On March 21, the House of Representatives passed the Patient Protection and Affordable Care Act (HR 3590) by a vote of 219-212; President Obama signed the legislation into law on March 23. On March 25, Congress passed a Reconciliation Bill that will make slight changes to the reform bill. It’s expected that Congress will continue to revisit the bill over the next several years as various sections of it begin to take effect.
ALFA has attached for your review a substantial overview of the entire health-care reform bill. While ALFA does not have a position on the legislation that was passed into law, it did support stand-alone bills that were rolled into the final health-care reform bill. Below you will find a short overview of some of the provisions ALFA supported as well as other provisions included in health care reform that could impact residents and providers.Should you have any questions about this legislation, please contact Maribeth Bersani at [email protected].
Elimination of Part D Cost-Sharing for Certain Non-Institutionalized Full Benefit Dual-Eligible Individuals: ALFA has been working with Congress over the past three years to address the co-pay inequity for dual-eligible residents of assisted living. Prior to the Medicare Part D program, all dual-eligible individuals (those receiving Medicare and Medicaid) were exempt from prescription drug co-payments. After Part D, only those living in skilled nursing settings were exempt, leaving individuals receiving services in home and community-based settings such as assisted living to pay their own way. The bill that ALFA championed was partially incorporated into the final health-care reform bill. This section represents a two-thirds fix to the Medicare Part D issue that ALFA has taken a lead in correcting. This new law would extend the exemption to cover all dual-eligible individuals receiving services under a 1115 or 1915 waiver program. It would not, however, cover those individuals receiving services through their state Medicaid plans.
Community Living Assistance Services and Supports Act (CLASS Act): ALFA has been working with the late Sen. Ted Kennedy’s staff on the CLASS Act for the last four years. As free-standing legislation, ALFA supported this measure over the years because it encourages personal responsibility and savings for long-term care needs, and provides choice for citizens of any age to decide on a long-term care setting. A slightly revised version of the CLASS Act was incorporated in the final health-care reform bill. The CLASS Act is a national and voluntary pooled-risk, long-term care insurance program. Individuals would contribute through a voluntary opt-out payroll deduction and after five years would be fully vested in the program and eligible for a tiered system of benefits based upon their required ADLs. (See page 53 of the full report for details.)
Training in Family Medicine, General Internal Medicine, General Pediatrics, Geriatrics, and Physicians Assistants, and Nursing Shortage: ALFA has urged Congress for years to address the lack of trained professionals in the field of geriatrics to care for a rapidly aging society. This section of health-care reform establishes millions of dollars in grant funding for the study of, among other areas, geriatrics. The legislation includes a number of provisions designed to address the current shortage of nurses working in the health-care field by providing for additional grants, scholarships, and workforce training programs. The measure directs HHS to enter into contracts with educational institutions to create a “Career Ladder” program, which would be intended to promote career development and advancement opportunities for those in the nursing field. Additionally, the measure authorizes $338 million over six years for Public Health Service Act nursing programs.
Money Follows the Person: ALFA supports the concept of the Money Follows the Person program to allow seniors and disabled individuals to live in the home and community-based setting of their choice. Unfortunately, the way the program is currently defined, assisted living is often not considered a home and community-based option. Now that health-care reform extends this program through 2016, ALFA will continue to advocate for assisted living to be an option for frail seniors.
Elder Justice Act: ALFA has been part of coalition supporting the Elder Justice Act for many years. This free-standing bill incorporated into health-care reform is intended to protect the rights of elderly long-term care residents. The measure authorizes a total of $52.5 million in fiscal years 2011 through 2014 for HHS to award grants to conduct agency activities that promote education and training in the field of long-term care. Funds could be used for training grants, projects to install electronic health records in long-term care communities, or programs to recruit workers to the long-term care field. The bill authorizes a grant program through which HHS would award grants to create mobile forensic centers to investigate allegations of crimes against seniors, and authorizes $18 million in fiscal years 2011 through 2014 for the grants. It also authorizes $15 million for HHS to provide funds to state and local adult protective services agencies to investigate elder abuse, as well as to collect and disseminate data on the prevalence of elder abuse and best practices to prevent such abuse. The provision calls for a coordinated criminal background check system between states and the FBI system for communities that participate in Medicaid.
In addition, the bill creates a new Elder Justice Coordinating Council within HHS, as well as a new Advisory Board on Elder Abuse, Neglect, and Exploitation, which would conduct research and make recommendations to the Coordinating Council. The goal of the council and advisory board would be to coordinate among HHS, the Justice Department, and state and local governmental agencies regarding efforts to combat elder abuse or neglect.
The following provisions, while not actively supported by ALFA, could impact senior living residents or providers.
Medicaid Provisions: The legislation creates a new, optional Medicaid benefit in which states could provide community-based services to individuals with disabilities who would otherwise require services in a hospital or nursing facility.
Medicare: This measure creates an Independent Payment Advisory Board (IPAC) to draft legislative proposals to slow the growth rate in Medicare spending if spending exceeds a certain target rate, starting in 2014. The bill explicitly prohibits the IPAC from making recommendations that would ration care, or change benefits, eligibility rules, or require cost-sharing, such as premiums and co-payments. The measure also makes a number of other changes designed to reduce the growth of Medicare spending.
Medicare Part D Drug Coverage ‘Closing the Doughnut Hole’: The bill requires drug makers to give seniors a 50 percent discount on any purchases made while they are in the coverage gap in Medicare’s prescription drug benefit, known as the “doughnut hole.” The reform legislation provides for a $250 rebate for beneficiaries who fall into this scenario in 2010, while the Reconciliation bill (HR 4872) modifies this provision to phase out the doughnut hole by 2020 at an estimated cost of $37.6 billion over 10 years.
Hospital Re-admissions Reduction Program: The measure reduces reimbursements to hospitals for what are considered preventable re-admissions of Medicare beneficiaries. The provision is intended to incentivize hospitals and health-care providers to allow for adequate medical follow-up to prevent multiple hospital re-admissions for individuals with chronic conditions. Starting in FY 2012, CMS would reduce payments by specified percentages, depending on the billing code, for preventable hospital re-admissions. The measure instructs CMS to determine the number of hospital re-admissions for a given condition that would be considered excessive, and thus subject to reduced reimbursements. It also directs CMS, within two years of enactment, to create a new program that would assist hospitals in reducing excessive re-admissions. CBO estimates that this provision would reduce mandatory spending by $7.1 billion through FY 2019.
Medical Malpractice: The legislation creates a five-year demonstration program in which states could evaluate alternatives to the current medical liability tort system. HHS could award grants to states that develop pilot programs that would allow for the resolution of medical malpractice disputes, and would promote a reduction of medical errors by encouraging the collection and analysis of relevant data.
Indian Health Service (IHS): The measure authorizes the IHS to provide funding for hospice care, assisted living, long-term care, and home and community-based services.
