Five LTC commissioners issue full alternative report

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Five members of the Congressional Commission on Long-Term Care have released a full report, providing an alternative to the commission report released last week. The five commissioners split with nine other panel members over that report, saying it should not be presented to Congress as the broad agreement of the group. 

The full commission could not reach consensus on a financing system for the nation's system of long-term services and supports, drawing criticism. The final report did not include recommendations related to financing but described different “approaches” for Congress to consider. The five dissenting commissioners said the group did not fulfill its mandate. Congress charged it with formulating a comprehensive plan to reform the nation's LTSS system, after lawmakers repealed the CLASS Act in January.

The alternative report includes six recommendations, and the first is to “create a broader financing solution” that includes a public social insurance program. The report suggests an LTSS benefit under Medicare Part A, similar to the hospice benefit, which would be financed by raising the payroll taxes and/or premiums.

“Under this model, a physician would be required to certify that the individual requires assistance with at least two activities of daily living, has needed such assistance for 90 days, and is likely to continue to need the services,” the report states. Ongoing cognitive issues could also qualify someone for coverage under this plan.

Another option described in the report would be to create a more limited benefit within Medicare or through a new program, providing “catastrophic” coverage for people who have a defined level of functional impairment. This would limit private insurers' exposure to risk, enabling them to offer policies that people could purchase to cover a more defined “hole” in LTSS coverage, according to the report.

"Private insurance can be part of the solution, but we need a public program that provides security," commissioner Judy Feder, Ph.D., told McKnight's last week. "We're all in this together, we're all at risk and we all need a mechanism and to contribute to mechanisms to protect ourselves."

Feder, of Georgetown University and the Urban Institute, was one of the five authors of the alternative report. These commissioners and some lawmakers also criticized that the full commission did not address the needs of the non-elderly disabled in a more rigorous fashion. The alternative report includes a number of recommendations on this topic. These include tax-deferred savings accounts for disabled people not receiving Medicaid coverage for LTSS.

The authors of the alternative report were all Democratic appointees to the bipartisan commission. Click here to access the complete report, including a list of the authors.