A Comprehensive Approach To Long-Term Services & Supports

September 23, 2013
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Rick Gawenda
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Five members of the Commission on Long Term Care issued an alternative report on September 23, 2013 outlining and discussing their recommendations to address the challenges facing our country’s long-term services and supports (LTSS) system. To transform today’s inadequate LTSS system into one that works, the Commission recommends the creation of a new system and, until it is established, improvements to existing public programs to better meet the needs of older adults and younger people with disabilities. The recommendations are as follows:

1. Create a Broader Financing Solution
2. Adopt a National Strategy to Improve and Strengthen the LTSS Workforce
3. Adopt a National Strategy to Recognize and Support Families in their Caregiving Role
4. Strengthen, Broaden and Improve Medicare’s Post-Acute Care Benefit
5. Strengthen and Improve Medicaid
6. Provide New Ways to Access LTSS for People with Disabilities

Recommendation 4 has implications for therapy services provided in the home, skilled nursing facilities, and outpatient therapy. To meet the needs of those who qualify for Medicare, the current Medicare program must be adapted to reduce counterproductive, outdated and unreasonable barriers to outpatient therapies, home health and skilled nursing facility care.

  • Remove the 3-day hospital stay requirement for SNF coverage so people without the need for an acute inpatient hospital stay can at least get some Medicare nursing facility coverage.
  • Revise the homebound requirement for Medicare home health coverage so that people who cannot obtain the services they need outside the home can obtain them at home.
  • Eliminate hospital “observation status,” or, at a minimum, count all days spent in the hospital as “inpatient” for purposes of qualifying for Medicare coverage for subsequent medically necessary SNF stays.
  • Eliminate annual caps on physical, speech and occupational therapy services so people with LTSS needs can receive the therapy services they need in the community throughout the year.
  • Ensure that the Jimmo v. Sebelius settlement is effectively implemented, to eliminate the “improvement standard” requirement for determining Medicare coverage, and ensuring coverage is available for skilled services to maintain an individual’s condition or slow deterioration.To read the full report, click HERE.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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