Implementing the Affordable Care Act: Making it Easier For Individuals to Navigate Their Health and Long Term Care 26 th National Home and Community Based Services Conference Tuesday, September 28, 2010
Affordable Care Act: More Than Coverage Expansion Health System Reform Payment reform Quality Delivery system redesign Center for Medicare and Medicaid Innovation (CMI) Medicare, Medicaid, CHIP Payment reforms to reduce expenditures while increasing quality
Medicare Prescription Drug Costs Doughnut Hole Better Preventive Care Annual Wellness Visit No co-payments for preventive benefits 2011: Part C and D enrollment period to begin October 17 and end December 7 Increased funding for SHIPs, AAAs, ADRCs
Attention to Chronic and Acute Care: Medicare Independence at Home demo Multi-Payer demo Care Transitions and Medical Homes Hospital value-based purchasing Payment Bundling Accountable Care Organizations (ACOs)
Elder Justice Act Adult Protective Services -- $400 million (over 4 years) in first-time dedicated funding (Auth) Long Term Care Ombudsman--$32.5M (over 4 years) in grants + $10M/year for training programs (Auth) Elder Justice Coordinating Council Within HHS-- national federal coordination on elder abuse issues Advisory Board to the EJCC composed of experts on elder abuse, neglect and exploitation
Other Long Term Services and Supports Nursing Home Reform Transparency NH Compare Improvements Workforce investments New resource to fight fraud Community Living Assistance Services and Support (CLASS) Program insurance option for in-home LTC support
ACA Prevention & Evaluation National Prevention, Health Promotion and Public Health Council up to 25 people Prevention & Public Health Fund FY10 $500M; FY11 $750M; FY12 $1B Increased Access to Clinical Preventive Services Medicare Changes & Medicaid Incentives Creating Healthier Communities Grants, Demo s & Evaluations
Increased Access to Clinical Preventive Services Subtitles B Change Medicare Coverage of Annual Wellness Visit & Personalized Prevention Plan (Sec. 4103) Opportunity for Aging Network Promote awareness of benefit, connect people get to PCP; expand availability of EBPP. Removal of Medicare Coinsurance and Deductible for preventive services meeting criteria (Sec. 4104) Prevention of Chronic Disease Grants to states to test approaches that encourage behavior modification and determine scalable solutions related to chronic disease prevention among adults in Medicaid. (Sec. 4108) ($100M until expended) Educate Citizens, Connect Medicare Beneficiaries to preventive services, Improve rates of utilization of covered clinical preventive services, Partnership Development with Health Care System and Public Health System Assure part of state grant application, Expand availability of EBPP, outreach and education campaign for provider and beneficiary education, strengthen partnership with public health and mental health/substance abuse systems.
Creating Healthier Communities Grants, Demo s & Evaluations Grant/Demo/Evaluation Opportunity for Aging Network Community Transformation Grants Submit Community Transformation Plan, Activities including physical activity, nutrition, and prevention and control of chronic disease. (Sec. 4201) Independent evaluation of Evidence Based Community Prevention and Wellness Programs. (Sec. 4202) ($50M until expended) GAO Study and Report on Medicare Beneficiary Access to Vaccines. Study to be published by June 1, 2011. (Sec. 4204) Demonstration Project Concerning Individualized Wellness Plan that are designed to reduce risk factors for preventable conditions Pilot with up to 10 Community Health Centers. State Grant Team, Use Aging Network infrastructure to promote healthy living and reduce disparities, leverage Recovery Act CPPW CDSMP infrastructure and partnerships Be part of evaluation. Deliver EBPP (physical activity, nutrition, falls, mental health, chronic disease selfmanagement, ). Be aware that study is occurring and results that may be learned regarding barriers to access. Partner with Community Health Centers in State or Community to provide awareness of the wellness plan, help link people to the CHC, generate EBPP that provide programs that help people change behavior and reduce risk.
Where are potential blind spots? 10
Blind Spots 11
Blind Spot 12
Partnerships Help Prevent Blind Spots 13
What are the key deliverables? 14
Funding Opportunities Part A. Medicare Improvement for Patients and Providers Act (MIPPA) Part B. ADRC Options Counseling and Assistance Programs CDSMP 15
Funding Opportunities Part A. Medicare Improvement for Patients and Providers Act (MIPPA) Part B. ADRC Options Counseling and Assistance Programs Part C. ADRC Nursing Home Transition and Diversion Programs Part D. ADRC Evidence-Based Care Transition Programs 16
Care Transitions/Coordination Care Transitions The process of engaging consumers and their informal caregivers in the discharge planning process to ensure they have the post-discharge care instructions and resources they need to avoid unnecessary hospitalization or institutionalization. Pharmacy Assisted Living HCBS Hospital Nursing Home Physician Practice
Where does this path lead? 18
Section 2405 Part A - MIPPA Part B Options Counseling 2010 $10.0 Million (ADRC) 2011 $10.0 Million (ADRC) 2012 $10.0 Million (ADRC) 2013 $10.0 Million (ADRC) 2014 $10.0 Million (ADRC) 19
Section 3026 Part D ADRC Evidence-Based Care Transition Programs 2010 $2.5 Million (ADRC) 2011 $100.0 Million (CMS) 2012 $100.0 Million (CMS) 2013 $100.0 Million (CMS) 2014 $100.0 Million (CMS) 2015 $100.0 Million (CMS) 20
Part C Nursing Home Diversion and Transition Programs 2010 $7.5 Million (24 States) Section 10202 2010 2010 2011 2011 MFP Expansion to 50 States MDS Section Q Changes State Balancing Incentive Program (SPE/NWD, Conflict Free Case Management, Universal Assessment Tool) 21
We re Rounding The Curve..
Section 3201 Part A - MIPPA Part B Options Counseling 2010-2012 CLASS Act Development 5 Year Period CLASS Enrollment 2018-2020 Nationwide Private Pay LTC Consumers Section 3205 CLASS Defined Benefit Advice and Counseling 23
Section 2405 Part A Part B Section 10202 Part C Section 3026 Part D Section 3201 Part A Part B 2010 2011 2012 ADRC $10.0 ADRC $10.0 ADRC $10.0 2010 2010 2010 $7.5 Million (24 States) MFP Expansion to 50 States) MDS Section Q Changes 2010 2011 2012 $2.5 Million (ADRC) $100.0 Million (CMS) $100.0 Million (CMS) 2010-2012 5 Year Period CLASS Act Development CLASS Enrollment 2013 2014 ADRC $10.0 ADRC $10.0 2011 2011 State Balancing Incentive Program (SPE/NWD, Conflict Free Case Management, Universal Assessment Tool) 2013 2014 2015 $100.0 Million (CMS) $100.0 Million (CMS) $100.0 Million (CMS) 2018-2020 CLASS Nationwide Private Pay LTC Consumers Defined Benefit Advice and Counseling 24