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CARIE Connection

Quote of the Month
“The capacity to care is the thing which gives life its deepest meaning and significance.” - Pablo Casals
Changes Impacting Veterans Benefits
On January 23, 2015, the Department of Veterans Affairs proposed a rule (RIN 2900 - AO73, Net Worth, Asset Transfers, and Income Exclusions for Needs-Based Benefits) that, if approved, will impact the ability of veterans and their spouses in need of long term care to access VA benefits.  More specifically, it relates to the VA Pension with Aid and Attendance benefits. The proposed rule imposes new restrictions including: establishment of a defined asset limit, a three-year look-back on asset transfers with a maximum ten-year penalty period, a 2-acre limit to home lot sizes, and caps to home-health care expenses.  It is questionable whether the VA can unilaterally make these changes without the approval of Congress.
The NAELA has dedicated webpage on this issue to keep you updated and to help in submitting comments.  The proposal is still in the Public Comment Period until March 24, 2015.  Public comments may be submitted through or by mail to: Director, Regulation Policy and Management (02REG), Department of Veterans Affairs, 810 Vermont Ave. NW., Room 1068, Washington D.C. 20420 or by fax to (202) 273-9026.
In addition to the proposed rule change, the VA is proposing to simplify services by creating a new 5 region map.  “Until recently, the VA divided its services into at least nine sometimes overlapping maps of the United States, delineating numerous regional networks involving literally hundreds of programs. By the end of June, however, all VA agencies will be required to align with a new five-region map that should make it easier for veterans to navigate the healthcare system. The reorganization of maps is part of an initiative, MyVA designed to re-orient the VA around the needs of veterans and "make VA a more customer-centric organization."

CMS HCBS Rules - Resources for Advocates
Justice in Aging (formerly known as the National Senior Citizens Law Center) released the following information to help advocates comment on CMS’ rules related to home and community-based services.  “In early 2014, after a lengthy public process, CMS finalized new rules that define the characteristics of a Home & Community-based Services (HCBS) setting. The new standards aim to improve HCBS quality and ensure individuals who receive Medicaid HCBS services can engage and fully participate in community life, better control and coordinate their care, and have opportunities to seek employment in competitive settings.  States have now had over a year to develop transition plans to ensure their current HCBS settings will come into compliance with the new rules by March 2019.  If your state has a draft transition plan out for public comment these comments and state samples are a useful starting point.  If the comment period on the draft plan has closed, these comments and state samples can still be used to prepare for further advocacy opportunities with CMS.

In response to persistent confusion and misinformation about the new HCBS settings rules, a group of national disability and aging organizations (including Justice in Aging) has put together a Q&A written for advocates and the general public to explain the transition process and what the rules do and do not require.

States must submit state-wide transition plans to CMS and must first provide the public opportunity to comment on these plans. You can find information on your state's status at Justice In Aging has a number of resources on the new rule, available here.”
In Pennsylvania, the Department of Human Services is seeking comments on its proposed statewide transition plan for all ten of the home and community-based service Waiver programs.  Comments are due March 22, 2015.
Improvements made to Nursing Home Compare
The Centers for Medicare & Medicaid Services (CMS) made improvements to the 5-star quality rating system on its Nursing Home Compare website.  The changes include: 
  • Adding two antipsychotic medication use quality measures. One measure will be for short-stay residents prescribed antipsychotics without diagnoses of schizophrenia, Huntington's disease, or Tourette syndrome. The second measure will assess continued use of such medications for long-stay nursing home residents without those same diagnoses.
  • Raising the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category on the website.
  • Adjusting staffing algorithms. Nursing homes must earn 4 stars on either the individual Registered Nurse (RN) only or the staffing categories to receive 4 stars on the overall staffing rating and can have no less than a 3-star rating on any of those categories.
  • Expanding surveys. State Survey Agencies will conduct specialized, onsite surveys of a sample of nursing homes to assess the adequacy of resident assessments and the accuracy of information reported to CMS.
Click here for the CMS fact sheet.
As a result of the improvements, about two thirds of nursing homes saw a decline in their quality measures rating and about one third had a decline in their “Overall Five Star Rating.“  According to Public Source, CMS lowered 50 nursing homes’ ratings in Pennsylvania to one star, and 75 nursing homes dropped below four and five stars, the above average ranking.  After calculating the use of antipsychotics in the scoring method, 248 Pennsylvania nursing homes lost their top ratings.
Pennsylvania News
On March 3, 2015, Pennsylvania Governor Tom Wolf delivered his budget request for the 2015-16 fiscal year.  It is a complicated budget in that there are many new tax and spending increases proposed that will be difficult to pass through the General Assembly.  More information will be available in the next newsletter.  House and Senate budget hearings are scheduled throughout the next few weeks.  On February 27, the Governor held a press conference and issued a press release announcing an initiative to improve home and community-based care for older Pennsylvanians.  The initiative is a combination of budget, legislative and executive actions.  As part of the initiative, Governor Wolf issued Executive Order 2015-05, Participant-Directed Home Care Services, forming “the Governor’s Advisory Group on Participant-Directed Home Care” to advise the Governor’s Office and other executive branch agencies and offices of the Commonwealth on ways to improve the quality of care delivered through home care services. The Advisory Group will include 7 members, including the Secretary of the Department of Human Services, or a designee (who serves as chairperson of the Advisory Group), and the Deputy Secretary of the Office of Long Term Living. The remaining five members will include participants (or their surrogates) and advocates for seniors and people with disabilities.
Just the Links
Community Catalyst released a report, The Path to a People-Centered Health System: Next Generation Consumer Health Advocacy.
NCOA created a “Core Benefits Cheat Sheet (2015).”
The USDA Food and Nutrition Service released a fact sheet about how SNAP benefits may be used.
The National Conference of State Legislatures has released a web brief that discusses the various ways that states are addressing the increasing need for non-emergency medical transportation.
The CDC released a report, Long-Term Care Services in the United States: 2013 Overview and updated the Community Health Status Indicators (CHSI) online tool that produces public health profiles for all 3,143 counties in the United States.
CMS released the 2015 National Impact Assessment of Quality Measures Report (2015 Impact Report).
The Equal Rights Center released a toolkit called The Opening Doors Toolkit: Fair Housing Self Advocacy for Older LGBT Adults.
SAGE has launched a national, multi-year LGBT elder housing initiative to ensure that millions of LGBT older people can access welcoming housing in all its forms.
The Department of Labor (DOL) has released a new fact sheet on an amendment to the rule defining spouse under Family and Medical Leave Act (FMLA). Fact Sheet: Final Rule to Amend the Definition of Spouse in the Family and Medical Leave Act Regulations.  The DOL final rule was published February 25 and goes into effect on March 27, 2015.
The Department of Justice announced that individuals may now file ADA complaints with the Department electronically. Filers will immediately receive a "reference number" to be used whenever contacting the Department about that complaint. Effective March 15, 2015, e-mail complaints will no longer be accepted by the Department.
The Pennsylvania Attorney General’s office has posted the following brochures to help veterans and their families:  Consumer Guide for Military and Veterans, Combating ID Theft, and, Pension Poaching - Know the Signs.
The Pennsylvania Health Care Cost Containment Council released a report, PA’s Super-Utilizers of Inpatient Hospital Care.
Just for Fun
New York City has posted fun Neighborhood Slice videos, “Chronicling the evolution of New York City’s unique neighborhoods through the eyes of those who have lived here the longest, each half hour episode of Neighborhood Slice features New Yorkers who have been a part of the fabric of their communities for decades in neighborhoods across the City.” You may view full episodes of the show or short 3 minute videos such as Gus Vlahavas, who talks about the changing neighborhood and how their family restaurant in Prospect Heights has been an important part of the neighborhood since 1936 and Jean Wnuk, veteran pattern maker who talks about her 60 years in the Garment District and why she still works.  You don’t need to be from NYC to enjoy these stories!
Please plan to attend CARIE’s annual auction to be held on Thursday, April 30, 2015 from 5:30 PM – 8:30 PM at WHYY – 150 North 6th Street, Philadelphia. This year’s theme is CARIE’s Cavalcade of Stars – Celebrating older loved ones and friends who inspire!  The event will honor two outstanding advocates as recipients of this year’s Spirit of CARIE award. Terry Roth, a public interest attorney, has been an effective advocate for the rights of people with disabilities of all ages for three decades. Dr. Norma Thomas, a professor and director of the Master of Social Work Program at California University of Pennsylvania, has effectively advocated on behalf of vulnerable elder members of minority communities and advanced education in the field of aging.  CBS 3’s Jim Donovan returns as the evening’s Master of Ceremonies. Auction items include exciting vacations, artwork, jewelry, event tickets, services, fun activities and much more!  New this year – silent auction online bidding.  Please visit our event website to purchase tickets, register for online bidding, and for sponsorship opportunities.  For more information contact Michele Mathes at (267) 546-3436 or
CARIE Connection Archives
Are looking for a past issue of CARIE Connection?  Click here to access past newsletters.
Public Policy Meeting Announcement
Due to inclement weather, the March Dorothy S. Washburn Legislative Committee meeting is postponed and will be held from 9:30 to 11:30 on Thursday, March 12, 2014 at CARIE’s office at Two Penn Center – Suite 1500.  Here is the agenda.  All are welcome.  Hope you can join us.  

As always, please contact me if you have any questions.
267-546-3438 or 1-800-356-3606, ext. 3438
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