Archive for the ‘Obama's Health Care Plan’ Category

Democrats Pushing for Six-Month Launch Date for Senior Care

The new health reform law includes a component called the Independence at Home (IAH) program, which is set to take effect on or before January 1, 2012. But a few Democratic proponents of the plan are pushing CMS to implement the program even sooner — within the next six months.

The IAH program aims to benefit chronically ill Medicare beneficiaries by encouraging teams of physicians and nurse practitioners to make house calls to the most vulnerable Medicare recipients. The VA enacted a similar program and successfully reduced hospital admissions by 25 percent and total healthcare costs by 15 percent, according to The Hill.

Currently, 5 percent of Medicare recipients account for 40 percent of total Medicare costs, a number which could be drastically reduced with improved efficiency in delivering care to this population. The program will hold providers responsible for reducing healthcare costs — if costs aren’t reduced by 5 percent, they don’t get paid by Medicare. The cost savings are divided between the provider and Medicare, providing further incentive for practitioners to comply.

This system represents a shift in thinking, according to George Taler, a physician at the Washington Hospital Center and an AAHCP (American Academy of Home Care Physicians) board member, who is quoted in The Hill’s article as saying, “In the current system, the more we do, the more we get paid. And so we do more.” Under the new program, physicians would earn more money by saving money, and so it creates a paradigm shift.

The IAH program is being implemented as a three-year pilot program, although proponents are encouraging CMS to extend the program beyond an initial three years and to  include at least 5,500 participants in the program.

Health Care Reform Discussed at ALFA Conference

ALFA Conference 2010Senior living executives attending the Assisted Living Federation of America (ALFA) Conference & Expo this week attended a briefing on the new health care reform laws. Issues addressed during the briefing should put many seniors’ minds at ease, including the fact that ALFA was an advocate for certain aspects of the new laws that will impact seniors.

ALFA advocated for changes that would improve access to care, improve the quality of care received, and provide more choices for seniors when it comes to long-term care. Seniors will be afforded more choices through adding flexibility to benefits and expanding coverage to include more non-traditional care, such as family caregiving.

Cost is a prominent issue that was not ignored. In fact, ALFA advocated for more options for using payor sources for residential care, rather than institutional settings, which are typically more expensive. ALFA was also a proponent of the new optional long-term care insurance benefit offered through employers, as a means to encourage consumers to plan in advance for long-term care needs.

Finally, as we discussed in an earlier post, the need for geriatricians, geriatric care managers, and elder care specialists is going to drastically increase as the population ages. In order to address this shortage, ALFA is in support of grants that will fund education and training related to senior care.

ALFA also plans to monitor the delivery of benefits as the government actually implements the new laws, and will be available to offer expertise and insight on behalf of the industry.

Image Copyright svilen001 on Stock.xchng

Saving for long-term care will soon be easy

One provision of the Health Care and Education Reconciliation Act of 2010 that has — suprisingly — garnered little attention from the media is the CLASS (Community Living Assistance Services and Supports) Act. Overshadowed by concerns about seniors losing Medicare benefits, the CLASS Act basically functions much like a long-term care insurance plan, with deductions coming out of participating employees’ paychecks.

According to California Health Advocates, a participant would be required to participate in the plan for at least five years (60 months) before becoming eligible for benefits. Once the eligibility period is completed and there is a need, cash benefits are paid out on a sliding scale based on the patient’s needs. Estimates indicate the average daily payout to be around $50. These funds can be used to pay for home care and support services or to help cover the cost of assisted living or nursing home stays.

The CLASS Act will likely begin in 2012, and although it’s optional, employees of participating companies will need to opt-out of enrollment during the start-up phase if they don’t want to participate. If an employee opts out but chooses to enroll at a later time, a premium penalty would be imposed. These benefits won’t replace Medicaid, and they won’t impact an individual’s ability to qualify for any type of government-assistance program.  

The most interesting point to note is that funds from the CLASS Act may also be used to compensate family caregivers for their services, which will help alleviate the financial burden on caregivers who are forced to take time off from work to attend to the needs of an elderly or disabled loved one.

Obama Administration Reassures: Seniors Won’t Lose Benefits Under Health Care Reform

Among all the buzz about health care reform, perhaps one of the more prominent sticking points has been how this new legislation will affect seniors. Opponents of the plan have been vocal about their concerns over cuts to Medicare, while supporters (which include the AARP and other senior-focused organizations) say health care will become more affordable for many seniors.

Linda Douglass, with the White House Office of Health Reform, weighed in with some reassurance for concerned seniors and other citizens on the White House Blog, making note of several important points that will benefit senior citizens. For example, Medicare’s prescription drug program, introduced just a few years ago where there was no prior prescription coverage under Medicare, will be improved.

Under the original Medicare Part D program, seniors are responsible for paying 100 percent of the cost of prescription drugs in a coverage gap known as the “donut hole” once they reach certain coverage limits. The health care reform bill implements a series of changes that will completely eliminate this coverage gap by the year 2020. In addition, preventative services will be covered in full for seniors as of next year — right now, they’re paying 20 percent of the cost of preventative care.

What about Medicare cuts? Will seniors be losing their Medicare coverage?

While there will be cuts to Medicare, the cuts focus on reducing fraud and waste by reducing subsidies and eliminating overpayments to private insurance companies offering Medicare Advantage plans, which typically cost the government more than traditional Medicare. Traditional Medicare benefits will remain intact. This is part of an overall goal to improve the health of all Americans by increasing the accountability of insurance companies and providers. Under the plan, incentives will be offered to providers (including physicians and hospitals) for reducing medical errors and coordinating care, which will both improve and simplify the overall health care system for seniors.

Because the goal is to keep costs down without limiting access to health care for seniors, an Independent Payment Advisory Board will be created. This board will keep an eye on Medicare spending and will submit legislative proposals to help control costs. Seniors can rest knowing that their health care benefits will not be cut significantly in the near future, but it’s likely that we’ll see more changes in the coming years. It’s vitally important for seniors to have a trusted friend or relative to help them navigate complex health care and financial issues.