LTC commissioners air differences while issuing full report to Congress

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Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments
Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments

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. Each of the commissioners made a statement at a public hearing Wednesday afternoon, revealing that approaches to the needs of the non-elderly disabled were a sticking point, in addition to differences over ideas for long-term care financing.

The 114-page document provides an in-depth assessment of challenges facing the current U.S. long-term care system and offers a broad array of potential solutions, based on public comments and hearings, and the 15 members' expertise in the field.

Some recommendations in the report, such as eliminating Medicare's three-night hospital inpatient requirement to qualify for post-acute coverage, already have widespread support. The commissioners also echoed many who have called for public resources to speed development and implementation of LTC-specific health information technology. Such technology would support the level of care coordination needed for other commission recommendations. These include expansion of “No Wrong Door” programs, which are meant to ensure that individuals end up in the most appropriate care setting no matter where they enter the LTC system.

However, 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.”

Congress called for the bipartisan commission after repealing the CLASS Act, which was intended to revamp long-term financing. By not offering a recommendation on how to address this issue, the panel did not fulfill its mission, according to members who last week offered their own set of recommendations.

Five of the six dissenters are Democratic appointees, and all five* are in favor of a publicly funded insurance system for LTSS. This is similar to “Approach B” presented in the full report released today. 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.  “Approach A” in the report focuses on strengthening private financing, such as by allowing 401K withdrawals to pay LTC insurance premiums.

Henry Claypool, executive vice-president of the American Association of People with Disabilities, and Lynnae Ruttledge, a Presidential appointee to the National Council on Disability, were also among those who voted against presenting the report as the broad agreement of the commission. They spoke at the public hearing about the need for a more in-depth consideration of the needs of the non-elderly disabled. Sen. Jay Rockefeller (D-WV), one of the leading supporters of the commission, also expressed concern in this area.

Responding to the commission's recommendations, Rockefeller said they seemed to only "touch the surface" with regard to people with disabilities.

Despite the 9-6 split, the commissioners praised the collegial, bipartisan spirit of the commission. Bruce Chernof, M.D., president and CEO of The SCAN Foundation and commission chairman, closed the hearing by saying Congress must embrace the same bipartisan spirit to enact needed reforms. The entire commission was in accord in acknowledging it faced enormous time constraints, and its report is not comprehensive enough to serve as a definitive blueprint for reform. It recommended that Congress create a national advisory committee to continue this work.

Click here to access the complete report.

*Editor's Note: This article has been updated to clarify that five commissioners, not six as originally stated, have joined to recommend a social insurance program. The sixth, Republican appointee Chris Jacobs of the Heritage Foundation, cited concerns about imposing additional burdens on providers, among other issues.

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