Now that health care reform has been passed into law, after more than a year of deliberations, we must position the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) to influence the regulations and legislative “fixes” that must occur. Before I get into the details, I want to underscore a few key points:

• Implementation of this historic health care reform law will be spread out over the next several years as new regulations are necessary to implement most provisions, which means we can still affect changes.
• We have a dedicated Health Care Reform webpage that provides exhaustive analysis, issue-based materials and a timeline of relevant effective dates – and will be updated regularly.

We are proud of the collective efforts of our members, affiliated businesses, and staff who worked tirelessly to advocate on behalf of our profession. Without you and your help, the final health care reform package would have exacted much more from our profession.

AHCA/NCAL’s Strategy for Next Steps

While the Patient Protection and Affordable Health Care Act is now the law of the land, it does not mean that health care reform is over. We are not seeking to repeal the law; but, will position ourselves to be at the table in order to shape the regulations required to implement these reforms.

As an immediate next step, we will divide up the major issues and establish work groups comprised of staff, committee members and appropriate consultants/counsel. These workgroups will outline our pressing concerns and provide suggested regulatory and legislative approaches.

Simultaneously, our legislative staff will advance “technical corrections” to address issues such as eliminating the delay in the RUGs IV system. We will also pursue a legislative agenda that addresses issues not included in health care reform – including a close look at Medicaid funding, and modernizing the Survey & Certification system.

What Does This Mean for AHCA/NCAL Members?

Many aspects of the new law may not be as bad as you fear.  It is important to remember that there is still much to be determined and clarified through the regulatory and rule making process, which means we can still affect change.

The employer insurance mandates included in the health care reform law seem to have triggered a great amount of member concerns. While many of the details are still to be determined through regulations, it is important to know that these provisions do not take effect until 2014. Initial review of AHCA/NCAL members indicates that many of you already provide health care coverage, which puts you in good stead when we look at these employer insurance mandates. Rather than try to oversimplify a complex issue, we will soon be offering comprehensive and easy to understand materials plus informational webinars.

We were able to reduce in half the $32 billion in Medicare cuts passed by the House, keeping cuts to $14.6 billion over ten years, and we delayed implementation until fiscal year 2012 (October 1, 2011). In other Medicare-related provisions, we also secured an extension in the Medicare Part B therapy cap exceptions process until December 31, 2010, and had language included which directs MedPAC to consider Medicaid when making recommendations for SNF Medicare updates. The law also creates a new Independent Medicare Advisory Board (IMAB) tasked with making recommendations to Congress on Medicare payment rates for providers including SNFs, which Congress will vote to approve or disapprove.

The House-passed health care reform bill included very draconian “transparency” provisions that would have added new and more civil monetary penalties (CMPs) for SNF infractions.  Ultimately, we succeeded in working with the Senate to ensure that the final transparency provisions were less onerous. Again, we will provide a full analysis with implementation dates, but some key points regarding transparency are as follows:

• Reporting of Additional Disclosable Parties: Within 2 years of enactment, HHS must issue final regulations that provide a standard format for the reporting of persons and entities related to the ownership and management of the facility, which we detail in our additional analysis.
• CMPs: Within the next year, CMPs may be significantly reduced for facilities that self-report and promptly correct deficiencies. Additionally, CMPs may be placed in an escrow account following completion of the informal dispute resolution process, or 90 days after the date of the imposition of the CMP.
• Quality Assurance and Improvement Program (QAPI): Prior to December 31, 2011, HHS will establish and implement a QAPI program for nursing homes.
• Nursing Home Compare: Within one year, HHS will expand the data on Nursing Home Compare to include more detailed staffing; links to state 2567s; summary information on the number, type, severity, and outcome of substantiated complaints; instances of criminal violations by employees; and more.
• GAO Report on Five Star: Under the law, GAO will evaluate how the Five Star Nursing Home Rating System is being implemented, problems associated with the system, and how it may be improved.
• National Independent Monitor Demonstration Project: HHS will establish a demonstration project to develop, test, and implement use of independent monitoring program to oversee interstate and large intrastate nursing facility chains. 

The law includes a significant victory for NCAL and for the low-income dual-eligible beneficiaries for whom NCAL has been advocating. The law eliminates the Medicare Part D co-pays for assisted living residents covered by Medicaid under Section 1115 or 1915 waivers or under a 1915(i) state plan amendment.

Several provisions in the health care reform law will help to address chronic workforce issues, including a demonstration project to provide further training opportunities for direct care workers employed in long term care settings.

Though the real-world impact is largely unknown, another provision that will impact long term care is the Community Living Assistance Services and Supports (CLASS) program. While the cash benefit of this program could be used to defray the costs of assisted living or nursing home care, we will watch this closely as it has potential to become another entitlement program.

Now What?

The information above reflects just some of the provisions that impact our members as health care professionals, employers, and taxpayers. Please be sure to visit our Health Care Reform webpage to view the ongoing updates and resources. While we have posted a considerable amount of information, I want to remind, and caution everyone that there is still so much left to be determined through regulation and the rule-making process. 

As always, we stand ready to assist you by providing resources and analysis that will help you to determine the implications of health care reform to you and your staff, patients, and families.