March 25, 2010, 11:53 AM
Attached is a summary of the law passed (in March 2010) prepared for the Asbury Communities which George Tjiattas sent me. It is shorter and clearer than the material I sent earlier. This is very complex legislation that is now being explained more clearly in the media, but we can all use more information. Sarah Hughes
Medicare
Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
Market basket freeze for second, third and fourth quarters of fiscal 2010 for skilled nursing facilities
Market basket freeze for 2010 for home health care, and accelerates regulatory changes that would further reduce Medicare home health reimbursement. Calls for a MedPAC study on home health care provider margins.
Improves accuracy of Medicare skilled nursing facility prospective payment system reimbursement for non-therapy ancillaries such as prescription drugs.
Delays cuts in Medicare hospice reimbursement for another year.
Directs CMS to develop a plan within three years for bundling Medicare payments for post-acute care. Converts an existing demonstration project to a pilot program and authorizes the program to include bundling of payments to hospitals and post-acute care providers as of January 1, 2011.
Requires nursing facilities to operate ethics and compliance programs within three years of enactment.
Requires posting of information on Nursing Home Compare regarding staffing and summaries of complaints made against a facility.
Requires skilled nursing facilities to break out their expenditures on direct care separately on Medicare cost reports [a provision AAHSA initiated and strongly favors].
Establishes a national criminal background check requirement for nursing home employees with direct access to residents.
Requires nursing facilities to train employees in dementia care and abuse prevention.
Increased penalties for Medicare fraud. Requires providers to adopt compliance programs to reduce waste, fraud and abuse. .
Extends the increased federal Medicaid match provided under the economic stimulus package for another six months, through June, 2011.
Medicaid:
Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
Market basket freeze for second, third and fourth quarters of fiscal 2010 for skilled nursing facilities
Market basket freeze for 2010 for home health care, and accelerates regulatory changes that would further reduce Medicare home health reimbursement. Calls for a MedPAC study on home health care provider margins.
Improves accuracy of Medicare skilled nursing facility prospective payment system reimbursement for non-therapy ancillaries such as prescription drugs.
Delays cuts in Medicare hospice reimbursement for another year.
Directs CMS to develop a plan within three years for bundling Medicare payments for post-acute care. Converts an existing demonstration project to a pilot program and authorizes the program to include bundling of payments to hospitals and post-acute care providers as of January 1, 2011.
Requires nursing facilities to operate ethics and compliance programs within three years of enactment.
Requires posting of information on Nursing Home Compare regarding staffing and summaries of complaints made against a facility.
Requires skilled nursing facilities to break out their expenditures on direct care separately on Medicare cost reports [a provision AAHSA initiated and strongly favors].
Establishes a national criminal background check requirement for nursing home employees with direct access to residents.
Requires nursing facilities to train employees in dementia care and abuse prevention.
Increased penalties for Medicare fraud. Requires providers to adopt compliance programs to reduce waste, fraud and abuse. .
Extends the increased federal Medicaid match provided under the economic stimulus package for another six months, through June, 2011.
Medicaid:
Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
Requires states to expand Medicaid to include childless adults starting in 2014.
Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
Illegal immigrants are not eligible for Medicaid.
Health Insurance:
Requires states to expand Medicaid to include childless adults starting in 2014.
Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
Illegal immigrants are not eligible for Medicaid.
Health Insurance:
Six months after enactment, insurance companies could no longer deny children coverage based on a preexisting condition.
Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
Insurance companies must allow children to stay on their parent's insurance plans through age 26.
Auto-enrollment of new hires for employers with 200 or more full-time equivalent employees, an opt out system.
Maximum of 90 day waiting period. Increasing wellness incentives to 30% of premium.
Paying for the Plan:
Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
Insurance companies must allow children to stay on their parent's insurance plans through age 26.
Auto-enrollment of new hires for employers with 200 or more full-time equivalent employees, an opt out system.
Maximum of 90 day waiting period. Increasing wellness incentives to 30% of premium.
Paying for the Plan:
Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).
Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
Tanning Tax -- 10 percent excise tax on indoor tanning services.
Pay an excise tax on high cost coverage exceeding $10,200 for singles and $27,500 for families. A higher threshold, $11,850 and $30,950, is set for retirees and employees in certain high-risk professions. (Slated to take effect in 2013, this excise tax would be delayed to 2018 by the reconciliation bill).
W-2 reporting of health coverage beginning in 2011
Other details:
Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
Tanning Tax -- 10 percent excise tax on indoor tanning services.
Pay an excise tax on high cost coverage exceeding $10,200 for singles and $27,500 for families. A higher threshold, $11,850 and $30,950, is set for retirees and employees in certain high-risk professions. (Slated to take effect in 2013, this excise tax would be delayed to 2018 by the reconciliation bill).
W-2 reporting of health coverage beginning in 2011
Other details:
Long term care provision for sick or aging family members currently included in health care bill may not stay in.
The CLASS ACT -- short for 'Community Living Assistance Services and Support' would allow people to collect daily cash benefits of about $50 to $70 a day to pay for home care, adult day programs or nursing homes after paying premiums for five years. The goal is offer a voluntary long term care alternative to Medicaid and private nursing home insurance.
The health care legislation incorporates several bills including the Nursing Home Transparency and Improvement Act, the Elder Justice Act, and the Patient Safety and Abuse Prevention Act. These are described below:
The CLASS ACT -- short for 'Community Living Assistance Services and Support' would allow people to collect daily cash benefits of about $50 to $70 a day to pay for home care, adult day programs or nursing homes after paying premiums for five years. The goal is offer a voluntary long term care alternative to Medicaid and private nursing home insurance.
The health care legislation incorporates several bills including the Nursing Home Transparency and Improvement Act, the Elder Justice Act, and the Patient Safety and Abuse Prevention Act. These are described below:
The Nursing Home Transparency and Improvement Act will require disclosure of the wide array of individuals and entities that own, operate, and finance nursing homes, and it will require nursing homes to escrow fines if they appeal violations.
The Elder Justice Act will provide training of long-term care ombudsmen and the capacity of other public agencies to investigate neglect and abuse.
The Patient Safety and Abuse Prevention Act provides for a national program of criminal background checks on workers who provide long-term care services in facilities and private homes.
The Elder Justice Act will provide training of long-term care ombudsmen and the capacity of other public agencies to investigate neglect and abuse.
The Patient Safety and Abuse Prevention Act provides for a national program of criminal background checks on workers who provide long-term care services in facilities and private homes.