1.This Act may be cited as the
Commission on Improving Long-Term Care
and Community Services Act of 2010
.
2.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.
3.Establishment;
policy recommendations and comprehensive national strategy
(a)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)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 strategyThe 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.4.
(a)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)Each member shall be appointed for the life
of the Commission.
(c)A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
(d)Members of the Commission
shall serve without pay.
(e)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)8 members of the Commission shall
constitute a quorum but a lesser number may hold hearings.
5.
(a)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)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.
6.The Commission shall meet at the call of the
Chairperson.
7.
(a)
(1)Appointment and
compensationThe 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)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
commissionSubparagraph (A) shall not apply to members of the
Commission.
(b)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 servicesThe 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)Notwithstanding section 1342 of title 31, United States
Code, the Commission may accept and use voluntary and uncompensated services as
the Commission determines necessary.
8.
(a)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 agentsAny 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)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)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 servicesUpon 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.
9.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).
10.Application of
Federal Advisory Committee ActThe 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.
11.
(a)The Commission shall
terminate 60 days after the date of submission of the report under section
9.
(b)Administrative
Activities Before TerminationThe 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.
12.Authorization of
appropriationsThere are
authorized to be appropriated such sums as are necessary for use in the
development and implementation of plans under this Act.