The purpose of this subchapter is to establish a national voluntary insurance program for purchasing community living assistance services and supports in order to—
(1) provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community through a new financing strategy for community living assistance services and supports;
(2) establish an infrastructure that will help address the Nation's community living assistance services and supports needs;
(3) alleviate burdens on family caregivers; and
(4) address institutional bias by providing a financing mechanism that supports personal choice and independence to live in the community.
(July 1, 1944, ch. 373, title XXXII, §3201, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 828.)
Pub. L. 111–148, title VIII, §8002(e), Mar. 23, 2010, 124 Stat. 847, provided that: “The amendments made by subsections (a), (b), and (d) [enacting this subchapter, amending section 1396a of this title, and amending provisions set out as a note under section 1396p of this title] take effect on January 1, 2011.”
Pub. L. 111–148, title VIII, §8002(f), Mar. 23, 2010, 124 Stat. 847, provided that: “Nothing in this title [enacting this subchapter, amending section 1396a of this title, enacting provisions set out as notes under this section and section 201 of this title, and amending provisions set out as a note under section 1396p of this title] or the amendments made by this title are [sic] intended to replace or displace public or private disability insurance benefits, including such benefits that are for income replacement.”
Pub. L. 111–148, title VIII, §8002(c), Mar. 23, 2010, 124 Stat. 846, provided that:
“(1)
“(2)
“(A) Individuals with disabilities of all ages.
“(B) Senior individuals.
“(C) Representatives of individuals with disabilities.
“(D) Representatives of senior individuals.
“(E) Representatives of workforce and labor organizations.
“(F) Representatives of home and community-based service providers.
“(G) Representatives of assisted living providers.”
In this subchapter:
The term “active enrollee” means an individual who is enrolled in the CLASS program in accordance with section 300ll–3 of this title and who has paid any premiums due to maintain such enrollment.
The term “actively employed” means an individual who—
(A) is reporting for work at the individual's usual place of employment or at another location to which the individual is required to travel because of the individual's employment (or in the case of an individual who is a member of the uniformed services, is on active duty and is physically able to perform the duties of the individual's position); and
(B) is able to perform all the usual and customary duties of the individual's employment on the individual's regular work schedule.
The term “activities of daily living” means each of the following activities specified in section 7702B(c)(2)(B) of title 26:
(A) Eating.
(B) Toileting.
(C) Transferring.
(D) Bathing.
(E) Dressing.
(F) Continence.
The term “CLASS program” means the program established under this subchapter.
The term “Eligibility Assessment System” means the entity established by the Secretary under section 300ll–4(a)(2) of this title to make functional eligibility determinations for the CLASS program.
The term “eligible beneficiary” means any individual who is an active enrollee in the CLASS program and, as of the date described in subparagraph (B)—
(i) has paid premiums for enrollment in such program for at least 60 months;
(ii) has earned, with respect to at least 3 calendar years that occur during the first 60 months for which the individual has paid premiums for enrollment in the program, at least an amount equal to the amount of wages and self-employment income which an individual must have in order to be credited with a quarter of coverage under section 213(d) of the Social Security Act [42 U.S.C. 413(d)] for the year; and
(iii) has paid premiums for enrollment in such program for at least 24 consecutive months, if a lapse in premium payments of more than 3 months has occurred during the period that begins on the date of the individual's enrollment and ends on the date of such determination.
For purposes of subparagraph (A), the date described in this subparagraph is the date on which the individual is determined to have a functional limitation described in section 300ll–2(a)(1)(C) of this title that is expected to last for a continuous period of more than 90 days.
The Secretary shall promulgate regulations specifying exceptions to the minimum earnings requirements under subparagraph (A)(ii) for purposes of being considered an eligible beneficiary for certain populations.
The terms “hospital”, “nursing facility”, “intermediate care facility for the mentally retarded”, and “institution for mental diseases” have the meanings given such terms for purposes of Medicaid.
The term “CLASS Independence Advisory Council” or “Council” means the Advisory Council established under section 300ll–6 of this title to advise the Secretary.
The term “CLASS Independence Benefit Plan” means the benefit plan developed and designated by the Secretary in accordance with section 300ll–2 of this title.
The term “CLASS Independence Fund” or “Fund” means the fund established under section 300ll–5 of this title.
The term “Medicaid” means the program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
The term “poverty line” has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).
The term “Protection and Advocacy System” means the system for each State established under section 15043 of this title.
(July 1, 1944, ch. 373, title XXXII, §3202, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 828.)
The Social Security Act, referred to in par. (11), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to subchapter XIX (§1396 et seq.) of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
The Secretary, in consultation with appropriate actuaries and other experts, shall develop at least 3 actuarially sound benefit plans as alternatives for consideration for designation by the Secretary as the CLASS Independence Benefit Plan under which eligible beneficiaries shall receive benefits under this subchapter. Each of the plan alternatives developed shall be designed to provide eligible beneficiaries with the benefits described in section 300ll–4 of this title consistent with the following requirements:
Beginning with the first year of the CLASS program, and for each year thereafter, subject to clauses (ii) and (iii), the Secretary shall establish all premiums to be paid by enrollees for the year based on an actuarial analysis of the 75-year costs of the program that ensures solvency throughout such 75-year period.
The monthly premium for enrollment in the CLASS program shall not exceed the applicable dollar amount per month determined under subclause (II) for—
(aa) any individual whose income does not exceed the poverty line; and
(bb) any individual who has not attained age 22, and is actively employed during any period in which the individual is a full-time student (as determined by the Secretary).
The applicable dollar amount described in this subclause is the amount equal to $5, increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) for each year occurring after 2009 and before such year.
At such time as the CLASS program has been in operation for 10 years, the Secretary shall establish all premiums to be paid by enrollees for the year based on an actuarial analysis that accumulated reserves in the CLASS Independence Fund would not decrease in that year. At such time as the Secretary determines the CLASS program demonstrates a sustained ability to finance expected yearly expenses with expected yearly premiums and interest credited to the CLASS Independence Fund, the Secretary may decrease the required amount of CLASS Independence Fund reserves.
A 5-year vesting period for eligibility for benefits.
A benefit trigger for provision of benefits that requires a determination that an individual has a functional limitation, as certified by a licensed health care practitioner, described in any of the following clauses that is expected to last for a continuous period of more than 90 days:
(i) The individual is determined to be unable to perform at least the minimum number (which may be 2 or 3) of activities of daily living as are required under the plan for the provision of benefits without substantial assistance (as defined by the Secretary) from another individual.
(ii) The individual requires substantial supervision to protect the individual from threats to health and safety due to substantial cognitive impairment.
(iii) The individual has a level of functional limitation similar (as determined under regulations prescribed by the Secretary) to the level of functional limitation described in clause (i) or (ii).
Payment of a cash benefit that satisfies the following requirements:
The benefit amount provides an eligible beneficiary with not less than an average of $50 per day (as determined based on the reasonably expected distribution of beneficiaries receiving benefits at various benefit levels).
The benefit amount is varied based on a scale of functional ability, with not less than 2, and not more than 6, benefit level amounts.
The benefit is paid on a daily or weekly basis.
The benefit is not subject to any lifetime or aggregate limit.
The CLASS Independence Advisory Council shall—
(A) evaluate the alternative benefit plans developed under paragraph (1); and
(B) recommend for designation as the CLASS Independence Benefit Plan for offering to the public the plan that the Council determines best balances price and benefits to meet enrollees’ needs in an actuarially sound manner, while optimizing the probability of the long-term sustainability of the CLASS program.
Not later than October 1, 2012, the Secretary, taking into consideration the recommendation of the CLASS Independence Advisory Council under paragraph (2)(B), shall designate a benefit plan as the CLASS Independence Benefit Plan. The Secretary shall publish such designation, along with details of the plan and the reasons for the selection by the Secretary, in a final rule that allows for a period of public comment.
Except as provided in subparagraphs (B), (C), (D), and (E), the amount of the monthly premium determined for an individual upon such individual's enrollment in the CLASS program shall remain the same for as long as the individual is an active enrollee in the program.
Subject to clause (ii), if the Secretary determines, based on the most recent report of the Board of Trustees of the CLASS Independence Fund, the advice of the CLASS Independence Advisory Council, and the annual report of the Inspector General of the Department of Health and Human Services, and waste, fraud, and abuse, or such other information as the Secretary determines appropriate, that the monthly premiums and income to the CLASS Independence Fund for a year are projected to be insufficient with respect to the 20-year period that begins with that year, the Secretary shall adjust the monthly premiums for individuals enrolled in the CLASS program as necessary (but maintaining a nominal premium for enrollees whose income is below the poverty line or who are full-time students actively employed).
Any increase in a monthly premium imposed as result of a determination described in clause (i) shall not apply with respect to the monthly premium of any active enrollee who—
(I) has attained age 65;
(II) has paid premiums for enrollment in the program for at least 20 years; and
(III) is not actively employed.
The reenrollment of an individual after a 90-day period during which the individual failed to pay the monthly premium required to maintain the individual's enrollment in the CLASS program shall be treated as an initial enrollment for purposes of age-adjusting the premium for reenrollment in the program.
An individual who reenrolls in the CLASS program after such a 90-day period and before the end of the 5-year period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual's enrollment in the program shall be—
(I) credited with any months of paid premiums that accrued prior to the individual's lapse in enrollment; and
(II) notwithstanding the total amount of any such credited months, required to satisfy section 300ll–1(6)(A)(ii) of this title before being eligible to receive benefits.
An individual subject to a nominal premium on the basis of being described in subsection (a)(1)(A)(ii)(I)(bb) who ceases to be described in that subsection, beginning with the first month following the month in which the individual ceases to be so described, shall be subject to the same monthly premium as the monthly premium that applies to an individual of the same age who first enrolls in the program under the most similar circumstances as the individual (such as the first year of eligibility for enrollment in the program or in a subsequent year).
In the case of an individual who reenrolls in the CLASS program after the end of the 5-year period described in subparagraph (C)(ii), the monthly premium required for the individual shall be the age-adjusted premium that would be applicable to an initially enrolling individual who is the same age as the reenrolling individual, increased by the greater of—
(i) an amount that the Secretary determines is actuarially sound for each month that occurs during the period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual's enrollment in the CLASS program and ends with the month preceding the month in which the reenollment is effective; or
(ii) 1 percent of the applicable age-adjusted premium for each such month occurring in such period.
In determining the monthly premiums for the CLASS program the Secretary may factor in costs for administering the program, not to exceed for any year in which the program is in effect under this subchapter, an amount equal to 3 percent of all premiums paid during the year.
No underwriting (other than on the basis of age in accordance with subparagraphs (D) and (E) of paragraph (1)) shall be used to—
(A) determine the monthly premium for enrollment in the CLASS program; or
(B) prevent an individual from enrolling in the program.
The Secretary shall establish procedures to—
(1) permit an individual who is eligible for the nominal premium required under subsection (a)(1)(A)(ii) to self-attest that their income does not exceed the poverty line or that their status as a full-time student who is actively employed; 1
(2) verify, using procedures similar to the procedures used by the Commissioner of Social Security under section 1383(e)(1)(B)(ii) of this title and consistent with the requirements applicable to the conveyance of data and information under section 1396w–2 of this title, the validity of such self-attestation; and
(3) require an individual to confirm, on at least an annual basis, that their income does not exceed the poverty line or that they continue to maintain such status.
(July 1, 1944, ch. 373, title XXXII, §3203, as added and amended Pub. L. 111–148, title VIII, §8002(a)(1), title X, §10801(a)(1), Mar. 23, 2010, 124 Stat. 830, 1015.)
2010—Subsec. (a)(1)(E). Pub. L. 111–148, §10801(a)(1)(A), struck out subpar. (E). Text read as follows: “The benefits allow for coordination with any supplemental coverage purchased through an Exchange established under section 18031 of this title.”
Subsec. (b)(1)(C)(i). Pub. L. 111–148, §10801(a)(1)(B), substituted “for reenrollment” for “for enrollment”.
Subsec. (c)(1). Pub. L. 111–148, §10801(a)(1)(C), struck out “, as part of their automatic enrollment in the CLASS program,” after “subsection (a)(1)(A)(ii)”.
Subject to paragraph (2), the Secretary, in coordination with the Secretary of the Treasury, shall establish procedures under which each individual described in subsection (c) may be automatically enrolled in the CLASS program by an employer of such individual in the same manner as an employer may elect to automatically enroll employees in a plan under section 401(k), 403(b), or 457 of title 26.
The procedures established under paragraph (1) shall provide for an alternative enrollment process for an individual described in subsection (c) in the case of such an individual—
(A) who is self-employed;
(B) who has more than 1 employer; or
(C) whose employer does not elect to participate in the automatic enrollment process established by the Secretary.
The Secretary and the Secretary of the Treasury shall, by regulation, establish procedures to ensure that an individual is not automatically enrolled in the CLASS program by more than 1 employer.
Enrollment in the CLASS program shall be made in such manner as the Secretary may prescribe in order to ensure ease of administration.
An individual described in subsection (c) may elect to waive enrollment in the CLASS program at any time in such form and manner as the Secretary and the Secretary of the Treasury shall prescribe.
For purposes of enrolling in the CLASS program, an individual described in this paragraph is an individual—
(1) who has attained age 18;
(2) who—
(A) receives wages or income on which there is imposed a tax under section 3101(a) or 3201(a) of title 26; or
(B) derives self-employment income on which there is imposed a tax under section 1401(a) of title 26;
(3) who is actively employed; and
(4) who is not—
(A) a patient in a hospital or nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental diseases and receiving medical assistance under Medicaid; or
(B) confined in a jail, prison, other penal institution or correctional facility, or by court order pursuant to conviction of a criminal offense or in connection with a verdict or finding described in section 402(x)(1)(A)(ii) of this title.
Nothing in this subchapter shall be construed as requiring an active enrollee to continue to satisfy subparagraph (A) or (B) of subsection (c)(2) in order to maintain enrollment in the CLASS program.
An amount equal to the monthly premium for the enrollment in the CLASS program of an individual shall be deducted from the wages or self-employment income of such individual in accordance with such procedures as the Secretary, in coordination with the Secretary of the Treasury, shall establish for employers who elect to deduct and withhold such premiums on behalf of enrolled employees.
The Secretary, in coordination with the Secretary of the Treasury, shall establish alternative procedures for the payment of monthly premiums by an individual enrolled in the CLASS program—
(A) who does not have an employer who elects to deduct and withhold premiums in accordance with paragraph (1); or
(B) who does not earn wages or derive self-employment income.
During each calendar year the Secretary of the Treasury shall deposit into the CLASS Independence Fund a total amount equal, in the aggregate, to 100 percent of the premiums collected during that year.
The amount deposited pursuant to paragraph (1) shall be transferred in at least monthly payments to the CLASS Independence Fund on the basis of estimates by the Secretary and certified to the Secretary of the Treasury of the amounts collected in accordance with subparagraphs (A) and (B) of paragraph (5).1 Proper adjustments shall be made in amounts subsequently transferred to the Fund to the extent prior estimates were in excess of, or were less than, actual amounts collected.
The Secretary, in coordination with the Secretary of the Treasury, shall establish procedures under which—
(1) an individual who, in the year of the individual's initial eligibility to enroll in the CLASS program, has not enrolled in the program, is eligible to elect to enroll in the program, in such form and manner as the Secretaries shall establish, only during an open enrollment period established by the Secretaries that is specific to the individual and that may not occur more frequently than biennially after the date on which the individual first elected to waive enrollment in the program; and
(2) an individual shall only be permitted to disenroll from the program (other than for nonpayment of premiums) during an annual disenrollment period established by the Secretaries and in such form and manner as the Secretaries shall establish.
(July 1, 1944, ch. 373, title XXXII, §3204, as added and amended Pub. L. 111–148, title VIII, §8002(a)(1), title X, §10801(a)(2), Mar. 23, 2010, 124 Stat. 834, 1015.)
2010—Subsec. (c)(2)(A). Pub. L. 111–148, §10801(a)(2)(A), added subpar. (A) and struck out former subpar. (A) which read as follows: “receives wages on which there is imposed a tax under section 3201(a) of title 26; or”.
Subsec. (d). Pub. L. 111–148, §10801(a)(2)(B), substituted “subparagraph (A) or (B) of subsection (c)(2)” for “subparagraph (B) or (C) of subsection (c)(1)”.
Subsec. (e)(2)(A). Pub. L. 111–148, §10801(a)(2)(C), substituted “paragraph (1)” for “subparagraph (A)”.
Subsec. (g)(1). Pub. L. 111–148, §10801(a)(2)(D), substituted “has not enrolled” for “has elected to waive enrollment”.
1 So in original. No par. (5) has been enacted.
The Secretary shall establish procedures under which an active enrollee shall apply for receipt of benefits under the CLASS Independence Benefit Plan.
Not later than January 1, 2012, the Secretary shall—
(i) establish an Eligibility Assessment System (other than a service with which the Commissioner of Social Security has entered into an agreement, with respect to any State, to make disability determinations for purposes of title II or XVI of the Social Security Act [42 U.S.C. 401 et seq., 1381 et seq.]) to provide for eligibility assessments of active enrollees who apply for receipt of benefits;
(ii) enter into an agreement with the Protection and Advocacy System for each State to provide advocacy services in accordance with subsection (d); and
(iii) enter into an agreement with public and private entities to provide advice and assistance counseling in accordance with subsection (e).
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, as certified by a licensed health care practitioner, including whether an active enrollee is eligible for a cash benefit under the program and if so, the amount of the cash benefit (in accordance 1 the sliding scale established under the plan).
An active enrollee shall be deemed presumptively eligible if the enrollee—
(i) has applied for, and attests is eligible for, the maximum cash benefit available under the sliding scale established under the CLASS Independence Benefit Plan;
(ii) is a patient in a hospital (but only if the hospitalization is for long-term care), nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases; and
(iii) is in the process of, or about to begin the process of, planning to discharge from the hospital, facility, or institution, or within 60 days from the date of discharge from the hospital, facility, or institution.
The Secretary shall establish procedures under which an applicant for benefits under the CLASS Independence Benefit Plan shall be guaranteed the right to appeal an adverse determination.
An eligible beneficiary shall receive the following benefits under the CLASS Independence Benefit Plan:
A cash benefit established by the Secretary in accordance with the requirements of section 300ll–2(a)(1)(D) of this title that—
(A) the first year in which beneficiaries receive the benefits under the plan, is not less than the average dollar amount specified in clause (i) of such section; and
(B) for any subsequent year, is not less than the average per day dollar limit applicable under this subparagraph for the preceding year, increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) over the previous year.
Advocacy services in accordance with subsection (d).
Advice and assistance counseling in accordance with subsection (e).
Advocacy services and advise and assistance counseling services under paragraphs (2) and (3) of this subsection shall be included as administrative expenses under section 300ll–2(b)(2) 2 of this title.
The Secretary shall establish procedures for administering the provision of benefits to eligible beneficiaries under the CLASS Independence Benefit Plan, including the payment of the cash benefit for the beneficiary into a Life Independence Account established by the Secretary on behalf of each eligible beneficiary.
Cash benefits paid into a Life Independence Account of an eligible beneficiary shall be used to purchase nonmedical services and supports that the beneficiary needs to maintain his or her independence at home or in another residential setting of their choice in the community, including (but not limited to) home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support. Nothing in the preceding sentence shall prevent an eligible beneficiary from using cash benefits paid into a Life Independence Account for obtaining assistance with decision making concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under State law, such as a living will or durable power of attorney for health care, in the case that an injury or illness causes the individual to be unable to make health care decisions.
The Secretary shall establish procedures for—
(i) crediting an account established on behalf of a beneficiary with the beneficiary's cash daily benefit;
(ii) allowing the beneficiary to access such account through debit cards; and
(iii) accounting for withdrawals by the beneficiary from such account.
In the case of an eligible beneficiary who is enrolled in Medicaid, the following payment rules shall apply:
If the beneficiary is a patient in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall retain an amount equal to 5 percent of the beneficiary's daily or weekly cash benefit (as applicable) (which shall be in addition to the amount of the beneficiary's personal needs allowance provided under Medicaid), and the remainder of such benefit shall be applied toward the facility's cost of providing the beneficiary's care, and Medicaid shall provide secondary coverage for such care.
Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for home and community based services, the beneficiary shall retain an amount equal to 50 percent of the beneficiary's daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such assistance (and shall not be used to claim Federal matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance.
A State shall be paid the remainder of a beneficiary's daily or weekly cash benefit under subclause (I) only if the State home and community-based waiver under section 1115 of the Social Security Act (42 U.S.C. 1315) or subsection (c) or (d) of section 1915 of such Act (42 U.S.C. 1396n), or the State plan amendment under subsection (i) of such section does not include a waiver of the requirements of section 1902(a)(1) of the Social Security Act [42 U.S.C. 1396a(a)(1)] (relating to statewideness) or of section 1902(a)(10)(B) of such Act [42 U.S.C. 1396a(a)(10)(B)] (relating to comparability) and the State offers at a minimum case management services, personal care services, habilitation services, and respite care under such a waiver or State plan amendment.
In this clause, the term “home and community-based services” means any services which may be offered under a home and community-based waiver authorized for a State under section 1115 of the Social Security Act (42 U.S.C. 1315) or subsection (c) or (d) of section 1915 of such Act (42 U.S.C. 1396n) or under a State plan amendment under subsection (i) of such section.
Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for PACE program services under section 1934 of the Social Security Act (42 U.S.C. 1396u–4), the beneficiary shall retain an amount equal to 50 percent of the beneficiary's daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such assistance (and shall not be used to claim Federal matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance.
If a beneficiary receiving assistance under Medicaid for PACE program services is a patient in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall be treated as in 3 institutionalized beneficiary under clause (i).
The Secretary shall establish procedures to allow access to a beneficiary's cash benefits by an authorized representative of the eligible beneficiary on whose behalf such benefits are paid.
The procedures established under subparagraph (A) shall ensure that authorized representatives of eligible beneficiaries comply with standards of conduct established by the Secretary, including standards requiring that such representatives provide quality services on behalf of such beneficiaries, do not have conflicts of interest, and do not misuse benefits paid on behalf of such beneficiaries or otherwise engage in fraud or abuse.
Benefits shall be paid to, or on behalf of, an eligible beneficiary beginning with the first month in which an application for such benefits is approved.
An eligible beneficiary may elect to—
(A) defer payment of their daily or weekly benefit and to rollover any such deferred benefits from month-to-month, but not from year-to-year; and
(B) receive a lump-sum payment of such deferred benefits in an amount that may not exceed the lesser of—
(i) the total amount of the accrued deferred benefits; or
(ii) the applicable annual benefit.
The applicable period for determining with respect to an eligible beneficiary the applicable annual benefit and the amount of any accrued deferred benefits is the 12-month period that commences with the first month in which the beneficiary began to receive such benefits, and each 12-month period thereafter.
The Secretary shall establish procedures under which cash benefits paid to an eligible beneficiary that increase or decrease as a result of a change in the functional status of the beneficiary before the end of a 12-month benefit period shall be included in the determination of the applicable annual benefit paid to the eligible beneficiary.
The Secretary, in coordination with the Secretary of the Treasury, shall recoup any accrued benefits in the event of—
(I) the death of a beneficiary; or
(II) the failure of a beneficiary to elect under paragraph (4)(B) to receive such benefits as a lump-sum payment before the end of the 12-month period in which such benefits accrued.
Any benefits recouped in accordance with clause (i) shall be paid into the CLASS Independence Fund and used in accordance with section 300ll–5 of this title.
An eligible beneficiary shall periodically, as determined by the Secretary—
(A) recertify by submission of medical evidence the beneficiary's continued eligibility for receipt of benefits; and
(B) submit records of expenditures attributable to the aggregate cash benefit received by the beneficiary during the preceding year.
Subject to the Medicaid payment rules under paragraph (1)(D), benefits received by an eligible beneficiary shall supplement, but not supplant, other health care benefits for which the beneficiary is eligible under Medicaid or any other Federally funded program that provides health care benefits or assistance.
An agreement entered into under subsection (a)(2)(A)(ii) shall require the Protection and Advocacy System for the State to—
(1) assign, as needed, an advocacy counselor to each eligible beneficiary that is covered by such agreement and who shall provide an eligible beneficiary with—
(A) information regarding how to access the appeals process established for the program;
(B) assistance with respect to the annual recertification and notification required under subsection (c)(6); and
(C) such other assistance with obtaining services as the Secretary, by regulation, shall require; and
(2) ensure that the System and such counselors comply with the requirements of subsection (h).
An agreement entered into under subsection (a)(2)(A)(iii) shall require the entity to assign, as requested by an eligible beneficiary that is covered by such agreement, an advice and assistance counselor who shall provide an eligible beneficiary with information regarding—
(1) accessing and coordinating long-term services and supports in the most integrated setting;
(2) possible eligibility for other benefits and services;
(3) development of a service and support plan;
(4) information about programs established under the Assistive Technology Act of 1998 [29 U.S.C. 3001 et seq.] and the services offered under such programs;
(5) available assistance with decision making concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under State law, such as a living will or durable power of attorney for health care, in the case that an injury or illness causes the individual to be unable to make health care decisions; and
(6) such other services as the Secretary, by regulation, may require.
Benefits paid to an eligible beneficiary under the CLASS program shall be disregarded for purposes of determining or continuing the beneficiary's eligibility for receipt of benefits under any other Federal, State, or locally funded assistance program, including benefits paid under titles 4 II, XVI, XVIII, XIX, or XXI of the Social Security Act (42 U.S.C. 401 et seq., 1381 et seq., 1395 et seq., 1396 et seq., 1397aa et seq.), under the laws administered by the Secretary of Veterans Affairs, under low-income housing assistance programs, or under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).
Nothing in this subchapter shall be construed as prohibiting benefits paid under the CLASS Independence Benefit Plan from being used to compensate a family caregiver for providing community living assistance services and supports to an eligible beneficiary.
The Secretary shall establish procedures to ensure that the Eligibility Assessment System, the Protection and Advocacy System for a State, advocacy counselors for eligible beneficiaries, and any other entities that provide services to active enrollees and eligible beneficiaries under the CLASS program comply with the following:
(1) If the entity provides counseling or planning services, such services are provided in a manner that fosters the best interests of the active enrollee or beneficiary.
(2) The entity has established operating procedures that are designed to avoid or minimize conflicts of interest between the entity and an active enrollee or beneficiary.
(3) The entity provides information about all services and options available to the active enrollee or beneficiary, to the best of its knowledge, including services available through other entities or providers.
(4) The entity assists the active enrollee or beneficiary to access desired services, regardless of the provider.
(5) The entity reports the number of active enrollees and beneficiaries provided with assistance by age, disability, and whether such enrollees and beneficiaries received services from the entity or another entity.
(6) If the entity provides counseling or planning services, the entity ensures that an active enrollee or beneficiary is informed of any financial interest that the entity has in a service provider.
(7) The entity provides an active enrollee or beneficiary with a list of available service providers that can meet the needs of the active enrollee or beneficiary.
(July 1, 1944, ch. 373, title XXXII, §3205, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 836.)
The Social Security Act, referred to in subsecs. (a)(2)(A)(i) and (f), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles II, XVI, XVIII, XIX, and XXI of the Act are classified generally to subchapters II (§401 et seq.), XVI (§1381 et seq.), XVIII (§1395 et seq.), XIX (§1396 et seq.), and XXI (§1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
Section 300ll–2(b)(2) of this title, referred to in subsec. (b)(4), was in the original section “3203(b)(3)”, and was translated as meaning section 3203(b)(2) of act July 1, 1944, to reflect the probable intent of Congress.
The Assistive Technology Act of 1998, referred to in subsec. (e)(4), is Pub. L. 105–394, Nov. 13, 1998, 112 Stat. 3627, which is classified principally to chapter 31 (§3001 et seq.) of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 3001 of Title 29 and Tables.
The Food and Nutrition Act of 2008, referred to in subsec. (f), is Pub. L. 88–525, Aug. 31, 1964, 78 Stat. 703, which is classified generally to chapter 51 (§2011 et seq.) of Title 7, Agriculture. For complete classification of this Act to the Code, see Short Title note set out under section 2011 of Title 7 and Tables.
1 So in original. Probably should be followed by “with”.
2 See References in Text note below.
3 So in original. Probably should be “an”.
4 So in original. Probably should be “title”.
There is established in the Treasury of the United States a trust fund to be known as the “CLASS Independence Fund”. The Secretary of the Treasury shall serve as Managing Trustee of such Fund. The Fund shall consist of all amounts derived from payments into the Fund under sections 300ll–3(f) and 300ll–4(c)(5)(C)(ii) of this title, and remaining after investment of such amounts under subsection (b), including additional amounts derived as income from such investments. The amounts held in the Fund are appropriated and shall remain available without fiscal year limitation—
(1) to be held for investment on behalf of individuals enrolled in the CLASS program;
(2) to pay the administrative expenses related to the Fund and to investment under subsection (b); and
(3) to pay cash benefits to eligible beneficiaries under the CLASS Independence Benefit Plan.
The Secretary of the Treasury shall invest and manage the CLASS Independence Fund in the same manner, and to the same extent, as the Federal Supplementary Medical Insurance Trust Fund may be invested and managed under subsections (c), (d), and (e) of section 1395t 1 of this title.
With respect to the CLASS Independence Fund, there is hereby created a body to be known as the Board of Trustees of the CLASS Independence Fund (hereinafter in this section referred to as the “Board of Trustees”) composed of the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services, all ex officio, and of two members of the public (both of whom may not be from the same political party), who shall be nominated by the President for a term of 4 years and subject to confirmation by the Senate. A member of the Board of Trustees serving as a member of the public and nominated and confirmed to fill a vacancy occurring during a term shall be nominated and confirmed only for the remainder of such term. An individual nominated and confirmed as a member of the public may serve in such position after the expiration of such member's term until the earlier of the time at which the member's successor takes office or the time at which a report of the Board is first issued under paragraph (2) after the expiration of the member's term. The Secretary of the Treasury shall be the Managing Trustee of the Board of Trustees. The Board of Trustees shall meet not less frequently than once each calendar year. A person serving on the Board of Trustees shall not be considered to be a fiduciary and shall not be personally liable for actions taken in such capacity with respect to the Trust Fund.
It shall be the duty of the Board of Trustees to do the following:
(i) Hold the CLASS Independence Fund.
(ii) Report to the Congress not later than the first day of April of each year on the operation and status of the CLASS Independence Fund during the preceding fiscal year and on its expected operation and status during the current fiscal year and the next 2 fiscal years.
(iii) Report immediately to the Congress whenever the Board is of the opinion that the amount of the CLASS Independence Fund is not actuarially sound in regards to the projection under section 300ll–2(b)(1)(B)(i) of this title.
(iv) Review the general policies followed in managing the CLASS Independence Fund, and recommend changes in such policies, including necessary changes in the provisions of law which govern the way in which the CLASS Independence Fund is to be managed.
The report provided for in subparagraph (A)(ii) shall—
(i) include—
(I) a statement of the assets of, and the disbursements made from, the CLASS Independence Fund during the preceding fiscal year;
(II) an estimate of the expected income to, and disbursements to be made from, the CLASS Independence Fund during the current fiscal year and each of the next 2 fiscal years;
(III) a statement of the actuarial status of the CLASS Independence Fund for the current fiscal year, each of the next 2 fiscal years, and as projected over the 75-year period beginning with the current fiscal year; and
(IV) an actuarial opinion by the Chief Actuary of the Centers for Medicare & Medicaid Services certifying that the techniques and methodologies used are generally accepted within the actuarial profession and that the assumptions and cost estimates used are reasonable; and
(ii) be printed as a House document of the session of the Congress to which the report is made.
If the Board of Trustees determines that enrollment trends and expected future benefit claims on the CLASS Independence Fund are not actuarially sound in regards to the projection under section 300ll–2(b)(1)(B)(i) of this title and are unlikely to be resolved with reasonable premium increases or through other means, the Board of Trustees shall include in the report provided for in subparagraph (A)(ii) recommendations for such legislative action as the Board of Trustees determine 2 to be appropriate, including whether to adjust monthly premiums or impose a temporary moratorium on new enrollments.
(July 1, 1944, ch. 373, title XXXII, §3206, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 842.)
Section 1395t of this title, referred to in subsec. (b), was in the original “section 1841(d) of the Social Security Act”, and was translated as meaning section 1841 of act Aug. 14, 1935, ch. 531, to reflect the probable intent of Congress.
1 See References in Text note below.
2 So in original. Probably should be “determines”.
There is hereby created an Advisory Committee to be known as the “CLASS Independence Advisory Council”.
The CLASS Independence Advisory Council shall be composed of not more than 15 individuals, not otherwise in the employ of the United States—
(A) who shall be appointed by the President without regard to the civil service laws and regulations; and
(B) a majority of whom shall be representatives of individuals who participate or are likely to participate in the CLASS program, and shall include representatives of older and younger workers, individuals with disabilities, family caregivers of individuals who require services and supports to maintain their independence at home or in another residential setting of their choice in the community,1 individuals with expertise in long-term care or disability insurance, actuarial science, economics, and other relevant disciplines, as determined by the Secretary.
The members of the CLASS Independence Advisory Council shall serve overlapping terms of 3 years (unless appointed to fill a vacancy occurring prior to the expiration of a term, in which case the individual shall serve for the remainder of the term).
A member shall not be eligible to serve for more than 2 consecutive terms.
The President shall, from time to time, appoint one of the members of the CLASS Independence Advisory Council to serve as the Chair.
The CLASS Independence Advisory Council shall advise the Secretary on matters of general policy in the administration of the CLASS program established under this subchapter and in the formulation of regulations under this subchapter including with respect to—
(1) the development of the CLASS Independence Benefit Plan under section 300ll–2 of this title;
(2) the determination of monthly premiums under such plan; and
(3) the financial solvency of the program.
The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14 of that Act, shall apply to the CLASS Independence Advisory Council.
There are authorized to be appropriated to the CLASS Independence Advisory Council to carry out its duties under this section, such sums as may be necessary for fiscal year 2011 and for each fiscal year thereafter.
Any sums appropriated under the authorization contained in this section shall remain available, without fiscal year limitation, until expended.
(July 1, 1944, ch. 373, title XXXII, §3207, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 844.)
The Federal Advisory Committee Act, referred to in subsec. (d), is Pub. L. 92–463, Oct. 6, 1972, 86 Stat. 770, which is set out in the Appendix to Title 5, Government Organization and Employees.
1 So in original. The word “and” probably should appear.
The Secretary shall regularly consult with the Board of Trustees of the CLASS Independence Fund and the CLASS Independence Advisory Council, for purposes of ensuring that enrollees 1 premiums are adequate to ensure the financial solvency of the CLASS program, both with respect to fiscal years occurring in the near-term and fiscal years occurring over 20- and 75-year periods, taking into account the projections required for such periods under subsections (a)(1)(A)(i) and (b)(1)(B)(i) of section 300ll–2 2 of this title.
No taxpayer funds shall be used for payment of benefits under a CLASS Independent Benefit Plan. For purposes of this subsection, the term “taxpayer funds” means any Federal funds from a source other than premiums deposited by CLASS program participants in the CLASS Independence Fund and any associated interest earnings.
The Secretary shall promulgate such regulations as are necessary to carry out the CLASS program in accordance with this subchapter. Such regulations shall include provisions to prevent fraud and abuse under the program.
Beginning January 1, 2014, the Secretary shall submit an annual report to Congress on the CLASS program. Each report shall include the following:
(1) The total number of enrollees in the program.
(2) The total number of eligible beneficiaries during the fiscal year.
(3) The total amount of cash benefits provided during the fiscal year.
(4) A description of instances of fraud or abuse identified during the fiscal year.
(5) Recommendations for such administrative or legislative action as the Secretary determines is necessary to improve the program, ensure the solvency of the program, or to prevent the occurrence of fraud or abuse.
(July 1, 1944, ch. 373, title XXXII, §3208, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 845.)
Section 300ll–2 of this title, referred to in subsec. (a), was in the original section “3202”, and was translated as meaning section 3203 of act July 1, 1944, to reflect the probable intent of Congress. Section 3202, which is classified to section 300ll–1 of this title, does not contain a subsec. (a) or (b).
1 So in original. Probably should be “enrollees’ ”.
2 See References in Text note below.
The Inspector General of the Department of Health and Human Services shall submit an annual report to the Secretary and Congress relating to the overall progress of the CLASS program and of the existence of waste, fraud, and abuse in the CLASS program. Each such report shall include findings in the following areas:
(1) The eligibility determination process.
(2) The provision of cash benefits.
(3) Quality assurance and protection against waste, fraud, and abuse.
(4) Recouping of unpaid and accrued benefits.
(July 1, 1944, ch. 373, title XXXII, §3209, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 845.)
The CLASS program shall be treated for purposes of title 26 in the same manner as a qualified long-term care insurance contract for qualified long-term care services.
(July 1, 1944, ch. 373, title XXXII, §3210, as added Pub. L. 111–148, title VIII, §8002(a)(1), Mar. 23, 2010, 124 Stat. 846.)