Health Care Reform Passes; Numerous Provisions Affect Long-Term Care
Late Sunday night, the U.S. House of Representatives passed by a narrow margin the health care reform bill that the Senate had approved last Christmas Eve. President Barack Obama signed the measure into law Tuesday. The House also passed another bill making changes in the Senate bill, and a slightly different version of that “reconciliation” bill cleared the Senate today. For the most part, however, the Senate bill will remain in place after the reconciliation bill is finalized. While some aspects of health care reform have received a great deal of public attention, and other aspects have received attention in long-term care circles, the legislation is packed with literally hundreds of provisions that are not so well known. Many of these affect long-term care - both specific reimbursement and regulatory measures and general laws applying to long-term care providers as employers. Among the key long-term care related items are:

• Language reducing the Medicare SNF market basket by a “productivity adjustment” starting in Federal Fiscal Year 2012.
  
  
• An extension of the exceptions process for the Part B therapy caps through December 31, 2010.
  
  
• Provisions confirming implementation of the MDS 3.0 October 1, 2010, along with certain portions of RUGS IV (including the restrictions on concurrent therapy and counting services delivered in hospitals), but delaying the remainder of RUGS IV until October 1, 2011.
  
  
• Language calling for acute/post-acute bundling experiments in both Medicare and Medicaid.
  
  
• An exemption from Part D coinsurance for Assisted Living Waiver and other home and community based waiver beneficiaries.
  
  
• A requirement that MedPAC consider Medicaid as well as Medicare when performing its analyses of health care sector profitability.
  

AHCA has produced a high-level, 24 page summary of these and many other provisions affecting long-term care. In addition, AHCA has furnished a presentation on key parts of the health care reform legislation that apply to providers as employers. Over the upcoming months and years, we will be working to understand and educate members about the impact and details of health care reform. Many of the programs in the legislation will not take effect for some time, and many of them will have to be fleshed out by existing and new governmental agencies.