Long-term Care Benefit Also Made Available in Health Reform

March 26, 2010 (PLANSPONSOR.com) - The health reform legislation contains a provision that will make long-term care insurance available to all Americans, who will be automatically enrolled with the choice to opt out.

Under the Community Living Assistance Services and Support (CLASS) Act, individuals will begin paying a premium immediately and, after five years, those with functional limitations have the option of receiving a cash benefit of around $50 a day that can be used for medical equipment and home renovations.      

In addition, Health Leaders Media reports that the bill will implement much stricter guidelines in terms of ownership transparency of nursing home chains.      

“This will allow patients and the public at large to better understand ownership and operational hierarchies that currently are difficult to identify. Making these changes in the industry will be challenging, particularly for large publically-owned chains,” says Katherine McCarthy, business account manager at PointRight in Lexington, MA, according to the news report. “However, those of us in the industry are all very excited that the bill will extend the therapy caps exceptions process through 2010. At the end of this year, they will have to revisit this issue again, at which point we are all hopeful for a long-term fix that ensures patients are able to receive the care they need based on medical necessity, rather than an arbitrary cap on funding.”      

The health reform bill also includes a provision to help close the Medicare Part D coverage gap for medications. According to the Senate’s summary of the Patient Protection and Affordable Care Act, “in order to have their drugs covered under the Medicare Part D program, drug manufacturers will provide a 50% discount to Part D beneficiaries for brand-name drugs and biologics purchased during the coverage gap beginning July 1, 2010. The initial coverage limit in the standard Part D benefit will be expanded by $500 for 2010.”