PRINTER'S NO. 3418
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2779
Session of
2022
INTRODUCED BY NEILSON, SCHLOSSBERG, HOHENSTEIN AND LEE,
AUGUST 22, 2022
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES,
AUGUST 22, 2022
AN ACT
1 Providing for long-term services and supports, establishing the
2 Long-Term Services and Supports Commission, the Long-Term
3 Services and Supports Council and the Long-Term Services and
4 Supports Trust Fund, imposing duties on the Department of
5 Human Services and the Department of Revenue and imposing a
6 payroll premium.
7 TABLE OF CONTENTS
8 Section 1. Short title.
9 Section 2. Definitions.
10 Section 3. Long-Term Services and Supports Trust Program.
11 Section 4. Long-Term Services and Supports Trust Commission.
12 Section 5. Long-Term Services and Supports Trust Council.
13 Section 6. Qualifying beneficiaries.
14 Section 7. Disbursement of benefits.
15 Section 8. Benefits.
16 Section 9. Payroll premium.
17 Section 10. Self-employed individuals.
18 Section 11. Long-Term Services and Supports Trust Fund.
19 Section 12. Management of fund.
 1 Section 13. Appeals.
2 Section 14. Information sharing.
3 Section 15. Report.
4 Section 16. Exclusions.
5 Section 17. Effective date.
6 The General Assembly of the Commonwealth of Pennsylvania
7 hereby enacts as follows:
8 Section 1. Short title.
9 This act shall be known and may be cited as the Long-Term
10 Care Trust Act.
11 Section 2. Definitions.
12 The following words and phrases when used in this act shall
13 have the meanings given to them in this section unless the
14 context clearly indicates otherwise:
15 "Approved service." Long-term services and supports,
16 including, but not limited to:
17 (1) Adult day services.
18 (2) Care transition coordination.
19 (3) Memory care.
20 (4) Adaptive equipment and technology.
21 (5) Environmental modification.
22 (6) Personal emergency response system.
23 (7) Home safety evaluation.
24 (8) Respite for family caregivers.
25 (9) Home delivered meals.
26 (10) Transportation.
27 (11) Dementia supports.
28 (12) Education and consultation.
29 (13) Eligible relative care.
30 (14) Professional services.
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 1 (15) Assisted living services.
2 (16) Adult family home services.
3 (17) Nursing home services.
4 "Benefit unit." Up to $100 paid by the department to a long-
5 term services and supports provider as reimbursement for
6 approved services provided to an eligible beneficiary on a
7 specific date.
8 "Commission." The Long-Term Services and Supports Trust
9 Commission established under section 4.
10 "Council." The Long-Term Services and Supports Trust Council
11 established under section 5.
12 "Department." The Department of Human Services of the
13 Commonwealth.
14 "Eligible beneficiary." A qualified individual who is 18
15 years of age or older, resides in this Commonwealth, was not
16 disabled before 18 years of age, has been determined to meet the
17 minimum level of assistance with activities of daily living
18 necessary to receive benefits through the program and who has
19 not exhausted the lifetime limit of benefit units.
20 "Fund." The Long-Term Services and Supports Trust Fund
21 established under section 11.
22 "Long-term services and supports provider." A person that
23 meets the qualifications applicable under law to the approved
24 service that the person provides, including a qualified or
25 certified home care aide, licensed assisted living facility,
26 licensed adult family home, licensed nursing home, licensed in-
27 home services agency, adult day services program, vendor,
28 instructor, qualified family member or other entities as
29 registered by the department.
30 "Premium." The payments required under section 9 and paid to
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 1 the Department of Revenue for deposit into the fund.
2 "Program." The Long-Term Services and Supports Trust Program
3 established under section 3.
4 "Qualified family member." A relative of an eligible
5 beneficiary qualified to meet the requirements established under
6 law for the approved service the relative provides that would be
7 required of any other long-term services and supports provider
8 to receive payments from the Commonwealth.
9 "Qualified individual." An individual who meets the duration
10 of payment requirements established under this act.
11 Section 3. Long-Term Services and Supports Trust Program.
12 (a) Establishment.--The Long-Term Services and Supports
13 Trust Program is established within the department.
14 (b) Administration.--The department, an actuary contracted
15 by the department and the Department of Revenue shall have the
16 responsibilities of implementing and administering the program
17 as provided under this section.
18 (c) Department of Human Services.--The department shall:
19 (1) Make determinations regarding an individual's status
20 as an eligible beneficiary under section 7.
21 (2) Approve long-term services and supports eligible for
22 payment as approved services under the program, as informed
23 by the commission.
24 (3) Register long-term services and supports providers
25 that meet minimum qualifications.
26 (4) Discontinue the registration of long-term services
27 and supports providers that:
28 (i) fail to meet the minimum qualifications
29 applicable in law to the approved service that the long-
30 term services and supports providers provide; or
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 1 (ii) violate the operational standards of the
2 program.
3 (5) Disburse payments of benefits to registered long-
4 term services and supports providers, utilizing and
5 leveraging existing payment systems for the provision of
6 approved services to eligible beneficiaries under section 8.
7 (6) Prepare and distribute written or electronic
8 materials to qualified individuals, eligible beneficiaries
9 and the public as deemed necessary by the commission to
10 inform the public of program design and updates.
11 (7) Provide customer service and address questions and
12 complaints, including referring individuals to other
13 appropriate agencies.
14 (8) Provide administrative and operational support to
15 the commission.
16 (9) Track data useful in monitoring and informing the
17 program, as identified by the commission.
18 (10) Track the use of lifetime benefit units to verify
19 the individual's status as an eligible beneficiary.
20 (11) Ensure approved services are provided through
21 audits or service verification processes within the service
22 provider payment system for registered long-term services and
23 supports providers and recoup any inappropriate payments.
24 (12) Establish criteria for the payment of benefits to
25 registered long-term services and supports providers under
26 section 8.
27 (13) Establish rules and procedures for benefit
28 coordination when the eligible beneficiary is also funded for
29 Medicaid and other long-term services and supports, including
30 Medicare, coverage through the Department of Labor and
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 1 Industry and private long-term care coverage.
2 (14) Promulgate rules and regulations necessary to
3 implement and administer the activities specified under this
4 section related to the program.
5 (d) Department of Revenue.--The Department of Revenue shall:
6 (1) Collect and assess employee premiums as provided in
7 section 9.
8 (2) Assist the commission, council and State actuary in
9 monitoring the solvency and financial status of the program.
10 (3) Make determinations regarding an individual's status
11 as a qualified individual under section 6.
12 (4) Promulgate rules and regulations necessary to
13 implement and administer the activities specified under this
14 section.
15 (e) Actuary.--The department shall contract with an actuary
16 and the contract shall include that the actuary do the
17 following:
18 (1) Beginning January 1, 2025, and biennially
19 thereafter, perform an actuarial audit and valuation of the
20 fund. Additional or more frequent actuarial audits and
21 valuations may be performed at the request of the council.
22 (2) Make recommendations to the council and the General
23 Assembly on actions necessary to maintain fund solvency. The
24 recommendations shall include options to redesign or reduce
25 benefit units, approved services, or both, to prevent or
26 eliminate any unfunded actuarially accrued liability in the
27 trust or to maintain solvency.
28 (3) Select and contract for actuarial, research,
29 technical and other consultants as the actuary deems
30 necessary to perform the actuary's duties under this act.
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 1 Section 4. Long-Term Services and Supports Trust Commission.
2 (a) Establishment.--The Long-Term Services and Supports
3 Trust Commission is established. The commission's
4 recommendations and decisions shall be guided by the joint goals
5 of maintaining benefit adequacy and maintaining fund solvency
6 and sustainability.
7 (b) Membership.--The commission shall include:
8 (1) The Secretary of Human Services or a designee.
9 (2) The Secretary of Revenue or a designee.
10 (3) Two members of the Senate, appointed by the
11 President pro tempore of the Senate.
12 (4) Two members of the House of Representatives,
13 appointed by the Speaker of the House of Representatives.
14 (5) One representative of an organization representing
15 the area agencies on aging.
16 (6) One representative of a home care association that
17 represents caregivers who provide services to private pay and
18 Medicaid clients.
19 (7) One representative of a union representing long-term
20 care workers.
21 (8) One representative of an organization representing
22 retired individuals.
23 (9) One representative of an association representing
24 skilled nursing facilities and assisted living providers.
25 (10) One representative of an association representing
26 adult family home providers.
27 (11) Two individuals receiving long-term services and
28 supports, or their designees, or representatives of consumers
29 receiving long-term services and supports under the program.
30 (12) One member who is a worker who is, or will likely
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 1 be, paying the premium established under section 9 and who is
2 not employed by a long-term services and supports provider.
3 (13) One representative of an organization of employers
4 whose members collect, or will likely be collecting, the
5 premium established under section 9.
6 (c) Terms.--Expect for the members under subsection (b)(1),
7 (2), (3) and (4), members of the commission shall be appointed
8 by the Governor for terms of two years, except that the Governor
9 shall appoint the initial members to staggered terms not to
10 exceed four years.
11 (d) Chair.--The secretary of the department, or the
12 secretary's designee, shall serve as chair of the commission.
13 (e) Meetings and quorum.--Meetings of the commission shall
14 be at the call of the chair. A majority of the voting members of
15 the commission shall constitute a quorum for any votes of the
16 commission. Approval of 60% of those voting members of the
17 commission who are in attendance is required for the passage of
18 any vote.
19 (f) Recommendations.--Beginning January 1, 2022, the
20 commission shall propose recommendations to the department
21 regarding:
22 (1) The establishment of criteria for determining that
23 an individual has met the requirements to be a qualified
24 individual as established under section 6 or an eligible
25 beneficiary as established under section 7.
26 (2) The establishment of criteria for minimum
27 qualifications for the registration of long-term services and
28 supports providers who provide approved services to eligible
29 beneficiaries.
30 (3) The establishment of payment maximums for approved
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 1 services consistent with actuarial soundness which may not be
2 lower than Medicaid payments for comparable services. A
3 service or supply may be limited by dollar amount, duration
4 or number of visits. The commission shall engage affected
5 stakeholders to develop this recommendation.
6 (4) Changes to rules or policies to improve the
7 operation of the program.
8 (5) Providing a recommendation to the council for the
9 annual adjustment of the benefit unit as provided under this
10 act.
11 (6) Assisting the actuary contracted by the department
12 with the preparation of regular actuarial reports on the
13 solvency and financial status of the program and advising the
14 General Assembly on actions necessary to maintain trust
15 solvency. The commission shall provide the actuary with all
16 actuarial reports for review. The actuary shall provide any
17 recommendations to the commission and the General Assembly on
18 actions necessary to maintain trust solvency.
19 (7) Whether and how to extend coverage to individuals
20 who became disabled before 18 years of age, including the
21 impact on the financial status and solvency of the trust. The
22 commission shall engage affected stakeholders to develop this
23 recommendation.
24 (8) Consultation with the actuary contracted by the
25 department on the development of an actuarial report of the
26 projected solvency and financial status of the program. The
27 actuary shall provide any recommendations to the commission
28 and the General Assembly on actions necessary to achieve
29 trust solvency.
30 (g) Expenses.--The commission shall monitor department
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 1 administrative expenses over time. Beginning November 15, 2021,
2 the commission shall annually report to the Governor, the
3 chairperson and minority chairperson of the Finance Committee of
4 the Senate and the chairperson and minority chairperson of the
5 Finance Committee of the House of Representatives on department
6 spending for administrative expenses and anticipated
7 administrative expenses as the program shifts into different
8 phases of implementation and operation. The November 15, 2026,
9 report shall include recommendations for a method of calculating
10 future department administrative expenses to limit
11 administrative expenses while providing sufficient funds to
12 adequately operate the program. The members under subsection (b)
13 (1), (2), (3) and (4) may advise the commission on the reports
14 prepared under this subsection but must recuse themselves from
15 the commission's process for review, approval and submission to
16 the General Assembly.
17 (h) Investment strategy subcommittee.--The commission shall
18 establish an investment strategy subcommittee consisting of the
19 members under subsection (b)(1), (2), (3) and (4) as voting
20 members of the subcommittee. In addition, four members appointed
21 by the Governor who are considered experienced and qualified in
22 the field of investment shall serve as nonvoting members. The
23 subcommittee shall provide guidance and advice to the State
24 Treasury on investment strategies for the fund, including
25 seeking counsel and advice on the types of investments that are
26 constitutionally permitted.
27 Section 5. Long-Term Services and Supports Trust Council.
28 (a) Establishment.--The Long-Term Services and Supports
29 Trust Council is established.
30 (b) Membership.--The council shall include:
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 1 (1) The Secretary of Human Services or a designee.
2 (2) The Secretary of Revenue or a designee.
3 (3) Two members of the Senate appointed by the President
4 pro tempore of the Senate.
5 (4) Two members of the House of Representatives
6 appointed by the Speaker of the House of Representatives.
7 (5) The Deputy Secretary for the Office of the Budget's
8 Office of Comptroller Operations.
9 (c) Adjustments to benefit unit.--On an annual b