Healthcare Reform Will Impact Long-Term Care

MacKenzie Kimball, March 23, 2010

The health reform legislation passed in the House Sunday contains numerous provisions related to long-term care.

One of these provisions is the Community Living Assistance Services and Support (CLASS) Act, which was originally introduced by the late Senator Edward Kennedy. The CLASS Act will make long-term care insurance available to all Americans, who will be automatically enrolled with the choice to opt out.

Individuals will begin paying a premium immediately and, after five years, those with functional limitations have the option of receiving a cash benefit of around $50 a day that can be used to offset the cost of long-term care services.

"The CLASS Act will help offset the high cost of long-term care services for aging and disabled populations. In particular, these funds will allow individuals flexibility to receive services in their homes and potentially prevent admissions to nursing homes," says Katherine McCarthy, business account manager at PointRight in Lexington, MA. "The overarching goal of healthcare reform is to make healthcare both more accessible and affordable in the U.S. Long-term care expenses, particularly in aging populations, are among the most costly to Medicare and Medicaid today. By providing insurance, there is a real opportunity to reduce costs in this sector."

The bill also includes a provision to help close the Medicare Part D coverage gap for medications. According to the Senate’s summary of the Patient Protection and Affordable Care Act, "in order to have their drugs covered under the Medicare Part D program, drug manufacturers will provide a 50 percent discount to Part D beneficiaries for brand-name drugs and biologics purchased during the coverage gap beginning July 1, 2010. The initial coverage limit in the standard Part D benefit will be expanded by $500 for 2010."

The bill will implement much stricter guidelines in terms of ownership transparency of nursing home chains.

"This will allow patients and the public at large to better understand ownership and operational hierarchies that currently are difficult to identify. Making these changes in the industry will be challenging, particularly for large publically-owned chains," McCarthy says. "However, those of us in the industry are all very excited that the bill will extend the therapy caps exceptions process through 2010. At the end of this year, they will have to revisit this issue again, at which point we are all hopeful for a long-term fix that ensures patients are able to receive the care they need based on medical necessity, rather than an arbitrary cap on funding."

In addition to the healthcare reform bill, the House passed a reconciliation bill containing changes to the just-passed legislation, which will be sent to the Senate for final approval.

One of these amendments awaiting a final vote is an amendment to delay the implementation of Resource Utilization Group, Version Four (RUG-IV), by a year. RUG-IV was originally scheduled to be implemented alongside the MDS 3.0 in October, but the amendment to the healthcare bill will not allow RUG-IV to be implemented before October 1, 2011.

MacKenzie Kimball MacKenzie Kimball is an associate editor in the long-term care market at HCPro. She writes PPS Alert for Long-term Care and manages MDSCentral.
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