HHS Announces New Affordable Care Act Options for Community-Based Care

April 26, 2012
Contact: HHS Press Office
(202) 690-6343

Medicaid and Medicare introduce greater flexibility for beneficiaries to receive care at home or in settings of their choice

New opportunities in Medicaid and Medicare that will allow people to more easily receive care and services in their communities rather than being admitted to a hospital or nursing home were announced today by Health and Human Services Secretary Kathleen Sebelius.

HHS finalized the Community First Choice rule, which is a new state plan option under Medicaid, and announced the participants in the Independence At Home Demonstration program. The demonstration encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Both are made possible by the Affordable Care Act. Studies have shown that home- and community-based care can lead to better health outcomes.

“We know that people frequently prefer to receive services in their own homes and communities whenever possible. The rule and demonstration announced today give people choice and provide states with flexibility to design programs that better meet the needs of beneficiaries,” Secretary Sebelius said. “Prior to passage of the Affordable Care Act, many families had few choices beyond nursing homes or other institutions for their loved ones. The actions taken today will help change that and can lead to better health for these individuals.”

The final rule released today on the Community First Choice Option provides states choosing to participate in this option a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution.

Also today, the first 16 organizations that will participate in the new Independence at Home Demonstration were announced. They will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients living with chronic illnesses. These 16 organizations were selected from a competitive pool of more than 130 applications representing hundreds of health care providers interested in delivering this new model of care.

The Independence at Home demonstration, which is voluntary for Medicare beneficiaries, provides chronically ill Medicare beneficiaries with a complete range of in-home primary care services.  Under the demonstration, the Centers for Medicare & Medicaid Services (CMS) will partner with primary care practices led by physicians or nurse practitioners to evaluate the extent to which delivering primary care services in a home setting is effective in improving care for Medicare beneficiaries with multiple chronic conditions and reducing costs. Up to 10,000 Medicare patients with chronic conditions will be able to get most of the care they need at home.

The demonstration is scheduled to begin on June 1, 2012, and conclude May 31, 2015.

HHS is also seeking comment on a proposed rule that describes a separate Home and Community-Based Services state plan option, which was originally authorized in 2005 then enhanced by the Affordable Care Act. Like the Community First Choice Option, this benefit will make it easier for states to provide Medicaid coverage for home and community-based services.

“Our goal is to provide person-centered support to every Medicare and Medicaid beneficiary, regardless of their physical ability or chronic health conditions,” Acting CMS Administrator Marilyn Tavenner said. “These services and programs will help keep these individuals’ health stable, and keep them home where they want to be, while giving us even more tools to achieve better care for the patient, better health for the population, all at lower costs.”

The announcements made today are one part of the Obama administration’s efforts to help people with disabilities and those living with chronic illness stay in their own homes when they wish to do so.  Earlier this month, Secretary Sebelius announced the creation of the new Administration for Community Living, bringing together key HHS organizations and offices dedicated to improving the lives of Americans with functional needs into one coordinated  and stronger entity. This new agency will work on increasing access to community supports and achieving full community participation for seniors and people with disabilities.

For more information on the Administration for Community Living visit: http://www.hhs.gov/acl/.

For more information on the Community First Choice Option visit: http://www.cms.gov/apps/media/fact_sheets.asp.

For more information on the Independence at Home demonstration and the organizations selected to participate visit:http://innovation.cms.gov/initiatives/independence-at-home.

The rules may be viewed at www.ofr.gov/inspection.aspx.


Health Reform Helps More Than 5.1M People with Medicare Save over $3.2B

March 19, 2012
Contact: HHS Press Office
(202) 690-6343

Since enactment of the health care law, Medicare beneficiaries received average savings of $635 on prescription drugs

As the second anniversary of the Affordable Care Act approaches, new data shows that more than 5.1 million seniors and people with disabilities on Medicare saved over $3.2 billion on prescription drugs because of the new health care law, Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), announced today while at the St. Louis Community College at Forest Park.

For St. Louis resident Fritzi Lainoff and her husband, the discounts meant $2,500 back in their pockets last year. “It was a blessing,” she said. “The law’s Medicare savings have made an enormous difference.”

Savings for seniors include a one-time $250 rebate check to seniors who hit the “donut hole” coverage gap in 2010 and a 50 percent discount on covered brand-name drugs in the donut hole in 2011.

In addition, data released today by the Centers for Medicare & Medicaid Services (CMS) show that through the first two months of 2012, about 103,000 seniors and people with disabilities saved $93 million in the donut hole.

“Without the health care law, more than 5.1 million seniors would have faced $3.2 billion in higher drug costs,” Secretary Sebelius said.  “As we move forward, seniors will save even more as the new law completely eliminates the Medicare donut hole, delivering more relief to Americans like the Lainoff’s.”

In 2012, Medicare beneficiaries will receive a 50 percent discount from manufacturers on covered brand name drugs and a 14 percent savings on generic drugs in the donut hole. The Affordable Care Act expands these discounts over time until the donut hole is closed in 2020.

“Already this year, tens of thousands of seniors and people with disabilities are starting to see increased savings as they enter the donut hole,” said CMS Acting Administrator Marilyn Tavenner.  “The Affordable Care Act has made prescription drugs more affordable for Medicare beneficiaries, protecting the health and pocketbooks of millions of America’s seniors.”

For more information on how the Affordable Care Act closes the donut hole over time, please visit:http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html

For a report on how the Affordable Care Act strengthened Medicare in 2011, please visit:http://www.cms.gov/apps/files/MedicareReport2011.pdf

En Español

PPACA: Enforcement Efforts Recover ~$4.1B

February 14, 2012
Contact: http://www.justice.gov | (202) 514-2007
HHS Press Office | (202) 690-6343

Health Care Fraud Prevention and Enforcement Efforts Result
in Record-Breaking Recoveries Totaling Nearly $4.1 Billion

Largest Sum Ever Recovered in Single Year

WASHINGTON –Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011.  This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.

These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration.  The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars.  These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.

“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder.  “We can all be proud of what’s been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS.  These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius.  “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”

Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011.  This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.

The recently-enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities.  The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.

Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams.  During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud.  The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.

In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General, dedicated to fighting fraud.  The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers.  In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion.  Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison.  The average prison sentence in strike force cases in FY 2011 was more than 47 months.

Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes.  This is the highest number of health care fraud defendants charged in a single year in the department’s history.  Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.

In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act.  These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.

The departments also continued their successes in civil health care fraud enforcement during FY 2011.  Approximately $2.4 billion was recovered through civil health care fraud cases brought under the False Claims Act (FCA).  These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks.  This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.

The fraud prevention and enforcement report announced today coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements today are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.

The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp.  For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.

For more information on the fraud prevention accomplishments under the Affordable Care Act visit:http://www.healthcare.gov/news/factsheets/2012/02/medicare-fraud02142012a.html

Twisting a Rite to Deny Rights

Yesterday, presidential candidate Mitt Romney blasted the ruling put forth by the 9th Circuit Court of Appeals:

“Today, unelected judges cast aside the will of the people of California who voted to protect traditional marriage,” Romney said. “This decision does not end this fight, and I expect it to go to the Supreme Court. That prospect underscores the vital importance of this election and the movement to preserve our values. I believe marriage is between a man and a woman and, as president, I will protect traditional marriage and appoint judges who interpret the Constitution as it is written and not according to their own politics and prejudices.”

And like Romney, conservative media pundits piled thickly on that theme claiming the court had “no” right to overturn a majority of the voters. Excuse me? Apparently conservatives believe that if a majority of Americans voted to say that black Americans had no right to vote, or that women had no rights to property that would be acceptable to them as well?

I’m sorry Mr. Romney, but I agree with the 2-1 ruling of the Circuit Court Panel which said, “Proposition 8 served no purpose, and had no effect, other than to lessen the status and human dignity of gays and lesbians in California.” Proposition 8 may have been approved by 52% of California’s voters, but a majority vote should never be the standard for denying equality of rights to any of American’s citizens. “Proposition 8 served no purpose and had not effect, other ban to lessen the status and human dignity of gays-and-lesbians, in California.” As such, the Panel declared Proposition “unconstitutional” under the U.S. Constitution.

The whole issue of “marriage” is a tricky thing. If marriage were just a religious rite, that would be one thing, but marriage goes far beyond just a religious rite. Marriage is a legal construct recognized within our tax code that bestows beneficial tax privileges to such couples, not just annually, in terms of what couples jointly are required to pay, but in terms of property inheritance rights as well. There are also other legal ramifications relative to who can or cannot speak for your interests when you’re incapacitated, and even who might be handed this country’s flag when one’s partner makes the ultimate sacrifice for this country.  Denying the right to marry to gay and lesbian couples legalizes discrimination against them in the following ways:

  • Denying more preferential “joint income” tax rates by the IRS and state taxing authorities
  • Denying them the ability to create “family partnerships” which would allow them to divide their small business income amongst family members
  • Denying them the ability to “inherit” a share of a spouse’s estate without tax consequence.
  • Denying them any exemptions from estate and gift taxes
  • Denying them the ability to set up estate trusts that are restricted to just “married” couples
  • Denying them priority in being appointed as a “conservator” for your partner’s (spouse’s) affairs when he/she is incapacitated
  • Denying them the ability to obtain spousal benefits under government Social Security, Medicare, or disability programs
  • Denying them the ability to obtain veterans/military benefits as spouses
  • Denying them the ability to draw spousal retirement plan benefits as the spouse of the deceased plan member
  • Denying them the ability to take bereavement leave for the death of their partner (spouse).
  • Denying them the ability to be considered as “immediate family” for purposes of being able to visit in an ICU
  • Need I go on?

Gay and Lesbian couples had been given, by law, the right to marry. Then in 2008, a majority of voters participating in the 2008 election decided they wanted to take that fundamental, given right away for no reasonable and necessary reason. In addition, it would have “legalized” discrimination in terms of taxation and other allowable rights against an entire class of people in our society. If we permit this type of discrimination and taking of rights for this one class of citizens, who or what is next? How long would it take for our nation to approach they type of tyranny that was every present in pre-WWII Nazi Germany where millions of it’s citizens were ultimately condemned and went up in the smoke of a large number of incinerators.

Well, Mr. Romney, who’s the Nazi now?

Read more about the Rights and Benefits of Marriage the Right wants to deny to Same-Sex couples here