ElderWeb

The Florida Agency for Health Care Administration announced that they have published a new guidebook online, called Understanding Prescription Drug Costs. The guide contains information for everyone who needs prescription drugs - whether or not they have health insurance to cover those costs. The purpose of this brochure is to help consumers know what cost-saving options there are and what questions to ask. They point out that the best sources of information to help save money on prescription drugs are physicians, pharmacists, and the customer service or employee benefits office of your health insurance plan. The brochure is a new addition to the extensive information about drugs available on FloridaHealthStat.com, the official source of consumer healthcare information from Florida government health and human service agencies.

The Florida Legislature is considering budget changes for Medicaid long term care programs. Among the changes requested by the Agency for Health Care Administration is a new program incorporating competitive bidding or capitation into the program used to reimburse nursing homes for Medicaid services, which is projected to provide $23 million in savings. Other reductions in spending include the elimination of the "Intermediate" category of nursing home service and the transfer of residents in this program to assisted living facilities, and an additional $23 million to buy more community services to allow elder Floridians to stay in their own homes.

To reduce the spiraling cost of the Medicaid budget, eligibility for Medicaid for people age 65 or older would be limited to those with incomes of no more than 87.5% of the Federal Poverty Guidelines, down from the current cap at 100% of the poverty level. The state would also no longer pay the Medicare Part B deductibles and coinsurance for people who are eligible for both Medicare and Medicaid, and they plan to create a restricted drug formulary to limit the prescription medications which would be covered by Medicaid.

Insure.com reports that 15 Palm Beach County, Fla., residents went to court on Jan. 22, 2001, charging Prudential Insurance Co. with fraud and racketeering and seeking $1 billion in damages. They are charging Prudential with questionable sales tactics targeted at elderly residents, including a "vanishing premium" scheme, in which an agent claims a life insurance policy's cash value will perform so well that the buyer can stop paying premiums within a certain number of years, and avoiding the term "insurance" to sell cash value life insurance policies as "personal pension plans." The plaintiffs in the case all opted out of a class action lawsuit against Prudential that the company settled in 1996 for more than $2 billion.

In a November 1st memorandum to Florida Lt. Governor Brogan's task force, Northeast Florida Area Agency on Aging Executive Director Annette Kjeer said that in Jacksonville, eight of the largest of 37 participating ALFs were withdrawing from the Assisted Living Waiver program, and the remaining ALFs in the program are too small to handle what is approximately one-third of the total client population.

The Assisted Living Waiver program helps lower-income elderly in need of daily assistance to live in an assisted living facility, a less expensive alternative to state-funded nursing home care, and for the elderly person, a much less restrictive residential setting. For a facility to participate in the waiver program it must hold extended congregate care (ECC) or limited nursing services (LNS) licenses. Insurers are telling ALFs they will no longer cover facilities holding these licenses because of the greater potential for lawsuits, so many are dropping their ECC and LNS licenses so they can continue to stay open. Unlike nursing homes, Florida law requires ALFs to carry liability insurance as a condition of licensure.

The Florida Health Care Association, an organization of facility operators, warned that the insurance crisis jeopardizes the assisted living program. They said that some elderly clients may have no other option than state-funded nursing home care, the very thing the Assisted Living Waiver program was intended to prevent. They also report that Florida long term care facilities are three times more likely to be sued than a non-Florida facility because of the unique Florida law that provides incentives to sue nursing homes and assisted living facilities. As a consequence, Florida has the highest liability insurance rates in the nation. A recent Department of Insurance report confirms liability insurers fleeing Florida.

Lt. Governor Frank Brogan heads up a task force created to investigate the availability and affordability of long-term care, including the liability insurance crisis faced by long term care providers in the state of Florida.

Governor Jeb Bush of Florida has proposed a series of initiatives designed to make Florida an "Elder-Friendly" state. Among other things, the governor proposes dedicating $46 million in new funding to improve the quality of nursing home care, $52.4 million to expand community-based options in long-term care for elders, $2.5 million to increase Medicaid fees for home health agencies, and $30 million to fund a new program to assist low-income elders in obtaining needed prescription drugs.

He also is encouraging communities and businesses to attain an "Elder-Ready" brand from the state which will greatly improve the livability of a community for elders. An elder-ready community has: easy access to drug stores, reliable transportation to medical care, pedestrian-friendly traffic lights and walkways, adequate lighting in public places, call boxes to enhance safety, zoning for elder-friendly housing, adequate health providers with gerontological training and much more.

In addition, Governor Bush indicated he is in favor of addressing the cost of litigation of long term care facilities, and noted that 30 assisted living facilities have been notified that they are at risk of losing their licenses because they do not carry liability coverage due to the cost or lack of availability of such insurance.

National HealthCare announced that it will cease operation of 12 owned or leased long-term health care centers and three assisted living centers in Florida. The divestiture, which will take place by October 1, 2000, will be done because NHC cannot obtain liability insurance for its Florida properties. The Florida centers are being leased to non-NHC affiliated companies. Negotiations are underway to replace liability insurance in other states with NHC properties. NHC operates 108 long-term healthcare centers, 35 homecare programs, 445 retirement apartments, 774 assisted living units, and two managed centers.

FloridaHealthStat.com, a new website created by the Agency for Health Care Administration this year, has officially been designated by the Governor's Office as the state's health care electronic portal. All four major health care agencies (AHCA, Dept. of Health, Dept. of Children & Families, and Dept. of Elder Affairs) will all be linked together on the one website. Consumers will then be able to retrieve all types of health care information from this one site. Information will include physician profiles, hospital and nursing home evaluations and a host of other information.

The Florida Department of Elder Affairs has prepared two disaster preparedness guides for older Floridians. They are "2000 Disaster Preparedness Guide for Elders" and the "What Should You Do If A Hurricane Threatens Your Community?" brochure. These guides are designed to help consumers plan for the possibility of a hurricane in the impending hurricane season, and deal with things like developing an escape plan, making a decision to evacuate, and what to do with the family pet.

The Miami Herald reports that the waiting list for services to help the elderly remain independent and in their homes is growing. Lat year the state used money from the Lawton Chiles Tobacco Endowment Fund to nearly eliminate the waiting list for community care for the elderly. The money represented a hefty increase for the programs, which many felt were underfunded for years. But the lists for community care and home care for the elderly are growing again, and more than 1,600 seniors in Broward and more than 1,900 in Miami-Dade await services today and some South Florida seniors have been waiting nearly a year for help.

Although the aid these seniors seek, such as house-cleaning or assistance with bathing, could mean the difference between living independently or moving to an assisted living facility or nursing home. In the past, elder advocates have tracked the waiting list as an indicator of unmet needs among the state's seniors. In the coming months, the state's Department of Elder Affairs plans to replace the traditional wait list with a new list that state officials say will eliminate redundancies and rank people according to need.

But the bulk of the funding increases is for Medicaid waiver programs, which focus on lower-income seniors. The division helps about 2,500 people a year. To take care of the current waiting list, Stephen Ferrante, interim director of the division, estimates he'd need $2 million more a year from the state.

The Florida Legislature has create a Task Force on the Availability and Affordability of Long-term Care, to study issues related to the provision of long-term care to the elderly in nursing homes and alternatives to nursing homes, and to make recommendations to the Governor and the Legislature. The Task Force has until the end of the year to come up with its proposals. The group will hold hearings in Tampa, Miami, Pensacola and Tallahassee this summer and fall to listen to the public.

The legislation states that the task force shall, at a minimum, study and make recommendations concerning the following:

The availability of alternative housing and care settings for the elderly, including the use of rent-subsidized facilities, assisted living facilities, and adult family care homes.

The availability of community-based care arrangements that support elderly individuals to age in place in their own homes and in alternative housing and care settings.

The role of family members in caring for elderly relatives and ways in which quality family care can be encouraged.

The adequacy of reimbursements for the cost of providing care to the elderly in nursing homes and in alternative housing and care settings.

The availability and affordability of long-term-care insurance coverage and the potential for funding long-term care through such coverage.

The role of the certificate-of-need process in the development of systems of long-term care for the elderly.

The extent to which the quality of care in long-term-care facilities in this state is compromised because of market changes that affect the financial stability of the long-term-care industry.

The effect of lawsuits against nursing homes and long-term care facilities on the cost of nursing home care and on the financial stability of the nursing home industry in the state.

The cost and availability of liability insurance coverage for long-term-care providers and the extent to which such costs affect the affordability of care.

The primary causes for recent bankruptcies facing the nursing home industry.

The ways in which other states have promoted the development of alternative and homebased care and what they have learned from these innovations.

The difference between the quality of care provided by for-profit skilled nursing facilities and by not-for-profit skilled nursing facilities.

The Florida Department of Insurance (DOI) has charged eight men with fraudulant activity related to the sale of viatical settlements. The eight suspects targeted for arrest are charged with submitting false information on a total of 11 life insurance applications to get more than $1 million worth of coverage from various insurers. The policies then were sold to viatical settlement providers for more than $700,000. These provider-companies marketed the fraudulently obtained policies to unsuspecting investors. All told, the eight are linked to the purchase of a total of 47 policies worth $4.9 million from 32 different insurance companies.

Viatical settlements involve the sale of a life insurance policy by beneficiaries who would like to receive a reduced amount of the policy benefits early, rather than having the full amount of the benefits go to their heirs after their death. Viaticals have traditionally been used as a way to provide cash to pay for long term care and other end-of-life costs for people who are very ill and close to death, although beneficiaries who are not near death can also sell policies to viatical settlement companies. There have been many instances of fraud in both the ways policies are purchased from beneficiaries, and the way viaticals are marketed to the public as investments.

The Lawton Chiles Endowment Fund is a $2-billion fund developed from Florida?s legal settlement with tobacco companies. When Governor Jeb Bush proposed the Chiles endowment last year, he said the money should go to Florida's neediest citizens, half for children's programs, half for the elderly. But when the Legislature ironed out the details this month, programs for the elderly received only one-sixth of the money in the fund. Half of the funds did go to programs for children, but the remainder of the money originally intended for programs for the elderly ended up being devoted to biomedical research.

Advocacy groups feel that programs for the elderly have been shortchanged, and point out there are many ways that money could be used to improve programs for caregivers and other aging initiatives in Florida. Opponents state that biomedical research will help the elderly, too. Larry Polivka, director of the Florida Policy Exchange Center on Aging at the University of South Florida, said the legislation caught him and other elderly advocates by surprise. The Florida chapter of AARP, which first heard about the legislation last week, was debating whether to ask Bush to veto it.

Both the Florida House and Senate have unanimously passed S940-The Prescription Affordability Act for Seniors, a bill to provide pharmaceutical assistance to the elderly in Florida. The act is a catastrophic pharmaceutical expense assistance program for people who qualify for limited assistance under the Florida Medicaid program as a result of being dually eligible for both Medicare and Medicaid, but whose limited assistance or Medicare coverage does not include any pharmacy benefit. Specifically eligible are low-income senior citizens who are Florida residents age 65 and over, who have an income between 90% and 120% of the federal poverty level, who are eligible for both Medicare and Medicaid, who are not enrolled in a Medicare health maintenance organization that provides a pharmacy benefit, and who request to be enrolled in the program.

As a condition of participation in the Florida Medicaid Program or the pharmaceutical expense assistance program, a pharmacy must agree to charge any individual who is a Medicare beneficiary and who is a Florida resident showing a Medicare card when they present a prescription a price no greater than the cost of ingredients equal to the average wholesale price minus 9%, and a dispensing fee of $4.50.

The program will be administered by the Agency for Health Care Administration (AHCA) in consultation with the Department of Elderly Affairs (DOEA).

Florida Treasurer Bill Nelson and Statewide Prosecutor Melanie Ann Hines have been probing the viatical business in Florida. Viatical providers and brokers buy life insurance policies, usually from the terminally ill, and resell them to investors who recoup their money plus some return when the insured dies. By selling a policy for a percentage of its face value, the insured can get cash now for medical, living or other expenses, by giving up a bigger payoff at death for one?s beneficiaries. The viatical business once focused on those dying from a terminal illness, now is targeting new clients - usually seniors with high payoffs - who may be willing to sell their life insurance policy to investors at a discount.

The business can be lucrative for dealers. Future First paid the insured as little as 12% of the face value for policies it bought, investigators said, and Life Benefits received a $48,510 commission for helping arrange the sale of just one policy for $122,746. Because of that, there is the opportunity for fraud on two levels. The insured may be victimized in the sale of the life insurance policy, and prospective investors (who are often elderly people themselves) may be defrauded when they purchase these policies as investments.

Nelson now is proposing to expand the state law governing viatical sales by the terminally ill to also cover the sale of life insurance policies of seniors and others. In an interim report issued Friday, the Statewide Grand Jury also made a series of recommendations for consideration by the Legislature, including increasing the penalties for viatical fraud from a misdemeanor to a felony.

Nursing home providers in Florida say the state's long term care system is near collapse because of runaway lawsuits, due to a loophole that currently gives trial lawyers incentives to sue nursing homes under a Florida law that applies only to long term care facilities. They say that lawsuits have resulted in sharply higher liability insurance rates which could force nursing homes across the state to close their doors. The Florida Association of Homes for the Aging said a survey of 23 of its members reported average premium increases of 177% this year, with some increases topping 1,000%.

The Florida Health Care Association and the Florida Association of Homes for the Aged called on state lawmakers to change the law under which nursing homes may be sued. Currently 20% of Florida's 82,000 nursing home beds are operating under Chapter 11 bankruptcy protection and provider spokesmen say that nursing homes in the state are three times as likely to be sued as nursing homes in other parts of the nation. Medicare cutbacks and low Medicaid reimbursement rates have contributed to significant financial problems for the industry, but an increase in liability lawsuits is bringing the crisis to a head.

The president of the Florida Medical Directors Association urged legislators to seriously consider proposals to make changes to the law, and said that physicians increasingly are trying to avoid treating the elderly in nursing homes for fear of becoming entangled in litigation.

Trial lawyers bringing lawsuits against the nursing homes say that legislation should not be changed to protect the owners against the results of their own mismanagement, and that the current law protects residents against abuse and neglect, and also ensures that family members may sue on behalf of their relatives.

SB 1222, introduced by Senator John McKay, was established to set up a long-term care study commission to report on this issue to the Legislature in January. House leaders are also considering introducing legislation.

The St Petersburg Times reports that a former insurance agent who swindled elderly clients out of $1.3 million has been sentenced to 10 years in jail and 10 years on probation. Had the judge followed sentencing guidelines, the punishment would have been only 17 months in jail, but he exceeded the guidelines because the victims were especially vulnerable because of their age. Many victims lost their life savings. One 72 year-old victim who lost $30,000 had to come out of retirement and return to work. The swindler was ordered to pay restitution, but it appears unlikely that any of his victims will be able to collect anything.