Access Alaska

From the New York Times: Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases... The system means that the burden of expensive health care can now affect insured people, too. Pay here.

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The family of a California teenager who died awaiting a liver transplant say they will sue the insurer who they blame for their daughter's death.

Nataline Sarkisyan, a 17-year-old from Glendale, Calif., died Thursday just a few hours after her insurer, CIGNA HealthCare, approved a procedure it had previously described as "too experimental."

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More here at CNN.

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Visit CIGNA (A Business of Caring) here. Let them know what you think

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Disability rights groups, typically supportive of individual liberty, have helped defeat bills out of fear that HMOs would see a chance to cut care.

Five times in the last dozen years, bills on medically assisted suicide have risen in the California Assembly, and five times they have failed.

In every instance, a great deal of the credit for their demise goes to a constituency associated with advancing personal choice and civil rights — namely, the disability rights movement.

Read more here.

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Group Wages Campaign in Alaska to Help Lower Medicare Drug Prices

ANCHORAGE, AK – With the aid of 89,000 members, AARP is calling on U.S. Senators Lisa Murkowski and Ted Stevens to stand with the overwhelming majority of Alaskans and vote to give Medicare the power to negotiate for lower prescription drug prices. Murkowski and Stevens are two of the few remaining Senators yet to publicly state their position on this important issue, and their votes are critical to the bill’s success.

On Wednesday, April 4, AARP members throughout Alaska and across the country will be calling Senators and urging them to support legislation that could help lower Medicare drug prices for Alaska’s Medicare beneficiaries.

According to a recent AARP poll, 85% of Alaska residents want Medicare to leverage the buying power of 43 million Medicare members to negotiate lower prices for prescription drugs. “You would think this would be an easy decision for Senator Murkowski and Senator Stevens. Our polls show that Alaska residents support giving Medicare the power to bargain for lower drug prices,” said Ken Osterkamp, AARP Alaska State Director. “AARP members want – and deserve - to know if Senator Murkowski and Senator Stevens will side with their constituents or with the pharmaceutical industry on this important issue.”

Americans pay more than anyone else in the world for most brand-name drugs. In 2006, on average, brand name prescription drug prices increased 6.2 percent for a sample of 193 brand-name drugs widely used by older Americans. During that same period general inflation was just 3.2 percent. Older Americans are the largest consumers of prescription drugs, with a typical senior taking four prescriptions daily.

Giving Medicare the authority to use its bargaining power to negotiate with drug companies to help achieve even lower drug prices would strengthen the Medicare drug benefit even further.

Earlier this year, the U.S. House of Representatives passed H.R. 4, the “Medicare Prescription Drug Price Negotiation Act of 2007” by a bipartisan vote of 255 – 170. AARP strongly supported H.R. 4 and is now putting its weight behind passing similar legislation in the Senate.

AARP is tracking key votes in the 110th Congress and reporting back to its 38 million members how Congress votes on legislation AARP members are interested in like health care.

“Giving Medicare bargaining power is a key issue for AARP Alaska’s 89,000 members, and we will be letting them know how their elected officials voted on this matter,” said Osterkamp.

Contact info

Murkowski, Lisa
709 HART SENATE OFFICE BUILDING WASHINGTON DC 20510
(202) 224-6665
Web Form: murkowski.senate.gov/contact.cfm
Stevens, Ted
522 HART SENATE OFFICE BUILDING WASHINGTON DC 20510
(202) 224-3004
Web Form: stevens.senate.gov/public/index.cfm?FuseAction=Contact.Em...

 

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March 29, 2007 

Joined by Wounded Soldier, Caregivers, Advocates for Military Families, Medical Experts

Washington, DC - Today on Capitol Hill, Senator Hillary Rodham Clinton (D-NY) joined with advocates for wounded soldiers and their families to announce a new legislative initiative, co-sponsored by Senator Susan Collins (R-ME), to improve the detection, assessment and treatment of traumatic brain injury and expand support systems for members and former members of the Armed Services with traumatic brain injury and their families. Senator Clinton also announced introduction of legislation to help ensure wounded soldiers receive the disability benefits they need and deserve and to further protect military family financial benefits. Senator Clinton was joined by Sergeant Ted Wade U.S Army 82nd Airborne Division, who incurred a severe traumatic brain injury and his wife Sarah Wade of Chapel Hill, NC; Lee Woodruff, TBI caregiver and co-author with husband Bob Woodruff of New York Times bestseller In An Instant; Dr. Bert Vargas, a resident at New York University School of Medicine who served as an Air Force flight surgeon in Iraq and leadership from the Wounded Warrior Project, the Military Officers Association of America, the National Military Family Association, the Brain Injury Association of America and the American Academy of Neurology.

"If you serve your country your country must serve you. This is the promise our country must keep to the men and women who enlist, who fight and who return home often bearing the visible and invisible scars of sacrifice. We have a duty to reform and ready the military for the increasing number of veterans suffering from complex injuries like traumatic brain injury. Today we are taking steps needed to ensure our men and women in uniform and their families have the care and support they need and deserve," said Senator Clinton.

Senator Clinton today introduced legislation to build on the groundbreaking "Heroes at Home" initiative she authored and secured in law last year aimed at helping U.S. troops and their families to transition after deployment in Iraq and Afghanistan and get the help they need with readjustment to work and coping with post-traumatic stress disorder and TBI. Today, Senator Clinton announced a new initiative to expand Heroes at Home by:

• Improving the screening process for our troops before deployment to improve TBI diagnoses after deployment. Traumatic brain injury, which affects approximately one out of every 10 returning service members, has been identified as the "signature wound" affecting soldiers deployed to Iraq and Afghanistan. Multiple deployments and prevalent use of IEDs have put service members at increased risk of sustaining more than one mild or moderate TBI. However, mild and moderate TBI may go undetected, especially if a service member has sustained more obvious injuries. It also can be difficult to distinguish mild TBI from Post Traumatic Stress Disorder since both conditions have common symptoms, such as irritability, anxiety and depression. Senator Clinton's bill will improve detection of mild and moderate TBI by implementing an objective, computer- based assessment protocol to measure cognitive functioning both prior to and after deployment. Senator Clinton's bill will require that the same assessment tool be used across all branches of the Armed Services and for every member of the Armed Forces who will be deployed to Iraq and Afghanistan.
• Helping families struggling to take care of a loved one with training and certification for dealing with brain injuries and psychological injuries. Family members of returning soldiers with TBI are often ill-equipped to handle the demands of caring for their loved one, which in some bases can become a full-time responsibility. Senator Clinton's bill will establish a Traumatic Brain Injury Family Caregiver Personal Care Attendant Training and Certification Program, which would train and certify family caregivers of TBI patients as personal care attendants, enabling them to provide quality care at home and at the same time qualify for compensation from the VA.
• Expanding Access to Needed Care. Service members and veterans continue to face problems in accessing needed medical and mental health care, especially veterans or Guard and Reserve members who live in rural areas. Senator Clinton's bill will help increase the reach of needed care for TBI by expanding use of telehealth and telemental health services. Senator Clinton's bill will create a demonstration project, administered jointly by the Departments of Defense and Veterans Affairs that would use telehealth technology to assess TBI and related mental health conditions and facilitate rehabilitation and dissemination of educational material on techniques, strategies and skills for servicemembers with TBI.

"The proposals in this legislation were built on the recommendations of family caregivers now tending to the wounds of their loved ones who have incurred Traumatic Brain Injuries on our nation's behalf. Senator Clinton and the Wounded Warrior Project have listened to these families and their requests for help and we applaud her for her leadership on this legislation. We stand committed to assisting the Senator in seeing this bill through to enactment," said John Melia, Executive Director of the Wounded Warrior Project.

The Heroes at Home Act of 2007 is endorsed by the Wounded Warrior Project, National Military Families Association, Military Officers Association of America, American Academy of Neurology and Brain Injury Association of America.

Senator Clinton today also announced introduction of legislation to help ensure wounded soldiers receive the disability benefits they need and deserve and to further protect military family financial benefits:

• Restoring Disability Benefits for Injured and Wounded Warriors Act of 2007. Following up on complaints she heard from New York soldiers at Walter Reed about widespread problems with disability claims, Senator Clinton today introduced legislation that will restore disability benefits for wounded and injured members of the Armed Forces. The act will direct reviews of disability claims, traumatic injury claims and the Physical Evaluation Board process, and re-open cases that warrant an increased disability benefit rating or traumatic injury payment. In addition, the bill will increase the availability of legal counsel for members appealing their disability cases, and direct the GAO to investigate efforts currently being made by the Department of Defense to address deficiencies in the Disability Evaluation Systems; the adequacy of the Department of Veterans Affairs Disability Schedule for Ratings as it relates to the nature of wounds our warriors suffer in combat today; and to report on the standards and procedures of Physical Evaluation Boards.
• Protecting Military Family Financial Benefits Act of 2007. Senator Clinton also introduced legislation that will protect financial benefits for military family members by closing gaps in coverage for Death Gratuity and Survivor Benefits beneficiaries and improve pre-deployment counseling and services for all members of the Armed Forces. Everyday single parents deploy to distant battlefields and leave their minor children in the care of a financially ill-prepared guardian or caretaker. Unfortunately, when tragedy strikes and a military service member makes the ultimate sacrifice, minor dependent children and families are excluded from receiving benefits and entitlements. In too many cases, pre-deployment systems and processes designed to protect military family financial benefits are under-resourced or not available and create unnecessary burden for survivors. Senator Clinton's bill will require each military service to provide adequate pre-deployment counseling and services to every deploying member of the Armed Forces to ensure that families and dependents receive survivor benefits and entitlements.

These bills are supported by the Wounded Warrior Project, National Military Families Association, Military Officers Association of America, American Legion and the Gold Star Mothers.

As New York's first Senator to serve on the Senate Armed Services Committee, Senator Clinton has made it one of her top priorities to ensure that our brave men and women in uniform have the healthcare and support they need. She has pressed for an independent investigation of the conditions at Walter Reed and called for a new GI Bill of Rights to once again honor the service and invest in the future of our men and women in uniform. She authored legislation signed into law last year that required an audit of widespread pay issues wounded soldiers are facing, recently released by the Army showing continuing problems. Senator Clinton has fought to ensure service members have the body armor they need. She has also secured in law access to TRICARE military health benefits for all drilling members of the National Guard and Reserves and their families.

Source: Senator Clinton
www.clinton.senate.gov/news/statements/details.cfm?id=271591&&

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The Campaign for PCA Reform started in 2004, sponsored by three Alaska-based companies (Ready Care, Center for Community, and Access Alaska), that were concerned about the extraordinary growth in the Personal Care Attendant (PCA) budget during the previous years. Through active education and advocacy with both the Administration and the Legislature, the Campaign put forward early versions of what became the 2005 Legislative Intent Language that encouraged the Department to harness the tremendous growth in the PCA program. The Campaign has continued to provide leadership to the PCA industry as a whole and works closely with the Department of Health and Social Services to better govern this vitally important service for Alaskan elders and individuals who experience disabilities.

Alaska’s Personal Care Program Must Have:

• Integrity
• Accountability
• Sustainability

We believe that everyone in the PCA system has a role to play in upholding these principles: DH&SS, PCA Provider companies, and PCA consumers.

The Campaign for PCA Reform has been working since 2004 to make these principles a reality at the highest levels in PCA service delivery, in State policy, and in management of the program. Our efforts are discussed in detail in our attached Briefing Paper.

Top PCA CAMPAIGN Issues for the 2007 Legislative Session.
(Synopsis)

• Legislation To Strengthen State Medicaid Audits, ensuring accountability and fairness, and protecting the State of Alaska from undue Federal fiscal recoveries.
• Legislative Support For Annual Rate Readjustments, so that PCA Providers never go another 10 years without any rate increase to keep up with increasing business and compliance costs. While PCA rates were frozen from 1998 through the present, Alaska Medicaid paid hospitals and nursing homes with automatic and annual index-based rate increases every year since 1999, averaging over 3% per annum.
• One Time Catch Up Adjustment In FY2008 Operating Budget. Medicaid has not allowed a single payment increase in PCA rates since 1998. We are seeking a 2.5% per annum equivalent, with a raise from the 1998 rate of $21 per hour to $26.88 for FY2008.
• To Assure The Legislature That Improvements Have Been And Are Being Made In The Integrity And Quality Of Dh&ss Management Of The Pca Program. We are available at any time to describe the progress that the State and Providers have made.<

BRIEFING PAPER ON 2007 CAMPAIGN FOR PCA REFORM
Progress On Turning Principles Into Reality

Integrity:
In April, 2006 new State regulations governing the PCA program were signed into law. These new regulations, among other changes, implemented a third-party assessor of services across the State. Professionally trained assessors have greatly improved program integrity by replacing the provider agency in its previous dual role as both assessor of eligibility/service level and provider. Third-party assessors also have increased the quality of assessments by ensuring only those individuals truly in need are receiving PCA services, and only at the accurate level of services necessary to maintain safe community living. PCA services are now based on a professionally conducted and objective assessment with no potential for conflict of interest.

Accountability:
With the implementation of SB41, PCA providers were audited for the first time in the history of the program. According to data provided by the Department of Health and Social Services, during audits conducted in FY2005 the billing error rate among PCA services providers was 14.42%. Through efforts of the PCA Provider’s Association and the technical assistance provided by the Division of Senior and Disability Services, in FY2006 the billing error rate dropped significantly to 4.75%. The Departmental goal for FY2008 is to show additional improvement of another 10% or 4.28%. PCA service providers have embraced the concept of accountability and will continue to strive for lower error rates. (Please note that billing “errors” are not necessarily “overpayments,” in fact most of the audited “errors” did not overpay the provider.)

Sustainability:
Ideas about the best way to care for the elderly and people with disabilities have undergone dramatic changes in the past several decades. In Alaska and at the national level, the pendulum has swung towards in-home care and greater control over services by the recipient of care. As our population ages and chooses to remain in Alaska, the need for in-home support services will grow as well. PCA services are often the first line of defense, after familial and community support, for seniors who require hands-on assistance to remain in their own homes. With the assistance of a PCA, seniors are able to meet their basic health needs often preventing the need for more costly medical intervention or out-of-home placement. PCA services have effectively reduced the amount of time an individual may need to spend in very costly nursing homes at the end of his or her life; however, there is a cost to the provision of PCA services as well.

In order to sustain this viable service, PCA Providers must be adequately compensated to meet the rising operational costs. The Department of Health and Social Services has identified sustainability of a qualified provider pool as a key component challenge stating: “In order to provide affordable access to quality health care services to eligible Alaskans, a sufficient supply of providers must be enrolled in Medicaid. A strategy to maintain provider participation is for provider reimbursement rates to keep pace with health care costs. Since provider participation in Medicaid is voluntary, if Medicaid’s rates are too low providers may stop seeing Medicaid clients.”

Top PCA CAMPAIGN Issues for the 2007 Legislative Session
(Expanded)

Legislation To Strengthen State Medicaid Audits
We support the ongoing technical assistance efforts of the Department in assisting PCA Providers in continuously improving their accuracy rates on billing issues. Now that the State has good background data, as a result of SB41, we are seeking legislation to further strengthen Alaska’s system for auditing Medicaid providers, particularly in dealing with collection of “overpayments.” We urge the Legislature to follow the example of many other states, and adopt “safe harbor” audit rates and audit recovery principles:

• 10% or less in overpayment billing errors would incur only the obligation to pay back the difference between the correct billing amount and the overpayments (if any), and to take corrective action to prevent future errors, so long as no intent to defraud or to ignore prior corrective actions is indicated. (No extrapolation assessment.)

• Billing errors, of any rate, that result in underpayment to the provider or that result in neither underpayment nor overpayment shall not be subject to payback to either provider or the State, but shall be subject to corrective action regulations of DH&SS (e.g., requiring proof of improved provider documentation practices).
• When the rate of overpayment errors is more than 10%, only the average amount of overpayment above the correct billing amount may be extrapolated against the rest of the provider’s Medicaid billings for the audit period. (Again, assuming no fraudulent intent or disregard of prior corrective action.)

This will not penalize those service providers who make simple billing errors yet still deal severely with those who are potentially committing fraudulent acts.

Legislative Support For Annual Rate Readjustments
The rates for reimbursement for PCA services have been frozen in regulation since 1998. We request regulations setting an annual adjustment to the PCA rate equal to the change in the consumer price index or the CMS nursing facility market basket (a national cost data study). It should be noted that Alaska’s Medicaid payment rates for hospitals and nursing homes are “re-based” every four years, and on the years in between the rates go up automatically by the percent of change in the CMS market basket. We support the Department’s efforts to establish rate-setting methodology that establishes uniformity among provider types of comparable services. This must happen to ensure that PCA providers are adequately compensated for the provision of their services. The cost of providing PCA services, as with all goods and services, continues to rise annually, including workers’ compensation insurance for this high-risk category of workers.

One Time Catch Up Adjustment In FY2008 Operating Budget.
We request a one-time “catch-up” adjustment of the current rate to reflect a 2.5% per annum adjusted rate from November 1998 through June 2008. For FY2008, this would raise the PCA rate to $26.88 an hour. Please note that the Governor’s budget includes funding for an 8% average increase between FY2004 and FY2008 in the Medicaid rates for hospitals and nursing homes, which are “re-based” every four years. PCA rates have not been adjusted since 1998.

Legislative Assurance Of Improvements In Integrity And Quality Of DH&SS Management Of PCA Program.
We support the continued efforts of the Department of Health and Social Services in conducting third-party assessments to determine eligibility and service level needs. PCA service providers are able to focus their attention on the provision of high-quality in-home support services without any potential for conflict of interest. Consumers can choose their service provider based on the quality of care they receive.

For more information, please contact:

Sandra J. Heffern
Chief Executive Officer
Ready Care
800 918-3045
sheffern@jobready-ak.com

Connie J. Sipe
Executive Director
Center for Community
csipe@cfc.org

James Beck
Executive Director
Access Alaska
800-770-4488
jbeck@accessalaska.org

Download PDF file

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Gov. Sarah Palin wants to extend for another five years the life of a program that gives monthly cash payments to low-income seniors plus end a little-used benefit that helps seniors pay for prescription drugs.

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Tribal health care reform may be a key to controlling the mounting costs of Alaska's Medicaid program, according to a report commissioned by the Alaska Legislature.

The report, penned by the Pacific Health Policy Group and presented to House and Senate committees on Tuesday, offers recommendations that its authors say could save the state between $80 million to a $100 million a year while improving health care services to Alaska Natives and others.

Read more in the Anchorage Daily News

"I sympathize with how complex Medicaid is for clients, health care providers, program managers, as well as employees. We also find it difficult as legislators to find a legislative fix for most of these problems," Senate President Lyda Green, R-Wasilla said.

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"A report commissioned by the Legislature has warned the state that the health care costs for Alaska’s neediest populations will continue to rise significantly during the next 10 years unless reforms are adopted to the Medicaid system. "

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From the Anchorage Daily News

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From the The Sentinel Effect

"Reports suggest it will take a concerted effort to address the health problems confronting our nation’s soldiers as they return from war. Their problems parallel some of the issues facing our overall health system, but in a more acute form. One such issue is catastrophic injury, and another is the complex world of brain injury."

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