Health Reform: Community Living Assistance Services and Support (CLASS) Act
If you have read my past several articles, you know that I have taken up the new Health Reform legislation – the Patient Protection and Affordable Care Act – as the theme. I feel compelled to present the facts, since there are many untrue sound bites about how horrible this legislation is. Certainly the bill is long and complicated and will be phased in over several years, hence we all need to learn about how it will impact us now and in the future.
I attended one of many education sessions that occurred around the state last month. Hopefully there will be more. U. S. Health and Human Services, Social Security, and AARP experts presented and responded to questions from senior audiences. Many of the questions from the audience reflected misconceptions, misunderstandings, and misinformation. But that is why we should go to these sessions, so we can get educated.
One area of health care reform that is not getting any press and very little discussion is that of the CLASS – Community Living Assistance Services and Support Act. Chronic conditions and long term support and services are huge areas of concern and a tremendous expense for all of us.
Dr. Bruce Chernof, President and CEO, SCAN Foundation, states that Medicare spends about 4.5% times more on elders in need of long-term care services per person per year ($18,902) than those that do not have any problems with activities of daily living or in need of long-term care supports or services ($4,289). He also notes that one-third of Medicaid spending, about $101 billion, is devoted to long-term services and supports. Clearly, health care reform needs to address the issue of chronic care and costs associated with it. The Patient Protection and Affordable Care Act does just that through the CLASS Act!
The CLASS Act establishes a new voluntary public-private approach to financing and accessing long term services and supports. This insurance program is funded by individual workers through payroll deductions with premiums set by the Secretary of the U. S. Department of Health and Human Services. Individuals must be enrolled in the program for 5 years, have a disability lasting more than 90 days, and meet functional and/or cognitive criteria. Persons will be paid cash and have the self-direction ability to apply that cash towards any service they deem appropriate. The cash can support family caregivers, renovate a home to accommodate a wheelchair, or obtain assistive devices without having to navigate complex government regulations or limitations in private insurance contracts. Private providers and state agencies will work together to make sure that the individuals are receiving the care they need in their own home or community.
The Act also works with home and community long term care services to expand the options to the state’s Medicaid community through new federal financial initiatives. State’s can receive more federal resources if they submit a plan and restructure three elements: 1) establish a “single point of entry – no wrong door” statewide system of access for long term services and supports; 2) establish conflict free case management; 3) adopt standardized assessment instruments for determining eligibility for non-institutional services.
Nevada should be in a good position for this enhancement. About 10 years ago, when I was a commissioner for the Governor’s Commission on Aging, I helped them research, plan, and implement of all these components. We did a series of hearings throughout the state to determine this as a need. The question is; how far has the state progressed? If the state does not spend 50% of their Medicaid budget on home and community based services, then they would be entitled to receive a share of the $3 billion federal resources available for achieving this balance. The state now could actually benefit because of the lack of progress over the past decade.
Other Act provisions that will really enhance the quality of life for elders include mandating the spousal impoverishment protections to home and community-based services, not just nursing home placement. The Act also strengthens the direct-care workforce through core competency training and certification, establishes a nationwide program to conduct background checks for direct care workers, and enhance chronic care coordination.
Chronic care coordination is desperately needed to enhance the quality of life and reduce health care costs, especially between institutional settings such as hospitals and home and community services. Too often, elders discharged from hospitals end up back in hospitals within 30 days because the transitional support services were not secured or they just ended up in a nursing home. In fact, nationally there is a 25% recidivism rate of Medicare elders ending up back in hospitals because the post-hospital care was not effective or appropriate. The Patient Protection and Affordable Care Act will change that. One more positive component to the health reform we can expect to see in the coming years.
Do you just accept all the political sound bites? For example, the country will go bankrupt on the backs of our children or grand children, or that our elders will suffer because of the Medicare cuts. Or do you try researching all the different components of the new health reform legislation and determine what your own conclusions are? I find out more detail each time I ask a question and look for the answers. I strive to educate myself with facts, you should as well. Attend health care reform educational sessions or discussion groups. Find out for yourself how it will impact you and other elders in Nevada. Clearly, it is my perception so far that this legislation will significantly add life to years.
Lawrence J. Weiss, Ph.D. is CEO of the Center for Healthy Aging. Dr. Weiss welcomes your comments on this column. Write to him at larry@addinglifetoyears.com or c/o Center for Healthy Aging, 11 Fillmore Way, Reno, NV 89519.
Patient Protection and Affordable Care Act: What is it? How does it impact me, here in Nevada?
Well, you might be confused by the title. Perhaps you know it better as “ObamaCare” or “Universal Health Care” or “Health Care Reform” or “Insurance Reform”. Yes, it is the Patient Protection and Affordable Care Act or H.R. 3590. However, this is a mouth full when it is so easy just to say “Obama Care” or “Universal Health Care”. These names, unfortunately, come with a very negative connotation. For example, Media Research Center’s Business & Media Institute states “Universal health care leads to an increase in big government, and then America would continue on the slippery slope toward socialism”. This organization went on to say how the “liberal” general media do not tell the truth. They cited examples of how they “don’t compare ‘Medicare-like’ public option to Medicare’s track record”, or how they report that the total number of uninsured is exaggerated, and how they barely discuss the costs.
Granted, media tend to sensationalize, but “do not tell the truth” – come on. This health reform builds on the private insurance industry. Medicare – perhaps one of the great pieces of legislation for seniors in history, while not perfect, is a very successful system (excluding all the unlawful entrepreneurs out to commit crimes of fraud and abuse). The numbers of uninsured are exaggerated? Actually there are over 50 million uninsured and growing daily because of unemployment and the health reform legislation only will cover about 32 million (518,000 Nevadans).
Well, I want to share with you some additional facts, beyond last month’s article, about our new health reform, the Patient Protection and Affordable Care Act, and how it can impact Nevadans. These facts come from www.healthreform.gov and they cite 27 different sources. I highly recommend that you visit this site. The site also has video of the leaders in Washington, such as Secretary Sebelius, Health and Human Services, discussing the legislation. It’s very informative.
Under reform in Nevada, 518,000 residents today, projected to increase by 56% by 2019, who do not currently have insurance will get it through an affordable health insurance exchange – not government! Options will exist for those who cannot get insurance because of pre-existing conditions, such as having diabetes (9% of Nevadans, about 50% of those who have diabetes are 60 and over.) or high blood pressure (27% of Nevadans, the 5th leading health expense).
In Nevada, 328,000 seniors on Medicare will receive free preventive services, because beginning in 2011, the legislation eliminates co-payments and co-insurance for preventive services and exempts preventive services from deductibles under the Medicare program. For example, a colonoscopy (44% have not had colorectal cancer screening) that costs $756, the co-pay is $175, which could be prohibitively expensive. Under the new law, a senior will not pay anything for the preventive service, as well as others like it, and have free wellness visits with their provider.
In addition, 58,200 Medicare seniors will have their brand-name drug costs in the Medicare Part D “doughnut hole” halved. Some seniors have been paying up to $4,080 per year, hence a significant savings.
Early retirees that have coverage from their former employer are estimated at about 39,100 in Nevada. Even though this health insurance coverage has eroded over time, retirees will receive premium relief and have stabilized coverage through a reinsurance program resulting in up to $1,200 savings in premiums per year.
Medicare Advantage plans have 30% of Nevada seniors enrolled in them. Since Medicare is overpaying these plans, they will reduce the payments to the plans, impacting the senior enrollees. Exactly how, is to be determined, but it has been estimated that the other 70% of Nevada Medicare beneficiaries in the traditional plan will pay an extra $45 per year in subsidized premiums to cover the excessive payments to Advantage Plans if the overpayment is not eliminated. Therefore, the reduction of payment to the Advantage plans will impact all Medicare Nevadans, some positively and some potentially negatively. However, the Center for Medicare and Medicaid Services will create Accountable Care Organizations that will work together to meet quality care and performance standards through better management, care coordination, and establishing health or medical homes utilizing community-based interprofessional teams.
The Patient Protection and Affordable Care Act will provide relief from rising health care costs by ending the “hidden tax”. It is estimated that $335 million is spent on uncompensated care to Nevadans. Providers lose this amount, which get passed on to the rest of us in hidden premiums. Therefore, when more people are covered by insurance through the health reform legislation, the burden of hidden premium costs covered by those of us who have insurance will disappear.
The health reform law will also improve quality and create more accountability and effectiveness with the health delivery system. It will invest in innovations in primary care and provide financial incentives for providers to better coordinate care and decrease readmissions to hospitals, which occur in 20% of all Medicare admissions or 15,400 patients being readmitted within 30 days. This is a tremendous expense to the Medicare patients and the hospital providers that the new Patient Protection and Affordable Care Act will reduce and/or eliminate.
Many other components of the new law also will take effect, too many to discuss in one article. But I will continue conveying what the new law is doing. Issues such as reducing paperwork or and administrative expense, incentivizing primary medical care, and providing supports for long-term home and community based services through the Community Living Assistance Services and Support (CLASS) act are important components and will be addressed in future articles of Adding Life to Years.
Health Care Reform: The Real Scoop
On March 21st, the House passed the health care reform bill that is historical. I would like to share with you what this really means to seniors – the real scoop.
During early March, I was fortunate enough to attend the National Council on Aging (NCOA) and American Society on Aging (ASA) Conference: Aging in America, in Chicago. Attending were over 3,000 professionals, providers, and policy administrators from across the country. I counted only about 4 from Nevada, which is another discussion.
The conference had many presenters on health policy and the health care reform legislation that was coming to a head. What an exciting time to be with the leaders in the field of aging. In this article, I would like to share with you what that leadership presented to the participants about health care reform, not really knowing what was to occur in the house a week later.
The health care reform debate has been going on for over a year, with a lot of confusing information. The lines in the sand have been drawn, by party lines. Unfortunately, the facts get distorted based on political perceptions and beliefs and not actual facts. We believe sound bites and do not seek the facts. Our media and its advertising process have a lot to do with this exposure. So given all this twisting and turning, what is the impact that health reform will actually have on you and Nevada seniors?
According to literature and presentations by NCOA public policy leadership, the 5 following facts are contained in the legislation and are the real scoop.
Fact #1: “The plan will provide health coverage for millions of uninsured Americans – plus extra protections for most people who currently have insurance.”
The plan provides insurance coverage for 32 million uninsured Americans. It will guarantee that insurance companies cannot deny coverage due to pre-existing conditions or drop them because they become sick or exhaust their coverage.
Fact #2: “The plan will not cut any benefits provided under traditional Medicare – and it will even improve some benefits.”
Help with prescription drug coverage: If you fell into the prescription coverage gap or “doughnut-hole”, the plan will eventually close that period where you had to pay 100% of the coverage. It also provides an easier appeal process if coverage was denied.
Chronic care coverage: If you have a chronic condition (e.g., heart disease, high blood pressure, arthritis, diabetes) like 80% of seniors, then you will receive better care through health care teams that provide patient centered care, keeping you out of hospitals and emergency rooms. It will enhance coordination and integration of care by teaching you how to care for yourself at home through evidence-based community programs that enhance independence.
Better preventive care: You will receive a new, free annual wellness visit and no out of pocket costs for preventive benefits under Medicare (e.g., cancer and diabetes screenings).
Fact #3: “The plan will help you find and afford long term services and supports at home.”
Many of us are forced to spend down our life savings and go into nursing homes at a cost of $60,000 – $80,000 a year because we cannot find or afford care in the home. The plan creates a new national insurance program called CLASS to help pay for care at home. Through voluntary payroll deductions, when we need care at home, the insurance will provide a cash benefit to you so you could pay for whatever non-medical service you need – home modifications, transportation, or paying a family member to provide personal care.
Fact #4: “The plan will improve care for older Americans in other ways.”
Help prevent and combat elder abuse, neglect, and exploitation.
Improve the training of the workforce that cares for seniors and increase numbers of primary care physicians (currently, only about 1% of MD’s, nurses, social workers, etc. are trained in geriatrics).
Improve nursing home quality.
Reduce health insurance premiums for Americans aged 55-65.
Fact #5: “The plan will reduce Medicare spending growth and it is fully paid for.”
The Medicare program will be strengthened according to an article entitled “How Health Reform Legislation Will Affect Medicare Beneficiaries”, from the Commonwealth Fund. “Despite criticism that health reform legislation will result in cuts to Medicare, the bills passed by the House of Representatives and the Senate, as well as President Obama’s proposal, contain provisions that would strengthen the program by reducing costs for prescription drugs, expanding coverage for preventive care, providing more help for low-income beneficiaries, and supporting accessible, coordinated, and comprehensive care that effectively responds to patients’ needs. The legislation also would help to extend the program’s fiscal solvency—for nine years, under the Senate bill. This issue brief examines the provisions in the pending legislation and how each one would work to improve benefits, extend the fiscal solvency of the Medicare Hospital Insurance Trust Fund, reduce pressure on the federal budget, and contribute to moving the health care system toward better access to care, improved quality, and greater efficiency.” (Guterman, Davis, Stremikis, March, 2010).
Even though health expenses are predicted to grow over the next 10 years, the health care plan will reduce that increase by $138,000 billion, according to the independent, nonpartisan Congressional Budget Office. Hence, it will be fully paid for, extend the solvency of the Medicare program, and even reduce the deficit.
The plan will slow the rate of payment increase to providers, which many providers have already agreed. Doctors will not be affected.
Reduce the payments to Medicare Advantage insurance plans which have about 25% of the senior population. Currently, Medicare pays over $1,000 more per person than traditional Medicare. The plan will level the playing field, which means that by cutting the reimbursement to these programs, the insurance plans may drop out or cut some of the extra benefits such as eyeglasses or hearing aids or increase premiums.
Reduce fraud and waste to make Medicare more efficient.
Ask high income Medicare beneficiaries to pay higher premiums. The plan will affect individuals with annual incomes of $85,000 and above and couples with incomes above $170,000.
Create a new Payment Advisory Panel to recommend ways to reduce costs in the future.
In summary, I am simply presenting to you 5 facts that the current legislation reforming health care in this country will have on you and the rest of the seniors in Nevada. Given the real scoop, this legislation will certainly “add life to years” for many us. I support it and you should as well.
Lawrence J. Weiss, Ph.D. is CEO of the Center for Healthy Aging. Dr. Weiss welcomes your comments on this column. Write to him at larry@addinglifetoyears.com or c/o Center for Healthy Aging, 11 Fillmore Way, Reno, NV 89519.