[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5187 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5187

 To require the Secretary of Health and Human Services to establish a 
   commission that is designed to construct a comprehensive national 
   strategy on how to increase the affordability, accessibility, and 
        effectiveness of long-term care and community services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 29, 2010

 Mr. Hastings of Florida (for himself, Mr. McGovern, Mrs. Christensen, 
 Ms. Corrine Brown of Florida, Mr. Cleaver, Mr. Conyers, Mr. Davis of 
 Illinois, Ms. DeLauro, Mr. Filner, Ms. Lee of California, Mr. Meek of 
 Florida, Mr. Meeks of New York, Ms. Norton, Ms. Richardson, Mr. Rush, 
 and Mr. Thompson of Mississippi) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Health and Human Services to establish a 
   commission that is designed to construct a comprehensive national 
   strategy on how to increase the affordability, accessibility, and 
        effectiveness of long-term care and community services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Commission on Improving Long-Term 
Care and Community Services Act of 2010''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Long-term care refers to a broad range and network of 
        health and social services that are used by persons who cannot 
        care for themselves independently because of a physical, 
        cognitive, or mental disability, or a combination thereof.
            (2) Well over 9,400,000 adults receive long-term care in 
        the United States, and over 1,000,000 children living in the 
        community have long-term care limitations.
            (3) The number of people who are in need of long-term care 
        is expected to grow due to the Nation's large aging population, 
        longer life spans among the chronically ill and persons living 
        with disabilities, and the higher incidence of acquired 
        disabilities from unmanaged conditions such as heart and 
        respiratory disease, obesity, stroke, and diabetes.
            (4) Most people with long-term care needs prefer to live at 
        home and remain in their communities. These individuals receive 
        assistance primarily through informal caregivers, families, and 
        friends who provide care without compensation.
            (5) Family caregivers can endure emotional and physical 
        stress, and often make significant financial and career 
        sacrifices to provide long-term care.
            (6) Formal providers range from institutional settings and 
        other residential care facilities to a variety of agencies and 
        organizations that provide a wide array of home and community-
        based services such as personal care, home-delivered meals 
        programs, transportation, and adult day care programs.
            (7) Direct care workers provide the majority of paid long-
        term care services to individuals with long-term care 
        limitations. Health care providers have expressed difficulty in 
        attracting and retaining direct care workers and the demand for 
        these workers is expected to increase.
            (8) Planning for long-term care expenses is an essential 
        part of financial planning, however, most individuals and 
        families do not plan for such expenses.
            (9) Identifying and arranging for long-term care services 
        can be a complex task for individuals and their families. 
        Uneven distribution of services in communities and across 
        States and United States territories often leads to 
        difficulties in accessing services.
            (10) A significant portion of formal long-term care costs 
        are financed with personal funds and this method of payment 
        potentially poses economic burdens to individuals and their 
        families that can result in financial ruin, including medical 
        bankruptcy.
            (11) The largest public payer for long-term care is 
        Medicaid, which allows States to enforce strict requirements 
        for eligibility, and discourages some Medicaid recipients from 
        acquiring a higher income for fear of losing Medicaid benefits.
            (12) Decisions pertaining to long-term care are often 
        emotionally charged and culturally contentious, and present 
        emotional and financial challenges for patients, families, and 
        their providers.
            (13) Although the financing and delivery of long-term care 
        plays a strong role in the way that such care is provided and 
        received, there has never been a comprehensive national plan 
        for the long-term care, particularly regarding home and 
        community-based services.
            (14) The last time that Congress comprehensively reviewed 
        policy options for long-term care reform was nearly two decades 
        ago, under a U.S. Bipartisan Commission on Comprehensive Health 
        Care referred to as the Pepper Commission.
            (15) Limited data on the use and need for long-term care 
        exists thereby hindering the development of a targeted national 
        strategy to address the disparities in routine access to these 
        services.
            (16) Personal choice, access, cost (including reimbursement 
        policy), effectiveness, and quality standards must be 
        adequately addressed when composing a national strategy for 
        long-term care.

SEC. 3. ESTABLISHMENT; POLICY RECOMMENDATIONS AND COMPREHENSIVE 
              NATIONAL STRATEGY.

    (a) Establishment.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services (in 
this Act referred to as the ``Secretary'') shall establish a commission 
(in this Act referred to as the ``Commission'') that is designed to 
construct a comprehensive national strategy (described in subsection 
(b)(2)) on how to increase the affordability, accessibility, and 
effectiveness of long-term care and community services in the United 
States and United States Territories.
    (b) Policy Recommendations and Comprehensive National Strategy.--
            (1) Policy recommendations.--The Commission's policy 
        recommendations under this Act must address economic, 
        geographic, cultural, social, transportation, workforce, and 
        other factors that limit access to quality home, community, and 
        institutional services that can result in the need for more 
        costly and less effective care, compromise the financial, 
        mental, and physical well-being of caregivers, compromise the 
        independence, mental health, physical health and dignity of 
        individuals, or result in the foregoing of needed services.
            (2) Comprehensive national strategy.--The comprehensive 
        national strategy described in this paragraph shall be 
        developed not later than 2 years after the date of the 
        enactment of this Act and shall provide recommendations on how 
        to--
                    (A) facilitate and maintain necessary changes in 
                business practices, public policy, care processes, and 
                administrative systems to support a consumer-oriented 
                long-term care system that delivers efficient, cost-
                effective, and consumer-centered care and services;
                    (B) address issues of waste, fraud, and abuse by 
                providers, agencies, facilities, professional and 
                paraprofessional staff, and others involved in 
                institutional, home, and community health settings by 
                targeting chronically poor performing providers, 
                decertifying persistently substandard providers, and 
                monitoring institutional, home, and community entities 
                to ensure compliance with State and Federal quality 
                standards and criteria;
                    (C) make priorities of preventive health and the 
                effective management of chronic diseases such as heart 
                and respiratory disease, diabetes, HIV/AIDS, stroke, 
                and obesity, in order to prevent them from becoming 
                permanently debilitating or disabling and help decrease 
                future dependence on long-term care;
                    (D) establish and support existing and future 
                evidence-based research efforts among States, 
                government entities, organizations, and stakeholders 
                that are designed to address gaps in data and knowledge 
                about long-term care and the populations in need of 
                these services, and provide information on the 
                effectiveness and consequences of long-term care 
                programs and policies;
                    (E) facilitate partnership and coordination among 
                State and Federal health care entities to improve 
                working conditions, training, management, requirements, 
                and competencies for long-term care workers 
                (particularly home health aides and other 
                paraprofessionals) to prevent turnover rates, staff 
                shortages, patient abuse, and improve job skills, job 
                satisfaction, and delivery of care;
                    (F) identify and address flaws in reimbursement 
                policies for long-term care services through Medicare 
                under title XVIII of the Social Security Act and 
                Medicaid under title XIX of such Act, and decrease the 
                reliance on out-of-pocket-spending for long-term care;
                    (G) improve access to affordable and safe housing 
                and transportation options for persons requiring long-
                term care and community services;
                    (H) increase access to home and community-based 
                services through Medicaid to meet consumer demands and 
                preferences and emphasize cost-effective non-
                institutional care alternatives that provide 
                satisfaction and high quality care to all those 
                requiring long-term care services;
                    (I) assist agencies and the private sector on 
                effectively disseminating information to consumers 
                about the various types of long-term care networks and 
                options available to consumers, educate consumers about 
                the potential benefits and risks of certain long-care 
                options, and inform consumers about State-specific 
                information regarding long-term care services;
                    (J) increase the use and affordability of long-term 
                care insurance and other fiscally responsible measures 
                to finance long-term care services;
                    (K) sufficiently fund and support programs, 
                facilities, and initiatives that have proven to 
                ameliorate the financial, physical, and mental stress 
                on informal caregivers, and improve their ability to 
                deliver services to individuals requiring long-term 
                care; and
                    (L) sufficiently fund and support programs, 
                entities, and initiatives that have proven to help 
                individuals achieve and maintain their highest possible 
                level of independence, health, and function.
        The comprehensive national strategy would include as available, 
        pursuant to request by the Committee to the Congressional 
        Budget Office, an analysis of the costs and savings that would 
        result from executing this comprehensive strategy on long-term 
        care to the extent possible.

SEC. 4. MEMBERSHIP.

    (a) In General.--The Commission shall be composed of 15 members who 
are appointed by the President and who are from Federal agencies such 
as the Social Security Administration, Institute of Medicine, 
Administration on Aging, Centers for Disease Control, Centers for 
Medicare and Medicaid Services, Health Resources Services 
Administration, and other national stakeholders.
    (b) Terms.--Each member shall be appointed for the life of the 
Commission.
    (c) Vacancies.--A vacancy in the Commission shall be filled in the 
manner in which the original appointment was made.
    (d) Basic Pay.--Members of the Commission shall serve without pay.
    (e) Travel Expenses.--Each member shall receive travel expenses, 
including per diem in lieu of subsistence, in accordance with sections 
5702 and 5703 of title 5, United States Code.
    (f) Quorum.--8 members of the Commission shall constitute a quorum 
but a lesser number may hold hearings.

SEC. 5. CHAIRPERSON.

    (a) In General.--The Chairperson of the Commission shall be elected 
by the members not later than 30 days after the date on which all of 
the original members of the Commission have been appointed.
    (b) Presidential Appointment.--If the members of the Commission are 
unable to elect the Chairperson in accordance with subsection (a), the 
President shall appoint a member of the Commission to be the 
Chairperson.

SEC. 6. MEETINGS.

    The Commission shall meet at the call of the Chairperson.

SEC. 7. STAFF.

    (a) In General.--
            (1) Appointment and compensation.--The Chairperson, in 
        accordance with rules agreed upon by the Commission, may 
        appoint and fix the compensation of a staff director and such 
        other personnel as may be necessary to enable the Commission to 
        carry out its duties, without regard to the provisions of title 
        5, United States Code, governing appointments in the 
        competitive service, and without regard to the provisions of 
        chapter 51 and subchapter III of chapter 53 of such title 
        relating to classification and General Schedule pay rates, 
        except that no rate of pay fixed under this subsection may 
        exceed the equivalent of that payable for a position at level 
        IV of the Executive Schedule under section 5316 of title 5, 
        United States Code.
            (2) Personnel as federal employees.--
                    (A) In general.--The staff director and any 
                personnel of the Commission who are employees shall be 
                employees under section 2105 of title 5, United States 
                Code, for purposes of chapters 63, 81, 83, 84, 85, 87, 
                89, and 90 of that title.
                    (B) Members of the commission.--Subparagraph (A) 
                shall not apply to members of the Commission.
    (b) Detailees.--Any Federal Government employee may be detailed to 
the Commission with reimbursement from the Commission, and such 
detailee shall retain the rights, status, and privileges of his or her 
regular employment without interruption.
    (c) Expert and Consultant Services.--The Commission is authorized 
to procure the services of experts and consultants in accordance with 
section 3109 of title 5, United States Code, but at rates not to exceed 
the daily rate paid to a person occupying a position at level IV of the 
Executive Schedule under section 5315 of title 5, United States Code.
    (d) Volunteer Services.--Notwithstanding section 1342 of title 31, 
United States Code, the Commission may accept and use voluntary and 
uncompensated services as the Commission determines necessary.

SEC. 8. POWERS.

    (a) Hearings and Sessions.--The Commission may, for the purpose of 
carrying out this Act, hold hearings, sit and act at times and places, 
take testimony, and receive evidence as the Commission considers 
appropriate. The Commission may administer oaths or affirmations to 
witnesses appearing before it.
    (b) Powers of Members and Agents.--Any member or agent of the 
Commission may, if authorized by the Commission, take any action which 
the Commission is authorized to take by this section.
    (c) Obtaining Official Data.--The Commission may secure directly 
from any Federal department or agency information necessary to enable 
it to carry out this Act. Upon request of the Chairperson of the 
Commission, the head of that department or agency shall provide that 
information to the Commission.
    (d) Mail.--The Commission may use the United States mail in the 
same manner and under the same conditions as other Federal departments 
and agencies.
    (e) Administrative Support Services.--Upon the request of the 
Commission, the Administrator of General Services shall provide to the 
Commission, on a reimbursable basis, the administrative support 
services necessary for the Commission to carry out its responsibilities 
under this Act.

SEC. 9. REPORT.

    Not later than 2 years after the date on which all original members 
have been appointed to the Commission, the Commission shall transmit to 
the President, Congress, and the general public a report that contains 
a detailed statement of the findings and policy recommendations of the 
Commission, including the comprehensive national strategy described in 
section 3(b)(2).

SEC. 10. APPLICATION OF FEDERAL ADVISORY COMMITTEE ACT.

    The Federal Advisory Committee Act (5 U.S.C. App.) (other than 
section 14(a)(2)(B), relating to the termination of advisory 
committees) shall apply to the Commission.

SEC. 11. TERMINATION.

    (a) In General.--The Commission shall terminate 60 days after the 
date of submission of the report under section 9.
    (b) Administrative Activities Before Termination.--The Commission 
may use the 60-day period referred to in subsection (a) for the purpose 
of concluding its activities, including providing testimony to 
committees of Congress concerning the report under section 9.

SEC. 12. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated such sums as are necessary 
for use in the development and implementation of plans under this Act.
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