Making it Easier For Individuals to Navigate Their Health and Long –Term Care

26th National Home and Community Based Services Conference

Tuesday, September 28, 2010

Implementing the

Affordable Care Act:

Affordable Care Act: More Than Coverage Expansion

Health System Reform

Payment reform

Quality

Delivery system redesign

Center for Medicare and Medicaid Innovation (CMI)

Medicare, Medicaid, CHIP

Payment reforms to reduce expenditures while

increasing quality

Medicare Prescription Drug Costs – Doughnut Hole

Better Preventive Care

Annual Wellness Visit

No co-payments for preventive benefits

2011: Part C and D enrollment period to begin October

17 and end December 7

Increased funding for SHIPs, AAAs, ADRCs

Attention to Chronic and Acute Care: Medicare

Independence at Home demo

Multi-Payer demo

Care Transitions and Medical Homes

Hospital value-based purchasing

Payment Bundling

Accountable Care Organizations (ACOs)

Elder Justice Act Adult Protective Services -- $400 million (over 4 years)

in first-time dedicated funding (Auth)

Long Term Care Ombudsman--$32.5M (over 4 years) in grants + $10M/year for training programs (Auth)

Elder Justice Coordinating Council—Within HHS--national federal coordination on elder abuse issues

Advisory Board to the EJCC composed of experts on elder abuse, neglect and exploitation

Other Long Term Services and Supports Nursing Home Reform

Transparency

NH Compare Improvements

Workforce investments

New resource to fight fraud

Community Living Assistance Services and Support

(CLASS) Program – insurance option for in-home LTC

support

ACA Prevention & Evaluation National Prevention, Health Promotion and Public

Health Council—up to 25 people

Prevention & Public Health Fund—FY10 $500M; FY11 $750M; FY12 $1B

Increased Access to Clinical Preventive Services—Medicare Changes & Medicaid Incentives

Creating Healthier Communities—Grants, Demo’s & Evaluations

Increased Access to Clinical Preventive Services—Subtitles BChange Opportunity for Aging Network

Medicare Coverage of Annual Wellness

Visit & Personalized Prevention Plan (Sec.

4103)

Promote awareness of benefit, connect people get to

PCP; expand availability of EBPP.

Removal of Medicare Coinsurance and

Deductible for preventive services meeting

criteria (Sec. 4104)

Educate Citizens, Connect Medicare Beneficiaries to

preventive services, Improve rates of utilization of

covered clinical preventive services, Partnership

Development with Health Care System and Public Health

System

Prevention of Chronic Disease—Grants to

states to test approaches that encourage

behavior modification and determine

scalable solutions related to chronic

disease prevention among adults in

Medicaid. (Sec. 4108) ($100M until expended)

Assure part of state grant application, Expand availability

of EBPP, outreach and education campaign for provider

and beneficiary education, strengthen partnership with

public health and mental health/substance abuse

systems.

Creating Healthier Communities—Grants, Demo’s & EvaluationsGrant/Demo/Evaluation Opportunity for Aging Network

Community Transformation Grants—

Submit Community Transformation Plan,

Activities including physical activity,

nutrition, and prevention and control of

chronic disease. (Sec. 4201)

State Grant Team, Use Aging Network infrastructure to

promote healthy living and reduce disparities, leverage

Recovery Act CPPW CDSMP infrastructure and

partnerships

Independent evaluation of Evidence

Based Community Prevention and

Wellness Programs. (Sec. 4202) ($50M until

expended)

Be part of evaluation. Deliver EBPP (physical activity,

nutrition, falls, mental health, chronic disease self-

management, ).

GAO Study and Report on Medicare

Beneficiary Access to Vaccines. Study to

be published by June 1, 2011. (Sec. 4204)

Be aware that study is occurring and results that may be

learned regarding barriers to access.

Demonstration Project Concerning

Individualized Wellness Plan that are

designed to reduce risk factors for

preventable conditions—Pilot with up to 10

Community Health Centers.

Partner with Community Health Centers in State or

Community to provide awareness of the wellness plan,

help link people to the CHC, generate EBPP that provide

programs that help people change behavior and reduce

risk.

Where are potential blind spots?

10

11

Blind Spots

Blind Spot

12

13

Partnerships Help Prevent Blind Spots

What are the key deliverables?

14

Funding Opportunities Part A. Medicare Improvement for Patients and

Providers Act (MIPPA)

Part B. ADRC Options Counseling and Assistance Programs

15

CDSMP

Funding Opportunities Part A. Medicare Improvement for Patients and

Providers Act (MIPPA)

Part B. ADRC Options Counseling and Assistance Programs

Part C. ADRC Nursing Home Transition and Diversion Programs

Part D. ADRC Evidence-Based Care Transition Programs

16

Care Transitions/Coordination

HCBS

Hospital

Nursing

Home

Physician

Practice

Assisted Living

Pharmacy

Care Transitions

The process of engaging consumers

and their informal caregivers in the

discharge planning process to ensure

they have the post-discharge care

instructions and resources they need

to avoid unnecessary hospitalization

or institutionalization.

Where does this path lead?

18

19

2010• $10.0 Million (ADRC)

2011• $10.0 Million (ADRC)

2012• $10.0 Million (ADRC)

• Part A - MIPPA

• Part B – Options Counseling

2013• $10.0 Million (ADRC)

2014• $10.0 Million (ADRC)

Section 2405

20

2010• $2.5 Million (ADRC)

2011• $100.0 Million (CMS)

2012• $100.0 Million (CMS)

• Part D – ADRC Evidence-Based Care Transition Programs

2013• $100.0 Million (CMS)

2014• $100.0 Million (CMS)

2015• $100.0 Million (CMS)

Section 3026

21

2010• $7.5 Million (24 States)

2010• MFP Expansion to 50 States

2010• MDS – Section Q Changes

• Part C – Nursing Home Diversion and Transition Programs

2011• State Balancing Incentive Program

2011• (SPE/NWD, Conflict Free Case

Management, Universal Assessment Tool)

Section 10202

We’re Rounding The Curve…..

23

2010-

2012

• CLASS Act Development

• Part A - MIPPA

• Part B – Options Counseling

5 Year Period

• CLASS Enrollment

2018-2020• Nationwide Private Pay LTC Consumers

CLASS• Defined Benefit – Advice and Counseling

Section 3201

Section 3205

24

Section

2405

• Part A

• Part B Section

10202

• Part C Section

3026

• Part D Section

3201

• Part A

• Part B

2010

• ADRC

• $10.0

2011

• ADRC

• $10.0

2012

• ADRC

• $10.0

2013

• ADRC

• $10.0

2014

• ADRC

• $10.0

2010• $7.5 Million

(24 States)

2010

• MFP Expansion to 50 States)

2010

• MDS –Section Q Changes

2011

• State Balancing Incentive Program

2011

• (SPE/NWD, Conflict Free Case Management, Universal Assessment Tool)

2010• $2.5 Million

(ADRC)

2011

• $100.0 Million (CMS)

2012

• $100.0 Million (CMS)

2013

• $100.0 Million (CMS)

2014

• $100.0 Million (CMS)

2015

• $100.0 Million (CMS)

2010-

2012

• CLASS Act Development

5 Year Period

• CLASS Enrollment

2018-2020

• Nationwide Private Pay LTC Consumers

CLASS

• Defined Benefit –Advice and Counseling