Update for Week Ending April 23, 2022

Update for Week Ending April 23, 2022

Congress Returns This Week

With their two-week break over, Congress returns to vote on legislation this week. Many of the votes will deal with national security issues, including aid for Ukraine. The Senate will also be voting on nominees for various positions in the Biden administration. No votes on health care or Social Security issues are scheduled.

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President Proposes New Rules for Medicare Enrollment

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity.

This proposed rule would provide Medicare coverage the month immediately after enrollment, thereby reducing the uninsured period and expand access through Medicare special enrollment periods.

It would also allow eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty. This proposed rule would make it easier for people to enroll in Medicare and eliminate delays in coverage.

The proposed rule would also establish a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant.

If finalized, the proposed rule would promote accessibility to vital life-saving drugs. This rule, if finalized, would become effective January 1, 2023.

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Fight Over Alzheimer’s Drug May Not be Over

We have previously reported on the decision of Medicare to cover the cost of the very expensive and controversial Alzheimer’s drug Aduhelm only in very limited circumstances. The decision was important because the unusually large increase in Medicare Part B premiums this year was due to the anticipated costs for covering the treatment of all Medicare-eligible Alzheimer’s patients with the drug Aduhelm.

With the decision to limit the coverage, it was announced that the Center for Medicare and Medicaid Services (CMS) is looking at lowering the Part B premium increase.

However, the maker of the Alzheimer’s drug and patient advocates are increasing their lobbying presence as they press Medicare to reverse its decision.

It is unclear if this increased lobbying effort will affect Medicare’s decision on lowering Part B premiums, but it is unfortunate that this has become a political issue rather than strictly a medical-scientific issue.

If the medical evidence was convincing on the effectiveness of Aduhelm in treating Alzheimer’s, it would be very different, but the results are not clear, which is why Medicare made the decision to pay for it only certain approved clinical trials.

We are watching for the CMS decision about lowering Part B premiums and we will report on it when it is made.

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Who Will Pay Costs for Improving Nursing Home Staffing?

The Biden administration is pushing for increasing federal nursing home staffing requirements. That effort has entered the important rule making phase, which will determine what the staffing requirements will be.

But now these crucial questions are being asked: How much will it cost, and who is going to pay for it?

As is well known, Covid hit elderly populations the hardest with more than 154,000 deaths among U.S. nursing home residents and staff.

As a result, the Biden administration issued a proposal for mandatory minimum staffing levels, which would fulfill a decades-long quest to shore up the quality and uniformity of care in the nation’s 15,000-plus nursing homes.

However, some industry critics say the facilities should pay the entire cost for any needed staff additions.

As reported by Bloomberg Government News, industry officials, citing low Medicaid reimbursement rates, say staffing requirements are unworkable and unrealistic, especially during a time of staffing shortages, rising labor costs, depressed occupancy, and costly infection-control measures. They say higher Medicaid payments, or some other federal funding is needed.

Better staffing in nursing homes, especially among registered nurses, has been linked to improved quality of care and infection control. A 2020 study of Connecticut’s 215 nursing homes found that in facilities with at least one confirmed case of Covid-19, every 20-minute increase in RN staffing—per resident, per day—was associated with 22% fewer infections and 26% fewer Covid deaths.

In 2001, the Center for Medicare and Medicaid Services (CMS) recommended a minimum standard of 4.1 nursing hours per resident each day to prevent harm and ensure the safety of long-term residents. That broke down to 2.8 hours from certified nursing assistants; 0.75 hours from registered nurses, and 0.55 hours from licensed practical nurses.

Only 25% of nursing homes, however, report providing that recommended level of 4.1 hours per resident per day.

The CMS will conduct a study to determine the appropriate level of mandatory care and how to finance it before announcing its plan next year. In the meantime, it has asked those affected by the pending decision to share their thoughts on the proposal.

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As we continue dealing with the Covid 19 pandemic, TSCL remains constant in our fight for you to protect your Social Security, Medicare, and Medicaid benefits. We have had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.

For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit our website at www.SeniorsLeague.org or follow TSCL Facebook or on Twitter.