Long Term Care
Posted on January 16, 2013
Experts and stakeholders agree the current health care system is unsustainable. By 2020, health care spending will comprise almost 20% of the gross domestic product. Furthermore, an ever growing body of evidence clearly indicates that the system is not experiencing improvements in quality that are reflective of the cost growth.
The Patient Protection and Affordable Care Act (ACA) takes significant strides towards the transformation of the American health care delivery system from a system that rewards volume to a system that rewards quality and value. The programs and initiatives…
Posted on January 8, 2013
Both the Senate and the House passed H.R.8 (89-8 and 257-167, respectively), the American Taxpayer Relief Act, on January 1, 2013. President Barack Obama signed the Act into law on January 3, 2013. The measure extends Bush-era income and other tax cuts for individuals and families making up to $400,000 and $450,000 respectively. For individuals and families above this income threshold, the bill increases taxes from 35% to 39.6%. H.R. 8 also postpones…
Posted on November 14, 2012
Historically, the American health care system through its siloed delivery and reimbursement models has failed to support a patient-centered and coordinated delivery system. Fragmentation has resulted in a health care system where potentially avoidable hospital readmissions, duplicative testing, and medication errors are common. Widespread adoption and use of Health Information Technology (HIT) has the potential to decrease these occurrences by enabling providers to electronically exchange health information with other providers and their patients across settings of care to better coordinate patient care.
Recognizing the potential benefit of widespread use of HIT, in 2009 Congress authorized…
Posted on August 29, 2012
Medicaid paid for nearly half of the nation’s $263 billion long-term care expenditures in 2010. Federal law discourages individuals from artificially impoverishing themselves in order to establish financial eligibility for Medicaid. Specifically, those who transfer assets for less than fair market value during a specified time period before applying for Medicaid may be ineligible for coverage for long-term care for a period of time. The Deficit Reduction Act (DRA) extended the look-back period to 60 months and introduced new requirements for the treatment of certain types of assets, such as annuities, in determining eligibility. States are responsible for assessing applicants’ eligibility for Medicaid, the criteria for which varies by state.
The Government Accountability Office (GAO) was asked to…
Provider group recommends federal officials instate incentives for long-term care providers to adopt EHR
Posted on August 28, 2012
Long-term and post-acute care providers and officials from the Office of the National Coordinator (ONC) for Health Information Technology recommended that Electronic Health Records (EHRs) design requirements focus on longitudinal care plans, transitions of care and patient assessments during a roundtable discussion held in May. A report summarizing the roundtable discussion stated that federal health officials should offer long-term care providers incentives to adopt Stage 3 Meaningful Use criteria for EHR.
Posted on August 10, 2012
The National Association of Medicaid Directors sent a letter to the Centers for Medicaid and CHIP Services (CMCS) Director Cindy Mann including recommendations on how to improve federal policies and procedures regarding managed long term supports and services programs.
Posted on August 7, 2012
A growing number of state Medicaid agencies are planning to launch or expand programs that offer risk-based contracts to managed care organizations (MCOs) to provide long-term services and supports (LTSS)—and, in some cases, acute and primary care—to older adults and people with disabilities. Because these individuals often have one or more chronic health conditions, they tend to use more health services than younger people and people without disabilities. In addition, they often depend on other services and supports such as personal care to perform activities of daily living, such as bathing and eating.
In risk-based managed care arrangements…
Posted on July 18, 2012
The Affordable Care Act (ACA) included a number of provisions designed to improve the delivery of health and long-term care support services for individuals who are eligible for and enrolled in both the Medicare and Medicaid programs, commonly referred to as “dual eligible.” An earlier Health Reform GPS Implementation Brief outlined these changes. Among the provisions identified in the Brief was new demonstration authority provided to the Department of Health and Human Services (HHS) to permit states to waive certain provisions of Medicare law to better coordinate care for dual eligibles, new grant funding available to as many as 15 states to plan and implement integrated programs of care for dual eligibles, and the release of a July 11 State Medicaid Director (SMD) Letter providing preliminary guidance to states on demonstration models designed to improve care coordination for dual eligibles, including both capitated and fee-for-service models. This Brief provides an update on the financial alignment model outlined in the SMD letter, with a focus on subsequent guidance to states and health plans seeking to participate in capitated demonstrations. This demonstration is being followed closely at the federal level, and both…
Bay Area Council offers guidance to promote a more affordable, higher-quality system without Washington
Posted on October 20, 2011
The California trade group, Bay Area Council, recently published the report, “Roadmap to a High-Value Health System: Addressing California’s Healthcare Affordability Crisis,” to address the skyrocketing health care costs in California. The report suggests ways in which employers, insurers, and health care providers can help build a more affordable, higher-quality health care system, without Washington’s help. According to the paper, the overwhelming majority of health care costs stem from emergencies. Thus, the council urges insurers and self-insured businesses to reward doctors and hospitals for keeping their patients healthy, rather than treating those who are sick. On the consumer side, the council suggests that members of health plans be encouraged to avoid chronic disease through lower premiums or cash incentives for meeting fitness goals. As for state policy makers, the council calls for them to support nascent private sector models. Additionally, the paper highlights a particularly critical task as setting up a successful California Health Benefit Exchange.
Posted on October 17, 2011
The United States Government Accountability Office (GAO) released a report, “Long-Term Care Hospitals: CMS Oversight is Limited and Should Be Strengthened,” which recommends that the Centers for Medicare & Medicaid Services (CMS) strengthen its oversight of long-term care hospital (LTCH) survey activities and improve data collection on quality of care. LTCHs specialize in the provision of care to individuals with multiple or chronic conditions. CMS does currently collect data on the quality of care at LTCHs, but the GAO argues that the data are limited for several reasons. First, CMS does not have detailed data on survey results conducted by The Joint Commission (TJC) prior to 2009. Second, CMS does not currently collect data on LTCH quality measures regarding health care delivery because LTCHs are not required to report them. However, under the ACA, LTCHs will be required to make such reports beginning in 2014.