LONG TERM CARE

CONCLUSION
Medicaid’s long-term care services are a critical source of support for millions of poor and lowincome
people. The long-term care system we have today is primarily financed by Medicaid,
and without significant policy changes, Medicaid is likely to be the major source of long-term
care coverage in the future. Medicaid, however, has important gaps and inequities. Medicaid is
not an option for many; for those who do qualify, Medicaid does not provide insurance
protection against large financial losses, but requires impoverishment. Eligibility and benefits
are limited in many states, and waiver programs may not be available to all who need them and
are financially eligible for them. Efforts to address these gaps are needed. Medicaid eligibility
policies could be revised to make the program’s means-testing less harsh. Federal financing
could be expanded to make it easier for states to provide community-based services for people
with long-term care needs. Barring major changes in the structure of long-term care financing,
improving Medicaid’s long-term care protections for people of modest means is likely to be a
key part of any future strategy for meeting the long-term care needs

A need for Defibillators at new senior center Malden

The Commonwealth of Massachusetts

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PETITION OF:





Bruce J. Ayers

Michael W. Morrissey









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In the Year Two Thousand and Seven.

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I looked at the law listing, the concern of our legislators, their coming a goings
and come to the conclusion that their is concern besides mine for the safety and welfare of the Senior population. I may be "in the dark" because it is hard to keep the general population in Malden informed of action being taken I have faithfully attended the Senior Building Committee Building meetings and have made a suggestion that a Defibillator be placed in the New Senior Community Center before opening of the exercise facilities. I would rather be considered always agitating rather than wait for a tradegy, I am sure it is on the adgenda but I hope not on the back burner


An Act requiring defibrillators in senior housing facilities.




Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:





SECTION 1. Section 8B of chapter 40 of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by inserting before the definition of “Buyer” the following definition:-

"AED”, an automatic external defibrillator medical device approved by the United States Food and Drug Administration that: (i) is capable of recognizing the presence or absence of ventricular fibrillation and rapid ventricular tachycardia in a patient; (ii) is capable of determining, without intervention by an operator, whether defibrillation should be performed on the patient; (iii) upon determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to the patient’s heart; and (iv) then, upon action by an operator, delivers an appropriate electrical impulse to the patent’s heart to perform defibrillation.

SECTION 2. Chapter 111 of the General Laws is hereby amended by inserting after section 57D the following section:—

Section 57E. All public and private senior housing facilities with an occupancy of 30 or more persons shall have on the premises at least 1 AED and shall have in attendance at least 1 employee or authorized volunteer as an AED provider as defined in section 12V½ of chapter 112. The provisions of said section 12V½ of said chapter 112 shall be applicable to any action under this section.

SECTION 3. Chapter 112 of the General Laws is hereby amended by striking out section 12V, as so appearing, and inserting in place thereof the following section:-

Section 12V. Any person, unless the usual and regular duties of such person include providing emergency medical care, who in good faith and without compensation renders emergency cardiopulmonary resuscitation or defibrillation, to any person who apparently requires cardiopulmonary resuscitation or defibrillation, shall not be liable for acts or omissions, other than gross negligence or willful or wanton misconduct, resulting from the rendering of such emergency cardiopulmonary resuscitation or defibrillation.

Short Supply of geriatricians

Public radio’s “Marketplace’’ recently offered an interesting segment lamenting the short supply of geriatricians.

At a time when the 85-and-over set is the fastest growing cohort in the American population and the nation’s 77 million baby boomers, like it or not, are heading into old age, this is unfortunate.

Geriatricians — essentially family doctors for the elderly — earn about $150,000 a year. That’s less than half the $400,000 of, say, radiologists, in a health care system that rewards specialists who do the most procedures and often spend the least time with patients.

Few experts in the field of geriatrics see any likelihood this will change, absent an overhaul of the reimbursement system. Instead, their focus is on teaching the core principles of their specialty to everyone in the medical arena who comes in contact with the elderly, from surgeons to discharge planners.

“If we got to the point where everybody in the health care system was an expert in caring for older people, we wouldn’t need geriatricians,” Dr. Leo M. Cooney of Yale University School of Medicine told me a few years back. “Or we wouldn’t need them as frontline providers. We’d be like consultants, making sure everyone else was as skilled as possible.’’

To listen to the “Marketplace” update, click here. And to read my earlier story, “Geriatrics Lags in Age of High-Tech Medicine,” click here.

Tell us about your experiences with your geriatrician — or your frustrations in trying to find one.

CAUTION IN ENROLLING HEALTH INSURANCE PLAN

New rule would limit insurers contact with elderly, disabled

Agents selling private health insurance plans to the elderly and disabled would be barred from cold-calling, door-to-door solicitations and pitching their products outside hospital waiting rooms or pharmacies, under a federal rule proposed Thursday.

The rule is designed to make it harder to pressure Medicare beneficiaries into signing up for insurance products they don't need or want. It essentially restricts face-to-face solicitations to those initiated by the customer.

A new Medicare drug benefit began Jan. 1, 2006. Since then, participants and state insurance commissioners have complained that some agents use false information to enroll people into certain plans, particularly those offering comprehensive health insurance.

"We want to make sure that beneficiaries aren't pressured into sales," said Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services. "In parking lots, waiting rooms and those kinds of places, a salesman can create a pressure environment or a threatening environment where a beneficiary will agree to anything just to get away."

.

About 27 million people get coverage for their prescription drug needs either through a private insurance plan that offers only the drug benefit or through a "Medicare Advantage" plan that offers comprehensive health benefits. In some cases, people were enrolled in plans even after they made it clear they didn't want the product.

Advocacy groups said the rule is a step in the right direction, but it won't be enough. They want states to regulate the insurance companies that offer Medicare Advantage plans. Currently, states only regulate the activities of the agents selling the plans.

"CMS doesn't have the boots on the ground to enforce even good rules like this," said Paul Precht, policy director for the Medicare Rights Center.

But Weems said the rule also gives CMS authority to issue fines of up to $25,000 per beneficiary affected by the company's conduct. Previously, the fine was $25,000 per contract.

"That is an extremely powerful enforcement tool," Weems said.

Several provisions in the proposed regulations are already part of voluntary guidelines for the industry. But there are some areas where Medicare went beyond what the insurance industry sought. For example, insurers routinely sent brochures in the mail explaining a product to a potential customer. Then agents would call to make sure they got the brochure. They would no longer be allowed to make those calls under the proposed rule.

Also, insurance agents commonly used their meetings about the drug benefit to pitch other types of products such as long-term care insurance or disability insurance. The regulation would prevent them from doing so _ unless the agent cleared it with the potential customer before the meeting.

Karen Ignagni, president of America's Health Insurance Plans, said the rule would prevent agents from marketing at health fairs or anywhere else where health care is delivered. She said the rule is an important step in protecting beneficiaries and questioned the need for more state regulation.

"Medicare is a federal program. Moving away from federal regulation toward 50 states approaching this in 50 different ways doesn't set a uniform standard for beneficiaries," Ignagni said. "That's why our board urged additional federal requirements."

Medicare officials said they hoped to issue a final rule by late October, which would allow for the changes to take effect before the next open enrollment season for the drug benefit.

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On the Net:

Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov