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Eliminating the three-day hospital stay requirement for Medicare coverage in a skilled-nursing facility is among the list of recommendations that the Commission on Long-Term Care will include in its final report to Congress on long-term services due by Sept. 30.

On Thursday, the 15-member congressionally mandated commission met its Sept. 12 deadline to vote on a blueprint that it intends to share with Congress. Created as part of the American Taxpayer Relief Act that Congress passed in January, the commission is responsible for developing a plan that would establish, implement and finance a long-term care system in the U.S. Panel members voted 9-6 that the report should be put forward as the broad agreement of the commission.

The commission was established following Congress' repeal of the landmark Community Living Assistance and Supports Act section of the Patient Protection and Affordable Care Act, which would have established a voluntary long-term care benefit for Americans paid for by workers' payroll contributions. Many experts said policymakers needed to address the problem of making long-term care affordable given the repeal of the CLASS Act. Many Americans lack affordable long-term care because Medicare doesn't pay for most long-term care, and Medicaid only covers it after people have exhausted their private assets. Only a small percentage of Americans have purchased private long-term care insurance, but that market has faced problems of expensive premiums and insurers exiting.

According to a summary from the commission, more than 25 recommendations were listed in the package that will be included in the final report this month. Those recommendations fell into broad categories of service delivery, workforce, finance and advancing a national advisory committee on long-term services and supports.

The biggest sticking point in designing a long-term care system in the U.S. is how to fund it, with liberals favoring some type of government program and conservatives supporting private financing.

The commission determined there should be a "sustainable balance" of private and public financing for long-term services and supports that allows individuals with functional limitations to remain in the workforce or in appropriate settings that they've chosen. With that as a guidepost, the commissioners suggested improvements for both Medicare and Medicaid. In addition to eliminating the three-day hospital stay requirement in Medicare, they suggest that Congress reconsider a Medicare requirement for receiving home health services that says an individual must be homebound to qualify. For Medicaid, the panel members suggest creating a demonstration project to provide workers with disability coverage for the long-term care services and supports they need to stay employed.

Meanwhile, the commission included a variety of recommendations pertaining to workforce issues, such as ensuring that family caregivers have access to relevant information through technology; urging the federal government to work with the states to enable national criminal background checks for all members of the long-term care workforce; and encouraging the states to adopt standards and establish a certification process for homecare workers.

"I am pleased that a majority of the Commission has agreed on a number of thoughtful recommendations that serve as a launching pad for future action by Congress and the Administration," Dr. Bruce Chernof, the panel's chairman, said in a news release. "I hope both the bipartisan nature of this report and the suite of ideas garnering broad agreement dispels the myth that our nation's long-term care crisis is just too hard a problem to tackle."

Separately Friday, five commissioners released some alternative recommendations because they said "given the unusually compressed timeframe and the broad range of views among the commissioners, the recommendations of the Commission did not fulfill its comprehensive charge." Chief among those recommendations is that a public social insurance program be established.

G. Lawrence Atkins, staff director for the Commission, said in an e-mail that the proposal from the five commissioners represent their personal views. Some of the proposals are similar to recommendations of the Commission and, in the area of financing, alternatives will be presented in the final report, he explained. "But the statement they released today will not be part of the Final Report, which we will release next Wednesday," Atkins said.

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