Long Term Care + Health Care Reform

What amendment funded buildings for nursing homes

Hill-Burton Act

Supreme Court Olmstead decision

Promoted broader healthcare community based services coverage for people with disabilities, per ADA community integration mandate

Americans Act Caregiver Program

authorizes grants to states to fund a range of supports that assist family and informal caregivers to care for their loved ones at home

Affordable Care Act

provides new options to states under the medicaid program to incentivize the improvement of their LTC infrastructures

Who initiates the 5 star quality rating system

Centers for medicare and medicaid services

examples of long-term care

home health care, assisted living facilities, nursing home, skilled nursing facilities, rehabilitation hospitals, hospice care

home health care

wide range of healthcare services that can be given in home for illness or injury

less expensive and more convenient

Can be for acute or terminally ill

Maintains patient’s self-sufficiency

assisted living facilities

independent alternative for older adults who require minimal assistance with daily living and personal care

residents do not require the medical and nursing care that is provided in nursing homes

nursing homes

local or residential facility for individuals with a disability or chronic illness

applicable to those who are older (or disabled) not able to take care of themselves on their own

What is the difference between a profit vs non-profit nursing home

non profit costs are higher

non-profit quality may be higher

Problem may be more with the type of coverage

Ratings within the 5 star rating system

Health Inspections

Staffing

Quality Measures

+ 1 overall rating (total of 4 ratings)

what is a skilled nursing facility

severe deficiencies and require constant care

usually have rns or cna

meet the needs of individuals who have the potential of functioning independently after a limited time of care

what is a rehabilitation hospital

patients recover and be able to return to functioning independently

focus on different areas

sometime tailored to drug/alcohol recovery

hospice care

intended for terminally ill individuals

interprofessional team assists with coordination of care

hospice patients can receive care in their home or special faciltiies

Ga senate bill 291

Death with Dignity Act that allows for terminally ill individuals with a poor prognosis to create provisions for end-of-life options.

What are challenges of long term care?

Finance

Quality of Staff

Quantity of Staff

3 primary goals of the affordable care act

Make affordable health care available to more people

Expand medicaid

Support innovative medical care delivery methods designed to lower cost of health care

how long does insurance coverage for young adults go up to

26 years of age

What was the 2024 federal poverty level for a single individual

$15,060

what satisfies the individual mandate?

obtaining coverage through employer

purchasing an individual health insurance plan

gov’t sponsored coverage

what is the individual mandate

penalty for people who went without qualifying health coverage

who is exempt from individual mandate?

Religious objectors

Native Americans

incarcerated individuals

Undocumented immigrants

Those for who the lowest cost health plan is more than 8% of income

Those with incomes below the federal income tax filing threshold

Tax Cuts and Jobs Act

Amount of the individual shared responsibility payment is reduced to zero for months beginning after 12/31/2018

what type of marketplace is Ga

State-based marketplace

What is an employer mandate

>/= FTEs (full time employees) not offering coverage is liable for penalties

Tax credits are available for employers with </= 25 FTEs

medicare changes from the ACA

Elimination of the Part D donut hole (2025)

Freezing income threshold for Part B and Part D premiums

Establishing the CMS and Medicaid Innovation

Change in Part D in 2025

Annual deductible: Enrollee pays 100% of drug costs until they meet the deductible

Initial Coverage: Enrollee pays 25% coinsurance once out of pocket costs reach $2000

Catastrophic: Enrollee pays no cost-sharing for Part D covered drugs