Children especially vulnerable to waterborne illnesses.

Health departments and healthcare providers may want to consider alerting consumers to a potential hazard in their own backyards. The American Academy of Pediatrics says private well water should be tested annually -- and in some cases, more often.

Researchers at the National Institute of Environmental Health Sciences, part of the National Institutes of Health, worked with the AAP to develop these recommendations and draft a new AAP policy statement about the things parents should do if their children drink well water. The recommendations call for annual well testing, especially for nitrate and microorganisms such as coliform bacteria, which can indicate that sewage has contaminated the well. The recommendations point out circumstances when additional testing should occur, including testing when there is a new infant in the house or if the well is subjected to structural damage.

"Children are especially vulnerable to waterborne illnesses that may come from contaminated wells," said Walter J. Rogan, MD, an epidemiologist at NIEHS and lead author on the policy statement and technical report that appears in the June issue of Pediatrics.

And approximately one-sixth of U.S. households now get their drinking water from private wells.

The new policy statement, "Drinking Water from Private Wells and Risks to Children," offers recommendations for inspection, testing and remediation of wells providing drinking water for children.

Not the Government's Turf

Don't expect the government to blow the whistle. "With few exceptions, well owners are responsible for their own wells," Rogan said.

Private wells are not subject to federal regulations and are only minimally regulated by states. With proper care, well water is safe; however, wells can become contaminated by chemicals or pathogenic organisms, NIH warned in a release.

For example: Nitrate, which comes from sewage or fertilizer, is the most common contaminant in wells. The presence of nitrates can be a problem particularly for infants under three months who cannot metabolize nitrate. Water with a nitrate concentration of more than 10 milligrams per liter should not be used to prepare infant formula or be given to a child younger than one year.

The policy statement suggests using bottled water for infants when nitrate contamination is detected or when the source of drinking water is not known.

The policy statement and accompanying technical report point out that water contamination is inherently local and that families with wells need to keep in contact with state and local health experts to determine what should be tested in their community. For example, some parts of the country may have arsenic, radon, salt intrusion or agricultural runoff that may get into the water supply.

"As people move out of urban and suburban areas into areas that are not reached by municipal water supplies, it is more important than ever that people know who to contact in their local health department to get information about local groundwater conditions," said N. Beth Ragan of NIEHS, who served as consultant on these reports. A compilation of state by state telephone and Web-based resources of local experts is included in the technical report.

"This statement will be extremely useful to many audiences -- especially pediatricians," said NIEHS Director Linda Birnbaum, PhD. "Pediatricians needed a one-stop shopping document that they can share with parents who have concerns about their children’s sources of drinking water."

The goal: Create aging and disability resource centers in every state.

The feds are making it easier for aging and disabled persons to receive information on their care options.

In support of President Barack Obama’s proclamation of the “Year of Community Living,” Department of Health and Human Services Secretary Kathleen Sebelius announced on June 22 a funding opportunity through Aging and Disability Resource Center Programs. ADRCs provide “one-stop shop” sources of information, one-on-one counseling, and access to programs and services that help people remain in their own homes and communities. ADRCs also partner with State Health Insurance Counseling Programs to help people with their Medicare benefits.

This funding opportunity will expand ADRCs across the country, HHS clarified. ADRCs are a collaborative effort of the Administration of Aging and the Centers for Medicare & Medicaid Services.

Background: Since 2003 AoA and CMS have jointly funded ADRC pilot programs in 45 states and territories. The new funding will build on and expand the existing pilots to ensure every state can offer this program and its services to their citizens.

“This program will help consumers and their families, and it can save taxpayer dollars," Secretary Sebelius said. "If people have options, they will be able to find the most appropriate and often lower-cost health-related and social services that support individuals to allow them to lead meaningful lives in their homes and communities.”

The Administration’s launch of “Year of Community Living” marked the 10^th year anniversary of the Supreme Court Olmstead v. L.C. decision. This landmark ruling supported community living options for people with disabilities to prevent discrimination under the Americans with Disabilities Act.

The funding availability includes two opportunities: 

• AoA-funding opportunity for ADRC development or expansion in up to 50 states over a three-year period. The maximum award for the ADRC opportunity will be $600,000; total funds available are $10 million. 

• CMS-award opportunity to programs in California, Hawaii, Maryland, and North Carolina to strengthen ADRC partnerships with hospitals so that more people who are being discharged and need post-acute care receive that care at home rather than in a nursing home facility. The award amount per state is $1,167,000.   

States applying for ADRC grants must involve a variety of agencies, organizations, and consumers representing seniors and people with disabilities in the design and implementation of their ADRC programs, HHS said. 

Meanwhile, CMS issued an Advanced Notice of Proposed Rulemaking to solicit input on removing federal barriers that prevent states from designing needs-based, person-centered home and community-based waiver programs. This notice also asks for comments on the characteristics of home and community-based settings. The ANPRM is at http://edocket.access.gpo.gov/2009/pdf/E9-14559.pdf .

For more information on ADRCs, go to www.adrc-tae.org .  

In other news…

• Providers and administrative staff involved in verifying CMNs have a CEU opportunity. The Centers for Medicare & Medicaid Services recently announced Certificate of Medical Necessity Web-Based Training is now available. More information about the course is at www.cms.hhs.gov/MLNGenInfo. Scroll to the "Related Links Inside CMS" section at the bottom of the page, and select Web Based Training Modules. You will find the "Certificate of Medical Necessity WBT" from the list provided. Upon completion of this course one should be able to:

1) List the items that require a Certificate of Medical Necessity (CMN);

2) Identify the responsibilities of Physicians, Physician Assistants, Nurse Practitioners, or Clinical Nurse Specialists as they relate to the CMN;

3) Define medical record documentation;

4) Identify the sections of a CMN;

5) List CMN common Errors; and

6) Identify CMN completion resources.

• Healthcare providers should keep a sharp eye on incoming faxes: On June 18, The Centers for Medicare & Medicaid Services sent an email warning providers of a scam where perpetrators are sending faxes to physician offices posing as the provider's Medicare carrier or Medicare Administrative Contractor. The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.

"If you receive a request for information in the manner described above, please check with your contractor before submitting any information," CMS advised. "Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at www.cms.hhs.gov/MLNGenInfo  or www.cms.hhs.gov/MedicareProviderSupEnroll ."

• Lab coats may be a thing of the past in hospitals -- and it's all hinging on an American Medical Association debate. Recent evidence from the Centers for Disease Control & Prevention about the rate of infections contracted in hospitals raised the question of whether lab coat sleeves could be a culprit. The AMA House of Delegates is pushing to ban lab coats in hospital settings, according to the Wall Street Journal Health Blog.