In another sales-sapping blow to Eli Lilly and Co., the Centers for Medicare and Medicaid Services has decided not to pay for patient use of a Lilly imaging drug used in Alzheimer’s assessments. The Indianapolis drugmaker said that it’s disappointed in the decision, which it called “contrary to expert opinion.” The CMS decision is a financial blow to Lilly’s Amyvid, a new drug marketed for use in brain scans to evaluate patients for Alzheimer’s disease and other brain dysfunctions. Approved by the Food and Drug Administration last year, Amyvid is the only drug of its kind on the market. In…
The CMS has approved a waiver that means Arkansas won't put residents eligible for the expansion on traditional Medicaid, but will instead be able to offer them private coverage. Arkansas Gov. Mike Beebe, a Democrat leading a deeply conservative state, crafted the option as a way to expand health care coverage without fully signing on to an expanded government program. His administration has been negotiating with the Centers for Medicare & Medicaid Services (CMS) for months over the waiver after the idea received an unexpectedly warm reception from Health and Human Services Secretary Kathleen Sebelius. Several other states have been…
One of the biggest fears that many people have today is the fear of having their life savings wiped out if they end up in a nursing home. What a shame to see someone’s life savings of 30, 40, or 50 years wiped out in a matter of months. Whether you or a family member is in a crisis or not, it is important that you understand what you can do to protect your hard earned assets! Most of the public does not yet realize that the laws on asset protection and long-term care planning has changed, therefore, it is…
Rep. Glenn Thompson (R-Pa.) introduced the Special Needs Trust Fairness Act of 2013 on May 23, 2013 (H.R. 2123). According to a press release from the National Academy of Elder Law Attorneys (NAELA), the bill would allow people with disabilities to create first-party special needs trusts to hold their assets without interfering with their access to Supplemental Security Income (SSI) and Medicaid. The bill addresses a quirk in the current law defining special needs trusts that prevents mentally competent people with disabilities from establishing so-called (d)(4)(A) trusts. As the law stands today, a first-party special needs trust must be created…
The U.S. Department of Justice has filed a lawsuit against the state of Florida, accusing it of violating the Americans with Disabilities Act (ADA) by placing children with severe special needs in nursing homes rather than in less restrictive settings. Last fall, a Justice Department investigation discovered that Florida had placed 221 children, many of whom require feeding tubes or ventilators, in nursing homes that are not equipped for juvenile patients. Investigators discovered that some children were left unattended for hours without adequate care. The state responded to the Justice Department's report with a promise to do better, but the…
Enroll America has rolled out its new toolkit to help maximize the number of Americans who enroll in health care coverage. An individual who has "presumptive eligibility" can be enrolled in Medicaid immediately if s/he answers a few questions and appears eligible. This is a temporary determination until more information can be gathered and assessed. This toolkit helps hospital administrators understand the opportunities provided by the ACA.
September 12, 2013SERVICE DELIVERY VISION: A more responsive, integrated, person-centered, and fiscally sustainable LTSS delivery system that ensures people can access quality services in settings they choose.Rebalancing – A Balanced Array of LTSS:Recommendation: Promote services for persons with functional limitations in the least restrictive setting appropriate to their needs– building a system, including Medicaid, with options for people who would prefer to live in the community.Integration:Recommendation 1: Establish a single point of contact for LTSS on the care team.Recommendation 2: Align incentives to improve the integration of LTSS with health care services in a person- and family-centered approach.Recommendation 3: Use…
One of the biggest fears that many people have today is the fear of having their life savings wiped out if they end up in a nursing home. What a shame to see someone’s life savings of 30, 40, or 50 years wiped out in a matter of months. Whether you or a family member is in a crisis or not, it is important that you understand what you can do to protect your hard earned assets! Most of the public does not yet realize that the laws on asset protection and long-term care planning has changed, therefore, it is…
On Aug. 1, 2013, the federal Commission on Long-Term Care held its third public hearing focused on “Strengthening Publicly and Privately Funded Long-Term Services and Supports” in SD-562 Dirksen Senate Office Building, Washington, D.C. The hearing consisted of four panels of witnesses on four subtopics: Panel 1: Strengthening Medicaid LTSS Panel 2: Strengthening Medicare for LTSS Panel 3: Strengthening Private Long-Term Care Insurance Panel 4: Interaction of Insurance, Private Resources, and Medicaid The 15-member commission was created by the fiscal cliff legislation and is tasked with developing recommendations for Congress on how to reform long-term care. Previous hearings focused on…
On the 48th anniversary of the signing of Medicare and Medicaid into law, the Department of Health and Human Services (HHS) released data showing that the average premium for a basic prescription drug plan in 2014 is projected to remain stable, at an estimated $31 per month. This news comes as seniors and people with disabilities continue to save money on out-of-pocket drug costs. Yesterday, HHS announced that more than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1,061 per beneficiary. The Affordable Care…
Frederick, MD 
301-663-9230
