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FOR IMMEDIATE RELEASE: December 27, 2005

Schumer: Oldest, Most Vulnerable Seniors In Rochester Nursing Homes Hit Hardest By Medicare Prescription Drug Plan Confusion

Medicare Plan Automatically Enrolls Some Seniors In Plans Without Notifying Nursing Home; Assigned Plan Might Not Even Work At Nursing Home Pharmacy; Some Residents Without Caregiver Can’t Change Enrollment

Typical Nursing Home Resident Is 84 Years Old, Has Eight Significant Health Problems And Takes Nine Medications; Medicare Plan Tells Nursing Home Operators To Give 800 Number To Residents

With approximately 7,000 nursing home residents in the grater Rochester area, U.S. Senator Charles E. Schumer today revealed that as confusing as the new Medicare drug plan is for healthy seniors, confusing regulations and arbitrary enrollments make it nearly impossible for nursing home residents and operators to get the right plans. For the two thirds of nursing home residents who are both Medicaid/Medicare eligible, the problems are stark. Many of these people are randomly enrolled in plans without the knowledge or participation of the nursing home medical staff or pharmacies. Often the randomly selected plan might not cover all the drugs that a particular resident needs. Many nursing homes operate their own pharmacies and residents have been assigned to plans that do not include their pharmacies. Many isolated residents without a authorized decision maker nearby can’t even change their plan to a more appropriate one. To make matters worse, nursing home operators are prohibited from giving residents recommendations about which plan to enroll in.

“While the new Medicare prescription drug plan is bad enough for healthy, educated seniors, it’s total chaos for the most vulnerable seniors living in nursing homes,” Schumer said. “For almost two-thirds of nursing home residents, it appears that some Medicare computer in Washington automatically picks a plan for a senior without regard for what drugs they take or what drugs the pharmacy at the nursing home they live in can provide. To make matters worse Medicare tells nursing home operators to give an 800 number or website to some of the very seniors who need help eating, getting dressed, and moving around. These regulations border on insanity and seem almost intentionally designed to throw our long term care facilities into total disarray. I’m writing to the Center for Medicare Services and demand they immediately streamline the process for long term care facilities.”

Across the United States here are about 18,000 nursing homes in the United States, about 2 million nursing home residents. In Monroe County approximately 20,000 seniors are Medicare/Medicaid dual eligible, over 4,500 of whom live in nursing homes.

The New York Association of Homes and Services for the Aging said that, “Medicare Part D is creating a tidal wave of concern on the part of nursing home residents, their families and the providers who are trying to serve and protect those in their care.”

Dual Medicare/Medicaid Eligible Seniors. Roughly two-thirds of nursing home residents are “dual-eligibles” meaning that they qualify for both Medicaid and Medicare. Starting at the beginning of the year, all of these dual-eligibles will have the new Medicare drug plan paying for drug coverage instead of Medicaid (Medicaid has previously covered drugs for dual-eligibles). Current dual-eligible nursing home residents must enroll in a Medicare drug plan before Jan. 1 or the Center for Medicare Services (CMS) will automatically—and randomly—enroll in one of possibly dozens of plans in their area. Nursing homes often only have one pharmacy that serves the residents of the nursing home. If a beneficiary is automatically enrolled in a plan that does not work with the nursing home pharmacy, come Jan. 1, that beneficiary will not have access to drug coverage.

Most nursing home residents are on an average of 8 drugs. All 8 drugs would need to be covered by the plan a nursing home resident is enrolled in—this is unlikely to happen if a beneficiary is randomly assigned to one of fifteen plan. Furthermore, because of CMS guidelines, nursing homes must search online or fax a request to CMS to ascertain what plan the residents have been auto-enrolled in. This request takes up for 10 days for CMS to process.

Restrictions On Nursing Home Operators: CMS guidelines prohibit nursing home staff/providers/pharmacists from “steering” their residents to specific plans. Nursing homes have been instructed to use toll-free numbers and internet resources. A typical nursing home resident is 84 years of age, suffers from eight different diseases and is on nine medications at any given time. Over half of all nursing home residents have some level of cognitive impairment. Many of these elderly, sick residents do not have a local friend or family member to assist them in this choice. However despite the isolation, illness, and mental impairments of many nursing home residents, nursing home staff are unable to help each resident find the right plan for them. Nursing home staff are told to give their aged, infirm residents the 800 number and Medicare website. Seniors without healthy attentive relatives have no outlet for help.

Today, Schumer sent a letter to CMS asking the department to for certain changes to expedite the Part D enrollment process for nursing home residents and operators. Those changes include:

• Establish a dedicated hotline for nursing home providers to expedite nursing home requests for information on their residents.
• Prevent CMS from auto-enrolling nursing home residents in random plans. Increase coordination between CMS and nursing homes to choose the most comprehensive plan available in that area, and use that plan as the default for auto-enrollment for those residents.
• Require nursing homes to ensure that their residents’ medications are covered in their plans’ formularies and that their plans allow for participation with dedicated long-term care pharmacies.
• Allow long term care facility health providers or social workers more flexibility in helping a resident to choose a plan
• Provide reimbursement to nursing home providers for time spent advocating for their residents


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