SENIOR ASSEMBLY FEDERAL PROPOSAL NO. 9

INTRODUCED BY SENIOR ASSEMBLY MEMBER ROLFE

LEGISLATIVE COUNSEL'S DIGEST

AFP 9: MEDICARE COVERAGE: FALLS RISK ASSESSMENT.

UNDER EXISTING LAW, MEDICARE PROVIDES COVERAGE FOR A MANDATORY FALLS RISK ASSESSMENT FOR ADULTS 65 YEARS OF AGE OR OLDER INCLUDED IN THE “WELCOME TO MEDICARE” EXAM (INITIAL PREVENTIVE PHYSICAL EXAM OR IPPE). UNDER EXISTING LAW, MEDICARE ALSO PROVIDES FOR AN ANNUAL PREVENTIVE CARE VISIT WHICH REQUIRES A HEALTH RISK SCREENING.

THIS MEASURE WOULD MEMORIALIZE THE CONGRESS AND THE PRESIDENT TO ENACT LEGISLATION THAT WOULD CREATE AN EXPRESS MEDICARE REIMBURSEMENT FOR A FALLS RISK AND PREVENTION ASSESSMENT BY PHYSICIANS AND MID-LEVEL MEDICAL PRACTITIONERS AS PART OF THE INITIAL AND ANNUAL PREVENTIVE CARE VISITS PROVIDED TO ADULTS 65 YEARS OF AGE AND OLDER.

VOTE: MAJORITY.

AFP 9: RELATING TO HEALTH CARE COVERAGE

WHEREAS, THE UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) REPORTS THAT FALLS ARE THE LEADING CAUSE OF FATAL INJURIES FOR AMERICANS 65 YEARS OF AGE AND OLDER; AND

WHEREAS, ONE IN THREE COMMUNITY-DWELLING PERSONS OVER 65 YEARS OF AGE FALLS EACH YEAR; AND

WHEREAS, ABOUT 18,000 OLDER AMERICANS DIE EVERY YEAR BECAUSE OF A FALL, A RATE THAT HAS RISEN DRAMATICALLY OVER THE LAST 10 YEARS; AND

WHEREAS, THE UNITED STATES SPENDS AN ESTIMATED $28.2 BILLION ANNUALLY ON MEDICAL CARE FOR OLDER ADULTS RELATED TO FALLS; AND

WHEREAS, IF WE CANNOT STEM THE RATE OF INCREASE IN FALLS, IT IS PROJECTED THAT THE DIRECT TREATMENT COSTS WILL REACH $54.9 BILLION ANNUALLY BY 2020, AT WHICH TIME THE COST TO MEDICARE WOULD BE $32.4 BILLION; AND

WHEREAS, OF THOSE ADULTS 65 YEARS OF AGE AND OLDER WHO ARE HOSPITALIZED FOR A HIP FRACTURE, 40 PERCENT NEVER RETURN HOME OR LIVE INDEPENDENTLY AGAIN AND 20 PERCENT WILL DIE WITHIN ONE YEAR; AND

WHEREAS, THE CDC STATES THAT “TODAY, THERE ARE PROVEN INTERVENTIONS THAT CAN REDUCE FALLS AND HELP OLDER ADULTS LIVE BETTER, AND LONGER”; AND

WHEREAS, THE COST OF ANNUAL FALLS PREVENTION ASSESSMENTS WOULD BE MORE THAN PAID FOR BY THE PREVENTION OF FALLS BY OLDER ADULTS AND THE SAVING OF THE RESULTING MEDICAL COSTS; AND

WHEREAS, UNDER CURRENT MEDICARE RULES, PHYSICIANS AND MID-LEVEL MEDICAL PRACTITIONERS ARE REIMBURSED FOR VARIOUS TYPES OF ASSESSMENTS FOR PREVENTION OF KNOWN RISKS; AND

WHEREAS, CURRENT MEDICARE RULES PROVIDE FOR A MANDATORY FALLS RISK ASSESSMENT INCLUDED IN THE “WELCOME TO MEDICARE” EXAM (INITIAL PREVENTIVE PHYSICAL EXAM OR IPPE); BUT BENEFICIARIES AND PROVIDERS ARE NOT AWARE OF THIS BENEFIT; AND

WHEREAS, THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (PUBLIC LAW 111-148) AUTHORIZES AN ANNUAL PREVENTIVE CARE VISIT, A NEW MEDICARE PREVENTIVE BENEFIT, WHICH REQUIRES HEALTH RISK SCREENING, BUT DOES NOT SPECIFY FALLS PREVENTION ASSESSMENT; NOW, THEREFORE, BE IT

RESOLVED, BY THE SENIOR ASSEMBLY AND THE SENIOR SENATE, JOINTLY, THAT THE SENIOR LEGISLATURE OF THE STATE OF CALIFORNIA AT ITS 2012 REGULAR SESSION, A MAJORITY OF THE MEMBERS VOTING THEREFOR, HEREBY PROPOSES THAT PHYSICIANS AND MID-LEVEL MEDICAL PRACTITIONERS BE ALLOWED AN EXPRESS MEDICARE REIMBURSEMENT FOR A FALLS RISK AND PREVENTION ASSESSMENT AS PART OF THE INITIAL AND ANNUAL PREVENTIVE CARE VISITS PROVIDED TO ADULTS 65 YEARS OF AGE AND OLDER; AND BE IT FURTHER

RESOLVED, THAT THE SENIOR LEGISLATURE OF THE STATE OF CALIFORNIA RESPECTFULLY MEMORIALIZES THE CONGRESS AND THE PRESIDENT TO ENACT APPROPRIATE LEGISLATION THAT WOULD ADDRESS THE CONCERNS SET FORTH IN THIS MEASURE; AND BE IT FURTHER

RESOLVED, THAT A COPY OF THIS MEASURE BE TRANSMITTED TO THE PRESIDENT AND VICE PRESIDENT, THE SPEAKER OF THE HOUSE OF REPRESENTATIVES, THE CHAIRPERSONS OF THE HOUSE AND SENATE COMMITTEES ON AGING, AND TO EACH SENATOR AND REPRESENTATIVE FROM CALIFORNIA IN THE CONGRESS OF THE UNITED STATES.

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RN 12 15841