AARP Eye Center
Federal • State
The federal government should create a public social insurance benefit that provides coverage for LTSS. It should be within Medicare or in a new public program.
Benefits should enable consumers to choose services most appropriate for their needs.
Strong federal and state oversight should ensure the equitable treatment of all people eligible to receive services. People must have equal access to services regardless of payer.
Care management should be used to coordinate health care and LTSS for people who need both types of services. Care management should be conflict-free, multidisciplinary, and available to all, regardless of payer.
The system should build on states’ experiences or require state and local agencies to have a major role in running any new program.
States should be required to implement a single point of entry for LTSS to determine financial and program eligibility and authorize services promptly.
Assessments to determine eligibility for services should measure the need for assistance caused by functional limitations without regard to whether the person being assessed has family who can assist with the care. This includes the need for assistance with activities of daily living and instrumental activities of daily living. It should also measure the need for long-term nursing services, medical management, and supervision due to cognitive and other mental impairments and behavioral problems.
Federal and state governments should consistently apply a standardized assessment to determine consumers’ needs.
A full range of home- and community-based services should be provided to delay or prevent institutionalization and help to control overall LTSS costs. These services include but are not limited to personal care in the home, case management, respite care, adult day services, accessible transportation, and supportive housing.
Consumer-directed LTSS should always be available, promoted, and supported, regardless of payer or provider. Federal and state agencies should offer consumers the option of a cash payment to select and manage their LTSS.
Services from all providers should be designed and delivered in a way that promotes independence.
The program should not provide financial incentives to use one type of care over another.
If federal and state governments use capitated payment systems, they should require strong consumer protection standards. Capitated rates must be sufficient to meet the needs of those served and allow consumers to choose the services that best meet their needs.