Bill Overview
Title: Securing Access to Care for Seniors in Critical Condition Act of 2022
Description: This bill exempts discharges from long-term care hospitals from the Medicare site-neutral payment rate if the discharge meets specified high acuity criteria and occurs on or after October 1, 2025.
Sponsors: Rep. Hern, Kevin [R-OK-1]
Target Audience
Population: Seniors in critical condition benefiting from long-term care hospitals under Medicare
Estimated Size: 1400000
- The bill affects long-term care hospitals and specifically patients who are discharged from these facilities.
- Medicare is a U.S. federal health insurance program primarily targeting U.S. citizens aged 65 and older.
- The legislation specifically looks to impact severely ill seniors who are Medicare beneficiaries, suggesting it directly affects older adults in critical condition who require or receive long-term care.
- While the bill is specifically about U.S. Medicare payment rates, similar structures might also be noted and adapted in other countries, but this bill itself does not directly affect them.
Reasoning
- Given the specified budget and the targeted population size of approximately 1,400,000 seniors, each potentially benefiting member could receive an average allocation of funds over the first year and the next ten years.
- It is crucial to factor in that not every senior utilizing long-term care services will require a high-cost intervention each year, thus the policy is expected to allow for flexibility in budgeting per patient over time.
- This policy primarily affects older adults in high-acuity, critical condition, potentially also indirectly impacting their families and caregivers.
- As this policy is about payment adjustments rather than direct service provision, significant changes in well-being may relate more to financial relief rather than direct physical health improvements for many patients.
Simulated Interviews
Retired teacher (Miami, FL)
Age: 82 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I hope the policy can help make sure I get timely care when my condition worsens.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired engineer (Dallas, TX)
Age: 89 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- I've struggled to get adequate support that Medicare would cover; this could be a lifeline.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 1 |
Retired nurse (Seattle, WA)
Age: 75 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 7.0 years
Commonness: 11/20
Statement of Opinion:
- If payment rates change, I might receive more frequent therapy without added personal costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Retired lawyer (Boston, MA)
Age: 67 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- I'm hopeful this act will reduce the financial burden my family faces.
- It might mean more comprehensive care for my husband, who has Alzheimer's.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 2 |
Retired firefighter (Chicago, IL)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- Medicare needs changes; hopefully this helps kids like mine who worry about my health and costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Retired musician (New Orleans, LA)
Age: 91 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 4.0 years
Commonness: 7/20
Statement of Opinion:
- I hope this policy saves me from having to make difficult decisions about my care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 2 |
| Year 20 | 4 | 1 |
Veteran and retired contractor (Atlanta, GA)
Age: 78 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- I have seen friends stress over how Medicare covers hospital bills. This gives a little relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 2 |
| Year 10 | 4 | 1 |
| Year 20 | 3 | 1 |
Retired librarian (Phoenix, AZ)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I don’t fully understand how Medicare works, but I want to stay where I feel safe.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Retired professor (Boston, MA)
Age: 66 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 6.0 years
Commonness: 15/20
Statement of Opinion:
- I hope this act helps me get care faster without crippling expenses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 1 |
Former caregiver (San Francisco, CA)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 9.0 years
Commonness: 10/20
Statement of Opinion:
- If this helps me prevent more out-of-pocket costs for needed therapy, it's a huge help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Cost Estimates
Year 1: $4500000000 (Low: $4000000000, High: $5200000000)
Year 2: $4650000000 (Low: $4100000000, High: $5300000000)
Year 3: $4800000000 (Low: $4200000000, High: $5400000000)
Year 5: $4950000000 (Low: $4350000000, High: $5550000000)
Year 10: $5300000000 (Low: $4600000000, High: $5900000000)
Year 100: $8500000000 (Low: $7300000000, High: $9500000000)
Key Considerations
- The policy impacts Medicare's financial sustainability due to increased spending without clear offsets.
- It aids financially struggling long-term care hospitals by lifting a payment restriction.
- The policy impacts only high acuity cases identified under specific criteria, limiting its broad applicability.