The Patient Protection and Affordable Care Act of 2010 (PPACA) may now be on track to shake up the U.S. long-term care (LTC) system as well as the acute care system.
PPACA provisions dealing with acute care attracted most of the media attention this spring when the Supreme Court heard oral arguments on the constitutionality of the law.
But, when the court ruled 5-4 last week that Congress had the authority to impose a tax on people who fail to buy a minimum level of health insurance, it appeared to clear the way for implementation, at least for now, of many PPACA provisions that could affect Medicare and Medicaid payments for post-acute care services and federal funding for federal and state programs that serve older people and people with disabilities.
Republicans are continuing to fight PPACA in Congress and in lawsuits that have not yet reached the Supreme Court.
The U.S. Department of Health and Human Services (HHS) admitted in October 2011 that it had not been able to find a way to make the best known PPACA LTC program — the Community Living Assistance and Support Services (CLASS) Act program, a voluntary, worker-funded LTC benefits program — actuarially sustainable. HHS suspended efforts to implement that program.
But PPACA includes many other provisions that could affect LTC providers and LTC users.
One section, for example, PPACA Title II, Subtitle E, is supposed to create new state LTC options.
The section created a Community First Choice program in October. The program is supposed to allocate a total of $3.7 billion in funding by 2014 for states that provide attendant services for people with disabilities who are eligible for Medicaid and are living outside LTC facilities.
Subtitle E also is supposed to pay for state efforts to remove barriers to providing home and community-based services, and it is supposed to finance state efforts to expand state aging and disability resource center programs.
In June, the U.S. Department of Health and Human Services (HHS) posted a disability resource center grant application announcement.
PPACA Section 10202 is supposed to create $3 billion in incentives for states that offer home and community-based LTC services as an alternative to nursing home-based LTC services.
Other PPACA sections:
- Set new nursing home ownership disclosure requirements and skilling nursing facility performance requirements.
- Will require LTC hospitals, inpatient rehabilitation hospitals and hospice programs to report quality measures, starting with measures for bed sore rates and catheter-related urinary tract infections.
- Will require the government to improve its nursing home comparison website and make it easier for consumers to file complaints through the Web.
Although the court upheld the constitutionality of PPACA, the majority said Congress had no right to force states to expand their Medicaid programs by threatening to withhold existing Medicaid funding streams.