On Sunday, March 21, in an historic vote, the U.S. House of Representatives passed H.R. 3590, the Patient Protection and Affordable Care Act, clearing it for signature by President Obama. This comprehensive health care reform bill previously was passed by the Senate on December 24, 2009, and contains a number of provisions which affect older adults, including:
Medicare
· Health care reform will extend the life of the Medicare Trust Fund which, without some intervention, was projected to be depleted in 2017.
· Health care reform will eliminate the Medicare Part D coverage gap by 2020 (including providing a $250 rebate to Medicare beneficiaries who reach the doughnut hole in 2010).
· Health care reform will reduce payments to Medicare Advantage (MA) (Part C) plans to make them equal (on average per beneficiary) to payments through traditional Medicare.
· Medicare Advantage plans provide Medicare benefits through a private insurance plan rather than through traditional fee-for-service Medicare run by the federal government. On average, MA plans currently receive $135 per beneficiary per month in excess of traditional fee-for-service Medicare.
· Individuals and couples enrolled in traditional Medicare pay higher premiums ($96 per year per couple) to subsidize these higher payments to the private insurance plans
· These subsidies to private insurance companies are unsustainable and threaten the future of the Medicare trust fund.
· Cuts to guaranteed Medicare benefits are prohibited in the health care reform bill. The only benefits that the private Medicare Advantage plans can eliminate are the optional extra benefits such as health club memberships, vision or dental.
· The health care reform bill contains provisions to slow the rate of growth in Medicare premiums by testing new care delivery models which focus on quality rather than quantity; reducing avoidable, dangerous and needless hospital readmissions caused by poor care or lack of follow-up; reducing fraud and abuse; and trimming future increases to hospitals and rehab providers.
· Health care reform would also reduce out of pocket expenses for prevention and wellness services for Medicare beneficiaries, and provide a free annual check up for Medicare beneficiaries.
Long-Term Care
· Require nursing homes to disclose their owners, operators, suppliers, financers and others they do business with so they can be held accountable for the care residents receive.
· Require the government to implement a system to collect and report information about how well nursing homes are staffed, including accurate information about the hours of nursing care residents receive; staff turnover rates; and how much facilities spend on wages and benefits.
· Require criminal background checks on employees of long-term care facilities.
· Establish the Community First Choice Option, which creates a state plan option to provide community based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care. States who choose this option will receive a six percent increased “federal match” to help them implement it.
· Offer spousal impoverishment protections to the spouses of all HCBS waiver participants.
· Create a Community Living Assistance Services and Supports (CLASS) program - a new national long-term care insurance program through voluntary payroll deductions that would provide a cash benefit to individuals who are unable to perform ADLs for purchase of assistance and supports.
· According to the Congressional Budget Office, the CLASS provisions would reduce the deficit by $70 billion over 10 years due to the payment of premiums by enrollees.
Elder Justice
· Establish an Elder Justice Coordinating Council to make recommendations to the Secretary of HHS on the coordination of activities of federal, state, local and private agencies and entities relating to elder abuse, neglect and exploitation. Recommendations contained in the report are due in 2 years.
· Provide $400 million in first time dedicated funding for Adult Protective Services (APS). Provides $100 million for state demonstration grants to test a variety of methods to detect and prevent elder abuse.
· Provide $26 million for the establishment and support of Elder Abuse, Neglect and Exploitation Forensic Centers to develop forensic expertise regarding and provide services relating to elder abuse, neglect, and exploitation.
· Provide $ 32.5 million in grants to support the Long-Term Care Ombudsman Program and an additional $40 million in training programs for national organizations and state long-term care ombudsman programs.
· Authorize $67.5 million in grants to enhance long-term care staffing through training and recruitment and incentives for individuals seeking or maintaining employment in long-term care, either in a facility or a community based long-term care entity.