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NAMD releases recommendations regarding long term care services

Posted on August 10, 2012 | No Comments

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Key Developments

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.

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The National Association of Medicaid Directors (NAMD) recently published a white paper on Medicaid system reform efforts. Over the past year, NAMD has been working, with support from the Commonwealth Fund, to collect a growing catalog of "best practices" and innovative state initiatives. NAMD details the results of these efforts in the paper, which identifies and addresses the major barriers and the most likely pathways to Medicaid-driven and Medicaid-relevant health system reform.
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...
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.
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...
The Congressional Budget Office presents the long-term budget outlook under two scenarios in a new report. These scenarios embody different assumptions regarding future policies governing federal revenues and spending. The first, the extended baseline scenario, reflects the assumption that current laws generally remain unchanged and that lawmakers will allow changes that are schedule under current law to occur, forgoing adjustments routinely made in the past that have boosted deficits. The second, the extended alternative fiscal scenario, incorporates the assumptions that certain policies that have been in place for a number of years will continue and some provisions of law that might be difficult to sustain for a long period will be modified. These two scenarios span a wide range of possible policy choices. The report focuses on the next 25 years and gives special focus to outlays for major health care programs. Under both scenarios, the report estimates that total outlays for federal health care programs will grow much faster than the gross domestic product (GDP), increasing from 5.4 percent of the GDP in 2012 to nearly 10 percent in 2037. National health care spending is also expected to rise. Health care expenditures is expected to increase to almost one-quarter of the GDP by 2037. CBO suggested that key factors contributing to this growth in spending have been the emergence of new medical technologies, rising personal income, and the expanding scope of health insurance coverage.
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.
House and Senate Republicans have issued a new report on the Community Living Assistance Services and Supports (CLASS) program, a long-term care insurance program created by the Affordable Care Act (ACA). The report, "CLASS' UNTOLD STORY: Taxpayers, Employers, and States on the Hook for Flawed Entitlement Program," was issued by the bicameral Repeal CLASS Working Group, and calls for the repeal of the CLASS program due to questions surrounding its financial sustainability.
The Patient Protection and Affordable Care Act (ACA) has the potential to help States reorient their systems of long-term care. The goal is to move away from nursing homes and institutional care and toward a greater emphasis on home- and community-based services. This will enable States to both meet a broad range of needs and support family caregivers. The report, "How The Affordable Care Act Can Help Move States Toward A High-Performing System Of Long-Term Services and Supports," published by Health Affairs, outlines five key characteristics of a high-performing system of long-term services and supports. The paper describes an emerging "scorecard" that could help measure states' progress toward this goal. Finally, the Health Affairs piece highlights aspects of the ACA which will support the creation of such a high-performing system for the disabled and those with chronic conditions.
By a vote of 267-159, the House approved a bill (H.R. 1173) yesterday to repeal a long-term care program, Community Living Assistance Program and Supports (CLASS), a provision of the Affordable Care Act (ACA). Twenty-eight Democrats joined a unanimous Republican Conference in support of the repeal. CLASS was added to the ACA as the first federally sponsored long-term care program available to most working adults on a voluntary basis. This repeal comes after an announcement in October 2011 from the Obama administration, stating that they had no intention of implementing the program due to financing issues. The repeal of the (CLASS) program has been a priority of the Republican controlled House, but it seems there is little chance that a similar bill would pass in the Democratic-controlled Senate.
The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius wrote a letter to Congress earlier today announcing that the Obama administration has given up on the Community Living Assistance Services and Supports (CLASS) program. The goal of the CLASS initiative was to improve long-term care insurance options for Americans. The CLASS Act was championed by the late Senator Edward M. Kennedy and Republicans have opposed the initiative since its introduction as part of last year's health care law.