| 04 May 2010
On Tuesday, March 23, 2010 President Barack Obama signed into law the Patient Protection and Affordable Care Act (H.R. 3590) This comprehensive health care reform bill is packed full of new legislation that and has left many Americans asking “How will this affect me”?
One area that we have been asked about many times is how this new reform will impact the care and benefits for our seniors. Below is a list of some reform items that will directly affect our seniors and the care they are and will be receiving:
Medicare
- Payments to Medicare Advantage (MA) (Part C) plans will be reduced to make them equal (on average, per beneficiary) to payments through traditional Medicare. Medicare Advantage plans provide Medicare benefits through private insurance plans rather than through traditional fee-for-service Medicare run by the federal government. On average, MA plans have received $135 more per beneficiary per month than the traditional fee-for-service Medicare. Although the bill will cut MA payments, there are no provisions for cuts to mandated benefits; as a result of the payment reductions, MA plans may cut extra, optional benefits such as vision and dental. One purpose of these provisions is to extend the life of the Medicare Trust Fund which, without some intervention, is projected to be depleted in 2017. *
- H.R. 3590 contains several beneficial Medicare provisions. It will:
- Provide a 50 percent discount on brand-name drugs and biologics filled in the Medicare Part D coverage gap (doughnut hole) for enrollees with incomes below $85,000 per individual and $170,000 per couple;*
- Eliminate Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home- and community-based services;
- Reduce the Medicare Part D coverage gap (doughnut hole) by $500 in 2010 (2010 only);*
- Cover, with no co-payment or deductible, an annual wellness visit and creation of a personalized prevention assessment and plan. Prevention services include referrals to education and preventive counseling or community-based interventions to address risk factors.
- Tie Medicare Part D premiums to income, and will move more Part B and Part D beneficiaries into higher-income categories — meaning higher premiums —due to a freeze on thresholds.*
- NOTE: Medicare Part D (e.g. closure of the Medicare Part D doughnut hole) and Medicare Advantage payment provisions will be modified by the Reconciliation Act of 2010 (H.R. 4872) if passed by the Senate.
Insurance Reform
- Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
Long-Term Care
- H.R. 3590 includes Community Living Assistance Services and Supports (CLASS) program provisions. The provisions will create a new national long-term care insurance program through voluntary payroll deductions that will provide a cash benefit to individuals who are unable to perform ADLs for the purchase of community living assistance services and supports.
- The provisions will allow inclusion of information on private long-term care insurance in the “National Clearinghouse for Long-Term Care Information.”
Nursing Home Transparency
- H.R. 3590 contains several nursing home transparency provisions. It will:
- Require nursing homes to disclose their owners, operators, suppliers, financers, and others with whom they do business so they can be held accountable for the care their residents receive;
- Require nursing homes to take steps internally to reduce criminal and civil violations;
- Establish a Quality Assurance and Performance Improvement Program to improve quality assurance standards;
- 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 cost reports that nursing homes will file with the government to show expenditures by category — nursing, therapy, capital assets, and administrative services;
- Require civil monetary penalties (fines) to be held in escrow pending appeals rather than allowing nursing homes to delay payment indefinitely while they file appeals.
- Implement a pilot program to improve federal government oversight of nursing home chains that have quality of care problems;
- Provide training to workers who care for residents with dementia and to prevent abuse.
Criminal Background Checks
- H.R. 3590 will extend to all states an existing pilot program that enables states to conduct national criminal background checks, including fingerprint checks, on individuals who apply for direct patient access jobs in long-term care facilities and with home care agencies that receive funding from Medicare or Medicaid, thus eliminating the ability of persons with criminal histories to move from state to state to work with vulnerable seniors and persons with disabilities.
Jenelle Boeckermann is CEO of alleviaCARE, LLC, a Professional In-Home Healthcare Company in the Twin Cities. She is also a member of the National Association of Home Care & Hospice, Private Duty Home Care Association, Minnesota Gerontological Society, Minnesota Home Care Association, and the Minneapolis Area Senior Workers Association. To Learn more please contact Jenelle at (952) 303-4725.