After hearing oral arguments this past March, the Supreme Court issued its decision on the Affordable Care Act last Thursday and upheld its constitutionality. The Court ruled that the ACA is upheld, including the individual mandate (as a tax), with the exception related to the federal government's power to terminate states' Medicaid funds (the Medicaid provision is limited but not invalidated). While it is a significant victory, the Consumer Voice wants to stress our concerns related to the Court's decision re: the Medicaid expansion provision. This ruling leaves millions of Americans who would have qualified for coverage under the Medicaid expansion provision at great risk. The provision remains intact but, with no penalties for the federal government to enforce for noncompliance, it is not likely states will comply. (For more information about this issue, go to NPR.) Furthermore, there will be much discussion about advancing programs using the tax code with some seeing this aspect as, "...a major blow to Congress's authority to pass social welfare laws." (Source: http://www.scotusblog.com/)

We at the National Consumer Voice for Quality Long-Term Care are generally happy with the high Court's decision as we ardently advocated on behalf of the law's passage and legalization, particularly for a number of provisions that provide transparency, access, accountability and quality for long-term care consumers.

The Consumer Voice has represented long-term care consumers and their families, citizen advocacy groups, long-term care ombudsmen, and other advocates for more than 37 years. The Affordable Care Act is the first comprehensive federal law in a generation to address the quality of care in nursing homes that receive Medicare and Medicaid funding. It is the first to make prevention of elder abuse a national priority. And by increasing access to home and community-based services, the ACA increases the potential that we will all have meaningful, quality choices in where and how we receive long-term care and services when we need them. 

We now urge the federal government to ramp up efforts to implement these important provisions for consumers.

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Join the Pioneer Network for a webinar in their three part webinar series on Integrating the MDS 3.0 Into Daily Practice. Webinar 8 “MDS and QAPI: A High Involvement Approach” will feature leads from the QAPI national demonstration discussing the new QAPI requirements being developed by CMS and tested at 17 nursing homes in four states. Also, the webinar will feature an MDS coordinator talking about the interplay between MDS and QAPI, and nursing home teams discussing how they used performance improvement projects (PIP) to foster staff engagement in individualizing care.

MDS and QAPI: A High Involvement Approach
Thursday, July 19, 2012
2:00pm EST

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The US Department of Health & Human Services Office of Inspector General performed a study of state home and community-based services (HCBS) waiver programs. States must operate their HCBS waiver programs in accordance with certain “assurances.” To meet these assurances, States must demonstrate that they have systems to effectively monitor the adequacy of service plans, the qualifications of providers, and the health and welfare of beneficiaries.

The report “Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs” describes the findings of the study. Out of 25 states reviewed, seven did not have adequate systems to ensure the quality of care provided to beneficiaries. These states did not correct these problems before or after renewal of their program.

The report recommended that CMS provide further guidance to States to help guarantee that they meet the assurances, require States that do not meet one or more assurances to develop plans to correct the problems, require at least one onsite visit before a waiver program is renewed, and make information about State compliance with the assurances available to the public.

Last week, Meredith Seife, a Deputy Regional Inspector General for the Office of Evaluation and Inspections in New York was interviewed about the report by Roberta Baskin, OIG Director of Media Communications in a podcast.

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On July 11, the Consumer Voice submitted comments to the Center for Medicaid and Medicare Services on proposed regulations for state plan home and community-based services (HCBS) and the definition of a home and community-based setting. We strongly supported the development of a definition of a home and community-based setting and pointed out that such a definition is particularly needed for provider-owned and controlled residential settings. Without a clear definition, Medicaid will continue to pay - as it is currently doing - for services in some settings that are just as institutional as a nursing facility. The Consumer Voice also provided input on other areas such as independent evaluation and assessment, person-centered service plans, provider qualifications, and self-directed services. 

To read the full set of comments, go to the Consumer Voice website.

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