Tamper-Resistant Prescription Pads; Funding for Geriatrics Health Professions Programs; Legislation on Physician Pay, Low-Income

New Medicaid Law Requires Tamper-Resistant Prescription Pads Starting This Month Doctors, nurse practitioners, and physician assistants will have to use special tamper- resistant prescription pads when writing prescriptions for Medicaid patients, under new legislation slated to take effect the first of this month. In guidance that the Centers for Medicare & Medicaid Services (CMS) issued in mid-August, the agency outlined the criteria the prescription pads must meet. The pads must “(1) prevent unauthorized copying of a completed or blank prescription form; (2) prevent the erasure or modification of information written on the prescription by the prescriber; or (3) prevent the use of counterfeit prescription forms” starting October 1 of this year. By October 1 of next year, the prescription pads must meet all three criteria, CMS noted. Prescriptions that are phoned in, faxed, sent electronically, or communicated verbally to the pharmacy will be exempt, and the policy will not apply when “a managed care entity pays for the prescription; or in most situations when drugs are provided in certain institutional and clinical facilities,” CMS reported. In addition, the new protocol allows for emergency refills “as long as a prescriber provides a verbal, faxed, electronic or compliant written prescription within 72 hours.” Among other things, the American Society of Consultant Pharmacists had strongly urged CMS to provide exceptions for phone and fax medication orders and for standard medication orders in long-term care facilities and the pharmacies that supply their medications. House Approves FY 2008 Funds for Title VII Geriatrics Health Professions Programs in Midst of Ongoing Advocacy -- Spearheaded by AGS and ADGAP -- On Behalf of Funding Title VII Geriatrics Health Professions Programs would continue to receive funding in fiscal year (FY) 2008 under a spending bill the House of Representatives approved in July. The measure passed in a 276-140 vote in the midst of a concerted advocacy effort on behalf of funding spearheaded by the AGS, the Association of Directors of Geriatrics Academic Programs (ADGAP), their members, and other advocates of quality healthcare for older adults. The House bill would earmark $31.5 million for Title VII Geriatrics Health Professions programs—geriatrics faculty fellowships, geriatrics academic career awards, and the nation's Geriatric Education Centers. The programs were funded at this level in both FY 2005 and in the current fiscal year. Congress cut all FY 2006 funding for the programs, but restored FY 2007 funding on the heels of numerous advocacy campaigns led by the AGS and ADGAP. Overall, the House legislation calls for $607 billion in spending on labor, health, and education programs—about $7 billion more than these programs received in FY 2007 and $10.6 billion more than President Bush requested. In a statement, the White House indicated that the President would veto the bill because of the cost. As this issue of the Journal went to press in mid-September, the Senate had yet to vote on Title VII legislation. House Passes Bill Blocking Cuts in Medicare Physician Pay, Improving Drug Coverage for Low-Income Beneficiaries, and Boosting Funds for SCHIP, But Also Curtailing SNH and Other Payments; Senate Votes to Increase SCHIP Funding Legislation that would block a mandated 10% cut in Medicare payments to physicians in 2008 and another 5% cut slated for 2009; hike these payments 0.5% both of those years; revise the controversial payment formula that mandated the cuts; improve Medicare prescription drug plan coverage for low-income older adults; and reauthorize a key children’s health insurance program won the approval of the House of Representatives in early August. The legislation, the Children’s Health and Medicare Protection (CHAMP) Act, would also freeze payments to other Medicare providers and cut funds for a popular Medicare program. The White House immediately threatened to veto the legislation, which would reauthorize and boost funding for the State Children's Health Insurance Program (SCHIP) $50 billion over five years, in addition to making numerous changes affecting Medicare beneficiaries. Among other things, the CHAMP Act would revise Medicare's contentious Sustainable Growth Rate formula, which mandates physician pay cuts whenever growth in outlays for these services outstrips growth in GDP. It would also eliminate the Medicare drug benefit's "doughnut hole" coverage gap for beneficiaries living on less than $1276 a month. It would raise the limit on the financial assets a beneficiary may have and still qualify for Extra Help under Part D, and it would cover Part B premiums for certain low-income beneficiaries. In addition, the act would align Medicare coverage for mental health services with coverage for physical health problems. And it would initiate a nationwide demonstration project to evaluate the efficacy of providing coverage for a "medical home" for certain Medicare patients. At the same time, however, the legislation would cut payments to Medicare Advantage plans by 12%, and freeze payments for home health providers and skilled nursing facilities. The day after the House measure passed, the Senate approved a $35 billion expansion of SCHIP, in a veto-proof vote of 68-31. The Senate bill, however, does not include Medicare provisions, and as this issue of the Journal went to press, the two chambers faced significant hurdles in trying to achieve consensus on a final measure that would attract enough votes to override a presidential veto. Senate Unanimously Endorses Elder Falls Prevention Act In a victory for the AGS, its members, and others who joined the AGS advocacy campaigns on behalf of the “Keeping Seniors Safe from Falls Act of 2007,” the Senate unanimously approved the legislation before its August recess. Falls are the leading cause of injury and death among adults age 65 and older. Introduced by Sens. Michael Enzi (R-WY) and Barbara Mikulski (D-MD), the legislation includes recommendations from the Falls Free Coalition's National Action Plan, and authorizes new programs to prevent falls among older adults—including demonstration projects with multiple intervention strategies addressing physical mobility, medication management, and home modification. As of mid-September, the House had yet to act on the legislation. AGS continues its advocacy efforts on behalf of Title VII Geriatrics Health Professions Programs funding, Medicare payment reform, and the “Keeping Seniors Safe from Falls Act of 2007.” If you haven't yet done so, please take a moment to register with AGS' Health in Aging Advocacy Center (at www.americangeriatrics.org/advoacy) so the AGS can alert you to upcoming grassroots advocacy campaigns focused on these priorities and others central to providing high-quality healthcare to older Americans.