The Congressional Budget Office has estimated that a legislative proposal for a disability insurance program would save $59 billion between 2010 and 2019. Also, if implemented, this program would lead to savings of $2.5 billion for the Medicaid program over that period, the public analysis agency said late last week.  

The program, which is known as the Community Living Assistance Services and Supports (CLASS) Act, would allow workers to pay a monthly average of $65 into an "Independence Fund." The fund, in turn, would offer a payout of $50 a day for those who no longer can perform at least two activities of daily living. People would have to be vested in the program for five years to receive the cash benefit. The program is a part of the Affordable Health Choices Act, a bill proposed by the Senate Committee for Health, Education, Labor and Pensions (HELP). A preliminary CBO estimate has placed the cost of the universal healthcare portion of this bill at $1 trillion over 10 years.  

In response to the scoring, the American Association of Homes and Services for the Aging, which helped craft the legislation, Friday released the following statement:  

"The scoring issued today by the Congressional Budget Office on Section 191 of the Affordable Health Choices Act proves that our country can create a national insurance trust for long-term services and supports that is affordable for average Americans and does not drain government resources."

In a background call about the scoring held Friday, a senior democratic adviser on the HELP committee noted that the program is intended to work in tandem with long-term care insurance products, and not act as a replacement for them.

"This is not about competing with the industry. It's about gloving with them," she said.

The 10-year cost projection by the CBO is based on the knowledge that, while premium collections would begin in 2011, no one would be receiving benefits until 2016. Also, it is based on an assumption that premiums are set on average at $65 a month. But to be actuarially sound, the CBO said that premiums would have to exceed the average dollar amount of $65 set by the legislation by $35 to $45.

The adviser on the call noted that the legislation allows for the secretary of the Department of Health and Human Services to change the premium and also to project solvency for the program based on the previous year, and over a two-year, 50-year, and 75-year outlook. If she determines that it would not be solvent, she could stop enrollment. Two populations would only have to pay $5 premiums: those whose incomes do not exceed the poverty line, and students.   

In response to a caller who asked how Medicaid could save $2.5 billion over 10 years, the adviser said she guessed it would be because the program would be the payer of first resort to Medicaid. Those who are impoverished and on Medicaid would pay into the program and thus receive cash from the disability program first.

CMS nursing home guidance focuses on resident quality of life, environment and choice

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The Centers for Medicare & Medicaid Services on Friday issued new guidance for nursing home surveyors emphasizing the importance of resident quality of life and homelike environments.

Nursing home surveys conducted after June 12 will include a heightened focus on areas such as care and service choices, creating a homelike environment, resident dignity and accommodating environmental needs and preferences, according to CMS. This new guidance is intended to support current efforts to create more homelike nursing facilities and focus on resident-centered care, CMS Acting Administrator Charlene Frizzera said.

CMS also seeks to deinstitutionalize nursing homes through the removal of certain technology and mechanisms associated with institutional environments. Overhead paging systems, alarms and large nursing stations, as well as meals served on institutional trays should be eliminated, according to the guidance. Facilities should also pay close attention to a resident's preference for his or her own daily schedule, CMS says.

More information about the new guidance can be found online at http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf.

U.S. Supreme Court lets law nullifying nursing home pre-admission arbitration agreements stand

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By refusing to review an Illinois appellate court ruling, the U.S. Supreme Court has tacitly agreed that a state law nullifying nursing home arbitration agreements supersedes the Federal Arbitration Act, which favors arbitration agreements, according to a Bureau of National Affairs report.

In the case of SSC Odin Operating Co. v. Carter, Sue Carter originally sued SSC Odin Operating Co. over the alleged wrongful death of Joyce Gott, a former resident of Odin Healthcare Center in Odin, IL. According to a state appellate court ruling, two provisions of the Illinois Nursing Home Care Act prohibit the facility from enforcing an arbitration agreement signed by Gott at the time of her admission. Most notably, the NHCA provisions apply to all contracts involving nursing home residents, not just arbitration clauses, and therefore can be applied to the arbitration agreement signed by Gott, the Appellate Court of Illinois ruled.

The nursing home operator argued that the Federal Arbitration Act should overrule any state law governing arbitration agreements, especially in light of the fact that the NHCA applies to nursing home contracts in a broad and more generalized way, rather than specifically singling out arbitration agreements. The Appellate Court of Illinois, however, shot down that argument in April 2008, saying instead that it is because the NHCA applies so generally to all nursing home contracts that it can be applied in this case. The Illinois Supreme Court refused to review the decision in October of last year. With its June 1 rejection of the case, the U.S. Supreme Court has let the lower court's ruling stand, thereby setting a precedent under which other states' laws might trump the Federal Arbitration Act.

MRSA thriving among one-quarter of nursing home residents, study results show

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Nearly one in every four nursing home residents has been colonized by methicillin-resistant Staphylococcus aureus (MRSA), according to a recently published report from Queen's University Belfast.

After taking samples from 1,111 residents and 553 staff members at 45 nursing homes in Ireland, researchers discovered that roughly 24% of residents and 7% of staff carry the tough-to-treat disease. According to report authors, 24% is the median rate of colonization, with individual nursing home results running the gamut: three nursing homes were entirely free of MRSA, while at least one had a 73% rate of resident colonization. Similarly, staff members at only 28 of the nursing homes that were tested were found to carry the disease; the highest rate of colonization was 28%.

In the first week of 2009, the Department of Health and Human Services released infection control guidelines designed to stem the spread of certain hospital-acquired infections, including MRSA (McKnight's, 1/8). The Queen's University Belfast report appears in the latest issue of the Journal of the American Geriatric Society.

Sebelius: New nurse, home health aide surveys designed to increase worker satisfaction

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The recently released Department of Health and Human Services survey of long-term care nursing assistants (CNAs), and a forthcoming survey of home health workers, reflects the department's commitment to the needs of the long-term care workforce, Secretary Kathleen Sebelius says.

HHS has been conducting these surveys in an effort to increase job satisfaction and recruitment, and reduce turnover rates in the long-term care industry, Sebelius says. Sebelius called CNAs and home health workers "the backbone of our long-term care system" in a letter to the editor published in Monday's Washington Post.

The results of the recently released CNA survey show that more than half of CNAs working in nursing homes were injured on the job last year, and that many are unable to afford employer sponsored healthcare. HHS is "wrapping up" the survey of home health aides, Sebelius said, though she did not give a release date

AAHSA report: Americans think healthcare reform should include long-term care

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Most Americans believe that long-term care services and supports should be a part of any upcoming healthcare reform, according to the results of a new survey from the American Association of Homes and Services for the Aging.

A total of 85% of those surveyed said that long-term care services and supports should be included in reform. More than half said that no healthcare reform package would be complete without them, the AAHSA report said. The results of the survey show that age, gender, region and income are not factors in this debate. Large majorities in all demographics endorse long-term care supports and services. A mere 13% said those services and supports should not be covered. The Mellman Group conducted the survey on behalf of AAHSA.

"These results prove once again that Americans do not draw the artificial line between acute care and long-term services and supports that policy makers use to exclude long-term services and supports from health care reform discussions," said AAHSA CEO Larry Minnix.