Assistance Services and Supports (CLASS ACT):• The bill establishes a new national voluntary
insurance program for long-term care, known as the CLASS Act. The program would
collect monthly insurance premiums on a voluntary basis with a five year period
of vesting required. The insurance program would provide cash benefit of at
least $50 a day to permit individuals to purchase community living assistance
services, such as transportation services, personal care services to permit
individuals to work or live independently in the community. HHS will develop an
actuarially sound benefit plan that will ensure a 75 year solvency plan.
The Senate will begin debate with a Motion to Proceed vote Saturday, November 21, 8 pm. Sixty votes are need to approve discussion and debate on the bill. This will be the first big hurdle for Senator Reid. If the Senate votes for cloture on Saturday night, discussion and debate on the bill and possible amendments is expected to begin November 30.
Below are some of the key provisions included in S. 3590 that impact family caregivers and their care recipients. If you or your organization feels strongly about any of these provisions, please consider contacting your Senators about these areas.
Key Provisions in S. 3590,
Patient Protection and Affordable Care Act, for Caregivers,
New Options for States to Provide Long-Term Services and Supports in Medicaid:• A new optional Medicaid benefit is created through which states may offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, skilled nursing facility, or intermediate care facility.
• The bill removes barriers to providing Home and Community-Based Services (HCBS) by giving states more options to provide more types of HCBS to assist individuals with high levels of needs. It also provides additional protections for recipients of home and community-based services against spousal impoverishment.
• Gives states the option of enrolling Medicaid beneficiaries with chronic health conditions into a health home. Health homes would be composed of a team of health professionals who would meet frequently to monitor and evaluate the health needs of the beneficiary with several chronic care conditions.
Increasing Access to Clinical Preventive Services:• Requires Medicare to pay for annual wellness coverage and personalized disease prevention plan for Medicare beneficiaries. :
Encouraging the Development of New Patient Care Models:• The bill creates a new demonstration program for chronically ill Medicare beneficiaries to test new Medicare payment and service delivery where physician and nurse practitioners directs a home-based primary care team to work with the patient and family caregiver to produce better health outcomes and prevent hospitalization.
• The bill also creates a new community-based care transition programs for Medicare beneficiaries at high-risk of hospitalization readmission. The models may vary and will promote communications and evaluate patient and caregiver needs to reduce necessity of hospital readmissions.
Health Care Quality Improvements:• The bill creates a program to establish and fund community-health teams to support the development of medical homes by increasing access to comprehensive, community based, coordinated care. The bill also incorporates a new program to help Medicare beneficiaries with chronic conditions manage their medications with the help of local health providers.
Health Insurance Changes:
• Prohibits all plans from establishing lifetime or annual limits on dollar value of benefits.
• Prohibits all plans from rescinding coverage except in cases of fraud.
• Requires all plans to cover, without any cost-sharing to consumers, preventive services and immunizations, recommended by government.
• Requires all plans to offer dependent health coverage until age 26.
• Requires insurance carriers to use easy to understand language and outline coverage options using a simple and standard format so that consumers can make “apples-to-apples” comparisons when looking at different insurance options.
• Requires insurers to make the appeals process more consumers friendly.
• Provides $5 billion to enact an immediate insurance program to provide financial aid to individuals who have been denied insurance coverage because of pre-existing condition. This is a temporary program designed to terminate when insurance exchanges are operational in 2014.
• Beginning 2014, new rules will end medical underwriting and pre-existing conditions exclusions. Insurers will be prohibited from denying coverage or setting rates based on health status, medical condition, claims experience, genetic information, or any other health related factor. Premiums can only vary based on family size, geography, and by age (but not more than three to one).
Closing the Coverage Gap in the Medicare Part D Drug Benefit:
• The bill requires drug manufacturers to provide a 50 percent discount to Part D beneficiaries for brand-name drugs and biologics beginning July1, 2010. The initial coverage limit in the standard Part D benefit will be expanded by $500 for 2010.
Expanded Role of Medicaid Health Services:• Beginning in 2014, all children, parents, and childless adults who are not entitled to Medicare and who have family incomes of up 133 percent of poverty ($29,237 for a family of four) will become eligible for Medicaid.
• Beginning in 2014 the Center for Medicare and Medicaid (CMS) will award grants to states to provide incentives for Medicaid beneficiaries to participate in programs to promote healthy lifestyles, such as helping individuals lower cholesterol/blood pressure, lose weight, quit smoking, manage or prevent diabetes.
Creating Healthier Communalities:• The goal of this new program is to strengthen community-based wellness programs aimed at the pre-Medicare population age 50-64 to evaluate chronic disease risk factors, and conduct public health interventions. Pilot programs would be created to screen, evaluate, and treat pre-Medicare population to screen for health problems and promote health. CMS would then conduct an evaluation of these programs.
Improving Staff Training for Health Care Workforce:• The bill requires HHS to establish a nationwide program for national and state background checks on direct care workers.
• Requires HHS and the Department of Labor and Justice Department to provide greater protections to individuals living in nursing homes through the “Elder Justice Act.