Dear Neighbors,

My dear 88 year old grandmother is residing in a Blackstone Valley nursing home.  She is suffering from dementia, blindness, and incurring deafness.  As a seven month resident of this area nursing home, she has lost weight going from 130 to 124 pounds.  She is deeply unhappy at this facility.  However, it is the only facility she can afford on her limited Medicare coverage.

A relative recently reported my grandmother  was served lunch with half drunk milk and half- edible chicken given on her plate.  The relative immediately complained to the head dietary aide.  The aide said the milk was not like that as it left the kitchen.

In addition, she said a lack of proper personal bathing and bathroom sanitation occurs at this facility.

Is anyone else in this situation?   How can one insure the nursing home is best paying attention to the patient's needs?  What state agency can help protect my grandmother and her best interests?

I think there is a medicare reporting agency method and does Alliance for Long Term Care in Warwick still do the ombuds duties for patient care?

Call the Dept of Health or even the Mathieu Center. I am sure they could forward the complaints or investigation request

The Alliance is the best best and they are located in Warwick on Warwick Avenue. I believe you can check the facility on either the DOH website or for medicare..

Good luck,,,,no one should suffer.

It may be time to change facilities as a medicaid bed may have opened up in the better facility

This may an interesting roadblock the legislature forgot about in changing the rules and losing the waiver and restarting the process

DEPARTMENT OF HEALTII & HUMAN SERVICES Centers for Medicare & Medicaid Services

CAIS

JFK Federal Building, Government Center Room 2275

CENTERS for MEDICARE

Boston, Massachusetts 02203

Consortium for Medicaid and Children's Health Operations I Region I

June 23, 2009

Gary D. Alexander, Secretary Executive Office ofHealth and Human Services Hazard Building, 2^{nd floor 74 West Road Cranston, Rhode Island 02920}

Dear Mr. Alexander:

This letter is in response to an e-mail Ann Martino sent to CMS on May 8, 2009. We appreciate your sharing Rhode Island Senate bill S. 53 and House Bill 5112 and allowing us an advance opportunity to comment on the impact the proposed changes might have on the Global Compact 1115 Demonstration.

Sections 40-8.9-9 (c) (1 & 2), are inconsistent with the current Standard Terms and Conditions (STCs) in the waiver. This proposed change would apply the pre-demonstration level ofcare criteria for a lifetime for certain individuals. In contrast, STC #30 details that once an individual improves to a level where they would no longer meet the pre-demonstration institutional level ofcare, or the individual chooses community care over institutional care, all future level ofcare determinations will bebasedonthenewlevel ofcarecriteriaestablishedfor purposes oftheGlobaldemonstration. This change, pending a full review, may be allowable, but will require a waiver amendment following the category 3 process, which will delay the full implementation ofthe waiver.

Section 40-8.9-9 (c) (3 & 4), are inconsistent with Federal Medicaid laws. These provisions propose to deem certain individuals to have satisfied the institutional level ofcare criteria for life based on their having satisfied the criteria prior to January 15, 2009. Section 1919(b)(3) ofthe Social Security Act requires that for individuals residing in a long term care facility, a comprehensive assessment be performed at least annually, and a quarterly review assessment be performed at least every three months. The result ofthese reviews determines whether or not the resident still meets institutional levelofcareandisentitledtocontinuingMedicaidcoverage ofthoseservices. Similarly,Federal regulations at 42 CFR 441.365 require that for home and community-based services, a redetermination ofneed is performed at least annually. As such, any guarantee of satisfaction of institutionallevel ofcarecriteria isunallowableand wouldjeopardizereceipt oftheFederalMedical Assistance Percentage match.

I would encourage you to alert your legislature that these changes, ifimplemented, would place Rhode Island out ofcompliance with the Global Compact 1115 demonstration and in violation ofFederal Medicaid law.

I look forward to resolving this matter with you and continuing to partner with Rhode Island in the implementationofthe Global waiver and the administration ofthe Medicaid program. Ifyou or your staff need additional infonnation or would like to discuss this matter, feel free to contact Lynn DelVecchio at (617) 565-1201 or Lynn.DeIVecchio@cms.hhs.gov

Sincerely,

lsi

Richard R. McGreal Associate Regional Administrator