently operating at levels similar to those that have shut down over the last decade.

The Save America’s Rural Hospitals Act will reverse this dangerous trend by:

• Eliminating Medicare sequestration for rural hospitals,

• Making Medicare telehealth service enhancements permanent for Federally Qualified Health Centers and Rural Health Clinics, and

• Making permanent increased Medicare payments for rural ground ambulance services.

 

Opinion -- Inflation Reduction Act Cuts Health Care Costs for Missourians

By the White House

President Biden believes that health care should be a right, not a privilege. Every American deserves the peace of mind that quality, affordable health insurance brings, and Americans facing illness should never have to worry about how they are going to pay for their treatment or face a choice between buying life-saving medications and putting food on the table. 

The Inflation Reduction Act of 2022 will lower health care costs for millions of Americans and put money back in the pockets of American families and seniors. The Act will cap prescription drug costs for hundreds of thousands of Missouri Medicare beneficiaries, reduce health insurance premiums for hundreds of thousands of Missourians by about $820 per year on average while expanding coverage to about 29,000 Missourians, and cap insulin co-payments for the tens of thousands of Missouri Medicare beneficiaries that use insulin. 

Cutting Prescription Drug Costs

Americans pay two to three times what citizens of other countries pay for prescription drugs. For some drugs, U.S. prices are even higher than that. For example, a GAO study found that Spiriva, used to control asthma and used by about 700,000 Medicare beneficiaries in 2020, had an estimated U.S. net price of $250 in 2020 and cost between $30 and $52 in France, Australia and Canada. Myrbetriq, used to control overactive bladder and used by over 600,000 Medicare beneficiaries in 2020, had an estimated U.S. net price of $164 and cost $43 in Canada. The Inflation Reduction Act finally takes on this problem by allowing Medicare to negotiate prices for high-cost drugs. It also provides seniors and people with disabilities who have  Medicare coverage with new protections against unaffordable prescription drug bills. 

• Protecting Hundreds of Thousands of Missourians from Catastrophic Drug Costs by Capping Medicare Beneficiary Out-of-Pocket Costs in Part D at $2,000. Currently, Medicare beneficiaries with conditions such as cancer, multiple sclerosis, and lung disease  can face thousands of dollars in out-of-pocket prescription drug costs, and millions of people in Medicare struggle to afford their medications. The Act will require Part D plans to offer improved financial protections that would phase in starting in 2024, with the $2,000 out-ofpocket cap taking effect in 2025. Each year, that will benefit about 34,000 Missouri Medicare beneficiaries who would otherwise have out-of-pocket costs above the cap, according to estimates from the Kaiser Family Foundation (KFF). And, for the first time, all 966,000 Missourians with Medicare Part D will have the peace of mind of knowing their pharmacy costs are capped.

• Saving Billions of Dollars for Seniors and People with Disabilities and the Federal Government by Allowing Medicare to Negotiate Prices for High-Cost Drugs. By bringing down the cost of these drugs, the legislation will save billions of dollars for both Medicare beneficiaries, who will see reduced out-of-pocket costs, and the federal government. Nationwide, KFF estimates suggest that some 5 to 7 million beneficiaries each year use the types of high-cost drugs that would be subject to negotiation and could see reduced cost sharing as a result.

• Addressing Rapid Prescription Drug Price Growth in Medicare. The Act requires companies to pay Medicare a rebate if they increase drug prices faster than inflation. That will achieve billions more in savings for the federal government and will further reduce outof-pocket costs for Medicare beneficiaries, starting in 2023.

• Saving Missouri Medicare Beneficiaries Money by Capping Insulin Copays at $35 per Month. Drug manufacturers have raised insulin prices so rapidly over the last few decades that some Medicare beneficiaries struggle to afford this life-saving drug that costs less than $10 a vial to manufacture. Starting in 2023, the legislation will cap the out-of-pocket cost of insulin for Medicare beneficiaries at no more than $35 for a month’s supply. Some 69,000 Missouri Medicare beneficiaries used insulin in 2020.

• Providing Extra Help Paying for Drugs for Missouri Medicare Beneficiaries with Low Incomes. The Act expands eligibility for full Part D Low-Income Subsidies – known as Extra Help – in 2024 to low-income beneficiaries with incomes up to 150% of poverty and modest assets. Currently, individuals with incomes between 135% and 150% of poverty only receive partial help, meaning that they still pay premiums and face more significant co-pays. About 11,000 Missouri Medicare beneficiaries received partial Extra Help in 2020 and could be helped by the expansion of income eligibility for full Extra Help, KFF estimates. 

• Saving Tens of Thousands of Missouri Medicare Beneficiaries Money by Ending Cost Sharing for Vaccines in Part D. While Medicare Part B covers vaccines such as the flu vaccine at no cost-sharing, patients receiving vaccines covered under Medicare Part D, such as the vaccine for shingles, must pay for a portion of the cost out of pocket. Starting in 2023, the legislation will require $0 cost-sharing for vaccines for Medicare Part D beneficiaries. Some 73,000 Missouri Medicare beneficiaries received a Part D vaccine in 2020, and that number is likely to rise as those vaccines become more affordable.

Lowering Health Insurance Premiums and Expanding Coverage

Since their creation in 2014, the Affordable Care Act (ACA) marketplaces and premium tax credits have played a critical role in providing affordable, quality health insurance coverage for people who don’t get health insurance through their jobs. As the ACA’s major coverage expansions took effect, the share of Missourians without health insurance fell by 32 percent. But because premium tax credits weren’t adequate for people with lower incomes, and weren’t available to middle-income people with high premium burdens, some people still couldn’t afford health insurance coverage or paid for health insurance at the expense of meeting their families’ other basic needs. 

President Biden promised to build on the Affordable Care Act by making premium tax credits more generous and lowering health care premiums for working families. The American Rescue Plan (ARP) kept that commitment by improving premium tax credits, and helped the U.S. reach its lowest uninsured rate in history. But those improvements were set to expire at the end of 2022. The Act continues those critical improvements through 2025, preventing premium spikes this January. Continuing these ACA improvements means: 

• Saving Hundreds of Thousands of Missourians about $820 per Year. About 250,000 Missourians with Marketplace coverage are saving an average of about $820 annually from the ARP subsidies that the Inflation Reduction Act would continue. Those savings increase to thousands of dollars per year for some middle-income older people who would otherwise face very high premium burdens. Among those benefiting the most from these affordability improvements are:

o Missouri small business owners and self-employed people. ACA coverage plays a critical role in providing affordable health coverage to 49,000 small business owners and self-employed adults in Missouri, Treasury data show. In fact, this population makes up 25 percent of ACA marketplace enrollment among working-age Missourians. 

o Middle-income older people who have retired or don’t have health coverage through their jobs. For example, a 60-year old Missourian with income of $60,000 would pay about 19 percent of income for benchmark health coverage without expanded premium tax credits, which cap premiums at 8.5 percent of income. 

• Allowing Tens of Thousands of Missourians to Gain Coverage. About 29,000 more Missourians will have health insurance next year compared to without the Inflation Reduction Act, according to HHS projections. The Act’s coverage expansions will:

o Improve health outcomes and likely save lives. Health insurance improves access to care and health, a large body of research finds. That includes a randomized trial finding that expanding Marketplace coverage saves lives: mortality fell among people  who gained Marketplace coverage due to randomized outreach. 

o Improve financial security. Health insurance reduces medical debt and improves credit scores and access to credit, research finds – making it possible for people to buy a home or take out an auto loan that in turn allows them to get or keep a job. Health insurance also reduces the frequency of bankruptcies and evictions, with one study finding that access to premium tax credits significantly reduces the share of people delinquent on rent or mortgage payments. 

o Narrow disparities in health coverage and access to care. Continuing the ACA improvements will reduce uninsured rates for all demographic groups, but the uninsured rate will fall disproportionately for Black people – narrowing existing gaps in coverage, Urban Institute researchers estimate. Narrowing gaps in coverage also narrows gaps in access to care, research finds. 

Editorial -- Unpaid Caregiving

While we’re on the subject of mental health, we need to focus on the topic of caregiving. Why don’t people want to work anymore? It turns out that 48 million Americans provide care to an adult or child with special needs. Out of those, 41.8 million provide unpaid care. 

Caregiving can take a toll on even the strongest people. They can quit activities that they like, isolate themselves from families, and it can push a person towards their breaking point. They can develop physical or mental health issues of their own. 

Now that the Supreme Court tells us that life begins at conception, it is only fair that we also focus on life after birth as well. Unfortunately, our society is failing our caregivers. Many employers won’t offer paid family leave or allow employees to work remotely. And then they wonder why nobody will work for them.

In 2020, Colorado passed Proposition 118, which will mandate paid family and medical leave effective January 1st, 2023. Missouri should consider a similar measure. Other steps that should be considered include raising income and asset limits for Medicaid. California is eliminating most Medicare asset limits, a process which started this year. 

On top of that, we need to reward such work as motherhood and caregiving, which has long been unpaid and which has long been a backbone of our society. We need a $1,000 a month universal basic income so that we can finally begin to reward the people who have decided to dedicate their lives to their children and other loved ones. 

Opinion -- Proposition B: The Right Thing to Do for Missouri's Children

 by State Rep. Chris Kelly
Missouri voters will soon decide whether to increase Missouri's tobacco tax from 17 cents a pack (lowest in the nation) to 90 centsan increase that would still place us nineteenth lowest in the nation. Fifty percent of the revenue will go to public elementary and secondary schools, 30% to higher education, and 20% for smoking cessation and healthcare programs. I sponsored a similar bill in the legislature and am a strong supporter of the tobacco tax increase, which will appear on the November 6th ballot as Proposition B.

Proposition B provides an opportunity to achieve several important results:

    €  Smoking will decrease
    €  Fewer Missouri young people will begin to smoke;
    €  Fewer Missourians will die from smoking-related diseases;
    €  Missouri will see lower Medicare and healthcare costs; and
    €  The estimated $283 million increase in revenue will go to our most pressing needs
        - $162 million new dollars for public Elementary and Secondary education;
        -   $85 million for our public institutions of Higher Education; and
        -   $56 million for smoking cessation and healthcare.

Criticisms of Proposition B aboundfrom threatened loss of businesses and jobs, to loss of state revenue from those purchasing tobacco products across state lines, to unfairly targeting smokers. These are desperate claims without merit. One criticism of Proposition B invoked by the tobacco lobby deserves further analysis.  That is, whether the additional revenue generated for education would simply offset the general revenue (GR) that would have gone to education, resulting in no effective increase in overall educational funding. You may have heard ads referring to the likelihood of money going in the "front door" and out the "back door"a criticism that has often been levied against lottery funds. In budget parlance, this is called "supplanting"where money is used from one source to take the place of money from another source. Supplanting would mean that no net addition of funds to education or healthcare would result.

The legal restrictions outlined in Proposition B and the protection given to education in the Missouri Constitution undercut this criticism. Nonetheless, I want to address this issue as fairly and as accurately as I can.

Supplanting can take several forms:

1.  Direct supplantation would occur if Prop B funds were placed into the General Revenue Fund, rather than into the Health and Education Trust Fund as mandated by law. This form of supplantation is neither legally possible nor politically plausible. By law, money placed into the special Health and Education Trust Fund can only be used for the three purposes set out in the lawElementary and Secondary Education, Higher Education, and Smoking Cession/Healthcare. The language specifically says that any balances in the Trust Fund "shall not revert to the general revenue fund."

2.  Indirect supplantation refers to supplanting in its most common form, a situation in which the legislature would reduce the amount of money now going into the General Fund for education by some amount because of the increases coming from Prop B‹the so-called "back door" approach. The plain language of Proposition B prevents this form of supplanting. For the Legislature to do this would be illegal.

Such supplanting of funds is also not politically feasible. First, education enjoys a Missouri constitutional preference in that, after public debt, education must receive priority funding. Second, the natural inclination of legislators is to fund education at the highest possible level, given revenue constraints. The political forces one would have to confront to reduce the amount of General Revenue currently going to education would be overwhelming. Even a suggestion of the taking of current GR from schools would result in a firestorm of opposition to legislators both from within and beyond their own party, inviting electoral disaster. Third, the amendment requires that the state auditor shall perform an annual audit of the fund, including "an evaluation of whether appropriations for tobacco-related programs and elementary, secondary, and higher education have increased." The state auditor is obligated to make copies of each audit available to the public and to the General
 Assembly.

3.  Supplanting through erosionIt is technically possible that, in future years some amount of General Revenue that would have gone to Higher Education, for example, might instead be used to deal with other state issuesthe dismal conditions of the Veterans' Homes, overtime compensation for prison guards, or nurses for disabled children who are wards of the state. It is impossible to quantify or know with certainty what the increase in GR funding to education would have been, absent the addition of Prop B funds. There is simply no reasonable way to determine what future funding might have been. We do not know if another Joplin-type storm will occur, or whether we will suffer another significant economic downturn, or if we will lose an expensive roof at a state hospital that requires state funds. We do know that education has the most effective advocates in the Capitol and that in any budgetary prioritization education is likely to prevail.

Having served on the Missouri House of Representatives Budget Committee for 14 years, with two terms as Chairman, I understand the process of state budgeting. Without the naiveté of youthful exuberance and with the experience of having seen how budgets are formed, I know that passing Proposition B will result in significant new revenue to healthcare and to education at all levels, and that neither direct nor indirect supplanting will occur.  Education will continue to receive both the statutory and popular lion's share of general revenue. The protections against supplanting as written into the amendment are intentionally as strong as could have been made and, unlike previous legislation involving lottery or gambling revenues, include language to prevent supplanting to the legal extent possible.

I am positive that the vast majority of my colleagues, both Republicans and Democrats, join me in that resolve. Should supplanting occur against all our efforts, Missouri voters will know and can take the next electoral opportunity to take decisive action against the legislators responsible. There is no perfect safeguard, but there is also no question that Prop B will result in significantly more revenue for education at every level, as well as for smoking cessation and healthcare.

During my 35 years in public life I have found that the best policy is to tell people the truth and trust them to do the right thing.  Ultimately, the voters will decide, as it should be, but before you cast your vote, please weigh the enormous benefits that Prop B brings to the state against the criticisms levied by those paid to promote their cause. I believe there is no legitimate reason to reject Prop B.

Proposition B is the right thing to do for Missouri's children. Please vote "YES" on November 6th.

McCaskill Votes to Protect Medicare, Social Security, Pell Grants

U.S. Senator Claire McCaskill today voted to protect Missouri’s working families from dramatic cuts to vital services like Medicare, Social Security, and Pell Grants.

McCaskill opposed separate budget proposals debated in the Senate—measures intended to dismantle Medicare and turn it into a voucher program, slash Social Security benefits, and gut the Pell Grant program. The proposals were meant to replace the current federal budget in place under the Budget Control Act of last year, which followed last year’s compromise over the debt ceiling.

The proposals—which McCaskill called “each more extreme than the last”—would have implemented dramatic cuts in services for working families, while preserving tax giveaways for big oil companies as well as multi-millionaires and billionaires.

“It’s astonishing to me that so many Washington politicians want to cut vital services for our working families in order to provide new tax-goodies for millionaires, billionaires, and powerful corporations,” McCaskill said. “These people need to drop their obsession with dismantling Medicare, Social Security, and Pell Grants, and instead turn their focus to putting more folks back to work with new job opportunities, and balancing the budget in a responsible way.”

Proposals considered in the Senate today—which kept in place huge tax giveaways for big oil companies, multi-millionaires, and billionaires—included dramatic cuts to vital services, such as:

·         Dismantling Medicare and replacing it instead with a voucher program

·         Slashing Social Security benefits and raising the retirement age to 70

·         Gutting Pell Grants by more than $6 billion

·         Dramatically cutting resources for road and bridge projects

McCaskill voted against the proposals.

McCaskill—a longtime advocate of capping federal spending and an opponent of Congressional earmarks—supported and helped pass the federal budget currently in place as part of the Budget Control Act. That legislation set the budget for two years, cutting the federal budget deficit by more than $2 trillion over that time.

WCCC Rated as Four Star Facility

Beverly Miller, the WCCC Director of Nursing, reported that the WCCC has been given a four star rating by Medicare at the regular WCCC Board Meeting Wednesday.. The Medicare.gov website has ratings of all the area nursing homes and the facility is one of the best in the area. King City is the only five-star facility in the area; Miller reported that it is very hard to get or keep. The others all have three or four star ratings with one with a one star rating.
Their rating criteria also includes surveys and complaints. There were two incidents which resulted in a deficiency and two self-reported deficiencies by the WCCC over the last three years. If a facility has a bad survey year, it can take a long time for it to disappear off the record. The facility was assessed no money in civil or administrative penalties for violations. The WCCC can use their rating for promotional and marketing purposes.
One of the main advantages of the facility is that it is a Missouri political subdivision with an elected, all-volunteer board; the WCCC is the only one in the area which is elected. Therefore, everything that comes in goes back into the facility instead of paying the salaries of a CEO or board members like for-profit facilities do. Another advantage is the amount of time that employees work with each resident; the employees help make decisions on who gets to go home and who gets to work on low census days. The facility also strives to recognize good employees on a regular basis.
The star ratings are also a way for families to compare facilities when looking for a place for a loved one to come to. The state and federal inspectors focus on something different every year; Miller said that belonging to an association was an advantage for the WCCC because they could keep abreast of the changes that were coming.
Secretary Jozy Moyer ran the meeting in the absence of Board President Scott Houk.
The minutes of last month’s meeting were clarified to reflect that Administrator Karen Fletchall had the OK to purchase board-approved water heaters in the event that the present system breaks down beyond repair.
The facility was in the red for the month. The WCCC received a private donation which helped with some expenses. On the negative side, the WCCC received less money in Medicare reimbursements. The census was back up to 30 residents; one was discharged back to her home Wednesday. Fletchall said that they were looking for places to purchase supplies cheaper and trying to tighten everything that they can. Fletchall reported that nearly all of the new cooling system was put in, which will save energy costs for the facility in the long run.
Fletchall represented the facility in the National Earthquake Drill last month in which participants acted out a scenario and received feedback. National Nursing Home Week was held last month and resident Etha Pearl Ray participated in an area pageant for nursing home residents. Employee Sandy Findley was recognized as Missouri Health Care Association District 2 CNA of the Year and will compete at the state level in August. Employees are doing Relay for Life Fundraisers.
The board approved changes to the employee manual regarding dress and appearance, attendance, and absenteeism. Fletchall said that the changes were necessary because they needed to be more specific about expectations and consequences. They could protect the WCCC so that they wouldn’t have to cover someone’s unemployment benefits in the event they were terminated. Fletchall said that it was not a matter of problems coming up but that it was just a matter of being proactive and acting before problems happened.

McCaskill says GOP Medicare Plan Off the Table

As Congress continues to work towards a compromise on deficit reduction proposals in advance of a vote on the debt ceiling, U.S. Senator Claire McCaskill today called for Vice President Biden to keep the House-passed Republican plan to dismantle Medicare out of bipartisan negotiations on deficit reduction. In the letter to Vice President Joe Biden, who is leading the discussions, the senators urged the administration to continue to oppose any GOP efforts to insert their plan to dismantle Medicare into a deficit reduction package. The letter was also signed by Senators Bill Nelson (D-FL), Ben Cardin (D-MD), Sherrod Brown (D-OH) and Jon Tester (D-MT).
“We must protect our nation’s seniors from ending Medicare as they know it, and forcing them to cover the rising costs of healthcare, even if they don’t have the means to do so. While it’s crucial we focus on deficit reduction, this proposal to destroy Medicare is irresponsible and unacceptable,” McCaskill said.

“As the working group moves beyond areas of consensus and into parts of the budget that will require the toughest choices, we wish to identify in advance one proposal that we cannot support in any form—the House-passed plan to dismantle Medicare,” the senators wrote. “For the good of the nation’s seniors, it must remain off the table.”

Despite the public’s overwhelming rejection of the GOP proposal to dismantle Medicare, many Republican leaders are insisting that the plan be part of a package to lower the debt. House Budget Chairman Paul Ryan recently declared that the plan to dismantle Medicare is “part of the debt ceiling talks.” And last week, Senate Republican Leader Mitch McConnell echoed that it is “on the table.” Further, the House majority recently reaffirmed its commitment to this plan through the adoption of a rule that declares the House-passed budget shall have “force and effect.”

Numerous reports have revealed the devastating impact the GOP’s Medicare-ending budget would have on the nation’s seniors. Across the country, the GOP’s reckless plan would cost 2 million private sector jobs over the next five years and increase seniors’ out-of-pocket health care costs by $6,359 in 2022 – more than double what they would otherwise pay. Analyses also show that starting next year if the GOP plan is law, nearly four million seniors nationwide will be forced to pay $2.2 billion more in prescription drug costs, and at least one million seniors will have to pay more than $110 million more for annual wellness visits in 2012.

New Affordable Care Act support to improve care coordination for nearly 200,000 people with Medicare

Today, the Department of Health and Human Services (HHS) announced the Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project, a new Affordable Care Act initiative that will pay an estimated $42 million over three years to up to 500 FQHCs to coordinate care for Medicare patients. This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare patients. This initiative is part of a broader effort by the Obama Administration, made possible by the Affordable Care Act, to improve care and lower costs.
“FQHCs provide essential primary care services to seniors and others in underserved communities”, said CMS Administrator Donald Berwick. “This project will go a long way toward creating comprehensive and coordinated healthcare opportunities for the many people with Medicare who rely on FQHCs as their primary medical providers.”
The FQHC Advanced Primary Care Practice demonstration will show how the patient-centered medical home (PCMH) model can improve quality of care, promote better health, and lower costs. Participating FQHCs are expected to achieve Level 3 PCMH recognition, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA). CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.
“The transformation to a patient-centered medical home is designed to improve the coordination of care for Medicare beneficiaries by helping doctors and other health professionals work in teams”, said Dr. Mary Wakefield HRSA Administrator. “FQHCs in this project can increase access to important primary care services and thus reduce the need for costly hospitalizations or emergency department visits.”
The FQHC APCP project is just one part of a wide-ranging effort by the Obama Administration to improve the quality of health care for all Americans, using important new tools provided by the Affordable Care Act. In addition to this demonstration, the Partnership for Patients is bringing together health care providers and other key stakeholders committed to keeping patients from getting injured or sicker in the health care system and to improving transitions between care settings. CMS will invest up to $1 billion to help drive these changes. Also, CMS has proposed rules to allow Medicare to pay new Accountable Care Organizations (ACOs) to improve coordination of patient care that would be expected to result in better care and lower costs.
FQHCs that have provided medical services to at least 200 Medicare beneficiaries in the previous 12-month period will be invited by letter to apply to participate in the demonstration. Applications for the project will be accepted from June 6, 2011 through August 12, 2011, and the demonstration will be conducted September 1, 2011 through August 31, 2014.
Details about the demonstration and the application process can be found on the CMS web site at: www.cms.gov/DemoProjectsEvalRpts/MD/ and linking to the demonstration web page or by visiting the CMS Innovation Center website at http://innovations.cms.gov/
Questions about this CMS demonstration should be directed to: fqhc_med_home@cms.hhs.gov

HHS agencies to provide ongoing support for communities impacted by Joplin disaster

U.S. Department of Health and Human Services personnel from the National Disaster Medical System (NDMS) began returning to their home states today after deploying to assist in mass fatality operations in the aftermath of a devastating tornado in Joplin, Mo. HHS will provide ongoing assistance with additional aspects of response and recovery.
NDMS, within the HHS Office of the Assistant Secretary for Preparedness and Response, provides medical, victim identification, and veterinary personnel, equipment and supplies to augment state and local resources in disaster response. Similar to military reservists, NDMS personnel come from private sector jobs around the country to respond as intermittent federal employees during disasters. In the tornado response, the state of Missouri requested NDMS support in victim identification.
This response represents the largest number of NDMS mass fatality personnel deployed to a domestic disaster since Hurricane Katrina in 2005. More than 100 personnel from NDMS Disaster Mortuary Operational Response Teams and Family Assistance Center Teams assisted the local coroner’s office in identifying victims of the tornado. This NDMS support for 24-hour efforts in Missouri helped the coroner’s office reunite all victims with their loved ones as quickly as possible in a dignified, respectful manner.
“We’re honored to help state and local authorities bring some sense of closure to the families who lost family members to this storm,” said Dr. Nicole Lurie, assistant secretary for preparedness and response. “Although the situation in Joplin is still difficult, we’ve witnessed a tremendous amount of pride and resilience in the community. HHS will continue to work closely with state and local officials on the ongoing need for social services as the community recover.”
State, federal, and nonprofit partners are collaborating to meet the child care needs of Joplin families. The HHS Administration for Children and Families, in partnership with the Missouri Department of Social Services, convened a task force to address emergency child care needs as well as the recovery of the community's child care capacity. The tornado destroyed 19 child care centers with combined capacity to serve approximately 600 children.
The HHS Substance Abuse and Mental Health Services Administration (SAMHSA) is working with the state to bring the National Crisis Counseling Program to the impacted counties. The program supports short-term interventions to help disaster survivors in their recovery process. Immediately after the tornado, SAMHSA provided stress and grief materials to state and local agencies for use in counseling programs, primary care sites and other areas from which survivors are likely to seek help. With 20 of the area’s 25 mental health facilities destroyed, SAMHSA is also providing technical assistance to the state in restoring this behavioral health infrastructure.
To ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid and Children’s Health Insurance Program beneficiaries in the affected area, the Centers for Medicare and Medicaid Services (CMS) is monitoring the status of health care facilities. CMS will waive or modify certain federal requirements as necessary and in accordance with the law for these facilities, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.
The Centers for Disease Control and Prevention is supporting the Joplin health department on restaurant inspections and on-going public health monitoring. CDC is also providing information on how to prevent illnesses and injuries as the community cleans up and clears debris from the tornado.
To ensure the safety of products regulated by the Food and Drug Administration, the FDA worked last week with state and local health departments to complete inspections of food processing facilities and pharmaceutical and medical device manufacturers that were located in the affected area.
For information on HHS support for response and recovery efforts in Missouri, visit www.phe.gov.

HHS Secretary Declares Public Health Emergency for Missouri

U.S Department of Health and Human Services Secretary Kathleen Sebelius has declared a public health emergency for Missouri in the aftermath of severe storms and tornadoes which struck the state Sunday night. The action will enable the Secretary to ensure that beneficiaries of the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP), continue to receive services during this emergency.

“Our hearts go out to the people of Joplin and the surrounding communities affected by last night’s tornadoes,” said Secretary Sebelius. “We are working closely with our state partners and community organizations to provide the support needed to respond to this disaster and in the ongoing flood recovery in the region.”

The public health emergency is declared under section 319 of the Public Health Service Act and is necessary so that HHS may waive or modify certain Medicare, Medicaid and CHIP requirements under section 1135 of the Social Security Act. The state can submit waiver requests through Centers for Medicare & Medicaid Services (CMS) Regional Office.

Under section 1135, HHS may permit affected health care facilities in Missouri to relax certain operating procedures temporarily so health care services can be delivered, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.

HHS agencies are working with state agencies and regional networks to respond to public health and medical needs of impacted communities. The HHS Assistant Secretary for Preparedness and Response is providing National Disaster Medical System assets to support the state and local health agencies in responding to the disaster.

A Disaster Mortuary Operational Response Assessment Team has deployed to Missouri to work with the state and local coroners and medical examiners in determining the full extent of federal mortuary resources that may be needed. A Disaster Mortuary Operational Response Team and a Family Assistance Center Team will provide assistance to coroners, medical examiners and families in identifying victims and returning remains to their loved ones. In addition, ASPR will provide a Disaster Portable Morgue Unit to support local mortuary operations.

An incident management team from the U.S. Food and Drug Administration (FDA) is working with state and local health departments to assist with inspections of FDA-regulated industries, such as food processing facilities and pharmaceutical and medical device manufacturers, impacted by the tornadoes to ensure the safety of FDA-regulated products.

An Incident Response Coordination Team will make sure federal public health and medical teams have what they need to assist the state at this critical time. This team is the “on the ground” command-and-control for federal public health and medical assets.

Information on steps to protect health immediately after a tornado or to prepare for disasters is available at http://www.phe.gov. Today’s Public Health Emergency declarations are available at http://www.hhs.gov/secretary/phe05232011.html.

Opinion: Sarah Steelman Refusing to Take Position on GOP Plan to End Medicare

By the Democratic Senatorial Campaign Committee

edicare in Missouri is in trouble and Sarah Steelman has refused to stand up for seniors and middle class families, refusing to answer questions about her position. It has been nearly two weeks since Republicans in Washington voted to end Medicare, Sarah Steelman's silence sends a disturbing message to all Missourians about the kinds of priorities she would represent.

“Sarah Steelman’s refusal to take a position on the Republican plan to destroy Medicare proves she has the wrong priorities when it comes to Missouri’s seniors and middle class families. The Republican plan to kill Medicare and hand out tax breaks for oil companies and billionaires could not be more misguided and dangerous. Missouri families need someone who has the courage to stand up and protect Medicare, not a politician who is reluctant to even take a position,” said Matt Canter, spokesman for Democratic Senatorial Campaign Committee. “Sarah Steelman is quietly telling Missourians who she will stand up for in Washington, and it’s most definitely not Missouri seniors or the middle class.”

Background:

· Wall Street Journal: GOP Plan Would “End Medicare.” According to the Wall Street Journal, “The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills.” [Wall Street Journal, 4/04/11]

· The GOP Budget Would Cut $1.4 Trillion In Benefits For Seniors, Families And Those In Nursing Homes, While Shifting Huge Burdens To State Governments. [Democrats.Senate.Gov, 4/07/11]

· CBO: Beneficiaries Would Pay More Under Ryan’s Plan Than Under Traditional Medicare. “Under the proposal, most beneficiaries who receive premium support payments would pay more for their health care than if they participated in traditional Medicare under either of CBO’s long-term scenarios.” [CBO, 4/05/11]

· Seniors Would Pay Twice as Much Than Under Current Medicare Coverage. According to analysis by the Center for American Progress, under the Ryan budget seniors would pay twice as much out of pocket as they would under the current Medicare plan. The analysis found “In 2022 65-year-olds would be forced to pay twice as much for care than they would under Medicare: $12,500 compared to $6,150.” [americanprogress.org, 4/12/11]

· Budget Office: GOP Medicare Plan Could Lead To Rationing. According to an NPR report, the CBO report on the GOP budget proposal warns that the plan could lead to rationing of care. [NPR, 4/06/11]

· Plan's Author: Budget Will Not End Subsidies. When challenged by Fox News Sunday host Chris Wallace about whether his budget will include reductions in oil and gas subsidies like the President’s Fiscal Commission did, Ryan responded that “we don't have a tax problem." [Fox News Sunday, 4/3/11]

Sarah Steelman has remained silent on the Republican plan to end Medicare. [Crickets, 4/26/11]

Letter to the Editor -- Government by the Rich, For the Rich

Letter to the Editor:

Republicans’ huge cuts to social safety net programs like food stamps and Medicaid serve those Americans that would otherwise be forced to go without these basic needs. Republicans plan to transfer Medicare into a system that subsidizes purchases of private insurance plans. How nice for the private insurance industry! The last I heard, the richest 3% of Americans pay no income taxes, thanks to legislation dating back to George Bush’s presidency.

It is obvious that those serving at the national level are paid generously for their dedication and hard work conducting the affairs of the nation. However, if programs must be cut, and if legislators truly care about the “underprivileged,” it is clear that those who receive such generous benefits (example – Senators and Representatives) would and should be willing to legislate cuts to their personal benefits before punishing the poor and elderly, many of whom have no other resource for food and health care. Oh! And here’s an idea – how about those richest one-third of Americans pitching in their fair share of taxes!?!!

Shirley Yurkonis

Savannah, MO

Medicare Premiums to Wipe Out Social Security COLA

Medicare premium increases may wipe out the Social Security COLA increase for this year, the Associated Press reports. This would be the third straight year that Social Security recipients will not be able to see any increases in their income. By law, beneficiaries have their Part B premiums deducted from their Social Security payments each month. This is likely to increase hardships for people in the area because rising gas prices will mean rising food prices as well as higher costs for other goods as well.

Affordable Care Act prevention benefits increasing access, lowering costs for people with Medicare

Today, the Department of Health and Human Services (HHS) released a new report showing that in less than two months, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This is a preventive benefit now covered by Medicare free of charge when obtained by a participating health care professional, thanks to the Affordable Care Act, along with many other recommended preventive services. The report also shows that this enhanced preventive benefits coverage will lower costs, including lowering Medigap premiums for employers, states and people with Medicare. Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services thanks to the Affordable Care Act.

“The Affordable Care Act is bringing new preventive benefits and savings to millions of Medicare beneficiaries this year,” said Secretary Sebelius. “Seniors and others with Medicare are already taking advantage of these important preventive services and wellness visits, which can help lower costs, prevent illness, and save lives.”

The report released today shows that, thanks to the Affordable Care Act, an average of 2,800 people with Medicare have received an annual wellness visit per day between January 1 and February 23, 2011. Because Congress has eliminated the part B coinsurance and deductibles for the annual wellness visit and many other preventive services, the report says that the use of these services should increase.

This will make a big difference for people with Medicare who, like most Americans, tend to use preventive services at roughly half the recommended rate. For example, only 43 percent of women with Medicare received a mammogram in 2008. The Affordable Care Act encourages beneficiaries to use more preventive services by waiving the usual coinsurance and deductible requirements for services recommended by the United States Preventative Services Task Force (USPSTF) as well as for an annual wellness visit. If those recommended services are obtained from qualified and participating health care providers, there are no out of pocket costs. For example, cancer screenings such as mammograms and colonoscopies as well as tobacco cessation counseling may now be obtained free of charge. To learn more about the new Medicare benefits in 2011, visit www.HealthCare.gov/news/factsheets/new_medicare_benefits.html.

In addition to improving the use of preventive services and creating additional savings for beneficiaries, Medicare’s enhanced prevention benefits will lead to lower premiums for employers who now fill this gap in coverage. The same is true with states that fill-in Medicare’s benefit gaps and cost sharing for low-income seniors through Medicaid. Lastly, many seniors buy Medigap insurance to cover Medicare’s cost sharing. With Medicare now paying for annual wellness visits and the part B cost sharing for many preventive services, Medigap premiums should be lower.

This is just one of the many ways the Affordable Care Act is helping improve the Medicare program. The law helps Medicare beneficiaries directly by taking on the rising cost of prescription drugs and providing important relief for beneficiaries who fall into the coverage gap – also known as the “donut hole.” In addition, Medicare’s use of the new tools provided by the Affordable Care Act and better management of the program have stabilized premiums for Medicare’s coverage of prescription drugs (Part D) and increased the number of prescription drug plans that voluntarily help fill the donut hole. Along with other efforts to improve care for people with Medicare, the Affordable Care Act will generate billions of dollars in savings for Medicare, extend the life of the Medicare Trust Fund by 12 years, and help cut costs for seniors and keep them healthy.

To read the report, visit www.HealthCare.gov/center/reports/prevention03162011a.html

Obama Seeks Deep Spending Cuts that Could Strike Home

The February 12th New York Times reports that Obama is going to seek deep spending cuts that he says will save the country $1.1 trillion over the next ten years. Many of the cuts could have repercussions locally. Among the budget cuts that affect the area:

--$1 billion in cuts in grants to states for water treatment plants for 2012. This would make it more difficult for Sheridan and Grant City to obtain money to keep up with costly regulations should they take effect. Sheridan is seeking to get grant money to overhaul an aging water system that was put in place around 1950 and is seeking to find a way to avoid discharging sludge from its water plant into the sewer system.

--Public health programs would also be cut. In addition, home energy assistance to low income families would be cut in half. This would affect many people in the county who have relied on these programs in the last few years to pay heating bills for homes.

--All the Bush era tax cuts would be made permanent except for people who made over $250,000 per year.

--Programs for education, infrastructure, innovation, and research would be increase. This could mean more money for Worth County and Northeast Nodaway schools down the road. This could mean more money for roads as well. The MODOT has contended that they need a lot more money from the Federal Government in order to bring Missouri roads into optimal condition.

--Neither party is willing to touch popular programs like Medicare, which the Times article says is facing unsustainable growth with the retirement of the Baby Boom population or to raise revenues.

--The article says that neither party can sustain the kind of cuts that either Obama or the Republicans are proposing given past history. There would be increasing pressure from interest groups which would translate to voter anger at the polls.

McCaskill Proposes Deficit Reduction Plan Including Plan to Cut Medicare, Social Security

Claire McCaskill is lead sponsor of a plan that Republicans say is needed to do deficit reductions. It would involve across the board cuts including Social Security and Medicare. She is the only Democratic senator to sign off on this so far. The problem is that people value action on the economy more than they do on the deficit.

http://www.stltoday.com/news/local/govt-and-politics/political-fix/article_44a43006-2e26-11e0-8d97-0017a4a78c22.html

Jack Remembers: First Medicare Card

On July 30th 1965 President Lyndon Johnson came to the Truman Library in Independence to sign the Medicare law. He then presented Harry Truman with the first Medicare card and Bess Truman with the second card ever issued.

I always told my children a bedtime story and one of these stories was about going to the square in Independence to see President Truman when he came home from the White House. He was always driven around the square real slowly in a white Plymouth convertible before going to the summer White House on 15th Street (Truman Road). I wanted my kids to see a live President and so when I read in the paper President Johnson was coming to Independence, we stood on a corner south of Truman Library where we knew the motorcade would be traveling. All of a sudden here came about a dozen black limousines with tinted glass windows being escorted by a multitude of motorcycle policemen. Since this was just two years after Kennedy’s assassination, the Secret Service did not want you to know which one of the cars the President was in. It was a big disappointment to me, but the kids were thrilled to see the Presidential Motorcade.

This was 45 years ago. I had no idea what Medicare was. And couldn’t actually have cared less. However, a few weeks ago I was coming back home in to town from my farm when I passed out driving my pickup truck. I quickly came to, managed to get home, and was so dizzy I couldn’t stand up. Laura called 911, and about four or five hours later I had a pacemaker. At the end of each month, Medicare sends out a summary of medical bills and any money they have paid. A few days ago, I got this notice they had paid Centerpointe Hospital $99,700 for my pacemaker. Thank you President Lyndon B. Johnson.

Jack can be reached at PO Box 40, Oak Grove, MO 64075 or jackremembers@aol.com

Benefits of Missouri RX Program

The Federal Government has been touting the prescription drug benefits of the Affordable Healthcare Act. However, the Missouri RX plan covers much of peoples’ prescription drug costs if they are enrolled in Medicare Part D. The following are the benefits of the MoRx program as listed on the Missouri Department of Social Services website:

–MoRx works with all Medicare Part D plans.

–MoRx pays for 50% of your out-of-pocket costs on medications that are covered by your Medicare Part D plan. This means you will save 50% on your deductible, 50% on your co-pays, including during the coverage gap and beyond. MoRx does not pay for the Medicare Part D plan's monthly premium.

–MoRx uses the formulary of the Medicare Part D plan. Any drug covered by a member's Medicare Drug Plan will also be covered by MoRx.

–Dual eligible members will continue to have coverage for Medicare-excluded drugs through MO HealthNet. Medicare-excluded drugs include specific over-the-counter drugs, vitamins, minerals, limited cough and cold drugs, benzodiazepines and barbiturates.

–MoRx covers up to a 31-day supply for each prescription.

–You can use any Missouri pharmacy that works with your Part D plan. (MoRx does not cover mail order services)

For additional information about the MoRx Plan, contact the MoRx Plan Helpdesk toll-free at 1-800-375-1406. For questions about enrolling in Medicare Part D, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Web site at www.medicare.gov. For questions about how MO HealthNet and Medicare Part D will work together, contact the Participant Services Unit toll-free at 1-800-392-2161.

71,995 Medicare Beneficiaries Have Received Prescription Drug Relief

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that 71,995 Medicare beneficiaries in Missouri, and three million people nationwide, have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the “donut hole” during 2010 have been mailed a one-time, tax-free $250 rebate check.

“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”

Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.

Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.

The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:

• As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
• In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
• Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.

People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov

Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.

• An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
• The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
• The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.

For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.

Medicare Benefits from Affordable Care Act Announced

Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit’ where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.

Improved cost-sharing for Medicare preventive services: Also, as of January 1, the Affordable Care Act ( ACA )also eliminates cost-sharing for Medicare-covered preventive services that are recommended by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts what Medicare pays for a service as payment in full) include:
-- abdominal aortic aneurysm screening
-- bone mass measurement
-- breast cancer screening/mammograms
-- cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
-- certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy)
-- diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
-- flu shots
-- Hepatitis B shots
-- HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
-- medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services)
-- Pap tests and pelvic exams
-- physical exams – both the “Welcome to Medicare” visit and the annual “wellness visit”
-- pneumococcal shot
-- prostate cancer screening
-- smoking cessation counseling

Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.

To learn more about Medicare-covered preventive benefits, go to: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx or contact Northwest Missouri Area Agency on Aging at 888-844-5626