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Making it Easier For Individuals to Navigate Their Health and Long –Term Care
26th National Home and Community Based Services Conference
Tuesday, September 28, 2010
Implementing the
Affordable Care Act:
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 BChange Opportunity for Aging Network
Medicare Coverage of Annual Wellness
Visit & Personalized Prevention Plan (Sec.
4103)
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)
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
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)
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 & EvaluationsGrant/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)
State Grant Team, Use Aging Network infrastructure to
promote healthy living and reduce disparities, leverage
Recovery Act CPPW CDSMP infrastructure and
partnerships
Independent evaluation of Evidence
Based Community Prevention and
Wellness Programs. (Sec. 4202) ($50M until
expended)
Be part of evaluation. Deliver EBPP (physical activity,
nutrition, falls, mental health, chronic disease self-
management, ).
GAO Study and Report on Medicare
Beneficiary Access to Vaccines. Study to
be published by June 1, 2011. (Sec. 4204)
Be aware that study is occurring and results that may be
learned regarding barriers to access.
Demonstration Project Concerning
Individualized Wellness Plan that are
designed to reduce risk factors for
preventable conditions—Pilot with up to 10
Community Health Centers.
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
11
Blind Spots
Blind Spot
12
13
Partnerships Help Prevent Blind Spots
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
15
CDSMP
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
HCBS
Hospital
Nursing
Home
Physician
Practice
Assisted Living
Pharmacy
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.
Where does this path lead?
18
19
2010• $10.0 Million (ADRC)
2011• $10.0 Million (ADRC)
2012• $10.0 Million (ADRC)
• Part A - MIPPA
• Part B – Options Counseling
2013• $10.0 Million (ADRC)
2014• $10.0 Million (ADRC)
Section 2405
20
2010• $2.5 Million (ADRC)
2011• $100.0 Million (CMS)
2012• $100.0 Million (CMS)
• Part D – ADRC Evidence-Based Care Transition Programs
2013• $100.0 Million (CMS)
2014• $100.0 Million (CMS)
2015• $100.0 Million (CMS)
Section 3026
21
2010• $7.5 Million (24 States)
2010• MFP Expansion to 50 States
2010• MDS – Section Q Changes
• Part C – Nursing Home Diversion and Transition Programs
2011• State Balancing Incentive Program
2011• (SPE/NWD, Conflict Free Case
Management, Universal Assessment Tool)
Section 10202
We’re Rounding The Curve…..
23
2010-
2012
• CLASS Act Development
• Part A - MIPPA
• Part B – Options Counseling
5 Year Period
• CLASS Enrollment
2018-2020• Nationwide Private Pay LTC Consumers
CLASS• Defined Benefit – Advice and Counseling
Section 3201
Section 3205
24
Section
2405
• Part A
• Part B Section
10202
• Part C Section
3026
• Part D Section
3201
• Part A
• Part B
2010
• ADRC
• $10.0
2011
• ADRC
• $10.0
2012
• ADRC
• $10.0
2013
• ADRC
• $10.0
2014
• ADRC
• $10.0
2010• $7.5 Million
(24 States)
2010
• MFP Expansion to 50 States)
2010
• MDS –Section Q Changes
2011
• State Balancing Incentive Program
2011
• (SPE/NWD, Conflict Free Case Management, Universal Assessment Tool)
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)
2010-
2012
• CLASS Act Development
5 Year Period
• CLASS Enrollment
2018-2020
• Nationwide Private Pay LTC Consumers
CLASS
• Defined Benefit –Advice and Counseling
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