May 22, 2012

WASHINGTON – U.S. Senators Herb Kohl, D-Wis., Chuck Grassley, R-Iowa, and Richard Blumenthal, D-Conn., today filed an amendment seeking to combat the costly, widespread and inappropriate use of antipsychotics in nursing homes.

“The overuse of antipsychotics is a common and well-recognized problem that puts frail elders at risk and costs taxpayers hundreds of millions of dollars each year,” Kohl said. “We need a new policy that helps to ensure that these drugs are being appropriately used to treat people with mental illnesses, not used to curb behavioral symptoms of Alzheimer’s or other dementias.”

“This amendment responds to alarming reports about the use of antipsychotic drugs with nursing home residents,” Grassley said. “It’s intended to empower these residents and their loved ones in the decisions about the drugs prescribed for them.”

“This measure is responsive to mounting evidence that antipsychotics are being misused and overused in the nursing homes we trust to care for our loved ones,” Blumenthal said. “The amendment will do what is necessary to curb this deeply concerning practice, putting the power to make key health care decisions back into the appropriate hands and eliminating unnecessary costs to taxpayers.”

The amendment to S. 3187, the Food and Drug Administration Safety and Innovation Act would require the Health and Human Services Secretary to issue standardized protocols for obtaining informed consent, or authorization from patients or their designated health care agents or legal representatives, acknowledging possible risks and side effects associated with the antipsychotic, as well as alternative treatment options, before administering the drug for off-label use.

While the Food and Drug Administration (FDA) has approved antipsychotic drugs to treat an array of psychiatric conditions, numerous studies conducted during the last decade have concluded that these medications can be harmful when used by frail elders with dementia who do not have a diagnosis of serious mental illness. In fact, the FDA issued two “black box” warnings citing increased risk of death when these drugs are used to treat elderly patients with dementia.

Last year, the Health and Human Services Office of the Inspector General (HHS OIG) issued a report showing that over a six-month period, 305,000, or 14 percent, of the nation’s 2.1 million elderly nursing home residents had at least one Medicare or Medicaid claim for atypical antipsychotics.

The HHS OIG also found that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with off-label conditions and that 88 percent were associated with a condition specified in the FDA box warning. Further, it showed that more than half of the 1.4 million claims for atypical antipsychotic drugs, totaling $116.5 million, failed to comply with Medicare reimbursement criteria.

The amendment also calls for a new prescriber education program to promote high-quality, evidence-based treatments, including non-pharmacological interventions. The prescriber education programs would be funded through settlements, penalties and damages recovered in cases related to off-label marketing of prescription drugs.

MAKING MEDICARE MAKE SENSE

Answers To Some of The Most Commonly Asked Medicare Questions

Q: Who Pays First If I Have Medicare and Other Health Coverage?

A: If you have Medicare and other health coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide who pays first. The “primary payer” pays what it owes on your bills first, and then your provider sends the rest to the “secondary payer” to pay. In some cases, there may also be a “third payer.” Whether Medicare pays first depends on a number of things, including the situations listed in the chart below. However, this chart doesn’t cover every situation. Be sure to tell your doctor and other health care provider’s insurance specialist/billing staff if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays. Note: Paying “first” means paying the whole bill up to the limits of the payer’s coverage. It doesn’t always mean the primary payer pays first in time.

If you have questions about who pays first or if your coverage changes, call the Medicare Coordination of Benefits Contractor (COBC) at 1-800-999-1118. TTY users should call 1-800-318-8782. For example, if you need to find out about Medicare’s coverage of End Stage Renal Disease and how it works with other insurance the COBC will answer your questions.   Also, to better serve you please have the following information ready when you call: your Medicare number (located on your red, white, and blue Medicare card) and one additional piece of information, such as your Social Security Number (SSN), address, Medicare effective date(s), or whether you have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) coverage.

Below is a summary chart of who likely pays first. If you would like a copy of the Medicare booklet referenced in the chart, titled, “Medicare and Other Health Benefits: Your Guide to Who Pays First,” call 1-800-633-4227, (which is 1-800-Medicare), and ask for CMS Product Number 02179, and tell them the title of the booklet.

Please note: In some cases, if you are entitled to, but don’t have, the first payer coverage, the second payer won’t cover you.  This can be vital information to know in some employer retiree plans and COBRA cases.  For instance, if you are 65 and older, and retired, and you do not enroll in Medicare, it is possible that your retiree coverage won’t cover you.  Check with your retiree plan to be sure.

*If your employer participates in a plan that is sponsored by two or more employers, the rules are slightly different.

Hosts Town Hall About Illinois' Future at Julian Middle School

OAK PARK – May 22, 2012. Governor Pat Quinn today hosted a town hall meeting with students at Julian Middle School about the urgent need for pension and Medicaid reform. With just 9 days left before the end of spring legislative session, the governor continued his push to stabilize Illinois’ Medicaid and pension systems and educate the public about our fiscal challenges. During the visit, Governor Quinn took questions from 8th graders about their stake in what happens in Springfield this session and the impact that these two issues have on the future of Illinois.

“At its core, this battle to resolve our fiscal challenges is about the future of our children," Governor Quinn said. "If we want to educate our kids and ensure they are ready for the workforce, our moment is now. We must assume responsibility to build a better future for our children. We must work together to get these vital reforms done."

During the discussion at Julian Middle School, students had the opportunity to ask Governor Quinn questions about what state government does, how it is funded and why they should get involved in causes they believe in. The governor explained how education funding is being squeezed by the unsustainable growth in the Medicaid and pension systems, and what can be done to rescue the systems to ensure their sustainability for generations to come.

Public pensions and Medicaid currently take up 39% of state general revenue spending, and will grow to 50% next year without major reforms. Inaction could also severely limit the state’s ability to fund core services like education and public safety, threaten the state’s credit rating and hurt the long-term sustainability of both systems. The visit comes a day after the Medicaid restructuring legislation was filed to reform Illinois’ Medicaid system and the Illinois Farm Bureau added its support to the governor’s plans to rescue and stabilize Illinois’ broken pension and Medicaid systems.

Governor Quinn’s plan to stabilize public pensions would save taxpayers up to $85 billion, eliminate the unfunded liability over 30 years and allow public employees who have faithfully contributed to the system to continue to receive pension benefits. His Medicaid restructuring plan would create $2.7 billion in savings by cutting waste, fraud and abuse; raising the price of cigarettes by one dollar, and bringing in dollar-for-dollar federal matching funds.

For more information about the urgency of repairing Illinois’ Medicaid and public pension systems and to take action, visit SaveOurState.illinois.gov.

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All presenting blood donors have the chance to win a prize package worth $200

PEORIA, Ill. (May 21, 2012) – Memorial Day weekends are always packed full of fun summer activities. But as individuals and families kick-off their summer plans, it’s important to remember that the need for blood does not take a summer holiday.

To help ensure a stable blood supply for patients in need this Memorial Day, the American Red Cross is encouraging all eligible blood donors to make donating blood and platelets a part of their summer holiday plans. Five presenting donors who give blood from May 24 through May 30 within the American Red Cross Heart of America Blood Services Region will win a GiftCertificates.com prize package worth $200 redeemable for items of their choosing. Winning donors can choose from restaurants, department stores, books, music, electronics and more!

“With the arrival of summer, blood donations tend to decline as eligible donors fill their schedules with vacations and other summer activities, leaving little time to donate,” said Shelly Heiden, CEO of the Heart of America Region. “The need for blood is constant. As donors choose how to spend their time this Memorial Day, we encourage them to make time to help give life by donating blood or platelets with the Red Cross.”

As part of the Red Cross’ Live Life. Give Life. summer-long promotion (May 21 – September 5), all presenting donors will also be entered to receive a prize certificate package worth $5,000 redeemable at GiftCertificates.com. One lucky donor will be able to live a little, using the prize certificate to choose from hundreds of available prize options.

How to Donate Blood
Simply call 1-800-RED CROSS (1-800-733-2767) or visit redcrossblood.org to make an appointment or for more information. All blood types are needed to ensure a reliable supply for patients. A blood donor card or driver’s license, or two other forms of identification are required at check-in. Individuals who are 17 years of age (16 with parental permission in some states), weigh at least 110 pounds and are in generally good health may be eligible to donate blood. High school students and other donors 18 years of age and younger also have to meet certain height and weight requirements.

About the American Red Cross
The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies more than 40 percent of the nation's blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission. For more information, please visit redcross.org or join our blog at http://blog.redcross.org.

The need is constant. The gratification is instant. Give blood.™



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