Looking Back on Health Care News for 2012
The year 2012 brought some surprises and some changes in healthcare and senior issues. Here is a recap of the top ten in my list.
- The Affordable Care Act was upheld. The ACA, otherwise referred to as Obamacare, was upheld by a divided U.S. Supreme Court. For the audience that I serve most directly this means, among other factors, that the prescription drug “doughnut hole” would continue to shrink and preventive services should be covered under Medicare without charge. However, the law is certainly not perfect and will likely need revisiting. One of the major thorn-in-the-side issues that comes to mind is possible unintended consequences with reduction in compensation to hospitals on recent readmissions.
- Fiscal Cliff Negotiations Leave “Doc Fix” Unresolved. Sometimes not doing something can be news. One of many issues left unsettled on December 31 with the “fiscal cliff” negotiations is the so-called “doc fix” which has been passed each year to prevent doctors providing Medicare services from taking a pay cut. This needs to be resolved permanently to allow doctors servicing Medicare patients to know where they stand .
- A settlement was reached on the “Improvement <Plateau> Standard” for Medicare payment for rehabilitative services after hospitalization. The Medicare law provides for payment for services for rehabilitation up to 100 days under Medicare Part “A” after 3 days of inpatient hospitalization. Coverage has typically been stopped under the “improvement” or “plateau” standard when the patient no longer shows improvement. The law actually also allows therapy to continue if it prevents deterioration. In federal court in Vermont, the case, Jimmo v. Sebelius resulted in agreement between the federal Centers for Medicare & Medicaid Services (CMS) and attorneys for the Center of Medicare Advocacy, a nonprofit advocacy group, and Vermont Legal Aid. If approved in January, CMS will revise its Medicare Benefit Policy and other Medicare Manuals to state that skilled nursing and therapy services necessary for maintenance of a person’s condition can be covered by Medicare. This would allow patients to continue to be covered by Medicare if therapy would prevent deterioration.
- Pennsylvania’s Filial Responsibility Law Was Upheld. As reported in my September 10, 2012 column, the Pennsylvania Superior Court in the case of HCR Manor Care v. Pittas, affirmed filial responsibility in Pennsylvania and allowed a son to be charged with his mother’s nursing home bill of $92,943 by reason of his biological relationship. This case received national attention. Where there is a successful Medicaid application, the adult child is protected from payment since medical providers cannot bill both Medicaid and the adult child. However, the Pennsylvania law which was passed in 2005 is not limited to nursing home care and Medicaid applications have become more complicated so the risk remains.
- The Anti-Granny Snatching Law was passed. While, strictly speaking, not a health care measure, the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act went into effect on September 5. This means assurance that a guardianship order entered in Pennsylvania would be respected in another state that has adopted the law.
- The use of “observation status” v. “admission” continues to be challenged. Bagnall v. Sebelius, another Center for Medicare Advocacy case with the National Senior Citizens Law Center, is still active challenging the practice where some hospital stays have been considered to be “under observation” vs. admission. The difference is that patients “under observation” are covered by Medicare “B” and not Medicare “A” and can be charged for various expenses including prescriptions while they are in the hospital and also charged for a subsequent nursing home stay even though they spent three days in the hospital.
- The Pennsylvania Block Grant Proposal for counties was made optional. On June 4 I wrote regarding a Pennsylvania proposal to combine six human service funding streams including mental health, intellectual disabilities, drug and alcohol, child care grants, and homeless assistance into one block grant for each area of the state and reducing the overall by 20%. This would mean each group competing against the other for already reduced funds. Protest against the budget proposal resulted in making the block grant mechanism optional with the counties and the reduction to 10% instead of 20%.
- Three final thoughts – An elimination, a restriction and one resource still standing. Finally, Pennsylvania totally eliminated General Cash Assistance, food stamps were severely restricted, but, to this date anyway, the County Pocopson Home remains standing. Happy 2013.
For more, listen to “50+ Planning Ahead” a weekly radio program on WCHE 1520 on every Wednesday from 4:30 pm to 5:00 pm with Janet Colliton, Colliton Law Assocs., PC, and Phil McFadden of Home Instead Senior Care.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.