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State's Lawmakers Grapple with Retirement Issues: Nursing-home Payments, Long Term Care Insurance on the Agenda for this Session
By Jeanne Gustafson, Spokane Journal of Business
January 24, 2008
Issues that involve caring for senior citizens have gotten a jump-start in the planned 60-day legislative session this year with the filing of a report Jan. 11 by a joint legislative task force on long-term care residential facility payment systems. The task force was created by last year’s Legislature to look at possible reimbursement reforms for elder care, but industry experts question the group’s recommendations.
Other issues the Legislature could tackle this session include protecting retirees from hefty premium increases for long-term care insurance policies they already own and increasing pay for low-income workers in the long-term care field.
The task force expired Dec. 31 and issued its report, including a controversial recommendation to redirect half of $8.8 million in funds that Gary Weeks, executive director of the Washington Health Care Association, says last years’ Legislature specifically set aside for increased reimbursement for care in 2009. The association mostly represents for-profit long-term care providers in the state.
Both Weeks and Bill Ulrich, president of Consolidated Billing Services Inc., of Spokane, which helps long-term-care facilities navigate the complexities of the Medicare and Medicaid billing processes, contend that the task force erred by recommending that some of the reimbursement money be designated for more studies of the payment system. Ulrich says the original goal was to simplify the payment system and the administration of it.
“The task force completely had a lack of understanding of what they needed to do,” Ulrich says.
Weeks concurs with Ulrich, saying that the task force didn’t address the specific charge it was given by the 2007 Legislature to make recommendations to restructure or replace payment methods. Ulrich says the final recommendations of the task force, if adopted by the Legislature, would result in nursing homes receiving smaller rate increases for the 2007-2009 budget cycle than any other long-term care providers.
Reimbursements seem to come to the fore on almost every senior issue. Attorney Richard Sayre, of Sayre & Sayre PS, of Spokane, says a guardianship program created by last year’s Legislature is underfunded. That causes most people willing to be guardians for the elderly to “take a pass” on the program, because they can’t get enough compensation to make it worth their effort to participate, he says.
Ulrich asserts that the way the state currently funds elder care, with reimbursements set below the costs incurred by care facilities, would never work in other programs.
“They would never get a bridge built if they went to a contractor and said, ‘We are only going to pay you 92 percent of what it costs to build the bridge,’” he says.
Ulrich and Weeks both say that $7 million included in the Governor’s supplemental budget for increased wages for low-wage workers was an important step. Ulrich says 65 percent of the cost of running a nursing home is in labor, and most of those workers are low-wage earners.
Unexpected premium hikes for long-term care insurance also are an issue, says Sen. Chris Marr, D-Spokane. He says constituents have complained to him about surprise increases for their long-term care insurance policies, which typically are sold as fixed-rate products. A loophole allows an insurer to initially underprice its products and subsequently ask for rate increases from the state Office of the Insurance Commissioner, Marr says. He says he will seek policy reforms that would protect people who have planned responsibly for their future care, only to be forced to pay much higher insurance premiums or downgrade their coverage.
Marr says he and Rep. Dawn Morrell, D-Puyallup, plan to introduce a bill that would close the door on some of the rate increases by penalizing insurance companies that engage in such pricing tactics.
The bill would adopt model legislation from the National Association of Insurance Commissioners that Marr says addresses that issue. As an example of the problem, he notes that Conseco Inc., a long-term care insurance provider based in Carmel, Ind., has been granted 137 percent in rate increases in Washington state since 2000.
Marr says such increases have a chilling effect on people being able to pay for their own extended care needs as they age.
Marr says only about 4 percent to 5 percent of the population buys long-term care policies. He argues that in order for the state to keep its own spending for long-term care down, people will need to use such insurance more.
“We want to encourage people to provide for themselves,” Marr says.
Also on the legislative agenda is a bill that would create policies to help boarding homes and assisted-living centers more easily provide short-term respite care for the elderly without going through a lengthy assessment process for the patient, Weeks says. That bill also would establish training for fall prevention and provide funding for such facilities to add beds to handle patients with behavioral problems, who frequently end up in emergency rooms or mental-health crisis centers due to a lack of onsite facilities where they live to monitor them more closely.
Another bill that Weeks says has been introduced would help keep seniors in group homes or boardinghouse-type facilities longer before they have to move where a higher level of care is available. The bill would allow registered nurses to designate certified nursing assistants to administer certain medications, such as insulin, to residents of those facilities, allowing such patients to stay in those facilities longer.
Weeks says people who need that daily medical support currently must be transferred to more expensive assisted-living care, or sometimes their families pay to have a nurse come to the group home each day to administer needed medications.
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