H.R. 6561 could expand for-profit
carriers' ability to start Program All-Inclusive for the Elderly plans.
The House Ways and
Means Committee has endorsed H.R. 6561, a bill that could help private
companies use government money to provide long-term care for people who are
still living at home.
Members of the
committee agreed to support the bill at a meeting Thursday, by a voice vote.
President Donald
Trump’s team has blocked many of the regulations and regulation drafts
developed by the administration of former President Barack Obama.
H.R. 6561 — the
“Comprehensive Care for Seniors Act of 2018″ bill — would require Trump’s
secretary of the U.S. Department of Health and Human Services (HHS) to complete
work on one set of regulations drafted by Obama’s HHS: new rules for “Program of
All-Inclusive Care for the Elderly” (PACE) plans.
The National PACE
Association said in a tweet Friday that it expects H.R. 6561 to come up on the
House floor for a vote this week.
If the bill becomes
law and takes effect as written, it would require HHS to publish final PACE
regulations by Dec. 31.
PACE Background
Medicaid can
already pay for long-term care services in nursing homes for patients
who meet state income and asset requirements.
Medicare can pay
for home health care services for people who need long-term care, but,
traditionally, “Original Medicare” and Medicare Advantage plans have not paid
for the kinds of services that frail older people and older people with
disabilities may need to get through the day, such as help with shopping,
preparing food, cleaning their homes, and bathing.
A PACE plan can use
a patient’s Medicaid and Medicare money to provide soup-to-nuts care, including
personal care, chore services, home health care, dental care, podiatry
services, transportation to medical appointments, outpatient care, hospital
care, end-of-life care, and, when necessary, nursing home care.
Enrollees typically
have to agree to let a PACE plan’s care managers manage their care and supply
their providers.
Congress included a
provision letting PACE plans use Medicare funding in the Balanced Budget Act of
1997. Congress also put a provision in the same act that lets a state
decide whether to add PACE plans to its Medicaid program.
The requirements
for setting up PACE plans have been complicated. In the past, for example, HHS
has set up a small pilot program that let for-profit companies offer PACE
plans. In most cases, however, PACE plan operators have had to be nonprofit
organizations.
Today, 123
sponsoring organizations operate PACE centers in 31 states, according to the
National PACE Association.
The PACE plans now
in place serve only about 45,000 people — but the National PACE
Association says that only about 2,250 of those people live in nursing homes,
even though all 45,000 are eligible for nursing home benefits. The other 42,750
are still living in the community.
The Proposed
Regulations
The Obama
administration released a draft PACE regulation update in 2016.
The regulation
would fine-tune PACE plan compliance and staffing standards.
The regulation
would also set up an electronic HHS application process for organizations that
want to set up new PACE plans, and it would let for-profit entities set up PACE
plans.
Another provision
could prohibit a PACE plan from using outside agents or brokers to market the
plan, for fear that an outside agent or broker might misrepresent the nature of
the plan.
HHS and the Centers
for Medicare and Medicaid Services, the HHS division that oversees Medicare and
Medicaid plans, often change the draft versions of regulations when preparing
the final versions.
Existing PACE
Competitors
Shannon Schuster,
director of regulatory affairs at UnitedHealthcare, a unit of UnitedHealth
Group Inc., noted in a comment letter submitted in October 2016 that
UnitedHealthcare has been offering two other types of Medicare Advantage
plans that already serve people who are eligible for Medicaid nursing home
benefits: Medicare Advantage Institutional Special Needs Plans (ISNPs) and
Medicare Advantage Institutional Equivalent Special Needs Plans (IESNPs).
ISNPs are Medicare
Advantage plans for people in nursing homes.
IESNPs are Medicare
Advantage plans for people who need the equivalent of nursing home care but are
still in the community.
Schuster suggested
in the UnitedHealthcare letter that PACE plans tend to focus on providing
services through plan-owned adult day care centers, and that IESNPs may tend to
provide more and better in-home services.
“Not all
beneficiaries are willing to give up existing physician and provider relationships
to receive care from PACE center providers,” Schuster wrote.
“Because each model
serves distinct subsets of the frail elderly population, United believes that
the population as a whole is best served by ensuring that all three models
remain viable, attractive, and equally accessible,” Schuster wrote.
Schuster
acknowledged that PACE plans have been providing more non-medical support
services, such as dental care and transportation services.
That’s because of
CMS restrictions on Medicare Advantage plan benefits, Schuster said.
CMS should change
the benefits rules to let Medicare Advantage plans provide more types of
benefits, Schuster said.
Future PACE
Competitors
Seema Verma, the
administrator of the Centers for Medicare and Medicaid Services, is already
trying to improve Medicare Advantage plan providers’ ability to cover support
services.
Verma recently
reinterpreted Medicare Advantage program rules in a way that could let Medicare
Advantage plans add coverage for services such as transportation services and
homemaker services.
Congress has been
talking about making changes in Medicare statutes that could let Original
Medicare and Medicare Advantage plans provide more long-term care
services.
The H.R. 6561 Team
Bitter partisanship
has hurt efforts by members of Congress to improve acute health care programs
for people ages 19 to 64.
Republicans and
Democrats have been able to work together on several pieces of legislation
that have changed Medicare rules and benefits.
H.R. 6561 is an
example of a Medicare bill that has strong bipartisan support.
The bill was
introduced by Rep. Jackie Walorski, R-Ind. and now has 10 cosponsors.
The cosponsors who
have been supporting the bill since the bill was introduced, on July 26, are
Reps. Lynn Jenkins, R-Kan.; Earl Blumenauer, D-Ore.; Gus Bilirakis, R-Fla.; Judy
Chu, D-Calif.; Christopher Smith, R-N.J.; Ron Kind, R-Wis.; and Debbie Dingell,
D-Mich.
Resources
Links to
information about H.R. 6561, including a copy of the bill text, are available here.
The National PACE
Association has posted a summary of the proposed regulations and other
information about the proposed regulations here.
https://www.thinkadvisor.com/2018/09/09/medicaid-medicare-long-term-care-bill-moves-forwar/
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