Discussion Topic-
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Chapter11PPTnotes.pptxChapter 11
Long-Term Care
Reimbursement
Learning Objectives
Understand how long-term care services are reimbursed
Identify and define public sources of reimbursement
Identify and define private sources of reimbursement
Learning Objectives (continued)
4. Understand how managed care works and its impact on long-term care
5. Understand the trends affecting long-term care reimbursement
Long-Term Care System Development
Little government involvement until welfare (Social Security) in 1935
Major involvement with Medicare and Medicaid in 1965
Has evolved since then
Current Reimbursement Options
Government (public) sources:
Medicare
Medicaid
Other
Private sources:
Out-of-pocket payments
Private long-term care insurance
Managed care organizations
Public/private partnerships
Medicare
Title XVIII of the Social Security Act
Covers elderly and some disabled
No means test
Covers (with some limitations):
Skilled nursing in nursing facilities and subacute care
Home health care
Hospice
© 2010 Jones nd Bartlett Publishers, LLC
Medicaid
Title XIX of the Social Security Act
Covers “medically indigent”
Funded partly by federal and partly by state governments
Run by the states under federal guidelines
Covers (depending on the state’s program):
Nursing care facilities
Assisted living
Home health care
Medicaid (continued)
State efforts to reduce costs:
Divert funds to less expensive forms of care (community-based)
“Spend-down” requirements
May be greatly expanded by the Affordable Care Act
Other Public Funding Sources
Supplemental Security Income program
Department of Veterans Affairs
Older Americans Act
Others
Private Reimbursement Sources
Out-of-pocket payments
Private long-term care insurance
Public/private partnership programs
Managed care
Public/Private Partnerships
Robert Wood Johnson Foundation demonstration projects
Provide incentives for consumers to provide some long-term care coverage in return for asset protection
2006 legislation to create nationwide program
Managed Care
Impact on long-term care
Types of MCO/provider arrangements
Making the transition to managed care
Managed care’s tarnished image
Trends in Reimbursement
Growth of private managed care
Growth of public managed care
Prospective payment
Emphasis on community-based care
Incentives for purchase of private
LTC insurance
Liability costs and tort reform
Financing Reform
Much talk, not much action until 2010
Passing of the ACA
Long-term care is not a high priority
Hard to define
Would be very expensive
Summary
Long-term care provider organizations are reimbursed by a combination of public and private organizations and agencies. Reimbursement is fragmented and varies by type of provider.
