[March 30, 2015]

SCAN Health Plan Endorses Legislation Aimed at Keeping Older Americans at Home, Rather Than in Nursing Homes, to Receive Care

SCAN Health Plan today strongly endorsed a new piece of bipartisan legislation that would allow older Americans to receive the individualized care they need in the comfort of their own homes rather than going to a nursing home. The legislation was introduced earlier this month by Sen. Chuck Grassley of Iowa and Sen. Ben Cardin of Maryland.

Presently the federal government does not pay for long-term services and support unless an individual is on Medicaid. The Grassley-Cardin bill would establish a new Community-Based Institutional Special Needs Plan (CBI-SNP) demonstration program that would target home- and community-based services for low-income, Medicare-only beneficiaries who need help with two or more activities of daily living, the usual criteria for nursing home eligibility. The goal is to prevent these Americans from having to enter an institution and spend down their remaining assets, thereby becoming eligible for Medicaid.

"Finding a way to help low-income, chronically ill Medicare beneficiaries remain in their homes and avoid institutionalization is not only what most people want but potentially will save Medicare and Medicaid millions of dollars," said Chris Wing, CEO of SCAN Health Plan. SCAN, which has served the Medicare and dual-eligible populations for more than three decades, is one of 14 organizations that comprise the Coalition to Promote Medicare Independence that ha been urging legislators to include a CBI-SNP demonstration in any future legislation that addresses Medicare reform or Medicare physician payment updates.

In December 2013 the Senate Finance Committee unanimously passed legislation that created a CBI-SNP, on a demonstration basis, in five states for three years. Under Grassley-Cardin the new demonstration would operate in up to five states initially, building on Medicare Advantage plans that have experience caring for this frail population. The plans would tailor services to beneficiaries, depending on individual needs. For instance, they might provide assistance with bathing or dressing, housekeeping or transportation, or even respite care for their primary caregiver.

Grassley and Cardin said the legislation will give hope to some of the nation's most vulnerable individuals and at the same time offer a path toward state and federal budget savings. A recent study from Avalere Health estimates that continuation of the CBI-SNP demonstration would result in a four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization.

"Sen. Cardin was right on the mark when he said that this community-based approach gives seniors the support and dignity they deserve and is a commonsense alternative to costly institutionalization," said Wing. "That is why we joined with the coalition in strongly advocating for this measure and why we urge others to show their support for what Sen. Grassley rightly calls a bridge for those who need care but otherwise would have to go to a nursing home to get it."

The bill will be assigned to the Finance Committee, with jurisdiction over Medicare and Medicaid, where Grassley and Cardin are members. Grassley is former chairman.

SCAN Health Plan is one of the nation's largest not-for-profit Medicare Advantage plans currently serving nearly 170,000 members in California and Arizona. For more information on SCAN visit scanhealthplan.com or facebook.com/scanhealthplan.

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