Long Term Services and Supports

Health Affairs has published a special issue devoted entirely to long-term care. Review articles on providers, issues related to Medicare and Medicaid, transition and diversion programs, new state strategies to meet LTC needs, quality of care, demographic issues, policy and financing, health spending, caregivers and the workforce, and palliative care and end-of-life.

Recently enacted health care reform has a number of implications for PAS users. The Center for Personal Assistance Services has compiled a number of publications on this topic. The information is divided into the categories of: overall, long-term care, Medicaid, Other and Implications. A link to the full text of the Act is included as well as a summary and timeline of the Act

Find a summary of the CLASS Act developed by the AARP Public Policy Institute. The legislation creates a voluntary national insurance program for long-term services and supports (LTSS) to help address the financial challenges many American households face when confronted with the high cost of LTSS. This fact sheet succinctly answers questions such as who can participate in CLASS, what are the benefit amounts, how are premiums computed and how CLASS interacts with Medicaid.

Predictors of service use was examined among four in-home and two community-based services. Results showed that race did not have a significant effect on service use, but gender had a significant effect for some services. The results indicated the importance of social supports and structural factors in predicting use. Implications for policies and practice to improve community outreach, access and utilization of services by different racial groups of elders are discussed.

Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2008, spending for these services was almost $191.1 billion (almost 10 percent of all U.S. personal health care spending), most of it paid by the federal-state Medicaid program. This publication presents data on LTSS spending by major public and private sources.

The Patient Protection and Affordable Care Act (PPACA) established the Community Living Assistance Services and Supports (CLASS) program, a new federally administered voluntary insurance program to help adults age 18 and over with disabilities pay for long-term services and supports (LTSS). This publication describes the major provisions of the legislation, including requirements for enrollment and eligibility, benefits and services, premium amounts, the CLASS Act trust fund, and timelines.

Find a link to a collection of fact sheets published by the AARP Public Policy Institute that discuss how health reform legislation specifically affects aspects of Medicare, Medicaid, health insurance and coverage, the health care delivery system, prevention, long term care options, and the primary care workforce. One specific fact sheet address how "Health Care Reform Improves Access to Medicaid Home and Community-Based Services".

Listen to a recorded webinar that analyzes the recently enacted legislation, highlighting the CLASS Act, the direct care workforce, Medicare payment for post-acute care, care coordination, and quality of care in nursing homes. It was presented by Joshua M. Wiener. Ph.D., a Senior Fellow and Program Director for Aging, Disability and Long-Term Care at RTI International.

What provisions in health care reform will have the most direct impact on family caregivers? This overview discusses long-term care incentives, including the CLASS Act, Community First Choice Option, the extension of Money Follows the Person demonstration programs and ADRC initiatives. The brief also addresses care quality and coordination, and changes involving health care coverage and health care workforce development.

While 1915(c) waivers are a prominent vehicle for the delivery of HCBS, they are not the only mechanism available to States. CMS developed a technical assistance paper that outlines the enrollment authorities that States may consider when designing managed HCBS programs, the review and approval process for each, and rate setting techniques that may be useful. The appendix offers a useful chart outlining the authorities, including their key flexibilities and limitations.