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Nelson: Closing Medicare ‘donut hole’ a ‘win-win’ for seniors and taxpayers

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U.S. Sen. Bill Nelson (D-FL) today urged Senate leaders to close the gap in Medicare’s prescription drug coverage, commonly known as the “donut hole” by 2019, as a way to not only lower the cost of prescription drugs for seniors, but also to help pay for additional disaster assistance needed in places like Florida and Puerto Rico.

Nelson says closing the so-called Medicare “donut hole” early would save taxpayers approximately $9 billion over ten years and help offset some of the additional spending being proposed in a budget deal the Senate is expected to take up later this week.

“Closing this gap in coverage will save seniors thousands of dollars every year on the cost of their prescription drugs,” Nelson said. “It also saves taxpayers more than $9 billion over ten years. To me, that’s a win-win for everyone.”

Under the nation’s current health care law, the Medicare “donut hole” is expected to close by 2020. Nelson says closing this gap in coverage by 2019, instead of 2020, and shifting more of the cost to drug makers, instead of Medicare, will help provide additional savings for both seniors and taxpayers.

According to the Department of Health and Human Services, previous provisions to close the “donut hole” have saved Florida’s 355,000 Medicare-covered seniors more than $350 million in 2015 alone. That’s an average annual savings of $987 per senior.

Nelson files bill to establish national panel on seniors and disasters

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U.S. Sen. Bill Nelson (D-FL) filed legislation today to create a national advisory committee to look for ways to better prepare and care for our nation’s seniors during a disaster, such as Hurricane Irma, which led to the deaths of eight seniors in a nursing home in Hollywood, Florida.
“What happened in Hollywood is inexcusable,” Nelson said. “This bill will require the head of HHS to appoint a panel of experts to provide our state and local leaders with the guidance they need to make sure such a tragedy never happens again.”
The bipartisan bill – cosponsored by Sens. Marco Rubio (R-FL), Susan Collins (R-ME) and Bob Casey (D-PA) – would require the secretary of Health and Human Services to establish a National Advisory Committee on Seniors and Disasters. The 15-member panel would be appointed by the secretary of HHS and made up of federal and local agency officials, as well as non-federal health care professionals with expertise in disaster response.
Once established, the panel would be charged with providing guidance to local, state and federal officials on how to better prepare seniors for an emergency, how to better evaluate their health needs during an emergency and what activities should be carried out when an emergency is declared.
The legislation filed today now heads to the Senate Committee on Health, Education, Labor and Pensions for consideration.
A copy of the bill text is available here.

Home care for seniors and disabled must be enough to prevent nursing home entry

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In her 90’s and unhappy with nursing home care, Josephine Hollister, wanted only to go back to her home of forty years to live out her life. Like more than 45 thousand Floridians who are elderly or disabled, Hollister was enrolled in the state’s Medicaid managed care program that is supposed to provide home health services for people who would otherwise need nursing home care. When Hollister went home, however, she was denied the services her doctors thought she needed. Determined to live on her own home, she exhausted her own small income and had to rely on voluntary help from her guardian to get the services she needed.
Hollister and four other citizens sued Florida’s Agency for Health Care Administration (AHCA), contending that the system places them at risk of having to enter nursing homes because adequate standards for home care were not in place. As the result of a recent settlement of the lawsuit, enrollees in the Long Term Care program will have significantly more protections in place to ensure that their care needs are adequately met at home.  Hollister was able to get the services she needed to stay in her own home, where she passed away on January 10th with her beloved dog by her side.
Under the settlement, AHCA agreed to adopt rules requiring Florida’s Medicaid Managed Care companies “to provide an array of home and community-based services that enable enrollees to live in the community and to avoid institutionalization.”
The plaintiffs contended that the managed care organizations ignored critical issues such as need for supervision, caregiver availability, and access to community services.
Nancy E. Wright, Esq., who filed the lawsuit along with Disability Rights Florida and Southern Legal Counsel, says, “The long-term care program is supposed to substitute for nursing home care, allowing people to remain in their own homes or in less restrictive community settings. When care needs are not met, caregivers are pushed to the extreme, and enrollees are not safe or just end up going into nursing homes, like it or not.”
“The Americans with Disabilities Act prohibits discrimination based on disability, which includes being forced into unnecessarily restrictive settings to receive care,” says Amanda E. Heystek, Esq., Disability Rights Florida. “Ms. Hollister wanted to live at home and just needed the right amount of care in order to safely do so.”
Disability Rights Florida was founded in 1977 as the statewide designated protection and advocacy system for individuals with disabilities in the State of Florida. It has been advocating for access to services, education, employment, independence, and the elimination of abuse and neglect for over 35 years.
Southern Legal Counsel, Inc. (SLC) is a Florida statewide not-for-profit public interest law firm that is committed to the ideal of equal justice for all and the attainment of basic human and civil rights. SLC primarily assists individuals and groups with public interest issues who otherwise would not have access to the justice system and whose cases may bring about systemic reform. SLC uses a range of strategies to achieve its goals, including litigation, policy advocacy, and training and technical assistance to lawyers, lay persons and organizations.
The Settlement Agreement referenced above resulted from Parrales et al v. Dudek (4:15-cv-00424), filed in the Northern District of Florida on August 27, 2015.