Medicare and Medicaid are passed as amendments to the SSA. Medicare’s focus is on acute care only and does not provide for long-term care (LTC). Under this legislation, the federal and state governments become the largest payers for LTC: nursing home utilization increases dramatically, along with government expenditures.
Dame Cicely Saunders establishes the first modern hospice: St. Christopher’s, in a London suburb.
Dr. Elisabeth Kubler-Ross writes abook, On Death and Dying, based on interviews with dying patients. In the best-selling book, Kubler-Ross calls for patient choice and advocates for home care as opposed to treatment in an institution.
Connecticut Hospice in Branford, Connecticut becomes the first modern hospice founded in the U.S.
SSA amendments create Title XX, which consolidate the federal assistance to states for social services into a single grant. Under Title XX states are required to prevent or reduce in appropriate institutional care by providing for home and community-based services (HCBS).
A U.S. Department of Health, Education, and Welfare task force reports that “the hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As such, it is the proper subject of federal support.”
The U.S. Department of Health and Human Services’ (HHS) National Long-Term Care Channeling Demonstration to test quality and cost-effectiveness of HCBS for frail seniors is implemented. It runs through 1986.
HCBS waiver program is enacted under Section 1915(c) of the SSA, allowing states to offer home and community-based services that are not strictly medical in nature through Medicaid as an alternative to institutional care.
The National Association for Home Care & Hospice (NAHC) is founded in April, with the goal of making the home the center of American health care.
Established under the Tax Equity and Fiscal Responsibility Act, the Katie Beckett Medicaid state plan option permits states to cover children with disabilities living in the community; previously, these children were eligible for Medicaid only if institutionalized.
President Reagan signs Medicare Hospice Benefit into law, covering care for 80%-85% of hospice beneficiaries.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA ‘85”) makes the hospice benefit permanent.
Congress creates the U.S. Bipartisan Commission on Comprehensive Health Care to recommend legislative action on health and long-term care. The Commission is renamed the Pepper Commission in honor of its creator and first chair, Representative Claude Pepper (D-FL).
Americans with Disabilities Act (ADA) enacted. The Act emphasizes the importance of integrating people with disabilities into the community and ending exclusion and segregation.
The Pepper Commission report on LTSS financing options includes recommendations for an initiative to establish government or social insurance to keep resources intact for people with severe disabilities at home or with the potential to return home after a short nursing home stay. The recommendations are never enacted.
Hospice is included as a nationally guaranteed benefit under President Clinton’s health care reform proposal. Clinton HealthCare Plan includes plans to expand HCBS; improve Medicaid coverage for institutional care; and establish minimum standards to improve the quality of private insurance for LTC and tax incentives to encourage its purchase. The plan is never enacted.
The growing end-of-life movement focuses national attention on quality of life at the end of life, need for increased public awareness and physician education.
Supreme Court’s Olmstead decision promotes broader HCBS coverage for people with disabilities, per ADA’s community integration mandate.
Americans Act Caregiver Program established, authorizing grants to states to fund a range of supports that assist family and informal caregivers to care for their loved ones at home.
Deficit Reduction Act provides federal funding to states to expand community-based care; authorizes the Medicaid Money Follows the Person (MFP) Rebalancing demonstration program; allows states to add an optional Medicaid state plan benefit for HCBS.
The Affordable Care Act (ACA) provides new options to states under the Medicaid program to incentivize the improvement of their LTC infrastructures and expand HCBS. Provisions include the Balancing Incentive Program, the Community First Choice state plan option and an MFP extension, among others. In addition, for the 5-year period beginning January 1, 2014,states are required to apply spousal impoverishment standards in determining eligibility for married Medicaid applicants receiving HCBS. Prior to this, these standards were applied to the spouses of nursing home residents only.
The first Baby Boomers turn 65.
Medicare mandates more frequent doctor visits if a patient remains on hospice beyond six months. A face-to-face patient encounter is required every 60 days to justify continual hospice care.
CMS finalizes new rules outlining the qualities that settings must meet to be considered “home and community-based” for the provision of Medicaid services.
1.49 million Medicare beneficiaries received hospice care.
William A. Dombi becomes interim president of NAHC in August, following the death of founder Val Halamandaris in late July.
Interim qualifier removed from Bill Dombi’s title as president of NAHC in February.