NATIONAL HEALTH PLANNING AND RESOURCES DEVELOPMENT ACT OF 1974

A letter was sent to the HEW Secretary on June 2, 1976, by the Council recommending that the Department, while in the process of reviewing health systems agencies' requests for approval of funding, in implementing the National Health Planning and Resources Development Act of 1974, examine the proposed structure and programs of the health systems agencies in terms of responsiveness to the health needs of the local elderly. The Council recommended also that the technical assistance program for health systems agencies contain a component on the health needs of the elderly, to insure that special cognizance is given to a major problem of large numbers of older people.

The Health Resources Administration of the Public Health Services in commenting on Secretary Mathews' June 28, 1976, response to the Council recommendations, stated that the Council approach to implementing the National Health Planning and Resources Development Act was most appropriate and welcome. Their letter went on to say that

the health systems agencies provide the appropriate opportunities for State and area agencies on aging to participate in the implementation of the program. The health systems agencies and the State health planning and development agencies provide a means by which older persons and service providers can work together to plan and develop health services for the elderly. This participation can be achieved not only through direct representation on the governing bodies of the planning agencies but also through participation in their plan development and project review committees, their public hearings and other public meetings. Effective citizen participation in the planning process must take advantage of this whole range of opportunities for involvement.

Medicaid

Following Council action at the March 16-17, 1976 meeting, a letter was sent to the Acting Administrator of the Social and Rehabilitation. Service, HEW, endorsing the position of Dr. Arthur S. Flemming, Commissioner on Aging, on a proposed medicaid modification of relatives' financial responsibility for medical assistance.

The problem concerned the determination of income and resources of spouses and parents available to medicaid applicants and recipients. Eligibility determination for medicaid adversely affects elderly couples when one spouse is in a nursing home for an extended period of time. The income of the spouse remaining in the community is considered to be actually available toward the cost of care for the institutionalized spouse. Commissioner Flemming's recommendation on the proposed regulations was that consideration be given to determining the actual amount of income needed to maintain the spouse who lives in the community before the amount of the contribution is determined, rather than automatically reducing the income of the noninstitutionalized spouse to the categorical grant level for one person.

Final regulations were pending in HEW at the end of the year. Another medicaid matter of concern to the Council was that of cost reimbursement to skilled nursing and intermediate care facilities.

A letter was sent on May 28 1976, to HEW Secretary Mathews stating the Council's position on proposed rules to amend regulations to the medicaid programs, title XIX of the Social Security Act, implementing Public Law 92-603, section 249 regarding cost reimbursement. That section added section 1902 (a) (13) (E) to the act requiring that State plans provide, "effective July 1, 1976, for payment of the skilled nursing facility and intermediate care facility services provided under the plan on a reasonable cost-related basis as determined in accordance with methods and standards which shall be developed by the State on the basis of cost finding methods approved and verified by the Secretary". The Council urged that the final regulations embody the following principles:

1. Modest cost associated with the social and human support of the long-term care patient should be construed as reasonable and be reimbursed.

2. No State should be allowed to develop reimbursement techniques which result in payment less than that which is reasonably incurred. Federal and State codes should be the minimum basis of such reasonableness.

The Council affirmed that this policy should be the basis for equal access to quality care for all persons and that the special problems associated with long-term care of minority groups need special consideration.

Final regulations were promulgated on July 1, 1976, which contained several substantive revisions from the proposed rules. The Council sent letters to the Secretary on September 9 and October 14, 1976, expressing "concern that the proposed rules never indicated the possibility of the delay in implementation of the regulations to January 1, 1978." The Council pointed out that this placed "an undue burden on providers who proceeded to improve the quality of care they offered on the good faith that the intent of Congress would be carried out."

HOME HEALTH CARE

The development of more and better home health care programs as part of the continuum of care for the chronically ill was a matter of attention by both the executive and legislative branches of Government in 1976. The Federal Council activity on the "frail elderly" is a somewhat different approach to this same concern.

When regulations were proposed for revision of medicaid regulations on August 21, 1975, removing the limitation which restricts proprietary agencies from qualifying as home health providers unless the State licenses such agencies, the Council wrote to HEW Secretary Mathews on March 18, 1976, expressing the recommendation that sufficient information be obtained as to whether such a revision will bring about an increase in the quality and quantity of home health care. Council members saw merits to both sides of this issue and requested consideration by the Secretary of the questions raised by the Commissioner on Aging to this effect.

The Acting Administrator, Social and Rehabilitation Service, Don I. Wortman, responded on June 17, 1976, to the Council at the request of the Secretary, with his assurance that careful consideration would be given to Council comments before final adoption of the regulations. On August 25, 1976, final regulations on home health services were published which included only those revisions necessary to clarify the previous ambiguities on persons eligible to receive home health services and types of services States must provide.

At its September 13-14, 1976 meeting, the Council adopted a statement on "Issues in Home Health Care" to be submitted for the record of HEW regional public hearings on that subject. The purpose of the hearings was to clarify many of the issues surrounding the delivery and financing of home health care, and to permit interested and knowledgeable individuals, public groups and organizations, and Federal, State, and local agencies to have an early impact on the HEW's response to these issues. The statement described the interest of the Council in the frail elderly:

During this past year, the Federal Council on the Aging has given particular attention to these oldest of older Americans. We are evolving national policy recommendations which focus on their need for social supports which neither the income maintenance nor health care systems fill. We believe that some of the concepts and programs which we will be presenting are most relevant to the issues involved in resolving some of the issues surrounding "home health care." The FCA report will be completed early in 1977, and transmitted to the Secretary, the President, and the Congress at that time.

In the interim, the Council would be most pleased to share draft materials on an informal basis with HEW staff and to be of assistance in considering the specific questions raised in the hearing announcement. In any event, as advisors to the Secretary and the Commissioner on Aging, the Council would hope to participate in the Department's announced intentions of increasing public attention to the problems and issues surrounding this vital matter.

The statement was sent to the HEW Secretary, the HEW contact person for the home health hearings, and to other appropriate parties for informational purposes.

Also on the issue of home health care, the Council responded to a request from Congressman William S. Cohen for comments on proposed legislation to establish a Special Commission on Quality Assurance and Utilization Control in Home Health Care. It was the opinion of the Council that a review of the roles of already existing advisory bodies would preclude the necessity for the establishment of a new entity. HEW initiatives were described including the public hearings on home health care. The letter of September 28, 1976, went on to say, "These hearings appear to be a sound method of improving medicare and medicaid programs relating to home health services by obtaining a wide variety of views from interested individuals, public and private groups, and government at all levels. This HEW initiative could produce needed short-range regulatory changes within a relatively short time in comparison to the time involved in activating an advisory body into a viable operating group."

INCREASED FUNDING FOR SECTION 202 HOUSING PROGRAM FOR THE ELDERLY AND HANDICAPPED

The Federal Council in a letter of April 22, 1976, recommended to Congressman Henry S. Reuss, the chairman of the House Committee on Banking, Currency and Housing, that the committee members support the amendment being offered by Congressman St Germain. The St Germain amendment regarding the section 202 program of the Housing and Community Development Act of 1974 provided authorized funding of $3.3 billion and also would revise the interest formula to more nearly reflect the cost of money to the Federal Government. This rate would be in the range of 6.5 percent. The Council felt that without this rate many of the section 202 projects would not be feasible. The Council has recommended a national housing policy that provides access to adequate, subsidized housing for the elderly poor and minorities. In the Council's opinion the section 202 program represents a major means for accomplishing that

recommendation.

The 94th Congress acted and the President approved two funding bills for 202 along these lines, Public Law 94-375 and Public Law 94-378.

HUD ASSISTANCE FOR MINORITY SPONSORS OF SUBSIDIZED HOUSING

As a result of Council action at the September 1976 meeting, the Federal Council recommended to the Secretary of Housing and Urban Development that the Department take affirmative action to increase access of minorities to subsidized housing. The Council recommended that HUD fund a national center to provide technical assistance and outreach services to interested sponsors, including minority sponsors, in need of assistance in order to properly complete the process of sponsorship of subsidized elderly housing.

HUD Secretary Carla Hills in her response to the Council's concern indicated that HUD is presently taking a number of steps to improve the section 202 program and carefully examining the section 202 selection criteria to determine whether participation by minority sponsors may have been unduly restricted. HUD is also considering a training program to help nonprofit minority sponsors to improve their applications and increase their participation in the program. HUD is not presently expecting this training to include the creation of a national center. Responsibility for the administration of the section 202 program will be decentralized to HUD field offices during fiscal year 1977, with training of field staff to assure knowledgeability of section 202 program requirements.

The Council will follow up this issue in 1977.

SPECIAL PROBLEMS OF OLDER WOMEN

The Council held hearings in late 1975 on National Policy Concerns for Older Women in conjunction with the annual meeting of the National Council on the Aging as a special activity during the International Women's Year. Early in 1976 a publication, "National Policy Concerns of Older Women: Commitment To A Better Life," was is

sued by the Council. The booklet was based on a public hearing held by the Council in September 1975. It was widely distributed to women's groups, aging organizations, and interested individuals.

Comments on the publication were solicited from the Administration on Aging, the National Institute on Aging, and the Social Security Administration. All three responses indicated an increasing awareness of the concerns of older women. These included a description of a research project on work options for older women currently being funded by the Administration on Aging, the inclusion of women in the longitudinal studies sponsored by the National Institute on Aging, and a study of the Low Income Aged and Disabled by the Social Security Administration.

Since the Council agreed that the lack of an adequate income was a major problem for older women, the Council at its December meeting, recommended that FCA staff should further examine the impact of the supplemental security income system on poor older women.

As part of its ongoing concern for the problems of older women, the Council has also continued its strong support to the U.S. Commission for International Women's Year in encouraging their special interest in older women. The Council has continued a liaison with the commission in the transition of International Women's Year into International Women's Decade and in planning State and national conferences in 1977. In this regard, the Council hopes to see the expansion of many organizational efforts in producing greater awareness and concern for older women.

FOOD STAMP PROGRAM

On March 30, 1976, the Council sent to the chairman of the House Committee on Agriculture and the chairman of the Senate Agriculture and Forestry Committee excerpts from the Council study on "The Interrelationship of Benefit Programs for the Elderly." Chairman Adkins pointed out that Council recommendations and the proposed study of the consideration of assets and asset income might be of assistance to these congressional committees as they undertook reform of food stamp legislation.

COMMITTEE ON MENTAL HEALTH AND ILLNESS OF THE ELDERLY

In 1975, the Council extended an offer to the Secretary of Health, Education, and Welfare of assistance and cooperation in the work of the Committee on Mental Health and Illness of the Elderly, established under Public Law 94-63, the Health Revenue Sharing and Health Services Act of 1975. The National Institute of Mental Health (specifically, the Center for Studies of the Mental Health of the Aging), had been designated to assume the lead responsibility in administering the committee's activities. It is a nine-member committee, appointed by the Secretary of HEW, to make a study and recommendations respecting: Future needs for mental health facilities; manpower and research to meet the mental health needs of elderly persons; the appropriate care of elderly persons who are in mental institutions or have been discharged from there; and proposals for implementing recommendations of the 1971 White House Conference on Aging regarding the mental health of the elderly.