On March 21, 2010 the U.S. House of Representatives passed the Senate Health Care reform bill (HR 3590) “The Patient Protection and Affordable Care Act,” as well as the budget reconciliation package the “Health Care and Education Affordability Act,” (HR 4872).
Several issues affecting the Long-Term Care industry are listed below:
-
There are no targeted reductions to the skilled nursing facility (SNF)market basket for FY 2010 or FY 2011
-
The implementation of RUG-IV was pushed back a year to October 1, 2011
-
MDS 3.0 has not been delayed (still effective October 1, 2010)
-
The changes to concurrent therapy requirements for MDS 3.0 were not delayed
-
Therapy Caps – the exceptions process for Medicare Part B outpatient services have been extended to December 31, 2010
-
A productivity adjustment to the skilled nursing facility market basket will be implemented beginning in FY 2012 (October 1, 2011)
-
Co-pays for dual eligibles receiving services in a Medicaid managed Care organization are eliminated
-
The maximum period for submission of Medicare claims would be reduced to not more than 12 months (effective January 1, 2010)
-
RAC Program - Medicare Parts C and D, as well as Medicaid, will now be included
-
All health care providers, including skilled nursing facilities, will be required to have a compliance and ethics program
-
An Independent Medicare Advisory Board (IMAB) will be established to develop and submit proposals to Congress aimed at extending the solvency of Medicare, slowing Medicare cost-growth and improving the quality of care delivered to Medicare beneficiaries
-
There will be a General Accountability Office study and report on the Five Star Quality Rating System
-
Stricter background check requirements for SNFs will be instituted
-
There will be new transparency requirements for nursing facilities:
-
Requires that SNFs must disclose information on their organizational structures as well as information on officers, directors, trustees, or managing employees, including names, titles, and start date of service
- Requires disclosure of owners with 5% of a facility’s total property/assets, or provide management or administrative management or clinical consulting services
-
- By January 1, 2013, the Secretary will implement a national, voluntary pilot program to coordinate care for Medicaid beneficiaries not covered under Part C
- A Medicaid bundled payment demonstration project will be established in eight states
- Creates incentives for states to offer Home and Community Based Services as Long-Term Care alternative to nursing homes. They will provide Federal Medical Assistance Percentage (FMAP) increases to States to rebalance their spending between nursing homes and HCBS by October 1, 2015 (FMAP increases)
These and other provisions have far reaching implications and are likely to change Health Care “AS WE KNOW IT” forever.