Highlight on Nevada: Governor signs post-acute care study bill into law

A bill signed into law by Nevada governor Brian Sandoval calls for the establishment of a legislative committee to study the quality and funding of post-acute care in Nevada. Assembly Bill No. 242 creates a subcommittee to oversee an interim study that will examine alternatives to institutionalization as a means of providing post-acute care in Nevada. The committee will be composed of legislators selected from the Nevada Senate Standing Committee on Health and Human Services and the Nevada Assembly Standing Committee on Heath and Human Services and will consider such alternatives as home- and community-based services.

The law, which originated in the Nevada Legislative Committee on Senior Citizens, Veterans, and Adults with Special Needs, and was sponsored by the Assembly Committee on Health and Human Services, requires the study to review the funding and quality of post-acute care options in Nevada. It must include a consideration of alternatives to traditional institutionalization for post-acute care such as home- and community-based waiver programs. The study must review the costs and savings of such alternatives and provide an analysis of the benefits and detriments on the quality of life for persons receiving the post-acute care services. Additionally, the study must include information about the post-acute care quality measures that are required to be reported to Medicare, Medicaid, and the state of Nevada. The law also requires the committee to detail the state and federal funding procedures for post-acute care and report on Nevada’s current post-acute care funding formula. Any recommendations that the committee would like to submit to the legislature must be approved by a majority of the committee members.

Under Section 1915(c) of the Social Security Act, states have the option of providing long-term care in home- and community-based settings (HCBS) through the Medicaid HCBS Waiver Program. Additionally, sections 2401 to 2406 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) provide incentives to assist states in increasing the availability of HCBS through Medicaid. Such programs can provide both standard medical services and non-medical services. Examples of covered standard medical services could include case management services, homemaker assistance, personal care, habilitation, adult day health services, and respite care. States may also propose other services that will assist in keeping individuals at home and in their communities rather than in institutional settings. Nevada currently offers its own Home and Community Based Waiver Program (HCBW) and the Community Options Program for the Elderly that provide non-medical services to elderly individuals to assist them in remaining in their homes as an alternative to nursing homes.

The Nevada post-acute care study suggests that the state may be following a national trend toward providing more HCBS rather than institutionalized care as a means of controlling costs while keeping patients at home. A 2013 report by the American Association of Retired Persons (AARP) that examined state studies of HCBS programs concluded that most states found a lower, per-individual cost of providing such services as compared with providing traditional institutional care.

The Nevada Health Care Association (NVHCA) expressed strong support for the post-acute care study. Nevada Business Magazine is reporting that Daniel Mathis, President and CEO of the NVHCA stated, “The study is quite comprehensive, and it’s a positive move in improving care in the state.” He was further reported as stating,  “Importantly, it reviews state and federal funding for post-acute care, including the funding formula used in the state. This is critical to improving quality measurements and the overall level of care in Nevada.”

Governor Sandoval signed the legislation into law on June 1, 2015, and it goes into effect on July 1, 2015. The results of the study and recommendations for legislation must be presented by the committee to the Director of the Legislative Counsel Bureau for submission to the following year’s legislative body.