Análisis y diagnóstico situacional de la actividad de faenado del

This title may be cited as the “Community Living Assistance Services and Supports Act” or the “CLASS Act”.

8002. The Community Living Assistance Services and Supports (CLASS) Act.

The Community Living Assistance Services and Supports (CLASS) Act is established as Title XXXII of the Public Health Service Act (Sections 3201-3210.)

Enrollment and disenrollment: An individual eligible for enrollment in the CLASS program is someone age 18 or over, who is actively employed, and who is not institutionalized in a health care or correctional facility. The Secretary of HHS, in coordination with the Secretary of Treasury will establish procedures for automatic enrollment of individuals in the CLASS program by their employers. Alternative procedures for enrollment will be established for self-employed individuals, those with more than one employer, and those whose employer does not elect to participate. Employees may opt-out of enrollment. The Secretary will establish biennial individual specific open enrollment periods for individuals who waive enrollment during their initial enrollment period, and disenrollment periods. The Secretary is to issue regulations for exceptions to the minimum earnings requirement.

Premiums: CLASS premiums shall be deducted from wages or self-employment income in accordance with established procedures. Alternative procedures will be established for employees of employers who do not participate and for those who do not earn wages or self-employment income. Premium payments will be deposited in the CLASS

Independence Fund. The tax treatment for the CLASS program shall be the same as for qualified long-term care insurance programs.

CLASS premiums amounts paid by enrollees will be based on an actuarial analysis of the 75 year costs for the program to assure program solvency. Nominal premiums of $5

per month (indexed annually to the CPI-U for each year after 2009) shall be established for individuals below poverty and for full-time students under age 22. The Secretary shall establish procedures for self-attestation and verification of income for those paying the nominal premium. Premiums may include up to 3% to cover program administrative costs. No underwriting shall be used to determine the premium or prevent enrollment in the program. Monthly premiums shall remain the same for an individual active enrollee for as long as the enrollee is in the program, with the following exceptions: premiums can be increased as necessary if the Secretary determines that the CLASS

Independence Fund is projected to be insufficient for the next 20 year period (the increase shall not apply to those paying the nominal premium; those age 65 and over; those who have paid premiums for at least 20 years; or those not actively employed); individuals with a 90 day lapse in premium payments will have their premium adjusted to their age at reenrollment but will receive credit for premiums paid if reenrollment occurs within 5 years of the lapse; individuals who cease to be full-time students; and

individuals reenrolling after a 5 year lapse shall pay a monthly 1% penalty or an amount determined actuarially sound by the Secretary.

CLASS Independence Benefit Plan: The Secretary of HHS, in consultation with

actuaries and experts, is to develop at least 3 actuarially sound benefit plan alternatives. The CLASS Independence Advisory Council shall evaluate the alternative benefit plans and recommend to the Secretary of HHS the one which best balances price and benefits as the one to be designated as the CLASS benefit plan offered to the public. The

Secretary shall designate the CLASS Independence Benefit Plan by October 1, 2010, in a final rule that allows for public comment.

Benefits eligibility: To be eligible for benefits an individual must: be an active enrollee in the CLASS program; have paid CLASS premiums for at least 60 months; have earned income of at least the amount one must have in order to be credited with a quarter of Social Security coverage for at least 3 calendar years during the 60 month period; and have paid CLASS premiums for at least 24 consecutive months if a lapse of premium payments of more than 3 months has occurred.

Benefit triggers: Benefits trigger upon a determination by a licensed health care practitioner that the individual has a functional limitation expected to last for at least 90 continuous days. The functional limitation must consist of one of the following: an inability to perform at least the minimum (2 or 3) activities of daily living (ADL) required under the plan; the individual requires substantial supervision due to cognitive

impairment; or the individual has a functional limitation similar to, as prescribed in regulations, the above situations. Beneficiaries must recertify eligibility periodically by submitting medical evidence of continued eligibility and submitting records of

expenditures attributable to the cash benefit during the preceding year.

By January 1, 2012, the Secretary of HHS will establish an eligibility assessment

system, enter into an agreement with the protection and advocacy system for each state, and enter in an agreement with public and private entities to provide counseling. The Secretary shall promulgate regulations to develop an expedited nationally equitable eligibility determination process, as certified by a licensed health care practitioner, an appeals process and a redetermination process, including whether an active enrollee is eligible for cash benefit and, if so, the amount of benefit. An enrollee is presumptively eligible if the enrollee has applied for and attested to be eligible for the maximum cash benefit available under the CLASS plan; is a patient in a hospital, nursing facility, or

mental institution, and is in the process of discharge from the facility within 60 days or is within 60 days after discharge. CLASS benefits shall be disregarded for purposes of determining eligibility for other government programs.

Cash benefits: The minimum cash benefit is an average of $50 per day. There will be between 2 and 6 benefit levels, based on a scale of functional ability. The benefit is paid daily or weekly and is not subject to lifetime or aggregate limits. The benefits must allow for coordination with any supplemental benefits purchased through a health insurance Exchange. Benefit payments for a beneficiary will be deposited into a Life Independence Account established by the Secretary for the individual. The cash benefits shall be used to purchase nonmedical services and supports the beneficiary needs to maintain independence at home or in a residential setting in the community, including, but not limited to, home modification, assistive technology, accessible transportation,

homemaker services, respite care, personal assistance, home care aides, and nursing support. Funds may also be used to obtain assistance with decision-making

concerning medical care. Institutionalized Medicaid beneficiaries and PACE enrollees shall retain 5% of their cash benefit (50% for home and community-based care) and in both cases the reminder is applied toward the State’s costs for care. Medicaid is

secondary payor. CLASS funds may not be claimed by the state as Medicaid matching funds.

Account funds shall be electronically managed, including crediting of deposits of benefits, accessing funds through debit cards, and accounting for beneficiary

withdrawals. Beneficiaries may opt to defer daily or weekly payments and receive a lump sum later for up to a year, but may not roll over benefits from year-to-year.

Benefits also include advocacy services and advice and assistance counseling. The agreement with a state shall require the Protection and Advocacy System to assign a counselor to each eligible beneficiary to provide information on access to the appeals process, assistance with annual recertification and notification; and other assistance as required by regulation. The agreements with entities to provide advice and assistance counseling shall require the entity to assign each beneficiary a counselor to provide information regarding accessing and coordinating long-term care services and supports; possible eligibility for other benefits and services; development of a service and support plan; information about the Assistive Technology Act of 1998 programs; and other services required by regulation.

CLASS Independence Fund (“Fund”): The Fund is established in the U.S. Treasury. The Secretary of Treasury is the trustee of the Fund and shall invest and manage the Fund in the same manner as the Medicare Part B (SMI) Trust Fund. The Board of Trustees for the Fund shall consist of the Secretaries Treasury, Labor and HHS, and 2 public trustees (from different political parties) nominated to 4-year terms by the President and confirmed by the Senate.

The Board must report to Congress by April 1 of each year on the status of the Fund and on its expected status for the subsequent and next 2 fiscal years. The report to

Congress must include a statement of Fund assets and disbursements during the

preceding fiscal year; an estimate of expected income and disbursements for the current and each of the next 2 fiscal years; a statement of the actuarial status of the Fund for the current year and each of the next 2 fiscal years, and as projected over the next 75 years; and an actuarial opinion by the Chief Actuary of the Centers for Medicare and Medicaid

Services (CMS) certifying that the methods used are generally acceptable and the cost estimates are reasonable. If the Board determines that the Fund is not actuarially sound and that premium increases will not be sufficient to resolve shortages, it is to make recommendations for necessary legislative action including whether to adjust premiums or to impose a moratorium on enrollment.

CLASS Independence Advisory Council (“Council”): The Council shall be composed of up to 15 members who are not federal employees, are appointed by the President, and a majority of whom are representative of CLASS program participants. Members shall serve overlapping 3-year terms and shall not be eligible to serve more than 2 terms. The President is to appoint the Chairman. Duties of the Council include advising the Secretary on matters of general policy and regulations related to the CLASS benefit plan, the determination of premiums, and the financial solvency of the program. FACA shall apply.

Beginning 1/1/2014 the Secretary of HHS shall submit an annual report to Congress that includes for the fiscal year: enrollment; eligible beneficiaries; amount of cash benefit payments; instances of fraud or abuse; and recommendations for administrative or legislative action necessary to improve the program, ensure solvency or prevent fraud and abuse.

The Inspector General of HHS is to submit an annual report to the Secretary of HHS and to Congress on waste, fraud, and abuse in the CLASS program including the eligibility determination process; payment of cash benefits; quality assurance and protection against waste, fraud and abuse; and recoupment of unpaid and accrued benefits. Information on the CLASS program is to be included in the National Clearinghouse for Long-term Care Information.

State requirements: Each state is required, within 2 years of enactment, to assess the extent to which entities are serving or have the capacity to serve as fiscal agents for, employers of, and providers of employment-related benefits for personal care attendant workers who provide care for CLASS beneficiaries, including in rural and underserved areas; create entities to ensure an adequate supply of such workers; and ensure that the creation of such entities will not negatively alter or impede existing programs.

Personal Care Attendants Workforce Advisory Panel (“Panel”): The Panel is to be

established within 90 days of enactment by the Secretary of HHS to examine and advise on workforce issues related to personal care attendant workers including adequacy of the number of such workers, their compensation, and access to their services. Members appointed to the Panel shall include individuals with disabilities of all ages and their representatives; seniors and their representatives; workforce and labor representatives; representatives of home and community-based service providers; representatives of assisted living providers.

TITLE IX--REVENUE PROVISIONS