Long Term Services and Supports

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.

A Southwestern Pennsylvania demonstration program has been initiated to promote relationship-centered care for elders and people living with disabilities in need of home and community-based services and supports. It involves a series of five three-day train-the-trainer programs based on the state model for personal care aides (PCAs). Included are the announcement and a fact sheet on direct-care workers in Pennsylvania.

What are the major components of the Community Living Assistance Services and Supports (CLASS) program? The program establishes a national, voluntary insurance program for purchasing community living services and supports that is designed to expand options for people who become functionally disabled and require long-term help. Find a description of the program, including its financing, eligibility criteria, benefit design and interaction with Medicaid.

Looking for information on the CLASS Act? This report compares provisions in both the House and Senate health care reform legislation, identifies key differences between the two bills, and discusses federal budget implications as estimated by the Congressional Budget Office (CBO) and the CMS. It also discusses cost and financing for long-term care services and the current market for private LTC insurance.

While intended to assist new participant direction partners, a wider audience may benefit from this review of directly-hired workers' characteristics, experiences, and training needs compared to agency-hired workers. This policy brief draws on research from two large scale participant-directed options for people with diverse disabilities: the Cash & Counseling Demonstration and Evaluation (CCDE) and the California In-Home Supportive Services (IHSS) program.

With funding from The SCAN Foundation, this issue of PPAR features articles that recount the laborious process that led to realization of the long-term care provisions found in ACA, analyze the key provisions of the legislation, and explore hurdles that are certain to be encountered during program implementation. Authors include national experts from The SCAN Foundation, RTI International, Oxford University, AAHSA, Avalere Health, AARP and Ecumen.

There are a number of challenges for the direct service workforce in rural areas. Review an issue brief and a recorded webinar presenting strategies that stakeholders can use to provide high-quality long-term care services and supports. States engaged in development of their direct service workforce can use these to gain knowledge of the challenges and learn about some direct service related strategies that other states and rural agencies have implemented.

As part of Research on Program Management Techniques by States to Rebalance their Long Term Care Systems, Final Case Studies were conducted in each State for the time period ending December 2007. These Case Studies focus particularly on the reflections of State government officials on rebalancing goals, accomplishments, and next steps as they reflect on all the State’s experiences in moving towards more community-based services.

The second in a series, this report explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care.