September - October 1997

Cover

 
  • Legal Issues in Securing Home Health Services Under Medicare and Medicaid

    Both the federal government and state legislatures across the country have been scrambling to find ways to contain costs, and health care is one of the major targets. Home care programs under Medicare and Medicaid have gained recent attention in part because of the perception that such programs are abused. This article examines the recent Balanced Budget Act’s effect on the Medicare home health benefit and reviews various legal claims that have challenged cuts in home care under Medicaid and the Americans with Disabilities Act. It pays particular attention to the obstacles and successes in New York to demonstrate that legal rights can be used to maximize home care services.

    By Valerie J. Bogart, Alfred J. Chiplin, Jr., Vicki Gottlich, and Judith A. Stein

  • The Buy-In Programs: Still Struggling After All These Years

    Buy-in programs, which mandate that states pay certain Medicare premiums, deductibles, and coinsurance through Medicaid, are designed to protect low-income beneficiaries from paying out-of-pocket health care costs. To a large extent these programs have not reached the nearly four million people eligible. This article reports the results of the National Senior Citizens Law Center’s 50-state survey that examined issues of outreach, eligibility and qualifying processes, cost sharing, provider participation, and managed care. It concludes that taking applications at social security offices, using short application forms, giving annual notice of the programs’ existence, and coordination of outreach would help individuals receive available benefits.

    By Patricia B. Nemore

  • Special Care Units for Persons with Alzheimer’s Disease: Consumers Beware

    Special care units in nursing homes and other long-term care facilities for persons with Alzheimer’s disease and related disorders purport to meet their special needs. Yet, in many states, facilities can market their services without any obligation to demonstrate why or how they are "special."

    By Dorothy Siemon, Bruce Vignery, and Laura Gallagher Watkin

  • Medicare Managed Care Appeal Rights: An Update

    Recent litigation, regulations, and congressional developments that affect the appeal rights of Medicare beneficiaries who enroll in managed care plans are highlighted in this article.

    By Vicki Gottlich

  • Health Care Financing Administration Retreats from Regulatory Role

    The concept of "total quality management" has preoccupied the manufacturing and service industries, especially in the early 1990s when the United States was forced to compete more fiercely in world markets. Various players have been attempting to apply it to health care. This article examines the Health Care Quality Improvement Project—a collaboration between the Health Care Financing Administration and health care providers—designed to incorporate procedures for improving quality care. The article determines that quality assurance initiatives have been in the health care industry for quite a while and asks advocates to examine the processes of care and not just outcomes.

    By Toby Edelman

  • Mediating Nursing Home Care Disputes: A Workable Option?

    The American Bar Association Commission on Legal Problems of the Elderly conducted an innovative pilot project testing the use of mediation to resolve nursing home care disputes. The project and its results are discussed.

    By Naomi Karp and Erica Wood

  • A Time of Change, a Need for Reinvigoration: Results of a National Survey of Legal Assistance to Older Persons

    Legal Services Corporation funding cuts and restrictions on permissible activities, as well as uncertainty surrounding the status of elder rights and legal services in the Older Americans Act, may affect the delivery of legal services to the most vulnerable elderly. This article reviews the results of the Center for Social Gerontology’s recent national survey on legal assistance.

    By Judith L. Falit

  • Elder Rights Advocacy and the Legal Services Corporation Restrictions: How Serious Is the Conflict?

    Since 1965 Legal Services Corporation (LSC) programs have been key providers of legal assistance under the Older Americans Act (OAA). But LSC activities were severely limited by the 104th Congress. This article explores the restrictions along with their exceptions and suggests that LSC-fund recipients may still undertake significant areas of advocacy and representation to protect essential rights and benefits for vulnerable elders.

    By Penelope A. Hommel

  • Elder Law Resources on the Internet

    Advocates for elderly persons will find a wealth of resources on the World Wide Web. This column highlights some of the numerous government agencies, advocacy organizations, and senior associations that maintain active sites on the Web.

    By Michelle Nicolet