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| No. 101 | 
Nov 12, 2009, 02:26 AM
Updated
Nov 12, 2009 at 03:02 AM by NRSKarenRN
 Re: HR 3962 Has Passed the House. Originally Posted by VickyRN  Question for NRSKarenRN - Do you know what sorts of long-term care coverage are included in HR 3962? Is coverage for nursing homes included and other types of LTC, such as assisted living? Subtitle C—Standards Guaranteeing Access to Essential Benefits4 SEC. 221. COVERAGE OF ESSENTIAL BENEFITS PACKAGE. (b) MINIMUM SERVICES TO BE COVERED.—Subject
23 to subsection (d), the items and services described in this
24 subsection are the following:
25 (1) Hospitalization.
1 (2) Outpatient hospital and outpatient clinic
2 services, including emergency department services.
3 (3) Professional services of physicians and other
4 health professionals.
5 (4) Such services, equipment, and supplies inci6
dent to the services of a physician’s or a health pro7
fessional’s delivery of care in institutional settings,
8 physician offices, patients’ homes or place of resi9
dence, or other settings, as appropriate.
10 (5) Prescription drugs.
11 (6) Rehabilitative and habilitative services.
12 (7) Mental health and substance use disorder
13 services, including behavioral health treatments.
14 (8) Preventive services, including those services
15 recommended with a grade of A or B by the Task
16 Force on Clinical Preventive Services and those vac17
cines recommended for use by the Director of the
18 Centers for Disease Control and Prevention.
19 (9) Maternity care.
20 (10) Well-baby and well-child care and oral
21 health, vision, and hearing services, equipment, and
22 supplies for children under 21 years of age.
23 (11) Durable medical equipment, prosthetics,
24 orthotics and related supplies.
See DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS
Nothing in bill specifically states "long term care coverage" except that rehabilitative care be covered under standard benefits--this should include SNF sub acute rehab care. Medicare program will continue with same benefit coverage paying for SNF under Medicare Part A plan.
Specific language about SNF focus on transparency: who owns facility, ethics and compliance programs, quality improvement program required, publish staffing info in facility and on Medicare compare website, and increasing payment 10% for non-therapy ancillary services.
Assisted living coverage not mentioned. However, Pg 1562 under section
Subtitle D—Community Living
Assistance Services and Supports
SEC. 2581. ESTABLISHMENT OF NATIONAL VOLUNTARY INSURANCE PROGRAM FOR PURCHASING COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORT (CLASS PROGRAM). ‘‘(1) LIFE INDEPENDENCE ACCOUNT.—
15 ‘‘(A) IN GENERAL.—The Secretary shall
16 establish procedures for administering the pro17
vision of benefits to eligible beneficiaries under
18 the CLASS Independence Benefit Plan, includ19
ing the payment of the cash benefit for the ben20
eficiary into a Life Independence Account es21
tablished by the Secretary on behalf of each eli22
gible beneficiary.
23 ‘‘(B) USE OF CASH BENEFITS.—Cash ben24
efits paid into a Life Independence Account of
25 an eligible beneficiary shall be used to purchase
1 nonmedical services and supports that the bene2
ficiary needs to maintain his or her independ3
ence at home or in another residential setting
4 of their choice in the community, including (but
5 not limited to) home modifications, assistive
6 technology, accessible transportation, home7
maker services, respite care, personal assistance
8 services, home care aides, and nursing support. Monies mentioned are $50.00/day @ 350/wk x 4= $1,400 --- which would barely meet fee of a few assisted living facilities in Philly suburbs. Would need problems in 2-6 areas of activities of daily living (ADL) to qualify...  | | No. 102 |
Nov 12, 2009, 03:37 AM
Re: HR 3962 Has Passed the House.
Thank you! This is very helpful. LTC expenses are going to become such an issue in the future with the aging Boomers. I am surprised this bill did not address LTC (except for skilled nursing, which is already covered under Medicare) and the "voluntary" insurance program (which we already have in private LTC insurance coverage). I wonder if this "voluntary" program will specifically cover nursing home expenses or if elders will still need to "spend down" their assets in order to qualify for Medicaid coverage?
| | No. 103 |
Nov 12, 2009, 08:48 AM
Re: HR 3962 Has Passed the House. Originally Posted by Medic2RN I agree Kolohe!! 
It isn't Timmy. He is busy running for public office.
I have a friend who is an internet junkie in his spare time - he does a lot of research for folks.
Both sides have folks like this - who look for ammo for their arguments. I just happened upon him by accident and he is funny as heck.
I can't tell you who he is . . . If I told you, I'd have to kill you. 
steph
| | No. 104 |
Nov 12, 2009, 08:51 AM
Re: HR 3962 Has Passed the House. Originally Posted by VickyRN Thank you! This is very helpful. LTC expenses are going to become such an issue in the future with the aging Boomers. I am surprised this bill did not address LTC (except for skilled nursing, which is already covered under Medicare) and the "voluntary" insurance program (which we already have in private LTC insurance coverage). I wonder if this "voluntary" program will specifically cover nursing home expenses or if elders will still need to "spend down" their assets in order to qualify for Medicaid coverage?
I know I sound like a meanie . . . . . but I think elders should have to "spend down" their assets or use their assets to pay for their medical care.
I see this all the time - hiding of assets in order to get coverage. That's illegal. And immoral.
steph
| | No. 105 |
Nov 12, 2009, 09:42 AM
Re: HR 3962 Has Passed the House. Originally Posted by Spidey's mom It isn't Timmy. He is busy running for public office.
I have a friend who is an internet junkie in his spare time - he does a lot of research for folks.
Both sides have folks like this - who look for ammo for their arguments. I just happened upon him by accident and he is funny as heck.
I can't tell you who he is . . . If I told you, I'd have to kill you.
steph
LOL....I want to know where not WHO....kill me. You're so funny. 
You can't do that Spidey...haha....I'm a HEAVILY armed woman!!
<Kolohe...It means guns...I know you'd try to turn that into a big arm joke> | | No. 106 |
Nov 12, 2009, 01:54 PM
Re: HR 3962 Has Passed the House. Originally Posted by Medic2RN LOL....I want to know where not WHO....kill me. You're so funny.
You can't do that Spidey...haha....I'm a HEAVILY armed woman!!
<Kolohe...It means guns...I know you'd try to turn that into a big arm joke>
Hey, me too. Heavily armed I mean. 
Kolohe . . . leave it alone.
steph
| | No. 107 |
Nov 12, 2009, 03:37 PM
Updated
Nov 13, 2009 at 11:06 PM by NRSKarenRN
Re: HR 3962 Has Passed the House. Originally Posted by Spidey's mom I know I sound like a meanie . . . . . but I think elders should have to "spend down" their assets or use their assets to pay for their medical care.
I see this all the time - hiding of assets in order to get coverage. That's illegal. And immoral.
steph
Totally agree with you re spending down assets prior to government assistance provided. I often have long and hard conversations with patients and their families re house that only the parent is residing in but incapable of living alone due to dementia/stroke/ bedbound, needs to be sold to pay for parents ongoing care "but daddy wanted me to get the house". Well your options are to move into his home; move dad into childrens home; hire 24hour care givers "that won't work, I work full time". Otherwise ALF or nursing home care is private pay when only custodial care needed. If no long term savings, then house will be sold or lean placed against property as part of estate recovery when using Medicaid funds.
| | No. 108 |
Nov 13, 2009, 05:10 AM
Re: HR 3962 Has Passed the House.
This is an excellent resource on long-term care insurance.
Among the current generation of elderly, about one-half of all older women and one-third of all older men will spend some time in a long-term care facility (either skilled nursing or intermediate care) during their lifetimes. Such care can be extremely expensive. A Shopper's Guide to Long Term Care Insurance |
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