Alzheimer's Foundation of America


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New Government Web Site Provides Information on Healthcare Changes and Choices

Q&A About New Health Reform Law: What Does Health Reform Mean for Individuals with Memory Concerns as well as Individuals with Alzheimer’s Disease and Related Dementias, and their Family Caregivers?

What does health reform do to improve care for individuals with multiple chronic conditions, including Alzheimer’s disease?
According to the Centers for Medicare & Medicaid Services (CMS), 95 percent of Medicare beneficiaries with Alzheimer’s disease have one or more other chronic conditions, such as coronary heart disease, congestive heart failure, diabetes and chronic obstructive pulmonary disease.  Studies have shown that home-based coordinated care for this population can reduce healthcare expenditures, improve quality of care and enhance health outcomes. The Independence at Home Act (IAH) demonstration program passed under health reform provides home-based coordinated care for high-cost Medicare beneficiaries with two or more chronic conditions. It is expected that this will help reduce emergency room visits and avoid hospitalizations, thereby freeing up needed hospital beds. In addition, health reform establishes a demonstration project, the Innovation Center at CMS that would test new models of coordinated care.


How does health reform benefit individuals with young onset Alzheimer’s disease (also known as early onset) or related dementias?
Within 90 days of enactment of health reform, people who have no insurance because of preexisting conditions will have immediate access to high-risk insurance pools. Within six months, insurers will no longer be able to deny people coverage when they get sick or impose lifetime caps on coverage. By 2014, health insurance companies will be barred from denying coverage to anyone with a preexisting condition.


How does health reform encourage prevention?
In the area of preventive health services, the law eliminates cost-sharing requirements for Medicare and Medicaid beneficiaries starting January 1, 2011. For example, the bill provides coverage under Medicare with no co-payment or deductible for an annual wellness visit that includes a comprehensive health risk assessment and a five- to 10-year personalized prevention plan. Additionally, screenings, such as for depression, and immunizations that the U.S. Secretary of Health and Human Services deems “essential” will be covered 100 percent. New private health insurance plans will be required to provide the same type of coverage within six months, and the provision will apply to all insurance plans starting in 2018. In addition, the law includes “detection of any cognitive impairment” in the new annual wellness exam for Medicare beneficiaries—a new and much-needed benefit for early identification of memory problems or Alzheimer’s disease and related dementias.


What does health reform do to address community-based long-term care?
Provisions from the Community Living Assistance Services and Supports (CLASS) Act included in health reform will enable Americans with functional disabilities to remain in their homes and communities.  By establishing a new disability insurance program financed through voluntary payroll deductions for adults who become unable to perform at least two activities of daily living, this provision will help adults who have or develop functional impairment to remain independent, employed, and residing and engaged in their communities. Following a five-year vesting period, the program will provide an individual with functional limitations a cash benefit of not less than an average of $50 per day to purchase nonmedical services and supports necessary to maintain independence, such as home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, nursing support, adult day services and integrated care within PACE (Program of All-Inclusive Care for the Elderly) programs.


What does health reform do to protect nursing home residents and to address elder abuse and neglect, especially in long-term care settings?
Marking the most significant improvements and changes in long-term care in a generation, provisions will increase transparency of nursing home operations and quality; improve the safety of people receiving care in long-term care facilities and their homes; and strengthen agencies that investigate neglect and abuse of the elderly, including the long-term care ombudsman program. The Nursing Home Transparency Act will require disclosure of the wide array of individuals and entities that own, operate and finance nursing homes, and it will require nursing homes to escrow fines if they appeal violations ; if the appeal is unsuccessful, some portion of the proceeds may be used to fund activities that benefit residents. It also will provide consumers ready access to information that is now unavailable or hard to obtain, such as accurate information about staffing levels and turnover rates, sanctions against facilities and inspection reports. It also requires pre-employment training in nursing home dementia care. The Patient Safety and Abuse Prevention Act calls for the creation of a national program of criminal background checks for persons seeking employment in nursing homes and other long-term care settings. The Elder Justice Act provisions will strengthen the network of agencies that investigate abuse and neglect in facilities and in the community, including improving the training of long-term care ombudsmen and state health inspectors, requiring reporting of neglect and abuse, and ensuring that residents are protected when nursing homes close.


What does health reform do to strengthen the geriatrics workforce?
In the coming years the number of individuals with Alzheimer’s disease and related dementias will increasingly outpace the number of healthcare providers with the knowledge and skills to adequately care for them. Inadequate training in geriatrics, chronic care management and long-term care leads to misdiagnoses, medication errors and poor care coordination—resulting in substandard care and higher costs. A direct care training provision in health reform provides much-needed funding over three years to establish new training opportunities for direct care workers who provide long-term care services and supports. In addition, geriatrics workforce provisions authorize funding to geriatric education centers to support training in geriatrics, chronic care management and long-term care for faculty in health professions schools and family caregivers; develop curricula and best practices in geriatrics; expand the geriatric career awards to advanced practice nurses, clinical social workers, pharmacists and psychologists; and establish traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing. As noted above, the Nursing Home Transparency Act requires pre-employment and ongoing training in nursing home dementia care.


How will health reform help families pay for medication?
Health reform provides assistance to Medicare beneficiaries in the “doughnut hole” or gap in prescription drug coverage. Beneficiaries whose initial benefits run out will receive a $250 rebate for both brand name drugs and biologics (drugs or vaccines made from a live product) in 2010 and a 50 percent discount on both brand name drugs and biologics purchased during the coverage gap beginning January 1, 2011. In subsequent years, coverage is extended to generic drugs. For Medicaid beneficiaries, health reform increases brand name drug rebates by 23 percent beginning immediately.


What does health reform do for individuals enrolled in clinical trials?
Health reform prohibits insurers from dropping coverage because an individual chooses to participate in a clinical trial and from denying coverage for routine care that insurers would otherwise cover just because an individual is enrolled in a clinical trial for the treatment of life-threatening diseases. The provision applies to all insurance products, including those offered in the Federal Employees Health Benefits Program, and to all clinical trials that involve life-threatening diseases.