Presentation on theme: "Who knows the music of Dick Dale – Dick Dale and the Del-Tones"— Presentation transcript:
1 Dr. Anthony Hill’s Policy Class Catholic University of America November 29, 2010 Who knows the music of Dick Dale – Dick Dale and the Del-Tones? He is the King of the Surf Guitar. He was my companion as I headed for Virginia Beach although the closest I got was hearing and seeing the surf from my hotel room – but sure enjoyed that.
3 “Lovers of sausage and the law should watch neither made.”
4 What Will Be Highlighted A Bit of LTC BackgroundPatient Protection and Affordable Care Act Long-Term Care Related ProvisionsElder Justice ActOther Patient Protection and Affordable Care Act Long-Term Care-Related ProvisionsMy Crystal Ball
5 Percentage of Population Over Age 65 2000201520255%-9.9% %-14.9% 15%-19.9% %Source: U.S. Census Bureau
6 An Aging Population Percentage of U.S. Population over Age 65 Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging PopulationCopyright 1996, Watson Wyatt Worldwide.5101520251930195019701990201020302050YearPercentage of Population
7 Older Population is Getting Older The fastest growing segment of the aging population is the “old old”, those over the age of 85: 1.6% to 3.8% in 2025 & in numbers from 4.2 million in 2000 to 6.1 million in 2010 – Population most likely to need long-term care
8 LTC Expenditures: A Lot Now & Much More in the Future In 1999, CBO projected that total LTC expenditures for seniors (including government and private spending but not the value of donated care) would rise from about $123 billion in 2000 to $346 billion by 2040.That estimate of a relatively modest increase in spending incorporated the assumption that the prevalence of impairment would decline at a rate of about 1.1 percent per year.CBO 2004
9 Health Care Expenditures for Chronic Conditions 83% of all Health Care Spending Involved People with Chronic Conditions in 2001Medicare – 98%Medicaid – 83%Privately Insured – 74%Uninsured – 72%Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions
10 Threats to Health Among Seniors 73% age report no regular physical activity81% age 75+ report no regular physical activity61% - unhealthy weight~35% - fall each year20% - clinically significant depression; age group at highest risk for suicideSources: State of Aging and Health, 2007;
11 What’s the health picture for Boomers? By 2030More than 6 of every 10 will be managing more than one chronic condition14 million (1 out of 4) will be living with diabetes>21 million (1 out of 3) will be considered obeseTheir health care will cost Medicare 34% more than others26 million (1 out of 2) will have arthritisKnee replacement surgeries will increase 800% by 2030“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
12 Diabetes Trends Among U.S. Adults, BRFSS 1990, 1996, and 2003 No Data <4% %–6% %–8% %–10% >10%
21 Elder Justice ActPatient Protection & Affordable Care Act (H.R. 3590), Sec. 6701Authorized for FYAmends Title XX of the SSA – Senate Finance Committee & House Ways & MeansOnly portion of original version of EJA (note Sestak’s Elder Abuse Victims Act of 2009)13 individual authorizations of appropriations – $195 million authorized – without funding, “close but no cigar”Heavily LTC focused
22 EJA: Mandatory Reporting of Crimes in Facilities Reporting to Law Enforcement of Crimes Occurring in Federally Funded LTC Facilities (to Secretary & Law Enforcement)Includes owners, operators, employees, managers, agents, contractors of LTC facilitiesCMPs for failure to do so; higher CMPs when residents harmed by crimeAdditional Penalties for RetaliationNo Appropriation – can start now
23 EJA: Other LTC Provisions Enhancement of Long-Term CareGrants & Incentives for LTC Staffing (Career Ladders, Wage & Benefit Increases, Technology, Adoption of Standards for Transactions re Clinical Data)Authorization -- $20M FY 11 (drops to $15 M in FY 13-14)Protecting Residents of LTC FacilitiesNational Training Institute for Surveyors (with National Complaint Intake System)Authorization -- $12 M FY 11-14Grants to State Survey Agencies re complaint investigations systemsAuthorization -- $5M FY 11-14
24 Other EJA Provisions National Nurse Aide Registry Study & report to Coordinating Council & Congress – 18 mos.Congress (Finance, W&Ms, E&C) “shall, as they deem appropriate, take action on the recommendationsAuthorization – such sumsForensics Centers (4 Stationary Centers, 6 Mobile Centers)Authorization -- $4M FY 11 (to $8 M)LTC Ombudsman Program Capacity & Training Grants
25 EJA and Adult Protective Services (APS) First dedicated federal funding for APS$100 million in new money to states for APS$25 million in new money for APS demo grants$3-4 million for HHS for a federal “home” for APS
26 What the EJA means for APS: State Funding Adult Protective Service Grant Program (State Formula Grants)Authorizes $100 millionFunds may be used only by states and local governments to provide adult protective services & may only be used for APS.State receiving funds would be required to provide these funds to the agency or unit of state government having legal responsibility for providing adult protective services in the state.Each state would be required to use these funds to supplement and not supplant other federal, state, and local public funds expended to provide adult protective services.California: If $100 million: $9.958 milllion =170 FTEs at $60,000 each (85 FTEs at $120,000)
27 Implementation of the EJA “Show me the money” – the battle & challenges for appropriationsWho will be responsible for what at HHS?What is the timetable especially sans appropriations – e.g., no action taken until appropriations?Those items not requiring appropriations – e.g., reporting of crimes in LTC facilities
28 The CLASS ActCLASS (Community Living Assistance Services and Supports) Act, a voluntary insurance program for employees to help pay for their future long-term care and support at home.CLASS differs from Medicaid waiver HCBS in that Medicaid requires the beneficiary to need nursing home-level care. CLASS does not.Also CLASS can cover people who are not low-income enough to be Medicaid eligible.
29 The CLASS Act: Hugh Potential Good But Many Questions Will premiums be low enough to attract buyers while providing sufficient money for benefits? How much?How to market to people 45+ who are struggling to pay college (or day care), home mortgage, and saving for retirement? Must convince people they need this (they are at risk of needing LTC).How do we prevent adverse selection?How will HHS determine level of disability? (Law says 2 OR 3 ADLs)How does the CLASS Act interact with LTCI plans. (Who pays first if a person has both?)Program is offered through employers, so will employers offer the program (not mandatory) so that employees can participate?
30 PPACA: New Options for States to Provide Long-Term Services and Supports (Subtitle E) Sec Community First Choice Option (Medicaid). Authorizes states to offer home and community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases. Effective Oct. 1, 2011, but sunsets after five years (according to Family Caregiver Alliance)Sec Removal of barriers to providing home and community-based services. Gives states the option of: (1) providing home and community-based services to individuals eligible for services under a waiver (instead of a state plan amendment); and (2) offering home and community-based services to specific, targeted populations. Creates an optional eligibility category to provide full Medicaid benefits to individuals receiving home and community-based services under a state plan amendment.
31 PPACA: New Options for States to Provide Long-Term Services and Supports (Subtitle E) Sec Money Follows the Person Rebalancing Demonstration. Amends the Deficit Reduction Act of 2005 to: (1) extend through FY2016 the Money Follows the Person Rebalancing Demonstration; and (2) reduce to 90 days the institutional residency period.Sec Protection for recipients of home and community-based services against spousal impoverishment. Applies Medicaid eligibility criteria to recipients of home and community-based services, during calendar 2014 through 2019, in such a way as to protect against spousal impoverishment.
32 PPACA: New Options for States to Provide Long-Term Services and Supports (Subtitle E) Sec Funding ($10 million per year for five years) to expand State Aging and Disability Resource Centers.Sec Sense of the Senate regarding long-term care. Expresses the sense of the Senate that: (1) during the 111th session of Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and (2) long-term services and supports should be made available in the community in addition to institutions.
33 PPACA: Selected Medicare Provisions Medicare Rx Drug “donut hole” to be phased out. (“Donut Hole” – the gap in coverage that occurs after an individual spends $2,830 on Rx drugs and must pay 100% of costs in 2010$250 rebate in 2010 for those entering the donut hole50% discount on brand name drugs & 7% on generics in donut hole in 2011gap gradually disappears until gone in 2020
34 PPACA: Selected Medicare Provisions Eliminates c0-pays and deductibles for most Medicare preventive services (e.g., colorectal cancer screening and mammograms)Provides for an annual “wellness visit” and personalized prevention plans – 2011Reduces payments for MA plans (due to concerns that plans receiving more money per beneficiary than Original Medicare benesMany fraud & abuse-related provisions
35 The Picture for Funding EJA, OAA, SSBG & Other?
36 OAA appropriations: Title III (in thousands) FY 1993FY 2000FY 2003FY 201093-10$%Supp. Serv.$313,708$310,082$355,673$368,348+$54,640+17%Home meals$89,659$146,970$180,985$217,676+$128,017+143%Cong. meals$363,236$374,336$384,592$440,783+$77,547+21%OAA Total$1,372,700$1,513,048$1,784,469$2,341,722+$969,022+70%Source: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004FY 2011 Administration on Aging Justification of Estimate for Appropriations CommitteesFY 2010 appropriations conference report, H.Rept
37 OAA appropriations: Title VII (in thousands) FY 1993FY 2000FY 2003FY 201093-10$%Ombudsman$3,870n/s$16,827+$12,957+335%Prev. abuse$4,348$5,056$708+16%Title VII$8,218$13,181$18,559$21,883+$13,665+166%OAA Total$1,372,700$1,513,048$1,784,469$2,341,722+$969,022+70%n/s= not specifiedSource: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004FY 2011 Administration on Aging Justification of Estimate for Appropriations CommitteesFY 2010 appropriations conference report, H.Rept
38 Social Services Block Grant Recent History Who has heard of it?Former Title XX of SSA -- HUGE importance to states for human services1996 Welfare Reform: Congress & Governors reduced SSBG from $2.8 B to $2.38 B, promising restoration to $2.8 B in FY 2003Agreement broken; SSBG further reduced to $1.7 B – its current level (over $1 B less than in in 1996 dollars)Repeated efforts to restore funding have been unsuccessful – But may again be fighting against further cuts!3/25/2017