Summary H.R. 3962 Health Care Reform

Employer Responsibility

• If offering coverage, must provide both individual and family coverage options.
• Employer must cover 72.5% of cost of individual policy and 65% of cost of family coverage.
• Requires automatic enrollment of employees in whatever health plan is offered – “opt out.”
• If employer does not offer coverage, would be required to pay a contribution of 8% of average employee salary to health exchange. Companies with payroll under $500,000 per year exempt.
  

Individual responsibility

• 2.5% tax on individuals who do not obtain acceptable coverage for themselves and their dependents.
• Tax credit to assist individuals with incomes under 400% of federal poverty level.
  

Medicare

• Market basket freeze for second, third and fourth quarters of fiscal 2010 for skilled nursing facilities. [Note: we prefer Senate Finance Committee approach that would keep the payment update in place but impose a 1% “productivity adjustment” cut to the market basket beginning in 2012.]
• Market basket freeze for 2010 for home health care, and accelerates regulatory changes that would further reduce Medicare home health reimbursement. Calls for a MedPAC study on home health care provider margins. Directs CMS to rebase home health prospective payment system in 2011.
• Improves accuracy of Medicare skilled nursing facility prospective payment system reimbursement for non-therapy ancillaries such as prescription drugs. Directs the development of an outlier provision for non-therapy ancillaries.
• Delays cuts in Medicare hospice reimbursement for another year.
• Allows physician assistants to order skilled nursing care and makes them eligible to be hospice care providers.
• Directs CMS to develop a plan within three years for bundling Medicare payments for post-acute care. Converts an existing demonstration project to a pilot program and authorizes the program to include bundling of payments to hospitals and post-acute care providers as of January 1, 2011.
• Subsidies to Medicare Advantage programs, which have been reimbursed at approximately 114% of the rates applicable to fee for service providers, will be phased out. Without the subsidies, these plans may cut back on goods or services they cover that are not covered by traditional Medicare, such as vision or dental care. However, Medicare Advantage plans still will have to compete with traditional Medicare, so it is possible that they will continue to cover the additional goods and services.
• Extends special needs plans that serve residents in continuing care retirement communities.
• Phases out the “doughnut hole” in Medicare Part D coverage of prescription drugs.
• Eliminates deadlines for long-term care pharmacists to file Part D claims to allow more time for improved coordination with state Medicaid programs.
• Requires Part D plans to develop utilization management techniques to reduce prescription drug waste in long-term care facilities.
• Eliminates Medicare cost sharing for dual eligibles receiving care under a home- and community-based services waiver who otherwise would need institutional care.
• Extends Medicare therapy caps exceptions process, currently due to expire 12/31/09, through 2011.
• Promotes the Medicare medical home demonstration project to a pilot program to assess the feasibility of reimbursing for patient-centered medical homes for both beneficiaries with multiple chronic conditions and for beneficiaries in general.
• Waives Medicare cost-sharing for preventive services.
• Allows clinical social workers to bill Medicare separately for services provided in skilled nursing facilities.
• Independence at Home demonstration program for chronically ill beneficiaries.
• Nursing home transparency – requires disclosure of ownership and facility organizational structure.
• Requires nursing facilities to operate ethics and compliance programs within three years of enactment.
• Requires posting of information on Nursing Home Compare regarding staffing and summaries of complaints made against a facility.
• Requires skilled nursing facilities to break out their expenditures on direct care separately on Medicare cost reports [a provision AAHSA initiated and strongly favors].
• Directs CMS to develop a standardized complain form.
• Requires CMS to develop a program for skilled nursing facilities to report staffing information in a uniform format based on payroll data, including information on agency or contract staff. Program must be in place two years after date of enactment.
• Establishes a national criminal background check requirement for nursing home employees with direct access to residents.
• Directs CMS and the Inspector General to develop a pilot program using an independent monitor to oversee interstate and large intrastate chains of nursing facilities.
• Requires written notification to residents of planned facility closure and planning for their relocation.
• Requires nursing facilities to train employees in dementia care and abuse prevention.
• Requires CMS to study training requirements for CNAs and supervisory personnel in nursing homes and recommend content and length of training.
• Requires full-time directors of food service to be qualified as Certified Dietary Managers, Dietician Technicians, or have a similar military or academic qualification.
• Increased penalties for Medicare fraud. Requires providers to adopt compliance programs to reduce waste, fraud and abuse.
• Repeals the 45% trigger that would have required cuts in Medicare if general revenue financing for the program exceeded certain levels.
  

Medicaid

• Expands eligibility to everyone with an income under 150% of federal poverty level. Federal government would pay 100% of the cost of coverage in 2013 and 2014, then 91% of the cost in 2015 and thereafter.
• Requires CMS to review the adequacy of Medicaid payment rates for to health care providers.
• Extends the increased federal Medicaid match provided under the economic stimulus package for another six months, through June, 2011.
• Establishes a four-year program of supplemental Medicaid payments to nursing facilities with high proportions of dual eligibles. $6 billion is authorized for this program over the four year period.
• Contains a sense of Congress statement in favor of Medicaid coverage of community-based attendant services.
  

Workforce

• Improvements to the federal nurse education program include increased loan repayment benefits and the removal of caps on awards for nurses pursuing advanced degrees.
• Creates advisory panel and a pilot program on improving working conditions and training for the long-term care workforce.
• Increases authorized funding levels for Family Caregiver Support to $260 million.
• Requires the Dept of Labor to establish a website as a clearinghouse of information on the health care labor market, including educational and training opportunities and financial aid information.
• Medical liability alternatives.
• Establishes an incentive program for states to adopt alternatives to medical malpractice litigation. Alternatives may not limit damages or cap attorneys’ fees, but the bill would not preempt any limits that may exist under state law.
  

Community Living Assistance Services and Supports

• Establishes a new, voluntary public long-term services and supports insurance plan [AAHSA strongly supports].