Word: vladeck
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...approached not only Shalala but also Medicare- and Medicaid-programs administrator Bruce Vladeck, whose office had written the sharper guidelines and who offered to consider revisions. Solomont says he was the "impetus" for at least two meetings with Vladeck and an exchange of letters. In one memo, Solomont asked Vladeck to review suggested changes: "Put it in your own words and send it back to us in a letter [to show] our mutual direction." To consumer advocates such as Toby Edelman of the National Senior Citizens Law Center, "it's disturbing they had access that ordinary people don't have...
Last month Vladeck loosened state enforcement authority by suggesting that fines are "most appropriate" for life-threatening offenses. The new guideline accedes to the industry's demands to make fines the "remedy of last resort." But Edelman says the guideline ensures that nursing homes will escape responsibility for the vast majority of offenses--like poor nutrition and lack of privacy--that do not rise to the level of "most serious" but can dominate nursing-home life...
Another proposed revision that Solomont sought and obtained has added more hoops to the informal process of resolving disputes between nursing-home owners and their regulators. Specifically, Vladeck recommended that state authorities meet face-to-face with nursing-care providers who dispute alleged offenses and that these discussions be joined by officials who have had no earlier involvement in the dispute and could thus provide a more "objective" point of view. Advocates like Edelman who oppose this change in the guidelines say it adds to the load of hard-pressed state regulators and thus undermines their ability to enforce...
...Vladeck, while acknowledging that industry lobbying was influential, says he would "comfortably defend each change on its merits." He also notes that the industry did not get all it asked for. Shalala, who was traveling in Europe, could not be reached for comment. Solomont, meanwhile, says that with his new job as finance chairman, the pressure increases "not to create an impression I was using that role in a way that was self-serving" and "not to be seen as representing any particular group." But then he adds, "Having said that, I'm not about to check what I believe...
...rights advocates and, indeed, of all those who give priority to the AIDS virus, as political concerns. Thus, he legitimizes dismissing the disease. Though the religious right claims that AIDS is God's answer to homosexuality, no health issue should be a political or moral concern. --Liz C. Vladeck...