In this Issue
- State Investigation Finds Several Laguna Honda Residents Nearly Drugged to Death
- House Passes FAIR Act to Ban Forced Arbitration
- CANHR and Attorney General Becerra Call on Trump Administration to Withdraw Proposal to Roll Back Nursing Home Standards
- DHCS Confirms Nursing Facility Residents with Intermediate Care Needs Are Eligible for Medi-Cal Coverage
- New Medicare Payment System for Skilled Nursing Facilities Takes Effect
- DA and AG Sue Santa Cruz Nursing Home for Dumping Residents
- Drug Company to Pay $116 Million for Kickback Conspiracy to Push Nuedexta on Nursing Home Residents with Dementia
State Investigation Finds Several Laguna Honda Residents Nearly Drugged to Death
When San Francisco City and County officials held a press conference on June 28, 2019 to address an abuse scandal at Laguna Honda, they described acts of its employees as horrific. They reported that a group of six employees abused 23 residents over a period of years, subjecting them to verbal and physical abuse, sexual harassment, drugging, humiliation and neglect. But they gave few details while assuring the public that residents were now safe.
The extreme nature of the abuse is now coming to light. On September 6, 2019, the San Francisco Examiner published a story describing findings of a California Department of Public Health investigation (CDPH) on the abuse scandal with a link to the State’s investigation report dated July 12, 2019.
House Passes FAIR Act to Ban Forced Arbitration
On September 20, 2019, the U.S. House of Representatives passed the FAIR Act (Forced Arbitration Injustice Repeal), a groundbreaking bill that would restore the rights of millions of Americans to sue businesses, including nursing homes, that violate their rights. By prohibiting pre-dispute arbitration agreements that force arbitration, the bill would give back the right to go to court to victims who have signed arbitration agreements, often unknowingly. Its passage, by a vote of 225-186, is a historic milestone, however, the bill must be passed by the Senate and signed by the President before it becomes law. While the fight to restore basic legal rights for American citizens is not over, the House vote is a great step forward!
CANHR and Attorney General Becerra Call on Trump Administration to Withdraw Proposal to Roll Back Nursing Home Standards
In separate letters submitted to the Centers for Medicare and Medicaid Services (CMS) this month, CANHR and Attorney General Xavier Becerra urged CMS to withdraw proposed regulations that would gut key residents’ rights and core safety standards for nursing home residents. The proposed rollbacks are a brazen attempt to enrich nursing home operators at the expense of nursing home residents. Attorney General Becerra described the proposed rollbacks as illegal, reckless and immoral in a related press release and stated: “In California, we don’t turn our backs on those who do not have the ability to fight back.”
DHCS Confirms Nursing Facility Residents with Intermediate Care Needs Are Eligible for Medi-Cal Coverage
On September 3, 2019, the California Department of Health Care Services (DHCS) issued an alert clarifying that Medi-Cal coverage is available for residents who need “intermediate care,” not just for those who required “skilled” care. This confirmation became necessary because CenCal Health, a Medi-Cal health plan serving San Luis Obispo and Santa Barbara Counties, has aggressively sought to deny Medi-Cal coverage to nursing facility residents on the basis of its assessments that they do not need “skilled” care. The DHCS alert helpfully confirms that nursing facility residents on Medi-Cal are allowed to remain while either intermediate or skilled care services are needed.
CANHR is working with an advocacy coalition to seek broader solutions to increasing coverage denials that are caused by the combination of outdated Medi-Cal regulations on nursing facility coverage and perverse financial incentives for Medi-Cal health plans to cut costs by denying nursing facility care to their members who need it.
New Medicare Payment System for Skilled Nursing Facilities Takes Effect
On October 1, 2019, Medicare is implementing a new payment system for skilled nursing facilities (SNFs) that is called the Patient-Driven Payment Model (PDPM). How “patient driven” the complicated payment system is (or is not) remains to be seen. The Centers for Medicare and Medicaid Services (CMS) claims it will change the financial incentives for SNFs to better serve residents.
Advocates expect that many skilled nursing facilities will aggressively game the new system to serve their financial interests rather than residents’ needs. A particular concern is that Medicare beneficiaries will receive less therapy than they do now and that SNFs have an incentive to replace individual therapy services with less effective but cheaper group therapy services. Another concern is that skilled nursing facilities will cut off Medicare coverage and push out Medicare beneficiaries even faster than they do now. CANHR is interested in hearing from Medicare beneficiaries on their experiences with nursing home coverage under PDPM.
DA and AG Sue Santa Cruz Nursing Home for Dumping Residents
On September 12, 2019, the Santa Cruz County District Attorney and California’s Attorney General jointly sued the operators of Hearts & Hands Post Acute Care & Rehab Center, a skilled nursing facility in Santa Cruz, for an unsafe environment, extensive criminal activity in the facility, and for engaging in a pattern of unsafely dumping residents to the streets, to unlicensed care homes and to hospitals without any notice of their rights. The lawsuit is just the latest evidence of the growing eviction crisis in California nursing homes and the extreme dangers residents are facing from nursing home operators who have no regard for their welfare.
Drug Company to Pay $116 Million for Kickback Conspiracy to Push Nuedexta on Nursing Home Residents with Dementia
On September 26, 2019, the U.S. Department of Justice announced that Avanir, a drug company based in California, had agreed to pay $116 million in criminal and civil penalties to resolve charges that it paid kickbacks and engaged in other illegal activities to market Nuedexta as a treatment for elders with dementia. The settlement resolves multiple whistleblower cases concerning the widespread use of Nuedexta to chemically restrain nursing home residents with dementia, which CNN first brought to public attention in its October 2017 story, The little red pill being pushed on the elderly. Nuedexta is only approved to treat a rare neurological condition, pseudobulbar affect, that is characterized by uncontrollable laughing and crying. However, the government alleged that Avanir successfully capitalized on national efforts to reduce the use of antipsychotic drugs on dementia patients in nursing homes by aggressively marketing Nuedexta as a substitute method of controlling residents’ behaviors that would go unnoticed by regulators. According to the DOJ’s press release, the scheme worked so well that one doctor (a paid speaker for Nuedexta) had put entire units of residents on Nuedexta at a nursing home where he worked. The settlement may not be strong enough to deter future misconduct by other drug companies. CNN’s story on the Avanir settlement reports that Medicare’s Part D prescription drug program spent roughly $225 million on Nuedexta in 2017, up more than 700% from five years earlier.