Lifecare Long-Term Care Protection Act (S. 2163)
Overview
Type of Reform: Creating a New Program
Description: Creates the Lifecare Long-term Care Protection Program that would:
- Create state-based assessment and care management agencies to determine eligible individuals and maintain provider registries.
- Provide up to three years of home and community-based care.
- Provide up to six months of facility care (with the option for more).
- Create optional insurance program for longer facility care stays.
Sponsoring Organization and Key Author(s):
- Introduced by Sen. Edward Kennedy (D-MA) on February 22, 1990.
- Two Democratic co-sponsors.
Impact and Action:
Senate Committee Referral: Senate Committee on Labor and Human Resources.
Program Details
Participation Criteria
Adults ages 65+, persons under age 19, or those receiving certain Social Security benefits.
Conditions for Receiving Benefits Scope of Services
Differ by age:
- Individuals ages 65+ meeting one of the following criteria:
- Completely dependent in one ADL.
- Unable to perform two or more ADLs without help or supervision.
- Cognitively impaired posing risk to self/others.
- Individuals ages 19 and under meeting one of the following criteria:
- Unable to perform two or more age-appropriate ADLs.
- Reliant on a medical device.
- Has a medical prognosis of less than one year to live.
Scope of Services
Adult day health, respite, heavy chore service, homemaker, home health aide, home mobility aids, home nursing, therapies, transportation, nutrition, and others.
Amount of Services
- Care manager determines care plan based on individual assessment and resource availability in jurisdiction.
- Respite care limited to 30 days or 720 hours per calendar year.
- HCBS limited to duration for three years.
- Facility care limited to six months with an extension for individuals who have not been an inpatient setting for at least six consecutive months, have a different diagnosis, or where there has been a substantial worsening of their condition since the last discharge.
Participant Financial Responsibility
- Copayments are the lesser of 5% of the insurance benefits the individual receives under Title II of the Social Security Act (if any) or 10% of the costs of their services.
- Balance billing prohibited.
Elimination Period
Not specified.
Provider Requirements
Care Management Agencies determine eligible providers and provider requirements.
Provider Payment Levels
- Limits HCBS payment levels to 65% of the average Medicare payment amount for nursing facility care for the first three years of care, and then to the cost of nursing facility care (less room and board) thereafter.
- Payments adjusted based on need severity.
Inflation Adjustments
Not specified.
Financing & Implementation
Revenue Source(s)
Not specified.
Total Program Costs
Estimated $15 million for FY 1991, $20 million for FY 1992, and $25 million for FY 1993.10
Program Administration
- HHS contracts with states/non-profits to operate Care Management Authorities that administer Lifecare.
- Care Management Authority responsibilities include making eligibility determinations, overseeing plans of care, and maintaining a registry of qualified providers.
Lifecare Long-Term Care Protection Act, 1990 (S. 2163)
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