Critique of S 1129 long term care benefit by ISPC Working Group on Long-Term Care, final, August 2019
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emailS.1129 — 116th Congress (2019-2020)
[Comments by the Working Group are in brackets, red, and underlined, like this sentence. The text in regular type is from the bill.]
SEC. 201. COMPREHENSIVE BENEFITS.
(a) In General.—Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic disease management.
(4) Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products.
(5) Mental health and substance abuse treatment services, including inpatient care. [People experiencing mental illness must be in charge of their care. They must have access to drop-in centers, peer support, and non-drug treatment. People who live with mental illness must be involved in the training of health care workers.]
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn care.
(8) Pediatrics, including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r))).
(9) Oral health, audiology, and vision services.
(10) Short-term rehabilitative and habilitative services and devices.
(11) Emergency services and transportation. [Emergency transportation for people who need it while away from home must include wheelchairs. That is, the wheelchair must accompany the patient or be stored in a place acceptable to the patient and may not be abandoned.]
(12) Necessary transportation to receive health care services for individuals with disabilities and low-income individuals. [Access to transportation must be considered a public service to which everyone has a right.]
[Add nutrition services.]
(13) Home and community-based long-term services and supports (to be provided in accordance with the requirements for home and community-based settings under sections 441.530 and 441.710 of title 42, Code of Federal Regulations), including—
In addition to references to specific sections of the Social Security Act, the bill should include a comprehensive and easy to read and understand list of all relevant provisions.
The provisions of the Social Security Act must be a minimum for coverage under single-payer.
Everyone must be guaranteed access to all necessary services. In the case of long-term care, medical necessity must be defined as those services adequate to allow people who choose to do so to live in the community and to participate fully to the extent that they wish to do so. People who use services must have an effective voice in defining medical necessity.
Must include long-term habilitative services.
Acquisition of care must be straightforward and timely.
Wheelchairs must be appropriate to the person with the disability.
People who use services must be involved in evaluation of all services, equipment, and staff.
[People with disabilities must be in charge of their own care.]
(A) services described in paragraphs (7), (8), (13), (19), and (24) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a));
(B) home and community-based services described in subsection (c)(4)(B) of section 1915 of the Social Security Act (including habilitation services defined in subsection (c)(5) of such section);
(C) self-directed home and community-based services described in subsection (i) of section 1915 of the Social Security Act;
(D) self-directed personal assistance services (as defined in subsection (j)(4)(A) of section 1915 of the Social Security Act); and
(E) home and community-based attendant services and supports described in subsection (k) of section 1915 of the Social Security Act.
[People must have guaranteed access to emergency home care, including home-based mental health care, as required for changes in their medical condition.]
[All home care workers must be guaranteed respect, training, a fair and living wage, benefits in accordance with the high value of their work, and the right to organize and to bargain collectively. Attracting high-quality workers to high-quality jobs can contribute to community development.]
All health care workers must have training in disability needs and culture. People with disabilities, including people who use long-term care services, must direct and be involved in this training.
[No quotas and no waiting lists for home- and community-based services or for all other necessary care.]
[People who use long-term care services must be involved in the development, evaluation, and monitoring of all services.]
[Long-term care supports for families, including families of children with disabilities, must be fully funded.]
[In all settings eliminate differences in staffing, training, treatment, including access to modalities other than allopathic medicine, and other inequities, by zip code.]
[Eliminate the need to know the right people in order to obtain services. Outreach to guarantee services to all.]
[Under national improved Medicare for all states will spend less on health care. Eliminate inequities by state and other geographic variables. ]
(b) Revision And Adjustment.—The Secretary shall, on a regular basis, evaluate whether the benefits package should be improved or adjusted to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements or adjustments.
SEC. 204. COVERAGE OF INSTITUTIONAL LONG-TERM CARE SERVICES UNDER MEDICAID.s
[Institutional long-term care must be covered under national improved Medicare for all on the same basis as home-and community-based services, with no deductibles, co-pays, co-insurance, or other out-of-pocket costs.
All people who want them must have access to services, including peer support, that allow them to transition into the community if that is their wish. Peer support must include outreach to people living in institutions to assess their desire to transition into the community and educate them about support for doing so.]
[Define “institutional.”]
[Institutions must have safe staffing levels. In no case should drugs be used as a substitute for skilled personal attention.
Workers must receive respect, a fair living wage, benefits in accordance with the high value of their work, and the right to organize and to bargain collectively.]
[No investor-owned for-profit institutions. All direct-care providers must be not-for-profit.]