Achieving Comprehensive Long-Term Services and Supports Reform

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.

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.

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.

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.

Benefits should be designed to enable consumers to choose the 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.

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 that 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.

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 the evaluation of clients’ outcomes to the extent feasible.

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.

Consumers—to the extent they are capable—or 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.

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… .