Achieving Comprehensive Long-Term Services and Supports Reform

Background

The U.S. needs a system that provides universal access to a comprehensive range of health care services and long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ( LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ).

The LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… component of the system, provide affordable, coordinated, high-quality LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… to offer consumers choices and give support to family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. . New sources of both public and private financing are critically important to develop a new system.

ACHIEVING COMPREHENSIVE LONG-TERM SERVICES AND SUPPORTS REFORM: Policy

Developing a comprehensive long-term services and supports system

In this policy: FederalState

A long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ( LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ) program should be part of a comprehensive system that provides universal access to a range of LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… and health care services and supports family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. .

Federal policymakers should develop a comprehensive system for financing LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… that includes a new social insurance program Group insurance that serves a social purpose and is operated by the government. Individuals contribute to the program either directly or indirectly through their employer. Tax revenues may also be used to fund these programs. The program protects participants from large or sudden… that provides a basic level of LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… . To ensure an adequate level of comprehensive services, the program should be designed to function seamlessly with a mix of other financing sources, including private long-term care insurance, individuals’ out-of-pocket expenditures, and Medicaid for individuals with low incomes.

The public and private sectors, including the Social Security Administration, the Centers for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… & Medicaid Services (CMS), and health insurance carriers should educate consumers and their families about their risk for needing LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… , the lack of coverage for LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… through Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and health insurance, and all options for financing LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

With better education, consumers can understand their options and responsibilities and make informed choices that are best suited to their needs and circumstances.

New funding sources, including a new publicly financed social insurance program

In this policy: FederalState

The cost of a new social insurance LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… program should be paid for with premiums, individual contributions through cost-sharing requirements, and general revenues.

The criteria for evaluating LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… financing proposals should include the extent to which they are progressive, broad-based, stable, affordable, and capable of growing with enrollment.

The federal government should finance LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… through a universal, comprehensive, publicly administered program such as Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… , or a similar social insurance program Group insurance that serves a social purpose and is operated by the government. Individuals contribute to the program either directly or indirectly through their employer. Tax revenues may also be used to fund these programs. The program protects participants from large or sudden… of shared risk.

Such a program should be part of a comprehensive system that provides universal access to a range of health care services and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… . The program should emphasize the independence, dignity, autonomy, and privacy of individual consumers so that they can maximize their physical and psychosocial potential.

Progressive financing and low-income protections

In this policy: FederalState

Because a contribution equal to the full actuarial cost of the LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… benefit is too expensive for many Americans, the financing provisions must take into account affordability and must be sustainable for the program overall.

Beneficiary cost-sharing for either community or institutional services should be modest and not favor one type of service over another. Public funds should pay for individuals who cannot afford to contribute to cost-sharing in order to protect people with low incomes.

Adequate financing and reserves

In this policy: FederalState

Some tax revenues for a new LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… program should be earmarked for an LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… trust fund to build adequate reserves to cover later generations. The new LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… program should require some maintenance of states’ current spending on LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… to help defray the federal government’s costs.

A financing package should adequately deal with transition costs as a new program is phased in since many older adults and people with disabilities would be eligible for benefits before a large reserve fund could be built up.

Ensuring essential features of a long-term services and supports social insurance program

In this policy: FederalState

Benefits should be designed to enable consumers to choose services they deem most appropriate for their needs.

Strong federal and state oversight should be provided to 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 Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… 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 Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… that can determine financial and program eligibility and authorize services in a prompt and timely fashion.

Assessments to determine eligibility for services should measure the need for assistance caused by functional limitations and the need for assistance with activities of daily living Eating, bathing, toileting, dressing, or transferring in or out of bed or a chair. and instrumental activities of daily living Eating, bathing, toileting, dressing, or transferring in or out of bed or a chair. without regard to whether the person being assessed has family who can assist with the care. It should also measure the need for supervision due to cognitive or mental impairment and behavioral problems, long-term nursing services, and medical management.

Federal and state governments should use a standardized assessment in a consistent manner to determine beneficiaries’ needs.

A full range of home- and community-based services Long-term services and supports provided in individuals’ homes or in home-like environments, such as supportive housing. should be provided to delay or prevent institutionalization and help to control overall LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… 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 A setting for long-term services and supports that includes board and care homes, assisted living facilities, and group homes that provide or arrange for services and help with activities of daily living (see separate entry) in a residential setting. .

Consumer-directed LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… 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 Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

The program must have strong consumer protection standards and enforcement mechanisms.
There is evidence that many consumers who receive a cash benefit manage their LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… more economically than those who receive benefits under an agency-administered model.

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.

Intermediate steps for achieving comprehensive reform

In this policy: FederalState

Until a comprehensive national LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… program is implemented, there are intermediate steps which should be taken.

The federal government should create a public social insurance benefit, either within Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… or in a new public program that provides some level of coverage to protect consumers who need LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

States should implement LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… programs that are affordable for those who do not meet Medicaid’s eligibility requirements but who still cannot afford LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

Coordination should be improved among LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… programs and between the health care and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… systems for people who need services from both.

Services in consumer-preferred settings—primarily in the home and community—should be expanded. Services that support family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. ’ ability to continue providing care should be included in the expansion.

Adequate oversight

In this policy: FederalState

The federal and state government should conduct regular, thorough, and consistent oversight to ensure consumers’ quality of care and quality of life, and to protect their rights in all LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… settings. Oversight should include evaluation of clients’ outcomes to the extent feasible.

Consumer focus

In this policy: FederalState

Consumers and their family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. , as appropriate, should be the focus of all LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… programs and services.

LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… consumers, including those from diverse communities, should participate in all aspects of program development, implementation, and oversight.

Consumersto the extent they are capableor their caregivers or legal representatives should have the option to make decisions about the LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… they receive and manage their own services and supports.

Improving coordination with other health programs

In this policy: FederalState

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… coverage of health services for those with chronic illnesses and disabling conditions should be improved (see also Chapter 7, Health - Health Care Coverage—Medicare and Chapter 7, Health - Reforming the Delivery of Health Care Services—Chronic Care Coordination, Accountable Care Organizations) and medical care management should be used to coordinate health care and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… for people who need both types of services. Care management should be conflict-free, multidisciplinary, and available to all, regardless of payer.

Covered services should be fully portable so people can receive them in a wide range of settings.

The effects of integrating other public LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… programs, such as state-funded and Department of Veterans Affairs programs, into a new system should be carefully considered to ensure that program changes enhance participant access. Existing programs should receive adequate federal funding to ensure veterans’ access to LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

Flexible, innovative, and efficient administration

In this policy: FederalState

A reformed LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… system must have an administrative structure capable of meeting the needs of diverse and growing numbers of beneficiaries.

Expanded access to home-and community-based services

In this policy: FederalState

Eligibility for services should be based on how LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… relate to an individual’s functional needs, chronic illness, and medical conditions.

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… ’s potential role in meeting beneficiaries’ LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… and medical needs should be reexamined and expanded to assist people who depend on family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. . It should include improved home health care and skilled-nursing facility benefits, personal care designed to help people with ADLs, and adult day care and other caregiver support services, such as assessment of caregiver needs, education and training, and respite care.

Improved Medicaid benefits should serve as an LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… safety net for vulnerable populations with low incomes and few assets and for those who become impoverished because of medical or LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… needs.

Services provided through the Older Americans Act and Social Services Block Grants should receive adequate funding because they are important to the home- and community-based LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… system.

Conflict-free care management should be available through public agencies to help individuals and their families access the full range of LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… .

Improved long-term care insurance

In this policy: FederalState

Long-term care insurance should be subject to stronger consumer protections and greater standardization so that consumers can make informed comparisons among policies.

Phased-in coverage

In this policy: FederalState
A comprehensive new program can be introduced gradually. The program should cover people who currently need services and build an adequate program for future generations through a range of financing resources.

Appropriate services

In this policy: FederalState

Avoiding unnecessary institutionalization by providing home- and community-based services Long-term services and supports provided in individuals’ homes or in home-like environments, such as supportive housing. —such as home care A range of services provided in the home, including health care, personal care, and supportive services. , conflict-free care management, personal care, respite care, adult day services, and supportive housing A setting for long-term services and supports that includes board and care homes, assisted living facilities, and group homes that provide or arrange for services and help with activities of daily living (see separate entry) in a residential setting. —is one of the most important and effective ways to control the costs associated with LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… (see also Expanding Home- and Community-Based Services in this chapter).

In order to help control LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… costs, federal and state governments should use a standardized assessment in a consistent manner to determine the beneficiary’s needs. The assessment should inform the care plan in addressing the person’s goals and needs. Longitudinal information from this assessment should be used to evaluate client outcomes and monitor quality of care. A universal core of assessment items should be developed and implemented across health care and LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… systems so that consumer outcomes can be tracked.

Improving data collection

In this policy: FederalState

Federal and state governments should ensure that standardized systems collect data on service use, costs, and quality, particularly for Medicaid and Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… . Accurate and timely LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… data are central to evaluating services and client outcomes and making sound policy decisions regarding the cost-effective allocation of financial resources.

Curbing fraud and abuse

In this policy: FederalState

Federal and state governments should adequately fund Medicaid fraud and abuse units, as well as investigate and prosecute providers in any services and supports setting who defraud Medicaid or abuse beneficiaries.

Conflict-free care management

In this policy: FederalState

Conflict-free care management should ensure effective and efficient coordination of high-quality client services.

Risk-sharing

In this policy: FederalState

Organizations and governmental agencies that provide any care management, including health maintenance organizations and social health maintenance organizations, should share the financial risk of cost overruns and the financial rewards of effective cost containment. Effective governmental oversight (e.g., periodic audits and look-back surveys The federal government generally contracts with state agencies to certify nursing facilities to participate in Medicare and Medicaid. The federal government conducts these assessments by resurveying a sample of facilities to determine if the state agency correctly performed its survey. … ) must be in place to help prevent conflicts of interest within the care management system.

Private payments

In this policy: FederalState

Any social insurance program Group insurance that serves a social purpose and is operated by the government. Individuals contribute to the program either directly or indirectly through their employer. Tax revenues may also be used to fund these programs. The program protects participants from large or sudden… should be supplemented by private payments and ensure protections for people with low incomes.