1. The Long-Term Care Imperative 2009 Legislative Agenda

2. Older Adult Services: A System in Transition
Adult Day
Services
Active Adult Commun-ities
Hospital/ Primary Care
Continuing Care
Retirement Communities
Transi-tional Care
Skilled Nursing
Facility
Home Care & Support
Services
Sub-Acute
Housing-with-
Services
Indepen-dent Living Units
Owner Occupied
Assisted
Living

3. The Facts Demand continues to shift and grow for a broad array of older adult services.
The Demographic Imperative Population of Minnesotans 85+ Projected to Increase 90% over 30 Years
# of HWS Units in Minnesota now Exceeds # of Nursing Home Beds by more than Double

4. The Facts
The total economic impact (direct and indirect) of nursing facilities, assisted living, and other residential care facilities in the State of Minnesota is more than $9.8 billion annually.
Source: Economic Impact of Long Term Care Facilities Prepared by the Lewin Group for the American Health Care Association.

5. Economic Impact of LTC Jobs Supported
Nursing facilities, assisted living and other residential care facilities directly support more than 142,000 jobs, including more than 87,000 health and social service jobs and more than 54,000 other jobs.
Source: Economic Impact of Long Term Care Facilities Prepared by the Lewin Group for the American Health Care Association.

6. Nursing Facility Expenditures and Wage Comparison
MN Hospitals vs. Nursing Facilities (2007 Wages)
Gap=$3.40 per hour or $7,072 per year
Gap=$1.63 per hour or $3,390 per year
Gap=$10.19 per hour or $21,195 per year
Sources: 2006 DHS Cost Reports, LTC Imperative Salary Survey, and most recent MN Health Care Cost Information Service Hospital Salary Data

7. 2009 Legislative Agenda
Provide a cost of living adjustment for ALL older adult service providers.
Includes all nursing facilities as well as home and community-based service providers for each year of the biennium.
Percentage based on SNF market basket. Current estimate is 2.91% (final percentage to be based on 4th Quarter Global Insight Health Care Cost Review should be similar).
Make permanent the 1% temporary nursing facility rate increase that took effect October 1, 2008.

8. Comparison of Care Center Rates vs. Costs
MN has the 4th Highest Projected Gap of 43 States in 2008
Source: Data from October 2008 Report Prepared By Eljay, llc for the American Health Care Association

9. 2009 Legislative Agenda
Continue nursing facility payment reform through consistent implementation of operating rate rebasing.
Eight-year phase-in of the operating rate rebasing passed in 2007.
Goal is to reduce the more than $20 per resident day difference between the average MA rate and the average cost of care.
Current statute puts off most rebasing until later years of the phase-in.
Smooth out rebasing phase-in schedule by adjusting rebased portion of the rate to increase an equal amount each year for eight years.
Support capital investment in nursing facilities.
Fund moratorium exceptions process at $3M for the biennium, which will leverage construction projects worth more than $200 million.

10. 2009 Legislative Agenda
Improve and streamline consumer access to home and community-based services.
Reduce fragmentation in the waiver-financed home care and assisted living programs by allowing consumers to receive all authorized services from a single provider.
Remove administrative barriers to the availability of sliding-scale, fee-supported home care in the Alternative Care program.
Prevent unnecessary admissions to skilled nursing facilities by reimbursing short-term incidental nursing services for community-dwelling seniors.

11. Options for Funding Older Adult Services
Allow for increased private contributions.
Allow for funding through local referendums for home and community-based infrastructure in various regions of the state.
Provide funding for employee health insurance across long-term care with existing funds earmarked for this purpose.
Improve long-term care services with funds available to the state from an increase in the federal Medicaid match percentage.

12. Long-Term Care Financing Reform
Principles
Personal responsibility and incentives for planning and saving for long-term care needs
Consumer choice and consumer empowerment
Pooled risk
Disability-based payments that bridge the current silos of disability and aging services programs
Support for informal care giving
Actions
Building across providers, business and citizen advocates for broad based solution(s) with legislation anticipated this year