Impact of Health Care Reform on the Senior Living Field Sequoia Region Meeting May 9, 2010 Joanne Handy, President & CEO Aging Services of California
Jan 12, 2016
Impact of Health Care Reform on the Senior Living Field
Sequoia Region MeetingMay 9, 2010
Joanne Handy, President & CEOAging Services of California
How Will Things be Different?
Members as EmployersMembers as Resident AdvocatesMembers as Providers
Members as Employers>50 employees
Must offer health insurance
Offer vouchers to those <400% FPL
Have <30 day waiting period for benefits
Coverage less than 60% of cost of benefits qualifies for Exchange or tax credit
Members as Resident Advocates Fills the doughnut holeExpands preventative services with no
cost-sharingMore assistance for low incomeIncrease payments for primary care
providersReduce overpayment to Medicare
Advantage PlansEncourage more care coordinationExtend solvency of the Medicare Trust
Fund
Members as Service ProvidersCLASS ActValue-based Medicare paymentsBundling post-acute servicesMore funding for home and community
based servicesFunding for care coordination and
transition managementReduce SNF and HHA market basket
increasesTransparency requirements for SNF
Phase-In Timeline•9/10
Cannot drop a sick enrollee
Kids stay on parent’s insurance ‘til 26$250 more in doughnut hole
• 1/11 85% of premiums must be spent on
benefits No cost-sharing for Medicare
preventative care
Phase-In Timeline2012
CLASS Act plan established
50% brand name drugs covered in the doughnut hole
2014Individual mandate in effect
End to annual and lifetime limits on benefits
2018 – Tax on “Cadillac” health plans2020 – Donut hole fully closed
What if . . .CLASS Act passes (it has!!)?Post-acute care is bundled?All dual-eligibles are in managed care
plans?Medicare pays for transition services?What if we ruled the world?
Class Act
CLASS is now a reality!
Will be implemented in 2012 and requires 5 years of contributions to vest. Therefore, 2017 is the first year that benefits could begin.
CLASS
ImpactSource of private funds for nursing
home, assisted living, home care, and other HCBS
Benefit expected to be $50-$100 per day for life, as long as ADL impairment of 2-4 ADLs
The form is a cash benefit to the consumer, not reimbursement to the provider
PositioningEducate consumers to participate
Provide home care – by affiliation or ownership
Strengthen marketing effort direct to consumers
Bundling
Post-acute care is bundled for 30 days and acute care
hospital holds the $$
Impact
Hospitals only refers to contracted SNF/HHA
SNF/HHA referrals have higher acute care needs
Incentive to use lowest cost post-acute sites
Positioning
SCPs become part of hospital networks
Outcome scores key to obtaining contracts
Must negotiate acuity-based ratesWhat’s the case for SNF/HHA controlling the bundle?
Dual Eligibles
All dually eligible patients in California are enrolled in a Managed Care Plan (MCO). This is proposed as part of the new 1115 waiver.
Impact
MCP becomes the payer for most long stay skilled nursing residents
MCPs pay less than Medi-calMore payment delays and billing
hasslesMCP incentivized to keep members
out of nursing homes
PositioningPACE programs expand to manage
less frail dually eligibles
Offer enhanced assisted living as an alternative to skilled
Develop a rate and contract negotiation strategy
Transition Benefit
Medicare pays for transition services from acute care to SNF, AL, independent living, and community. Starts in 2011.
Evidence derived from Naylor, Coleman, and Boult transition models
Impact
Payment available for transition services to prevent acute care readmissions. Existing models utilize nurses, social worker, or a team.
Positioning
Do you want to be a transition provider?
Develop your intervention strategy in your program now
The Cheese is Moving . . .