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Legislative and Regulatory News, June 2004 HHS Secretary Tommy G. Thompson announced June 3 that Missouri, Colorado, and Massachusetts will be the three states where Medicare will conduct a demonstration project involving a new and more liberalized definition of homebound. This definition would allow Medicare beneficiaries receiving home health benefits to leave their home more frequently and for longer periods without risking the loss of those benefits, HHS said. "This demonstration will give those with chronically disabling conditions a chance to live full lives and contribute to their communities while still receiving services in their homes," Secretary Thompson stated in a release. Current rules used to determine who qualifies for Medicare payment of services at home require that any time away from home must be "infrequent or of short duration," which have been clarified in recent years to allow the homebound to leave home for adult day care or religious services. The demonstration project removes a limitation based on actual time spent away from home, eliminating the concern among many homebound persons that they will lose their home-based care if they attempt to take advantage of activities outside the home. Up to 15,000 beneficiaries will be eligible to enroll in the two-year demonstration, which will begin in the fall. To qualify for the demonstration, Medicare beneficiaries must have a permanent, severe disability that is not expected to improve. In addition, the individual must meet certain needs-based criteria. For more information, go to http://www.hhs.gov/news/press/2004pres/20040603.html. Report Finds Seniors Confused About New Prescription Drug Law A report published this month by the Kaiser Family Foundation finds Medicare beneficiaries "confused and uncertain" about the Medicare prescription drug discount card program that debuted June 1 and the new Medicare drug benefit that will be available in 2006. The Kaiser report was based on interviews with 10 focus groups conducted in May in Pittsburgh; Kansas City, KS; and Washington, DC, by pollsters from Peter D. Hart Research Associates and Public Opinion Strategies. The main purpose of these focus groups was to assess beneficiaries' knowledge, perceptions, and early experiences with the new Medicare drug law. Kaiser found that seniors' opinions "are frequently shaped by the news and the advertising environment, much of which they report as being negative." Regarding the drug discount program, seniors are concerned that discounts are not substantial enough to make drugs affordable; are not guaranteed; and end after two years, according to the results of the focus groups. They are also apprehensive about choosing from among the more than 70 available cards and think the $600 credit is a good idea, but may be insufficient. On hearing a description of the law's potential to provide relief to lower-income beneficiaries, however, Kaiser said that many participants viewed the new law as beneficial for poorer people (both the $600 credit in 2004 and 2005 and subsidies beginning in 2006). Panelists also reacted favorably to a description of the new preventive benefits available in 2005. Negativity by seniors toward the 2006 Medicare drug benefit focuses on the gap in coverage ("doughnut hole") between $2,250 and $5,100 in total drug spending, new Part D prescription drug premium levels (on top of Medicare Part B), the qualifying level for the lower-income subsidies, and a belief that their own supplemental plans, that include prescription drug coverage, are better. Other concerns about the law raised by focus group participants include personal cost, how it will affect their current coverage, whether they would have access to the drugs prescribed by their doctors, logistics of the benefits, and the need for information to make good decisions. On June 1, the Centers for Medicare and Medicaid Services reported lower-than-expected enrollment in the drug discount card program. CMS said approximately 2.87 million seniors had signed up. Of those, 2.3 million were automatically enrolled as a result of being a member of a Medicare managed care plan. Before the program took effect, the government estimated that more than 7 million people would sign up for a card. The focus group report, The Medicare Prescription Drug Law-What are Seniors Saying?, is available at http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=36719 AHRQ Solicits Measures of Family Assessment of Nursing Home Care AHRQ is currently soliciting survey instruments or items from survey instruments that measure family assessments of nursing home care. CMS established as a priority, support for the development of a standardized survey for measuring and publicly reporting family and residents' assessments of nursing home care that could be used nationwide. AHRQ is participating in the development and testing of the survey instruments at CMS's request. A resident survey has been developed and is in the process of being field tested. The next step is the development of a standardized instrument for investigation of family perspectives on residents' nursing home care. Submissions are due July 6. For more information, consult the May 6 Federal Register at http://www.access.gpo.gov/su_docs/fedreg/a040506c.html. Fact Sheets on Quality Measures Available From AHRQ In other news, AHRQ announced that three new fact sheets on quality improvement strategies are now available. The first, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, explores the challenges of translating research into clinical practice. The second and third fact sheets, Closing the Quality Gap: Diabetes Care Strategies and Closing the Quality Gap: Hypertension Care Strategies, focus on improving the treatment of patients with these conditions. The fact sheets are available at http://www.ahrq.gov/qual/errorsix.htm. HHS Awards Grants for Prevention Programs HHS Secretary Tommy G. Thompson announced June 2 continuation grants totaling over $4 million in prevention programs for minority groups and community organizations to support projects targeted at reducing the risk of disease and disability among the elderly. The announcement reflects HHS' continued efforts to reduce and prevent chronic disease, as outlined in its "Blueprint for Action", available at http://aspe.hhs.gov/health/blueprint/. For a list of the groups that received grants, go to http://www.aoa.gov/press/pr/2004/04_Jun/06_02_04.asp.
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