IMPACT OF NEW HEALTH LAW ON SENIORS. Sue Jensen PhD, RN, CCM
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1 IMPACT OF NEW HEALTH LAW ON SENIORS Sue Jensen PhD, RN, CCM
2 OBJECTIVES Identify the changes in the ACA Health Law which directly impacts senior citizens Identify specific changes in ACA related to Medicare and Medicare Advantage Identify educational and service resources available to professionals and individuals relative to the ACA and seniors
3 AFFORDABLE CARE ACT March 2010 Accessibility Accountability Ensure Medicare Solvency Quality
4 POLITICAL CHALLENGES SOME WANT TO REPEAL THE LAW
5 IMPROVING ACCESSIBILITY Expanding Eligibility Funding Providers CMI
6 IMPROVING ACCOUNTABILITY Fraud Identification Facility Disclosure Regulate Insurers Outcome Driven
7 IMPROVING QUALITY Promoting Partnerships Prevention & Education Management of Chronicity Care Coordination
8 ACA & HEALTH INSURANCE PRACTICES Insurance companies can no longer drop you if you become ill Lifetime caps are banned Annual limits on coverage no longer legal Free preventative care (effective 9/10) Extends coverage for young adults until age 26 Eliminates denials due to pre-existing conditions (9/11 for children & in 2014 for all)
9 MEDICARE SOLVENCY Fraud Reduction Reform Delivery System Modernize Financing Systems Improve Quality
10 DIRECT EFFECT PROGRAMS Medication Therapy Management
11 DONUT HOLE PATCHED
12 PREVENTATIVE CARE BENEFITS Yearly Wellness Visit Preventative screenings for diabetes and certain cancers (mammograms, colonoscopies, etc.)
13 ACA AND NURSING HOME CARE More protections from abuse Information regarding nursing homes, # of complaints and violations, etc. available Each state must have a comprehensive nursing home website with information Additional information with links to state nursing home websites will be available on the CMS website Easier to file complaints and get resolution to complaints
14 MEDICATION THERAPY MANAGEMENT Required Plan D Providers At Risk Individuals Annual Review Identify Potential Adverse Reactions Must Provide a Take Away
15 UNDERSTANDING THE PROGRAMS Program Overview Program Eligibility Timelines for when they go into effect varies
16 CENTER FOR MEDICARE INNOVATION (CMI) Stimulate Creativity Improve Quality Streamline Innovation Control Costs Continuity of Care Demonstration Projects Pilot Programs
17 MEDICAL HOME Personal Physician Use Health Assessments Integrated Care Plan Reviews Medications Care Coordination with monthly fee
18 HOME & COMMUNITY BASED SERVICES Expanded Eligibility Income Needs-Based Criteria Statewide Eligibility 5 Year Renewal Periods
19 INDEPENDENCE AT HOME Practitioners direct care Primary Care Teams Tailored to Chronic Conditions Target Spending Levels Reduce Hospital Stays & Readmissions
20 COMMUNITY-BASED TRANSITIONS From hospital to home Community-Based Organizations High Admission Rates High Risk Beneficiaries Medically Underserved Populations
21 CARE TRANSITIONS 5-30% Readmitted Can Be Telephonic/Care Coordination involved Reconciliation & Understanding
22 2010 STATE AWARDS
23 MONEY FOLLOWS THE PERSON
24 COMMUNITY FIRST CHOICE (CFC) Transitioning from Institutional Care Person-Centered Plans Began October Billion for Next 3 Years Federal Matching + 6%
25 COMMUNITY FIRST CHOICE (CFC) Implementation Councils Assisted Living an Option Pays For Transition Pays for ADL s (activities of daily living)
26 MICHIGAN CHOICE WAIVER PROGRAM Eligible adults who meet income & asset criteria can receive Medicaid-covered services like those provided by nursing homes but can stay in their own homes. Examples of services: homemaker, respite, adult day care, transportation, chore services, counseling, personal emergency response system, personal care supervision
27 REGION 8 Area Agency of Aging of Western MI 1279 Cedar St NE, GR MI 49503; HHS, Health Options 2100 Ray Brook SE, Ste 203, GR, MI or
28 MEDICARE ADVANTAGE OVERHAUL 1,600 Choices 10 Million Enrolled 13% More =14,000,000,000 Extra Benefits $1,138 per Member
29 MEDICARE ADVANTAGE OVERHAUL 2011 Payments Frozen 2012 Cuts 12% Annually Cuts Avoided with Excellence
30 MEDICARE ADVANTAGE OVERHAUL Obtaining Excellent Status Receive Bonus Quality Initiatives Care Coordination
31 MEDICARE ADVANTAGE Cannot charge more than regular Medicare for certain services such as chemo, kidney dialysis and skilled nursing care Starting in 2014, must limit how much is spent on administrative costs Starting in 2012, Medicare will begin to lower subsidies so that Advantage is more in line with regular Medicare (could result in a drop in extra services such as gym memberships, eyeglasses, etc.)
32 AVAILABLE RESOURCES/REFERENCES AARP ( Healthcare.gov MI Department of Community Health ( The Bottom Line: How the Affordable Care Act Helps Michigan Families (
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