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 bur-
dens 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 re-
quirements 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 commu-
nity-based services. 
(14) The last time that Congress comprehen-
sively reviewed policy options for long-term care re-
form was nearly two decades ago, under a U.S. Bi-
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partisan 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 dis-
parities in routine access to these services. 
(16) Personal choice, access, cost (including re-
imbursement policy), effectiveness, and quality 
standards must be adequately addressed when com-
posing 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 con-
struct a comprehensive national strategy (described in 
subsection (b)(2)) on how to increase the affordability, ac-
cessibility, and effectiveness of long-term care and commu-
nity services in the United States and United States Terri-
tories. 
(b) POLICY RECOMMENDATIONS AND COMPREHEN-
SIVE NATIONAL STRATEGY.— 
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(1) POLICY RECOMMENDATIONS.—The Commis-
sion’s policy recommendations under this Act must 
address economic, geographic, cultural, social, trans-
portation, workforce, and other factors that limit ac-
cess 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, com-
promise 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, profes-
sional and paraprofessional staff, and others in-
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volved in institutional, home, and community 
health settings by targeting chronically poor 
performing providers, decertifying persistently 
substandard providers, and monitoring institu-
tional, 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 dis-
eases such as heart and respiratory disease, di-
abetes, HIV/AIDS, stroke, and obesity, in order 
to prevent them from becoming permanently de-
bilitating or disabling and help decrease future 
dependence on long-term care; 
(D) establish and support existing and fu-
ture 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 
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improve working conditions, training, manage-
ment, 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 de-
livery of care; 
(F) identify and address flaws in reim-
bursement policies for long-term care services 
through Medicare under title XVIII of the So-
cial 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 serv-
ices; 
(H) increase access to home and commu-
nity-based services through Medicaid to meet 
consumer demands and preferences and empha-
size cost-effective non-institutional care alter-
natives that provide satisfaction and high qual-
ity care to all those requiring long-term care 
services; 
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