Stethoscope on a USA flag

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.