Long Term Commission Issues Final Report to Congress

On September 18, the Commission on Long-Term Care (the Commission) issued a Report to Congress providing recommendations for long-term care reform.  This follows a September 13 press release by five dissenting commissioners issuing alternative recommendations.  The following is a synopsis of the issues discussed relevant to Medicaid, Medicare and/or home and community-based services (HCBS).

Key Points

Rebalancing: The Commission, in its recommendations, is very pro-home care. It recommends that Congress provide incentives to states to give people more options of care for those who prefer to live in the community.  The Commission recommended that this care should be 1) the most integrated possible; 2) person-centered in nature; and 3) based on objective needs assessments.  To achieve these goals, the Commission advised that:

• CMS should prioritize access to HCBS when devising systems of care;
• Individuals and family caregivers should have sufficient information to “enable them to make informed choices between institutional and HCBS services”;
• CMS should streamline the Medicaid waiver process, specifically with regard to HCBS provisions;
• CMS should give states technical assistance to encourage rebalancing; and
• A study should be commissioned that analyzes cost savings resulting from: 1) increased access to HCBS; 2) more successful transitions into HCBS; and 3) fewer unnecessary admissions and readmissions into institutions

Quality: The Commission stressed the importance of quality measures in long-term care to promote quality and appropriateness of HCBS, specifically advising Congress to:

• Develop HCBS quality measurement tools; and
• Develop mechanisms and procedures for these tools

Payment Reform: The Commission recommended Medicare payment reforms, but did not mention Medicaid payment reforms.  Among the Medicare payment reforms is the elimination of the homebound requirement to qualify for home care benefits – a proposal long-supported by the National Association for Home Care & Hospice (NAHC)

Financing: The Commissioners did not agree on the proper approach to financing and thus did not make a recommendation.  They issued two alternative approaches of financing long-term services and supports (LTSS) reform: 1) via private options and 2) via a public, social insurance option.  The two public options were 1) creating a comprehensive Medicare LTSS benefit or 2) creating a basic LTSS benefit as part of Medicare Part A or in a new public program.

Workforce:  The Commission recommended the following with regard to the home care workforce:

• States should allow nurses to delegate/supervise some HCBS tasks to direct care workers – a provision long advocated by NAHC;
• Have national criminal background checks for all LTSS workers;
• Encourage states to develop certification for home care workers; and
• Have CMS explore the idea of national training standards for direct care workers, using Medicaid as an incentive.

To see the full Report, click here. 

To see a PowerPoint presentation of the Report, click here. 

For previous articles from NAHC’s Medicaid Council on each of the Commission’s four hearings, click here, here, here, and here. 

For a link to the Commission’s website, click here.

Upon release of the Commission’s Final Recommendations, NAHC’s President Val J. Halamandaris stated that:

“There are Commission recommendations that NAHC supports including reconsidering the requirement for receiving home health services under Medicare that the individual be ‘homebound,’ and promoting services for persons with functional limitations in the least restrictive setting appropriate to their need—building a system, including Medicaid, with options for people who would prefer to live in the community.”

To read NAHC’s statement on the Final Recommendations of the Commission, please click here.

Alternative Recommendations

On September 13, five of the Commissioners issued alternative recommendations to the Commission’s Report.  In the press release, these commissioners expressed concern that no meaningful LTSS reform can take place “without committing significant resources, instituting federal requirements, and developing social insurance financing.”  Specifically, these commissioners advocated strengthening Medicaid through extending and streamlining financial incentives for states for HCBS.  This would, in turn, aid in rebalancing.

To see the full press release, click here.

Analysis

Rebalancing: The National Council on Medicaid Home Care – a NAHC affiliate - welcomes the Commission’s emphasis on the need for rebalancing, as promoting HCBS over institutional care wherever possible and whenever it makes sense ethically, clinically, and financially.  For further reading on HCBS utilization among states, see the Council’s brief on Senator Harkin’s recent report to Congress entitled Separate and Unequal: States Fail to Fulfill the Community Living Promise of the Americans with Disabilities Act, here.  The Council also supports easing the bureaucratic burden of states looking to invest in HCBS, and to that end supports the streamlining of the Medicaid waiver process as proposed by the Commission.   

Additionally, the Council notes that while the Commission discussed the HCBS waitlists, citing that they currently comprise an estimated 500,000 people nationally, it did not propose recommendations to reduce and eventually eliminate these waitlists. 

For previous Council articles on the waitlists in Kansas, click here and here.

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