The U.S. Department of Justice and the AIDS Law Project of Pennsylvania have reached a $715,000 settlement agreement with the Milton Hershey School of Hershey, PA, to resolve alleged violations of the Americans with Disabilities Act (ADA). The school refused to enroll a child because he has HIV. The school has agreed to change its disability discrimination policy and to provide training to its staff on the ADA.

The US Court of Appeals for the Seventh Circuit has reversed the dismissal of the U.S. Equal Employment Opportunity Commission’s (EEOC) disability discrimination lawsuit against United Airlines, Inc. The court now agrees that “reasonable accommodation” under the Americans with Disabilities Act includes reassignment to a vacant job when employees cannot be accommodated in their current position. The EEOC had charged United with violating the ADA by requiring its employees with disabilities to compete for vacant jobs in the company.

The U.S. Department of Justice and the city of Portland, OR have reached a preliminary agreement to improve Portland Police Bureau practices when interacting with people with mental illness. An investigation found that the PPB has engaged in excessive force against people who have, or are believed to have, mental illness. The agreement will address policies on the “use of force” to make sure that officers have guidance when encountering someone with mental illness, particularly in the use of tasers. Crisis intervention training for officers will also be increased.

The U.S. Department of Justice has reached a settlement agreement with Grand Circle LLC, doing business as Grand Circle Travel to resolve alleged violations of the Americans with Disabilities Act (ADA). The company cancelled the reservation of a person who uses a motorized scooter without offering a reason. The agreement will make sure that persons with disabilities, including those who use wheelchairs or other mobility aids, have equal access to the company’s travel services and facilities. The company will also change its treatment of customers with disabilities and train its staff on the ADA.

Bank of America N.A. has been charged with violating the Fair Housing Act and the Equal Credit Opportunity Act for discriminating against home loan applicants who receive Social Security Disability Insurance (SSDI). The bank asked applicants to provide details of their medical conditions and required a letter from their doctor documenting the income they received from SSDI. The bank has also agreed to revise its policies on documenting disability income, hold employee trainings and pay monies to the loan applicants who were affected by the alleged misconduct.

The Workforce Recruitment Program (WRP) is a recruitment and referral program that connects federal and private sector employers nationwide with college students and recent graduates with disabilities looking for jobs. Read the stories of six federal employees who found their path to government service through WRP and were profiled by its “I Am the Workforce” Photo Project. These stories show the broad cross section of skills and talents available to employers who choose to hire through WRP.

The House is scheduled to vote today to repeal the Affordable Care Act (for the 33rd time). If your representative is likely to vote for repeal and you’d like to persuade him/her to do otherwise, here are some talking points:

• Congress should focus on creating jobs, ending outsourcing and improving the economy instead of voting for the 33rd time to take patient protections away from Americans.
• A vote to repeal will take away patient protections for Americans that they already enjoy:

1. Up to 17 million children can no longer be denied coverage because of a pre-existing condition.
2. 6.6 million young people have obtained insurance through their parents’ plans.
3. 5.3 million seniors have already saved $3.7 billion on prescription drugs.
4. 105 million Americans no longer face lifetime limits on their insurance coverage.

Early this month, the Center for Medicare and Medicaid Services announced 2013 payment and policy updates for both Medicare Part C and D plans.

Below are a few of the 2013 highlights and the Part D benefit costs, as outlined in CMS’ recent press release:

• Controlling Beneficiary Costs and Premium Increases: CMS will again exercise its authority under the Affordable Care Act to deny Part C and D plan bids, if it determines that the bid proposes too significant an increase in cost sharing for beneficiaries or decrease in benefits from one year to the next.
• Lower drug costs: CMS will address improvements in the Medicare prescription drug benefit, specifically those provisions that close the Part D coverage gap, or “donut hole.”   As a result of the Affordable Care Act, in 2013, eligible drug plan enrollees with liability in the donut hole will only pay 47.5% of the costs of covered brand-name drugs.  For generic drugs in the gap, cost sharing shrinks to 79%, from 86% in 2012. People enrolled in Medicare Part D who do not receive the low income subsidy (also known as Extra Help) and enter the coverage gap will pay less each year until 2020, when they will pay only 25% for covered brand-name and generic drugs, closing the donut hole.
• Stronger Part D & MA plan quality: In 2013, CMS will alert plan members if their drug or health plan has failed for 3 straight years to achieve at least a 3 (out of 5) star quality rating and offer a special enrollment period that will allow the member to move to a higher quality plan. For MA plans, the 3-year Quality Bonus Payment demonstration will continue to provide financial incentives to improve quality of care for Medicare beneficiaries.
• Reducing inappropriate overuse of prescription drugs: For Part D plans, CMS describes drug utilization management improvements to address overprescribing and overutilization of opiates and other medications to ensure beneficiary safety and prevent fraud.
• Supplemental Benefits: CMS is clarifying its definition of certain supplemental benefits in an effort to ensure transparency and consistency across all MA plans that choose to offer such benefits.  CMS is also extending additional supplemental benefit options to qualifying dual eligible special needs plans (D-SNPs).
• Part D Benefit Parameters: Statutory updates to the annual benefit parameters for the defined standard Part D prescription drug benefit in Calendar Year (CY) 2013. They include:

Part D Benefit ParameterDefined Standard Benefit	CY 2012	CY 2013
Deductible	$320	$325
Initial Coverage Limit (Total drug costs after deductible before hitting coverage gap)	$2,930	$2,970
Out-of-Pocket Threshold (Total amount beneficiary pays before hitting catastrophic phase)	$4,700	$4,750
Minimum Cost-sharing for Generic/Preferred Multi-Source Drugs in the Catastrophic Phase	$2.60	$2.65
Minimum Cost-sharing for Other Drugs in the Catastrophic Phase	$6.50	$6.60

The national Part D base beneficiary premium for next year has also been announced. It will be $31.17 in 2013. This premium amount is used when calculating a Part D late enrollment penalty (for someone who delayed enrolling into Part D when first eligible and who didn’t have other equivalent coverage). And the California Part D low-income premium subsidy amount (benchmark plan amount) will be $29.88 in 2013.

Also, as of last year, people with higher incomes (individuals with annual incomes over $85,000 and couples with incomes over $170,000) pay a higher Part D monthly premium. Below is a chart of the higher Part D premiums for such people in 2013.

Note: The formula used to determine a person’s premium amount is the same one used for Part B premiums, known as the Income Related Monthly Adjustment Amount (IRMAA). A person’s income level is be based on income reported to the IRS. These IRMAA-related premiums are either deducted from a beneficiary’s Social Security check or the beneficiary is billed. This premium is in addition to and separate from the premium paid to one’s Part D plan.

Concerns about Medicare and rising health care costs ranked as the 4th most pressing financial concern for pre-Medicare people ages 50-64, according to a recent AARP “Anxiety Index” survey. The other top 3 concerns were rising prices, taxes and financial stability in retirement.

Contrary to the common stereotype that baby boomers are living plush and “high on the hog,” many boomers have experienced significant financial set-backs in the last 10 years with the volatile stock market and dissolution of pension plans and retirement funds. These experiences are reflected in the survey results, with:

• 72% of non-retired boomers believing they will probably be forced to delay retirement, and 50% having little confidence that they will ever be able to retire;
• 65% having little confidence that they will have the means to live comfortably in retirement; and
• 59% fearing that the negative effects of the economic downturn on their retirement savings will force them to rely more heavily on Social Security and Medicare, both of which they are concerned won’t be around when they need them.

In the poll of 1,852 registered voters ages 50+, 95% of them said Medicare was critical to maintaining the health of older adults and those with disabilities, yet only 41% of this group said they were somewhat or very confident that it would exist for them and future generations upon retirement.

As Medicare fraud is a hot topic in California, our Senior Medicare Patrol (SMP) is continually receiving and resolving complex cases.

Below is a quick glimpse of a few recent cases our SMP team has successfully resolved.

If you or someone you know has a question about fraud or would like to report fraud, contact our SMP office at 855-613-7080. Also visit our Medicare Fraud section to learn more and find information on becoming an SMP volunteer.

Every year a host of mailings from the Centers from Medicare and Medicaid Services (CMS), Social Security and Medicare Advantage health plans are sent to millions of Medicare beneficiaries. Some of these notices (the color-coded ones) are for people receiving the Part D low-income subsidy (Extra Help) for their prescription drug costs; others are for people in Medicare Advantage plans notifying them of any benefit, formulary and cost-sharing changes for the new year. Additional notices include those to beneficiaries who are in terminating or non-renewing plans, those to higher income beneficiaries about income related Part B and D premium adjustments, and those to people receiving Social Security about benefit payment changes for the coming year due to cost of living increases, variations in the premiums that are withheld, etc.

CMS  has a comprehensive chart (PDF) that lists all such notices for 2012/2013 detailing the mail date, sender, what the mailing and/or color is, the main message, and any action the beneficiary should take upon receiving one of these notices. All notices that are available online are hyperlinked, yet the hyperlinked notices for this year won’t be available later this fall.

A number of important health care bills passed the California State Legislature last week. One bill, AB 999 authored by Assembly Aging and Long-Term Care Committee Chair Mariko Yamada (D-Davis) protects consumers from excessive premium rate increases by modifying the long-term care insurance (LTC) premium rate development process. It also helps consumers make more informed choices about buying a policy by giving them the opportunity to review a policy’s language before purchase. More can be read about this bill in the California Department of Insurance’s recent press release.

The other health care bills, if signed by the Governor this month, will ensure that California is ready to adopt the many health care reforms scheduled to begin in 2014. While federal law under the Affordable Care Act includes many provisions, resources and a platform for improving the quality, coverage and protections in our health care system, it is still up to each state to bring this law into reality, to enforce the new consumer protections, and make sure Californians know about and enroll in to their new coverage options. Health Access recently published a brief summary (PDF) of the legislation.

The Department of Veterans Affairs (VA) is reaching out to providers, health care professionals and advocates, social workers, and other people who have contact with veterans through their jobs in an effort to make sure our veterans know about their VA benefits. Many Veterans, according to the VA, don’t fully understand all the VA benefits they qualify to receive. That’s why the VA is now aiming some of its education to providers who work with this population as a way to spread the word about these benefits and increase the numbers of Veterans who make full use of the benefits to which they are entitled. With more than 22 million military Veterans nationwide, if you are a professional in the health care field your chances of working with a Veteran are quite high.

One upcoming educational activity the VA is sponsoring is a webinar that gives professionals who work with Veterans a basic understanding about VA benefits and some resources they can use to refer Veterans to VA to get their entitled benefits. The next session is on September 11, 2012 from 9:00 – 10:30a.m. PDT. Register at: http://goo.gl/OROVb.

Also, our website section on Medicare and VA benefits and our fact sheet, Medicare and Veterans Administration Medical Benefits Package, gives an overview of the VA benefits and how to apply.

For any questions about the VA sponsored webinar, contact Voncelle James at (202) 530-9219 or voncelle.james@va.gov.

The Million Hearts initiative aims to prevent one million heart attacks and strokes over the next five years by minding the “ABCs.”

Bonnie Burns, a Training and Policy Specialist, was interviewed on KGO’s New Talk bay area radio station regarding CalPERS’ announcement of long-term care (LTC) insurance premium rate increases. Recently CalPERS LTC insurance policy holders received a notice of premium increases of 85% for 2015. Of the 140,000 people in California with these policies, many are understandably upset and feel that the promises made to them when buying their policies are not being met. One woman who has been paying about $3,000/year in premiums, has been notified that she’ll need to pay $15,000/year to keep her policy with the rate increase. This type of increase is unsustainable for most.

In the interview, Burns speaks to this situation and encourages people to contact their local Health Insurance Counseling and Advocacy Programs (HICAP) for assistance. CalPERS will offer some adjustments to people’s polices so they can have a lower premium and still keep some benefits. It will be important for people to understand all their options before making a decision one way or another about their policies.

The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.