How the new healthcare law affects you
[Editor's Note: A sentence regarding the CLASS Act has been changed below. There is no specific start date yet for the collection of premiums.]
OK, so I promised I'd tell you more about what is in the healthcare reform law that affects you, long-term care providers. So here goes …
Below is a rundown of key aspects of the law. (Many thanks to the American Association of Homes and Services for the Aging for its assistance with this):
— The law preserves the Medicare market basket update for 2010 and 2011 for skilled nursing facilities. A productivity adjustment will be applied starting in 2012. That is projected to cut the update by an estimated 1%.
— It extends the therapy caps exceptions process through the end of the year.
— It delays the start of the RUG-IV classification system until Oct. 1, 2011.
Some other need-to-know provisions of the Patient Protection and Affordable Care Act:
— It enacts the Community Living Assistance Services and Supports (CLASS) Act, which creates a disability long-term care insurance program. Workers and adults can opt to pay into the trust through voluntary payroll deductions. **There is no specific start date for the collection of premiums at this point.
— It requires more nursing home transparency. There will be more disclosure of nursing home ownership and organizational structure under the law. It also requires reporting of nursing home staffing levels in a format based on payroll data.
— It gradually reduces the doughnut hole in the Medicare Part D prescription drug program, completely closing the hole by 2020.
— It expands Medicaid. As an example, states next year will have the option to provide Medicaid coverage to all low-income individuals through a state plan amendment.
And here are some noteworthy provisions affecting long-term care:
— There will be more funding for Medicaid home- and community-based services. States will be allowed to cover community-based attendant services to Medicaid beneficiaries with disabilities if the beneficiary otherwise would require hospital or nursing home level care.
— The law requires CMS to establish a nationwide program of criminal background checks for employees of long-term care providers who have direct access to residents.
— It implements the Elder Justice Act. The Centers for Medicare & Medicaid Services must cooperate with the Departments of Justice and Labor to award grants protecting nursing home residents and provide incentives for individuals to train and work in nursing facilities.
— CMS must establish a national, voluntary, pilot bundling payment program by 2013.
— It authorizes three years of funding for new training opportunities for direct-care workers providing long-term services and supports.
— It calls for demonstration projects on culture change and on the application of technology in nursing homes.
— It requires the Government Accountability Office to study the Five-Star Quality Rating System.
Other provisions to keep an eye on:
—It establishes a Center for Medicare and Medicaid Innovation within CMS.
—The law establishes a 15-member Independent Payment Advisory Board to provide Congress with proposals for reducing Medicare cost growth and improving quality.
These are many of the nuts and bolts of the new law. It clearly marks a new chapter in healthcare and long-term care. Keep reading McKnight's to find out the impact of these changes on your profession and on your residents.