New Data re Incidence and Cost of Alzheimer’s

May 16th, 2012

Two Data Briefs released by the SCAN Foundation today offer stunning data on the incidence and cost of Alzheimer’s and other dementias in the Medicare-only and Dual Eligible populations.

In 2009, 13% of dual eligibles age 65 and over were diagnosed with dementia, compared to 4% of Medicare-only beneficiaries.2 As the prevalence of dementia increased with age, differences among dual eligibles and Medicare-only beneficiaries continued to exist. Link to SCAN’s Brief

Medicare spending for older beneficiaries diagnosed with dementia was significantly higher than spending for older beneficiaries without dementia in 2009 ($22,236 per capita on beneficiaries with dementia diagnoses, compared to $4,739 per capita on beneficiaries without these diagnoses). This trend persisted regardless of the number of co-occurring chronic conditions. Link to SCAN’s 2nd Brief

Separately, this information is indeed stunning. But when we think about the implications for the Integration of Managed Care and Long Term Services and Supports for Duals that is coming to Alameda County as early as March 2013 (yes, 3/1/13 is the new launch date), the data spotlights just how critical it is that the Demonstration achieves it’s promise of person-centered, well-coordinated care.

- Wendy

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Senior Services Coalition Submits Comments on State Dual Demonstration Plan

May 7th, 2012

The comment period for California’s Dual Demonstration Plan draft closed on Friday. SSC submitted a set of comments on the draft. Below are portions of our comments (for the complete template document, email Wendy).

DHCS’s Draft Duals Plan indicates that Demonstration Health Plans will be responsible for IHSS, MSSP, CBAS and other Section 1115© home and community-based services… It is necessary to emphasize that the plans do not have the authority to reduce, eliminate or otherwise marginalize these powerful long term services and supports, whether in pursuit of short term profitability or otherwise… It is essential, for instance, to protect the range of purchased services that MSSP is able to tap in order to solve a patient crisis, and to maintain the MSSP team model that partners a Nurse with a Social Worker, as these two perspectives result in a high level of effectiveness in assessments, care plans and interventions.

We strongly recommend that the managed care plans be required to maintain at least the current level of services/number of “slots” and fee structures so that the use of powerful models such as MSSP and CBAS is not marginalized or subject to the whim of the Plans’ bottom lines, and so that the providers of these services are adequately compensated.

We strongly urge the State to allow beneficiaries who apply for and win exceptions to mandatory enrollment in the Demonstration to nevertheless be allowed to continue receiving waivered services, at least during the first two years of the Demonstration. This patient protection will ensure continuity of care is not at risk for a very vulnerable subset of beneficiaries.

We strongly urge the state to continue the MSSP waiver and require managed care plans to maintain MSSP as a distinct, independent program unless and until each managed care plan demonstrates it’s aptitude in providing plan members with personalized medical and social case management, demonstrates a high level of success with provision of long term services and supports that lead to good patient outcomes, and that the demonstration of these achievements is reviewed and confirmed by a diverse stakeholder advisory group.

We strongly oppose this “lock-in” provision. Considering that the State plans for passive enrollment to take place in a remarkably short time frame, and that, as witnessed in the mandatory enrollment of Medi-Cal Only SPDs, the majority of beneficiaries will not have enough time to act in their own best interest and pick the plan that best suits their needs, it is irresponsible to lock beneficiaries in to one demonstration plan if there are other demonstration plan options in the county. We understand the importance of continuity for the Plans to be able to evaluate incoming enrollees, as well as the state’s arguement for passive enrollment, but do not agree that this should be allowed to compromise participants’ meaningful participation in choosing their plan. A compromise is suggested, in which incoming enrollees are are contacted and evaluated by the plan during a 30-day “cooling off” period, during which any enrollee would have the option of switching to another plan.

We are glad to see that PACE will be a clear option for enrollment, and that managed care plans will be encouraged to contract with PACE providers to serve plan members who could benefit from PACE services, but we strongly recommend that beneficiaries be able to switch to a PACE plan if they are eligible and desire to do so. This ability to choose to enroll in a PACE plan should be in effect even during the 6-month “lock in” period. In addition, in counties with PACE providers, managed care plans should actively offer PACE as an alternative to nursing home admission for any plan member for whom nursing home admission is imminent.

We strongly recommend that the state require managed care plans to evaluate members for and offer Adult Day Health Care or ADHC-like options to patients who, while not meeting the criteria for CBAS, could nevertheless benefit from the multi-disciplinary care offered at an ADHC/CBAS center or the protective supervision and monitoring offered at an Adult Day Care center, either short term or longer term. For instance, a patient being discharged from hospital to nursing home, or from hospital to home or from nursing home to home who needs significant support or therapy services to either maintain or gain the ability to function independently, could greatly benefit and should be offered ADHC or other daytime care as an option.

We are concerned that the principles fundamental to IHSS will be compromised without the continuation of local public authorities for IHSS and local consumer advisory bodies. Legislation has recently been proposed in California’s Senate that could ultimately shift current responsibilities of public authorities to the State and consolidate public authorities into a single, state-wide agency. Moving public authority services to Sacramento would be a tragic disservice to consumers and would undermine the collaborative ability of local stakeholders. We recommend that strong language be added to this Demonstration Plan that maintains the role of public authorities in each county in local planning; consumer advocacy; worker screening, training and health coverage; bargaining; and emergency worker replacement services.

We disagree with the statement on page 19 of the Duals Plan that “Medi-Cal managed care health plans will have had many months to adapt to the unique needs of the SPD population and to adjust their networks accordingly. ” Medi-Cal Managed Care Plans have not had to adjust their networks to include Medicare or LTSS providers since they are not responsible for providing those services to the SPD population. To the extent plans have made adjustments as indicated, these should become requirements, not optional adjustments.

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Looking to May Revise, Governor Bound to Propose Deeper Cuts

May 3rd, 2012

Soon, Governor Brown will release his May Revise budget proposal (a revision of his January budget plan for FY 2012-13, and one that is closer to the reality of recent income tax revenues). The news won’t be good. State revenues are already coming in $3 billion below projections in the Governor’s January budget.

Although the November ballot initiative that will nudge up tax rates for the wealthy and add a quarter percent to sales tax rates is polling well, even if it passes it won’t happen soon enough, or have a big enough impact to avoid deeper cuts. The question is, where could deeper cuts come from, with California’s health, human services and education systems already so compromised.

“We will do what we have to do to balance the budget, but we will do so again in ways that minimize — that attempt, I should say, with an emphasis on attempt to minimize — the impacts to people who are most in need,” says Senate Pro Tem Steinberg.

This doesn’t bode well, and community stakeholders need to prepare for advocacy.

- Wendy

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HHS Creates New Adminitration for Community Living

April 27th, 2012

Last week the Department of Health and Human Services announced that it is creating a new organization, the Administration for Community Living (ACL) with the goals of increasing access to community supports so people can live engaged lives, and focusing attention and resources on the unique needs of older Americans and people with disabilities.

The ACL will merge the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities in a single agency, with “enhanced policy and program support for both cross-cutting initiatives and efforts focused on the unique needs of individual groups such as children with developmental disabilities, adults with physical disabilities, or seniors, including seniors with Alzheimer’s.” Kathy Greenley, the current head of AOA and a great champion of aging services, will lead the Administration for Community Living.

Here is a link to Secretary Sebalius’ statement.

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Governor’s Proposal to Cut IHSS Domestic Services Would Affect 10,620 People in Alameda County

April 11th, 2012

The Governor’s proposed budget would eliminate IHSS domestic services for recipients who live with other household members. Domestic and related services include meal preparation and cleanup, housework, shopping, and laundry. According to a new analysis by California Budget Project, the elimination would “save” the state $207 million in FY 2012-13, but would result in a loss of $424 million in county and federal funds. The whopping total loss to the program would be $631 million! The cut would affect about 254,000 seniors, children and adults with disabilities statewide, about 10,620 of them in Alameda County.

Click here to go to California Budget Project’s summary and county-by-county analysis.

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New Development in the State’s Integration of Managed Care and Long Term Services and Supports for Dual Eligibles

April 9th, 2012

Alameda County is not one of the four “Dual Integration Demonstration” counties announced by DHCS on Wednesday. What does this mean? That depends on legislative action in June.

The proposal that Department of Health Care Services released on April 4 – and will submit to Center for Medicare & Medicaid Services for approval following a 30-day comment period – seeks to launch the Dual Demonstration in ten counties in 2013. That’s the four counties that current legislation permits (DHCS chose Los Angeles, San Diego, Orange and San Mateo), plus six other counties that applied for Demonstration Status (Alameda, Santa Clara, Riverside, San Bernardino, and Sacramento).

The ten-county demonstration is included in the Governor’s proposed budget trailer bill as part of his Coordinated Care Initiative, a plan to extend managed care to all California Counties by 2015. The proposed phase-in anticipates the launch of the Dual Demonstration in the first ten counties as early as January 2013, dependent on California’s legislature passing the budget trailer bill and CMS approving the state’s plan.

While we can’t be sure what the legislature or CMS will do in the short term, the writing is on the wall. In the next few years, the integration of managed care and long term services and supports for Alameda County’s 47,000 dual eligibles will fundamentally change the way low-income seniors and people with disabilities receive medical and supportive services in the community. Because this change will impact community-based organizations that provide so many services to seniors who are not Duals, this will really change the system for everyone. By engaging in the process and working together, providers and consumers can define the new system (stay tuned for more on this process).

What you can do now: The period for comment on DHCS’s Dual Integration Demonstration runs through 5 p.m. May 4, 2012. Click here to view DHCS’s Draft Plan and to download the comment submission form (follow the instructions to complete the form and email to DHCS).

DHCS will hold a teleconference Tuesday April 10th from 2pm – 3:30pmwith stakeholders to review the demonstration proposal and take initial questions. Click here to register with DHCS for your unique call-in and pin numbers. If you need assistance registering, call 916-287-3338.

Join a Workgroup.  DHCS has formed seven workgroups to develop policy recommendations for the Dual Demonstration.  Workgroups will convene in a series of in person/conference call meetings currently scheduled from April through June.  Click here for details (the .pdf contains links to an RSVP site).

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Senior Services Coalition Sets 2012 Policy Agenda

April 9th, 2012

At our March 7 Annual Meeting, SSC members weighed in on our Policy Agenda for the coming year. This Agenda drives our scope of work and priorities and guides us as we address emerging opportunities. Our Policy Agenda is divided into two categories: 

Priorities for Action are policy areas that have been well-defined by our past work and for which current events call for immediate attention and focused effort. This year our priorities include Funding, Integration of Managed Care and LTSS for Duals, Food Insecurity, Housing, and Increasing Revenues/November Ballot Initiative.  

Objectives for Policy Change include policy areas that SSC supports, but are not part of our current scope of work. This is the part of our Policy Agenda that allows us to be ready to respond to requests for support and other opportunities. This year these objectives include Elder Economic Security, Mental Health, Support Health PAC Expansion, California CLASS Act, Transportation.

Click here to link to our most recent e-newsletter that includes a link to a .pdf of the 2012 Policy Agenda.

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Hoarding & Cluttering – The Conference

March 20th, 2012

One of the issues that has surfaced from SSC’s recent work in local communities is hoarding. Hoarding and cluttering pose a social, behavioral, environmental, and financial burden on local resources that is often overlooked by policy makers. It is an issue that requires treatment and action planning as part of a comprehensive plan. First responders and senior service providers are often overwhelmed and are under-resourced to assist a senior in accessing viable options and services.

The Mental Health Association of San Francisco will be presenting the 14th Annual Hoarding and Cluttering Conference on April 26th & 27th, 2012 at the Westin San Francisco Airport Hotel. The event will draw together stakeholders and experts from multidisciplinary fields with a focus on solutions to the personal and community burdens that arise from hoarding, cluttering and collecting behaviors.

Link to the web site here. You can review the conference brochure here. Early Bird rates end March 23.

For more information or for group discounts, call or email Mark Salazar at the Mental Health Association of San Francisco at 415-421-2926, ext 317 or mark@mha-sf.org

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March 15 Senate Budget Committee Hearing on Governor’s Proposals

March 13th, 2012

On Thursday, March 15 at 9:30 a.m. the State Senate Budget Subcommittee on Health & Human Services will convene to examine the Governor’s budget proposals for FY 2012/13 that would eliminate most domestic and related services for IHSS and institute the 20% reduction to IHSS hours that is in the current year budget but has been blocked by court order. The Subcommittee will also take up the Governor’s proposal tho fold MSSP into Medi-Cal Managed Care as a part of the Governor’s proposed expansion of the Dual Demonstration.

The Subcommittee will hear from the Departments of Aging, Health Care Services and Social Services, and from the public. Senator DeSaulnier chairs the subcommittee, which will meet at the State Capitol Building in Room 4203. The hearing can be viewed at www.calchannel.com.

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Before the paint is dry on the pilots… informational hearings re proposal to launch Duals Managed Care Integration in Ten Counties

February 22nd, 2012

The state is currently preparing to receive applications from counties seeking to launch Pilots that will integrate Medi-Cal and Medicare managed care with long term supports and services (including IHSS, ADHC, MSSP), nursing homes, and ultimately with behavioral health care. Alameda County – with about 45,000 “duals” – is one of the counties preparing to apply. Meanwhile, informational calls and hearings are taking place on the Governor’s new budget proposal to include more counties:

Wednesday, February 22, 11:00 a.m. to noon
Department of Health Care Services teleconference on Governor’s ten-county proposal
To register, to to
http://myaccount.maestroconference.com/conference/register/3FXVB0DJJLKOU0J

Thursday, February 23, from about 9:30 a.m.
Senate Budget and Fiscal Review Committee holds an informational hearing re Governor ’s Proposals: Long-Term Care and expansion Medi-Cal Managed Care including his proposal to cut IHSS and centralize the Public Authority function at the state level.
State capitol room 4203; some public comment will be heard.
Watch on CalChannel by going to
http://www.calchannel.com/

Background - The Governor’s FY 12/13 budget proposes to launch integrated managed care for dually eligible seniors and people with disabilities in ten counties starting in 2013. (Current legislation and the state’s Request For Solutions allows for four Dual Integration Demonstration counties.) This proposal assumes that all duals in the ten Integration Project counties would be enrolled into Managed Care Plans; that authorization for IHSS, MSSP, and Medi-Cal coverage of ADHC would be the responsibility of the Managed Care Plans; and that this change would phase-in over 12 months. The Governor’s proposal acknowledges challenges that include consumer protections, uniform assessment tools and consumer choice, but anticipates that the “single point of accountability for services” will result in cost savings and increased quality.

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