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Avalere Health Finds New Plan to Reform Medicare Post-Acute and Long Term Care System Could Save U.S. Approximately $35 Billion Over Ten Years
Date:4/21/2009

AL/Alliance Proposal." To view the report, visit www.ahca.org or www.aqnhc.org.

The key components of the AHCA/NCAL/Alliance plan are:

  • A voluntary, federal LTC benefit. A federal benefit covering LTC expenses would be available to those who commit a portion of their private funds, known as a personal responsibility amount (PRA), to LTC.
  • Greater consumer choice. People participating in the program would have greater choice of care settings and services, with expanded access to assisted living and other home-and-community-based services in addition to nursing facility care.
  • A standardized benefit built on a public-private partnership. Individuals with limited assets and incomes below 150% of the poverty line would qualify for the federal benefit without any PRA. For everyone else, the PRA amount would vary from $50,000 to $180,000 based on income and assets. Once individuals satisfy the PRA, the government pays all remaining care costs.
  • More effective care coordination. As part of the benefit package, care coordinators will assist in assessing an individual's needs and finding the right care at the right time, whether the individual needs long-term chronic care and supports or short-term post-acute care.
  • Evidence-based payment system for Post-Acute Care (PAC). The development of a new prospective payment system (PPS) for Medicare PAC services to enhance care coordination by basing payments primarily on patient need rather than the setting in which services are delivered.

"The health care reform goals articulated by President Obama and our congressional leaders - expanding
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SOURCE The Alliance for Quality Nursing Home Care
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