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1997 September - October

Elder Rights Advocacy and the Legal Services Corporation Restrictions

How Serious Is the Conflict?

By Penelope A. Hommel

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.

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A Time of Change, a Need for Reinvigoration

Results of a National Survey of Legal Assistance to Older Persons

By Judith L. Falit

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.

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Health Care Financing Administration Retreats from Regulatory Role

By Toby Edelman

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.

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The Buy-In Programs

Still Struggling After All These Years

By Patricia Nemore

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.

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Legal Issues in Securing Home Health Services Under Medicare and Medicaid

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

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.

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