Transcript Protection for Seniors in the Affordable Care Act

THE AFFORDABLE CARE
ACT: WHAT SENIORS
NEED TO KNOW ABOUT
LONG TERM CARE &
ELDER JUSTICE
Richard J. Mollot
Long Term Care Community Coalition (LTCCC)
www.ltccc.org
www.nursinghome411.org
www.assisted-living411.org
Presentation courtesy of NY StateWide Senior Action
Council, Inc.
NUMEROUS PROTECTIONS AND BENEFITS FOR
ELDERLY & DISABLED IN THE FEDERAL
AFFORDABLE CARE ACT (ACA)
The ACA provides for a wide range of benefits
for people old and young, especially people
who have difficulty accessing health
insurance and access to health care.
Many people don’t realize that the law:
1. actually made improvements to many
existing programs and
2. combined several existing bills which
increased protections and transparency.
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NURSING HOME CARE: IMPROVEMENTS TO
QUALITY, TRANSPARENCY & ACCOUNTABILITY
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Every nursing home will have to:
1. Meet new quality assurance & performance
improvement standards;
2. Implement a program to detect and prevent civil
& criminal violations.
NY State will have to:
1. Develop a standardized complaint form;
2. Develop a complaint resolution process.
U.S. Government will have to:
1. Establish a program for background checks of
nursing home employees;
2. Oversee use of fines to improve resident care.
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ELDER JUSTICE ACT: IMPROVEMENTS TO
DETECTING & PREVENTING ELDER ABUSE
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Nursing Homes:
1.
All nursing home staff now required to report suspicion of
crime – this includes nurse staff, all other employees,
owners & contractors. If serious bodily harm is suspected:
must report within two hours, if not within 24 hours. Big
fines (up to $200,000 or more) if failure to report.
2.
Law prohibits retaliation against someone for reporting – up
to $200,000 for retaliation.
U.S. Government will:
1.
Establish National Coordinating Council to coordinate elder
justice activities;
2.
Establish programs to improve LTC Ombudsman Programs
& training institute for nursing home inspectors; and
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3.
Help the states improve adult protective services.
HOME & COMMUNITY BASED CARE: IMPROVED
OPPORTUNITIES TO AVOID NURSING HOME PLACEMENT
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Traditionally, long term care was furnished almost entirely in
nursing homes. However, in recent years, more and more people
have been seeking long term care outside of the nursing home
setting. Home and community-based long-term services (HCBS)
refers to assistance with daily activities that generally helps people
to remain in their homes or in less institutional settings than a
traditional nursing home (such as assisted living).
The ACA helps states expand and improve their programs to help
people who need long term care avoid nursing homes and even helps
residents who can safely live outside of their nursing home get out.
These programs include: “Money Follows the Person,” “HCBS State
Plan Option Changes,” and “Community First Choice Option.”
Spousal impoverishment protections, which allow a spouse to keep
certain assets and income without affecting Medicaid eligibility for
the spouse needing HCBS, go into effect in 2014 for a five year period
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under current law.
MEDICARE PART D DRUG COVERAGE:
NEW AND ENHANCED BENEFITS TO IMPROVE
ACCESS TO CARE & MEDICATIONS
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Medicare Prescription Drug Coverage:
1.
2.
3.
2010: Part D enrollees whose spending reached the
coverage gap received a $250 rebate.
2011: Part D enrollees whose spending reaches the
coverage gap should receive a 50% discount from
drug manufacturers on name-brand drugs and
certain vaccines and other therapeutic products
covered through Part D. Subsidies on coinsurance
for generic drug prescriptions filled in the coverage
gap begin to be phased in.
2013: Federal subsidies on coinsurance for brandname drug prescriptions filled in the coverage gap
begin to be phased in.
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OTHER MEDICARE CHANGES:
IMPROVED ACCESS TO PREVENTATIVE SERVICES
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New Medicare enrollees now get free checkup;
Medicare Part B enrollees are eligible for a free yearly
wellness checkup intended to help identify and
manage potential health problems; and
Many preventative services now available for free for
eligible individuals, such as: cardiovascular screening,
breast cancer screening, cervical and vaginal cancer
screening, colorectal cancer screening, prostate cancer
screening, vaccinations, bone mass measurements,
diabetes screening, glaucoma tests and HIV
screening.
Individuals can go to www.MyMedicare.gov and
talk to their health care provider to determine
what services they might be eligible for.
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OCTOBER 2011 UPDATE: IMPACT ON MEDICARE OF
PRES. OBAMA’S DEFICIT REDUCTION PROPOSALS
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In September, President Obama proposed $320 billion
in savings over 10 years from changes to federal
spending on Medicare and Medicaid (including $248
billion in Medicare savings).
Positive: The President has threatened to veto any bill
that takes away Medicare benefits without an increase
in contributions from "the wealthiest Americans and
biggest corporations.”
Negative: The President’s proposal includes shifting
costs to Medicare beneficiaries by:
implementing co-payment for home health care;
 increasing Part B deductible for new beneficiaries;
 increasing number of people subject to income-based
Medicare Parts B and D premiums; and
 increasing costs of some Medigap policies.
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RESOURCES FOR HELP & MORE INFORMATION
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StateWide & LTCCC have developed briefs with more
information on what NY seniors need to know. Email
[email protected] to receive a copy of briefs on:
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Nursing Home Care
Home & Community Based Services
New Medicare Benefits
Elder Justice
Statewide Senior Action’s Patients Rights Helpline,
including information on accessing services and
benefits: call 800-333-4374 or go to www.nysenior.org.
Medicare Rights Center’s online database of Medicare
information: http://www.medicareinteractive.org/.
LTCCC homepage: www.ltccc.org.
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