Michigan LTC Conference: People' Partnerships, Possibilities

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Michigan LTC ConferencePeople. Partnerships,
Possibilities

• Susan Nedza, M.D., MBA
• Chief Medical Officer
• Region V-Centers for Medicare Medicaid Services
• US Department of Health Human Services
• March 23-24, 2006

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CMS Accomplishments

• The Disabled and Elderly Health Programs Group
  (DEHPG) under the Center for Medicaid and State
  Operations provides national leadership for the
  design of financially sound Medicaid programs.
• DEHPG assists States in developing programs that
  support individuals of all ages and foster
• long term care and pharmacy services
• full participation in community life and
  independent living and
• economic self-sufficiency, and recovery.

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GUIDING PRINCIPLES

• DEHPGs guiding principles in delineating
  strategic plan goals are to ensure
• State flexibility
• Accountability (program and personal)
• Individual choice

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2006 DEHPG Strategic Action Plan

• Vision To transform the provision of Medicaid
  services to support individual choices and
  preferences.

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2006 Strategic Action Plan

• GOAL 1. ACCESS VIA PARTNERSHIPS
• Obj. A Increase the support for and
  understanding of program changes by engaging
  stakeholders in developing policy.
• Obj. B. Increase beneficiaries access to the
  Part D Medicare Prescription Drug benefit through
  working with States to wrap-around and support
  efforts to implement the Medicare Modernization
  Act (MMA).

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2006 Strategic Action Plan

• GOAL 2 INNOVATION FLEXIBILITY
• Obj. A Increase beneficiaries access to
  services and service options through problem
  solving and solution finding with States which
  results in program innovations and flexibility.
• Obj. B Increase support for State efforts to
  manage costs while ensuring programs operate in a
  manner consistent with law and regulations.

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2006 Strategic Action Plan

• Goal 3 CHOICE
• Assist beneficiaries lead better lives by
  advancing policies and programs that facilitate
  individual choice and control, and promote
  community living.

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2006 Strategic Action Plan

• Goal 4 QUALITY- Improve the quality of services
  beneficiaries receive by better defining and
  advancing quality principles for our programs.
• Obj. A Build States capacity for using quality
  elements and measures in order to continuously
  improve each of our programs. 
• Obj. B Improve responsiveness to States through
  increasing administrative efficiency and ensuring
  consistent program guidance and oversight.

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CMS Quality and Efficiency Agenda

• Vision To transform the healthcare system.

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CMS Definition of Quality

• The right care for every person every time. (at
  the right place?)
• This is a move from paying for what is medically
  necessary to appropriate.
• What is appropriateness?
• Includes cost in the equation
• Timing
• Location
• Who will be paid

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Medicare Value Based Purchasing

• The movement to pay for performance in all
  sectors is accelerating
• Quality measurement will increasingly be tied to
  payment
• Efficient provision of services will be rewarded.

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Value Based Purchasing

• Quality- at the patient level
• Efficiency- at the system level
• Integration for payment for quality strategies
  across the continuum of care
• LTC will be affected both actively and passively
  by all of these initiatives

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Nursing Home Pay for Performance Demonstration

• Hospital-based and freestanding facilities
• Incentive payments on level of performance and
  improvement over time
• Objectives
• Promote quality
• Facilitate sharing of best practices
• Provide info to guide policy development

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Potential Performance Measures

• MDS-based
• Outcomes from state survey inspections
• Staffing and stability
• Rate of Avoidable hospitalizations
• Others
• Process of care
• Quality of life
• Resident satisfaction

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Deficit Reduction Act of 2005
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DRA

• By 2030, spending for Medicare, Medicaid, and
  Social Security alone will be almost 60 percent
  of the entire Federal budget.
• The annual growth of entitlement programs needs
  to be slowed to affordable levels, but these
  programs do not need to be cut.
• Reforms that can reduce the annual growth of
  mandatory spending such as the Deficit Reduction
  Act can save taxpayers nearly 40 billion over
  the next five years .

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DRA

• The Deficit Reduction Act, together with the
  Medicare Act of 2003, require wealthier seniors
  to pay higher premiums for their Medicare
  coverage.

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DRA

• The DRA helps restrain Medicaid spending by
  reducing Federal overpayment for Rx drugs
• The bill also gives governors more flexibility to
  design Medicaid benefits that efficiently and
  affordably meet their states' needs, tightens
  loopholes that have allowed individuals to
  transferring assets to their children so they can
  qualify for Medicaid benefits.

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DRA- Chapter 2 LTC Under Medicaid

• Subchapter A Reform of Asset Transfer Rules -
  changes the start date for the period of
  ineligibility for Medicaid LTC services, as
  proposed in the Presidents Budget.
• This chapter curtail abuses in Medicaid LTC by
• lengthening the look-back period to 60 months
• disqualifying individuals w/home equity over
  500K
• Imposing partial months of ineligibility
• allowing states to accumulate multiple transfers
  into one penalty period

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DRA- Chapter 2 LTC Under Medicaid

• Sec. 6011. Lengthening look-back period change
  in beginning date for period of ineligibility
• This provision lengthens the look-back period
  from 36 months to 60 months.
• The look-back period is the amount of time for
  which states are required to determine whether an
  individual transferred or gifted assets for less
  than fair market value.
• Gifting or transferring assets for less than fair
  market value is one way individuals spend down to
  become Medicaid eligible for long-term care.

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DRA- Chapter 2 LTC Under Medicaid

• Sec. 6012. Disclosure and treatment of annuities-
  
• this provision requires states to make Medicaid
  LTC services contingent upon applicants
  disclosing a description of any interest the
  individual or community spouse has in an annuity
  regardless of whether the annuity is irrevocable
  or is treated as an asset.

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DRA- Chapter 2 LTC Under Medicaid

• Sec. 6014. Disqualification for long-term care
  assistance for individuals with substantial home
  equity
• Individuals shall not be eligible for LTC
  assistance if the individuals equity interest in
  the individuals home exceeds 500K.
• The State may elect to change the 500K home
  equity limit to any amount up to 750K.
• The Secretary is to establish a process where
  this requirement is waived in cases of
  demonstrated hardship.

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DRA- Chapter 2 LTC Under Medicaid

• Sec. 6021. Expansion of State Long-Term Care
  Partnership Program
• The LTC Partnership program is currently
  operational in four states California,
  Connecticut, Indiana and New York.
• More than 180,000 long-term care insurance
  policies have been purchased in those states, and
  it is estimated that through these Partnerships,
  approximately 30 million of assets have been
  protected. The Partnership benefits consumers,
  Medicaid and private insurers.

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DRA- Chapter 6

• This Chapter includes the Family Opportunity Act,
  the Money Follows the Person Rebalancing
  Demonstration and other misc. provisions.
• The Family Opportunity Act- permits families with
  disabled children to buy into Medicaid, create
  demonstration grants for community-based
  alternatives to psychiatric residential treatment
  facilities for individuals under the age of 21,
  and restores Medicaid eligibility for certain SSI
  beneficiaries.

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DRA- Chapter 6

• This Chapter includes the Family Opportunity Act,
  the Money Follows the Person Rebalancing
  Demonstration
• The Money Follows the Person (MFP) rebalancing
  demonstration provides the Secretary with the
  authority to award competitive grants to States
  to pay for a period of 1 year an MFP-enhanced
  FMAP rate for the provision of HCBS to
  individuals who transition from institutional
  long-term settings to home or community-based
  settings of their choice.

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DRA- Chapter 6

• This Chapter includes the Family Opportunity Act,
  the Money Follows the Person Rebalancing
  Demonstration and other misc. provisions.
• Other provisions to assist the disabled in
  receiving care in the community include a state
  option for expanded access to home and
  community-based services for the elderly and
  disabled and
• a state option for self-directed personal
  assistance services (cash and counseling).

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DRA- Chapter 6

• Subchapter C Miscellaneous
• Sec. 6086. Expanded access to home and
  community-based services (HCBS) Acting through
  the Director of the Agency for Healthcare
  Research and Quality (AHRQ), the Secretary shall
  develop program performance indicators and
  measures of client satisfaction for home and
  community based services offered under State
  Medicaid programs.
• The Secretary shall use the indicators to assess
  the outcomes of such services offered and make
  best practices publicly available. The provision
  makes 1 million available for the period of
  FY06-FY10 for research on HCBS quality.

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Conclusion

• Medicaid Reform will continue to affect the long
  term care industry
• Increasingly, value based purchasing will become
  more prevalent
• The Deficit Reduction Act will slow the growth in
  Medicaid expenditures.

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THANK YOU!