PRINTER'S NO. 4223
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2767
Session of
2020
INTRODUCED BY NEILSON, ZIMMERMAN, SHUSTERMAN, HOHENSTEIN, HILL-
EVANS AND ROEBUCK, AUGUST 7, 2020
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES,
AUGUST 7, 2020
AN ACT
Providing for long-term services and supports, establishing the
Long-Term Services and Supports Commission, the Long-Term
Services and Supports Council and the Long-Term Services and
Supports Trust Fund, imposing duties on the Department of
Human Services and the Department of Revenue and imposing a
payroll premium.
TABLE OF CONTENTS
Section 1. Short title.
Section 2. Definitions.
Section 3. Long-Term Services and Supports Trust Program.
Section 4. Long-Term Services and Supports Trust Commission.
Section 5. Long-Term Services and Supports Trust Council.
Section 6. Qualifying beneficiaries.
Section 7. Disbursement of benefits.
Section 8. Benefits.
Section 9. Payroll premium.
Section 10. Self-employed individuals.
Section 11. Long-Term Services and Supports Trust Fund.
Section 12. Management of fund.
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Section 13. Appeals.
Section 14. Information sharing.
Section 15. Report.
Section 16. Exclusions.
Section 17. Effective date.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Long-Term
Care Trust Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Approved service." Long-term services and supports,
including, but not limited to:
(1) Adult day services.
(2) Care transition coordination.
(3) Memory care.
(4) Adaptive equipment and technology.
(5) Environmental modification.
(6) Personal emergency response system.
(7) Home safety evaluation.
(8) Respite for family caregivers.
(9) Home delivered meals.
(10) Transportation.
(11) Dementia supports.
(12) Education and consultation.
(13) Eligible relative care.
(14) Professional services.
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(15) Assisted living services.
(16) Adult family home services.
(17) Nursing home services.
"Benefit unit." Up to $100 paid by the department to a long-
term services and supports provider as reimbursement for
approved services provided to an eligible beneficiary on a
specific date.
"Commission." The Long-Term Services and Supports Trust
Commission established under section 4.
"Council." The Long-Term Services and Supports Trust Council
established under section 5.
"Department." The Department of Human Services of the
Commonwealth.
"Eligible beneficiary." A qualified individual who is 18
years of age or older, resides in this Commonwealth, was not
disabled before 18 years of age, has been determined to meet the
minimum level of assistance with activities of daily living
necessary to receive benefits through the program and who has
not exhausted the lifetime limit of benefit units.
"Fund." The Long-Term Services and Supports Trust Fund
established under section 11.
"Long-term services and supports provider." A person that
meets the qualifications applicable under law to the approved
service that the person provides, including a qualified or
certified home care aide, licensed assisted living facility,
licensed adult family home, licensed nursing home, licensed in-
home services agency, adult day services program, vendor,
instructor, qualified family member or other entities as
registered by the department.
"Premium." The payments required under section 9 and paid to
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the Department of Revenue for deposit into the fund.
"Program." The Long-Term Services and Supports Trust Program
established under section 3.
"Qualified family member." A relative of an eligible
beneficiary qualified to meet the requirements established under
law for the approved service the relative provides that would be
required of any other long-term services and supports provider
to receive payments from the Commonwealth.
"Qualified individual." An individual who meets the duration
of payment requirements established under this act.
Section 3. Long-Term Services and Supports Trust Program.
(a) Establishment.--The Long-Term Services and Supports
Trust Program is established within the department.
(b) Administration.--The department, an actuary contracted
by the department and the Department of Revenue shall have the
responsibilities of implementing and administering the program
as provided under this section.
(c) Department of Human Services.--The department shall:
(1) Make determinations regarding an individual's status
as an eligible beneficiary under section 7.
(2) Approve long-term services and supports eligible for
payment as approved services under the program, as informed
by the commission.
(3) Register long-term services and supports providers
that meet minimum qualifications.
(4) Discontinue the registration of long-term services
and supports providers that:
(i) fail to meet the minimum qualifications
applicable in law to the approved service that the long-
term services and supports providers provide; or
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(ii) violate the operational standards of the
program.
(5) Disburse payments of benefits to registered long-
term services and supports providers, utilizing and
leveraging existing payment systems for the provision of
approved services to eligible beneficiaries under section 8.
(6) Prepare and distribute written or electronic
materials to qualified individuals, eligible beneficiaries
and the public as deemed necessary by the commission to
inform the public of program design and updates.
(7) Provide customer service and address questions and
complaints, including referring individuals to other
appropriate agencies.
(8) Provide administrative and operational support to
the commission.
(9) Track data useful in monitoring and informing the
program, as identified by the commission.
(10) Track the use of lifetime benefit units to verify
the individual's status as an eligible beneficiary.
(11) Ensure approved services are provided through
audits or service verification processes within the service
provider payment system for registered long-term services and
supports providers and recoup any inappropriate payments.
(12) Establish criteria for the payment of benefits to
registered long-term services and supports providers under
section 8.
(13) Establish rules and procedures for benefit
coordination when the eligible beneficiary is also funded for
Medicaid and other long-term services and supports, including
Medicare, coverage through the Department of Labor and
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Industry and private long-term care coverage.
(14) Promulgate rules and regulations necessary to
implement and administer the activities specified under this
section related to the program.
(d) Department of Revenue.--The Department of Revenue shall:
(1) Collect and assess employee premiums as provided in
section 9.
(2) Assist the commission, council and State actuary in
monitoring the solvency and financial status of the program.
(3) Make determinations regarding an individual's status
as a qualified individual under section 6.
(4) Promulgate rules and regulations necessary to
implement and administer the activities specified under this
section.
(e) Actuary.--The department shall contract with an actuary
and the contract shall include that the actuary do the
following:
(1) Beginning January 1, 2024, and biennially
thereafter, perform an actuarial audit and valuation of the
fund. Additional or more frequent actuarial audits and
valuations may be performed at the request of the council.
(2) Make recommendations to the council and the General
Assembly on actions necessary to maintain fund solvency. The
recommendations shall include options to redesign or reduce
benefit units, approved services, or both, to prevent or
eliminate any unfunded actuarially accrued liability in the
trust or to maintain solvency.
(3) Select and contract for actuarial, research,
technical and other consultants as the actuary deems
necessary to perform the actuary's duties under this act.
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Section 4. Long-Term Services and Supports Trust Commission.
(a) Establishment.--The Long-Term Services and Supports
Trust Commission is established. The commission's
recommendations and decisions shall be guided by the joint goals
of maintaining benefit adequacy and maintaining fund solvency
and sustainability.
(b) Membership.--The commission shall include:
(1) The Secretary of Human Services or a designee.
(2) The Secretary of Revenue or a designee.
(3) Two members of the Senate, appointed by the
President pro tempore of the Senate.
(4) Two members of the House of Representatives,
appointed by the Speaker of the House of Representatives.
(5) One representative of an organization representing
the area agencies on aging.
(6) One representative of a home care association that
represents caregivers who provide services to private pay and
Medicaid clients.
(7) One representative of a union representing long-term
care workers.
(8) One representative of an organization representing
retired individuals.
(9) One representative of an association representing
skilled nursing facilities and assisted living providers.
(10) One representative of an association representing
adult family home providers.
(11) Two individuals receiving long-term services and
supports, or their designees, or representatives of consumers
receiving long-term services and supports under the program.
(12) One member who is a worker who is, or will likely
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be, paying the premium established under section 9 and who is
not employed by a long-term services and supports provider.
(13) One representative of an organization of employers
whose members collect, or will likely be collecting, the
premium established under section 9.
(c) Terms.--Expect for the members under subsection (b)(1),
(2), (3) and (4), members of the commission shall be appointed
by the Governor for terms of two years, except that the Governor
shall appoint the initial members to staggered terms not to
exceed four years.
(d) Chair.--The secretary of the department, or the
secretary's designee, shall serve as chair of the commission.
(e) Meetings and quorum.--Meetings of the commission shall
be at the call of the chair. A majority of the voting members of
the commission shall constitute a quorum for any votes of the
commission. Approval of 60% of those voting members of the
commission who are in attendance is required for the passage of
any vote.
(f) Recommendations.--Beginning January 1, 2021, the
commission shall propose recommendations to the department
regarding:
(1) The establishment of criteria for determining that
an individual has met the requirements to be a qualified
individual as established under section 6 or an eligible
beneficiary as established under section 7.
(2) The establishment of criteria for minimum
qualifications for the registration of long-term services and
supports providers who provide approved services to eligible
beneficiaries.
(3) The establishment of payment maximums for approved
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services consistent with actuarial soundness which may not be
lower than Medicaid payments for comparable services. A
service or supply may be limited by dollar amount, duration
or number of visits. The commission shall engage affected
stakeholders to develop this recommendation.
(4) Changes to rules or policies to improve the
operation of the program.
(5) Providing a recommendation to the council for the
annual adjustment of the benefit unit as provided under this
act.
(6) Assisting the actuary contracted by the department
with the preparation of regular actuarial reports on the
solvency and financial status of the program and advising the
General Assembly on actions necessary to maintain trust
solvency. The commission shall provide the actuary with all
actuarial reports for review. The actuary shall provide any
recommendations to the commission and the General Assembly on
actions necessary to maintain trust solvency.
(7) Whether and how to extend coverage to individuals
who became disabled before 18 years of age, including the
impact on the financial status and solvency of the trust. The
commission shall engage affected stakeholders to develop this
recommendation.
(8) Consultation with the actuary contracted by the
department on the development of an actuarial report of the
projected solvency and financial status of the program. The
actuary shall provide any recommendations to the commission
and the General Assembly on actions necessary to achieve
trust solvency.
(g) Expenses.--The commission shall monitor department
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administrative expenses over time. Beginning November 15, 2020,
the commission shall annually report to the Governor, the
chairperson and minority chairperson of the Finance Committee of
the Senate and the chairperson and minority chairperson of the
Finance Committee of the House of Representatives on department
spending for administrative expenses and anticipated
administrative expenses as the program shifts into different
phases of implementation and operation. The November 15, 2025,
report shall include recommendations for a method of calculating
future department administrative expenses to limit
administrative expenses while providing sufficient funds to
adequately operate the program. The members under subsection (b)
(1), (2), (3) and (4) may advise the commission on the reports
prepared under this subsection but must recuse themselves from
the commission's process for review, approval and submission to
the General Assembly.
(h) Investment strategy subcommittee.--The commission shall
establish an investment strategy subcommittee consisting of the
members under subsection (b)(1), (2), (3) and (4) as voting
members of the subcommittee. In addition, four members appointed
by the Governor who are considered experienced and qualified in
the field of investment shall serve as nonvoting members. The
subcommittee shall provide guidance and advice to the State
Treasury on investment strategies for the fund, including
seeking counsel and advice on the types of investments that are
constitutionally permitted.
Section 5. Long-Term Services and Supports Trust Council.
(a) Establishment.--The Long-Term Services and Supports
Trust Council is established.
(b) Membership.--The council shall include:
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(1) The Secretary of Human Services or a designee.
(2) The Secretary of Revenue or a designee.
(3) Two members of the Senate appointed by the President
pro tempore of the Senate.
(4) Two members of the House of Representatives
appointed by the Speaker of the House of Representatives.
(5) The Deputy Secretary for the Office of the Budget's
Office of Comptroller Operations.
(c) Adjustments to benefit unit.--On an annual basis, the
council shall determine adjustments to the benefit unit to
ensure benefit adequacy and solvency of the fund. The benefit
unit shall be adjusted at a rate no greater than the Consumer
Price Index, as determined by the council. In determining
adjustments to the benefit unit, the council shall review the
actuary's actuarial audit and valuation of the fund, any
recommendations by the actuary and commission, data on relevant
economic indicators and program costs and sustainability.
(d) Chair.--The secretary of the department, or the
secretary's designee, shall serve as chair of the council.
(e) Meetings and quorum.--The council shall meet at least
once annually to determine adjustments to the benefit unit under
subsection (c). Additional meetings of the council shall be at
the call of the chair. A majority of the voting members of the
council shall constitute a quorum for any votes of the council.
Approval of 60% of the members of the council who are in
attendance is required for the passage of any vote. The council
may adopt rules for the conduct of meetings, including
provisions for meetings and voting to be conducted by
telephonic, video or other conferencing process.
Section 6. Qualifying beneficiaries.
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(a) Determination.--The Department of Revenue shall deem an
individual to be a qualified individual as provided under this
act if the individual has paid the long-term services and
supports premiums required under section 9 for the equivalent of
either:
(1) a total of 10 years without interruption of 5 or
more consecutive years; or
(2) three years within the last six years.
(b) Requirements.--When deeming an individual to be a
qualified individual, the Department of Revenue shall require
that the individual have worked at least 500 hours during each
of the 10 years in subsection (a)(1) and each of the 3 years in
subsection (a)(2).
Section 7. Disbursement of benefits.
(a) General rule.--Beginning January 1, 2025, approved
services shall be available and benefits payable to a registered
long-term services and supports provider on behalf of an
eligible beneficiary under this section.
(b) Eligible beneficiary.--A qualified individual may become
an eligible beneficiary by filing an application with the
department and undergoing an eligibility determination which
includes an evaluation that the qualified individual requires
assistance with at least three activities of daily living. The
department shall engage a qualified assessor so that the
determination may be made within 45 days from receipt of the
application by the qualified individual to use a benefit.
(c) Receipt of services and benefits.--An eligible
beneficiary:
(1) May receive approved services and benefits through
the program in the form of a benefit unit payable to a
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registered long-term services and supports provider.
(2) May not receive more than the dollar equivalent of
365 benefit units over the course of the eligible
beneficiary's lifetime.
(d) Reimbursements.--If the department reimburses a long-
term services and supports provider for approved services
provided to an eligible beneficiary and the payment is less than
the benefit unit, only the portion of the benefit unit that is
used shall be taken into consideration when calculating the
individual's remaining lifetime limit on receipt of benefits.
(e) Combination of benefit units.--Eligible beneficiaries
may combine benefit units to receive more approved services per
day as long as the total number of lifetime benefit units has
not been exceeded.
Section 8. Benefits.
(a) Payment.--Benefits provided under this act shall be paid
periodically and promptly to registered long-term services and
supports providers.
(b) Qualified family members.--Qualified family members may
be paid for approved personal care services in the same way as
individual providers, through a licensed home care agency or
through a third option if recommended by the commission and
adopted by the department.
Section 9. Payroll premium.
(a) General rule.--Beginning January 1, 2022, the Department
of Revenue shall assess for each individual in employment with
an employer a premium based on the amount of the individual's
wages. The initial premium rate shall be 0.58% of the
individual's wages. Beginning January 1, 2024, and biennially
thereafter, the premium rate shall be set by the Independent
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Fiscal Office at a rate no greater than 0.58%. In addition, the
Independent Fiscal Office shall set the premium rate at the
lowest amount necessary to maintain the actuarial solvency of
the fund in accordance with recognized insurance principles and
designed to attempt to limit fluctuations in the premium rate.
To facilitate the premium rate setting the actuary contracted by
the department shall perform a biennial actuarial audit and
valuation of the fund and make recommendations to the
Independent Fiscal Office.
(b) Duties of employers.--An employer shall:
(1) Collect from employees the premiums provided under
subsection (a) through payroll deductions and remit the
amounts collected to the Department of Revenue.
(2) In collecting employee premiums through payroll
deductions, act as the agent of the employees and shall remit
the amounts to the Department of Revenue as required by this
act.
(c) Collective bargaining agreements.--Nothing in this act
shall require a party to a collective bargaining agreement
taking effect within 24 months or less of the effective date of
this section to reopen negotiations of the agreement or to apply
any of the responsibilities under this act unless and until the
existing agreement is reopened or renegotiated by the parties or
expires.
(d) Collection.--Premiums shall be collected in the manner
and at such intervals as provided by the Department of Revenue.
(e) Deposit of premiums.--The Department of Revenue shall
deposit all premiums collected under this section into the fund.
(f) Increase of premiums.--If the premiums under this
section are increased, the Department of Revenue shall notify
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each qualified individual by mail that the individual's premiums
have been increased, describe the reason for increasing the
premiums and describe the plan for restoring the funds so that
premiums are returned to 0.58% of the individual's wages.
(g) Exemption.--An employee who demonstrates that the
employee has long-term care insurance is exempt from the premium
assessment under this section.
Section 10. Self-employed individuals.
(a) Electing coverage.--Beginning January 1, 2022, a self-
employed individual, including a sole proprietor, independent
contractor, partner or joint venturer may elect coverage under
this act. An individual electing coverage under this subsection
is responsible for payment of all premiums assessed to an
employee under section 9. The individual shall file a notice of
election in writing with the Department of Revenue, in a manner
prescribed by the Department of Revenue. The individual shall be
eligible for benefits after paying the long-term services and
supports premium for the time required under section 6.
(b) Withdraw from coverage.--A self-employed individual who
has elected coverage may withdraw from coverage at times
prescribed by the Department of Revenue by filing a notice of
withdrawal in writing with the Department of Revenue, with the
withdrawal to take effect no sooner than 30 days after filing
the notice with the Department of Revenue.
(c) Cancellation.--The Department of Revenue may cancel
elective coverage if the self-employed individual fails to make
required payments or file reports. The Department of Revenue may
collect due and unpaid premiums and may levy an additional
premium for the remainder of the period of coverage. The
cancellation shall be effective no later than 30 days from the
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date of the notice in writing advising the self-employed
individual of the cancellation.
(d) Rules and regulations.--The Department of Revenue shall
promulgate rules and regulations for determining the hours
worked and the wages of individuals who elects coverage under
this section and for the enforcement of this section.
Section 11. Long-Term Services and Supports Trust Fund.
(a) Establishment.--The Long-Term Services and Supports
Trust Fund is established as a special fund in the State
Treasury. Money in the fund shall be appropriated on a
continuing basis to the department for the purposes of this act.
(b) Administration of fund.--The following shall apply:
(1) All receipts from employers under section 9 shall be
deposited in to the fund.
(2) Expenditures from the fund may be used for the
administrative activities of the department and the
Department of Revenue.
(3) Benefits associated with the program shall be
disbursed from the fund by the department. Only the secretary
of the department or the secretary's designee may authorize
disbursements from the fund.
(4) The fund shall provide reimbursement of any amounts
from other sources that may have been used for the initial
establishment of the program.
(c) Utilization of revenue.--The revenue generated under
this act shall be utilized to expand long-term care in this
Commonwealth. The money may not be used either in whole or in
part to supplant existing State or county funds for programs
that meet the definition of approved services.
(d) Money expended for other purposes.--Money deposited in
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the fund shall remain in the fund until expended in accordance
with the requirements of this act. If money is expended for any
purpose other than supporting the long-term services and
supports program, the Department of Revenue shall notify each
qualified individual by mail that the individual's premiums have
been expended for an alternate use, describe the alternate use
and state the Department of Revenue's plan for restoring the
funds so that premiums are not increased and benefits are not
reduced.
Section 12. Management of fund.
(a) Investment of money in fund.--The department shall have
the State Treasury invest the money in the fund. The State
Treasury shall have full power to invest, reinvest, manage,
contract, sell or exchange investment money in the fund.
(b) Investment policy.--All investments made by the State
Treasury shall be made with the degree of judgment and care
required and the investment policy established by the State
Treasury.
(c) Investment with other funds.--As deemed appropriate by
the State Treasury, money in the fund may be commingled for
investment with other funds subject to investment by the State
Treasury.
(d) Policies.--The department shall establish all policies
relating to the fund, other than the investment policies as
provided under this section.
(e) Disbursement.--With the exception of expenses of the
State Treasury under this section, disbursements from the fund
shall be made only on the authorization of the secretary of the
department or the secretary's designee and money in the fund may
be spent only for the purposes specified under this act.
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(f) Consultation.--The State Treasury shall routinely
consult and communicate with the department on the investment
policy, earnings of the fund and related needs of the program.
Section 13. Appeals.
Determinations made by the department under this act,
including determinations regarding functional eligibility or
related to registration of long-term services and support
providers, are subject to appeal in accordance with 2 Pa.C.S. ยง
702 (relating to appeals). In addition, the standards and
procedures adopted for appeals under this section shall address
the following:
(1) Time lines.
(2) Eligibility and benefit determination.
(3) Judicial review.
(4) Fees.
Section 14. Information sharing.
The department shall:
(1) Seek access to Medicare data from the Federal
Centers for Medicare and Medicaid Services of the United
States Department of Health and Human Services to analyze the
potential savings in Medicare expenditures due to the
operation of the program.
(2) Apply for a demonstration waiver from the Federal
Centers for Medicare and Medicaid Services of the United
States Department of Health and Human Services to allow for
the Commonwealth to share in the savings generated in the
Federal match for Medicaid long-term services and supports
and Medicare due to the operation of the program.
(3) Submit a report on the status of the waiver to the
following by December 1, 2022:
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(i) The chairperson and minority chairperson of the
Aging and Youth Committee of the Senate.
(ii) The chairperson and minority chairperson of the
Aging and Older Adult Services Committee of the House of
Representatives.
(iii) The chairperson and minority chairperson of
the Finance Committee of the Senate.
(iv) The chairperson and minority chairperson of the
Finance Committee of the House of Representatives.
Section 15. Report.
Beginning December 1, 2026, and annually thereafter, the
commission shall report to the General Assembly on the program,
including:
(1) Projected and actual program participation.
(2) Adequacy of premium rates.
(3) Fund balances.
(4) Benefits paid.
(5) Demographic information on program participants,
including age, gender, race, ethnicity, geographic
distribution by county, legislative district and employment
sector.
(6) The extent to which the operation of the program has
resulted in savings to the Medicaid program by avoiding costs
that would have otherwise been the responsibility of the
Commonwealth.
Section 16. Exclusions.
Any benefits used by an individual under this act are not
income or resources for any determinations of eligibility for
any other State program or benefit, Medicaid, a State-Federal
program or for any other means-tested program.
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Section 17. Effective date.
This act shall take effect 60 days.
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