Hcr e&o ltc training 410


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Hcr e&o ltc training 410

  1. 1. 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
  2. 2. Long Term Care (LTC) <ul><li>How the Law Changes LTC: </li></ul><ul><li>New Options and Incentives for Medicaid Home and Community Based Services (HCBS) </li></ul><ul><li>New Protections and Better Information for Consumers </li></ul><ul><li>Benefits of the Law: </li></ul><ul><li>Significant New Medicaid Incentives to Expand Services </li></ul><ul><li>Helps People Live in the Setting of their Choice </li></ul><ul><li>Improves Consumer Decision-making and Quality of LTC </li></ul><ul><li>AARP’s Position Going Forward: </li></ul><ul><li>New Law Builds on Important Federal and State Programs that AARP has Helped to Develop </li></ul><ul><li>AARP Made LTC Improvements a Cornerstone of our Support for HCR and is Committed to Implementation & Education of Public </li></ul>AARP
  3. 3. Overview of Improvements <ul><li>Provisions Affecting Home and Community-Based Services (HCBS) </li></ul><ul><ul><li>Community First Choice Option </li></ul></ul><ul><ul><li>State Balancing Incentives Payments Program </li></ul></ul><ul><ul><li>HCBS State Plan Option Changes </li></ul></ul><ul><ul><li>Money Follows the Person Rebalancing Demonstration </li></ul></ul><ul><ul><li>Spousal Impoverishment for HCBS </li></ul></ul><ul><ul><li>Aging and Disability Resource Centers </li></ul></ul><ul><ul><li>Co-Pays For Duals </li></ul></ul><ul><li>Provisions Affecting Nursing Home Residents and Consumers </li></ul><ul><ul><li>Information and Disclosure </li></ul></ul><ul><ul><li>Oversight and Enforcement </li></ul></ul><ul><li>Provisions to Improve Quality across all Settings </li></ul><ul><ul><li>Criminal Background Checks </li></ul></ul><ul><ul><li>Elder Justice </li></ul></ul>AARP
  4. 4. Medicaid Community First Choice Option <ul><li>New state plan option to provide HCBS attendant services & supports to individuals needing institutional level of care </li></ul><ul><li>Offer statewide; no limits on ## of participants; assistance with ADLs, IADLs, health-related tasks, etc. </li></ul><ul><li>Financial eligibility requirements for participation </li></ul><ul><li>Incentive: 6% enhanced federal Medicaid matching rate (FMAP) </li></ul><ul><li>Development and Implementation Council </li></ul><ul><li>Data collection, quality / evaluation and reports to Congress </li></ul><ul><li>Begins effective Oct. 1, 2011 </li></ul>AARP
  5. 5. Medicaid HCBS: State Balancing Incentives Payments Program (BIPP) <ul><li>Goal: help states balance long-term services and supports (LTSS) systems (HCBS over institutional care) </li></ul><ul><li>States apply for grant & and agree to develop: statewide single entry point; conflict-free case management; standardized assessment; data collection </li></ul><ul><li>Grants through temporary (5 year) enhanced FMAP; $3 bil federal </li></ul><ul><ul><li>States with less than 25% total Medicaid LTSS spending on HCBS get a 5% FMAP increase (target of 25%) </li></ul></ul><ul><ul><li>States with 25-49% total Medicaid LTSS spending on HCBS get a 2% FMAP increase (target of 50%) </li></ul></ul><ul><li>State maintenance of effort on eligibility </li></ul><ul><li>Begins Oct. 1, 2011 </li></ul>AARP
  6. 6. Medicaid HCBS State Plan Option – Immediate Changes to Current Law <ul><li>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 </li></ul><ul><li>States now: </li></ul><ul><ul><li>Can include services not listed in statute with CMS approval (expanded scope of services) </li></ul></ul><ul><ul><li>Can’t limit coverage to a specific geographic area </li></ul></ul><ul><ul><li>Can’t limit the number of individuals covered </li></ul></ul><ul><ul><li>May target individuals with particular conditions (allows states to waive comparability) </li></ul></ul><ul><ul><li>May tighten functional eligibility, but individuals already receiving coverage are protected. </li></ul></ul><ul><li>Begins April 1, 2010 </li></ul>AARP
  7. 7. Medicaid HCBS: Money Follows the Person Rebalancing Demonstration <ul><li>Grants awarded to states to transition Medicaid enrolled nursing home residents to homes or community settings through FY 2016 </li></ul><ul><li>Minimum Nursing Home residency requirement reduced from 6 months to 90 days—rehab days are not counted </li></ul><ul><li>Begins: April 22, 2010 </li></ul>AARP
  8. 8. Medicaid HCBS: Spousal Impoverishment <ul><li>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 </li></ul><ul><li>New law extends these same spousal impoverishment protections to the spouses of individuals receiving Medicaid HCBS </li></ul><ul><li>Begins: Five years beginning Jan. 1, 2014 </li></ul>AARP
  9. 9. Other HCBS Related Provisions <ul><li>$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 </li></ul><ul><li>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 </li></ul>AARP
  10. 10. Nursing Homes: Information and Disclosure <ul><li>New law provides better and easier access to information on: </li></ul><ul><ul><li>Nursing Home Ownership/Organizational Structure </li></ul></ul><ul><ul><li>Standardized Staffing Data based on Payroll Records </li></ul></ul><ul><ul><li>Complaints and How to Make Complaints </li></ul></ul><ul><ul><li>Crimes </li></ul></ul><ul><ul><li>Expenditures </li></ul></ul><ul><ul><li>Survey Reports and Investigations </li></ul></ul><ul><li>States must have/maintain comprehensive nursing home websites </li></ul><ul><li>CMS Nursing Home Compare Website will be modified to include: </li></ul><ul><ul><li>Timely updates of inspection information </li></ul></ul><ul><ul><li>Links to state government nursing home websites and inspection forms </li></ul></ul><ul><ul><li>Consumer rights page with state specific information </li></ul></ul><ul><li>GAO to study Five Star Rating System and report to Congress </li></ul>AARP
  11. 11. Nursing Homes: Oversight and Enforcement <ul><li>States must establish complaint resolution processes that meet specified criteria </li></ul><ul><li>Some Medicare and Medicaid fines may be used to benefit residents or support consumer involvement </li></ul><ul><li>New requirements (& penalties) in the event of facility closure </li></ul><ul><li>Two new demonstration projects on culture change and information technology authorized </li></ul>AARP
  12. 12. Criminal Background Checks and Elder Justice <ul><li>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 </li></ul><ul><ul><li>Federal dollars to states to help fund the program </li></ul></ul><ul><li>Elder Justice – elder abuse prevention, detection, response, and coordination of efforts </li></ul><ul><ul><li>Must be funded before programs can start </li></ul></ul>AARP