First look at 2006 WV Legislation and seniors; and it's not "HIPPA," it's "HIPAA"

You'll be the smartest one on your block if you learn that the infamous HIPAA (with 2 A's, one P) is actually the Health Information Portability and Accountability Act. Not HIPPA.

And back to things that really matter, our state legislature is now in its annual 2 month regular session. The state Bureau of Senior Services kindly publishes a weekly legislative roundup of the status of bills affecting seniors. From that large list I cooked down a few to keep an eye on:

Many about healthcare, including:

• requiring itemized statements of services billed for Medicaid recipients (SB 79, HB 2318)
• a good samaritan-type law waiving liability for physicians providing services to indigent people (SB 82)
• requiring health insurance policies to cover acupuncture (SB 104. 190)
• creating an Alzheimer's Caregiver Assistance Program (SB 109) and establishing an Alzheimer's Disease Registry (SB 112)
• authorizing dispensing and delivery of drugs to remote health clinics (SB 143)
• establishing the WV Fair Share Health Care Act allowing the state to offset healthcare costs from large employers who spend too little on employee health bene's (SB 147)
• permitting physicians to issue "do not resuscitate" orders on patients who lack healthcare decisionmaking capacity and for whom CPR would not be effective (SB 161, HB 4022)
• exempting from the Medicaid preferred drug list certain anti-psychotic drugs for certain high-risk patients (HB 2406)
• making in-home care available on a sliding fee scale for seniors age 65+ (HB 2324)
• requiring Alzheimer's training for certain personnel of longterm care facilities and adult day care facilities (HB 2649)
• establishes information sharing between pharmacies to prevent multiple prescriptions abuse (HB 2768)
• prohibiting pharmacists from refusing to fill prescriptions without valid reason (HB 2807)
• creates voluntary state income tax check-off to develop pharmaceutical assistance program for WV seniors (HB 3265)
  

Some particularly about nursing homes:

• adds "nursing homes" to the list of facilities whose certain unlicensed staff are authorized to administer drug (HB 2138)
• permits electronic monitoring of nursing home residents by themselves or their representatives (HB 2272)
• creates quality assurance program for nursing homes (HB 2281)
• requiring specific staffing levels in nursing homes and providing penalties for non-compliance (HB 2360)
  

Some about consumer issues, including:

• creating a physician's lien on injury awards and settlements (SB 48)
  
• creating an Insurance Advocacy Unit within the state Attorney General's Office (SB 140)
• requiring consumer notification of negative credit ratings (SB 185)
• eliminating the 90-day mandatory reinstatement of lapsed auto insurance policies (SB 198)
• prohibiting non-renewal of auto and property insuance policies (SB 203)
• exempting seniors age 65+ from having to pay the fees associated with redemption of property from tax sale within 2 years (HB 2097)
  
• requiring hospitals to disclose their infection rates (HB 2180)
• making the senior discount at campgrounds and parks year-round (HB 2300)
• requiring grab bars to be installed in all hotel and motel baths and showers (HB 2312)
• reducing the statute of limitation on consumers filing actions regarding revolving credit against creditors pursuant to the Consumer Protection Act (CPA) from 4 years to 1 year (HB 3113)
• eliminating the probate of uncontested small estates (HB 3221)
• increasing the amount of the homestead tax exemption from $20,000 to $50,000 (HJR 1) or from $20,000 to $40,000 (HJR 06, and 19)

Some about abuse, neglect, and protection issues:

• requiring Adult Protective Services to complete a face-to-face interview with an adult reported to be abused or neglected within 14 days of the report, and within 72 hours if imminent danger or serious physical abuse is alleged in the report (HB 2048)
• adding identity theft to the list of crimes for which victims can get victims compensation funds awarded (HB 2049)
• creating a program to reprogram and distribute (HB 2067, 2842)

And one that defies normal categorization: raising the age for which one may request to be excused from jury duty from 65 to 70 (HB 2013).

And this is just the beginning of the session, so there will likely be more bills affecting seniors in the next weeks.

Case of the Week: 1/9/06

County: Grant
Age: 64

This client contacted us because his administrative hearing with the Department of Motor Vehicles has been postponed. Our client was pulled over for drinking and driving. His attorney was able to get a favorable outcome in the criminal case since our client was not under the influence of alcohol; however, his administrative case to determine wether his driving privileges should be suspended has not happened yet because the arresting officer is currently serving in Iraq. Our client wanted to know his due process and administrative due process rights. I researched the issue for him and explained that although the WV Supreme Court has stated a driver's license is a property interest within the protection of the WV Due Process Clause, the commissioner under the Code of State Rules may postpone a hearing upon his own motion for good cause. Since the arresting officer, who is crucial to the hearing, will not be available, then the commission has the authority to postpone. Also, since our client still has his driving privileges, he is not being harmed by the delay. Our client is low income and the research we provided is quite valuable to him as it would have cost quite a bit to have a private attorney do the same research.

Coal Company Retirees, M'care Part D, UMWA update

This is a followup to my post last week in this blog about coal retirees getting threatened with losing their company healthcare benefits if they didn't enroll in a Medicare Part D plan by December 31, 2005.

According to Brian Sampson in the President's office at the United Mine Workers Union (UMWA), all the coal companies the UMWA deals with nationwide took the 28% government incentive to keep all their current retiree drug benefits in place except these four: Peabody, Consol, Arch, and Bluestone. These four companies instead demanded each of their retirees (and their dependants) enroll in a Part D plan or lose all retiree health coverage by December 31, 2005.

UMWA quickly went into negotiations with these four companies to advocate the position that the collective bargaining agreements in place guaranteed these retirees their existing benefits, and they could not be forced to enroll in a Part D plan to keep what they already had a right to. UMWA, however, did send letters to their member retirees recommending that they go ahead and enroll while the union continued to dispute the actions of the companies.

According to a press release from UMWA issued December 29, 2005, the companies have all agreed not to take away the health benefits of those who have not enrolled in drug plans while the dispute is resolved. According to Brian, all four companies have also agreed that they will provide wraparound coverage at the levels they provided before. This means that retirees would not have to pay any more out of pocket than they did before. Hopefully they would each have two prescription cards, one from the Part D provider they chose, and one from the company's provider which would cover deductibles and copays beyond the out-of-pocket limits they had before. If the companies require burdensome paperwork or other hoops for retirees to jump through to get the wraparound coverage, this will be an important issue for advocacy.

Also according to Brian all sides have agreed to expedite the issue, and if they cannot come to an agreement it will go through the Resolution of Dispute (ROD) process of collective bargaining, to be decided by a board of trustees. If the UMWA is not satisfied with that decision, they may take it to the next level which is arbitration. Brian expects that the resolution will be final before May 15, 2006, since all sides know that the federal legislation creating Part D imposes penalties on current beneficiaries who enroll after that date.

So at this point we at WVSLA agree that it is probably best for these retirees who have not yet enrolled to go ahead and do so. Humana is the company with the lowest premiums in West Virginia, and though UMWA does not endorse the company, they suggest their members who haven't chosen yet to consider enrolling in Humana to at least get enrolled in something. If the companies do provide wraparound coverage it won't much matter what the Part D plan covers since the companies will make up the difference, so low premiums will suit most retirees best.

Because of the agreements reached so far, retirees should not be experiencing coverage lapses. Consol retirees who are having problems with coverage at the pharmacy can contact Consol's retiree call center at 1-877-240-0139. Retirees from Peabody, Arch, and Bluestone who are experiencing coverage problems can contact the union at (304) 346-0342.

Coal Company Retirees and Medicare Prescription Drug Plan Enrollment

Just before the end of 2005 a panic developed among many Medicare-eligible coal company retirees. They got letters saying that they (and their spouses and dependents) would lose all their retiree healthcare benefits if they did not enroll in a Medicare prescription drug plan by December 31, 2005. These retirees have typically had excellent healthcare coverage, including some of the best prescription drug coverage of any retirement plans available in West Virginia. Some have paid no more than $50 out of pocket per year for drugs, even if they got thousands of dollars worth of prescriptions each year.

What about those retirees who are very sick and whose lives depend on costly medical care? What about those retirees who couldn't read or understand their letter (perhaps because of illiteracy, macular degeneration, mental incapacity, low education, etc.)? What about those retirees who never got the letter? What about the covered spouses and children of these retirees who never saw any such letter?

Even for those retirees and dependants who understood, there are literally 57 different drug plans available, each with different premiums, copayments, deductibles, and formularies. How could they possibly digest all that and make a good choice? The only real way to compare 57 different plans is through Medicare.gov's interactive Plan Finder database. How many of these retirees are computer-savvy enough to go through that process? Even if you can type and navigate the website, try typing "hydrochlorothiazide" or "metronidazole" without errors. And all this under the deadline of the busiest time of the year for many, the holiday season, with plenty of snow and cold to contend with.

Then those retirees who were also members of the United Mine Workers of America (UMWA) got letters saying that, though the union disagreed with the coal companies that they could take away retiree health coverage for failure to enroll in a drug plan, the union was recommending that affected retirees go ahead and comply by enrolling while they advocated their position.

For those who got the letters, understood them, and needed help choosing and enrolling in a plan, there was very limited help available. The process of choosing a plan can be time consuming, even using the interactive web-based Plan Finder. This is especially true for folks who take numerous prescription drugs. The toll-free numbers for Medicare, many of the drug companies, and other helping agencies were virtually impossible to get through on during those last weeks of December. One Morgantown senior said she finally hung up after being on hold with Humana (one of the popular and cheaper plan providers) with 1 hour and 40 minutes, hoping to enroll to keep from losing her benefits. Another had a surgery scheduled for January 5, 2006. Even if she could get her healthcare reinstated after successfully enrolling, if it couldn't be done in a week, she would have to bear the huge costs of a surgery because of the lapse in coverage.

At the last possible minute, in the Gazette-Mail on Saturday, December 31, 2005, Cecil Roberts of the UMWA is quoted as saying that retirees from Peabody, Consol, Arch, and Bluestone will not lose their coverage if they have not enrolled in a drug plan by December 31, 2005.

And yet this morning we have reports of covered retirees going to pick up their monthly prescriptions at the same pharmacies they've gone to for years and being told suddenly that they have been "red-flagged," and no longer have any drug coverage at all. Even some who have successfully enrolled in plans, but have not yet gotten their cards and coverage info.

Some of these prescriptions are a matter of life and death. Imagine the impact that all this confusion and threats of having no more coverage can have on a sick elderly retiree.

We are currently attempting to verify the quotes in the article, and to find out if there is still some deadline for these Medicare-eligible retirees to get enrolled in a plan to preserve all their retiree health coverage. As soon as we have more detail and confirmation, we will post it here.

Happy new year.