Workforce Provisions in ACA
Summary of Key EWA Priorities in the Patient Protection and Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (ACA), signed into law by President Obama, represents a major step forward for the Eldercare Workforce Alliance (EWA), with numerous key provisions that reflect EWA’s goals of addressing the workforce crisis in caring for an aging America. The new law addresses many of EWA’s priorities, including:
- Strengthening the direct-care workforce
- Addressing clinician and faculty shortages
- Re-designing health care delivery
EWA will work in support of appropriate and timely implementation of the workforce provisions within the health care reform law and continue to advocate for measures which strengthen and expand the health care workforce to meet the complex health care needs of older Americans.
The following summary highlights these new workforce and long-term care provisions:
GERIATRICS HEALTH PROFESSIONS EDUCATION AND TRAINING
Title V, Subtitle D, Sec. 5305 (pp. 504-507)
- Expands Eligibility for Geriatric Academic Career Awards to a variety of new disciplines to include additional disciplines beyond physicians. Makes a technical fix that allows the Award to be paid to the Institution rather than to the Awardee. This amends Title VII of the Public Health Service Act.
- Authorizes a new Geriatric Career Incentive Awards Program for grants to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management. ($10 million over 3 years) This amends Title VIII of the Public Health Service Act. Effective 2011-2013.
- Authorizes $10.8 million in Supplemental Grants to Geriatric Education Centers (Title VII) to support training in geriatrics, chronic care management, and long-term care for faculty in a broad array of health professions schools, and direct care workers and family caregivers. Geriatric Education Centers receiving these grants are required to develop and offer training courses to family caregivers and direct care providers at no charge or minimal cost or incorporate mental health and dementia “best practices” training into their courses. This amends Title VII of the Public Health Services Act. Effective 2011-2014.
TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS
(Title V, Subtitle D, Sec. 5302)
- Authorizes $10 million over three years to establish advanced training opportunities, e.g., tuition support for obtaining a nursing degree or specialized training, for new and incumbent direct care workers (certified nurse aides, home health aides and personal/home care aides). Once training is complete, the trainees must work in the field of geriatrics, long-term care or chronic care management for at least 2 years. This amends Title VII of the Public Health Service Act. Effective from 2011 – 2013.
DIRECT CARE WORKER DEMONSTRATION FOR PERSONAL AND HOME CARE AIDES
Title V, Subtitle D, Sec 5507 (pp. 545-550)
- Provides $85 million per year in mandatory funding for three years to conduct a Medicaid demonstration in up to six states for development of training programs for personal and home care aides. Of the appropriated dollars, no more than $5 million per year for 3 years (FY 2010 -2012) allowed for personal and home care aide demonstrations. Establishes a national panel of long-term care workforce experts to develop the core competencies for these training programs and to make recommendations on how such training could be provided. Requires the Secretary to conduct an evaluation of the demonstration and report recommendations to Congress. Effective from 2010 – 2014.
NATIONAL HEALTH CARE WORKFORCE COMMISSION & ASSESSMENT
Title V, Subtitle B, Sec 5101 (pp. 474-481)
- National Health Care Workforce Commission (pp. 474-481) Establishes a National Health Care Workforce Commission that serves as a national resource and develops and commissions evaluations of education and training activities to determine whether the demand for health care workers is being met (among other things). Appointments made by September 30, 2010. The commission shall include no less than one representative of the health care workforce and health professionals. The commission shall: 1) review current and projected health care workforce supply and demand; 2) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies; 3) submit a yearly report to Congress and the Administration containing the results of such reviews and recommendations; and 4) submit a yearly report to Congress and the Administration on, at a minimum, one high priority area. High priority areas include topics such as integrated health care workforce planning; an analysis of the nature, scopes of practice, and demand for health care workers in the enhanced information technology and management workplace; and the education and training capacity, projected demands.
- Health Care Workforce Assessment (pp. 485-488) Codifies the existing National Center for Health Care Workforce Analysis, and establishes several regional centers for health workforce analysis. The centers will coordinate with State and local agencies collecting labor and workforce statistical information and coordinate and provide analyses and reports on Title VII to the Commission.
CARE COORDINATION DEMONSTRATION GRANTS
- Independence at Home Demonstration Program
Title III, Subtitle A, Part III, (pp. 286-290)
Sec 3024 creates a new chronic care demonstration program for chronically ill Medicare beneficiaries to test a payment incentive and service delivery system that utilizes physician and nurse practitioner directed home-based primary care teams aimed at reducing expenditures and improving health outcomes. Interdisciplinary teams would be eligible for shared-savings if they achieve quality outcomes, cost savings and patient satisfaction. The Secretary of HHS will determine what dollar amounts are necessary for the demonstration. Effective January 2012 for up to three years.
HOME AND COMMUNITY BASED SERVICES
Title VIII, Sec 8002 (pp. 710-729)
- Community Living Assistance Services and Supports (CLASS ACT)
Establishes a new, voluntary, self-funded public LTC insurance program for the purchase of community living assistance services and supports by individuals with functional limitations: and provides cash benefit that is not less than an average of $50 per day. No taxpayer funds will be used to pay benefits under this provision. Effective January 2011.
- Establishes a Personal Care Attendants Workforce Advisory Council (within the CLASS ACT) (pp. 726-729) for the purpose of examining and advising the Secretary and Congress on workforce issues related to personal care attendant workers, with respect to the adequacy of the number of such workers, the salaries, wages, and benefits of such workers, and access to the services provided by such workers. (Amends Public Health Service Act – adds Title XXXII, Sec 3210 (c)). Effective January 2011.