Federal Regulatory Guidance and Actions: Community Living Assistance Services and Supports (CLASS Act)

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CAD flagThis is one in a series of NCSL documents offering assistance to states in interpreting and implementing the Affordable Care Act.

Community Living Assistance Services and Supports (CLASS Act)

Establishes a new, voluntary, self-funded public long‐term care insurance program, to be known as the CLASS Independence Benefit Plan, for the purchase of community living assistance services and supports by individuals with functional limitations. Requires the Secretary to develop an actuarially sound benefit plan that ensures solvency for 75 years; allows for a five‐year vesting period for eligibility of benefits; creates benefit triggers that allow for the determination of functional limitation; and provides cash benefit that is not less than an average of $50 per day. No taxpayer funds will be used to pay benefits under this provision.

Creates a new national insurance program to help adults who have or develop functional impairments to remain independent, employed and stay a part of their communities.

  • Financed through voluntary payroll deductions (with opt-out enrollment similar to Medicare Part B), this program will remove barriers to independence and choice (e.g., housing modifications, assistive technologies, personal assistance services, transportation) by providing a cash benefit to individuals unable to perform two or more functional activities of daily living.

Definitions

  • “Active enrollee” means an individual who has enrolled and paid premiums to maintain enrollment. “Activities of daily living” include eating, toileting, transferring, bathing, dressing, and 9 continence or the cognitive equivalent.
  • An “eligible beneficiary” has paid premiums for at least 60 months and for at least 12 consecutive months. (§ 3203) CLASS Independent Benefit Plan
  • Directs the Secretary of Health & Human Services to develop two alternative benefit plans within specified limits.
  • The monthly maximum premiums will be set by the Secretary to ensure 75 years of solvency.
  • There is a five year vesting period for benefit eligibility.
  • The benefit triggers when an individual is unable to perform not less than two activities of daily living for at least 90 days.
  • The cash benefit will be not less than $50 per day.
  • Not later than Oct. 1, 2012, the Secretary will designate a CLASS benefit plan, taking into consideration the recommendations of the CLASS Independence Advisory Council.

Enrollment and Disenrollment

  • The Secretary will establish procedures to allow for voluntary automatic enrollment by employers, as well as alternative enrollment processes for self-employed, employees of non-participating employers, spouses and others. Individuals may choose to waive enrollment in CLASS in a form and manner to be established by the Secretary.
  • Premiums will be deducted from wages or self-employment income according to procedures established by the Secretary.

CLASS Independence Fund

  • The CLASS Independence Fund will be located in the Department of the Treasury and the Secretary of the Treasury will act as the Managing Trustee.
  • A CLASS Independence Fund Board of Trustees will include the Commissioner of Social Security, the Secretary of the Treasury, the Secretary of Labor, the Secretary of Health & Human Services, and two members of the public.
CLASS Independence Advisory Council
  • The CLASS Independence Advisory Council, created under this Title, will include not more than 15 members, named by the President, a majority of whom will include representatives of individuals who participate or are likely to participate in the CLASS program.
  • The Council will advise the Secretary on matters of general policy relating to CLASS.