Transcript 1998 Long-Term Care Legislation

Overview of the
Joint Commission on Health Care
Presentation to VCU MPH Class
November 28, 2005
Kim Snead
Executive Director
Background
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The Joint Commission on Health Care (JCHC) was created by
the 1992 session of the General Assembly to continue the work
of the Commission on Health Care for all Virginians, established
in 1990.
“The purpose of the Joint Commission on Health Care is to
study, report, and make recommendations on all areas of health
care provision, regulation, insurance, liability, licensing, and
delivery of services.” JCHC seeks to ensure that the greatest
number of Virginians receives quality cost-effective health care
and long-term care services.
Joint Commission on Health Care
Membership of the JCHC
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Ten members of the House of Delegates, appointed
by the Speaker of the House.
Eight members of the Virginia Senate, appointed by
the Senate Committee on Rules.
The Secretary of Health and Human Resources is an
ex officio member.
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Current JCHC Members
Del. Harvey B. Morgan, Chair
Sen. William C. Mims, Vice-Chair
Del. Clifford L. Athey, Jr.
Del. Benjamin L. Cline
Del. Phillip A. Hamilton
Del. Kenneth R. Melvin
Del. John J. Welch, III
Del. Robert H. Brink
Del. Franklin P. Hall
Del. R. Steven Landes
Del. John M. O’Bannon, III
Sen. Harry B. Blevins
Sen. Benjamin J. Lambert, III
Sen. Linda T. Puller
Sen. William C. Wampler
The Honorable Jane H. Woods
Sen. R. Edward Houck
Sen. Stephen H. Martin
Sen. Nick Rerras
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Role of JCHC Staff
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JCHC has a full-time staff of four: an executive
director, 2 health policy analysts and an office
manager
— Provide impartial, apolitical analysis of issues involving
health care, behavioral health care, and long-term care
— Identify a range of policy options for consideration by the
Joint Commission
— Assist in supporting legislation and budget amendments that
the members introduce on behalf of JCHC.
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Study Process
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Staff research and presentation of Studies (MayOctober)
— Public comments received (after issue brief)
— Public comments summarized (next meeting after
issue brief)
Subcommittee meetings conducted (May-October)
JCHC consideration of decision matrix (Nov.)
JCHC vote on legislative package (Nov.)
General Assembly session
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Review of Federal Funding for HIV/AIDS
Prevention and Treatment in VA
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The 2005 Appropriations Act required JCHC to review federal funding on
Virginia’s HIV/AIDS prevention and treatment program
— 17,000 individuals are known to be living with HIV or AIDS in VA;
another 25% or 4,200 are unaware of being HIV-positive.
Medicaid is the primary funding source for services for individuals with
HIV or AIDS
— In 2004, Medicaid expenditures in VA were $6.7 million with more
than 50% for pharmaceutical expenditures.
Other major sources of federal funding for services addressing HIV/AIDS
include Health Resources and Services Administration (HRSA) through
the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act
and the Centers for Disease Control (CDC)
— Funding from these federal sources has been reduced
— Available State matching funds have been reduced
— A deficit of $6.1 million in needed funding is projected by the VA
Dept. of Health in FY 2007 , if additional funding is not appropriated.
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Review of Federal Funding for HIV/AIDS
Prevention and Treatment in VA
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JCHC members discussed the desire not to take on funding of federallymandated programs that had their federal funding reduced, even though
many of the programs are needed.
Options presented but not approved included budget amendments for:
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$285,000 per year for other prevention funding
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$164,000 per year for the Advancing HIV Prevention Initiative
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$1 million to stabilize access to HIV primary care services in
NOVA and SW VA
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$4.3 million to fund projected shortfall in ADAP funding for
individuals with HIV/AIDS who have limited or no coverage for
medication .
JCHC actions approved for the 2006 General Assembly Session
— Introduce budget amendment for $265,110 per year to expand HIV
resistance testing program
— Introduce a resolution encouraging VCU School of Dentistry to
investigate funding for dental services under the Ryan White
Comprehensive AIDS Resource Emergency Act
— In addition, JCHC will continue to monitor funding issues in 2006.
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Reconsideration of Medicaid
Asset Transfer Policy in Virginia
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HB 2601 (2005) would have allowed DMAS to seek a waiver
from the federal government to establish more restrictive asset
transfer limits for qualifying for Medicaid long-term care services.
Federal restrictions addressing the issue of improper asset
transfers in order to qualify for Medicaid long-term care services,
were first enacted as part of the Boren-long Amendments to the
1980 Omnibus Reconciliation Act.
On the national level, Medicaid is now the largest purchaser of
nursing facility services
— $51 billion in 2003.
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National Distribution of
Nursing Facility Funding
2003 Nursing Home Expenditure Distribution by Source of
Funds According to CMS National Health Accounts
Other Public
2%
Out-of-Pocket
28%
Medicaid
46%
Private Insurance
8%
Other Private
4%
Medicare
12%
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Overview of Medicaid Long-Term Care
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States are not required to provide Medicaid programs. However, if
they do, they must provide certain services to individuals classified as
categorically needy.
 Long-term care services that a state must provide include:
— Home health (which at a minimum includes intermittent or part-time
nursing services, home health aides, and medical supplies and
appliances for use in the home)
— Nursing facility services for beneficiaries age 21 or older.
 In Virginia, nursing facility (NF) reimbursement cost $547,287,699 in
2003 (VA’s Medicaid funding requires a 50% match of State funds)
— 76% of NF expenditures were for individuals classified as aged
— Clearly this figure is likely to increase with the aging of baby
boomers, if action is not taken.
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Increasing Medicaid Costs
Are a National Concern
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In response to projections showing significant increases in the
cost of Medicaid LTC expenses ($51 billion in the US in 2003),
groups such as the National Governor’s Association have
considered methods for restricting asset transfers including
changes in the look-back period and penalty provisions
— Look back period is the time period examined for an
improper asset transfer; currently 36 months for all transfers
except trusts which involves a 60-month look back period
— Penalty period is the time period that an individual is
ineligible for Medicaid LTC payments due to an improper
asset transfer
— Penalty period = Uncompensated value of assets transferred
Avg. monthly cost private pay NF at application
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Reconsideration of Medicaid
Asset Transfer Policy in Virginia
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A number of Options were presented for JCHC consideration
— Actions to encourage purchase of LTC insurance
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Introduce legislation to provide a 10% tax credit rather
than a tax deduction for purchase of LTC insurance
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Introduce legislation to provide a tax credit for employers
who provide LTC insurance for their employees.
— Actions to further restrict asset transfers
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Introduce legislation authorizing DMAS to apply for a
waiver to implement more restrictive asset transfer
restrictions (as HB 2601 of 2005 would have provided).
— Actions that require study
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Introduce a resolution requesting a JLARC study of the
incidence of and methods used to shelter assets in order
to qualify for Medicaid.
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Review of Health Savings Accounts
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HSAs were created in Medicare legislation signed into law in December
2003
— HSAs are accounts in which money is placed to pay for medical
expenses; the accounts must be paired with qualifying highdeductible health plans
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HSA funds are tax deductible and owned by the individual even
though employers can contribute into the accounts
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Covered individuals cannot be eligible for Medicare or have
other health insurance (except for the required high-deductible
insurance and specific types of coverage such as accident,
disability, dental, vision, LTC)
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Maximum contributions currently are the lesser or $2,650 for
individuals and $5,250 for families or the amount of the
deductible in the high-deductible health plan
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HSA funds can be used for medical expenses, qualified LTC
insurance, COBRA coverage, health insurance while
unemployed, and in a few other specific situations.
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Review of Health Savings Accounts
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Potential advantages of HSAs
— Encouraging savings for future needs which may provide a source of
funding for non-covered services, health insurance while
unemployed, LTC needs, medical expenses after retirement but
before Medicare coverage
— Unspent funds in HSAs can be rolled over from year to year
— For some populations, including young adults who can no longer
receive coverage on their parents’ policies and lower-income selfemployed individuals, HSAs may be the only type of health care
coverage they can afford.
Potential disadvantages of HSAs
— Several studies found that while employees who have to pay a large
share of their medical care eliminated 1/4th of unnecessary visits to
their doctors, they also eliminated 1/3rd of crucial visits
— HSAs may attract the “healthy and wealthy” making comprehensive
coverage for others more expensive
— The number of uninsured and underinsured Americans could
increase if more employers and employees choose not to offer/have
comprehensive health insurance.
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Joint Commission on Health Care
JCHC Internet website:
http://legis.state.va.us/jchc/jchchome.htm
Includes meeting schedules, studies, reports, and
legislation.
Joint Commission on Health Care
900 E. Main Street, Suite 3072E
P. O. Box 1322
Richmond, VA 23218
804-786-5445/(FAX) 804-786-5538
[email protected]
JCHC Staff
Kim Snead, Executive Director
April R. Kees, Principal Health Policy Analyst
Catherine W. Harrison, Senior Health Policy Analyst
Mamie V. White Jones, Office Manager
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