Some birthday! The Affordable Care Act was two years old March 23, the eve of three days of Supreme Court arguments over whether some of it, or all of it, should be struck down. The court cases primarily involve whether Congress has the constitutional authority to require everyone to have health insurance and to expand participation in Medicaid; but the justices also heard arguments on whether—if they strike down those key provisions--they should also invalidate the whole statute.

If the court decides to kill the entire law, what would happen to its new protections for nursing home residents and expansion of home and community-based services? CMS officials say they have discussed the prospect of the law’s repeal but won’t talk about it publicly.

The ACA was the vehicle for passing a backlog of health and long-term care-related bills in 2010, including the Nursing Home Transparency and Improvement Act, the Elder Justice Act, and parts of several bills to expand the availability of home and community-based care. These provisions are in various states of completion. For example, CMS has made several changes to Nursing Home Compare and is preparing to post others this summer—around the time the Supreme Court decision is expected.

Other completed or nearly completed programs and requirements include:

•             Nurse aide training in dementia care and abuse prevention;

•             Criminal background checks on workers under a program now being implemented in 17 states;

•             60-day notification and preparation for voluntary nursing home closures;

•             Mandatory reporting of suspected crimes in long-term care facilities; and

•             Escrow of civil monetary penalties, after an independent review, when nursing homes appeal deficiencies. 

Meanwhile, the House passed a new “Ryan Budget” that would repeal the ACA, cut federal Medicaid spending by 22 percent over the next decade, and turn Medicaid into a block grant. The Center on Budget and Policy Priorities noted that funding levels would not keep pace with health care inflation or the increase in elderly beneficiaries and thus would fall “further behind need with each passing year.” Historically, Medicaid block grant proposals have also reduced or eliminated protections in federal law, including the Nursing Home Reform Act. For more information, see Ryan Medicaid Block Grant Would Cut Medicaid by One-Third by 2022 and More After That.

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The Senate sent a letter requesting additional funding for Older Americans Act (OAA) programs. The letter stressed that OAA programs are imperative during difficult economic times. “There are now 40 million Americans over the age of 65, or approximately 13% of the total US population… The fastest growing segment of the aging population is individuals over 85. These are the most vulnerable older adults, who most tend to need the long-term services, supports and protection from abuse, neglect and financial exploitation that are provided under the OAA.” The Senators requested that OAA programs’ funding levels increase to reflect the demand and costs for the services they provide.

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The webcast is now available for Alliance for Health Reform’s March 27^th webinar, Implementing Health Reform in the States. The webinar offered an update on what’s happening in the states with implementation of the health reform law passed in Congress in 2010. For example, states have a lot of leeway in how they set up health insurance exchanges, where uninsured individuals and small business will be able to buy coverage starting in 2014. The law provides for Medicaid expansions that will bring an estimated 16 million additional Americans under the Medicaid umbrella. The webinar addressed if states will aggressively promote the program to these newly eligible individuals and what would happen if the Supreme Court rules that the Medicaid expansion is unconstitutional after hearing arguments on this subject.

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The National Consumer Law Center (NCLC) is holding a webinar on April 11^th entitled “Abuse in Later Life: Responses, Resources, Collaborations.” This webinar will provide an introduction for aging advocates to domestic violence and sexual assault services and resources available for older victims, including screening, safety planning, legal and social service responses, and community collaborations.

Abuse in Later Life: Responses, Resources, Collaborations
Wednesday, April 11, 2012
2:00pm-3:30pm EST

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Donald Berwick, who headed the Centers for Medicare & Medicaid Services for a year-and-a-half, will become a Senior Fellow at the Center for American Progress (CAP), a liberal think tank in Washington. During his short tenure as administrator at CMS, Berwick met with the Consumer Voice and other advocates about the widespread abuse of antipsychotic drugs in nursing homes and immediately called on the long-term care pharmacy and nursing home industries and his CMS staff to develop action plans to stop their misuse. The CMS campaign was launched last week.  See the Consumer Voice’s news release.

Berwick’s confirmation fell victim to political controversy over health care reform and his appointment as permanent administrator was blocked by Senate Republicans. He stepped down last December. CAP announced that Berwick “will focus on defending health care reform, ensuring its successful implementation, and developing new ideas to provide better care at lower costs.”

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The California Department of Public Health’s (DPH) Antipsychotic Drug Collaborative has issued its first citation and monetary fine against a nursing home for illegally drugging residents with chemical restraints. The citation, carrying a $1000 fine, was issued against Briarwood Health Care, a nursing home in Sacramento.

California Advocates for Nursing Home Reform (CANHR) recently published a report about the Collaborative’s findings. CANHR was critical of the Collaborative’s enforcement efforts, partially because it ignored federal law in the investigations and because no fines were issued to any of the flagged nursing homes. The citation against Briarwood is a first on both accounts.

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Join Friday Morning Collaborative for a webinar on Friday, April 13^th – Managed Long-Term Services and Supports: Overview of Key Issues and Guiding Principles.   This webinar will provide information about state’s programs in Medicaid managed long-term services and supports.

Managed Long-Term Services and Supports: Overview of Key Issues and Guiding Principles
Friday, April 13, 2012
2:00pm-3:30pm EST

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Join the National Center on Elder Abuse (NCEA) for a webinar on April 9^th – The NCEA in Conversation with the Field. This webinar, presented by the co-directors of the NCEA, will outline the NCEA’s short-term and long-term goals and provide information on how to get involved with World Elder Abuse Awareness Day (June 15).

The NCEA in Conversation with the Field
Monday, April 9, 2012
2:00pm-2:45pm EST

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Florida State Ombudsman Jim Crochet recently published an op-ed piece in the South Florida Sun-Sentinel. The piece highlighted the lack of eviction protections for ALF residents. 

“Florida law currently allows an ALF administrator to relocate or terminate a resident from an ALF for almost any reason, as long as the administrator provides the resident with 45 days notice and documents the reason. ALF residents cannot challenge their evictions in court. Although many residents have advanced care needs, similar to residents of nursing homes, they lack a process for an appeal of an involuntary discharge…. Florida needs to pass legislation providing basic due process to ALF residents, including the ability to challenge a proposed relocation in a neutral forum and require that a 45-day written notice be handed to the resident.”

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