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New Bipartisan Commission to Kick Off Search for Answers on Long-Term Care

By Jane Norman, CQ HealthBeat Associate Editor

January 2, 2013 -- A new high-level commission created to develop a national plan for long-term services for the elderly and disabled will have six months to come up with recommendations on one of the most complex and difficult issues in health care.

The fiscal cliff bill (HR 8), approved by the Senate and House and sent to President Barack Obama last week, has nine pages devoted to establishment of the Commission on Long-Term Care, a 15-member temporary body modeled on other independent health care panels, such as the Medicare Payment Advisory Commission (MedPAC).

While the commission is meant to be bipartisan, Democrats will dominate by a 9-6 margin because Obama will name three members in addition to three each named by the majority and minority leaders of each chamber. The measure requires rapid action, too. The members are to be named within 30 days of the fiscal cliff bill being signed into law.

Commission members are supposed to represents consumers, older adults, people with cognitive or functional limitations, family caregivers, health care workers, private long-term care insurance providers, state insurance departments and state Medicaid agencies.

At the end of their work, commission members will make their recommendations through a majority vote and submit them in 10 days or less to the president, House and Senate. The statute requires that the commission's recommendations be introduced in the House and Senate the first legislative day after the panel submits them to Congress, which means that some kind of comprehensive measure could come before Congress by next fall. But there is no requirement that lawmakers actually vote on the proposals, one weakness critics have already pinpointed.

But the commission does have the power to hold hearings, request studies by the Government Accountability Office and ask for cost estimates from the Congressional Budget Office. The panel is supposed to go out of business 30 days after the panel members vote on the recommendations.

The commission is the brainchild of Democratic Sen. John D. Rockefeller IV of West Virginia, who's been working on the language on it for more than a year.

Rockefeller also has been a strong supporter of a controversial program in the 2010 health care law (PL 111-148, PL 111-152), the Community Living Assistance Services and Supports Act, or CLASS. The fiscal cliff bill repeals that program, which the Department of Health and Human Services had shelved in October 2011 because of doubts it would be financially feasible. CLASS was intended to provide a $50-a-day cash benefit for long-term support and services, funded by voluntary contributions by workers who signed up.

Advocates and some Democrats had continued to argue the CLASS program should be kept but it was strongly opposed by Republicans who feared that the administration might attempt to resurrect it unless it was eliminated. Rockefeller had wanted the new commission to take action before CLASS was killed or revised.

"While I am heartened that this bipartisan commission was included in the final fiscal cliff deal, I am deeply disappointed that it was included at the expense of the CLASS Act," Rockefeller said in a statement.

Rockefeller also said that it was "frustrating" that Republicans insisted on repeal. "The lack of a comprehensive long-term care system in this country has been a problem for decades," he said. "The CLASS Act wasn't perfect, but it was a solid start at a meaningful solution that could have been improved upon."

Last week, advocates also were dismayed that the final stake had been driven through CLASS but they were relieved that the new commission would continue the discussion of what to do about long-term care. Repeal was disappointing, said Connie Garner, executive director of Advance CLASS, a coalition of groups that backed the program. "The good news, and it is good news, is the conversation hasn't ended," she said.

Garner also said advocates appreciated Rockefeller's work in ensuring the commission language was inserted in the measure, and she said she is not worried the time frame is too short. "It's not like this issue hasn't been looked at over the years," she said.

The groups in the coalition also have decided to remain together and monitor the work of the commission to make sure it's doing its job, she said.

Some observers familiar with the issue were not optimistic. Howard Gleckman, an author and resident fellow at the Urban Institute who writes extensively about long-term care, said in a post on his "Caring for Our Parents" blog that "there may be less than meets the eye" when it comes to the commission because its plan seems "destined to gather dust on a bookshelf somewhere."

Gleckman said the tight time frame is a concern, too, as is the lack of a requirement for any congressional vote.

According to the bill text, the commission is to come up with a plan for the establishment, implementation and financing of a high-quality system that ensures the availability of long-term services and supports for older people, people with limitations or disabilities, and people who want to plan for their future long-term-care needs.

The recommendations are supposed to address how such a system would interact with Medicare and with Medicaid, the program which often is now the source of care for people who spend down their assets. The commission also is to look at whether there are enough health care workers to provide long-term care and what might be done to develop a larger and better workforce.

The commission is also charged with taking into account projected demographic and changes in the U.S. population and new technologies to improve the availability of services and supports for long-term care. It's supposed to consult with MedPAC, the Medicaid and CHIP Payment and Access Commission, the National Council on Disability, and consumer groups.

Rockefeller said he will be watching what develops. "Going forward, I hope that this commission will lead to the kind of honest conversation we need to have about long-term care," he said. "I look forward to the swift appointment of bipartisan commission members and to tangible results."

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