Title I: Long Term Care - Subtitle A: Tax Incentives - Amends IRC to allow an additional itemized deduction for a certain percentage of the amount of eligible long-term care premiums paid during the taxable year for coverage for the taxpayer, spouse, and dependents under a qualified long-term care insurance contract. Sets forth special rules for individuals who have attained age 55. Adds contingent nonforfeiture requirements to specified insurance model regulations under IRC. Allows long-term care insurance to be offered under: (1) cafeteria plans, for purposes of IRC definition of qualified benefits; and (2) flexible spending arrangements, for purposes of IRC provisions relating to employer contributions to accident and health plans.
(Sec. 102) Allows a nonrefundable personal credit for taxpayers who are eligible caregivers for individuals with long-term care needs. Sets forth: (1) limitations based on adjusted gross income; and (2) special rules where there is more than one eligible caregiver for an individual.
Subtitle B: Federal Employees and Uniformed Services Group Long-Term Care Insurance - Long-Term Care Security Act - Amends Federal civil service provisions to direct the Office of Personnel Management (OPM) to establish and administer a program through which Federal employees and annuitants, current and retired members of the uniformed services, and their qualified relatives may obtain long-term care insurance through a qualified carrier (a company licensed to issue such insurance in all States).
(Sec. 112) Directs OPM, without regard to statutes requiring competitive bidding, to contract with one or more qualified carriers to provide such insurance. Sets forth contract terms and conditions, including that the carrier participate in an administrative process to settle claim disputes. Provides for seven-year contracts. Requires OPM, after a certain period, to recommend to specified congressional committees whether the insurance program should be continued. Requires each master insurance contract to include full portability of benefits.
Makes insured individuals responsible for 100 percent of the charges of coverage and allows individuals to have amounts withheld from pay for their coverage and coverage for qualified relatives. Requires each carrier to maintain a separate accounting of premium amounts received.
Provides that contract terms for coverage or benefits under this Act shall preempt State and local law relating to long-term care insurance or contracts.
Requires qualified carriers to furnish reasonable reports and permit audits. Requires two reports from the General Accounting Office to OPM and each House of Congress evaluating the insurance program.
Provides jurisdiction for disputed claims through U.S. district courts after exhausting all available administrative remedies.
Subtitle C: Seniors' Access to Continuing Care - Senior Access to Continuing Care Act of 2000 - Amends ERISA and PHSA to prohibit health insurance provided through a managed care organization under a group health plan (and, for the PHSA, health insurance in the individual market) from denying coverage with regard to a continuing care retirement community or other qualified facility concerning: (1) post-hospitalization services in the same community or facility as in pre-hospitalization; (2) skilled nursing services without a preceding hospitalization; and (3) the same facility the participant's or beneficiary's spouse already resides in. Makes the prohibition: (1) depend on whether such services are otherwise covered; and (2) regardless of whether the organization is under contract with the community or facility. Prohibits related denial of enrollment or renewal, incentives to enrollees, and penalties or incentives to physicians. Declares that this subtitle does not preempt State laws meeting certain requirements, including requirements more protective of participants or beneficiaries than requirements under this subtitle. Provides for enforcement.
(Sec. 125) Expresses the sense of the Senate concerning the care of older Americans.
Subtitle D: Expansion of Home-Based Long-Term Care Services Under the Social Services Block Grant - Amends SSA to restore a State's authority to transfer up to ten percent of funds for Temporary Assistance for Needy Families (TANF) to the Social Services Block Grant.
(Sec. 132) Restores a specified amount of funds for the Social Services Block Grant.
(Sec. 133) Appropriates additional funds for expansion of home-based long-term care services.
Title II: Support and Planning for Long-Term Care - Subtitle A: Support and Surveys - Amends OAA to establish the National Family Caregiver Support Grant Program. Provides for: (1) grants to States for State programs and for area agencies on aging to provide multifaceted systems of support services for family caregivers and other caregivers who are informal providers of in-home services and community care for older individuals; (2) innovation grants; and (3) activities of national significance. Authorizes appropriations.
(Sec. 202) Directs the Secretary of Health and Human Services (HHS) to conduct and report on a multi-city and county survey to determine if communities are elder-ready, or prepared to accommodate the needs of aging baby boomers.
Subtitle B: Education and Studies - Directs the Secretary of Labor, in conjunction with the Secretary of HHS and the Administrator of the Small Business Administration, to establish and carry out a national public information campaign to provide employers and employees with information concerning the benefits of long-term health care coverage. Authorizes appropriations.
(Sec. 212) Directs the Comptroller General to prepare and submit to the appropriate committees of Congress a report on the long-term care programs of the Veterans Administration.
(Sec. 213) Directs the Secretary of HHS to conduct, and report to Congress on, at least one study to determine: (1) activities or programs to improve the quality of life for the elderly; (2) measures to be taken to prevent or delay the onset of age-related functional decline and disease and disability among the elderly; (3) whether medicare health promotion and disease prevention benefits reduce or delay the need by seniors for long-term care services; and (4) the manner in which the aging of the population in the United States will impact the administration and solvency of Federal programs.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2935 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2935
To amend the Employee Retirement Income Security Act of 1974, the
Internal Revenue Code of 1986, and the Public Health Service Act to
increase Americans' access to long term health care, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 26, 2000
Mr. Graham (for himself, Mr. Grassley, Ms. Mikulski, Mr. Bayh, Mr.
Breaux, Ms. Collins, and Mr. Akaka) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974, the
Internal Revenue Code of 1986, and the Public Health Service Act to
increase Americans' access to long term health care, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Omnibus Long-term
Care Act of 2000''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--LONG TERM CARE
Subtitle A--Tax Incentives
Sec. 101. Treatment of premiums on qualified long-term care insurance
contracts.
Sec. 102. Credit for taxpayers with long-term care needs.
Subtitle B--Federal Employees and Uniformed Services Group Long-Term
Care Insurance
Sec. 111. Short title.
Sec. 112. Long-term care insurance.
Sec. 113. Effective date.
Subtitle C--Seniors' Access to Continuing Care
Sec. 121. Short title.
Sec. 122. Amendments to the Employee Retirement Income Security Act of
1974.
Sec. 123. Amendments to the Public Health Service Act relating to the
group market.
Sec. 124. Amendment to the Public Health Service Act relating to the
individual market.
Sec. 125. Sense of the Senate concerning the care of older Americans.
Subtitle D--Expansion of Home-Based Long-Term Care Services Under the
Social Services Block Grant
Sec. 131. Restoration of authority to transfer up to 10 percent of TANF
funds to the Social Services Block Grant.
Sec. 132. Restoration of funds for the Social Services Block Grant.
Sec. 133. Appropriation of additional funds for expansion of home-based
long-term care services.
TITLE II--SUPPORT AND PLANNING FOR LONG-TERM CARE
Subtitle A--Support and Surveys
Sec. 201. National Family Caregiver Support Grant Program.
Sec. 202. Community survey.
Subtitle B--Education and Studies
Sec. 211. Long-term care coverage educational campaign.
Sec. 212. Report on long-term care.
Sec. 213. Aging study and report.
TITLE I--LONG TERM CARE
Subtitle A--Tax Incentives
SEC. 101. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE
CONTRACTS.
(a) In General.--Part VII of subchapter B of chapter 1 of the
Internal Revenue Code of 1986 (relating to additional itemized
deductions) is amended by redesignating section 222 as section 223 and
by inserting after section 221 the following new section:
``SEC. 222. PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.
``(a) In General.--In the case of an individual, there shall be
allowed as a deduction an amount equal to the applicable percentage of
the amount of eligible long-term care premiums (as defined in section
213(d)(10)) paid during the taxable year for coverage for the taxpayer,
his spouse, and dependents under a qualified long-term care insurance
contract (as defined in section 7702B(b)).
``(b) Applicable Percentage.--For purposes of subsection (a)--
``(1) In general.--Except as otherwise provided in this
subsection, the applicable percentage shall be determined in
accordance with the following table based on the number of
years of continuous coverage (as of the close of the taxable
year) of the individual under any qualified long-term care
insurance contracts (as defined in section 7702B(b)):
``If the number of years of
The applicable long-term
continuous coverage is--
care percentage is--
Less than 1............................ 60
At least 1 but less than 2............. 70
At least 2 but less than 3............. 80
At least 3 but less than 4............. 90
At least 4............................. 100.
``(2) Special rules for individuals who have attained age
55.--In the case of an individual who has attained age 55 as of
the close of the taxable year, the following table shall be
substituted for the table in paragraph (1).
``If the number of years of
The applicable long-term
continuous coverage is--
care percentage is--
Less than 1............................ 70
At least 1 but less than 2............. 85
At least 2............................. 100.
``(3) Only coverage after 2000 taken into account.--Only
coverage for periods after December 31, 2000, shall be taken
into account under this subsection.
``(4) Continuous coverage.--An individual shall not fail to
be treated as having continuous coverage if the aggregate
breaks in coverage during any 1-year period are less than 60
days.
``(c) Coordination With Other Deductions.--Any amount paid by a
taxpayer for any qualified long-term care insurance contract to which
subsection (a) applies shall not be taken into account in computing the
amount allowable to the taxpayer as a deduction under section 162(l) or
213(a).''
(b) Contingent Nonforfeiture Requirements Added to Consumer
Protection Provisions.--
(1) Section 7702B(g)(2)(A)(i) of the Internal Revenue Code
of 1986 (relating to model regulation) is amended by adding at
the end the following new subclause:
``(XII) Section 23 (relating to
contingent nonforfeiture benefits), if
the policyholder declines the offer of
a nonforfeiture provision described in
paragraph (4).''
(2) Section 7702B(g)(2)(A)(ii) of such Code (relating to
model Act) is amended by adding at the end the following new
subclause:
``(III) Section 8 (relating to
contingent nonforfeiture benefits), if
the policyholder declines the offer of
a nonforfeiture provision described in
paragraph (4).''
(c) Reference to NAIC Model Act Updated.--Section 7702B(g)(2)(B)(i)
of the Internal Revenue Code of 1986 (relating to model provisions) is
amended by striking ``January 1993'' and inserting ``January 1999''.
(d) Long-Term Care Insurance Permitted To Be Offered Under
Cafeteria Plans and Flexible Spending Arrangements.--
(1) Cafeteria plans.--Section 125(f) of the Internal
Revenue Code of 1986 (defining qualified benefits) is amended
by inserting before the period at the end ``; except that such
term shall include the payment of premiums for any qualified long-term
care insurance contract (as defined in section 7702B) to the extent the
amount of such payment does not exceed the eligible long-term care
premiums (as defined in section 213(d)(10)) for such contract''.
(2) Flexible spending arrangements.--Section 106 of such
Code (relating to contributions by an employer to accident and
health plans) is amended by striking subsection (c).
(e) Conforming Amendments.--
(1) Section 62(a) of the Internal Revenue Code of 1986 is
amended by inserting after paragraph (17) the following new
item:
``(18) Premiums on qualified long-term care insurance
contracts.--The deduction allowed by section 222.''
(2) Section 7702B(g)(2)(A)(i) of such Code, as amended by
subsection (b)(1), is amended by striking ``7A'' both places it
appears, ``7B'', ``7C'', ``7D'', ``7E'', ``8'', ``9'', ``9F'',
``10'', ``11'', ``12'', and ``23'' the first place it appears
and inserting ``6A'', ``6B'', ``6C'', ``6D'', ``6E'', ``7'',
``8'', ``8F'', ``9'', ``10'', ``11'', and ``22'', respectively.
(3) Section 4980C(c)(1)(A) of such Code is amended by
striking ``13'', ``14'', ``20'', ``21'', ``21C(1)'',
``21C(6)'', ``22'', ``24'', and ``25'' and inserting ``12'',
``13'', ``19'', ``20C(1)'', ``20C(6)'', ``21'', ``25'', and
``26'', respectively.
(4) The table of sections for part VII of subchapter B of
chapter 1 of such Code is amended by striking the last item and
inserting the following new items:
``Sec. 222. Premiums on qualified long-
term care insurance contracts.
``Sec. 223. Cross reference.''
(f) Effective Dates.--
(1) In general.--Except as provided in paragraphs (2) and
(3), the amendments made by this section shall apply to taxable
years beginning after December 31, 2000.
(2) Consumer protection provisions.--The amendments made by
subsections (b), (c), (e)(2), and (e)(3) shall apply to
policies issued after the date which is 1 year after the date
of the enactment of this Act.
(3) Cafeteria plans and flexible spending arrangements.--
The amendments made by subsection (c) shall apply to taxable
years beginning after December 31, 2001.
SEC. 102. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.
(a) In General.--Subpart A of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to nonrefundable
personal credits) is amended by inserting after section 25A the
following new section:
``SEC. 25B. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.
``(a) Allowance of Credit.--
``(1) In general.--There shall be allowed as a credit
against the tax imposed by this chapter for the taxable year an
amount equal to the applicable credit amount multiplied by the
number of applicable individuals with respect to whom the
taxpayer is an eligible caregiver for the taxable year.
``(2) Applicable credit amount.--For purposes of paragraph
(1), the applicable credit amount shall be determined in
accordance with the following table:
``For taxable years beginning
The applicable
in calendar year--
credit amount is--
2001........................................... $1,000
2002........................................... 1,500
2003........................................... 2,000
2004........................................... 2,500
2005 or thereafter............................. 3,000.
``(b) Limitation Based on Adjusted Gross Income.--
``(1) In general.--The amount of the credit allowable under
subsection (a) shall be reduced (but not below zero) by $100
for each $1,000 (or fraction thereof) by which the taxpayer's
modified adjusted gross income exceeds the threshold amount.
For purposes of the preceding sentence, the term `modified
adjusted gross income' means adjusted gross income increased by
any amount excluded from gross income under section 911, 931,
or 933.
``(2) Threshold amount.--For purposes of paragraph (1), the
term `threshold amount' means--
``(A) $150,000 in the case of a joint return, and
``(B) $75,000 in any other case.
``(3) Indexing.--In the case of any taxable year beginning
in a calendar year after 2001, each dollar amount contained in
paragraph (2) shall be increased by an amount equal to the
product of--
``(A) such dollar amount, and
``(B) the medical care cost adjustment determined
under section 213(d)(10)(B)(ii) for the calendar year
in which the taxable year begins, determined by
substituting `August of 2000' for `August of 1996' in
subclause (II) thereof.
If any increase determined under the preceding sentence is not
a multiple of $50, such increase shall be rounded to the next
lowest multiple of $50.
``(c) Definitions.--For purposes of this section--
``(1) Applicable individual.--
``(A) In general.--The term `applicable individual'
means, with respect to any taxable year, any individual
who has been certified, before the due date for filing
the return of tax for the taxable year (without
extensions), by a physician (as defined in section
1861(r)(1) of the Social Security Act) as being an
individual with long-term care needs described in
subparagraph (B) for a period--
``(i) which is at least 180 consecutive
days, and
``(ii) a portion of which occurs within the
taxable year.
Such term shall not include any individual otherwise
meeting the requirements of the preceding sentence
unless within the 39\1/2\ month period ending on such
due date (or such other period as the Secretary
prescribes) a physician (as so defined) has certified
that such individual meets such requirements.
``(B) Individuals with long-term care needs.--An
individual is described in this subparagraph if the
individual meets any of the following requirements:
``(i) The individual is at least 6 years of
age and--
``(I) is unable to perform (without
substantial assistance from another
individual) at least 3 activities of
daily living (as defined in section
7702B(c)(2)(B)) due to a loss of
functional capacity, or
``(II) requires substantial
supervision to protect such individual
from threats to health and safety due
to severe cognitive impairment and is
unable to preform, without reminding or
cuing assistance, at least 1 activity
of daily living (as so defined) or to
the extent provided in regulations
prescribed by the Secretary (in
consultation with the Secretary of
Health and Human Services), is unable
to engage in age appropriate
activities.
``(ii) The individual is at least 2 but not
6 years of age and is unable due to a loss of
functional capacity to perform (without
substantial assistance from another individual)
at least 2 of the following activities: eating,
transferring, or mobility.
``(iii) The individual is under 2 years of
age and requires specific durable medical
equipment by reason of a severe health
condition or requires a skilled practitioner
trained to address the individual's condition
to be available if the individual's parents or
guardians are absent.
``(2) Eligible caregiver.--
``(A) In general.--A taxpayer shall be treated as
an eligible caregiver for any taxable year with respect
to the following individuals:
``(i) The taxpayer.
``(ii) The taxpayer's spouse.
``(iii) An individual with respect to whom
the taxpayer is allowed a deduction under
section 151 for the taxable year.
``(iv) An individual who would be described
in clause (iii) for the taxable year if section
151(c)(1)(A) were applied by substituting for
the exemption amount an amount equal to the sum
of the exemption amount, the standard deduction
under section 63(c)(2)(C), and any additional
standard deduction under section 63(c)(3) which
would be applicable to the individual if clause
(iii) applied.
``(v) An individual who would be described
in clause (iii) for the taxable year if--
``(I) the requirements of clause
(iv) are met with respect to the
individual, and
``(II) the requirements of
subparagraph (B) are met with respect
to the individual in lieu of the
support test of section 152(a).
``(B) Residency test.--The requirements of this
subparagraph are met if an individual has as his
principal place of abode the home of the taxpayer and--
``(i) in the case of an individual who is
an ancestor or descendant of the taxpayer or
the taxpayer's spouse, is a member of the
taxpayer's household for over half the taxable
year, or
``(ii) in the case of any other individual,
is a member of the taxpayer's household for the
entire taxable year.
``(C) Special rules where more than 1 eligible
caregiver.--
``(i) In general.--If more than 1
individual is an eligible caregiver with
respect to the same applicable individual for
taxable years ending with or within the same
calendar year, a taxpayer shall be treated as
the eligible caregiver if each such individual
(other than the taxpayer) files a written
declaration (in such form and manner as the
Secretary may prescribe) that such individual
will not claim such applicable individual for
the credit under this section.
``(ii) No agreement.--If each individual
required under clause (i) to file a written
declaration under clause (i) does not do so,
the individual with the highest modified
adjusted gross income (as defined in section
32(c)(5)) shall be treated as the eligible
caregiver.
``(iii) Married individuals filing
separately.--In the case of married individuals
filing separately, the determination under this
subparagraph as to whether the husband or wife
is the eligible caregiver shall be made under
the rules of clause (ii) (whether or not one of
them has filed a written declaration under
clause (i)).
``(d) Identification Requirement.--No credit shall be allowed under
this section to a taxpayer with respect to any applicable individual
unless the taxpayer includes the name and taxpayer identification
number of such individual, and the identification number of the
physician certifying such individual, on the return of tax for the
taxable year.
``(e) Taxable Year Must Be Full Taxable Year.--Except in the case
of a taxable year closed by reason of the death of the taxpayer, no
credit shall be allowable under this section in the case of a taxable
year covering a period of less than 12 months.''
(b) Conforming Amendments.--
(1) Section 6213(g)(2) of the Internal Revenue Code of 1986
is amended by striking ``and'' at the end of subparagraph (K),
by striking the period at the end of subparagraph (L) and inserting ``,
and'', and by inserting after subparagraph (L) the following new
subparagraph:
``(M) an omission of a correct TIN or physician
identification required under section 25B(d) (relating
to credit for taxpayers with long-term care needs) to
be included on a return.''
(2) The table of sections for subpart A of part IV of
subchapter A of chapter 1 of such Code is amended by inserting
after the item relating to section 25A the following new item:
``Sec. 25B. Credit for taxpayers with
long-term care needs.''
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2000.
Subtitle B--Federal Employees and Uniformed Services Group Long-Term
Care Insurance
SEC. 111. SHORT TITLE.
This subtitle may be cited as the ``Long-Term Care Security Act''.
SEC. 112. LONG-TERM CARE INSURANCE.
(a) In General.--Subpart G of part III of title 5, United States
Code, is amended by adding at the end the following:
``CHAPTER 90--LONG-TERM CARE INSURANCE
``Sec.
``9001. Definitions.
``9002. Availability of insurance.
``9003. Contracting authority.
``9004. Financing.
``9005. Preemption.
``9006. Studies, reports, and audits.
``9007. Jurisdiction of courts.
``9008. Administrative functions.
``9009. Cost accounting standards.
``Sec. 9001. Definitions
For purposes of this chapter:
``(1) Employee.--The term `employee' means--
``(A) an employee as defined by section 8901(1);
and
``(B) an individual described in section 2105(e);
but does not include an individual employed by the government
of the District of Columbia.
``(2) Annuitant.--The term `annuitant' has the meaning such
term would have under paragraph (3) of section 8901 if, for
purposes of such paragraph, the term `employee' were considered
to have the meaning given to it under paragraph (1) of this
subsection.
``(3) Member of the uniformed services.--The term `member
of the uniformed services' means a member of the uniformed
services, other than a retired member of the uniformed
services.
``(4) Retired member of the uniformed services.--The term
`retired member of the uniformed services' means a member or
former member of the uniformed services entitled to retired or
retainer pay.
``(5) Qualified relative.--The term `qualified relative'
means each of the following:
``(A) The spouse of an individual described in
paragraph (1), (2), (3), or (4).
``(B) A parent, stepparent, or parent-in-law of an
individual described in paragraph (1) or (3).
``(C) A child (including an adopted child, a
stepchild, or, to the extent the Office of Personnel
Management by regulation provides, a foster child) of
an individual described in paragraph (1), (2), (3), or
(4), if such child is at least 18 years of age.
``(D) An individual having such other relationship
to an individual described in paragraph (1), (2), (3),
or (4) as the Office may by regulation prescribe.
``(6) Eligible individual.--The term `eligible individual'
refers to an individual described in paragraph (1), (2), (3),
(4), or (5).
``(7) Qualified carrier.--The term `qualified carrier'
means an insurance company (or consortium of insurance
companies) that is licensed to issue long-term care insurance
in all States, taking any subsidiaries of such a company into
account (and, in the case of a consortium, considering the
member companies and any subsidiaries thereof, collectively).
``(8) State.--The term `State' includes the District of
Columbia.
``(9) Qualified long-term care insurance contract.--The
term `qualified long-term care insurance contract' has the
meaning given such term by section 7702B of the Internal
Revenue Code of 1986.
``(10) Appropriate secretary.--The term `appropriate
Secretary' means--
``(A) except as otherwise provided in this
paragraph, the Secretary of Defense;
``(B) with respect to the Coast Guard when it is
not operating as a service of the Navy, the Secretary
of Transportation;
``(C) with respect to the commissioned corps of the
National Oceanic and Atmospheric Administration, the
Secretary of Commerce; and
``(D) with respect to the commissioned corps of the
Public Health Service, the Secretary of Health and
Human Services.
``Sec. 9002. Availability of insurance
``(a) In General.--The Office of Personnel Management shall
establish and, in consultation with the appropriate Secretaries,
administer a program through which an individual described in paragraph
(1), (2), (3), (4), or (5) of section 9001 may obtain long-term care
insurance coverage under this chapter for such individual.
``(b) General Requirements.--Long-term care insurance may not be
offered under this chapter unless--
``(1) the only coverage provided is under qualified long-
term care insurance contracts; and
``(2) each insurance contract under which any such coverage
is provided is issued by a qualified carrier.
``(c) Documentation Requirement.--As a condition for obtaining
long-term care insurance coverage under this chapter based on one's
status as a qualified relative, an applicant shall provide
documentation to demonstrate the relationship, as prescribed by the
Office.
``(d) Underwriting Standards.--
``(1) Disqualifying condition.--Nothing in this chapter
shall be considered to require that long-term care insurance
coverage be made available in the case of any individual who
would be eligible for benefits immediately.
``(2) Spousal parity.--For the purpose of underwriting
standards, a spouse of an individual described in paragraph
(1), (2), (3), or (4) of section 9001 shall, as nearly as
practicable, be treated like that individual.
``(3) Guaranteed issue.--Nothing in this chapter shall be
considered to require that long-term care insurance coverage be
guaranteed to an eligible individual.
``(4) Requirement that contract be fully insured.--In
addition to the requirements otherwise applicable under section
9001(9), in order to be considered a qualified long-term care
insurance contract for purposes of this chapter, a contract
shall be fully insured, whether through reinsurance with other
companies or otherwise.
``(5) Higher standards allowable.--Nothing in this chapter
shall, in the case of an individual applying for long-term care
insurance coverage under this chapter after the expiration of
such individual's first opportunity to enroll, preclude the
application of underwriting standards more stringent than those
that would have applied if that opportunity had not yet
expired.
``(e) Guaranteed Renewability.--The benefits and coverage made
available to eligible individuals under any insurance contract under
this chapter shall be guaranteed renewable (as defined by section 7A(2)
of the model regulations described in section 7702B(g)(2) of the
Internal Revenue Code of 1986), including the right to have insurance
remain in effect so long as premiums continue to be timely made.
However, the authority to revise premiums under this chapter shall be
available only on a class basis and only to the extent otherwise
allowable under section 9003(b).
``Sec. 9003. Contracting authority
``(a) In General.--Without regard to section 3709 of the Revised
Statutes (41 U.S.C. 5) or any other statute requiring competitive
bidding, the Office of Personnel Management shall contract with 1 or
more qualified carriers for a policy or policies of long-term care
insurance. The Office shall ensure that each resulting contract (in
this chapter referred to as a `master contract') is awarded on the
basis of contractor qualifications, price, and reasonable competition.
``(b) Terms and Conditions.--
``(1) In general.--Each master contract under this chapter
shall contain--
``(A) a detailed statement of the benefits offered
(including any maximums, limitations, exclusions, and
other definitions of benefits);
``(B) the premiums charged (including any
limitations or other conditions on their subsequent
adjustment);
``(C) the terms of the enrollment period; and
``(D) such other terms and conditions as may be
mutually agreed to by the Office and the carrier
involved, consistent with the requirements of this
chapter.
``(2) Premiums.--Premiums charged under each master
contract entered into under this section shall reasonably and
equitably reflect the cost of the benefits provided, as
determined by the Office. The premiums shall not be adjusted
during the term of the contract unless mutually agreed to by
the Office and the carrier.
``(3) Nonrenewability.--Master contracts under this chapter
may not be made automatically renewable.
``(c) Payment of Required Benefits; Dispute Resolution.--
``(1) In general.--Each master contract under this chapter
shall require the carrier to agree--
``(A) to provide payments or benefits to an
eligible individual if such individual is entitled to
such payments or benefits under the terms of the
contract; and
``(B) with respect to disputes regarding claims for
payments or benefits under the terms of the contract--
``(i) to establish internal procedures
designed to expeditiously resolve such
disputes; and
``(ii) to establish, for disputes not
resolved through procedures under clause (i),
procedures for 1 or more alternative means of
dispute resolution involving independent third-
party review under appropriate circumstances by
entities mutually acceptable to the Office and
the carrier.
``(2) Eligibility.--A carrier's determination as to whether
or not a particular individual is eligible to obtain long-term
care insurance coverage under this chapter shall be subject to
review only to the extent and in the manner provided in the
applicable master contract.
``(3) Other claims.--For purposes of applying the Contract
Disputes Act of 1978 to disputes arising under this chapter
between a carrier and the Office--
``(A) the agency board having jurisdiction to
decide an appeal relative to such a dispute shall be
such board of contract appeals as the Director of the
Office of Personnel Management shall specify in writing
(after appropriate arrangements, as described in
section 8(c) of such Act); and
``(B) the district courts of the United States
shall have original jurisdiction, concurrent with the
United States Court of Federal Claims, of any action
described in section 10(a)(1) of such Act relative to
such a dispute.
``(4) Rule of construction.--Nothing in this chapter shall
be considered to grant authority for the Office or a third-
party reviewer to change the terms of any contract under this
chapter.
``(d) Duration.--
``(1) In general.--Each master contract under this chapter
shall be for a term of 7 years, unless terminated earlier by
the Office in accordance with the terms of such contract.
However, the rights and responsibilities of the enrolled
individual, the insurer, and the Office (or duly designated
third-party administrator) under such contract shall continue
with respect to such individual until the termination of
coverage of the enrolled individual or the effective date of a
successor contract.
``(2) Exception.--
``(A) Shorter duration.--In the case of a master
contract entered into before the end of the period
described in subparagraph (B), paragraph (1) shall be
applied by substituting `ending on the last day of the
7-year period described in paragraph (2)(B)' for `of 7
years'.
``(B) Definition.--The period described in this
subparagraph is the 7-year period beginning on the
earliest date as of which any long-term care insurance
coverage under this chapter becomes effective.
``(3) Congressional notification.--No later than 180 days
after receiving the second report required under section
9006(c), the President (or his designee) shall submit to the
Committees on Government Reform and on Armed Services of the
House of Representatives and the Committees on Governmental
Affairs and on Armed Services of the Senate, a written
recommendation as to whether the program under this chapter
should be continued without modification, terminated, or
restructured. During the 180-day period following the date on
which the President (or his designee) submits the
recommendation required under the preceding sentence, the
Office of Personnel Management may not take any steps to rebid
or otherwise contract for any coverage to be available at any
time following the expiration of the 7-year period described in
paragraph (2)(B).
``(4) Full portability.--Each master contract under this
chapter shall include such provisions as may be necessary to
ensure that, once an individual becomes duly enrolled, long-
term care insurance coverage obtained by such individual
pursuant to that enrollment shall not be terminated due to any
change in status (such as separation from Government service or
the uniformed services) or ceasing to meet the requirements for
being considered a qualified relative (whether as a result of
dissolution of marriage or otherwise).
``Sec. 9004. Financing
``(a) In General.--Each eligible individual obtaining long-term
care insurance coverage under this chapter shall be responsible for 100
percent of the premiums for such coverage.
``(b) Withholdings.--
``(1) In general.--The amount necessary to pay the premiums
for enrollment may--
``(A) in the case of an employee, be withheld from
the pay of such employee;
``(B) in the case of an annuitant, be withheld from
the annuity of such annuitant;
``(C) in the case of a member of the uniformed
services described in section 9001(3), be withheld from
the basic pay of such member; and
``(D) in the case of a retired member of the
uniformed services described in section 9001(4), be
withheld from the retired pay or retainer pay payable
to such member.
``(2) Voluntary withholdings for qualified relatives.--
Withholdings to pay the premiums for enrollment of a qualified
relative may, upon election of the appropriate eligible
individual (described in section 9001 (1) through (4)), be
withheld under paragraph (1) to the same extent and in the same
manner as if enrollment were for such individual.
``(c) Direct Payments.--All amounts withheld under this section
shall be paid directly to the carrier.
``(d) Other Forms of Payment.--Any enrollee who does not elect to
have premiums withheld under subsection (b) or whose pay, annuity, or
retired or retainer pay (as referred to in subsection (b)(1)) is
insufficient to cover the withholding required for enrollment (or who
is not receiving any regular amounts from the Government, as referred
to in subsection (b)(1), from which any such withholdings may be made,
and whose premiums are not otherwise being provided for under
subsection (b)(2)) shall pay an amount equal to the full amount of
those charges directly to the carrier.
``(e) Separate Accounting Requirement.--Each carrier participating
under this chapter shall maintain records that permit it to account
for all amounts received under this chapter (including investment
earnings on those amounts) separate and apart from all other funds.
``(f) Reimbursements.--
``(1) Reasonable initial costs.--
``(A) In general.--The Employees' Life Insurance
Fund is available, without fiscal year limitation, for
reasonable expenses incurred by the Office of Personnel
Management in administering this chapter before the
start of the 7-year period described in section
9003(d)(2)(B), including reasonable implementation
costs.
``(B) Reimbursement requirement.--Such Fund shall
be reimbursed, before the end of the first year of that
7-year period, for all amounts obligated or expended
under subparagraph (A) (including lost investment
income). Such reimbursement shall be made by carriers,
on a pro rata basis, in accordance with appropriate
provisions which shall be included in master contracts
under this chapter.
``(2) Subsequent costs.--
``(A) In general.--There is established in the
Employees' Life Insurance Fund a Long-Term Care
Administrative Account, which shall be available to the
Office, without fiscal year limitation, to defray reasonable expenses
incurred by the Office in administering this chapter after the start of
the 7-year period described in section 9003(d)(2)(B).
``(B) Reimbursement requirement.--Each master
contract under this chapter shall include appropriate
provisions under which the carrier involved shall,
during each year, make such periodic contributions to
the Long-Term Care Administrative Account as necessary
to ensure that the reasonable anticipated expenses of
the Office in administering this chapter during such
year (adjusted to reconcile for any earlier
overestimates or underestimates under this
subparagraph) are defrayed.
``Sec. 9005. Preemption
``The terms of any contract under this chapter which relate to the
nature, provision, or extent of coverage or benefits (including
payments with respect to benefits) shall supersede and preempt any
State or local law, or any regulation issued under such law, which
relates to long-term care insurance or contracts.
``Sec. 9006. Studies, reports, and audits
``(a) Provisions Relating to Carriers.--Each master contract under
this chapter shall contain provisions requiring the carrier--
``(1) to furnish such reasonable reports as the Office of
Personnel Management determines to be necessary to enable it to
carry out its functions under this chapter; and
``(2) to permit the Office and representatives of the
General Accounting Office to examine such records of the
carrier as may be necessary to carry out the purposes of this
chapter.
``(b) Provisions Relating to Federal Agencies.--Each Federal agency
shall keep such records, make such certifications, and furnish the
Office, the carrier, or both, with such information and reports as the
Office may require.
``(c) Reports by the General Accounting Office.--The General
Accounting Office shall prepare and submit to the President, the Office
of Personnel Management, and each House of Congress, before the end of
the third and fifth years during which the program under this chapter
is in effect, a written report evaluating such program. Each such
report shall include an analysis of the competitiveness of the program,
as compared to both group and individual coverage generally available
to individuals in the private insurance market. The Office shall
cooperate with the General Accounting Office to provide periodic
evaluations of the program.
``Sec. 9007. Jurisdiction of courts
``The district courts of the United States have original
jurisdiction of a civil action or claim described in paragraph (1) or
(2) of section 9003(c), after such administrative remedies as required
under such paragraph (1) or (2) (as applicable) have been exhausted,
but only to the extent judicial review is not precluded by any dispute
resolution or other remedy under this chapter.
``Sec. 9008. Administrative functions
``(a) In General.--The Office of Personnel Management shall
prescribe regulations necessary to carry out this chapter.
``(b) Enrollment Periods.--The Office shall provide for periodic
coordinated enrollment, promotion, and education efforts in
consultation with the carriers.
``(c) Consultation.--Any regulations necessary to effect the
application and operation of this chapter with respect to an eligible
individual described in paragraph (3) or (4) of section 9001, or a
qualified relative of such an individual, shall be prescribed by the
Office in consultation with the appropriate Secretary.
``(d) Informed Decisionmaking.--The Office shall ensure that each
eligible individual applying for long-term care insurance under this
chapter is furnished the information necessary to enable that
individual to evaluate the advantages and disadvantages of obtaining
long-term care insurance under this chapter, including the following:
``(1) The principal long-term care benefits and coverage
available under this chapter, and how those benefits and
coverage compare to the range of long-term care benefits and
coverage otherwise generally available.
``(2) Representative examples of the cost of long-term
care, and the sufficiency of the benefits available under this
chapter relative to those costs. The information under this
paragraph shall also include--
``(A) the projected effect of inflation on the
value of those benefits; and
``(B) a comparison of the inflation-adjusted value
of those benefits to the projected future costs of
long-term care.
``(3) Any rights individuals under this chapter may have to
cancel coverage, and to receive a total or partial refund of
premiums. The information under this paragraph shall also
include--
``(A) the projected number or percentage of
individuals likely to fail to maintain their coverage
(determined based on lapse rates experienced under
similar group long-term care insurance programs and,
when available, this chapter); and
``(B)(i) a summary description of how and when
premiums for long-term care insurance under this
chapter may be raised;
``(ii) the premium history during the last 10 years
for each qualified carrier offering long-term care
insurance under this chapter; and
``(iii) if cost increases are anticipated, the
projected premiums for a typical insured individual at
various ages.
``(4) The advantages and disadvantages of long-term care
insurance generally, relative to other means of accumulating or
otherwise acquiring the assets that may be needed to meet the
costs of long-term care, such as through tax-qualified
retirement programs or other investment vehicles.
``Sec. 9009. Cost accounting standards
``The cost accounting standards issued under section 26(f) of the
Office of Federal Procurement Policy Act (41 U.S.C. 422(f)) shall not
apply with respect to a long-term care insurance contract under this
chapter.''.
(b) Conforming Amendment.--The analysis for part III of title 5,
United States Code, is amended by adding at the end of subpart G the
following:
``90. Long-Term Care Insurance............................. 9001.''.
SEC. 113. EFFECTIVE DATE.
The Office of Personnel Management shall take such measures as may
be necessary to ensure that long-term care insurance coverage under
title 5, United States Code, as amended by this subtitle, may be
obtained in time to take effect not later than the first day of the
first applicable pay period of the first fiscal year which begins after
the end of the 18-month period beginning on the date of enactment of
this Act.
Subtitle C--Seniors' Access to Continuing Care
SEC. 121. SHORT TITLE.
This subtitle may be cited as the ``Seniors' Access to Continuing
Care Act of 2000''.
SEC. 122. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) In General.--Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et
seq.) is amended by adding at the end the following new section:
``SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.
``(a) In General.--With respect to health insurance coverage
provided to participants or beneficiaries through a managed care
organization under a group health plan, or through a health insurance
issuer providing health insurance coverage in connection with a group
health plan, such plan or issuer may not deny coverage for services
provided to such participant or beneficiary by a continuing care
retirement community, skilled nursing facility, or other qualified
facility in which the participant or beneficiary resided prior to a
hospitalization, regardless of whether such organization is under
contract with such community or facility if the requirements described
in subsection (b) are met.
``(b) Requirements.--The requirements of this subsection are that--
``(1) the service involved is a service for which the
managed care organization involved would be required to provide
or pay for under its contract with the participant or
beneficiary if the continuing care retirement community,
skilled nursing facility, or other qualified facility were
under contract with the organization;
``(2) the participant or beneficiary involved--
``(A) resided in the continuing care retirement
community, skilled nursing facility, or other qualified
facility prior to being hospitalized;
``(B) had a contractual or other right to return to
the facility after hospitalization; and
``(C) elects to return to the facility after
hospitalization, whether or not the residence of the
participant or beneficiary after returning from the
hospital is the same part of the facility in which the
beneficiary resided prior to hospitalization;
``(3) the continuing care retirement community, skilled
nursing facility, or other qualified facility has the capacity
to provide the services the participant or beneficiary needs;
``(4) the continuing care retirement community, skilled
nursing facility, or other qualified facility is willing to
accept substantially similar payment under the same terms and
conditions that apply to similarly situated health care
facility providers under contract with the organization
involved.
``(c) Services To Prevent Hospitalization.--A group health plan or
health insurance issuer to which this section applies may not deny
payment for a skilled nursing service provided to a participant or
beneficiary by a continuing care retirement community, skilled nursing
facility, or other qualified facility in which the participant or
beneficiary resides, without a preceding hospital stay, regardless of
whether the organization is under contract with such community or
facility, if--
``(1) the plan or issuer has determined that the service is
necessary to prevent the hospitalization of the participant or
beneficiary; and
``(2) the service to prevent hospitalization is provided as
an additional benefit as described in section 417.594 of title
42, Code of Federal Regulations, and would otherwise be covered
as provided for in subsection (b)(1).
``(d) Rights of Spouses.--A group health plan or health insurance
issuer to which this section applies shall not deny payment for
services provided by a skilled nursing facility for the care of a
participant or beneficiary, regardless of whether the plan or issuer is
under contract with such facility, if the spouse of the participant or
beneficiary is already a resident of such facility and the requirements
described in subsection (b) are met.
``(e) Exceptions.--Subsection (a) shall not apply--
``(1) where the attending acute care provider and the
participant or beneficiary (or a designated representative of
the participant or beneficiary where the participant or
beneficiary is physically or mentally incapable of making an
election under this paragraph) do not elect to pursue a course
of treatment necessitating continuing care; or
``(2) unless the community or facility involved--
``(A) meets all applicable licensing and
certification requirements of the State in which it is
located; and
``(B) agrees to reimbursement for the care of the
participant or beneficiary at a rate similar to the
rate negotiated by the managed care organization with
similar providers of care for similar services.
``(f) Prohibitions.--A group health plan and a health insurance
issuer providing health insurance coverage in connection with a group
health plan may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage with a managed care
organization under the plan, solely for the purpose of avoiding
the requirements of this section;
``(2) provide monetary payments or rebates to enrollees to
encourage such enrollees to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending physician because such physician
provided care to a participant or beneficiary in accordance
with this section; or
``(4) provide incentives (monetary or otherwise) to an
attending physician to induce such physician to provide care to
a participant or beneficiary in a manner inconsistent with this
section.
``(g) Rules of Construction.--
``(1) HMO not offering benefits.--This section shall not
apply with respect to any managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, that does not provide benefits for stays in a
continuing care retirement community, skilled nursing facility,
or other qualified facility.
``(2) Cost-sharing.--Nothing in this section shall be
construed as preventing a managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, from imposing deductibles, coinsurance, or other
cost-sharing in relation to benefits for care in a continuing
care facility.
``(h) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage to the
extent that a State law (as defined in section 2723(d)(1) of
the Public Health Service Act) applies to such coverage and is
described in any of the following subparagraphs:
``(A) Such State law requires such coverage to
provide for referral to a continuing care retirement
community, skilled nursing facility, or other qualified
facility in a manner that is more protective of
participants or beneficiaries than the provisions of
this section.
``(B) Such State law expands the range of services
or facilities covered under this section and is
otherwise more protective of the rights of participants
or beneficiaries than the provisions of this section.
``(2) Construction.--Section 731(a)(1) shall not be
construed to provide that any requirement of this section
applies with respect to health insurance coverage, to the
extent that a State law described in paragraph (1) applies to
such coverage.
``(i) Penalties.--A participant or beneficiary may enforce the
provisions of this section in an appropriate Federal district court. An
action for injunctive relief or damages may be commenced on behalf of
the participant or beneficiary by the participant's or beneficiary's
legal representative. The court may award reasonable attorneys' fees to
the prevailing party. If a beneficiary dies before conclusion of an
action under this section, the action may be maintained by a
representative of the participant's or beneficiary's estate.
``(j) Definitions.--In this section:
``(1) Attending acute care provider.--The term `attending
acute care provider' means anyone licensed or certified under
State law to provide health care services who is operating
within the scope of such license and who is primarily
responsible for the care of the enrollee.
``(2) Continuing care retirement community.--The term
`continuing care retirement community' means an organization
that provides or arranges for the provision of housing and
health-related services to an older person under an
agreement effective for the life of the person or for a specified
period greater than 1 year.
``(3) Managed care organization.--The term `managed care
organization' means an organization that provides comprehensive
health services to participants or beneficiaries, directly or
under contract or other agreement, on a prepayment basis to
such individuals. For purposes of this section, the following
shall be considered as managed care organizations:
``(A) A Medicare+Choice plan authorized under
section 1851(a) of the Social Security Act (42 U.S.C.
1395w-21(a)).
``(B) Any other entity that manages the cost,
utilization, and delivery of health care through the
use of predetermined periodic payments to health care
providers employed by or under contract or other
agreement, directly or indirectly, with the entity.
``(4) Other qualified facility.--The term `other qualified
facility' means any facility that can provide the services
required by the participant or beneficiary consistent with
State and Federal law.
``(5) Skilled nursing facility.--The term `skilled nursing
facility' means a facility that meets the requirements of
section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
(b) Clerical Amendment.--The table of contents in section 1 of the
Employee Retirement Income Security Act of 1974 is amended by inserting
after the items relating to subpart B of part 7 of subtitle B of title
I the following new item:
``Sec. 714. Ensuring choice for continuing care.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2001.
SEC. 123. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE
GROUP MARKET.
(a) In General.--Subpart 2 of part A of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at
the end the following new section:
``SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.
``(a) In General.--With respect to health insurance coverage
provided to enrollees through a managed care organization under a group
health plan, or through a health insurance issuer providing health
insurance coverage in connection with a group health plan, such plan or
issuer may not deny coverage for services provided to such enrollee by
a continuing care retirement community, skilled nursing facility, or
other qualified facility in which the enrollee resided prior to a
hospitalization, regardless of whether such organization is under
contract with such community or facility if the requirements described
in subsection (b) are met.
``(b) Requirements.--The requirements of this subsection are that--
``(1) the service involved is a service for which the
managed care organization involved would be required to provide
or pay for under its contract with the enrollee if the
continuing care retirement community, skilled nursing facility,
or other qualified facility were under contract with the
organization;
``(2) the enrollee involved--
``(A) resided in the continuing care retirement
community, skilled nursing facility, or other qualified
facility prior to being hospitalized;
``(B) had a contractual or other right to return to
the facility after hospitalization; and
``(C) elects to return to the facility after
hospitalization, whether or not the residence of the
enrollee after returning from the hospital is the same
part of the facility in which the beneficiary resided
prior to hospitalization;
``(3) the continuing care retirement community, skilled
nursing facility, or other qualified facility has the capacity
to provide the services the enrollee needs;
``(4) the continuing care retirement community, skilled
nursing facility, or other qualified facility is willing to
accept substantially similar payment under the same terms and
conditions that apply to similarly situated health care
facility providers under contract with the organization
involved.
``(c) Services To Prevent Hospitalization.--A group health plan or
health insurance issuer to which this section applies may not deny
payment for a skilled nursing service provided to an enrollee by a
continuing care retirement community, skilled nursing facility, or
other qualified facility in which the enrollee resides, without a
preceding hospital stay, regardless of whether the plan or issuer is
under contract with such community or facility, if--
``(1) the plan or issuer has determined that the service is
necessary to prevent the hospitalization of the enrollee; and
``(2) the service to prevent hospitalization is provided as
an additional benefit as described in section 417.594 of title
42, Code of Federal Regulations, and would be covered as
provided for in subsection (b)(1).
``(d) Rights of Spouses.--A group health plan or health insurance
issuer to which this section applies shall not deny payment for
services provided by a skilled nursing facility for the care of an
enrollee, regardless of whether the plan or issuer is under contract
with such facility, if the spouse of the enrollee is already a resident
of such facility and the requirements described in subsection (b) are
met.
``(e) Exceptions.--Subsection (a) shall not apply--
``(1) where the attending acute care provider and the
enrollee (or a designated representative of the enrollee where
the enrollee is physically or mentally incapable of making an
election under this paragraph) do not elect to pursue a course
of treatment necessitating continuing care; or
``(2) unless the community or facility involved--
``(A) meets all applicable licensing and
certification requirements of the State in which it is
located; and
``(B) agrees to reimbursement for the care of the
enrollee at a rate similar to the rate negotiated by
the managed care organization with similar providers of
care for similar services.
``(f) Prohibitions.--A group health plan and a health insurance
issuer providing health insurance coverage in connection with a group
health plan may not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage with a managed care
organization under the plan, solely for the purpose of avoiding
the requirements of this section;
``(2) provide monetary payments or rebates to enrollees to
encourage such enrollees to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending physician because such physician
provided care to an enrollee in accordance with this section;
or
``(4) provide incentives (monetary or otherwise) to an
attending physician to induce such physician to provide care to
an enrollee in a manner inconsistent with this section.
``(g) Rules of Construction.--
``(1) HMO not offering benefits.--This section shall not
apply with respect to any managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, that does not provide benefits for stays in a
continuing care retirement community, skilled nursing facility,
or other qualified facility.
``(2) Cost-sharing.--Nothing in this section shall be
construed as preventing a managed care organization under a
group health plan, or through a health insurance issuer
providing health insurance coverage in connection with a group
health plan, from imposing deductibles, coinsurance, or other
cost-sharing in relation to benefits for care in a continuing
care facility.
``(h) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage to the
extent that a State law (as defined in section 2723(d)(1))
applies to such coverage and is described in any of the
following subparagraphs:
``(A) Such State law requires such coverage to
provide for referral to a continuing care retirement
community, skilled nursing facility, or other qualified
facility in a manner that is more protective of the
enrollee than the provisions of this section.
``(B) Such State law expands the range of services
or facilities covered under this section and is
otherwise more protective of enrollee rights than the
provisions of this section.
``(2) Construction.--Section 2723(a)(1) shall not be
construed to provide that any requirement of this section
applies with respect to health insurance coverage, to the
extent that a State law described in paragraph (1) applies to
such coverage.
``(i) Penalties.--An enrollee may enforce the provisions of this
section in an appropriate Federal district court. An action for
injunctive relief or damages may be commenced on behalf of the enrollee
by the enrollee's legal representative. The court may award reasonable
attorneys' fees to the prevailing party. If a beneficiary dies before
conclusion of an action under this section, the action may be
maintained by a representative of the enrollee's estate.
``(j) Definitions.--In this section:
``(1) Attending acute care provider.--The term `attending
acute care provider' means anyone licensed or certified under
State law to provide health care services who is operating
within the scope of such license and who is primarily
responsible for the care of the enrollee.
``(2) Continuing care retirement community.--The term
`continuing care retirement community' means an organization
that provides or arranges for the provision of housing and
health-related services to an older person under an agreement
effective for the life of the person or for a specified period
greater than 1 year.
``(3) Managed care organization.--The term `managed care
organization' means an organization that provides comprehensive
health services to enrollees, directly or under contract or
other agreement, on a prepayment basis to such individuals. For
purposes of this section, the following shall be considered as
managed care organizations:
``(A) A Medicare+Choice plan authorized under
section 1851(a) of the Social Security Act (42 U.S.C.
1395w-21(a)).
``(B) Any other entity that manages the cost,
utilization, and delivery of health care through the
use of predetermined periodic payments to health care
providers employed by or under contract or other
agreement, directly or indirectly, with the entity.
``(4) Other qualified facility.--The term `other qualified
facility' means any facility that can provide the services
required by the enrollee consistent with State and Federal law.
``(5) Skilled nursing facility.--The term `skilled nursing
facility' means a facility that meets the requirements of
section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to group health plans for plan years beginning on or
after January 1, 2001.
SEC. 124. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE
INDIVIDUAL MARKET.
(a) In General.--The first subpart 3 of part B of title XXVII of
the Public Health Service Act (42 U.S.C. 300gg-51 et seq.) (relating to
other requirements) is amended--
(1) by redesignating such subpart as subpart 2; and
(2) by adding at the end the following new section:
``SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.
``The provisions of section 2707 shall apply to health maintenance
organization coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to such coverage
offered by a health insurance issuer in connection with a group health
plan in the small or large group market.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market on or after
January 1, 2001.
SEC. 125. SENSE OF THE SENATE CONCERNING THE CARE OF OLDER AMERICANS.
It is the sense of the Senate that--
(1) in the coming decade, people who are over the age of 65
will constitute 20 percent or more of the population of the
United States;
(2) in the coming decade, the number of people who are over
the age of 85 and will most likely need long-term care may
double or triple;
(3) the number of persons who are age 65 or older who have
difficulty carrying out at least 1 activity of daily living is
estimated to increase between the year 2000 and 2024 by 42
percent, or from 5.2 million persons to 7.4 million persons;
(4) women rely on long-term care services for more years
than men do since women live longer;
(5) women who are age 65 or older are twice as likely as
men who are age 65 or older to have an income of less than
$10,000 per year;
(6) long-term care expenses can have a catastrophic effect
on families, in that a lifetime of savings may be spent for
long-term care expenses for a spouse, parent, or grandparent
before such spouse, parent, or grandparent becomes eligible for
governmental assistance; and
(7) the Federal Government should be committed to providing
benefits that are designed to ensure the physical, emotional,
and financial well being of older Americans in the new century.
Subtitle D--Expansion of Home-Based Long-Term Care Services Under the
Social Services Block Grant
SEC. 131. RESTORATION OF AUTHORITY TO TRANSFER UP TO 10 PERCENT OF TANF
FUNDS TO THE SOCIAL SERVICES BLOCK GRANT.
(a) In General.--Section 404(d)(2) of the Social Security Act (42
U.S.C. 604(d)(2)) is amended to read as follows:
``(2) Limitation on amount transferable to title xx
programs.--A State may use not more than 10 percent of the
amount of any grant made to the State under section 403(a) for a fiscal
year to carry out State programs pursuant to title XX.''.
(b) Effective Date.--The amendment made by subsection (a) applies
to amounts made available for fiscal year 2001 and each fiscal year
thereafter.
SEC. 132. RESTORATION OF FUNDS FOR THE SOCIAL SERVICES BLOCK GRANT.
(a) In General.--Section 2003(c)(11) of the Social Security Act (42
U.S.C. 1397b(c)(11)) is amended to read as follows:
``(11) $2,380,000,000 for the fiscal year 2001 and each
fiscal year thereafter.''.
(b) Effective Date.--The amendment made by subsection (a) applies
to amounts made available for fiscal year 2001 and each fiscal year
thereafter.
SEC. 133. APPROPRIATION OF ADDITIONAL FUNDS FOR EXPANSION OF HOME-BASED
LONG-TERM CARE SERVICES.
(a) In General.--Section 2003 of the Social Security Act (42 U.S.C.
1397b) is amended by adding at the end the following:
``(d) With respect to any fiscal year in which the amount
appropriated to carry out this title equals or exceeds the amount
specified in subsection (c) for such fiscal year, an additional amount
equal to 10 percent of the amount so appropriated is hereby
appropriated for such fiscal year out of any funds in the Treasury not
otherwise appropriated. The additional amount appropriated under this
subsection shall be allotted among the States and jurisdictions
described in subsections (a) and (b) in the same manner as the
allotments for such States and jurisdictions are determined under such
subsections. Amounts allotted under this subsection shall be used to
expand the provision of home-based services for elderly or disabled
individuals.''.
TITLE II--SUPPORT AND PLANNING FOR LONG-TERM CARE
Subtitle A--Support and Surveys
SEC. 201. NATIONAL FAMILY CAREGIVER SUPPORT GRANT PROGRAM.
(a) In-Home Services.--Part D of title III of the Older Americans
Act of 1965 (42 U.S.C. 3030h et seq.) is amended to read as follows:
``PART D--NATIONAL FAMILY CAREGIVER SUPPORT GRANT PROGRAM
``Subpart 1--State Grant Program
``SEC. 341. PROGRAM AUTHORIZED.
``(a) In General.--The Assistant Secretary shall award grants to
States with State plans approved under section 307, to pay for the
Federal share of the cost of carrying out State programs and enable
eligible area agencies on aging to provide multifaceted systems of
support services for family caregivers and other caregivers who are
informal providers of in-home services and community care for older
individuals.
``(b) Family Caregiver Support Services.--In providing services
under this part, an area agency on aging shall provide support
services, including providing--
``(1) information to eligible caregivers about available
services;
``(2) assistance to eligible caregivers in gaining access
to the services;
``(3) individual counseling, organization of support
groups, and caregiver training to eligible caregivers to assist
the caregivers in making decisions and solving problems
relating to their caregiving roles;
``(4) respite care to enable eligible caregivers to be
temporarily relieved from their caregiving responsibilities;
and
``(5) supplemental services, on a limited basis, to
complement the care provided by eligible caregivers.
``(c) Eligibility and Priority.--
``(1) Eligibility.--In order for a caregiver of an older
individual to be eligible to receive services provided by a
State program under this part, the State shall--
``(A) find that the caregiver is a caregiver as
described in subsection (a); and
``(B) determine that the older individual meets the
condition specified in subparagraph (A)(i) of (B) of
section 102(28).
``(2) Priority.--In providing the services, the State shall
give priority for services to older individuals with greatest
social need and greatest economic need, and older individuals
providing care and supports to persons with mental retardation
and related developmental disabilities (as defined in section
102 of the Developmental Disabilities Assistance and Bill of
Rights Act (42 U.S.C. 6001) (referred to in this part as
`developmental disabilities')) consistent with the requirements
of section 305(a)(2)(E), and their caregivers.
``(d) Coordination With Service Providers.--In carrying out this
part, each area agency on aging shall coordinate the activities of the
agency with the activities of other community agencies and voluntary
organizations providing the types of services described in subsection
(b).
``(e) Quality Standards and Mechanisms and Accountability.--
``(1) Quality standards and mechanisms.--The State shall
establish standards and mechanisms designed to assure the
quality of services provided with assistance made available
under this part.
``(2) Data and records.--The State shall collect data and
maintain records relating to the State program in a
standardized format specified by the Assistant Secretary. The
State shall furnish the records to the Assistant Secretary, at
such time as the Assistant Secretary may require, in order to
enable the Assistant Secretary to monitor State program
administration and compliance, and to evaluate and compare the
effectiveness of the State programs.
``(3) Reports.--The State shall prepare and submit to the
Assistant Secretary reports on the data and records required
under paragraph (2), including information on the services funded under
this part, and standards and mechanisms by which the quality of the
services shall be assured.
``(f) Availability of Funds.--
``(1) In general.--A State shall use the portion of the
State allotment under section 304 that is from amounts
appropriated under section 303(d) to carry out the State
program under this part.
``(2) Use of funds for administration of area plans.--
Amounts made available to a State to carry out the State
program under this part may be used, in addition to amounts
available in accordance with section 303(c)(1), for costs of
administration of area plans.
``(3) Federal share.--
``(A) In general.--Notwithstanding section
304(d)(1)(D), the Federal share of the cost of carrying
out a State program under this part shall be 75
percent.
``(B) Non-federal share.--The non-Federal share of
the costs shall be provided from State and local
sources.
``SEC. 342. MAINTENANCE OF EFFORT.
``Funds made available under this part shall supplement, and not
supplant, any Federal, State, or local funds expended by a State or
unit of general purpose local government (including an area agency on
aging) to provide services described in section 341(b).
``Subpart 2--National Innovation Programs
``SEC. 346. INNOVATION GRANT PROGRAM.
``(a) In General.--The Assistant Secretary shall carry out a
program for making grants to appropriate entities on a competitive
basis to foster the development and testing of new approaches to--
``(1) sustaining the efforts of family caregivers and other
informal caregivers of older individuals;
``(2) serving the needs of particular groups of caregivers
of older individuals, including minority caregivers and distant
caregivers; and
``(3) linking family support programs with the State entity
or agency that administers or funds programs for persons with
mental retardation or related developmental disabilities and
their families.
``(b) Evaluation and Dissemination of Results.--The Assistant
Secretary shall provide for evaluation of the effectiveness of programs
and activities funded with grants made under this section, and for
dissemination to States of descriptions and evaluations of the programs
and activities, to enable States to incorporate successful approaches
into their individual State programs under this part.
``(c) Availability of funds.--
``(1) In general.--The Assistance Secretary shall reserve
not more than 10 percent of the amount appropriated under
section 303(d) for a fiscal year to carry out the program of
the Assistant Secretary under this section.
``(2) Native american programs and activities.--Twenty
percent of the amount reserved under paragraph (1) shall be
available for programs and activities under this section for
caregivers serving Indians and Native Hawaiians, as defined in
section 625.
``SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.
``(a) In General.--The Assistant Secretary shall, directly or by
grant or contract, carry out activities of national significance to
promote quality and continuous improvement in the support services
provided to family caregivers and other informal caregivers of older
individuals, through program evaluation, training, technical
assistance, and research.
``(b) Availability of Funds.--The Assistant Secretary shall reserve
not more than 2 percent of the amount appropriated under section 303(d)
to carry out the activities under this section.''.
(b) Authorization of Appropriations.--Section 303(d) of the Older
Americans Act of 1965 (42 U.S.C. 3032(d)) is amended to read as
follows:
``(d) There are authorized to be appropriated $125,000,000 for
fiscal year 2001, and such sums as may be necessary for each of fiscal
years 2002 through 2005, to carry out part D (relating to the national
family caregiver support grant program).''.
(c) Conforming Amendment.--
(1) Transfer of definition.--Section 102 of the Older
Americans Act of 1965 (42 U.S.C. 3002) is amended by adding at
the end the following:
``(45) The term `in-home services' includes--
``(A) services of homemakers and home health aides;
``(B) visiting and telephone reassurance;
``(C) chore maintenance;
``(D) in-home respite care for families, and adult
day care as a respite service for families;
``(E) minor modification of homes that is necessary
to facilitate the ability of older individuals to
remain at home, that is not available under another
program (other than a program carried out under this Act);
``(F) personal care services; and
``(G) other in-home services as defined--
``(i) by the State agency in the State plan
submitted in accordance with section 307; and
``(ii) by the area agency on aging in the
area plan submitted in accordance with section
306.''.
(2) References.--
(A) Section 307(a)(10) of such Act (42 U.S.C.
3027(a)(10)) is amended by striking ``(as defined in
section 342)''.
(B) Sections 382 and 383 of such Act (42 U.S.C.
3030q, 3030r) are repealed.
(C) Section 429F(a) of such Act (42 U.S.C. 30305n)
is amended--
(i) by striking paragraph (2); and
(ii) by striking ``this section:'' and all
that follows through ``The term'' and inserting
``this section, the term''.
SEC. 202. COMMUNITY SURVEY.
(a) In General.--The Secretary of Health and Human Services shall
conduct a multi-city and county survey to determine if communities are
elder-ready, or prepared to accommodate the needs of aging baby
boomers.
(b) Purpose.--The Secretary shall conduct the survey described in
subsection (a) to determine if cities and counties across the United
States are prepared to accommodate the needs of aging baby boomers
regarding housing, safety, health care, transportation, and access to
community services and leisure activities.
(c) Title of Survey.--The survey described in subsection (a) shall
be entitled ``Is Your Community Elder-Ready?''.
(d) Report.--
(1) In general.--The Secretary of Health and Human Services
shall prepare and submit a report to the appropriate committees
of Congress and cities and counties that the Secretary
determines should receive such report regarding the findings of
such survey described in subsection (a).
(2) Content.--The report described in paragraph (1) shall
identify existing resources and challenging areas for cities or
counties to resolve or address in order for such cities or
counties to become elder ready. Such report shall also include
recommendations, action plans, and timetables for dealing with
deficiencies.
Subtitle B--Education and Studies
SEC. 211. LONG-TERM CARE COVERAGE EDUCATIONAL CAMPAIGN.
(a) In General.--The Secretary of Labor, in conjunction with the
Secretary of Health and Human Services and the Administrator of the
Small Business Administration, shall establish and carry out a national
public information campaign to provide employers and employees with
information concerning the benefits of long-term health care coverage.
(b) Authorization of Appropriations.--There is authorized to be
appropriated, such sums as may be necessary to carry out subsection
(a).
SEC. 212. GAO REPORT ON LONG-TERM CARE.
Not later than 24 months after the date of enactment of this Act,
the Comptroller General of the General Accounting Office shall prepare
and submit to the appropriate committees of Congress a report
concerning the long-term care programs of the Veterans Administration,
including--
(1) a description of the long-term care services provided
under such programs;
(2) data concerning the utilization and financing of such
programs;
(3) information concerning the quality assurance processes
used under such programs;
(4) a description of any recent modifications to such
programs; and
(5) a description of the management challenges faced in
administering such programs.
SEC. 213. AGING STUDY AND REPORT.
(a) Studies.--The Secretary of Health and Human Services shall
conduct not less than 1 study to determine--
(1) activities or programs to conduct to improve the
quality of life for the elderly;
(2) measures to be taken to prevent or delay the onset of
age-related functional decline and disease and disability among
the elderly;
(3) whether medicare health promotion and disease
prevention benefits reduce or delay the need by seniors for
long-term care services; and
(4) the manner in which the aging of the population in the
United States will impact the administration and solvency of
Federal programs, such as programs under titles XVIII, XIX, and
XX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et
seq., and 1397 et seq.) and programs established under the
Older Americans Act of 1965 (42 U.S.C. 3001 et seq.).
(b) Report.--Not later than January 1, 2003, the Secretary of
Health and Human Services shall prepare and submit to Congress a report
regarding the study described in subsection (a).
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S7674-7675)
Read twice and referred to the Committee on Finance.
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