Long Term Services and Supports

The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration suspended the CLASS Act because of the high risk of fiscal insolvency. This article discusses several CLASS Act design and implementation issues, including the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers.

This critical essay examines how effectively the Patient Protection and Affordable Care Act (ACA) addresses prevailing deficiencies in the nation's long-term care system and whether the ACA will result in meaningful reform. This article also reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them, including incentives/options for expanding home- and community-based care and a number of research and demonstration projects.

States have continued to rebalance their long-term services and supports (LTSS) toward more home and community-based services (HCBS). This report uses diverse methods to assess the different incentives affecting states’ decisions to implement the four Medicaid HCBS options under the Patient Protection and Affordable Care Act (PPACA); two new options (Community First Choice and the Balancing Incentive Program) and two existing [Money Follows the Person and 1915(i)].

This report discusses recent major policy developments that pertain to the service needs of people with developmental disabilities and their families, and recommends opportunities to enhance collaboration among the aging, disability and long-term care networks. Key policy initiatives addressed include the Aging and Disability Resource Centers, the Lifespan Respite Act, the National Alzheimer’s Project Act, and the Patient Protection and Affordable Care Act.

Launched in 2007 during the Bush administration, the Money Follows the Person Program has supported states’ rebalancing efforts of moving low-income older adults and disabled people from long-term care facilities into the community. The program offers states extra Medicaid funding to pay for the participant's home and community-based services over 12 months. This article addresses the major challenges of the participating states in terms of administering the program.

Summarizes a program evaluation of a Federally-funded state-based system to protect patient rights for those with significant mental health disability. The PAIMI Program was initiated in 1986 in response to congressional findings of widespread abuse, neglect, and exploitation of individuals in state psychiatric institutions. Twenty-two years later, the program is still addressing those issues, along with new problems arising from delivery of mental health services in community-based settings.

This is the second “year in review” of developments in family caregiving, and there remains considerable room for improvement in how this nation supports the over 42 million family caregivers (and growing) who provide an estimated $450 billion in “free” care annually. The guide provides an overview of key developments in 2011. Two shorter versions, "45 Facts About Family Caregivers" and "27 Things You May not Know about Women and Caregiving" are also available.

Program provides guidance for a three-year effort to use OSHA outreach & inspections to reduce specific occupational hazards in nursing & residential care facilities. The Department of Labor identified the following hazards: Exposure to blood & other potentially infectious material; Exposure to other communicable diseases; Ergonomic stressors related to lifting patients; Workplace violence; Slips, trips, and falls; Exposure to hazardous chemicals & drugs.

Discussions were conducted to uncover lessons from abroad for Community Living Assistance Services & Supports (CLASS), a federally run voluntary public long-term care insurance program created under the Accountable Care Act of 2010. Discussions were conducted during an international conference of LTC experts, followed by personal meetings & individual correspondence. Findings indicate that programs in the five countries studied have lessons, both positive & negative, relevant to CLASS design.

This report presents budgeting and contractual strategies used in Arizona, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Washington and Wisconsin. In different ways, these states have made substantial progress in transforming their LTSS systems by developing flexible accounting policies that have reduced NF utilization and captured the savings to support their HCBS programs.