National Library of Medicine launches MedlinePlus Connect:  Free tool links patient portals and EHRs to consumer health information

The National Library of Medicine, the world’s largest medical library and a component of the National Institutes of Health (NIH), has formally launched MedlinePlus Connect. This free service allows health organizations and health information technology (HIT) providers to link patient portals and electronic health record (EHR) systems to MedlinePlus.gov, a trusted source of authoritative, up-to-date health information for patients, families and health care providers. MedlinePlus brings together information from NIH, other federal agencies, and reputable health information providers. MedlinePlus covers a wide range of health conditions and wellness issues, and includes key resources to inform patients about their health.

Patients using portals or EHRs that have implemented MedlinePlus Connect can access easy-to-understand health information on MedlinePlus that is directly related to their diagnoses, medications, and lab tests. “MedlinePlus Connect is the latest result of NLM’s long standing commitment to using technology and standards to bring high quality information to patients and clinicians when and where they need it,” noted NLM Director Donald A.B. Lindberg, M.D.

To use MedlinePlus Connect, an organization should contact their EHR vendor or work with their in-house technical staff to follow the instructions in the technical documentation. Full details, including an online demonstration, are available at http://medlineplus.gov/connect. MedlinePlus Connect accepts the coding standards already in the organization’s system, such as ICD-9-CM, SNOMED CT CORE Problem List Subset, RxNorm, NDC, and LOINC. MedlinePlus Connect only needs to be set up once and NLM regularly maintains the vocabulary mappings and topic links.

Since MedlinePlus Connect helps EHRs identify patient-specific education resources, MedlinePlus Connect may assist eligible health care providers in meeting one of the criteria for meaningful use of certified EHR technology. Health care providers must meet a number of criteria to demonstrate meaningful use in order to qualify for Medicare or Medicaid EHR incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act.

“One of our core principles is that meaningful use of EHRs should help patients get access to information that is meaningful and useful to them,” noted Farzad Mostashari, M.D., Sc.M., national coordinator for health IT. “This meaningful use objective helps patients obtain information tailored to their health situation, and this free service helps providers do this efficiently.”

The Institute for Family Health, a federally qualified health center network that operates 26 practices in New York State, first piloted MedlinePlus Connect in 2010. In 2002, the Institute became the first health center network in New York to have an EHR and practice management system. The initial MedlinePlus Connect pilot, supported by the Institute’s patient health information portal, was quickly followed by pilots at other health care organizations using a variety of EHR and patient portal systems.

MedlinePlus Connect can now serve any heath IT system that uses the HL7 Infobutton Standard.

This breakthrough project, which harnesses technology to improve the public’s health, received the coveted HHSinnovates Award from Department of Health and Human Services Secretary Kathleen Sebelius on March 31, 2011.

MedlinePlus Connect Quick Facts:

• MedlinePlus Connect is free and does not require registration.
• You can link your certified EHR to MedlinePlus Connect to help you achieve one of the 10 menu set criteria for Meaningful Use of certified EHR technology.
• MedlinePlus Connect does not have to be used exclusively to link to patient education information. Many EHR systems can be configured to link to more than one source of consumer health information.
• You only need to implement MedlinePlus Connect once for the whole system; individual links do not need to be created.
• MedlinePlus Connect is not a replacement for MedlinePlus. It is a value-added service to bring MedlinePlus content to EHR systems and patient portals.

The U.S. Department of Health and Human Services issued the following news release on June 22, 2011:

Up to $500 million in Affordable Care Act funding will help health providers improve care


The U.S. Department of Health and Human Services (HHS) announced that up to $500 million in Partnership for Patients funding will be available to help hospitals, health care provider organizations and others improve care and stop millions of preventable injuries and complications related to health care acquired conditions and unnecessary readmissions. This funding, made available by the Affordable Care Act, will be awarded by the Centers for Medicare & Medicaid Services (CMS) Innovation Center through a solicitation and other procurements for federal contracts announced today.

“Since the Partnership for Patients was announced, we have had an overwhelming response from hospitals, doctors, employers, and other partners who want to be a part of this historic effort to improve patient safety,” said CMS Administrator Donald M. Berwick, M.D. “We are now looking to contract with local and statewide entities that can foster and support hospitals’ efforts to improve health care and reduce harm to patients.”

The Partnership for Patients is a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership’s two goals arereducing harm in hospital settings by 40-percent and reducing hospital readmissions by 20- percent over a 3-year period. To achieve these goals, the Partnership is seeking to contract with large health care systems, associations, state organizations, or other interested parties to support hospitals in the hard work of redesigning care processes to reduce harm. “Hospital Engagement Contractors” will be asked to conduct the following:Partnership for Patients announces Federal contracting opportunities

• Design intensive programs to teach and support hospitals in making care safer;
• Conduct trainings for hospitals and care providers;
• Provide technical assistance for hospitals and care providers; and
• Establish and implement a system to track and monitor hospital progress in meeting quality
• improvement goals.

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors

Florida's AARP ripped Governor Scott's veto of SB 1992, which would have lifted the burden of statutory fingerprinting costs and thus freed up desperately needed funds from charities such as Meals on Wheels, which provides meals for needy seniors. 

The 2010 Legislature passed a bill in 2010 mandating that all volunteers working with seniors be fingerprinted at Level 2 Security.  However, doing this for each volunteer who is never alone with, or has access to the seniors’ information can cost an agency a lot of money.  Each fingerprinting costs $60.  To make matters worse, many of the seniors who volunteer have compromised fingerprints anyway.  An agency such as Broward Meals on Wheels has at least 1,000 volunteers, which equates to a huge financial drain.   This year, with the support of the Florida Department of Elder Affairs and the Area Agencies on Aging, senior service agencies asked for a modification of the law so that those volunteering less than a certain number of hours and who don’t have access to the seniors or information would be exempt.

However, all of this and the money savings was lost with Governor Scott's veto last week.


AARP Florida: Gov. Scott’s Veto of Meals on Wheels Volunteer Bill Baffling
Posted June 24, 2011

Governor's veto kills legislation to reduce regulatory burden on community volunteer organizations and committed volunteers; shows selective concern about increased risk to seniors

AARP Florida’s top official said Friday that the state’s largest membership organization for those 50+ was perplexed about Gov. Scott’s veto of SB 1992, legislation that would have eliminated some burdensome and costly government regulation stifling community volunteers serving frail older Floridians.

“AARP always has concerns about risks to older people,” said Jeff Johnson, AARP’s interim state director. “Yet it is odd that Gov. Scott vetoed this bill, but signed legislation that puts frail seniors more at risk -- the law allowing nursing homes to reduce nursing care for the frailest of all Floridians. There is an abundance of evidence that cutting nursing-home staffing standards leads directly to serious, even tragic, health problems for nursing-home residents.”

Johnson said AARP was baffled by Scott’s decision to veto SB 1992, given that the legislation was designed to reduce the burden on community-based programs, such as Meals on Wheels and their volunteers.
According to a state Senate staff analysis of SB 1992, a law passed in 2010 had dramatically and negatively affected community-based organizations that offer services to older Floridians, including Meals on Wheels programs. The staff analysis says: “The Meals on Wheels program is dependent on volunteers, and the program is currently losing volunteers who cannot afford to pay for the cost of a Level 2 background screening.

If this trend continues, and the program continues to lose volunteers or is unable to recruit new volunteers, frail, homebound seniors will not receive needed meals and their nutrition will suffer.”

Senate staffers also noted that without SB 1992, churches and civic organizations might have problems providing holiday meal deliveries. The bill also would have helped avoid problems for senior centers, congregate meal sites and health and wellness programs dependent on volunteer labor. The report notes application of the Level 2 screening programs has negatively impacted caregivers, very often family members, of Home Care for the Elderly caregivers.

“No one wants older Floridians exposed to abuse. However, we believe the vetoed legislation struck a balance between protecting the clients of community service agencies and the capability of those agencies to provide needed services,” Johnson said.

Johnson urged Gov. Scott to include representatives of local agencies serving older Floridians in a working group that is re-examining the issue.


For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors

The Florida Current reported last week that, in an effort to stop the State of Florida's plan to force seniors, disabled and poor into an HMO plan that has already failed, State Senator Nan Rich sent a two-page letter to U.S. Health & Human Services Secretary Kathleen Sebelius asking that the federal government “reject any requests submitted by the state of Florida to implement statewide managed care of Medicaid.”

To send your support for Senator Rich's letter to your state and federal legislators, as well as to Secretary Sebelius, see the hyperlinks below:

• Email for Secretary Sebelius:  Kathleen.Sebelius@hhs.gov
• Find your Florida and Federal Legislator:  http://www.flsenate.gov/Senators/Find

Above: State Senator Nan Rich speaks out against Florida's failed policies against seniors (Photo Credit: Ana Goni-Lessan)

 

One week after the state wrapped up the requisite public meetings on a new Medicaid overhaul the Senate Minority Leader sent a letter to the federal government asking that it reject the waivers the state needs to make it all happen.


“People have been outraged about the failed corporate takeover of Medicaid in the experiment counties for years, now we see that citizens across the state don't want to subject poor kids, disabled and seniors to a plan that puts HMOs before patients and jeopardizes access to healthcare they desperately need,” said Laura Goodhue, CHAIN spokesperson. "I believe Washington is listening to how Florida really feels about this.”

The Florida Current reports that Mercer Edged Milliman to get the $2 million Florida Agency for Health Care Administration contract to implement the State's Medicaid $22 billion overhaul:


AHCA signs $2 million Medicaid contract

Christine Jordan Sexton, 6/24/2011

The Florida Legislature rejected $36 million in Bush-era federal grant money that would have helped get seniors out of nursing homes and into better care. Their excuse?  The money was part of federal health care reform:  The Florida Current reports:

Legislature rejects federal grant money again

Christine Jordan Sexton, 6/24/2011

Florida lawmakers on Friday rejected federal grant money that would have implemented a program meant to transfer people from nursing homes to community based care initiatives.

The Legislative Budget Commission on Friday shot down a budget amendment that would have allowed the state Agency for Health Care Administration to hire staff and begin implementing the Money Follows the Person grant. The budget amendment would have authorized AHCA to spend $2 million, all federal dollars. Florida would have received $36 million over the life of the five-year grant.

An amendment must be approved by a majority of House members as well as a majority of Senate members. House members rejected the proposed amendment by a 2-5 vote and Senate members approved by the measure by a 4-3 vote.

Rep. Denise Grimsley, R-Sebring and chairman of the budget panel, said she thought the administrative costs were too high and she said that the state has successfully been transferring patients from nursing homes into the community. Since 2009, she said, 1900 people have been moved from nursing homes back into the community.

"I realize they are federal dollars, but they are also taxpayer dollars,'' Grimsley said.

Rep. Robert Schenck, R-Spring Hill, and chairman of the House Health and Human Services Committee, also opposed the amendment, telling members of the budget panel that the Medicaid overhaul just passed has similar goals and approving the MFP program would be duplicative. The new Medicaid law requires long-term care patients to be enrolled in managed care plans by October 2013.

The MFP grant initially was rejected by the House this past session, which refused to include the authority in the 2011-2012 budget. The House rejected the grant at the time by saying it was part of the Patient Protection and Affordable Care Act, or federal health care reform.

The state of Florida is leading a lawsuit against the federal health care reform bill. Florida applied for a $1 million planning grant for a health information exchange but the Office of Insurance Regulation subsequently decided to return the grant after Gov. Rick Scott had been elected. Scott made his political name opposing the federal health overhaul.

Sen. Nan Rich, D-Weston, was among a handful of senators who spoke in favor of the amendment, saying it would put "people in a better place."

The budget panel on Friday did approve several other items, including a plan to overhaul the e-mail system for state government. This means that tens of thousands of state workers in the next few months will soon have a common set of e-mail addresses that end in the domain name of myflorida.com.

The state agency helping oversee the transition contends that the move to the centralized e-mail system -- which would require the hiring of outside vendors to help -- could save as much as $15.3 million over a seven-year period.

But Grimsley was open skeptical of how much money the state would save. She roundly criticized David Taylor, the state chief information officer and director of the Agency for Enterprise Information Technology, and said that his agency had given lawmakers conflicting information. She said she was voting to move ahead because she believed that a centralized system would produce some level of savings.

Under the plan approved on Friday there will be a phased-in changeover to the new system between October and the end of 2012. Under the migration plan developed by the state, the governor’s office and a large agency such as the Agency for Health Care Administration would switch over to the system in December 2011, while the Department of Health would change in February 2012.

The one executive agency that is not going to switch over is the Department of Legal Affairs, which currently uses IBM Lotus Notes to handle its e-mail as well as other agency functions. A top official in the office of Attorney General Pam Bondi in a letter to AEIT called the crossover both “functionally and economically prohibitive.”

The budget commission on Friday also signed off on a nearly $459,000 settlement that will end a six-year legal battle between a vendor and the Department of Management Services.

DMS in 2000 signed Loncoleman Corp. to a three-year contract to provide maintenance services at the sprawling Capital Circle office complex in southeast Tallahassee.

Due to a clerical error, Loncoleman was approved for monthly payments at the end of 2003 but did not get paid. The state, however, then discovered problems with the vendor’s work and withheld past and future invoice payments. The contract was terminated in March 2004 but later that year the company sued the state and won an initial victory in court in 2005. But then the state countersued Loncoleman.

DMS Secretary Jack Miles in early May agreed to a settlement to end the ongoing legal battles. DMS officials said they decided to settle the case because there is a substantial risk that an unfavorable verdict in the case would be larger than the proposed settlement.

The total amount of the settlement is equal to the November and December 2003 invoices plus interest of more than $174,000, according to a copy of the settlement.

The Florida Current provides a timely update on Florida's Medicaid Reform experiment . . . .


State asks to extend Medicaid reform experiment for another month

Christine Jordan Sexton, 6/20/2011
www.thefloridacurrent.com

The Agency for Health Care Administration signed paperwork for the federal government on Monday asking for a 30-day extension on its five-year Medicaid Reform experiment in five Florida counties.

AHCA Deputy Medicaid Secretary Phil Williams said that he expects that the extension will be granted because the federal government suggested that Florida make the request. The state's current waiver for the Medicaid Reform program in Broward, Duval and three other Northeast Florida counties is scheduled to expire at the end of June.

Williams also said he expects a full-blown three-year extension of the sweeping Medicaid 1115 waiver -- and the authority to have upward of $1 billion a year in federal "Low Income Pool" dollars to help fund the health care for the poor and uninsured. He made his comments to a blue ribbon panel called the Florida Commission on Review of Taxpayer Funded Hospital Districts.

The low income pool dollars are targeted mostly to hospitals that receive additional payments to help cover the costs of providing services to Medicaid, uninsured and under-insured individuals. LIP dollars are also targeted toward clinics. A 24 member board -- called the Low Income Pool Council -- makes recommendations to the Legislature on how the dollars should be spent.

During a conference call on Monday afternoon with another panel, Williams said it is possible that some additional terms and conditions will be placed on the state. He told members of the Medicaid Reform Technical Advisory Panel that some of the new conditions may require approval by state lawmakers.

Williams said he could not answer whether or not federal authorities would like the state to adopt medical loss ratios -- or MLR's. Medical loss ratios require managed care providers to spend a certain amount of money on direct care to patients. They are a key component of the federal health care reform.

The current Medicaid Reform plan in place is separate from a complete statewide overhaul of the state's $22 billion Medicaid program that legislators approved earlier this year. That overhaul requires federal approval as well. The state plans to submit a waiver request for the overhaul by Aug. 1 of this year.

latimes.com
Helping seniors live at home longer
The new Patient Protection and Affordable Care Act aims to provide at-home alternatives to nursing home care.

By Tammy Worth, Special to the Los Angeles Times
June 19, 2011


Patricia McGinnis has six brothers and sisters who help her take care of their 89-year-old mother. Though their mother is alert and able to live on her own, she is blind and has balance problems that have led to several falls, for which she has received care.
It takes all of the siblings working together to help their mother stay at home. But every day, as president of the California Advocates for Nursing Home Reform, McGinnis deals with people who don't have that choice and must live in nursing homes because they lack the financial resources or social support to remain at home as they age.


Home-based care is increasingly seen as a legitimate and less costly alternative to nursing home care. The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, includes provisions to assist people who want to stay in their homes longer.


"I think it's probably one of the most important reforms to long-term care since Medicare and Medicaid went into effect in 1965," McGinnis said. "This is imperative, so I am really excited about it."


About 1.5 million people live in nursing homes in the U.S., according to the Centers for Disease Control and Prevention. And more than 10 million Americans — mostly people 65 or older — need long-term services and support to help them with daily activities, according to the Kaiser Family Foundation.


Elinor Ginzler, senior vice president for livable communities at AARP, said the organization is always fighting for more funding to help people stay in their homes longer.


"Nursing homes are not a first choice," she said. "People like where they are living. We surveyed the 50-plus population and found that 86% of them want to stay in their homes."


One of the main reasons is financial.


The cost of staying at a nursing home ranges from about $40,000 to $85,000 a year, according to a recent report by John Hancock Financial Services Inc., an insurance and financial services company. The average cost of a home health aide, on the other hand, is about $37,000 a year.


A long-term care insurance policy McGinnis purchased some time ago pays for most of her mother's healthcare at home. But not everyone has that kind of insurance. "If you look at the baby boomers coming up, I wonder how we are going to pay for all of this," she said. "The average retirement savings of people 55 or older is $29,000 a year."


New provisions of the Affordable Care Act should help. The most ambitious part of the act to do with long-term care is the Community Living Assistance Services and Supports Act, or CLASS — a voluntary, consumer-financed insurance plan to cover long-term care expenses.


"It is a really different and new way of looking at the delivery and financing of long-term care in the U.S.," said Dee Mahan, deputy director of health policy at FamiliesUSA, a nonprofit healthcare advocacy organization. "I think the program is really, really important."


The insurance plan is similar to those currently available in the private market, but there are a few major distinctions. First, the program will be administered by the government. Second, any working adult age 18 or older will be able to enroll, regardless of any preexisting medical condition, and benefits will be good for as long as someone needs long-term care.


And unlike most private long-term care insurance plans, which restrict how money can be used, the government plan will offer benefits that could be used for a wide variety of expenses including hiring a home care provider and doing home modifications.


Before receiving daily cash benefits through the government program, people will have to pay premiums for at least five years and work for a minimum of three of those years. The benefits will be calculated based on the degree of disability or cognitive impairment. Although the average daily benefit won't be defined until October 2012, the law states that it must be no less than $50, and it is expected to be about $75, according to a Congressional Budget Office report.


Employers that take part in the program will automatically enroll their employees, who will be able to opt out. Others will be able to enroll individually.


The cost of premiums has yet to be determined, but it will depend on age and will be cheaper for younger people. The cost for low-income individuals and full-time students will start at $5 a month. The plan will be funded entirely through premiums — one of its only flaws, Ginzler said.


"CLASS runs the risk of not being implemented optimally," she said. "For it to work, you have to have a large pool of people paying into the system. And the reality is that most people don't want to think about their need for long-term care; they would rather plan for their funeral than their disability."


Other provisions in the Affordable Care Act will also help individuals stay in their homes longer if they choose.


Expanded spousal impoverishment protection: Before receiving Medicaid assistance for nursing home care, individuals must first "spend down" their assets to an amount set by the state (essentially, impoverishment). However, home-dwelling spouses of individuals who receive Medicaid assistance at nursing homes can retain a certain amount of income and assets to protect these couples against total financial ruin.


The same protection does not apply to the spouses of individuals receiving Medicaid for home-based services — but the Affordable Care Act has a provision that allows individuals to get Medicaid assistance for home- and community-based care without forcing their spouses to spend all of their assets. The provision will go into effect in 2014 and will last for five years.


"Community-first choice option": According to FamiliesUSA, 35 states provide home- and community-based care services through Medicaid. When budgets are tight, however, these services are among the first to get cut, Ginzler said. The "community first" option, available to states starting this October, is intended to expand these programs through a 6% increase in the amount of matching funds the government offers to states for the cost of these services.


Money follows the person: A demonstration project is helping people on Medicaid leave nursing homes and return to their communities. It offers case management services and assistance with home modifications, one-time housing expenses and help with other costs associated with this transition. To be eligible for benefits, people were required to live in nursing homes for at least six months; the Affordable Care Act stipulates that they need to stay there only 90 consecutive days. It also extends the project for five years.


Balancing incentive payments program: This program, which will run from October through the end of September 2015, will increase federal matching funds by up to 5% for state Medicaid programs that provide home- and community-based care. The program will apply to states that currently spend less than half of their Medicaid funds for long-term services on noninstitutional care. The plan will also help states increase access to long-term services and standardize eligibility criteria.

The U.S. Government Accountability Office ("GAO") issued the following June 14, 2011 report (GAO-11-756T) on "Disability Insurance: Preliminary Observations on SSA Efforts to Detect, Prevent, and Recover Overpayments."

A summary and hyperlinks to the full report are below:Highlights Page (PDF) Full Report (PDF, 22 pages) Accessible Text

Summary

The Social Security Administration's ("SSA") Disability Insurance ("DI") program paid almost $123 billion in benefits in fiscal year 2010 to more than 10 million workers and dependents. The program has grown rapidly in recent years and is poised to grow further as the baby boom generation ages.

The GAO examined (1) what is known about the extent SSA makes work-related overpayments to, and recovers overpayments from, DI beneficiaries, and (2) SSA's policies and procedures for work continuing disability reviews ("work CDRs") and potential DI program vulnerabilities that may contribute to overpayments to beneficiaries who have returned to work.  To answer these questions, the GAO reviewed work CDR policies and procedures, interviewed SSA headquarters and processing center officials, and visited 4 of 8 processing centers.

The GAO reviewed a random nongeneralizable sample of 60 CDR case files across those 4 centers to ensure we had a wide range of cases for our review (15 cases from each). These 4 centers received almost 80 percent of all work CDRs from SSA's Internal Revenue Service enforcement data match in fiscal year 2009.

Disability Insurance overpayments detected by SSA increased from about $860 million in fiscal year 2001 to about $1.4 billion in fiscal year 2010, though the full extent of overpayments to beneficiaries who have returned to work and are no longer eligible is unknown.  Overpayments may also go to beneficiaries who are no longer eligible due to medical improvement, but SSA estimates about 72 percent of all projected DI overpayments were work related during fiscal years 2005 through 2009.  While the agency collected, or recovered, $839 million in overpayments in fiscal year 2010, monies still owed by beneficiaries grew by $225 million that same year, and total DI overpayment debt reached $5.4 billion. SSA does not have agency-wide performance goals for debt collection, for example, the percent of outstanding debt collected annually. And while SSA does have a policy for full repayment within three years, 19 of the 60 continuing disability review (work CDR) cases the GAO reviewed had repayment plans exceeding three years.

SSA officials told the GAO that lengthy repayment plans are often the result of an individual's limited income, but SSA does not review or approve repayment plans which exceed agency policy. During the course of our review, we also found a limitation in SSA's Recovery of Overpayments, Accounting and Reporting (ROAR) system. Used to track overpayments and collections, ROAR does not reflect debt due SSA past year 2049 so the total balance due the program is unknown, and likely larger than the agency is reporting. SSA officials acknowledged this issue, but are unable to determine the extent of the problem at this time.

They told the GAO they have a work group which will recommend action to correct the problem. But until this issue is addressed, SSA officials told us the agency can only track and report on overpayments scheduled to be repaid through 2049. The amount owed after that year is unreflected in current totals even as it annually increases.

The SSA has numerous policies and processes in place to perform work CDRs, though two key weaknesses have hindered SSA's ability to identify and review beneficiary earnings, which affect eligibility for DI benefits. First,the SSA lacks timely earnings data on beneficiaries who return to work.

In 49 of the 60 CDR cases the GAO reviewed, there was no evidence in the file that the beneficiary reported returning to work, as required by the program. To identify these unreported earnings, the SSA primarily relies on data matching with the Internal Revenue Service ("IRS"), then sends these matches to staff for a work CDR.

However, the IRS data may be more than a year old when received by the SSA, and the SSA says it is not cost effective to gain access to and use other sources of earnings information, such as the National Directory of New Hires database. In addition, we found cases may wait up to 15 additional months before SSA staff begin work on the CDR. Second, the SSA lacks formal, agency-wide performance goals for work CDRs. While it targets 270 days to develop a case, actual processing time taken ranged from 82 to 992 days (with a median of 396 days) in the 60 cases we reviewed, and overpayments which accrued as a result topped $1 million total.

SSA officials reported several initiatives to more effectively prioritize work CDR cases, for example, those with the largest potential overpayment amounts, but these efforts are in the early stages and we could not yet assess their effectiveness.

The GAO has ongoing work on this issue and has no recommendations at this time.



For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors

Above:  General Bob Milligan


Florida veterans agency gets new interim leader

From the Associated Press


TALLAHASSEE, Fla. (AP) - Former Florida Comptroller Bob Milligan is retiring as interim executive director of the state Department of Veterans Affairs.

Gov. Rick Scott and the Florida Cabinet on Thursday appointed Earl Daniell, the department's chief of staff, to succeed Milligan as interim director.

Both are retired Marines. Milligan was a lieutenant general and Daniell a colonel.

Milligan took the Veterans Affairs job on an interim basis last year following the death of retired Navy Adm. Leroy Collins Jr., whose father was Florida's governor from 1955 through 1961.

Collins was killed when an SUV struck him while he was riding a bicycle in Tampa.

Milligan served on the Cabinet as the state's elected comptroller in the 1990s.

The chief financial officer now handles the comptroller's duties since that position was abolished.

Five Questions All Caregivers Should Ask Themselves
Preparing for Caregiving: What Caregivers Should Know
By Carol Bradley Bursack
Reprinted from AgingCare.com in TCPalm.com
June 15, 2011

Are you prepared to take on the responsibility of caregiving? How do you know if you can handle the commitment of having your parent move in? What signals alert you that you are in trouble of getting lost in caregiving? How do you know when caregiving has become too much and its time to think about other arrangements?

Many of us dove into caregiving with full hearts and no planning, then ended up sustaining this life-altering mode for months and often years. But at some point as a caregiver, you need to have a honest, realistic talk with yourself. You will, eventually need to include others in your final decisions, but some honest, quiet soul searching can help you sort out your own priorities and determine how much you can handle.

Do you have children at home? What are their needs? Do you have a supportive spouse or partner, a negative partner, or no partner? How does this relationship affect your caregiving and how does your caregiving affect your relationship? Are you are social person, a loner or somewhere in between? How do you fit in your "alone time," your own social life and your work and family needs with your caregiving? Where do you need to draw a line and say "I can do this much and no more." You may not be able to control your circumstances, but you can control your response to them. Will you continue watchfulness and maintenance of your own health, or will you let that slip? You, too, must be a priority.These are questions at the heart caregiving. Unfortunately, for most caregivers, these questions do not arise until they are feeling overwhelmed and depleted. Being able to say, "No, I can no longer continue to provide care in this way," could possibly save you from emotional and physical burnout, while deepening the level of honesty and openness in your relationships with your parents and family.

There may come a time when our parents and elderly loved ones need more help than we can give them. Accepting this isn't easy, but its crucial not only for the health and safety of your loved one, but for your own well-being as well. If you don't have siblings to help you look for care options, or you have them but they truly refuse to help, you aren't the first person this has happened to. Leave no stone unturned until you get some help. You do have options:

Home health care.

Home care is generally defined as non-medical support services delivered at the home of the senior. The aim of home care is to allow seniors to remain at home longer rather than enter an assisted living community, nursing home or other type of senior care.

Assisted living, nursing homes or other senior care residences. If you need to move your elders into assisted living or a nursing home, then do your homework and find the best option available. Assure them that you aren't abandoning them, but you can't care for them all alone.

Caregiver Support Programs. Check your state's website and find their version of "aging services." Each state has a version of the Family Caregiver Support Program. It may go by a different name in your state, but they generally give wonderful support both practical and emotional. If you live in an area where you have an , they provide a great deal of community support.

Counseling. If you are guilt-ridden or filled with resentment no matter what you do, see a counselor.

The point is, you must find some balance in your life. If you go years being eaten up with resentment, your own health will suffer. And you won't be as good a caregiver as you want to be. Far better to find some respite and balance your life, once the emergency that got you into caregiving has passed, than to have your own life go down in flames.

Elder care author, columnist and speaker Carol Bradley Bursack is an AgingCare.com contributing editor and moderator of the forum.


For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors

Florida Governor Rick Scott signed CS/HB 843 on Friday, June 17, 2011.


Effective July 1, 2011, the bill creates new Florida law s. 430.81, F.S., which authorizes the Florida Department of Elder Affairs to designate a home health agency as a teaching agency for home and community-based care if the home health agency meets certain requirements.


The bill defines the term “teaching agency for home and community-based care” as a home health agency licensed under part III of chapter 400, F.S. that has access to a resident population of sufficient size to support education, training, and research relating to geriatric care.


CS/HB 843 provides that home health agencies seeking designation as a teaching agency for home and community based care may demonstrate proof of financial responsibility as provided in s. 430.80(3)(g), F.S., in lieu of general and professional liability insurance coverage.


Finally, the bill authorizes a teaching agency to be affiliated with an academic research university in the State that meets certain criteria.


Background


The Florida Department of Elder Affairs ("department") administers programs and services through designated planning and service areas.  The department is designated as the state unit on aging as defined in the federal Older Americans Act ("the act") and must exercise all responsibilities pursuant to the act.


The Older Americans Act requires the department to fund a service delivery system through designated area agencies on aging in each of the state’s 11 planning and service areas.  In addition, chapter 430, F.S., requires the department to fund service-delivery lead agencies that coordinate and deliver care at the consumer level in the counties comprising each planning and service area.


Lead agencies are designated by Area Agencies on Aging once every six years through a competitive procurement process.  Lead agencies provide and coordinate services for elders in designated areas. There are 58 lead agencies serving all of Florida’s 67 counties.  Lead agency providers are either non-profit corporations or county government agencies.  Lead agencies are the only entities that can provide fee-for-service case management on an ongoing basis.  Lead agency services include:


Care Management Adult Day Care Adult Day Health Care Home Delivered Meals Case Aide Chore Service Companionship Consumer Medical Supplies Counseling Escort Emergency Alert Response Emergency Home Repair Home Health Aide Homemaker Home Nursing Information and Referral Legal Assistance Medical Therapeutic Services Personal Care – help with bating, eating and dressing. Respite Care Shopping Assistance Transportation


“Home health agency” is defined in part III of chapter 400, F.S., as an organization that provides home health services and staffing services.  Home health services are health and medical services and medical supplies furnished to an individual in the individual’s home or place of residence.  These services include:

Nursing care; Physical, occupational, respiratory, or speech therapy; Home health aide services; Dietetics and nutrition practice and nutrition counseling; and Medical supplies, restricted to drugs and biologicals prescribed by a physician.


There are 2,317 licensed home health agencies in Florida as of February 23, 2011.  Home health agencies must be licensed by the Agency for Health Care Administration. The licensure requirements for home health agencies are in the general provisions of part II of chapter 408, F.S., the specific home health agency provisions of part II of chapter 400, F.S., and chapter 59A-8 of the Florida Administrative Code. Florida law prohibits unlicensed activity and authorizes AHCA to fine unlicensed providers $500 for each day of noncompliance, and authorizes state attorneys and AHCA to bring an action to enjoin unlicensed providers.  Unlicensed activity is a second-degree misdemeanor and each day of continued operation is a separate offense.


The requirements for training of health care professionals are under the Department of Education and the requirements for licensing and continuing education are determined by the Board of Nursing and other boards under the Department of Health. Section 400.497(1), F.S., permits home health agencies to train their own home health aides. However, home health agencies must become licensed by the Department of Education as a career education school in order to train any home health aides that will be employed by other home health agencies to train certified nursing assistants or others.


Home health agencies can become certified for Medicare and/or Medicaid, but they must meet the Medicare Conditions of Participation in 42 Code of Federal Regulations, Part 484 prior to certification.  The federal regulations require applicants to comply with a complex comprehensive assessment prior to an initial certification survey.


Academic Health and Science Centers


Academic Health and Science Centers in the State University System have three primary purposes:

Teach students going into healthcare professions; Conduct research to advance healthcare knowledge; and Serve patients with health care problems.


These centers provide facilities, faculty and staff, curriculum, and opportunities for health science students to train in the various health science areas and get practical experience in their disciplines during their training.

There are two state Academic Health and Science Centers in Florida. These centers are located at the University of Florida and the University of South Florida. Currently, there are two other medical education programs in the State University System however they are not as extensive as health centers, which include multiple health education programs.


Funding for the Academic Health and Science Centers is provided annually by the Legislature in the form of specific appropriations in the General Appropriations Act to the two centers. For Fiscal Year 2009-10, the program received a total of $222.3 million from legislative appropriations, $143.7 million in general revenue, and $14.2 million in revenue from lottery, and $52.6 million from the student fee budget authority.


Teaching Nursing Home Pilot Project


Section 430.80, F.S., was created by the Legislature in 1999 to establish a pilot project, allowing AHCA to implement a comprehensive multidisciplinary program of geriatric education and research in a nursing home facility designated by AHCA as a teaching nursing home.  Currently, there is no statute that provides a similar program for home and community-based care.


Pursuant to s. 430.80(3), F.S., nursing home licensees must meet the following requirements to be designated as a teaching nursing home:


Provide a comprehensive program of integrated senior services that include institutional services and community-based services; Participate in a nationally recognized accreditation program and hold a valid accreditation; Have been in business in Florida for a minimum of 10 consecutive years; Demonstrate an active program in multidisciplinary education and research that relates to gerontology; Have a formalized contractual relationship with at least one accredited health profession education program located in Florida; Have senior staff members who hold formal faculty appointments at universities that have at least one accredited health profession education program; and Maintain insurance coverage pursuant to s. 400.141(1)(s) or proof of financial responsibility in a minimum amount of $750,000.


Special Insurance Provision


Section 400.141(1)(s), F.S., requires all licensed nursing home facilities to maintain general and professional liability insurance coverage that is in force at all times.  In lieu of general and professional liability insurance coverage, a state-designated teaching nursing home and its affiliated assisted living facilities created under s. 430.80, F.S., may demonstrate proof of financial responsibility as provided in s. 430.80(3)(g), F.S.


In providing proof of financial ability to operate in the required minimum amount of $750,000, such proof may include:


Maintaining an escrow account consisting of cash or assets eligible for deposit in accordance with s. 625.52, F.S., or; Obtaining and maintaining pursuant to chapter 675, F.S., an unexpired, irrevocable, nontransferable and nonassignable letter of credit issued by any bank or savings association organized and existing under the laws of Florida or any bank or savings association organized under the laws of the United States that has its principal place of business in this state or has a branch office which is authorized to receive deposits in this state.


Effect of CS/HB 843's Changes

The bill creates s. 430.81, F.S., which authorizes the Department of Elder Affairs to designate a home health agency as a teaching agency for home and community-based care. The requirements to receive designation as a teaching agency for home and community-based care are similar to the requirements for nursing homes seeking designation as a teaching nursing home under the teaching nursing home pilot project. 


The bill creates s. 430.81, F.S., which authorizes the Department of Elder Affairs to designate a home health agency as a teaching agency for home and community-based care. The requirements to receive designation as a teaching agency for home and community-based care are similar to the requirements for nursing homes seeking designation as a teaching nursing home under the teaching nursing home pilot project.  In order to receive this designation, home health agencies must:


Have been a not-for-profit, designated community care for the elderly lead agency for home and community-based services for more than 10 consecutive years; Participate in a nationally recognized accreditation program and hold valid accreditation; Have been in business in Florida for a minimum of 20 consecutive years; Demonstrate an active program in multidisciplinary education and research that relates to gerontology; Have a formalized affiliation agreement with at least one established academic research university with a nationally accredited health professions program in Florida; Have salaried academic faculty from a nationally accredited health professions program; Be a Medicare and Medicaid certified home health agency that has participated in the nursing home diversion program for a minimum of five consecutive years; and Maintain insurance coverage pursuant to s. 400.141(1)(s), F.S., or proof of financial responsibility in a minimum amount of $750,000.


Proof of financial responsibility may include maintaining an escrow account or obtaining and maintaining an unexpired, irrevocable, nontransferable, and non-assignable letter of credit issued by any bank or savings association authorized to do business in the state. The bill provides that the letter of credit is to be used to satisfy the obligation of the agency to a claimant upon presentation of a final judgment against the facility or upon presentation of a settlement agreement signed by all parties to the agreement when the final judgment or settlement is a result of a liability claim against the agency.


The bill also provides a definition of the term “teaching agency for home and community-based care” as a home health agency that is licensed under part III of chapter 400, F.S. and has access to a resident population of sufficient size to support education, training, and research related to geriatric care.
Finally, the bill authorizes a teaching agency for home and community-based care to be affiliated with an academic health center in the state in order to foster the development of methods for improving and expanding the capabilities of home health agencies to respond to the medical, health care, psychological, and social needs of the frail and elderly population. The bill provides that a teaching agency for home and community-based care is to serve as a resource for research and for training health care professionals in providing health care services in homes and community-based settings to the frail and elderly persons.


On April 5, 2011, the Health and Human Services Access Subcommittee adopted a strike-all amendment to CS/HB 843, which was enacted with Governor Scott's signature on June 17.


The amendment:


Amends the bill to change the agency authorized to designate home health agencies as teaching agencies to the Department of Elderly Affairs instead of the Agency for Health Care Administration; Removes the requirement that home health agencies must serve a geographic area with a minimum of 200,000 adults age 60 and older to qualify as a teaching agency; Changes the requirement in the bill that home health agencies must be in business in this state for a minimum of 30 years, instead to a minimum of 20 years to qualify as a teaching agency; Removes authority of the Agency for Health Care Administration to charge a fee of up to $250 to home health agencies seeking designation as a teaching agency.


References

• Department of Elder Affairs, Elder Services Network Components and Their Roles, available at http://elderaffairs.state.fl.us/english/pubs/pubs/sops2007/Files/Elder%20Services%20Network%20Components%20and%20their%20roles.pdf

For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors