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How Will the New Healthcare Law Affect Long-Term Care?

By Laura Kuhn

It's been on your television and in your newspaper for months now and soon it'll be in your facility. It's the new healthcare law, better known to some as H.R. 3962.

Frankly, it was hard to keep track of what was and wasn't in the bill, and it definitely went through some drastic changes. So what's in the final law, and what will it mean for long-term care? Here are some of the highlights


The healthcare law enacts the Community Living Assistance Service and Supports (CLASS) Act, which creates a long-term care insurance program. Workers and adults can opt to pay into the program through voluntary payroll deductions. At this point, there is no specific start date for the collection of premiums.1

Filling the "donut hole"

Right now, Medicare Part D enrollees hit a gap in prescription drug coverage between $2,830 and $6,440 in total drug spending. The new law will close the donut hole completely by 2020, but beginning this year, seniors who hit the donut hole will be provided with a $250 rebate check to help offset their costs. Beginning in 2011, they'll receive a 50 percent discount on brand-name drugs and gradually increasing discounts on generic drugs.2

The market basket update

The Medicare market basket update for 2010 and 2011 for skilled nursing facilities was preserved. Beginning in 2012, a productivity adjustment that will cut the update by an estimated 1 percent will be applied.1

The home health market basket was also frozen for 2010, and the law accelerates regulatory changes that would further reduce Medicare home health reimbursement. In addition, CMS was directed to rebase the home health prospective payment system in 2011.3

Nursing Home Transparency and Improvement Act

The new law requires more disclosure of nursing home ownership and organizational structure. It also requires that nursing homes report their staffing levels using a format based on payroll data, including the use of contract/agency staff.4

The goal of these measures is to provide better resources and tools for enforcing quality standards in nursing facilities and encourage homes to improve on their own.5

The Elder Justice Act

The Elder Justice Act was signed into law as part of the healthcare reform legislation after a nearly decade-long fight for increased federal focus on elder abuse. The act provides for additional research, worker training for adult protective services (APS) and elder abuse forensic studies.6

The act also creates an Elder Justice Coordinating Council composed of government officials from all departments that handle elder abuse, neglect and exploitation. The council members will make recommendations to the Secretary of Health and Human Services on coordinating the work of the different agencies.7

In addition to the council described above, the act establishes an Advisory Board on Elder Abuse, Neglect and Exploitation that will be made up of 27 individuals who have expertise and experience in the areas of elder abuse, neglect and exploitation prevention, detection, treatment, intervention or prosecution. This board will develop plans for elder justice activities as well as best practices and consensus on improving quality and preventing abuse and neglect.7

The Patient Safety and Abuse Prevention Act

This act will expand an already-successful pilot program that created a national criminal background check system for employees in nursing homes and long-term care facilities. The majority of background checks are currently only being performed at the state level, which allows offenders to cross state lines without fear of their criminal history being revealed.6

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