The Commission on Long-Term Care has issued its full report to Congress, fleshing out recommendations that it released last week addressing LTC service delivery, workforce issues and financing systems.
Nothing in this report would surprise any reasonably well-informed long-term care professional. Recommendations made include concepts such as eliminating Medicare’s three-night hospital inpatient requirement to qualify for post-acute coverage, expansion programs which are meant to ensure that individuals end up in the most appropriate care setting no matter where they enter the LTC system, and provision of additional public resources to speed development and implementation of LTC-specific health information.
Other recommendations include: support for site-neutral payments, a streamlined Medicaid waiver process, state review of scope-of-practice requirements, and completion of a simpler, more usable standard assessment mechanism that can be used across care settings.
Sound a bit sarcastic? Well, honestly, perhaps it is. Perhaps we shouldn’t be surprised that things turned out so poorly. Congress finally got around to establishing this committee in January, as part of a larger fiscal cliff deal. Then it took our president and Congressional leaders three month to finalize its members. And of course, it should come as no surprise that the commissioners were divided on the best ideas related to financing for long-term services and supports, and rather than making recommendations offered two different approaches. One approach favors a publicly funded insurance system for Long-Term Services and Supports (LTSS). Such a program might take the form of a comprehensive LTSS benefit in Medicare Part A, financed in part through a tax increase, or it might be a new public program that would insure only against catastrophic risk. The second approach in the report focuses on strengthening private financing, such as by allowing 401K withdrawals to pay LTC insurance premiums.
The commission concluded by recommending that Congress create a national advisory committee to continue this work. I categorized this under things that make a person go Hmmmmmm……