Later-Life Household Wealth Before and After Disability Onset
Richard W. Johnson
Urban Institute
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Later-Life Household Wealth Before and After Disability Onset
To assess the financial impact on families of LTSS needs and the potential for families to set aside funds to cover future LTSS spending, this brief examines later-life household wealth before and after disability onset. We followed over time a large sample of older adults who did not have any functional limitations at baseline, comparing the dist
householdwealth.pdf
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How Much Nursing Home Care Can Home Equity Finance?
Stephan Lindner
Urban Institute
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How Much Nursing Home Care Can Home Equity Finance?
Older adults who have income and assets have choices should they need long-term services and supports (LTSS). In this paper we estimate the extent to which older adults could potentially use home equity to help pay for nursing home care. By estimating the relationship between home equity and care costs, we provide an upper bound on how much assist
homeequity.pdf
Older Adults' Living Expenses and the Adequacy of Income Allowances for Medicaid Home and Community-Based Services
Richard W. Johnson and Stephan Lindner
Urban Institute
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Older Adults' Living Expenses and the Adequacy of Income Allowances for Medicaid Home and Community-Based Services
This brief assesses the adequacy of the income allowances granted to older Medicaid HCBS enrollees and their spouses. We measure household expenditures made by older households and compare them to the Medicaid HCBS income allowances provided by the state in which they reside, to see how much they would have to reduce their spending if they enrolle
livingexp.pdf
Health Care Spending Growth and Federal Policy
In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spendin
SpendingGrowth.pdf
Observations on Trends in Prescription Drug Spending
Key findings
• Expenditures on prescription drugs are rising and are projected to continue to rise faster than overall health spending thereby increasing this sector’s share of health care spending.
• ASPE estimates that prescription drug spending in the United States was about $457 billion in 2015, or 16.7 percent of overall personal
Drugspending.pdf
Short-Term Fixes to the Sustainable Growth Rate Process . Footnotes
1 E.g., GAO, Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms. Washington GAO, Report #GAO-05-85, October 2004.
2 Data presented in this section are based on NORC’s analysis of allowed charges from the Physician/Supplier Procedure Summary Master Files (PSPSMFs) for years 1996-2004.
Short-Term Fixes to the Sustainable Growth Rate Process . Appendix. SGR Spending Predictions
Data Sources. Implementation of the SGR process requires that CMS use the most current information at its disposal to estimate components of the SGR formula, including spending, and components that are used to calculate the SGR (which in turn, are used to calculate annual target spending and cumulated target spending). As noted in the text,
Short-Term Fixes to the Sustainable Growth Rate Process . 6.0 Discussion
The primary objective of this report has been to evaluate revisions to the current SGR physician payment update methodology with a focus on refinements to attributes of the SGR process and changes in the definition of target spending. A spreadsheet model of the current SGR process was constructed for comparative study of effects of changes in th
Short-Term Fixes to the Sustainable Growth Rate Process . 5.4 Additional Refinements
Refinements to the SGR process that have been discussed above can be considered simultaneously. Tables 15a and 15b document effects on CFs of sequentially imposing two refinements on the rebased model with drug and lab spending excluded from SGR spending: use of the higher SGR values (displayed in Table 12), e.g., to accommodate desire for hig
Short-Term Fixes to the Sustainable Growth Rate Process . 5.3 Elimination of Drug and Lab Spending from the SGR
An argument raised by some providers and critics of the SGR process is that the payment update should not be based on events beyond control of providers. An example is spending for drugs and lab tests. These components of SGR spending are less within the control of providers than services and procedures routinely provided under the MFS. Drug
Short-Term Fixes to the Sustainable Growth Rate Process . 5.2 Rebasing Target Spending
The current SGR process was implemented with an initial target level based on actual spending levels in the late 1990s. Since that time, each year’s target has been increased using the SGR. Over time, the rate of spending has increased and the cumulated difference between annual actual and target spending levels has grown rapidly.
Short-Term Fixes to the Sustainable Growth Rate Process . 5.1 Effects of Changes in SGR Values
A fundamental explanation for payment update declines that have been recently experienced and are likely in the near future without significant changes to the SGR process is that spending increases faster than target spending levels. This over-spending determines the penalty of the UAF, which can more than offset the MEI when the update is calcu
Short-Term Fixes to the Sustainable Growth Rate Process . 5.0 Changes in Target-Setting Processes
Changes in the UAF formula can be used to change the size of penalties/rewards associated with over-/under-spending, which in turn changes the rate at which provider payments would change year to year. An alternative approach is to alter the way in which target spending is defined or the composition of spending that is counted towards target spe
Short-Term Fixes to the Sustainable Growth Rate Process . 4.2.2 The Size of the UAF Penalty
In addition to changes in the UAF penalty floor, the size of the UAF penalty for over-spending can be reduced by lowering the weights applied to the measures of over-spending in the previous year and cumulated spending. A rationale for the cumulated spending term of the UAF is that CFs can be adjusted to help the Medicare program recover a porti
Short-Term Fixes to the Sustainable Growth Rate Process . 4.2.1 The UAF Floor
An option that retains some cost-containment incentives but does not lead to negative payment updates is to set the UAF floor such that the largest over-spending penalty would completely offset the MEI. Under this option, the floor is a negative percent that would be just large enough in magnitude to offset the MEI, producing a 0-percent update.
Short-Term Fixes to the Sustainable Growth Rate Process . 4.2 Changes in the Design of the UAF
As indicated in the summary discussion of the current SGR update process, the magnitude of the UAF is a key determinant of the size of Medicare payment updates. Without the UAF portion of the SGR process, payments would be updated using the MEI. The UAF is the means by which the update process recovers over-spending.
