A federal district court holds that a nursing home suing on behalf of its residents has a private right of action to sue the state for violating federal Medicaid law regarding patient liability amounts. Westminster Nursing Center v. Cohen (U.S. Dist. Ct., E.D. N.C., No. 5:17-CV-96-FL, Nov. 22, 2017).

Medicaid recipients at a nursing home were required to pay some of their income to the nursing home as a patient monthly liability amount. The recipients missed their payments and incurred a negative account balance with the nursing home. The recipients applied for a deviation in monthly payments based on the arrearage in payments to the nursing home, but the state either denied their requests or did not respond, claiming that under state regulations an arrearage in patient monthly liability is not a type of necessary medical expense that must be deducted from patient monthly liability.

The nursing home, as the designated representative for the Medicaid recipients, sued the state, alleging violations of the Medicaid Act’s medical assistance and nursing facility services mandate, among other things. Under the mandate, the state may reduce payments for long-term nursing home care if a resident has independent income, but the state may not consider amounts that the regulations allow a resident to set aside for other purposes, such as medical expenses. The state filed a motion to dismiss, arguing that the nursing home did not have a right to sue under § 1983.

The United States District Court, Eastern District of North Carolina, denies the motion to dismiss in part, holding that the medical assistance and nursing facility services mandate creates a private right of action that is enforceable under § 1983. The court rules that the federal Medicaid provision regarding Medicaid patient monthly liability amounts is “couched in mandatory, rather than precatory, terms.”

Advocates Oppose Tax Cuts That Will Jeopardize Health Care for Older Adults,
People with Disabilities & Their Families

Washington, DC ─ More than 40 organizations whose missions are to promote access to affordable, high-quality health care and long-term services and supports for older adults, people with disabilities, and their families, sent a letter to leaders in the US Senate as they consider tax changes this week. The letter expresses the organizations’ strong opposition to tax bills that would diminish health and long-term care availability and affordability for older adults and people with disabilities.

Both Senate and House tax bills under consideration would explode the national debt by $1.5 trillion and drive up the yearly deficit. The letter’s signatories oppose the bills because this tremendous revenue shortfall will lead to cuts in Medicaid, Medicare, Social Security and other programs that millions of older adults, people with disabilities, and their families rely on. For example, more than 57 million older adults and people with disabilities rely on Medicare, including 11 million low-income beneficiaries who have both Medicare and Medicaid.

The Senate tax plan repeals the Affordable Care Act’s (ACA) individual mandate and would leave 13 million Americans uninsured. The letter explains that this repeal will raise the costs of insurance for people with preexisting and chronic conditions, making it more difficult for the 3.3 million adults over 55 who obtain insurance through the ACA marketplaces to afford health care.

The elimination of the medical expense tax deduction, currently in the House bill, would also disproportionately harm older adults, people with disabilities and their families. This population has particularly high out-of-pocket health costs that create a significant financial burden. Repealing the medical expense tax deduction would threaten the financial security of people already struggling with health and economic challenges.

The organizations’ letter urges Senate leaders to adopt a bipartisan, transparent process for tax reform that takes these issues into consideration – and includes public hearings, open comments, multi-stakeholder meetings, and sufficient time for the Congressional Budget Office (CBO) to analyze the bill.

Read the full letter and see list of signatories here.

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The Center for Medicare Advocacy (http://www.medicareadvocacy.org) is a national, nonprofit, non-partisan law organization that works to advance access to comprehensive Medicare coverage and quality health care for older people and people with disabilities through legal analysis, education, and advocacy.

Justice in Aging (www.justiceinaging.org) is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.

The Medicare Rights Center (www.medicarerights.org) is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.

Center for Medicare Advocacy – Matt Shepard: 860-456-7790, mshepard@MedicareAdvocacy.org
Justice In Aging – Vanessa Barrington: 510-256-1200, vbarrington@justiceinaging.org
Medicare Rights Center – Mitchell Clark: 212-204-6286, mclark@medicarerights.org

By Robert Preidt, HealthDay Reporter

TUESDAY, Nov. 28, 2017 (HealthDay News) — More doctors in the United States are turning to a new clinical specialty — nursing home care.

The number of physicians and health care providers concentrating on nursing home patients grew by about one-third between 2012 and 2015, researchers from the University of Pennsylvania School of Medicine found.

The trend is likely driven by the aging population and increased federal government oversight of nursing homes, the researchers said.

“We don’t know how this trend will play out in the long term, but nursing home specialists have the potential to change the way health care is delivered in this setting,” said lead author Dr. Kira Ryskina, an assistant professor at UPenn.

“On one hand, clinicians who practice in the nursing home exclusively could improve patient outcomes and reduce costs by leveraging expertise in nursing home processes of care, for example,” Ryskina said in a university news release.

“But concentrating patient care among nursing home specialists could also mean that patients are no longer seen by their primary care providers, who traditionally follow patients for years and across care settings,” Ryskina added.

Nursing home specialists were defined as people for whom nursing home care accounts for at least 90 percent of their billing.

Analyzing Medicare data, the researchers found that the number of doctors, nurse practitioners and physician assistants who were nursing home specialists rose from about 5,100 in 2012 to more than 6,800 in 2015 — about 34 percent.

During that same period, there was little change in the overall number of these health care providers billing from nursing homes — 33,218 to 33,087.

Of all health care providers who do any work in nursing homes, 21 percent now “specialize” in nursing home care, according to the study.

The findings were published Nov. 28 in the Journal of the American Medical Association.

There are more than 15,000 nursing homes in the United States, with a total capacity of nearly 1.7 million beds. Because of a wide variation in the quality of health care, the U.S. Centers for Medicare and Medicaid Services has proposed reforms and penalties for low-quality care.

The nursing home industry may now be adapting to closer government oversight by employing physicians who specialize in nursing home care, according to the study authors.

Hospitals did something similar over the past two decades, the researchers pointed out.

“Hospitals in recent years have sought to improve care by concentrating it among ‘hospitalist’ physicians who focus on treating hospitalized patients,” Ryskina said.

“Twenty years ago, the hospitalist movement started in the same way, wherein hospitals were under pressure to reduce costs, and readmissions. We might be seeing the beginnings of a similar trend in nursing home care,” Ryskina added.

Article Courtesy of HealthDay.com