NCSL Urged To Back New AHCA-NCAL-Alliance Medicare Post-Acute And Long Term Care Reform Plan

Main Category: Medicare / Medicaid / SCHIP
Article Date: 28 Apr 2009 - 1:00 PDT

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Following up on the announcement this week by Avalere Health that a new Medicare post-acute and long term care reform plan developed by the American Health Care Association (AHCA), the National Center for Assisted Living (NCAL) and Alliance for Quality Nursing Home Care could both enhance U.S. seniors' care choices as well as save approximately $35 billion in federal funds over ten years, AHCA and NCAL today turned their attention to how the plan will benefit state lawmakers as they struggle with fiscal crises of historic magnitude. The spring meeting of the National Conference of State Legislature's (NCSL) commences today in Washington.

"Our plan, which emphasizes better coordination of both care and financing, greater private sector involvement and appropriate personal responsibility, will allow our state as well as federal lawmakers to finally gain improved control of eldercare financing issues," said Bruce Yarwood, President and CEO of AHCA/NCAL, noting one of the NCSL sessions today is entitled, "Achieving High-Quality Long-Term Care: The Importance of Chronic Care Coordination.

"The fact many states are diverting Medicaid dollars in the federal stimulus bill to purposes unrelated to eldercare is emblematic of the budgetary chaos at hand," he continued. "It is clear we must institute new, comprehensive solutions to address systemic imbalances. We intend to ensure state lawmakers know the facts surrounding our plan, and how its passage into federal law will benefit their elderly constituents."

David Kyllo, Executive Director of NCAL, said the reform proposal addresses many of the concerns of state lawmakers as they pertain to both coordination of care and its ongoing accessibility across the entire spectrum of care. "Our reform effort creates a sustainable, patient-centered long term and post-acute care system that will provide Americans more control over their individual health care futures, and help ensure state lawmakers endure far less year to year volatility in terms of eldercare budgeting."

Yarwood said the plan would help replace the current patchwork financing structure, increase the viability of private long term care financing, and streamline the increasingly problematic post-acute and long term care delivery systems. "Implementation of our proposed plan would help achieve a more reliable long term and post-acute care financing system. All of citizens could be assured their future post-acute and long-term health care needs are secured without jeopardizing their retirement security."

The plan is available here.

The key components of the AHCA/NCAL/Alliance plan are:

- A voluntary, federal LTC benefit. A federal benefit covering LTC expenses would be available to those who commit a portion of their private funds, known as a personal responsibility amount (PRA), to LTC.

- Greater consumer choice. People participating in the program would have greater choice of care settings and services, with expanded access to assisted living and other home-and-community-based services in addition to nursing facility care.

- A standardized benefit built on a public-private partnership. Individuals with limited assets and incomes below 150% of the poverty line would qualify for the federal benefit without any PRA. For everyone else, the PRA amount would vary from $50,000 to $180,000 based on income and assets. Once individuals satisfy the PRA, the government pays all remaining care costs.

- More effective care coordination. As part of the benefit package, care coordinators will assist in assessing an individual's needs and finding the right care at the right time, whether the individual needs long-term chronic care and supports or short-term post-acute care.

- Evidence-based payment system for Post-Acute Care (PAC). The development of a new prospective payment system (PPS) for Medicare PAC services to enhance care coordination by basing payments primarily on patient need rather than the setting in which services are delivered.

In continuing their effort to explain the proposal, and the policy benefits associated with the Medicare post-acute and long term care reform plan, Yarwood and Kyllo also indicated they will hold a May 1, 2009 briefing on Capitol Hill. Details are forthcoming.

Source
American Health Care Association
National Center for Assisted Living

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