Affordable Care Act Aging Network Opportunities Judy Baker Regional Director Health and Human Services October 18, 2010

Policy Trends Federal Policy shifts toward addressing Consumer Preference Choice-focused systems encouraged Olmstead Money Follows the Person HCBS and Medicaid Innovations

Trends in Aging and Disability Services Aging within the community is preferred to institutionalization Components to aging in place: – Health Care – Socialization – Mobility – Nutrition Planning for where and when people receive LTSS is important

Key Reforms that Address Consumer Preference CLASS Act – AAA’s will have opportunities for public outreach and education Incentives to States to create alternatives to nursing homes Opportunities for Demonstrations for new service delivery models Benefits that support care coordination (prevention coverage, health risk assessments, care transitions)

LONG-TERM CARE: An Overview Balancing Medicaid Prevention and Wellness Transitions Ensuring Quality The CLASS Act Source: NASUAD

Care Transitions Source: NASUAD

Aging Network Opportunities Source: NASUAD

Payment Reform Payment Delivery CMS Center for Innovation Medicare and Medicaid Demonstration Projects Temporary increase in Medicaid primary physician rates Source: NASUAD

Fighting Fraud Source: NASUAD

Aging Network Opportunities Grants for developing new evidence-based approaches to care transition Improving care by integrating Aging and Disability Resource Centers into the hospital discharge process. Improving care by integrating Aging and Disability Resource Centers into the hospital discharge process. Developing new partnerships among health systems, Medicaid, primary care physicians and managed care organizations. Developing new partnerships among health systems, Medicaid, primary care physicians and managed care organizations. Outreach and assistance to Medicare beneficiaries Integrating wellness and prevention programs into routine medical care Integrating wellness and prevention programs into routine medical care Options Counseling – a critical role for Aging and Disability Resource Centers

Medicaid Expansion States will be eligible for a larger federal match for Medicaid patients requiring long-term care and in- home services. The Community First Choice Program could expand Medicaid eligibility up to 150 percent of the poverty level.

Money Follows the Person The Money Follows the Person program, which helps people move from a facility to the community, is extended until The Money Follows the Person program, which helps people move from a facility to the community, is extended until Aging and Disability Resource Centers have the opportunity to expand. Aging and Disability Resource Centers have the opportunity to expand.

Aging Network Opportunities Prevention Prevention $100 million in grants to states to provide incentives for prevention of chronic disease. Coordination opportunity with health departments. Independent evaluation of Administration on Aging evidence-based disease prevention program. Improved collaboration between public health and health providers.

Aging Network Opportunities Single entry point access to comprehensive set of programs to support community living Collaborative, cross agency approach and public/private partnerships Single, coordinated systems of information, referral, and access to aging and disability long- term support services Benefits – Increased efficiency and information sharing among agencies – Comprehensive provider database, comprehensive client assessment and case management tool – Consistent Information and consumer friendly

Aging Network Opportunities Other opportunities: ● Creation of new forensic centers ● Culture change demonstrations ● Training for direct care workers

Funding Changes – ADRC’s Increased funding for ADRCs - $10 million a year for 5 years ($50 million total) Funding comes from mandatory side of the budget not discretionary side- “pre-paid for 5 years First round of funding was incorporated in AoA mega-grant for ADRCs to develop options counseling standards

Funding Changes - Medicare Part D Coverage and Enrollment Assistance Filling “donut hole” over next 10 years. Expanded Enrollment Period Expanded assistance for AAAs, SHIPs and ADRCs to provide counseling and enrollment assistance.($45 million- extends previous funding through MIPPA)

Funding Changes – Health and Wellness - Project 2020 Healthy Aging, Living Well ($50 million for CMS evaluation of AoA Evidence-based programs) Funding for Aging Network for CDSMP. Larger pot of health and wellness funds in CDC – to access AAAs need to partner with local health departments Medicare Benefit Educational Opportunities to inform beneficiaries about free annual physicals, colorectal screenings and mammograms.

Care Transitions Future CMS funding on evidence- based care transitions. Hospitals to be penalized for preventable hospital readmissions that occur within 30 days of discharge. AoA positioning the Aging Network to play role in care transitions via $2.5 million mega-grant. Growing interest in medical community of AAAs potential role in care transition work.

Elder Justice Elder Justice The elder justice portion of the ACA will: The elder justice portion of the ACA will: expand adult protective services expand adult protective services provide new funding to pay for nationwide criminal background checksprovide new funding to pay for nationwide criminal background checks provide funding for long-term care ombudsman programs.provide funding for long-term care ombudsman programs.

Elder Justice Act Nursing home transparency to identify owners/operators & hold them accountable Consumer information on nursing home staffing, sanctions & inspection reports to help compare facilities Improved training of long-term care ombudsmen & workers caring for patients with Alzheimer’s disease

The Affordable Care Act: What’s in it for the Aging Network ADRCs Medicare Part D “donut hole”/Enrollment Assistance Health and Wellness Care Transitions Health Home HCBS Expansion in Medicaid Protections for Vulnerable Elderly CLASS

ACA Will Require the Aging Network to …. Forge New Partnerships Develop Unit Costing of Services Price Services at Cost ++ Expand into Private Pay Contract with Service Providers in New Ways Expand Consumer-Directed Services Market themselves More Broadly