Subscribe to The Pulse

Long-Term Care

Medicaid change on long-term care delayed

A state health agency Thursday delayed approval of a change in the Medicaid eligibility system for people in long-term care whose incomes are above the government program’s thresholds.

The Department of Community Health’s board had been set to approve a switch for some lower-income Georgians — who now use “Qualified Income Trusts” (QITs) to qualify for Medicaid — to a “medically needy” eligibility program.

These people make too much money to qualify for regular Medicaid, but not enough money to pay for their health care needs.


But consumer advocates have expressed concerns that the change in eligibility methods would help only people in nursing homes and institutional hospice programs — and not those with Medicaid “waivers’’ who live in community settings. The new policy could also limit people’s choices in long-term care arrangements, the advocacy groups say.

Department of Community Health (DCH) officials said Thursday that in delaying the board vote, they sought additional time before implementation. “We want to make sure it’s done right rather than fast,’’ said Jerry Dubberly, the Georgia Medicaid director. full story

Action on Alzheimer’s, maternal deaths

A Senate panel Thursday unanimously passed separate bills that would move the state’s aging services into a new agency, and would track the prevalence of Alzheimer’s disease and other forms of dementia in Georgia.

Sen. Renee Unterman (R-Buford), who chairs the Senate Health and Human Services Committee, said the two bills and a related resolution arose from proposals by a task force on Alzheimer’s and related types of dementia.

Sen. Renee Unterman

Sen. Renee Unterman

Dementia — from Alzheimer’s and other causes — is on the increase in Georgia and throughout the nation. Deaths from Alzheimer’s nationally jumped 68 percent between 2000 and 2010, according to the Alzheimer’s Association.

An estimated 120,000 people in Georgia are living with Alzheimer’s, a figure that’s expected to rise to 160,000 by 2025.

Unterman told GHN that her advocacy on the issue stems from the experience of a friend whose father was diagnosed with Alzheimer’s. “It was a personal experience that showed the sacrifices and struggles families went through,’’ Unterman said.

The Senate Health and Human Services Committee also approved a bill Thursday to review all maternal deaths in the state. Georgia has the highest rate of maternal deaths among the 50 states. full story

Progress being made against costly readmissions

Hospital readmissions are bad for everyone.

They’re obviously bad for discharged patients. No one wants to leave the hospital, get worse instead of better and then have to be hospitalized again.

Readmissions are also bad for the hospitals involved, because they can be penalized by Medicare for a high readmission rate within 30 days of discharge.

signERIn turn, readmissions are bad for nursing homes that have to send patients back to the hospital. Given their incentive to reduce readmissions, hospitals may not want to steer people to nursing homes that send back too many recently discharged patients.

But new efforts to improve care coordination among hospitals, nursing homes and other providers are succeeding in reducing readmission rates, experts say.

Georgia’s nursing homes and hospitals are collaborating more than ever to reduce readmissions, say officials with Georgia’s Quality Improvement Organization (QIO), a state-based group funded by Medicare to review medical care.

A big driver in this change has been the readmission penalties that hospitals now face. These penalties were created by the 2010 Affordable Care Act.

Jonathan Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services, told GHN recently that the penalties have forced hospitals and nursing homes to improve their coordination. full story

A lingering gap in nursing home safety

More than 900 U.S. nursing homes, including six in Georgia, have been listed by federal officials as not fully complying with a regulation to have automatic fire sprinklers in every patient area.

The Centers for Medicare and Medicaid Services (CMS) sent a memo to state officials last week on the sprinkler rule compliance. It did not identify the nursing homes that are not fully sprinkler-equipped. The deadline for installation was Aug. 13.

smslogoIn 2008, CMS issued a rule that the long-term care industry had five years to install the systems in the approximately 16,000 U.S. nursing homes, where more than 1 million Americans live.

The federal rules came in response to the deaths of 31 people in nursing home fires in Nashville, Tenn., and Hartford, Conn., in 2003.

After the deadly fires, “there was enormous pressure on CMS to respond,’’ said Alan Horowitz, an Atlanta attorney with  law firm Arnall Golden Gregory who specializes in long-term health care issues.

Georgia’s record appears to be good compared with other states on the rate of compliance with the sprinkler regulation. full story

Lawmakers try to ease burden of Alzheimer’s

Rep. Hank Johnson

Rep. Hank Johnson

“It’s about people,” said U.S. Rep. Hank Johnson, a Georgia Democrat.

Johnson was referring to proposed legislation (H.R. 1507) to provide enhanced services for those affected by dementia, including Alzheimer’s disease. It’s the Health Outcomes, Planning, and Education Act, also known as the HOPE Act.

If passed, the bill would provide Medicare coverage for clinical diagnosis of Alzheimer’s and treatment planning, and would require documentation of evaluation and any care planning in an individual’s medical record. Johnson is an originating co-sponsor of the bill, which would amend title XVIII of the Social Security Act.

“Alzheimer’s is a devastating disease that not only robs patients of their essence, but has huge implications for their loved ones,” Johnson said.

Currently more than 5 million Americans suffer from Alzheimer’s disease, making it the sixth leading cause of death for those 65 and older in the United States. According to the Alzheimer’s Association, the cost of caring for those with Alzheimer’s and other types of dementia is expected to total about $203 billion in 2013, with the estimated cost increasing to $1.2 trillion (in today’s dollars) by mid-century.

In Georgia, there were 120,000 people with Alzheimer’s disease in 2010, and the number is expected to grow to 160,000 by 2025, according to a 2012 Alzheimer’s Association report. full story

  • Sign up for our mailing list.