One of the more anticipated provisions in the Patient Protection and Affordable Care Act (PPACA) is the implementation of the CLASS program in 2011. The program is a voluntary, self-funded public long-term care insurance program. The original legislation was one of the final legacies from the late Senator Ted Kennedy, intended to help those who are functionally impaired maintain independence.

The CLASS Independence Benefit plan will allow purchase of community-living assistance services and supports for those with functional limitations. The Department of Health and Human Services (HHS) is mandated to develop a sound benefit plan that will be solvent for 75 years, and will allow for a five-year vesting period for eligibility benefits. In addition, HHS will create benefit triggers to allow the determination of functional limitation, and a cash benefit not less than an average of $50 per day. Taxpayer funds will not be used for benefits.

The benefit will trigger when a person is unable to perform at least two activities of daily living for at least 90 days. Activities of daily living include eating, toileting, transferring, bathing, and dressing. An eligible beneficiary is one who has paid premiums for at least 60 months and at least 12 consecutive months.

HHS will establish procedures to allow for voluntary automatic enrollment by employers, as well as alternative enrollment processes for the self-employed, employees of non-participating employers, spouses and others. Individuals may waive enrollment. The premiums will be deducted from wages or self-employment income.

The benefits other than cash will include advocacy services, advice and assistance counseling. The cash benefits will be paid into a Life Independence Account for purchase of non-medical services and supports that help the beneficiary remain independent in the home or another residential setting. That can include home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance service, home care aides and nursing support.

A CLASS Independence Fund will be established and set in the Department of the Treasury. In addition, a CLASS Independence Advisory Council will be created with up to 15 members named by the president. The Council will include representatives of individuals who participate or are likely to participate in the CLASS program. The Council will serve to advise on matters of general policy relating to CLASS.

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