I 

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 longterm care and community services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Commission on Im3 proving Long-Term Care and Community Services Act of 

4 2010’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) Long-term care refers to a broad range and 

8 network of health and social services that are used 

9 by persons who cannot care for themselves independ10 ently because of a physical, cognitive, or mental dis11 ability, or a combination thereof. 

12 (2) Well over 9,400,000 adults receive long13 term care in the United States, and over 1,000,000 

14 children living in the community have long-term care 

15 limitations. 

16 (3) The number of people who are in need of 

17 long-term care is expected to grow due to the Na18 tion’s large aging population, longer life spans 

19 among the chronically ill and persons living with dis20 abilities, and the higher incidence of acquired dis21 abilities from unmanaged conditions such as heart 

22 and respiratory disease, obesity, stroke, and diabe23 tes. 

24 (4) Most people with long-term care needs pre25 fer to live at home and remain in their communities. 

26 These individuals receive assistance primarily 


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1 through informal caregivers, families, and friends 

2 who provide care without compensation. 

3 (5) Family caregivers can endure emotional and 

4 physical stress, and often make significant financial 

5 and career sacrifices to provide long-term care. 

6 (6) Formal providers range from institutional 

7 settings and other residential care facilities to a vari8 ety of agencies and organizations that provide a 

9 wide array of home and community-based services 

10 such as personal care, home-delivered meals pro11 grams, transportation, and adult day care programs. 

12 (7) Direct care workers provide the majority of 

13 paid long-term care services to individuals with long14 term care limitations. Health care providers have ex15 pressed difficulty in attracting and retaining direct 

16 care workers and the demand for these workers is 

17 expected to increase. 

18 (8) Planning for long-term care expenses is an 

19 essential part of financial planning, however, most 

20 individuals and families do not plan for such ex21 penses. 

22 (9) Identifying and arranging for long-term 

23 care services can be a complex task for individuals 

24 and their families. Uneven distribution of services in 

25 communities and across States and United States 


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1 territories often leads to difficulties in accessing 

2 services. 

3 (10) A significant portion of formal long-term 

4 care costs are financed with personal funds and this 

5 method of payment potentially poses economic bur6 dens to individuals and their families that can result 

7 in financial ruin, including medical bankruptcy. 

8 (11) The largest public payer for long-term care 

9 is Medicaid, which allows States to enforce strict re10 quirements for eligibility, and discourages some 

11 Medicaid recipients from acquiring a higher income 

12 for fear of losing Medicaid benefits. 

13 (12) Decisions pertaining to long-term care are 

14 often emotionally charged and culturally contentious, 

15 and present emotional and financial challenges for 

16 patients, families, and their providers. 

17 (13) Although the financing and delivery of 

18 long-term care plays a strong role in the way that 

19 such care is provided and received, there has never 

20 been a comprehensive national plan for the long21 term care, particularly regarding home and commu22 nity-based services. 

23 (14) The last time that Congress comprehen24 sively reviewed policy options for long-term care re25 form was nearly two decades ago, under a U.S. BiVerDate Mar 15 2010 00:05 May 01, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5187.IH H5187

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1 partisan Commission on Comprehensive Health Care 

2 referred to as the Pepper Commission. 

3 (15) Limited data on the use and need for long4 term care exists thereby hindering the development 

5 of a targeted national strategy to address the dis6 parities in routine access to these services. 

7 (16) Personal choice, access, cost (including re8 imbursement policy), effectiveness, and quality 

9 standards must be adequately addressed when com10 posing a national strategy for long-term care. 

11 SEC. 3. ESTABLISHMENT; POLICY RECOMMENDATIONS AND 

12 COMPREHENSIVE NATIONAL STRATEGY. 

13 (a) ESTABLISHMENT.—Not later than 90 days after 

14 the date of the enactment of this Act, the Secretary of 

15 Health and Human Services (in this Act referred to as 

16 the ‘‘Secretary’’) shall establish a commission (in this Act 

17 referred to as the ‘‘Commission’’) that is designed to con18 struct a comprehensive national strategy (described in 

19 subsection (b)(2)) on how to increase the affordability, ac20 cessibility, and effectiveness of long-term care and commu21 nity services in the United States and United States Terri22 tories. 

23 (b) POLICY RECOMMENDATIONS AND COMPREHEN24 SIVE NATIONAL STRATEGY.— 


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1 (1) POLICY RECOMMENDATIONS.—The Commis2 sion’s policy recommendations under this Act must 

3 address economic, geographic, cultural, social, trans4 portation, workforce, and other factors that limit ac5 cess to quality home, community, and institutional 

6 services that can result in the need for more costly 

7 and less effective care, compromise the financial, 

8 mental, and physical well-being of caregivers, com9 promise the independence, mental health, physical 

10 health and dignity of individuals, or result in the 

11 foregoing of needed services. 

12 (2) COMPREHENSIVE NATIONAL STRATEGY.— 

13 The comprehensive national strategy described in 

14 this paragraph shall be developed not later than 2 

15 years after the date of the enactment of this Act and 

16 shall provide recommendations on how to— 

17 (A) facilitate and maintain necessary 

18 changes in business practices, public policy, 

19 care processes, and administrative systems to 

20 support a consumer-oriented long-term care 

21 system that delivers efficient, cost-effective, and 

22 consumer-centered care and services; 

23 (B) address issues of waste, fraud, and 

24 abuse by providers, agencies, facilities, profes25 sional and paraprofessional staff, and others inVerDate Mar 15 2010 00:05 May 01, 2010 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5187.IH H5187

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1 volved in institutional, home, and community 

2 health settings by targeting chronically poor 

3 performing providers, decertifying persistently 

4 substandard providers, and monitoring institu5 tional, home, and community entities to ensure 

6 compliance with State and Federal quality 

7 standards and criteria; 

8 (C) make priorities of preventive health 

9 and the effective management of chronic dis10 eases such as heart and respiratory disease, di11 abetes, HIV/AIDS, stroke, and obesity, in order 

12 to prevent them from becoming permanently de13 bilitating or disabling and help decrease future 

14 dependence on long-term care; 

15 (D) establish and support existing and fu16 ture evidence-based research efforts among 

17 States, government entities, organizations, and 

18 stakeholders that are designed to address gaps 

19 in data and knowledge about long-term care 

20 and the populations in need of these services, 

21 and provide information on the effectiveness 

22 and consequences of long-term care programs 

23 and policies; 

24 (E) facilitate partnership and coordination 

25 among State and Federal health care entities to 


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1 improve working conditions, training, manage2 ment, requirements, and competencies for long3 term care workers (particularly home health 

4 aides and other paraprofessionals) to prevent 

5 turnover rates, staff shortages, patient abuse, 

6 and improve job skills, job satisfaction, and de7 livery of care; 

8 (F) identify and address flaws in reim9 bursement policies for long-term care services 

10 through Medicare under title XVIII of the So11 cial Security Act and Medicaid under title XIX 

12 of such Act, and decrease the reliance on out13 of-pocket-spending for long-term care; 

14 (G) improve access to affordable and safe 

15 housing and transportation options for persons 

16 requiring long-term care and community serv17 ices; 

18 (H) increase access to home and commu19 nity-based services through Medicaid to meet 

20 consumer demands and preferences and empha21 size cost-effective non-institutional care alter22 natives that provide satisfaction and high qual23 ity care to all those requiring long-term care 

24 services; 


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1 (I) assist agencies and the private sector 

2 on effectively disseminating information to con3 sumers about the various types of long-term 

4 care networks and options available to con5 sumers, educate consumers about the potential 

6 benefits and risks of certain long-care options, 

7 and inform consumers about State-specific in8 formation regarding long-term care services; 

9 (J) increase the use and affordability of 

10 long-term care insurance and other fiscally re11 sponsible measures to finance long-term care 

12 services; 

13 (K) sufficiently fund and support pro14 grams, facilities, and initiatives that have prov15 en to ameliorate the financial, physical, and 

16 mental stress on informal caregivers, and im17 prove their ability to deliver services to individ18 uals requiring long-term care; and 

19 (L) sufficiently fund and support pro20 grams, entities, and initiatives that have proven 

21 to help individuals achieve and maintain their 

22 highest possible level of independence, health, 

23 and function. 

24 The comprehensive national strategy would include 

25 as available, pursuant to request by the Committee 


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1 to the Congressional Budget Office, an analysis of 

2 the costs and savings that would result from exe3 cuting this comprehensive strategy on long-term care 

4 to the extent possible. 

5 SEC. 4. MEMBERSHIP. 

6 (a) IN GENERAL.—The Commission shall be com7 posed of 15 members who are appointed by the President 

8 and who are from Federal agencies such as the Social Se9 curity Administration, Institute of Medicine, Administra10 tion on Aging, Centers for Disease Control, Centers for 

11 Medicare and Medicaid Services, Health Resources Serv12 ices Administration, and other national stakeholders. 

13 (b) TERMS.—Each member shall be appointed for the 

14 life of the Commission. 

15 (c) VACANCIES.—A vacancy in the Commission shall 

16 be filled in the manner in which the original appointment 

17 was made. 

18 (d) BASIC PAY.—Members of the Commission shall 

19 serve without pay. 

20 (e) TRAVEL EXPENSES.—Each member shall receive 

21 travel expenses, including per diem in lieu of subsistence, 

22 in accordance with sections 5702 and 5703 of title 5, 

23 United States Code. 


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1 (f) QUORUM.—8 members of the Commission shall 

2 constitute a quorum but a lesser number may hold hear3 ings. 

4 SEC. 5. CHAIRPERSON. 

5 (a) IN GENERAL.—The Chairperson of the Commis6 sion shall be elected by the members not later than 30 

7 days after the date on which all of the original members 

8 of the Commission have been appointed. 

9 (b) PRESIDENTIAL APPOINTMENT.—If the members 

10 of the Commission are unable to elect the Chairperson in 

11 accordance with subsection (a), the President shall ap12 point a member of the Commission to be the Chairperson. 

13 SEC. 6. MEETINGS. 

14 The Commission shall meet at the call of the Chair15 person. 

16 SEC. 7. STAFF. 

17 (a) IN GENERAL.— 

18 (1) APPOINTMENT AND COMPENSATION.—The 

19 Chairperson, in accordance with rules agreed upon 

20 by the Commission, may appoint and fix the com21 pensation of a staff director and such other per22 sonnel as may be necessary to enable the Commis23 sion to carry out its duties, without regard to the 

24 provisions of title 5, United States Code, governing 

25 appointments in the competitive service, and without 


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1 regard to the provisions of chapter 51 and sub2 chapter III of chapter 53 of such title relating to 

3 classification and General Schedule pay rates, except 

4 that no rate of pay fixed under this subsection may 

5 exceed the equivalent of that payable for a position 

6 at level IV of the Executive Schedule under section 

7 5316 of title 5, United States Code. 

8 (2) PERSONNEL AS FEDERAL EMPLOYEES.— 

9 (A) IN GENERAL.—The staff director and 

10 any personnel of the Commission who are em11 ployees shall be employees under section 2105 

12 of title 5, United States Code, for purposes of 

13 chapters 63, 81, 83, 84, 85, 87, 89, and 90 of 

14 that title. 

15 (B) MEMBERS OF THE COMMISSION.— 

16 Subparagraph (A) shall not apply to members 

17 of the Commission. 

18 (b) DETAILEES.—Any Federal Government employee 

19 may be detailed to the Commission with reimbursement 

20 from the Commission, and such detailee shall retain the 

21 rights, status, and privileges of his or her regular employ22 ment without interruption. 

23 (c) EXPERT AND CONSULTANT SERVICES.—The 

24 Commission is authorized to procure the services of ex25 perts and consultants in accordance with section 3109 of 


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1 title 5, United States Code, but at rates not to exceed the 

2 daily rate paid to a person occupying a position at level 

3 IV of the Executive Schedule under section 5315 of title 

4 5, United States Code. 

5 (d) VOLUNTEER SERVICES.—Notwithstanding sec6 tion 1342 of title 31, United States Code, the Commission 

7 may accept and use voluntary and uncompensated services 

8 as the Commission determines necessary. 

9 SEC. 8. POWERS. 

10 (a) HEARINGS AND SESSIONS.—The Commission 

11 may, for the purpose of carrying out this Act, hold hear12 ings, sit and act at times and places, take testimony, and 

13 receive evidence as the Commission considers appropriate. 

14 The Commission may administer oaths or affirmations to 

15 witnesses appearing before it. 

16 (b) POWERS OF MEMBERS AND AGENTS.—Any mem17 ber or agent of the Commission may, if authorized by the 

18 Commission, take any action which the Commission is au19 thorized to take by this section. 

20 (c) OBTAINING OFFICIAL DATA.—The Commission 

21 may secure directly from any Federal department or agen22 cy information necessary to enable it to carry out this Act. 

23 Upon request of the Chairperson of the Commission, the 

24 head of that department or agency shall provide that in25 formation to the Commission. 


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1 (d) MAIL.—The Commission may use the United 

2 States mail in the same manner and under the same con3 ditions as other Federal departments and agencies. 

4 (e) ADMINISTRATIVE SUPPORT SERVICES.—Upon 

5 the request of the Commission, the Administrator of Gen6 eral Services shall provide to the Commission, on a reim7 bursable basis, the administrative support services nec8 essary for the Commission to carry out its responsibilities 

9 under this Act. 

10 SEC. 9. REPORT. 

11 Not later than 2 years after the date on which all 

12 original members have been appointed to the Commission, 

13 the Commission shall transmit to the President, Congress, 

14 and the general public a report that contains a detailed 

15 statement of the findings and policy recommendations of 

16 the Commission, including the comprehensive national 

17 strategy described in section 3(b)(2). 

18 SEC. 10. APPLICATION OF FEDERAL ADVISORY COMMITTEE 

19 ACT. 

20 The Federal Advisory Committee Act (5 U.S.C. App.) 

21 (other than section 14(a)(2)(B), relating to the termi22 nation of advisory committees) shall apply to the Commis23 sion. 


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1 SEC. 11. TERMINATION. 

2 (a) IN GENERAL.—The Commission shall terminate 

3 60 days after the date of submission of the report under 

4 section 9. 

5 (b) ADMINISTRATIVE ACTIVITIES BEFORE TERMI6 NATION.—The Commission may use the 60-day period re7 ferred to in subsection (a) for the purpose of concluding 

8 its activities, including providing testimony to committees 

9 of Congress concerning the report under section 9. 

10 SEC. 12. AUTHORIZATION OF APPROPRIATIONS. 

11 There are authorized to be appropriated such sums 

12 as are necessary for use in the development and implemen13 tation of plans under this Act. 

Æ 


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