AAHSA'S Health Reform Hub

These days, it seems like there's more confusion about health care reform than there is clear explanation of what is being debated and what it means for aging services. The Hub is designed to be your "one stop shop" for information about the health care reform debate and what you can do to make sure that final legislation includes creation of a national insurance program for long-term care and appropriate payment for nursing homes. 

On Jan. 19, 2010, Republican Scott Brown defeated Attorney General Martha Coakley in a special election to fill the U.S. Senate seat of the late Edward Kennedy (D). Unless a Republican votes outside of his or her party, the result undoes the 60-vote majority needed in the Senate to stop a filibuster by invoking cloture.     
 
Due to the change in the party make-up of the Senate, the House and Senate leadership are in talks with the White House about what options, if any, are available to move a health care reform measure this year. We are working with all sides to keep alive our priorities, including Medicare payment updates, extension of the increased federal Medicaid match, and the CLASS plan for reforming long-term services and supports financing.
 
The House and Senate have passed health care reform legislation. The provisions of the bills passed by the two houses differ significantly from each other, and members of the House and Senate now are working to resolve these differences and draft the final language of the legislation.

Both bills contain the Community Living Assistance Services and Supports (CLASS) plan to establish a new mechanism for financing long-term services and supports.

We still must reinforce the need to include these provisions in the final health care reform legislation. In addition, there are several key provisions of each bill that we would like to see in the final health care reform measure, and other provisions that should be dropped. 

What Congress Should Include
We need Congress to keep the CLASS Act provisions included in the final legislation. Frail individuals want to stay in their own homes as long as possible, and helping them do that by inclusion of the CLASS Act in health reform promotes personal financial responsibility for that choice, as well as access to services.

The final bill must also provide financial life support to senior service providers. Medicare increases to cover inflation for skilled nursing facilities (SNF), hospice and home health are essential, as is a 2-year extension of the therapy caps exceptions process. The House provision that would give a $6 billion Medicaid boost to nursing homes will help cover dramatic state shortfalls in Medicaid. AAHSA is a strong supporter of home and community-based services (HCBS). We recognize, however, that when people enter nursing homes with enhanced levels of disability, their needs increase. Provider costs for these individuals must be recognized.

Access to HCBS is key to helping people stay at home. Strong, specific solutions are needed:

1. Community First Choice provisions.
2. Changes to Medicaid spousal eligibility.
3. Expansion of Aging and Disability Resource Centers.
4. Money Follows the Person Demonstration.
5. Expansion of Medicaid eligibility for state plan amendment services.
6. Independence at Home-House Call initiative.
7. Increased funding for the National Family Care Giver program.

The RUGS-IV classification system for nursing home residents should also be implemented. The proposed classification system does a better job of identifying resident needs and helps support clinically complex care.

We're also pushing for funding for major studies of issues and innovations for the aging services field. Several proposed studies would explore the effectiveness of current practices in aging services. Those include the a GAO study of the CMS five-star nursing home rating system, an examination of reasons for disparities in home health margins and an IOM study on "limited English proficiency" translation requirements. There is also an IOM study of the CMS five-star system, and a CMS study of the Medicare hospital wage index. Innovations such as the proposed pilot on the bundling of acute and long-term care services, exploration of new care management models and care transitions are very important.

What Congress Should Exclude
Congress should not include increased monetary penalties in the nursing home transparency provisions. The current enforcement system provides a range of remedies, with the intent that the regulatory response fit the circumstances. Increasing the punitive nature of the process is not an effective way to improve quality of care.