Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA) Page: 4 of 18
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Community Living Assistance Services and Supports (CLASS) Provisions in PPACA
The aging of the population is expected to increase the demand for long-term care (LTC) services
over the next three decades. The cost of obtaining paid help for these services may far exceed
many individuals' financial resources. Also, public programs that finance this care, such as
Medicaid or Medicare, are limited in scope. To address gaps in LTC coverage and assist
individuals and families in paying for such services, on March 23, 2010, the President signed into
law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as
amended by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010 [HCERA]).
PPACA establishes a federally administered voluntary LTC insurance program entitled the
Community Living Assistance Services and Supports (CLASS) program.
This report first discusses the cost and financing for LTC services as well as the current market
for private LTC insurance. It then details those CLASS program requirements for enrollment,
premiums, eligibility, benefits, administration, and oversight. The report also discusses federal
budget implications, as estimated by the Congressional Budget Office (CBO) and the Centers for
Medicare and Medicaid Services (CMS). Finally, the report provides a timeline of the CLASS
program provisions enacted under PPACA.
Cost and Financing of Long-Term Care Services
Unlike medical treatments, LTC services and supports primarily assist individuals in their day-to-
day activities of daily living (ADLs).' While medical services are typically provided to treat
specific acute and chronic conditions in a health care setting, these services are different from
LTC services. Specifically, LTC services include a wide range of health and social services and
supports provided to individuals who have functional disabilities or cognitive impairments over
an extended period of time, with the goal of maximizing their ability to live independently.2 The
probability of needing LTC services increases with age. One study has estimated that more than
two-thirds of individuals who reach the age of 65 will require LTC services at some point before
For those individuals who need LTC, the costs of providing such care will depend on the setting,
intensity (including the skill level of the provider), and the duration of LTC services provided. For
example, the care may be provided in an individual's private home, in a community-residential
care setting such as an assisted living facility, or in an institutional setting such as a nursing home.
For those receiving care at home, the cost will vary depending on the skill level of the paid
caregiver. In 2009, the average cost of personal unskilled care at home (such as bathing, dressing,
and transferring from a bed or chair) was $19 an hour, whereas skilled care from a visiting nurse
was $46 an hour.4 In addition, the cost of care will also vary by intensity and duration of care.
1 These "activities of daily living" or ADLs include bathing, dressing, eating, toileting, and transferring (from a bed to a
chair or vice-versa). Instrumental activities of daily living include things like food preparation, medication
management, and housekeeping.
2 C. Evashwick, "The Continuum of Long-Term Care: An Integrated Systems Approach," 2004.
3 P. Kemper, H.L. Komisar, and L. Alecxih, "Long-Term Care Over An Uncertain Future: What Can Future Retirees
Expect?" Inquiry 42, winter 2005-2006.
4 Genworth Financial 2009 Cost of Care Survey, April 2009, at http://www.genworth.com/content/etc/medialib/
Congressional Research Service
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Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA), report, July 20, 2010; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc806921/m1/4/: accessed February 23, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.