The HCBC sprung form labor negotiations with unions and employee groups, and it was essentially given the responsibility of negotiating and developing the city's health care plan within financial limits established by the city.
As part of this process, the city's insurance broker helps educate HCBC members about health care issues.
HCBC members then present the proposed health care package to the City Council at both a work session and business session meeting.
After the package has been approved by the City Council, the HCBC meets to plan the rollout to employees.
The most notable and clearly defined outcomes of the HCBC have been the reduction in the rates of increase for the city's insurance coverage, the shift of a portion of health care costs to employees, the creation of a city-sponsored employee wellness program, and a reduction in employee sick leave usage.
Reimbursement for publicly subsidized RCF residence was not high in any State, but three States did offer some such assistance using Medicaid HCBC waivers and/or State supplemental payments to Supplemental Security Income.
Additional information, such as on the number of persons receiving HCBC covered services or the number of home care visits per 1,000 population could perhaps further refine the enumeration of alternative service supply and demand, but these data are not available in the ARF and require either county inventories or access to State administrative records not available to this project.
Analyses and the simulations were conducted separately for each State, thereby holding constant other policies (such as certificate of need, income eligibility, reimbursement levels for LTC services, and expenditures on HCBC) and the regulation-enforcement practices prevailing within each State.
Maine's rank in per capita HCBC spending is 10th nationally, and Oregon is ranked 7th (Bectel and Tucker, 1998).
However, as the simulated effects on case mix were more pronounced in some States than others, it seems appropriate that attention be given to further delineation of other LTC policies and their implementation and that the supply of alternative services, such as HCBC and unlicensed housing, be incorporated into the analysis.
Among other key points, the report noted that payment of HCBC services should be driven by quality outcomes, and that new programs should be developed to support assisted living as an alternative to nursing home placement for low-income elderly.
The work groups, consisting of 80 key state officials, members of the senior coalition groups, HCBC and nursing home providers, under the guidance of a representative Steering Committee, meet regularly.