Long Term Care
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.
GAO makes recommendations to CMS regarding oversight of long-term care hospitals
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.
HHS Secretary Sebelius announces drop of CLASS Act
Posted on October 14, 2011
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.
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Urban Institute paper says duals should be Medicare’s responsibility
Posted on October 5, 2011
“Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead,” a new paper authored by researchers at the Urban Institute and funded by the Robert Wood Johnson Foundation, explores why Medicare, as opposed to the States or Medicaid, should take responsibility for dual eligibles. The authors rationalize that acute care, where savings and quality improvement are most readily achievable, best falls under Medicare’s umbrella. According to the paper, enhancing State responsibility for overall spending, on the other hand, would increase the risk of cost-shifting to Medicare, which could potentially undermine the quality of care for vulnerable beneficiaries.
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GOP issues report on CLASS Act
Posted on September 16, 2011
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.
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Commonwealth article recommends reinstatement of COBRA until 2014
Posted on August 28, 2011
Chronically high unemployment rates have left many Americans without job-based health insurance. Affordable insurance programs such as Medicaid and the Children’s Health Insurance Program (CHIP) are, at present, only available to pregnant women, children, and parents with very low incomes. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), which was in place from 2008-2010, individuals who were employed by a firm with 20 or more workers and had health insurance sponsored by that firm could retain their coverage for up to 18 months in the event that they lost their job. The Affordable Care Act (ACA), upon full implementation in 2014, will dramatically increase coverage options for people who lose their jobs. In the report, “Realizing Health Reform’s Potential: When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help,” the Commonwealth Fund encourages policymakers to bridge the gap for Americans until 2014. The Commonwealth Fund recommends that first, policymakers should consider an additional extension of unemployment benefits, as the current extension is set to expire in December 2011. Second, the paper suggests that government consider reestablishing the COBRA premium subsidies to help the millions of Americans who have lost their job-based health insurance until the ACA coverage takes effect in 2014.
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Dual-eligible Medicare/Medicaid Beneficiaries
Posted on August 10, 2011
According to the Centers for Medicare and Medicaid Services (CMS), in 2008 there were an estimated 9.2 million individuals who were eligible for and enrolled in both the Medicare and Medicaid programs (commonly referred to as “dual eligibles”). Two-thirds of dual eligibles qualify because they are over age 65, while the other third qualify because of a disability. Dual-eligible beneficiaries typically have multiple chronic conditions that require a higher level of care and result in increased spending relative to other Medicare and Medicaid beneficiaries; however, their care is not usually coordinated. Policymakers have expressed concern that the lack of coordination between the two programs results in higher costs and poorer health outcomes than would be achieved if Medicare and Medicaid services were better integrated.
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HHS announces new initiatives to improve care for duals
Posted on July 11, 2011
The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health of Health and Human Services (HHS) has announced a new round of initiatives to help improve quality and cost of care for individuals who are eligible for both Medicare and Medicaid. CMS has issued three fact sheets, along with preliminary guidance in the form of a State Medicaid Director Letter (SMDL), further outlining these initiatives. They involve upcoming demonstrations on new financial models for improved care coordination, efforts to improve nursing home care quality, and information on a new technical assistance resource center that will help states better serve high-cost, high-need beneficiaries.
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NEJM article compares and contrasts Paul Ryan’s “Roadmap for America’s Future” with the ACA
Posted on May 13, 2011
The New England Journal of Medicine’s perspective piece “Consensus and Conflict in Health System Reform–The Republican Budget Plan and the ACA” by Timothy Stoltzfus Jost, J.D., compares and contrasts Representative Paul Ryan’s (R-WI) “Roadmap for America’s Future” with the Affordable Care Act (ACA). In terms of their similarities, both plans would create a health care system in which many Americans purchase private health insurance using partially means-tested public subsidies through an exchange-based, information-rich competitive market, which is (more or less) open to all regardless of health status. Those who choose to remain uninsured would incur a penalty (or forgo a benefit), and those who purchased insurance would be responsible for significant costs. Jost also details five key differences between Roadmap and the ACA in the piece.
Health Affairs article suggests how the ACA can improve long-term care services
Posted on March 9, 2011
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.
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- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–NFIB on Severability
- House approves CLASS repeal
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