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CLASS Proposed Rule in October Will Make Major Changes to Program

By Rebecca Adams, CQ HealthBeat Associate Editor

May 26, 2011 — Federal officials plan to issue a proposed rule in October that will make significant changes to the controversial Community Living Assistance Services and Supports (CLASS) program as envisioned by the health overhaul law, according to Assistant Secretary for Aging Kathy Greenlee.

Greenlee, who spoke with reporters after testifying before the Senate Special Aging Committee about the reauthorization of the Older Americans Act (PL 89-73), said the administration is considering making several changes that had been debated before the health care law (PL 111-148, PL 111-152) was enacted last year.

Health and Human Services Secretary Kathleen A. Sebelius and Greenlee have previously said that they want to revise the long-term care program to make sure it is solvent for the next 75 years. And they plan to do that before Oct. 1, 2012, when the secretary is supposed to outline how the program will work. Sebelius has promised Congress that she will not implement the program unless it is financially sustainable.

Some of the changes they are still weighing, Greenlee said, are whether to increase the minimum earnings requirement for enrollees, index the premiums for inflation, and beef up anti-fraud protections.

The voluntary insurance program is intended to provide a $50 a day cash benefit for the elderly as well as for younger people with disabilities so they could keep living in their own homes. But the program's financial stability has been questioned by actuaries and President Obama's fiscal commission.

The committee's top Republican, Bob Corker of Tennessee, said Democrats as well as Republicans have voiced concerns about the program's sustainability.

Corker said that even though similar concerns about Medicare have recently gotten attention in Congress, the CLASS Act is even more worrisome.

"With the CLASS Act, people believe it's already at that stage, as it's been set up," he said.

Corker also asked for more details about how the implementation of the CLASS Act is being funded. Greenlee said HHS is using authorized funding to implement the 2010 health care law and tracking which personnel are working solely on CLASS Act issues and which are dividing their time with other matters.

"We are adequately handling the accounting that needs to be done," Greenlee testified.

Greenlee recommended that Congress update the Older Americans Act by including evidence-based interventions for helping to improve the health of chronically ill people, moving the Senior Community Service Employment Program from the Department of Labor to the Administration on Aging, and providing permanent legal authority for the anti-fraud program known as the Senior Medicare Patrol Program, which encourages seniors to report suspected fraud.

Former first lady Rosalynn Carter also appeared at the hearing.

Carter asked Congress to make four major changes to Older Americans Act:

  • To create a National Quality Caregiving Task Force to oversee an initiative to support family members and other caregivers of older Americans. The task force might be led by the departments of Health and Human Services and Veterans Affairs.
  • To help create and fund state programs to assess and monitor the health of people who care for older people.
  • To ensure that services for caregivers that have been proven in studies to work are provided.
  • To continue funding for the National Family Caregiving Support program, which provides services to people who are caring for relatives or other aging people.

Carter's recommendations were part of a broader report, "Averting the Caregiving Crisis: Why We Must Act Now," by the Rosalynn Carter Institute for Caring, a program at Georgia Southwestern University that fosters partnerships that support home and community-based services.

Over the next four years, the number of Americans who are age 60 and older will increase by 15 percent, to 65.7 million, Greenlee said.

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