State and Community News California Passess The recently enacted California Adult Day Care Act (AB 1611) calls for a community-based system of adult day health care which will enable older persons with medical or psychiatric impairments to maintain independent living. Therapeutic, social, and health activities and services are to be included. An Adult Day Health Care Review Committee will be established in the State Department of Health. The Committee will include representatives of the Department of Aging and the California Commission on Aging, who will establish guidelines and administer the program. A local committee to review county plans will also be established. In turn, this committee will recommend individual proposals. In order to obtain a license, a local center must meet requirements in the Act. Only city or county governments and non-profit corporations may operate a center. Medi-Cal recipients will also be eligible for services. A companion Act, AB 1612, provides start-up funds for Adult Day Care Centers. Other legislation benefiting the elderly includes AB 998 which calls for setting up model multi-purpose centers. Section 9400 of this Act establishes pilot projects to develop information about effective methods to prevent premature disengagement of older persons from their communities and subsequent commitment to institutions. Senior services are to include a coordinated, integrated system of delivering social and health services. Connecticut Issues Services Brochure A brochure entitled "A Senior Citizens Reference Journal on Available Services" has been issued by the Division on Aging of Hartford, Connecticut. The 12 page guide describes a variety of services provided by the city for persons over 60. Information on each program includes location, eligibility, hours of operation, fees, and level of care. Programs discussed include the medical, dental, optometry, and podiatry programs, the Dial-A-Ride transportation program, the crime prevention project, social counseling, job placement, and assistance with such financial matters as preparation of income tax returns and budgeting. Also listed are the names, addresses, and phone numbers of senior centers in Hartford, and phone numbers for the Connecticut Department of Social Services, the Poison Information Center, Hartford Fire Department, Food Stamp Office, and Temporary Emergency Housing office. Copies of the brochure are available from Dr. Leonard F. Menczer, Director, Division on Aging, 354 Main St., Hartford, Conn. 06106. Dr. George Davis, Dr. George E. Davis, first Executive Director of the Indiana Commission on the Aging and Aged and a nationally recognized authority in the field of gerontology, died at the age of 84 in March. A charter member of the Indiana Commission on Aging, Dr. Davis served as Vice-Chairman under Dr. Frank O. Beck and as chairman from 1957 until 1960. At that time he was appointed the commission's first executive director, a post he held for 12 years. He continued as a commission member and in July 1977, was named Chairman Emeritus. During Dr. Davis' tenure on the commission he became one of the chief architects of Indiana's programs for the elderly. In the 23 years since the commission was created, Dr. Davis led the agency in encouraging programs, centers, and housing units for the elderly. He saw the area agency concept established and county councils on aging organized in each of Indiana's 92 counties. Under his leadership, planning grants for the nutrition program were started in nine areas. This program was the forerunner of the present one which currently serves 13,000 lunches each week day in about 350 locations throughout the state. Dr. Davis also chaired the education committee of the first White House Conference on Aging and helped to form the Indiana InterCollege Council on Aging which was the first in the United States. Maryland Opens More Dr. Matthew Tayback, Director of the Maryland Office on Aging, has announced that three additional homes have received certification as sheltered housing. They include Strawbridge Estates in Carroll County, Locust Lodge in Anne Arundel County, and a smaller duplex home in Washington County. Sheltered housing facilities will be certified in the future by the Office on Aging after consultation with the State Department of Health and Mental Hygiene, the county health officer, and the local government. The consultation is designed to insure conformance with local housing codes. "Sheltered housing is continuing to grow as a model alternative housing program for the elderly in Maryland," Dr. Tayback notes. "We feel this type of accommodation is an innovative solution in those instances where the elderly cannot remain in certain boarding type homes because of the lack of Health Department Licensure." Sheltered housing provides semiindependent living for the disabled elderly who need some assistance with daily activities and serves as a middle ground between independent living and institutionalization. Over 30 sheltered housing units accommodating some 1,000 residents are projected to be in full operation in Maryland by 1979. They will include existing apartment complexes, new construction, and the experimental type of housing program in which. smaller boarding homes are being utilized as sheltered housing. The three newly certified sheltered housing units fall within the latter category. State and Community News Dr. Tayback emphasized that his Office would not certify sub-standard housing and would make certain that only the best-run homes are certified as sheltered housing for the State's elderly. New Mexico Seniors Ten Raton, New Mexico, senior citizens took matters into their own hands to expand their senior center building with the help of their community. The senior citizens, who range in age from 65 to 82 years, built an 18' x 20' addition to the Raton Senior Center, doing all the work themselves with the exception of the electrical wiring and carpeting. With donations of material and discounts from merchants, the total cost of the project was under $2,500, paid for with funds raised by local senior citizens, county funds, and cash gifts. Roberto Mondragon, Director, New Mexico Commission on Aging, presented a special award to the 10 senior volunteers for their initiative and energetic activity. Rhode Island's The holiday season of 1977 was made brighter for many of Rhode Island's lonely, elderly residents in long-term care facilities through an imaginative program conducted by the State Department of Elderly Affairs. Over 4,000 persons responded to "Holiday Greeting Card," the State agency's program of forwarding cards to older persons in Rhode Island's institutions and nursing homes, as well as to those residing in the community. Among groups sending cards were nursing homes, long-term care State institutions, hospitals, Retired Senior Volunteer Programs, home health agencies, several Red Cross Chapters, schools, and sororities. Individuals from all parts of Rhode Island also sent cards. The Department was able to pass along five or more cards to each of the more than 2,000 elderly persons who participated. The total mailed was 8,000 and included Christmas, Hanukkah, and New Year's cards. News of Federal Agencies Social Security The Social Security Administration has announced it has begun implementing a 1977 change in the law which will eliminate payment of monthly benefits to some persons who work only part of a year. Immediately affected are about 250,000 persons who began receiving social security checks before 1978 and have substantial income from work this year. Under the new law, persons who plan to work part of the year and earn more than the law allows, would not be sent benefit checks for the months they did not work. Instead, retirees would receive any benefits due them, after the end of the year. Benefits would be reduced $1 for every $2 of income over the maximum annual income allowed by the law. Under prior law, school teachers, farmers, seasonal workers, and some self-employed persons who applied for benefits but planned to work part of the year were considered to be "retired" for each month they did not work or earned less than an allowable monthly limit. They were therefore eligible to receive monthly benefit checks for those months. They could keep the money, even though their incomes for the remainder of the year exceeded the annual amount the law allowed them to earn and still receive benefits. Under the new law, benefits may be reduced or stopped if total earnings for the year exceed the annual limit. The annual earnings limit was increased for 1978 to $4,000 for people 65 to 72, and to $3,240 for those under 65. People who earn above those limits will have $1 in benefits withheld for each $2 in earnings above the limit. The new provision does not apply to people in their first year of retirement. A person who works part of the year, then retires and applies for retirement benefits, will get monthly checks for the rest of the year. New retirees will be subject to the new law in subsequent years, however. The year of retirement means the year in which a person becomes entitled to benefits, earns less than the monthly limit for at least one month, and does not perform substantial services in self-employment. The new monthly limit on 1978 wages for people 65 and over is $334; for people under 65, the limit is $270. The new law only applies to those who receive social security old-age and survivors insurance benefits. Of the estimated 250,000 persons immediately affected by the change, about 190,000 are retired workers over 62, of whom 151,000 are 65 or older. About 25,000 are dependents over 62 of retired workers. Of the 250,000 people affected, about 210,000 will have earnings of more than $10,000 in 1978. About 17,000 will have earnings below $7,000. Savings to the social security trust funds as a result of the new provisions are estimated at $159 million in fiscal 1978 and $224 million in fiscal 1979. New Rules Designed to Reduce Medicaid Errors HEW's Health Care Financing Administration has issued final regulations to improve its Medicaid Eligibility Quality Control program. The improvement should save approximately $275 million during the 1979 fiscal year by reducing program er rors. The new regulations require States to determine if other medical insurance coverage is available to Medicaid patients before Medicaid pays the bill. States must also add a review to identify errors in claims processing to ensure that payments to health care providers are based on complete and accurate claims. Eligibility errors, for which review is already required, ac count for the greatest amount of misspent dollars. During Fiscal Year 1977, more than $1 billion was lost because Federal and State payments were made for ineligible patients. Another estimated $600 million was lost because States did not collect payments from other medical insurance available to Medicaid recipients, and an additional $200 million was wasted in claims processing errors. Full requirements for the revised program become effective on July 1. Requirements for changes in the review process must be implemented by November 1978. Task Force Report on HEW Secretary Joseph A. Califano, Jr., has released a report by the HEW Task Force on the Treatment of Women Under Social Security, noting that it was "an important step toward our goal of assuring that women are treated fairly under social security." The Secretary established the task force in November 1977, amidst growing concern that social security has not kept pace with the changing role of women in society. He asked the group to describe the issues surrounding this problem, such as the way in which the system treats women who are divorced, married women who work, and homemakers. He also asked the Task Force to analyze approaches to solving the inequality problem which have been proposed by individuals outside the govern ment. Although the Task Force made no recommendations, it concluded that provisions for family protection and the treatment of women under social security require further attention by the Department. The Task Force report will serve as the basis for a six-month study and report to the Congress by the Secre tary of HEW on proposals to eliminate dependence as a factor in the determination of entitlement to spouses' benefits under social security, and of proposals to bring about equal treatment for men and women under the social security program. The study was required by the Congress as part of the 1977 Social Security Amendments (P.L. 95-216). The Task Force findings will also become a resource for the newly-appointed Advisory Council on Social Security. Copies of the report can be obtained by writing to Social Security Commissioner, P. O. Box 17054, Baltimore, Md., 21235. More Housing Units for Elderly and Handicapped Some 24,000 housing units for the elderly and handicapped will be made available more speedily this year under new decentralized procedures of a housing assistance program conducted by the U.S. Department of Housing and Urban Development. The rental and cooperative housing is financed with direct loans made by HUD under the Section 202 program. Loans are made to eligible nonprofit borrowers to build new apartments or substantially rehabilitate existing units. Applications for the loans under the new procedures will now be processed by HUD's area offices, rather than the Department's central office in Washington. A total of $750 million has been made available to the Department in fiscal 1978 for lending under the program. Most of the lending authority will be allocated soon to HUD's regional and field offices. For the past two years of operations under the revised program, funding reservations have been made for construction of 492 projects, involving financing of $1.6 billion. News of Federal Agencies The program is designed primarily for low and moderate income elderly and handicapped people, but the occupants of Section 202 housing are expected to have a wide range of income and may include some who need no assistance. For tenants with income below 80 percent of the median income of the area, subsidies will be available under HUD's Section 8 Housing Assistance Payments program. Under the Section 8 program, lower income families receive rental assistance amounting to the difference between what they can afford and the fair market rent for adequate housing units. Occupants pay between 15 percent and 25 percent of their income for rent. Processing of applications for Section 202 reservations and Section 8 assistance are consolidated under the regulations which became effective on March 31. FAA Issues Travel Guide for Elderly, Handicapped Making air travel easier and more convenient for handicapped and elderly persons is the aim of a new guidebook published by the Department of Transportation's Federal Aviation Administration. "Access Travel: Airports" lists specially-designed features, facilities, and services that meet the travel needs of the wheelchair-bound, the blind, the deaf, and the aged at 220 airport terminals in 27 countries. For each terminal, the guide identifies 69 services important to handicapped travelers, including reserved parking. areas, ramps, accessible rest rooms, elevator controls with raised lettering, telephones with amplifiers, and special transportation facilities. Single, free copies of the guide are available from the Consumer Information Center, Department 619F, Pueblo, Colo. 81009. Advisory Council to HEW Secretary Joseph A. Califano, Jr. has announced the appointment of the Advisory Council on the Social Security program. The Council is authorized by Section 706 of the Social Security Act. Under the law, the Advisory Council is charged with reviewing the status of the four social security trust funds: the Old Age and Survivors Insurance Trust Fund, the Disability Insurance Trust Fund, the Hospital Insurance Trust Fund, and the Supplementary Medical Insurance Trust Fund. Those funds will be reviewed in terms of their scope of coverage, adequacy of benefits, and all other aspects of the social security program, including its impact on public assistance programs. "While the Congress acted last year to restore the system to solvency and financial integrity, it is clear that many structural problems and longterm financing issues require further study during the term of this Council," Secretary Califano said. Specific areas likely to be studied include: methods of financing social security programs, social security cash benefit levels, treatment of women under social security, the social security "retirement test," social security disability insurance program, mandatory coverage of public employees under social security, and the relationship of Medicare and its trust fund to any national health program proposal. Upon completion of its study, the Council will submit reports of its findings to Secretary Califano for transmittal to the Congress and the Boards of Trustees of the social security trust funds. The Council's report is due by Oct. 1, 1979. Stanford G. Ross was named by Secretary Califano to serve as chairman of the Advisory Council. News of Federal Agencies Lawrence Thompson, Director of Social Security Policy, Office of the Assistant Secretary for Planning and Evaluation, will be the executive director of the Advisory Council. New PSRO Guides to Assess Medicare HEW's Health Care Financing Administration issued final regulations on Feb. 8 establishing which conditional Professional Standards Review Organizations (PSRO's) must follow to assume responsibilities for reviewing health services under the Medicare and Medicaid programs. The rules are designed to help PSRO's assure that services paid for by Medicare and Medicaid are medically necessary, appropriate, and of acceptable quality, and to prevent duplication of review and certification activities. The PSRO statute provides for three stages of developmentplanning, conditional, and fully qualified. A PSRO is termed conditional before it demonstrates that it can perform all required review functions in hospitals and long term care institutions. "Among other improvements the regulations will make, they will give state governors a voice in helping to decide on the capability of PSRO's at different stages of their development," said HCFA Administrator Robert A. Derzon. HCFA Acts to Make More Accessible HEW's Health Care Financing Administration issued final regulations of Feb. 8 establishing conditions for certification of rural health clinics as suppliers of service under Medicaid and Medicare. "In the many rural communities that lack physicians, local residents depend on clinics staffed by specially trained physician assistants and nurse practitioners who provide the medical care traditionally furnished by physicians," said HCFA Administrator Robert A. Derzon. "With physician supervision, these physician assistants and nurse practitioners can do an excellent job and fulfill an urgent need. Certifying the clinics in which they work to supply services for Medicaid and Medicare beneficiaries-when the clinics meet HEW requirements-will make it possible for many citizens in rural areas to have proper medical care covered through government financing," he explained. Some 700 clinics are expected to be certified under these regulations. The majority are located in the Appalachian region. HCFA estimates that $10 million will be paid to rural health clinics in FY 1978 for Medicare services and $4 million for Medicaid. They expect a total of $67 million to be paid the clinics for Medicare and Medicaid services in fiscal 1979. To be certified, a clinic must be located in a rural area where there are not enough physicians and must have at least one nurse practitioner or physician assistant on the staff. In addition, it must arrange for medical supervision and telephone consultation by one or more physicians. The doctor must periodically review services furnished by the physician assistant or nurse practitioner, and must be available to prepare necessary medical orders and assist in medical emergencies. A physician does not have to be present when services are provided. Clinics must make arrangements with one or more Medicare and Medicaid certified hospitals for referral and admission of patients who need services not available at the clinic. Services and supplies presently covered by Medicaid and Medicare when provided by a physician will now be covered when provided by a physician or nurse practitioner if the assistant or practitioner is legally authorized under State law to perform the services. If there is a shortage of home health agencies in the area, coverage may include parttime nursing care furnished to a homebound patient by a nurse. The regulations are the first of three sets of rules that will put into effect provisions of the Rural Health Clinic Services Act of 1977 (Public Law 95210) permitting Medicaid and Medicare to pay for services in rural health clinics. The law applies to services provided to Medicare patients beginning March 1, 1978 and to services provided to Medicaid beneficiaries on July 1 and thereafter. Medicare Part B Medicare beneficiaries who voluntarily enroll in the program's supplemental medical insurancePart B-that helps pay for physicians' bills and a variety of other medical expenses will pay 50 cents more every month beginning on July 1. On that date the monthly premium will increase from $7.70 to $8.20. On that same date, the premium for Part A Hospital Insurance-will rise from $54 to $63 for those older Americans who are not automatically eligible for Medicare but who voluntarily enroll in this part of the Medicare program. At present there are only 21,000 such voluntary enrollees. The vast majority of Medicare beneficiaries do not pay a premium for Part A because their social security or Railroad Retirement coverage pays for this insurance. As required by law, during the last quarter of each year, the Secretary of HEW must review and announce the monthly premium rates to be paid by Medicare enrollees for Parts A and B. |