Getting LTC reform’s foot in the D.C. door

With the general election looming, organ-izations representing the long-term care community are working to create a political climate in Washington that will be as friendly as possible to their objectives and concerns. “If we have a debate on healthcare reform and it does not include a long-term care delivery system, our industry will be put at greater risk,” said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care (AQNHC). “Next year, we expect to have a major healthcare reform discussion regardless of who is president,” he predicted. “Neither Sen. Obama nor Sen. McCain have spoken to the post-acute and long-term care component. That is essential in view of the needs, particularly considering the funding challenges facing both Medicare and Medicaid.”

Thus, Rosenbloom said, the AQNHC and the American Health Care Association (AHCA) have together developed a legislative proposal intended to be a “starting point in the discussion.”

“We want to try to make sure that long-term care and post-acute care have a seat at the table when decisions are made,” he said. The key, of course, is to make sure that key principals of concern are addressed as the healthcare reform debate unfolds. Part of the “education” process needed to make that happen occurred at the Democratic and Republican national conventions this fall when representatives of the AQNHC, AHCA, and the National Center for Assisted Living (NCAL) participated in convention-related events and took every opportunity to discuss the importance of including long-term care issues within the overall healthcare reform debate.

AHCA and NCAL partnered with other health-related organizations to sponsor a town hall meeting at the Democratic convention in Denver and a similar event was staged at the GOP convention in Minneapolis. According to a media advisory from AHCA/NCAL, key messages offered during the discussions included the fact that “few Americans—whether they sit at their kitchen tables or hold a seat in Congress—think much about long-term care. They should.” Participants were told that most Americans will need long-term care services at some point in their life, and that each year more than 3 million rely on care provided in one of the nation’s nearly 16,000 nursing facilities and millions more depend on care and services offered by assisted living communities or in their own homes.

“While the demand for long-term care services is expected to more than double by 2040, we are struggling to recruit and retain a workforce that can meet the growing needs of our profession and our nation,” AHCA/NCAL said. “With nearly 80% of long-term care residents relying on Medicare or Medicaid to pay for the care they need, the pressure on federal and state government resources is even greater.” AHCA/NCAL said they hope to achieve “patient-centered, cost-effective, and sustainable long-term care that is part of our nation’s overall healthcare system and that cannot only meet today’s needs, but tomorrow’s expectations.”

While those are lofty goals that need to be considered as broad healthcare reform issues in the coming 111th Congress, there are some specific legislative concerns that key players in the industry want to address.

“How these general issues play out is critical,” said Rosenbloom. Both the AQNHC and AHCA/NCAL have political action committees (PACs) dedicated to supporting candidates for the House and Senate whom they believe will be supportive of the industry’s positions on key issues. AHCA/NCAL says its PAC “raises funds that will support candidates in the 2008 election cycle and beyond who seek to preserve access to long-term care for America’s seniors and people with disabilities.”

Rosenbloom said the Alliance’s PAC follows a “giving strategy that dovetails with our policy objectives to the extent that we can.” Contributions are made, regardless of party, he said, explaining that the goal is to support candidates and incumbents who will be sensitive to the long-term care needs of the nation. Some of the most important issues to be addressed by the new Congress when it convenes next January will include:

Medicare and Medicaid reimbursement. “This continues to be high on our priority list and we will watch it closely,” Rosenbloom said, noting that the Centers for Medicare & Medicaid Services (CMS) is expected in April to announce the results of a new study that will influence payment levels for skilled nursing facilities (SNFs). “It’s too soon to tell if this will be good news or bad news,” he added.

SNF disclosure requirements. Rosenbloom pointed out that Sens. Herbert Kohl (D-Wis.) and Chuck Grassley (R-Iowa) have sponsored legislation to broaden financial disclosure requirements for nursing homes that participate in Medicare and Medicaid. “We’ve been working with those senators on a possible compromise, and we expect to see this bill reintroduced next year,” Rosenbloom said.

False Claims Act Amendments. Also sponsored by Grassley, the bill would broaden the application of the False Claims Act, which imposes penalties on persons who knowingly present a false or fraudulent claim for government money or property for payment or approval. The measure, stemming from problems involving contractors in Iraq, could have “significant ramifications” for healthcare providers, according to Rosenbloom. “We’ve been working with other healthcare groups to leave application of this law exactly where it is now,” he said.

Arbitration legislation. AQNHC and AHCA/NCAL oppose the House-passed Fairness in Nursing Home Arbitration Act (H.R. 6126), which would prohibit predispute of arbitration agreements with residents of nursing facilities or assisted living residences. “The growing use of predispute agreements throughout the healthcare sector helps bring about more timely, less adversarial settlements,” said Bruce Yarwood, AHCA president and CEO, adding that the bill “needlessly discriminates against long-term care providers and the patients and residents in our nation’s nursing facilities and assisted living residences.” While the measure has passed the House, Rosenbloom does not believe there is time left before Congress adjourns for the elections to give it final approval and send it to the president. However, that issue will be back next year, he predicted.

Bob Gatty has covered governmental developments for the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, based in Sykesville, Maryland.

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Long-Term Living 2008 October;57(10):12-14

Topics: Advocacy , Articles