The Affordable Care Act: What Seniors Need To Know About Long Term Care & Elder Justice

1. 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.

2. 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: • actually made improvements to many existing programs and • combined several existing bills which increased protections and transparency.

3. Nursing Home Care: Improvements to Quality, Transparency & Accountability • Every nursing home will have to: • Meet new quality assurance & performance improvement standards; • Implement a program to detect and prevent civil & criminal violations. • NY State will have to: • Develop a standardized complaint form; • Develop a complaint resolution process. • U.S. Government will have to: • Establish a program for background checks of nursing home employees; • Oversee use of fines to improve resident care.

4. Elder Justice Act: Improvements to Detecting & Preventing Elder Abuse • Nursing Homes: • 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. • Law prohibits retaliation against someone for reporting – up to $200,000 for retaliation. • U.S. Government will: • Establish National Coordinating Council to coordinate elder justice activities; • Establish programs to improve LTC Ombudsman Programs & training institute for nursing home inspectors; and • Help the states improve adult protective services.

5. Home & Community Based Care: Improved Opportunities to Avoid Nursing Home Placement • 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 under current law.

6. Medicare Part D Drug Coverage: New and Enhanced Benefits to Improve Access to Care & Medications • Medicare Prescription Drug Coverage: • 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 brand-name drug prescriptions filled in the coverage gap begin to be phased in.

7. Other Medicare Changes:Improved Access to Preventative Services • 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.

8. October 2011 Update: Impact on Medicare of Pres. Obama’s Deficit Reduction Proposals • 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.

9. Resources for Help & More Information • StateWide & LTCCC have developed briefs with more information on what NY seniors need to know. Email info@ltccc.org to receive a copy of briefs on: • 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.