Brain Injury Association Information, Brain Injury Legislative News, Current Affairs, Medicare and Medicaid Information
Brain Injury Action Alert: Stop the Medicare Therapy Cap
The Brain Injury Association of America has just issued the following legislative alert that requires action on your part:
Congress has less than 30 days to extend the Medicare therapy cap exceptions process. In order to ensure your voice is heard on Capitol Hill, The Brain Injury Association of America is working with the Therapy Cap Coalition to promote awareness of the December 31st deadline.
TODAY every member of the coalition is activating its grassroots network, and asking its members to email or call their legislators. You can help by calling or emailing your Member and ask them to extend the exceptions process through 2013. Without Congressional action, a hard cap of $1900 will take effect January 1, 2013. It is vital that PROVIDERS AND PATIENTS take action! Flood Congress with emails and telephone calls TODAY!
MESSAGE: • Ask your legislators to extend the Medicare therapy cap exceptions process through 2013. • Emphasize the patient impact of letting a hard cap of $1900 take effect in 2013. For example: o For many people with brain injury, rehabilitation is the single most effective treatment to restore function and arrest. Individuals that sustain a brain injury will need physical therapy, speech therapy and occupational therapy. Since no two brain injuries are the same one can not estimate the amount of therapy every individual will need therefore a cap on therapy will cause individuals to either forgo treatment or pay for it out of their own pockets.
o Tell Congress that a hard therapy cap disproportionately impacts those patients who need treatment the most. The Brain Injury Association of America is working diligently with Congressional offices on Capitol Hill to develop a solution before year's end but TIME IS RUNNING OUT!
Please take five minutes and contact your legislators NOW. You can make a difference and help prevent a hard Medicare therapy cap of $1,900 from being implemented in 2013. To find your Representative's contact information click here or call 202-224-3121. To contact your Senator's click here or call 202-224-3121. If you have any questions please contact Amy Colberg at the Brain Injury Association of America.
Current Affairs, Medicare and Medicaid Information
Important Message on Nursing Home and Hospital Care in New York
Stop Nursing Home & Hospital Chains From Taking Over Patient Care In New York State
The NY Senate's budget proposal includes a provision to allow chain ownership of healthcare facilities - including nursing homes and hospitals - in New York State. This would radically change the "business" of healthcare in New York. The State has long prohibited private equity like publically traded corporations from owning healthcare facilities as a means of protecting New Yorkers from providers whose first priority might be satisfying their shareholders and who could remove assets and operations from the state, thus making them unaccountable for the care they provide to our citizens.
According to a recent report from The Center for Medicare Advocacy click here:
In 2011, the first-ever analysis of the ten largest for-profit nursing home chains reported that between 2003 and 2008, compared to all other ownership groups, facilities owned by the top ten for-profit chains had:
1. The lowest staffing levels;
2. The highest number of deficiencies identified by public regulatory agencies; and
3. The highest number of deficiencies causing harm or jeopardy to residents.
The Government Accountability Office (GAO) reported in 2011 that nursing facilities acquired between 2004 and 2007 by the top ten private equity firms:
1. Had more total deficiencies than not-for-profit facilities;
2. Reported lower total nurse staffing ratios; and
3. Showed capital-related cost increases and higher profit margins, compared to other facilities.
In 2010, the GAO reported that compared to other nursing facilities, Special Focus Facilities (i.e., those identified by CMS as among the poorest performing facilities nationwide):
1. Are more likely to be part of a chain and for-profit, compared to other facilities;
2. Have fewer registered nurses per resident day; and
3. Are ranked lower on CMS’s Five-Star System.
In short, opening the door for private equity to operate in New York would put New Yorkers at serious risk. This is not a step that should be taken lightly or slipped into a large budget proposal. Please speak out now to let Governor Cuomo and our Senators and Assembly members know that you are concerned about this issue. Click here to take action now.
The New York based nursing home and medical malpractice lawyers at De Caro & Kaplen, LLP can assist you in a case against a nursing home for poor care casuing bed sores, falls, medication errors or patient abuse.
Brain Injury Rehabilitation, Medicare and Medicaid Information
New York State Mental Retardation and Developmental Disability New Information Line-Complaint Line and Web Site
The New York State Office of Mental Retardation and Developmental Disabilities (OMRDD) has established a new information and complaint line as well as a new web site.
The information line is designed to help people get answers to questions about supports and services for individuals with developmental disabilities in New York State. It is also sued to take complains of alleged misconduct, fraud, waste and abuse in the service system.
The toll free information line offers assistance in English, Spanish and most other languages. A significant amount of useful information is also available at their web site.
The telephone number is 1-866- 946- 9733; TTY 1-866-933-4889. You can also go to the Office of Mental Retardation and Developmental Disability web site.
Brain Injury Lawyers and Law, Current Affairs, Medicare and Medicaid Information
Nursing Home Rating Scale
The quality of care rendered in nursing homes has always been of interest to me. In addition to representing victims of traumatic brain injury, De Caro & Kaplen, LLPalso represents victims of nursing home abuse including patient’s who have sustained decubitus ulcers (bed sores), falls and brutality in nursing homes.
While it is important for families to always visit a nursing home before their loved one is admitted and to continue to monitor care once an admission takes place, some further information can now be obtained from a new system that rates nursing home care across the country.
A five star rating system has been established by the Centers for Medicare & Medicaid Services. This federal agency oversees the quality of care in the nation's nursing homes. You can access the nursing home ratings by clicking the highlighted text.
Hopefully this new information will benefit the public and cause nursing homes that fall below acceptable levels of care to provide more appropriate care to their residents.
Medicare and Medicaid Information
Survey of State Medicaid Waiver Programs
Traumatic brain injury waiver programs that will enable those suffering from brain damage to receive services in a home or community based setting vary greatly from state to state.
MedThe Center for State Health Policy, the Institute for Health, Health Care Policy and Aging Research, Rutgers University has recently published an issue brief, “A Survey of Medicaid Brain Injury Programs” by Leslie Hendrickson, Visiting Professor at Rutgers Center for State Health Policy, and Randall M. Blume of Blume Associates, LLC.
The 116-page paper addresses waivers targeted to individuals with a brain injury. States that had such waivers were identified and contacted to obtain information about how the state decided to create a waiver program, what the eligibility requirements were to obtain services, what the services were, and other information.
In late 2007, the Center for State Health Policy surveyed 23 states that operate brain injury waivers. Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006. Three states began waivers for individuals with brain injuries in
2002 or later, and three other states discontinued waivers in 2006. Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers. Arizona operates its long-term care system as an
Services provided under the brain injury waivers vary considerably from a single waiver service to extensive arrays of services. The size of the waivers also varies from 19 individuals to over 3,600 individuals served in a year.
You can read about: traumatic brain injury waiver services
Brain Injury Lawyers and Law, Brain Injury Legislative News, Medicare and Medicaid Information
Medicaid Assistance following a brain injury
One of the most important resources for persons with a brain injury are the health and rehabilitation benefits provided by Medicaid. New York has been the leader in establishing home based care for victims of brain injury through its Medicaid waiver program. This program will fund services in the community which in the past would only be funded if provided in a nursing home setting.
The Medicaid benefits are "needs based" meaning that in order to qualify, your income must be below certain set levels. These low income levels has made it very difficult for many individual to receive needed assistance.
Medicaid has now raised the Resource Level to $13,050 for a single individual and to $19,200 for a couple on Medicaid. The increase of the Medicaid resource allowance from $4,350 to $13,050 for a single individual (and from $6,400 to $19,200 for a couple) may make it easier for some individuals and couples to qualify for Medicaid, and to access Medicaid nursing home and home care services including the traumatic brain injury home based waiver program in New York State.
You can obtain more information on the New York State Medicaid Traumatic Brain Injury Waiver program by going to the Brain Injury Waiver web page
Brain Injury Association Information, Brain Injury Legislative News, Brain Injury Veteran Issues, Medicare and Medicaid Information
Brain Injury Association of America Condemns President's Budget Requests
The Brain Injury Association of America has requested that I circulate the following press release concerning the proposed elimination of the Federal Traumatic Brain Injury (TBI) Program in President Bush's budget submission to Congress:
Brain Injury Association of America Condemns President’s Fiscal 2009 Budget
(Washington, D.C.) – For the third year in a row, The White House has proposed the complete elimination of the Health Resources and Services Administration (HRSA) Federal TBI Program, which provides grants to state agencies and protection and advocacy organizations to improve access to health and other services for individuals with traumatic brain injury (TBI) and their families.
Increasingly, national policymakers and the American public are coming to understand the dramatic implications of TBI on active duty service members, veterans and civilians alike. In his State of the Union speech last week, President Bush pledged his dedication to meeting the health care needs “of a new war and a new generation.”
“As more service members and veterans join the 1.4 million civilian children and adults who sustain TBIs in the U.S. each year, the lack of priority given to TBI in the President’s budget is deeply disappointing,” said Susan Connors, president and CEO of the Brain Injury Association of America (BIAA), adding, “President Bush just doesn’t get it.”
“My family’s experience demonstrates the interdependence of military and civilian systems of care,” said Dave Woodruff, a member of the BIAA Board of Directors whose brother, ABC anchor Bob Woodruff suffered a severe TBI while covering the war in Iraq. The Federal TBI Program supports coordination among state government agencies and public and private organizations to improve TBI care from trauma to community re-integration. Most military and civilian patients end up living in the community where a complex maze of service systems, if it exists, must be coordinated.
BIAA will work vigorously to restore funding for HRSA's TBI Program, joining with coalition partners at the national level and calling on the highly effective Congressional Brain Injury Task Force to educate their colleagues in Congress and The White House on the need for and value of the Federal TBI Program.
Brain Injury & Concussions, Brain Injury Association Information, Brain Injury Legislative News, Brain Injury Rehabilitation, Brain Injury Veteran Issues, Medicare and Medicaid Information
Virginia Faulted on Care to Brain Injured
A report issued by a Virginia legislative review commission concluded that tens of thousands of people in Virginia with traumatic-brain injuries lack adequate residential facilities, access to therapy, transportation or occupational help.
Further jeopardizing the already taxed system of brain injury care in Virginia is the prospect of returning veterans with brain damage who will also require care with no plans on how to deal with this growing epidemic.
Unfortunately, Virginia is not the only State that lacks the proper resources to adequately care for the thousands of individuals who must live with a traumatic brain injury on a daily basis. Most states do not maintain proper statistics on the number of individuals who sustain brain injury in a give year and lack proper support services for brain damaged individuals and their families. Rehabilitative services in many places are fragmented and not easily accessible. Most states have improper levels of funding to support brain injury services and most individuals do not receive the services they deserve.
In Virginia, most if not all facilities will not accept Medicaid to pay for residential care. In fact, the only facility in the state that does accept Medicaid payments for residential care for traumatic brain injury victims will stop accepting these patients later this month.
But, Medicaid funding is not the only issue. Issues of private insurance and why these health insurers are not paying for brain injury rehabilitation services needs to be addressed.
You can read more about this 130 page report by clicking here.
Brain Injury Lawyers and Law, Brain Injury Legislative News, Brain Injury Rehabilitation, Medicare and Medicaid Information
Unmet Needs of Brain Damage Victims
I was recently appointed as Chairperson of a new committee formed by the New York State Traumatic Brain Injury Services Coordinating Council to examine the obstacles that persons with a brain injury are having in New York State to obtaining needed treatment.
In the last several years the council has devoted a great deal of attention to services provided through the Medicaid, Traumatic Brain Injury waiver program. The council realizes that there are many individuals who have sustained brain damage that are not eligible for the waiver and have needs that may not be fully met by the current health care delivery system. Consequently, this new committee within the council was formed which I was selected to chair.
The council has approved the following letter which has been posted by the New York State Health Department on its health provider network to obtain information that will be helpful in examining this important area. I ask you to please respond with relevant information.
"Dear Provider, Individual(s) with TBI and Other Interested Parties:
The Traumatic Brain Injury Services Coordinating Council (TBISCC) was formed by act of the New York State Legislature to advise the Department of Health regarding service needs of persons who have sustained a traumatic brain injury.
The TBISCC has examined a number of issues relating to availability and quality of services for individuals with a brain injury. Recently, the TBISCC has turned its attention to the unmet needs of those who have sustained a traumatic brain injury, particularly to the obstacles to obtaining treatment and assistance through third party payers, such as:
- Benefit Limitations (i.e. they wouldn't pay beyond a certain number of days)
- Medical Necessity (i.e. they didn't think the services were necessary)
- Coverage Limits (i.e. the services needed were not covered)
- Reimbursement Limits (i.e. the plan reimbursement was inadequate to fund the services required)
Third party providers include Worker's Compensation, no fault insurance, health insurance, managed care plans or other insurance plans that provide benefits for medical care and rehabilitation following a brain injury.
We have enclosed a questionnaire which we ask you to complete and return to us concerning problems you may have encountered with third party payers in obtaining brain injury related services. In addition, we also would welcome your suggestions for improving the delivery of services to persons who have sustained a traumatic brain injury where funds are provided by third party payers. Please feel free to share the questionnaire with anyone you know who would also like to prove us with input on these issues."
Please return your questionnaire and other information to the Council by written communication at
Traumatic Brain Injury Services Coordinating Council
New York state Department of Health
161 Delaware Avenue
Albany, NY 12054
Attention: Dawn Crary
[You can a questionnaire by requesting one from Dawn Crary or forward your narrative experience directly to her.]
Very truly yours,
Michael V. Kaplen, Esq.
TBISCC Unmet Needs Subcommittee Chairperson
Charles Wolf, TBISCC Chairperson
Judith Avner, Esq. TBISCC, Vice Chairperson
Medicare and Medicaid Information
Consumer Guide Available to Assist People with Disabilities in Navigating Medicare Part D Coverage
Advancing Independence, a disability-focused policy organization, released today a new guide, Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare: A Guide for People with Disabilities, Benefits Counselors, Disability Organizations and Others On Transitioning to the Medicare Part D Prescription Drug Benefit.
While many organizations are developing helpful materials to assist Medicare beneficiaries through this transition, this guide was written specifically to address special concerns of people with disabilities. The guide was written in a question and answer format and includes worksheets that individuals can use in consulting their physicians about current pharmaceutical use and
in comparing and selecting a plan that meets their needs.
Medicare plays a critical role in enhancing the health and independence of nearly 15 million people with disabilities of all ages most of whom rely extensively on prescription medications.
It is essential that they be able to make the best use of the new Medicare prescription drug benefit, said Bob Williams, Principal of Advancing Independence and a co-author of the report.
The report was a collaborative effort between Advancing Independence and the Health Policy Institute at Georgetown University. Free copies of the guide can be obtained in PDF and
HTML formats at http://hpi.georgetown.edu/rxchanges.html.