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Hcr e&o ltc training 410

Hcr e&o ltc training 410






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    Hcr e&o ltc training 410 Hcr e&o ltc training 410 Presentation Transcript

    • AARP Education & Outreach Regional Trainings for State Offices Spring 2010 Chronic & Long Term Care Improvements Under Health Reform AARP Government Relations and Advocacy Health & Long-term Care Teams
    • Long Term Care (LTC)
      • How the Law Changes LTC:
      • New Options and Incentives for Medicaid Home and Community Based Services (HCBS)
      • New Protections and Better Information for Consumers
      • Benefits of the Law:
      • Significant New Medicaid Incentives to Expand Services
      • Helps People Live in the Setting of their Choice
      • Improves Consumer Decision-making and Quality of LTC
      • AARP’s Position Going Forward:
      • New Law Builds on Important Federal and State Programs that AARP has Helped to Develop
      • AARP Made LTC Improvements a Cornerstone of our Support for HCR and is Committed to Implementation & Education of Public
    • Overview of Improvements
      • Provisions Affecting Home and Community-Based Services (HCBS)
        • Community First Choice Option
        • State Balancing Incentives Payments Program
        • HCBS State Plan Option Changes
        • Money Follows the Person Rebalancing Demonstration
        • Spousal Impoverishment for HCBS
        • Aging and Disability Resource Centers
        • Co-Pays For Duals
      • Provisions Affecting Nursing Home Residents and Consumers
        • Information and Disclosure
        • Oversight and Enforcement
      • Provisions to Improve Quality across all Settings
        • Criminal Background Checks
        • Elder Justice
    • Medicaid Community First Choice Option
      • New state plan option to provide HCBS attendant services & supports to individuals needing institutional level of care
      • Offer statewide; no limits on ## of participants; assistance with ADLs, IADLs, health-related tasks, etc.
      • Financial eligibility requirements for participation
      • Incentive: 6% enhanced federal Medicaid matching rate (FMAP)
      • Development and Implementation Council
      • Data collection, quality / evaluation and reports to Congress
      • Begins effective Oct. 1, 2011
    • Medicaid HCBS: State Balancing Incentives Payments Program (BIPP)
      • Goal: help states balance long-term services and supports (LTSS) systems (HCBS over institutional care)
      • States apply for grant & and agree to develop: statewide single entry point; conflict-free case management; standardized assessment; data collection
      • Grants through temporary (5 year) enhanced FMAP; $3 bil federal
        • States with less than 25% total Medicaid LTSS spending on HCBS get a 5% FMAP increase (target of 25%)
        • States with 25-49% total Medicaid LTSS spending on HCBS get a 2% FMAP increase (target of 50%)
      • State maintenance of effort on eligibility
      • Begins Oct. 1, 2011
    • Medicaid HCBS State Plan Option – Immediate Changes to Current Law
      • Since 2006, State Medicaid plan option available to expand HCBS without a waiver to individuals who need less than institutional level of care BUT few states have taken up the option
      • States now:
        • Can include services not listed in statute with CMS approval (expanded scope of services)
        • Can’t limit coverage to a specific geographic area
        • Can’t limit the number of individuals covered
        • May target individuals with particular conditions (allows states to waive comparability)
        • May tighten functional eligibility, but individuals already receiving coverage are protected.
      • Begins April 1, 2010
    • Medicaid HCBS: Money Follows the Person Rebalancing Demonstration
      • Grants awarded to states to transition Medicaid enrolled nursing home residents to homes or community settings through FY 2016
      • Minimum Nursing Home residency requirement reduced from 6 months to 90 days—rehab days are not counted
      • Begins: April 22, 2010
    • Medicaid HCBS: Spousal Impoverishment
      • Current law allows the spouse of a nursing home resident with Medicaid to keep a certain level of income and assets to protect against impoverishment and allow him/her to live at home
      • New law extends these same spousal impoverishment protections to the spouses of individuals receiving Medicaid HCBS
      • Begins: Five years beginning Jan. 1, 2014
    • Other HCBS Related Provisions
      • $10 million per year for five years starting in 2010 for Aging and Disability Resource Centers – “one-stop shops” for information and other assistance regarding long-term services and supports
      • No Medicare Part D cost sharing for full dual eligibles (persons with Medicare and Medicaid) receiving home and community-based services (HCBS) who would otherwise receive institutional care
    • Nursing Homes: Information and Disclosure
      • New law provides better and easier access to information on:
        • Nursing Home Ownership/Organizational Structure
        • Standardized Staffing Data based on Payroll Records
        • Complaints and How to Make Complaints
        • Crimes
        • Expenditures
        • Survey Reports and Investigations
      • States must have/maintain comprehensive nursing home websites
      • CMS Nursing Home Compare Website will be modified to include:
        • Timely updates of inspection information
        • Links to state government nursing home websites and inspection forms
        • Consumer rights page with state specific information
      • GAO to study Five Star Rating System and report to Congress
    • Nursing Homes: Oversight and Enforcement
      • States must establish complaint resolution processes that meet specified criteria
      • Some Medicare and Medicaid fines may be used to benefit residents or support consumer involvement
      • New requirements (& penalties) in the event of facility closure
      • Two new demonstration projects on culture change and information technology authorized
    • Criminal Background Checks and Elder Justice
      • National program for national and state criminal background checks on certain employees of long-term care providers – both home and community-based and institutional settings
        • Federal dollars to states to help fund the program
      • Elder Justice – elder abuse prevention, detection, response, and coordination of efforts
        • Must be funded before programs can start