II

106TH CONGRESS

1ST SESSION S. 10

To provide health protection and needed assistance for older Americans,

including access to health insurance for 55 to 65 year olds, assistance

for individuals with long-term care needs, and social services for older

Americans.

IN THE SENATE OF THE UNITED STATES

JANUARY 19, 1999

Mr. DASCHLE (for himself, Ms. MIKULSKI, Mr. CLELAND, Mr. HARKIN, Mr.

SARBANES, Mr. KENNEDY, Mrs. BOXER, Mr. DURBIN, Mr. ROCKEFELLER, Mr. DODD, Mr. BRYAN, Mr. JOHNSON, Mr. KOHL, Mr. KERRY,

and Mr. LAUTENBERG) introduced the following bill; which was read

twice and referred to the Committee on Finance

A BILL

To provide health protection and needed assistance for older

Americans, including access to health insurance for 55

to 65 year olds, assistance for individuals with longterm care needs, and social services for older Americans.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Health Protection and Assistance For Older Americans

6 Act of 1999’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—HEALTH CARE COVERAGE CHOICES FOR 55 TO 65 YEAR

OLDS

Subtitle A—Access to Medicare Benefits for Individuals 62-to-65 Years of

Age

Sec. 101. Access to medicare benefits for individuals 62-to-65 years of age.

‘‘PART D—PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS

AGE 62-TO-65 YEARS OF AGE

‘‘Sec. 1859. Program benefits; eligibility.

‘‘Sec. 1859A. Enrollment process; coverage.

‘‘Sec. 1859B. Premiums.

‘‘Sec. 1859C. Payment of premiums.

‘‘Sec. 1859D. Medicare Early Access Trust Fund.

‘‘Sec. 1859E. Oversight and accountability.

‘‘Sec. 1859F. Administration and miscellaneous.’’.

Subtitle B—Access to Medicare Benefits for Displaced Workers 55-to-62

Years of Age

Sec. 111. Access to medicare benefits for displaced workers 55-to-62 years of

age.

Subtitle C—COBRA Protection for Early Retirees

CHAPTER 1—AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME

SECURITY ACT OF 1974

Sec. 121. COBRA continuation benefits for certain retired workers who lose retiree health coverage.

CHAPTER 2—AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT

Sec. 125. COBRA continuation benefits for certain retired workers who lose retiree health coverage.

CHAPTER 3—AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986

Sec. 131. COBRA continuation benefits for certain retired workers who lose retiree health coverage.

TITLE II—EXPANSION OF LONG-TERM CARE PROTECTION

Sec. 201. Long-term care tax credit.

Sec. 202. Federal employees group long-term care insurance.

TITLE III—REAUTHORIZATION OF THE OLDER AMERICANS ACT

OF 1965

Sec. 301. Authorizations of appropriations.

Sec. 302. National family caregiver support program.
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Sec. 303. Allotments.

Sec. 304. Availability of title III-D funds for reallotment.

Sec. 305. Conforming amendments.

Sec. 306. Effective date.

1 TITLE I—HEALTH CARE COV2 ERAGE CHOICES FOR 55 TO 65

3 YEAR OLDS

4 Subtitle A—Access to Medicare

5 Benefits for Individuals 62-to-65

6 Years of Age

7 SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVID8 UALS 62-TO-65 YEARS OF AGE.

9 (a) IN GENERAL.—Title XVIII of the Social Security

10 Act is amended—

11 (1) by redesignating section 1859 and part D

12 as section 1858 and part E, respectively; and

13 (2) by inserting after such section the following

14 new part:

15 ‘‘PART D—PURCHASE OF MEDICARE BENEFITS BY

16 CERTAIN INDIVIDUALS AGE 62-TO-65 YEARS OF AGE

17 ‘‘SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY.

18 ‘‘(a) ENTITLEMENT TO MEDICARE BENEFITS FOR

19 ENROLLED INDIVIDUALS.—

20 ‘‘(1) IN GENERAL.—An individual enrolled

21 under this part is entitled to the same benefits

22 under this title as an individual entitled to benefits

23 under part A and enrolled under part B.
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1 ‘‘(2) DEFINITIONS.—For purposes of this part:

2 ‘‘(A) FEDERAL OR STATE COBRA CONTINU3 ATION PROVISION.—The term ‘Federal or State

4 COBRA continuation provision’ has the mean5 ing given the term ‘COBRA continuation provi6 sion’ in section 2791(d)(4) of the Public Health

7 Service Act and includes a comparable State

8 program, as determined by the Secretary.

9 ‘‘(B) FEDERAL HEALTH INSURANCE PRO10 GRAM DEFINED.—The term ‘Federal health in11 surance program’ means any of the following:

12 ‘‘(i) MEDICARE.—Part A or part B of

13 this title (other than by reason of this

14 part).

15 ‘‘(ii) MEDICAID.—A State plan under

16 title XIX.

17 ‘‘(iii) FEHBP.—The Federal employ18 ees health benefit program under chapter

19 89 of title 5, United States Code.

20 ‘‘(iv) TRICARE.—The TRICARE

21 program (as defined in section 1072(7) of

22 title 10, United States Code).

23 ‘‘(v) ACTIVE DUTY MILITARY.—Health

24 benefits under title 10, United States
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1 Code, to an individual as a member of the

2 uniformed services of the United States.

3 ‘‘(C) GROUP HEALTH PLAN.—The term

4 ‘group health plan’ has the meaning given such

5 term in section 2791(a)(1) of the Public Health

6 Service Act.

7 ‘‘(b) ELIGIBILITY OF INDIVIDUALS AGE 62-TO-65

8 YEARS OF AGE.—

9 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

10 an individual who meets the following requirements

11 with respect to a month is eligible to enroll under

12 this part with respect to such month:

13 ‘‘(A) AGE.—As of the last day of the

14 month, the individual has attained 62 years of

15 age, but has not attained 65 years of age.

16 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR

17 AGE).—The individual would be eligible for ben18 efits under part A or part B for the month if

19 the individual were 65 years of age.

20 ‘‘(C) NOT ELIGIBLE FOR COVERAGE

21 UNDER GROUP HEALTH PLANS OR FEDERAL

22 HEALTH INSURANCE PROGRAMS.—The individ23 ual is not eligible for benefits or coverage under

24 a Federal health insurance program (as defined

25 in subsection (a)(2)(B)) or under a group
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1 health plan (other than such eligibility merely

2 through a Federal or State COBRA continu3 ation provision) as of the last day of the month

4 involved.

5 ‘‘(2) LIMITATION ON ELIGIBILITY IF TERMI6 NATED ENROLLMENT.—If an individual described in

7 paragraph (1) enrolls under this part and coverage

8 of the individual is terminated under section

9 1859A(d) (other than because of age), the individual

10 is not again eligible to enroll under this subsection

11 unless the following requirements are met:

12 ‘‘(A) NEW COVERAGE UNDER GROUP

13 HEALTH PLAN OR FEDERAL HEALTH INSUR14 ANCE PROGRAM.—After the date of termination

15 of coverage under such section, the individual

16 obtains coverage under a group health plan or

17 under a Federal health insurance program.

18 ‘‘(B) SUBSEQUENT LOSS OF NEW COV19 ERAGE.—The individual subsequently loses eli20 gibility for the coverage described in subpara21 graph (A) and exhausts any eligibility the indi22 vidual may subsequently have for coverage

23 under a Federal or State COBRA continuation

24 provision.
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1 ‘‘(3) CHANGE IN HEALTH PLAN ELIGIBILITY

2 DOES NOT AFFECT COVERAGE.—In the case of an

3 individual who is eligible for and enrolls under this

4 part under this subsection, the individual’s continued

5 entitlement to benefits under this part shall not be

6 affected by the individual’s subsequent eligibility for

7 benefits or coverage described in paragraph (1)(C),

8 or entitlement to such benefits or coverage.

9 ‘‘SEC. 1859A. ENROLLMENT PROCESS; COVERAGE.

10 ‘‘(a) IN GENERAL.—An individual may enroll in the

11 program established under this part only in such manner

12 and form as may be prescribed by regulations, and only

13 during an enrollment period prescribed by the Secretary

14 consistent with the provisions of this section. Such regula15 tions shall provide a process under which—

16 ‘‘(1) individuals eligible to enroll as of a month

17 are permitted to pre-enroll during a prior month

18 within an enrollment period described in subsection

19 (b); and

20 ‘‘(2) each individual seeking to enroll under sec21 tion 1859(b) is notified, before enrolling, of the de22 ferred monthly premium amount the individual will

23 be liable for under section 1859C(b) upon attaining

24 65 years of age as determined under section

25 1859B(c)(3).
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1 ‘‘(b) ENROLLMENT PERIODS.—

2 ‘‘(1) INDIVIDUALS 62-TO-65 YEARS OF AGE.—In

3 the case of individuals eligible to enroll under this

4 part under section 1859(b)—

5 ‘‘(A) INITIAL ENROLLMENT PERIOD.—If

6 the individual is eligible to enroll under such

7 section for July 2000, the enrollment period

8 shall begin on May 1, 2000, and shall end on

9 August 31, 2000. Any such enrollment before

10 July 1, 2000, is conditioned upon compliance

11 with the conditions of eligibility for July 2000.

12 ‘‘(B) SUBSEQUENT PERIODS.—If the indi13 vidual is eligible to enroll under such section for

14 a month after July 2000, the enrollment period

15 shall begin on the first day of the second month

16 before the month in which the individual first is

17 eligible to so enroll and shall end 4 months

18 later. Any such enrollment before the first day

19 of the third month of such enrollment period is

20 conditioned upon compliance with the condi21 tions of eligibility for such third month.

22 ‘‘(2) AUTHORITY TO CORRECT FOR GOVERN23 MENT ERRORS.—The provisions of section 1837(h)

24 apply with respect to enrollment under this part in
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1 the same manner as they apply to enrollment under

2 part B.

3 ‘‘(c) DATE COVERAGE BEGINS.—

4 ‘‘(1) IN GENERAL.—The period during which

5 an individual is entitled to benefits under this part

6 shall begin as follows, but in no case earlier than

7 July 1, 2000:

8 ‘‘(A) In the case of an individual who en9 rolls (including pre-enrolls) before the month in

10 which the individual satisfies eligibility for en11 rollment under section 1859, the first day of

12 such month of eligibility.

13 ‘‘(B) In the case of an individual who en14 rolls during or after the month in which the in15 dividual first satisfies eligibility for enrollment

16 under such section, the first day of the follow17 ing month.

18 ‘‘(2) AUTHORITY TO PROVIDE FOR PARTIAL

19 MONTHS OF COVERAGE.—Under regulations, the

20 Secretary may, in the Secretary’s discretion, provide

21 for coverage periods that include portions of a

22 month in order to avoid lapses of coverage.

23 ‘‘(3) LIMITATION ON PAYMENTS.—No payments

24 may be made under this title with respect to the ex25 penses of an individual enrolled under this part un-
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1 less such expenses were incurred by such individual

2 during a period which, with respect to the individual,

3 is a coverage period under this section.

4 ‘‘(d) TERMINATION OF COVERAGE.—

5 ‘‘(1) IN GENERAL.—An individual’s coverage

6 period under this part shall continue until the indi7 vidual’s enrollment has been terminated at the earli8 est of the following:

9 ‘‘(A) GENERAL PROVISIONS.—

10 ‘‘(i) NOTICE.—The individual files no11 tice (in a form and manner prescribed by

12 the Secretary) that the individual no

13 longer wishes to participate in the insur14 ance program under this part.

15 ‘‘(ii) NONPAYMENT OF PREMIUMS.—

16 The individual fails to make payment of

17 premiums required for enrollment under

18 this part.

19 ‘‘(iii) MEDICARE ELIGIBILITY.—The

20 individual becomes entitled to benefits

21 under part A or enrolled under part B

22 (other than by reason of this part).

23 ‘‘(B) TERMINATION BASED ON AGE.—The

24 individual attains 65 years of age.

25 ‘‘(2) EFFECTIVE DATE OF TERMINATION.—
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1 ‘‘(A) NOTICE.—The termination of a cov2 erage period under paragraph (1)(A)(i) shall

3 take effect at the close of the month following

4 for which the notice is filed.

5 ‘‘(B) NONPAYMENT OF PREMIUM.—The

6 termination of a coverage period under para7 graph (1)(A)(ii) shall take effect on a date de8 termined under regulations, which may be de9 termined so as to provide a grace period in

10 which overdue premiums may be paid and cov11 erage continued. The grace period determined

12 under the preceding sentence shall not exceed

13 60 days; except that it may be extended for an

14 additional 30 days in any case where the Sec15 retary determines that there was good cause for

16 failure to pay the overdue premiums within

17 such 60-day period.

18 ‘‘(C) AGE OR MEDICARE ELIGIBILITY.—

19 The termination of a coverage period under

20 paragraph (1)(A)(iii) or (1)(B) shall take effect

21 as of the first day of the month in which the

22 individual attains 65 years of age or becomes

23 entitled to benefits under part A or enrolled for

24 benefits under part B (other than by reason of

25 this part).
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1 ‘‘SEC. 1859B. PREMIUMS.

2 ‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—

3 ‘‘(1) BASE MONTHLY PREMIUMS.—The Sec4 retary shall, during September of each year (begin5 ning with 1999), determine the following premium

6 rates which shall apply with respect to coverage pro7 vided under this title for any month in the succeed8 ing year:

9 ‘‘(A) BASE MONTHLY PREMIUM FOR INDI10 VIDUALS 62 YEARS OF AGE OR OLDER.—A base

11 monthly premium for individuals 62 years of

age or older is equal to 1 12 ⁄12 of the base annual

13 premium rate computed under subsection (b)

14 for each premium area.

15 ‘‘(B) DEFERRED MONTHLY PREMIUMS FOR

16 INDIVIDUALS 62 YEARS OF AGE OR OLDER.—

17 The Secretary shall, during September of each

18 year (beginning with 1999), determine under

19 subsection (c) the amount of deferred monthly

20 premiums that shall apply with respect to indi21 viduals who first obtain coverage under this

22 part under section 1859(b) in the succeeding

23 year.

24 ‘‘(3) ESTABLISHMENT OF PREMIUM AREAS.—

25 For purposes of this part, the term ‘premium area’

26 means such an area as the Secretary shall specify to
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1 carry out this part. The Secretary from time to time

2 may change the boundaries of such premium areas.

3 The Secretary shall seek to minimize the number of

4 such areas specified under this paragraph.

5 ‘‘(b) BASE ANNUAL PREMIUM FOR INDIVIDUALS 62

6 YEARS OF AGE OR OLDER.—

7 ‘‘(1) NATIONAL, PER CAPITA AVERAGE.—The

8 Secretary shall estimate the average, annual per

9 capita amount that would be payable under this title

10 with respect to individuals residing in the United

11 States who meet the requirement of section

12 1859(b)(1)(A) as if all such individuals were eligible

13 for (and enrolled) under this title during the entire

14 year (and assuming that section 1862(b)(2)(A)(i)

15 did not apply).

16 ‘‘(2) GEOGRAPHIC ADJUSTMENT.—The Sec17 retary shall reduce, as determined appropriate, the

18 amount determined under paragraph (1) for a pre19 mium area (specified under subsection (a)(3)) that

20 has costs below the national average, in order to as21 sure participation in all areas throughout the United

22 States.

23 ‘‘(3) BASE ANNUAL PREMIUM.—The base an24 nual premium under this subsection for months in a

25 year for individuals 62 years of age or older residing
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1 in a premium area is equal to the average, annual

2 per capita amount estimated under paragraph (1)

3 for the year, adjusted for such area under paragraph

4 (2).

5 ‘‘(c) DEFERRED PREMIUM RATE FOR INDIVIDUALS

6 62 YEARS OF AGE OR OLDER.—The deferred premium

7 rate for individuals with a group of individuals who obtain

8 coverage under section 1859(b) in a year shall be com9 puted by the Secretary as follows:

10 ‘‘(1) ESTIMATION OF NATIONAL, PER CAPITA

11 ANNUAL AVERAGE EXPENDITURES FOR ENROLL12 MENT GROUP.—The Secretary shall estimate the av13 erage, per capita annual amount that will be paid

14 under this part for individuals in such group during

15 the period of enrollment under section 1859(b). In

16 making such estimate for coverage beginning in a

17 year before 2004, the Secretary may base such esti18 mate on the average, per capita amount that would

19 be payable if the program had been in operation over

20 a previous period of at least 4 years.

21 ‘‘(2) DIFFERENCE BETWEEN ESTIMATED EX22 PENDITURES AND ESTIMATED PREMIUMS.—Based

23 on the characteristics of individuals in such group,

24 the Secretary shall estimate during the period of
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1 coverage of the group under this part under section

2 1859(b) the amount by which—

3 ‘‘(A) the amount estimated under para4 graph (1); exceeds

5 ‘‘(B) the average, annual per capita

6 amount of premiums that will be payable for

7 months during the year under section 1859C(a)

8 for individuals in such group (including pre9 miums that would be payable if there were no

10 terminations in enrollment under clause (i) or

11 (ii) of section 1859A(d)(1)(A)).

12 ‘‘(3) ACTUARIAL COMPUTATION OF DEFERRED

13 MONTHLY PREMIUM RATES.—The Secretary shall

14 determine deferred monthly premium rates for indi15 viduals in such group in a manner so that—

16 ‘‘(A) the estimated actuarial value of such

17 premiums payable under section 1859C(b), is

18 equal to

19 ‘‘(B) the estimated actuarial present value

20 of the differences described in paragraph (2).

21 Such rate shall be computed for each individual in

22 the group in a manner so that the rate is based on

23 the number of months between the first month of

24 coverage based on enrollment under section 1859(b)
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1 and the month in which the individual attains 65

2 years of age.

3 ‘‘(4) DETERMINANTS OF ACTUARIAL PRESENT

4 VALUES.—The actuarial present values described in

5 paragraph (3) shall reflect—

6 ‘‘(A) the estimated probabilities of survival

7 at ages 62 through 84 for individuals enrolled

8 during the year; and

9 ‘‘(B) the estimated effective average inter10 est rates that would be earned on investments

11 held in the trust funds under this title during

12 the period in question.

13 ‘‘SEC. 1859C. PAYMENT OF PREMIUMS.

14 ‘‘(a) PAYMENT OF BASE MONTHLY PREMIUM.—

15 ‘‘(1) IN GENERAL.—The Secretary shall provide

16 for payment and collection of the base monthly pre17 mium, determined under section 1859B(a)(1) for the

18 age (and age cohort, if applicable) of the individual

19 involved and the premium area in which the individ20 ual principally resides, in the same manner as for

21 payment of monthly premiums under section 1840,

22 except that, for purposes of applying this section,

23 any reference in such section to the Federal Supple24 mentary Medical Insurance Trust Fund is deemed a
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1 reference to the Trust Fund established under sec2 tion 1859D.

3 ‘‘(2) PERIOD OF PAYMENT.—In the case of an

4 individual who participates in the program estab5 lished by this title, the base monthly premium shall

6 be payable for the period commencing with the first

7 month of the individual’s coverage period and ending

8 with the month in which the individual’s coverage

9 under this title terminates.

10 ‘‘(b) PAYMENT OF DEFERRED PREMIUM FOR INDI11 VIDUALS COVERED AFTER ATTAINING AGE 62.—

12 ‘‘(1) RATE OF PAYMENT.—

13 ‘‘(A) IN GENERAL.—In the case of an indi14 vidual who is covered under this part for a

15 month pursuant to an enrollment under section

16 1859(b), subject to subparagraph (B), the indi17 vidual is liable for payment of a deferred pre18 mium in each month during the period de19 scribed in paragraph (2) in an amount equal to

20 the full deferred monthly premium rate deter21 mined for the individual under section

22 1859B(c).

23 ‘‘(B) SPECIAL RULES FOR THOSE WHO

24 DISENROLL EARLY.—
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1 ‘‘(i) IN GENERAL.—If such an individ2 ual’s enrollment under such section is ter3 minated under clause (i) or (ii) of section

4 1859A(d)(1)(A), subject to clause (ii), the

5 amount of the deferred premium otherwise

6 established under this paragraph shall be

7 pro-rated to reflect the number of months

8 of coverage under this part under such en9 rollment compared to the maximum num10 ber of months of coverage that the individ11 ual would have had if the enrollment were

12 not so terminated.

13 ‘‘(ii) ROUNDING TO 12-MONTH MINI14 MUM COVERAGE PERIODS.—In applying

15 clause (i), the number of months of cov16 erage (if not a multiple of 12) shall be

17 rounded to the next highest multiple of 12

18 months, except that in no case shall this

19 clause result in a number of months of

20 coverage exceeding the maximum number

21 of months of coverage that the individual

22 would have had if the enrollment were not

23 so terminated.

24 ‘‘(2) PERIOD OF PAYMENT.—The period de25 scribed in this paragraph for an individual is the pe-
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1 riod beginning with the first month in which the in2 dividual has attained 65 years of age and ending

3 with the month before the month in which the indi4 vidual attains 85 years of age.

5 ‘‘(3) COLLECTION.—In the case of an individual

6 who is liable for a premium under this subsection,

7 the amount of the premium shall be collected in the

8 same manner as the premium for enrollment under

9 such part is collected under section 1840, except

10 that any reference in such section to the Federal

11 Supplementary Medical Insurance Trust Fund is

12 deemed to be a reference to the Medicare Early Ac13 cess Trust Fund established under section 1859D.

14 ‘‘(c) APPLICATION OF CERTAIN PROVISIONS.—The

15 provisions of section 1840 (other than subsection (h))

16 shall apply to premiums collected under this section in the

17 same manner as they apply to premiums collected under

18 part B, except that any reference in such section to the

19 Federal Supplementary Medical Insurance Trust Fund is

20 deemed a reference to the Trust Fund established under

21 section 1859D.

22 ‘‘SEC. 1859D. MEDICARE EARLY ACCESS TRUST FUND.

23 ‘‘(a) ESTABLISHMENT OF TRUST FUND.—

24 ‘‘(1) IN GENERAL.—There is hereby created on

25 the books of the Treasury of the United States a
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1 trust fund to be known as the ‘Medicare Early Ac2 cess Trust Fund’ (in this section referred to as the

3 ‘Trust Fund’). The Trust Fund shall consist of such

4 gifts and bequests as may be made as provided in

5 section 201(i)(1) and such amounts as may be de6 posited in, or appropriated to, such fund as provided

7 in this title.

8 ‘‘(2) PREMIUMS.—Premiums collected under

9 section 1859B shall be transferred to the Trust

10 Fund.

11 ‘‘(b) INCORPORATION OF PROVISIONS.—

12 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

13 subsections (b) through (i) of section 1841 shall

14 apply with respect to the Trust Fund and this title

15 in the same manner as they apply with respect to

16 the Federal Supplementary Medical Insurance Trust

17 Fund and part B, respectively.

18 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply19 ing provisions of section 1841 under paragraph

20 (1)—

21 ‘‘(A) any reference in such section to ‘this

22 part’ is construed to refer to this part D;

23 ‘‘(B) any reference in section 1841(h) to

24 section 1840(d) and in section 1841(i) to sec25 tions 1840(b)(1) and 1842(g) are deemed ref-
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1 erences to comparable authority exercised under

2 this part; and

3 ‘‘(C) payments may be made under section

4 1841(g) to the trust funds under sections 1817

5 and 1841 as reimbursement to such funds for

6 payments they made for benefits provided

7 under this part.

8 ‘‘SEC. 1859E. OVERSIGHT AND ACCOUNTABILITY.

9 ‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—

10 The Board of Trustees of the Medicare Early Access

11 Trust Fund under section 1859D(b)(1) shall report on an

12 annual basis to Congress concerning the status of the

13 Trust Fund and the need for adjustments in the program

14 under this part to maintain financial solvency of the pro15 gram under this part.

16 ‘‘(b) PERIODIC GAO REPORTS.—The Comptroller

17 General of the United States shall periodically submit to

18 Congress reports on the adequacy of the financing of cov19 erage provided under this part. The Comptroller General

20 shall include in such report such recommendations for ad21 justments in such financing and coverage as the Comptrol22 ler General deems appropriate in order to maintain finan23 cial solvency of the program under this part.
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1 ‘‘SEC. 1859F. ADMINISTRATION AND MISCELLANEOUS.

2 ‘‘(a) TREATMENT FOR PURPOSES OF THIS TITLE.—

3 Except as otherwise provided in this part—

4 ‘‘(1) an individual enrolled under this part shall

5 be treated for purposes of this title as though the in6 dividual was entitled to benefits under part A and

7 enrolled under part B; and

8 ‘‘(2) benefits described in section 1859 shall be

9 payable under this title to such an individual in the

10 same manner as if such individual was so entitled

11 and enrolled.

12 ‘‘(b) NOT TREATED AS MEDICARE PROGRAM FOR

13 PURPOSES OF MEDICAID PROGRAM.—For purposes of ap14 plying title XIX (including the provision of medicare cost15 sharing assistance under such title), an individual who is

16 enrolled under this part shall not be treated as being enti17 tled to benefits under this title.

18 ‘‘(c) NOT TREATED AS MEDICARE PROGRAM FOR

19 PURPOSES OF COBRA CONTINUATION PROVISIONS.—In

20 applying a COBRA continuation provision (as defined in

21 section 2791(d)(4) of the Public Health Service Act), any

22 reference to an entitlement to benefits under this title

23 shall not be construed to include entitlement to benefits

24 under this title pursuant to the operation of this part.’’.

25 (b) CONFORMING AMENDMENTS TO SOCIAL SECU26 RITY ACT PROVISIONS.—
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1 (1) Section 201(i)(1) of the Social Security Act

2 (42 U.S.C. 401(i)(1)) is amended by striking ‘‘or the

3 Federal Supplementary Medical Insurance Trust

4 Fund’’ and inserting ‘‘the Federal Supplementary

5 Medical Insurance Trust Fund, and the Medicare

6 Early Access Trust Fund’’.

7 (2) Section 201(g)(1)(A) of such Act (42

8 U.S.C. 401(g)(1)(A)) is amended by striking ‘‘and

9 the Federal Supplementary Medical Insurance Trust

10 Fund established by title XVIII’’ and inserting ‘‘,

11 the Federal Supplementary Medical Insurance Trust

12 Fund, and the Medicare Early Access Trust Fund

13 established by title XVIII’’.

14 (3) Section 1820(i) of such Act (42 U.S.C.

15 1395i–4(i)) is amended by striking ‘‘part D’’ and in16 serting ‘‘part E’’.

17 (4) Part C of title XVIII of such Act is

18 amended—

19 (A) in section 1851(a)(2)(B) (42 U.S.C.

20 1395w–21(a)(2)(B)), by striking ‘‘1859(b)(3)’’

21 and inserting ‘‘1858(b)(3)’’;

22 (B) in section 1851(a)(2)(C) (42 U.S.C.

23 1395w–21(a)(2)(C)), by striking ‘‘1859(b)(2)’’

24 and inserting ‘‘1858(b)(2)’’;
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1 (C) in section 1852(a)(1) (42 U.S.C.

2 1395w–22(a)(1)), by striking ‘‘1859(b)(3)’’ and

3 inserting ‘‘1858(b)(3)’’;

4 (D) in section 1852(a)(3)(B)(ii) (42

5 U.S.C. 1395w–22(a)(3)(B)(ii)), by striking

6 ‘‘1859(b)(2)(B)’’ and inserting

7 ‘‘1858(b)(2)(B)’’;

8 (E) in section 1853(a)(1)(A) (42 U.S.C.

9 1395w–23(a)(1)(A)), by striking ‘‘1859(e)(4)’’

10 and inserting ‘‘1858(e)(4)’’; and

11 (F) in section 1853(a)(3)(D) (42 U.S.C.

12 1395w–23(a)(3)(D)), by striking ‘‘1859(e)(4)’’

13 and inserting ‘‘1858(e)(4)’’.

14 (5) Section 1853(c) of such Act (42 U.S.C.

15 1395w–23(c)) is amended—

16 (A) in paragraph (1), by striking ‘‘or (7)’’

17 and inserting ‘‘, (7), or (8)’’, and

18 (B) by adding at the end the following:

19 ‘‘(8) ADJUSTMENT FOR EARLY ACCESS.—In ap20 plying this subsection with respect to individuals en21 titled to benefits under part D, the Secretary shall

22 provide for an appropriate adjustment in the

23 Medicare+Choice capitation rate as may be appro24 priate to reflect differences between the population
25

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1 served under such part and the population under

2 parts A and B.’’.

3 (c) OTHER CONFORMING AMENDMENTS.—

4 (1) Section 138(b)(4) of the Internal Revenue

5 Code of 1986 is amended by striking ‘‘1859(b)(3)’’

6 and inserting ‘‘1858(b)(3)’’.

7 (2)(A) Section 602(2)(D)(ii) of the Employee

8 Retirement Income Security Act of 1974 (29 U.S.C.

9 1162(2)) is amended by inserting ‘‘(not including an

10 individual who is so entitled pursuant to enrollment

11 under section 1859A)’’ after ‘‘Social Security Act’’.

12 (B) Section 2202(2)(D)(ii) of the Public Health

13 Service Act (42 U.S.C. 300bb–2(2)(D)(ii)) is amend14 ed by inserting ‘‘(not including an individual who is

15 so entitled pursuant to enrollment under section

16 1859A)’’ after ‘‘Social Security Act’’.

17 (C) Section 4980B(f)(2)(B)(i)(V) of the Inter18 nal Revenue Code of 1986 is amended by inserting

19 ‘‘(not including an individual who is so entitled pur20 suant to enrollment under section 1859A)’’ after

21 ‘‘Social Security Act’’.
26

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1 Subtitle B—Access to Medicare

2 Benefits for Displaced Workers

3 55-to-62 Years of Age

4 SEC. 111. ACCESS TO MEDICARE BENEFITS FOR DISPLACED

5 WORKERS 55-TO-62 YEARS OF AGE.

6 (a) ELIGIBILITY.—Section 1859 of the Social Secu7 rity Act, as inserted by section 101(a)(2), is amended by

8 adding at the end the following new subsection:

9 ‘‘(c) DISPLACED WORKERS AND SPOUSES.—

10 ‘‘(1) DISPLACED WORKERS.—Subject to para11 graph (3), an individual who meets the following re12 quirements with respect to a month is eligible to en13 roll under this part with respect to such month:

14 ‘‘(A) AGE.—As of the last day of the

15 month, the individual has attained 55 years of

16 age, but has not attained 62 years of age.

17 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR

18 AGE).—The individual would be eligible for ben19 efits under part A or B for the month if the in20 dividual were 65 years of age.

21 ‘‘(C) LOSS OF EMPLOYMENT-BASED COV22 ERAGE.—

23 ‘‘(i) ELIGIBLE FOR UNEMPLOYMENT

24 COMPENSATION.—The individual meets the

25 requirements relating to period of covered
27

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1 employment and conditions of separation

2 from employment to be eligible for unem3 ployment compensation (as defined in sec4 tion 85(b) of the Internal Revenue Code of

5 1986), based on a separation from employ6 ment occurring on or after January 1,

7 1999. The previous sentence shall not be

8 construed as requiring the individual to be

9 receiving such unemployment compensa10 tion.

11 ‘‘(ii) LOSS OF EMPLOYMENT-BASED

12 COVERAGE.—Immediately before the time

13 of such separation of employment, the indi14 vidual was covered under a group health

15 plan on the basis of such employment, and,

16 because of such loss, is no longer eligible

17 for coverage under such plan (including

18 such eligibility based on the application of

19 a Federal or State COBRA continuation

20 provision) as of the last day of the month

21 involved.

22 ‘‘(iii) PREVIOUS CREDITABLE COV23 ERAGE FOR AT LEAST 1 YEAR.—As of the

24 date on which the individual loses coverage

25 described in clause (ii), the aggregate of
28

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1 the periods of creditable coverage (as de2 termined under section 2701(c) of the

3 Public Health Service Act) is 12 months or

4 longer.

5 ‘‘(D) EXHAUSTION OF AVAILABLE COBRA

6 CONTINUATION BENEFITS.—

7 ‘‘(i) IN GENERAL.—In the case of an

8 individual described in clause (ii) for a

9 month described in clause (iii)—

10 ‘‘(I) the individual (or spouse)

11 elected coverage described in clause

12 (ii); and

13 ‘‘(II) the individual (or spouse)

14 has continued such coverage for all

15 months described in clause (iii) in

16 which the individual (or spouse) is eli17 gible for such coverage.

18 ‘‘(ii) INDIVIDUALS TO WHOM COBRA

19 CONTINUATION COVERAGE MADE AVAIL20 ABLE.—An individual described in this

21 clause is an individual—

22 ‘‘(I) who was offered coverage

23 under a Federal or State COBRA

24 continuation provision at the time of
29

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1 loss of coverage eligibility described in

2 subparagraph (C)(ii); or

3 ‘‘(II) whose spouse was offered

4 such coverage in a manner that per5 mitted coverage of the individual at

6 such time.

7 ‘‘(iii) MONTHS OF POSSIBLE COBRA

8 CONTINUATION COVERAGE.—A month de9 scribed in this clause is a month for which

10 an individual described in clause (ii) could

11 have had coverage described in such clause

12 as of the last day of the month if the indi13 vidual (or the spouse of the individual, as

14 the case may be) had elected such coverage

15 on a timely basis.

16 ‘‘(E) NOT ELIGIBLE FOR COVERAGE

17 UNDER FEDERAL HEALTH INSURANCE PRO18 GRAM OR GROUP HEALTH PLANS.—The individ19 ual is not eligible for benefits or coverage under

20 a Federal health insurance program or under a

21 group health plan (whether on the basis of the

22 individual’s employment or employment of the

23 individual’s spouse) as of the last day of the

24 month involved.
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1 ‘‘(2) SPOUSE OF DISPLACED WORKER.—Subject

2 to paragraph (3), an individual who meets the fol3 lowing requirements with respect to a month is eligi4 ble to enroll under this part with respect to such

5 month:

6 ‘‘(A) AGE.—As of the last day of the

7 month, the individual has not attained 62 years

8 of age.

9 ‘‘(B) MARRIED TO DISPLACED WORKER.—

10 The individual is the spouse of an individual at

11 the time the individual enrolls under this part

12 under paragraph (1) and loses coverage de13 scribed in paragraph (1)(C)(ii) because the in14 dividual’s spouse lost such coverage.

15 ‘‘(C) MEDICARE ELIGIBILITY (BUT FOR

16 AGE); EXHAUSTION OF ANY COBRA CONTINU17 ATION COVERAGE; AND NOT ELIGIBLE FOR COV18 ERAGE UNDER FEDERAL HEALTH INSURANCE

19 PROGRAM OR GROUP HEALTH PLAN.—The indi20 vidual meets the requirements of subparagraphs

21 (B), (D), and (E) of paragraph (1).

22 ‘‘(3) CHANGE IN HEALTH PLAN ELIGIBILITY

23 AFFECTS CONTINUED ELIGIBILITY.—For provision

24 that terminates enrollment under this section in the

25 case of an individual who becomes eligible for cov-
31

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1 erage under a group health plan or under a Federal

2 health insurance program, see section

3 1859A(d)(1)(C).

4 ‘‘(4) REENROLLMENT PERMITTED.—Nothing in

5 this subsection shall be construed as preventing an

6 individual who, after enrolling under this subsection,

7 terminates such enrollment from subsequently re8 enrolling under this subsection if the individual is el9 igible to enroll under this subsection at that time.’’.

10 (b) ENROLLMENT.—Section 1859A of such Act, as

11 so inserted, is amended—

12 (1) in subsection (a), by striking ‘‘and’’ at the

13 end of paragraph (1), by striking the period at the

14 end of paragraph (2) and inserting ‘‘; and’’, and by

15 adding at the end the following new paragraph:

16 ‘‘(3) individuals whose coverage under this part

17 would terminate because of subsection (d)(1)(B)(ii)

18 are provided notice and an opportunity to continue

19 enrollment in accordance with section

20 1859E(c)(1).’’;

21 (2) in subsection (b), by inserting after Not22 withstanding any other provision of law, (1) the fol23 lowing:

24 ‘‘(2) DISPLACED WORKERS AND SPOUSES.—In

25 the case of individuals eligible to enroll under this
32

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1 part under section 1859(c), the following rules

2 apply:

3 ‘‘(A) INITIAL ENROLLMENT PERIOD.—If

4 the individual is first eligible to enroll under

5 such section for July 2000, the enrollment pe6 riod shall begin on May 1, 2000, and shall end

7 on August 31, 2000. Any such enrollment be8 fore July 1, 2000, is conditioned upon compli9 ance with the conditions of eligibility for July

10 2000.

11 ‘‘(B) SUBSEQUENT PERIODS.—If the indi12 vidual is eligible to enroll under such section for

13 a month after July 2000, the enrollment period

14 based on such eligibility shall begin on the first

15 day of the second month before the month in

16 which the individual first is eligible to so enroll

17 (or reenroll) and shall end 4 months later.’’;

18 (3) in subsection (d)(1), by amending subpara19 graph (B) to read as follows:

20 ‘‘(B) TERMINATION BASED ON AGE.—

21 ‘‘(i) AT AGE 65.—Subject to clause

22 (ii), the individual attains 65 years of age.

23 ‘‘(ii) AT AGE 62 FOR DISPLACED

24 WORKERS AND SPOUSES.—In the case of

25 an individual enrolled under this part pur-
33

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1 suant to section 1859(c), subject to sub2 section (a)(1), the individual attains 62

3 years of age.’’;

4 (4) in subsection (d)(1), by adding at the end

5 the following new subparagraph:

6 ‘‘(C) OBTAINING ACCESS TO EMPLOYMENT7 BASED COVERAGE OR FEDERAL HEALTH INSUR8 ANCE PROGRAM FOR INDIVIDUALS UNDER 62

9 YEARS OF AGE.—In the case of an individual

10 who has not attained 62 years of age, the indi11 vidual is covered (or eligible for coverage) as a

12 participant or beneficiary under a group health

13 plan or under a Federal health insurance pro14 gram.’’;

15 (5) in subsection (d)(2), by amending subpara16 graph (C) to read as follows:

17 ‘‘(C) AGE OR MEDICARE ELIGIBILITY.—

18 ‘‘(i) IN GENERAL.—The termination

19 of a coverage period under paragraph

20 (1)(A)(iii) or (1)(B)(i) shall take effect as

21 of the first day of the month in which the

22 individual attains 65 years of age or be23 comes entitled to benefits under part A or

24 enrolled for benefits under part B.
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1 ‘‘(ii) DISPLACED WORKERS.—The ter2 mination of a coverage period under para3 graph (1)(B)(ii) shall take effect as of the

4 first day of the month in which the individ5 ual attains 62 years of age, unless the in6 dividual has enrolled under this part pur7 suant to section 1859(b) and section

8 1859E(c)(1).’’; and

9 (6) in subsection (d)(2), by adding at the end

10 the following new subparagraph:

11 ‘‘(D) ACCESS TO COVERAGE.—The termi12 nation of a coverage period under paragraph

13 (1)(C) shall take effect on the date on which

14 the individual is eligible to begin a period of

15 creditable coverage (as defined in section

16 2701(c) of the Public Health Service Act)

17 under a group health plan or under a Federal

18 health insurance program.’’.

19 (c) PREMIUMS.—Section 1859B of such Act, as so

20 inserted, is amended—

21 (1) in subsection (a)(1), by adding at the end

22 the following:

23 ‘‘(B) BASE MONTHLY PREMIUM FOR INDI24 VIDUALS UNDER 62 YEARS OF AGE.—A base

25 monthly premium for individuals under 62
35

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years of age, equal to 1 1 ⁄12 of the base annual

2 premium rate computed under subsection (d)(3)

3 for each premium area and age cohort.’’; and

4 (2) by adding at the end the following new sub5 section:

6 ‘‘(d) BASE MONTHLY PREMIUM FOR INDIVIDUALS

7 UNDER 62 YEARS OF AGE.—

8 ‘‘(1) NATIONAL, PER CAPITA AVERAGE FOR AGE

9 GROUPS.—

10 ‘‘(A) ESTIMATE OF AMOUNT.—The Sec11 retary shall estimate the average, annual per

12 capita amount that would be payable under this

13 title with respect to individuals residing in the

14 United States who meet the requirement of sec15 tion 1859(c)(1)(A) within each of the age co16 horts established under subparagraph (B) as if

17 all such individuals within such cohort were eli18 gible for (and enrolled) under this title during

19 the entire year (and assuming that section

20 1862(b)(2)(A)(i) did not apply).

21 ‘‘(B) AGE COHORTS.—For purposes of

22 subparagraph (A), the Secretary shall establish

23 separate age cohorts in 5-year age increments

24 for individuals who have not attained 60 years
36

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1 of age and a separate cohort for individuals who

2 have attained 60 years of age.

3 ‘‘(2) GEOGRAPHIC ADJUSTMENT.—The Sec4 retary shall adjust the amount determined under

5 paragraph (1)(A) for each premium area (specified

6 under subsection (a)(3)) in the same manner and to

7 the same extent as the Secretary provides for adjust8 ments under subsection (b)(2).

9 ‘‘(3) BASE ANNUAL PREMIUM.—The base an10 nual premium under this subsection for months in a

11 year for individuals in an age cohort under para12 graph (1)(B) in a premium area is equal to 165 per13 cent of the average, annual per capita amount esti14 mated under paragraph (1) for the age cohort and

15 year, adjusted for such area under paragraph (2).

16 ‘‘(4) PRO-RATION OF PREMIUMS TO REFLECT

17 COVERAGE DURING A PART OF A MONTH.—If the

18 Secretary provides for coverage of portions of a

19 month under section 1859A(c)(2), the Secretary

20 shall pro-rate the premiums attributable to such cov21 erage under this section to reflect the portion of the

22 month so covered.’’.

23 (d) ADMINISTRATIVE PROVISIONS.—Section 1859F

24 of such Act, as so inserted, is amended by adding at the

25 end the following:
37

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1 ‘‘(d) ADDITIONAL ADMINISTRATIVE PROVISIONS.—

2 ‘‘(1) PROCESS FOR CONTINUED ENROLLMENT

3 OF DISPLACED WORKERS WHO ATTAIN 62 YEARS OF

4 AGE.—The Secretary shall provide a process for the

5 continuation of enrollment of individuals whose en6 rollment under section 1859(c) would be terminated

7 upon attaining 62 years of age. Under such process

8 such individuals shall be provided appropriate and

9 timely notice before the date of such termination

10 and of the requirement to enroll under this part pur11 suant to section 1859(b) in order to continue entitle12 ment to benefits under this title after attaining 62

13 years of age.

14 ‘‘(2) ARRANGEMENTS WITH STATES FOR DE15 TERMINATIONS RELATING TO UNEMPLOYMENT COM16 PENSATION ELIGIBILITY.—The Secretary may pro17 vide for appropriate arrangements with States for

18 the determination of whether individuals in the State

19 meet or would meet the requirements of section

20 1859(c)(1)(C)(i).’’.

21 (e) CONFORMING AMENDMENT TO HEADING TO

22 PART.—The heading of part D of title XVIII of the Social

23 Security Act, as so inserted, is amended by striking ‘‘62’’

24 and inserting ‘‘55’’.
38

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1 Subtitle C—COBRA Protection for

2 Early Retirees

3 CHAPTER 1—AMENDMENTS TO THE EM4 PLOYEE RETIREMENT INCOME SECU5 RITY ACT OF 1974

6 SEC. 121. COBRA CONTINUATION BENEFITS FOR CERTAIN

7 RETIRED WORKERS WHO LOSE RETIREE

8 HEALTH COVERAGE.

9 (a) ESTABLISHMENT OF NEW QUALIFYING

10 EVENT.—

11 (1) IN GENERAL.—Section 603 of the Employee

12 Retirement Income Security Act of 1974 (29 U.S.C.

13 1163) is amended by inserting after paragraph (6)

14 the following new paragraph:

15 ‘‘(7) The termination or substantial reduction

16 in benefits (as defined in section 607(7)) of group

17 health plan coverage as a result of plan changes or

18 termination in the case of a covered employee who

19 is a qualified retiree.’’.

20 (2) QUALIFIED RETIREE; QUALIFIED BENE21 FICIARY; AND SUBSTANTIAL REDUCTION DE22 FINED.—Section 607 of such Act (29 U.S.C. 1167)

23 is amended—

24 (A) in paragraph (3)—
39

•S 10 IS

1 (i) in subparagraph (A), by inserting

2 ‘‘except as otherwise provided in this para3 graph,’’ after ‘‘means,’’; and

4 (ii) by adding at the end the following

5 new subparagraph:

6 ‘‘(D) SPECIAL RULE FOR QUALIFYING RE7 TIREES AND DEPENDENTS.—In the case of a

8 qualifying event described in section 603(7), the

9 term ‘qualified beneficiary’ means a qualified

10 retiree and any other individual who, on the day

11 before such qualifying event, is a beneficiary

12 under the plan on the basis of the individual’s

13 relationship to such qualified retiree.’’; and

14 (B) by adding at the end the following new

15 paragraphs:

16 ‘‘(6) QUALIFIED RETIREE.—The term ‘qualified

17 retiree’ means, with respect to a qualifying event de18 scribed in section 603(7), a covered employee who,

19 at the time of the event—

20 ‘‘(A) has attained 55 years of age; and

21 ‘‘(B) was receiving group health coverage

22 under the plan by reason of the retirement of

23 the covered employee.

24 ‘‘(7) SUBSTANTIAL REDUCTION.—The term

25 ‘substantial reduction’—
40

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1 ‘‘(A) means, as determined under regula2 tions of the Secretary and with respect to a

3 qualified beneficiary, a reduction in the average

4 actuarial value of benefits under the plan

5 (through reduction or elimination of benefits,

6 an increase in premiums, deductibles, copay7 ments, and coinsurance, or any combination

8 thereof), since the date of commencement of

9 coverage of the beneficiary by reason of the re10 tirement of the covered employee (or, if later,

11 January 6, 1999), in an amount equal to at

12 least 50 percent of the total average actuarial

13 value of the benefits under the plan as of such

14 date (taking into account an appropriate ad15 justment to permit comparison of values over

16 time); and

17 ‘‘(B) includes an increase in premiums re18 quired to an amount that exceeds the premium

19 level described in the fourth sentence of section

20 602(3).’’.

21 (b) DURATION OF COVERAGE THROUGH AGE 65.—

22 Section 602(2)(A) of such Act (29 U.S.C. 1162(2)(A)) is

23 amended—

24 (1) in clause (ii), by inserting ‘‘or 603(7)’’ after

25 ‘‘603(6)’’;
41

•S 10 IS

1 (2) in clause (iv), by striking ‘‘or 603(6)’’ and

2 inserting ‘‘, 603(6), or 603(7)’’;

3 (3) by redesignating clause (iv) as clause (vi);

4 (4) by redesignating clause (v) as clause (iv)

5 and by moving such clause to immediately follow

6 clause (iii); and

7 (5) by inserting after such clause (iv) the fol8 lowing new clause:

9 ‘‘(v) SPECIAL RULE FOR CERTAIN DE10 PENDENTS IN CASE OF TERMINATION OR

11 SUBSTANTIAL REDUCTION OF RETIREE

12 HEALTH COVERAGE.—In the case of a

13 qualifying event described in section

14 603(7), in the case of a qualified bene15 ficiary described in section 607(3)(D) who

16 is not the qualified retiree or spouse of

17 such retiree, the later of—

18 ‘‘(I) the date that is 36 months

19 after the earlier of the date the quali20 fied retiree becomes entitled to bene21 fits under title XVIII of the Social Se22 curity Act, or the date of the death of

23 the qualified retiree; or
42

•S 10 IS

1 ‘‘(II) the date that is 36 months

2 after the date of the qualifying

3 event.’’.

4 (c) TYPE OF COVERAGE IN CASE OF TERMINATION

5 OR SUBSTANTIAL REDUCTION OF RETIREE HEALTH COV6 ERAGE.—Section 602(1) of such Act (29 U.S.C. 1162(1))

7 is amended—

8 (1) by striking ‘‘The coverage’’ and inserting

9 the following:

10 ‘‘(A) IN GENERAL.—Except as provided in

11 subparagraph (B), the coverage’’; and

12 (2) by adding at the end the following:

13 ‘‘(B) CERTAIN RETIREES.—In the case of

14 a qualifying event described in section 603(7),

15 in applying the first sentence of subparagraph

16 (A) and the fourth sentence of paragraph (3),

17 the coverage offered that is the most prevalent

18 coverage option (as determined under regula19 tions of the Secretary) continued under the

20 group health plan (or, if none, under the most

21 prevalent other plan offered by the same plan

22 sponsor) shall be treated as the coverage de23 scribed in such sentence, or (at the option of

24 the plan and qualified beneficiary) such other
43

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1 coverage option as may be offered and elected

2 by the qualified beneficiary involved.’’.

3 (d) INCREASED LEVEL OF PREMIUMS PERMITTED.—

4 Section 602(3) of such Act (29 U.S.C. 1162(3)) is amend5 ed by adding at the end the following new sentence: ‘‘In

6 the case of an individual provided continuation coverage

7 by reason of a qualifying event described in section

8 603(7), any reference in subparagraph (A) of this para9 graph to ‘102 percent of the applicable premium’ is

10 deemed a reference to ‘125 percent of the applicable pre11 mium for employed individuals (and their dependents, if

12 applicable) for the coverage option referred to in para13 graph (1)(B)’.’’.

14 (e) NOTICE.—Section 606(a) of such Act (29 U.S.C.

15 1166) is amended—

16 (1) in paragraph (4)(A), by striking ‘‘or (6)’’

17 and inserting ‘‘(6), or (7)’’; and

18 (2) by adding at the end the following:

19 ‘‘The notice under paragraph (4) in the case of a qualify20 ing event described in section 603(7) shall be provided at

21 least 90 days before the date of the qualifying event.’’.

22 (f) EFFECTIVE DATES.—

23 (1) IN GENERAL.—The amendments made by

24 this section (other than subsection (e)(2)) shall

25 apply to qualifying events occurring on or after Jan-
44

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1 uary 6, 1999. In the case of a qualifying event oc2 curring on or after such date and before the date of

3 the enactment of this Act, such event shall be

4 deemed (for purposes of such amendments) to have

5 occurred on the date of the enactment of this Act.

6 (2) ADVANCE NOTICE OF TERMINATIONS AND

7 REDUCTIONS.—The amendment made by subsection

8 (e)(2) shall apply to qualifying events occurring

9 after the date of the enactment of this Act, except

10 that in no case shall notice be required under such

11 amendment before such date.

12 CHAPTER 2—AMENDMENTS TO THE

13 PUBLIC HEALTH SERVICE ACT

14 SEC. 125. COBRA CONTINUATION BENEFITS FOR CERTAIN

15 RETIRED WORKERS WHO LOSE RETIREE

16 HEALTH COVERAGE.

17 (a) ESTABLISHMENT OF NEW QUALIFYING

18 EVENT.—

19 (1) IN GENERAL.—Section 2203 of the Public

20 Health Service Act (42 U.S.C. 300bb–3) is amended

21 by inserting after paragraph (5) the following new

22 paragraph:

23 ‘‘(6) The termination or substantial reduction

24 in benefits (as defined in section 2208(6)) of group

25 health plan coverage as a result of plan changes or
45

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1 termination in the case of a covered employee who

2 is a qualified retiree.’’.

3 (2) QUALIFIED RETIREE; QUALIFIED BENE4 FICIARY; AND SUBSTANTIAL REDUCTION DE5 FINED.—Section 2208 of such Act (42 U.S.C.

6 300bb–8) is amended—

7 (A) in paragraph (3)—

8 (i) in subparagraph (A), by inserting

9 ‘‘except as otherwise provided in this para10 graph,’’ after ‘‘means,’’; and

11 (ii) by adding at the end the following

12 new subparagraph:

13 ‘‘(C) SPECIAL RULE FOR QUALIFYING RE14 TIREES AND DEPENDENTS.—In the case of a

15 qualifying event described in section 2203(6),

16 the term ‘qualified beneficiary’ means a quali17 fied retiree and any other individual who, on

18 the day before such qualifying event, is a bene19 ficiary under the plan on the basis of the indi20 vidual’s relationship to such qualified retiree.’’;

21 and

22 (B) by adding at the end the following new

23 paragraphs:

24 ‘‘(5) QUALIFIED RETIREE.—The term ‘qualified

25 retiree’ means, with respect to a qualifying event de-
46

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1 scribed in section 2203(6), a covered employee who,

2 at the time of the event—

3 ‘‘(A) has attained 55 years of age; and

4 ‘‘(B) was receiving group health coverage

5 under the plan by reason of the retirement of

6 the covered employee.

7 ‘‘(6) SUBSTANTIAL REDUCTION.—The term

8 ‘substantial reduction’—

9 ‘‘(A) means, as determined under regula10 tions of the Secretary of Labor and with respect

11 to a qualified beneficiary, a reduction in the av12 erage actuarial value of benefits under the plan

13 (through reduction or elimination of benefits,

14 an increase in premiums, deductibles, copay15 ments, and coinsurance, or any combination

16 thereof), since the date of commencement of

17 coverage of the beneficiary by reason of the re18 tirement of the covered employee (or, if later,

19 January 6, 1999), in an amount equal to at

20 least 50 percent of the total average actuarial

21 value of the benefits under the plan as of such

22 date (taking into account an appropriate ad23 justment to permit comparison of values over

24 time); and
47

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1 ‘‘(B) includes an increase in premiums re2 quired to an amount that exceeds the premium

3 level described in the fourth sentence of section

4 2202(3).’’.

5 (b) DURATION OF COVERAGE THROUGH AGE 65.—

6 Section 2202(2)(A) of such Act (42 U.S.C. 300bb–

7 2(2)(A)) is amended—

8 (1) by redesignating clause (iii) as clause (iv);

9 and

10 (2) by inserting after clause (ii) the following

11 new clause:

12 ‘‘(iii) SPECIAL RULE FOR CERTAIN

13 DEPENDENTS IN CASE OF TERMINATION

14 OR SUBSTANTIAL REDUCTION OF RETIREE

15 HEALTH COVERAGE.—In the case of a

16 qualifying event described in section

17 2203(6), in the case of a qualified bene18 ficiary described in section 2208(3)(C) who

19 is not the qualified retiree or spouse of

20 such retiree, the later of—

21 ‘‘(I) the date that is 36 months

22 after the earlier of the date the quali23 fied retiree becomes entitled to bene24 fits under title XVIII of the Social Se-
48

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1 curity Act, or the date of the death of

2 the qualified retiree; or

3 ‘‘(II) the date that is 36 months

4 after the date of the qualifying

5 event.’’.

6 (c) TYPE OF COVERAGE IN CASE OF TERMINATION

7 OR SUBSTANTIAL REDUCTION OF RETIREE HEALTH COV8 ERAGE.—Section 2202(1) of such Act (42 U.S.C. 300bb–

9 2(1)) is amended—

10 (1) by striking ‘‘The coverage’’ and inserting

11 the following:

12 ‘‘(A) IN GENERAL.—Except as provided in

13 subparagraph (B), the coverage’’; and

14 (2) by adding at the end the following:

15 ‘‘(B) CERTAIN RETIREES.—In the case of

16 a qualifying event described in section 2203(6),

17 in applying the first sentence of subparagraph

18 (A) and the fourth sentence of paragraph (3),

19 the coverage offered that is the most prevalent

20 coverage option (as determined under regula21 tions of the Secretary of Labor) continued

22 under the group health plan (or, if none, under

23 the most prevalent other plan offered by the

24 same plan sponsor) shall be treated as the cov25 erage described in such sentence, or (at the op-
49

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1 tion of the plan and qualified beneficiary) such

2 other coverage option as may be offered and

3 elected by the qualified beneficiary involved.’’.

4 (d) INCREASED LEVEL OF PREMIUMS PERMITTED.—

5 Section 2202(3) of such Act (42 U.S.C. 300bb–2(3)) is

6 amended by adding at the end the following new sentence:

7 ‘‘In the case of an individual provided continuation cov8 erage by reason of a qualifying event described in section

9 2203(6), any reference in subparagraph (A) of this para10 graph to ‘102 percent of the applicable premium’ is

11 deemed a reference to ‘125 percent of the applicable pre12 mium for employed individuals (and their dependents, if

13 applicable) for the coverage option referred to in para14 graph (1)(B)’.’’.

15 (e) NOTICE.—Section 2206(a) of such Act (42 U.S.C.

16 300bb–6(a)) is amended—

17 (1) in paragraph (4)(A), by striking ‘‘or (4)’’

18 and inserting ‘‘(4), or (6)’’; and

19 (2) by adding at the end the following:

20 ‘‘The notice under paragraph (4) in the case of a qualify21 ing event described in section 2203(6) shall be provided

22 at least 90 days before the date of the qualifying event.’’.

23 (f) EFFECTIVE DATES.—

24 (1) IN GENERAL.—The amendments made by

25 this section (other than subsection (e)(2)) shall
50

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1 apply to qualifying events occurring on or after Jan2 uary 6, 1999. In the case of a qualifying event oc3 curring on or after such date and before the date of

4 the enactment of this Act, such event shall be

5 deemed (for purposes of such amendments) to have

6 occurred on the date of the enactment of this Act.

7 (2) ADVANCE NOTICE OF TERMINATIONS AND

8 REDUCTIONS.—The amendment made by subsection

9 (e)(2) shall apply to qualifying events occurring

10 after the date of the enactment of this Act, except

11 that in no case shall notice be required under such

12 amendment before such date.

13 CHAPTER 3—AMENDMENTS TO THE

14 INTERNAL REVENUE CODE OF 1986

15 SEC. 131. COBRA CONTINUATION BENEFITS FOR CERTAIN

16 RETIRED WORKERS WHO LOSE RETIREE

17 HEALTH COVERAGE.

18 (a) ESTABLISHMENT OF NEW QUALIFYING

19 EVENT.—

20 (1) IN GENERAL.—Section 4980B(f)(3) of the

21 Internal Revenue Code of 1986 is amended by in22 serting after subparagraph (F) the following new

23 subparagraph:

24 ‘‘(G) The termination or substantial reduc25 tion in benefits (as defined in subsection (g)(6))
51

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1 of group health plan coverage as a result of

2 plan changes or termination in the case of a

3 covered employee who is a qualified retiree.’’.

4 (2) QUALIFIED RETIREE; QUALIFIED BENE5 FICIARY; AND SUBSTANTIAL REDUCTION DE6 FINED.—Section 4980B(g) of such Code is

7 amended—

8 (A) in paragraph (1)—

9 (i) in subparagraph (A), by inserting

10 ‘‘except as otherwise provided in this para11 graph,’’ after ‘‘means,’’; and

12 (ii) by adding at the end the following

13 new subparagraph:

14 ‘‘(E) SPECIAL RULE FOR QUALIFYING RE15 TIREES AND DEPENDENTS.—In the case of a

16 qualifying event described in subsection

17 (f)(3)(G), the term ‘qualified beneficiary’ means

18 a qualified retiree and any other individual who,

19 on the day before such qualifying event, is a

20 beneficiary under the plan on the basis of the

21 individual’s relationship to such qualified re22 tiree.’’; and

23 (B) by adding at the end the following new

24 paragraphs:
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1 ‘‘(5) QUALIFIED RETIREE.—The term ‘qualified

2 retiree’ means, with respect to a qualifying event de3 scribed in subsection (f)(3)(G), a covered employee

4 who, at the time of the event—

5 ‘‘(A) has attained 55 years of age; and

6 ‘‘(B) was receiving group health coverage

7 under the plan by reason of the retirement of

8 the covered employee.

9 ‘‘(6) SUBSTANTIAL REDUCTION.—The term

10 ‘substantial reduction’—

11 ‘‘(A) means, as determined under regula12 tions of the Secretary of Labor and with respect

13 to a qualified beneficiary, a reduction in the av14 erage actuarial value of benefits under the plan

15 (through reduction or elimination of benefits,

16 an increase in premiums, deductibles, copay17 ments, and coinsurance, or any combination

18 thereof), since the date of commencement of

19 coverage of the beneficiary by reason of the re20 tirement of the covered employee (or, if later,

21 January 6, 1999), in an amount equal to at

22 least 50 percent of the total average actuarial

23 value of the benefits under the plan as of such

24 date (taking into account an appropriate ad-
53

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1 justment to permit comparison of values over

2 time); and

3 ‘‘(B) includes an increase in premiums re4 quired to an amount that exceeds the premium

5 level described in the fourth sentence of sub6 section (f)(2)(C).’’.

7 (b) DURATION OF COVERAGE THROUGH AGE 65.—

8 Section 4980B(f)(2)(B)(i) of such Code is amended—

9 (1) in subclause (II), by inserting ‘‘or (3)(G)’’

10 after ‘‘(3)(F)’’;

11 (2) in subclause (IV), by striking ‘‘or (3)(F)’’

12 and inserting ‘‘, (3)(F), or (3)(G)’’;

13 (3) by redesignating subclause (IV) as sub14 clause (VI);

15 (4) by redesignating subclause (V) as subclause

16 (IV) and by moving such clause to immediately fol17 low subclause (III); and

18 (5) by inserting after such subclause (IV) the

19 following new subclause:

20 ‘‘(V) SPECIAL RULE FOR CER21 TAIN DEPENDENTS IN CASE OF TER22 MINATION OR SUBSTANTIAL REDUC23 TION OF RETIREE HEALTH COV24 ERAGE.—In the case of a qualifying

25 event described in paragraph (3)(G),
54

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1 in the case of a qualified beneficiary

2 described in subsection (g)(1)(E) who

3 is not the qualified retiree or spouse

4 of such retiree, the later of—

5 ‘‘(a) the date that is 36

6 months after the earlier of the

7 date the qualified retiree becomes

8 entitled to benefits under title

9 XVIII of the Social Security Act,

10 or the date of the death of the

11 qualified retiree; or

12 ‘‘(b) the date that is 36

13 months after the date of the

14 qualifying event.’’.

15 (c) TYPE OF COVERAGE IN CASE OF TERMINATION

16 OR SUBSTANTIAL REDUCTION OF RETIREE HEALTH COV17 ERAGE.—Section 4980B(f)(2)(A) of such Code is

18 amended—

19 (1) by striking ‘‘The coverage’’ and inserting

20 the following:

21 ‘‘(i) IN GENERAL.—Except as pro22 vided in clause (ii), the coverage’’; and

23 (2) by adding at the end the following:

24 ‘‘(ii) CERTAIN RETIREES.—In the

25 case of a qualifying event described in
55

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1 paragraph (3)(G), in applying the first

2 sentence of clause (i) and the fourth sen3 tence of subparagraph (C), the coverage

4 offered that is the most prevalent coverage

5 option (as determined under regulations of

6 the Secretary of Labor) continued under

7 the group health plan (or, if none, under

8 the most prevalent other plan offered by

9 the same plan sponsor) shall be treated as

10 the coverage described in such sentence, or

11 (at the option of the plan and qualified

12 beneficiary) such other coverage option as

13 may be offered and elected by the qualified

14 beneficiary involved.’’.

15 (d) INCREASED LEVEL OF PREMIUMS PERMITTED.—

16 Section 4980B(f)(2)(C) of such Code is amended by add17 ing at the end the following new sentence: ‘‘In the case

18 of an individual provided continuation coverage by reason

19 of a qualifying event described in paragraph (3)(G), any

20 reference in clause (i) of this subparagraph to ‘102 per21 cent of the applicable premium’ is deemed a reference to

22 ‘125 percent of the applicable premium for employed indi23 viduals (and their dependents, if applicable) for the cov24 erage option referred to in subparagraph (A)(ii)’.’’.
56

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1 (e) NOTICE.—Section 4980B(f)(6) of such Code is

2 amended—

3 (1) in subparagraph (D)(i), by striking ‘‘or

4 (F)’’ and inserting ‘‘(F), or (G)’’; and

5 (2) by adding at the end the following:

6 ‘‘The notice under subparagraph (D)(i) in the case of a

7 qualifying event described in paragraph (3)(G) shall be

8 provided at least 90 days before the date of the qualifying

9 event.’’.

10 (f) EFFECTIVE DATES.—

11 (1) IN GENERAL.—The amendments made by

12 this section (other than subsection (e)(2)) shall

13 apply to qualifying events occurring on or after Jan14 uary 6, 1999. In the case of a qualifying event oc15 curring on or after such date and before the date of

16 the enactment of this Act, such event shall be

17 deemed (for purposes of such amendments) to have

18 occurred on the date of the enactment of this Act.

19 (2) ADVANCE NOTICE OF TERMINATIONS AND

20 REDUCTIONS.—The amendment made by subsection

21 (e)(2) shall apply to qualifying events occurring

22 after the date of the enactment of this Act, except

23 that in no case shall notice be required under such

24 amendment before such date.
57

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1 TITLE II—EXPANSION OF LONG2 TERM CARE PROTECTION

3 SEC. 201. LONG-TERM CARE TAX CREDIT.

4 (a) ALLOWANCE OF CREDIT.—

5 (1) IN GENERAL.—Section 24(a) of the Internal

6 Revenue Code of 1986 (relating to allowance of child

7 tax credit) is amended to read as follows:

8 ‘‘(a) ALLOWANCE OF CREDIT.—There shall be al9 lowed as a credit against the tax imposed by this chapter

10 for the taxable year an amount equal to the sum of—

11 ‘‘(1) $500 multiplied by the number of qualify12 ing children of the taxpayer, plus

13 ‘‘(2) $1,000 multiplied by the number of appli14 cable individuals with respect to whom the taxpayer

15 is an eligible caregiver for the taxable year.’’

16 (2) ADDITIONAL CREDIT FOR TAXPAYER WITH

17 3 OR MORE SEPARATE CREDIT AMOUNTS.—So much

18 of section 24(d) of such Code as precedes paragraph

19 (1)(A) thereof is amended to read as follows:

20 ‘‘(d) ADDITIONAL CREDIT FOR TAXPAYERS WITH 3

21 OR MORE SEPARATE CREDIT AMOUNTS.—

22 ‘‘(1) IN GENERAL.—If the sum of the number

23 of qualifying children of the taxpayer and the num24 ber of applicable individuals with respect to which

25 the taxpayer is an eligible caregiver is 3 or more for
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1 any taxable year, the aggregate credits allowed

2 under subpart C shall be increased by the lesser

3 of—’’.

4 (3) CONFORMING AMENDMENTS.—

5 (A) The heading for section 32(n) of such

6 Code is amended by striking ‘‘CHILD’’ and in7 serting ‘‘FAMILY CARE’’.

8 (B) The heading for section 24 is amended

9 to read as follows:

10 ‘‘SEC. 24. FAMILY CARE CREDIT.’’

11 (C) The table of sections for subpart A of

12 part IV of subchapter A of chapter 1 of such

13 Code is amended by striking the item relating

14 to section 24 and inserting the following new

15 item:

‘‘Sec. 24. Family care credit.’’.

16 (b) DEFINITIONS.—Section 24(c) of the Internal

17 Revenue Code of 1986 (defining qualifying child) is

18 amended to read as follows:

19 ‘‘(c) DEFINITIONS.—For purposes of this section—

20 ‘‘(1) QUALIFYING CHILD.—

21 ‘‘(A) IN GENERAL.—The term ‘qualifying

22 child’ means any individual if—

23 ‘‘(i) the taxpayer is allowed a deduc24 tion under section 151 with respect to such

25 individual for the taxable year,
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1 ‘‘(ii) such individual has not attained

2 the age of 17 as of the close of the cal3 endar year in which the taxable year of the

4 taxpayer begins, and

5 ‘‘(iii) such individual bears a relation6 ship to the taxpayer described in section

7 32(c)(3)(B).

8 ‘‘(B) EXCEPTION FOR CERTAIN NONCITI9 ZENS.—The term ‘qualifying child’ shall not in10 clude any individual who would not be a de11 pendent if the first sentence of section

12 152(b)(3) were applied without regard to all

13 that follows ‘resident of the United States’.

14 ‘‘(2) APPLICABLE INDIVIDUAL.—

15 ‘‘(A) IN GENERAL.—The term ‘applicable

16 individual’ means, with respect to any taxable

17 year, any individual who has been certified, be18 fore the due date for filing the return of tax for

19 the taxable year (without extensions), by a phy20 sician (as defined in section 1861(r)(1) of the

21 Social Security Act) as being an individual with

22 long-term care needs described in subparagraph

23 (B) for a period—

24 ‘‘(i) which is at least 180 consecutive

25 days, and
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1 ‘‘(ii) a portion of which occurs within

2 the taxable year.

3 Such term shall not include any individual oth4 erwise meeting the requirements of the preceding sentence unless within the 391 5 ⁄2 month pe6 riod ending on such due date (or such other pe7 riod as the Secretary prescribes) a physician (as

8 so defined) has certified that such individual

9 meets such requirements.

10 ‘‘(B) INDIVIDUALS WITH LONG-TERM CARE

11 NEEDS.—An individual is described in this sub12 paragraph if the individual meets any of the fol13 lowing requirements:

14 ‘‘(i) The individual is at least 6 years

15 of age and—

16 ‘‘(I) is unable to perform (with17 out substantial assistance from an18 other individual) at least 3 activities

19 of daily living (as defined in section

20 7702B(c)(2)(B)) due to a loss of

21 functional capacity, or

22 ‘‘(II) requires substantial super23 vision to protect such individual from

24 threats to health and safety due to se25 vere cognitive impairment and is un-
61

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1 able to perform at least 1 activity of

2 daily living (as so defined) or to the

3 extent provided in regulations pre4 scribed by the Secretary (in consulta5 tion with the Secretary of Health and

6 Human Services), is unable to engage

7 in age appropriate activities.

8 ‘‘(ii) The individual is at least 2 but

9 not 6 years of age and is unable due to a

10 loss of functional capacity to perform

11 (without substantial assistance from an12 other individual) at least 2 of the following

13 activities: eating, transferring, or mobility.

14 ‘‘(iii) The individual is under 2 years

15 of age and requires specific durable medi16 cal equipment by reason of a severe health

17 condition or requires a skilled practitioner

18 trained to address the individual’s condi19 tion to be available if the individual’s par20 ents or guardians are absent.

21 ‘‘(3) ELIGIBLE CAREGIVER.—

22 ‘‘(A) IN GENERAL.—A taxpayer shall be

23 treated as an eligible caregiver for any taxable

24 year with respect to the following individuals:

25 ‘‘(i) The taxpayer.
62

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1 ‘‘(ii) The taxpayer’s spouse.

2 ‘‘(iii) An individual with respect to

3 whom the taxpayer is allowed a deduction

4 under section 151 for the taxable year.

5 ‘‘(iv) An individual who would be de6 scribed in clause (iii) for the taxable year

7 if section 151(c)(1)(A) were applied by

8 substituting for the exemption amount an

9 amount equal to the sum of the exemption

10 amount, the standard deduction under sec11 tion 63(c)(2)(C), and any additional stand12 ard deduction under section 63(c)(3) which

13 would be applicable to the individual if

14 clause (iii) applied.

15 ‘‘(v) An individual who would be de16 scribed in clause (iii) for the taxable year

17 if—

18 ‘‘(I) the requirements of clause

19 (iv) are met with respect to the indi20 vidual, and

21 ‘‘(II) the requirements of sub22 paragraph (B) are met with respect to

23 the individual in lieu of the support

24 test of section 152(a).
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1 ‘‘(B) RESIDENCY TEST.—The require2 ments of this subparagraph are met if an indi3 vidual has as his principal place of abode the

4 home of the taxpayer and—

5 ‘‘(i) in the case of an individual who

6 is an ancestor or descendant of the tax7 payer or the taxpayer’s spouse, is a mem8 ber of the taxpayer’s household for over

9 half the taxable year, or

10 ‘‘(ii) in the case of any other individ11 ual, is a member of the taxpayer’s house12 hold for the entire taxable year.

13 ‘‘(C) SPECIAL RULES WHERE MORE THAN

14 1 ELIGIBLE CAREGIVER.—

15 ‘‘(i) IN GENERAL.—If more than 1 in16 dividual is an eligible caregiver with re17 spect to the same applicable individual for

18 taxable years ending with or within the

19 same calendar year, a taxpayer shall be

20 treated as the eligible caregiver if each

21 such individual (other than the taxpayer)

22 files a written declaration (in such form

23 and manner as the Secretary may pre24 scribe) that such individual will not claim
64

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1 such applicable individual for the credit

2 under this section.

3 ‘‘(ii) NO AGREEMENT.—If each indi4 vidual required under clause (i) to file a

5 written declaration under clause (i) does

6 not do so, the individual with the highest

7 modified adjusted gross income (as defined

8 in section 32(c)(5)) shall be treated as the

9 eligible caregiver.

10 ‘‘(iii) MARRIED INDIVIDUALS FILING

11 SEPARATELY.—In the case of married indi12 viduals filing separately, the determination

13 under this subparagraph as to whether the

14 husband or wife is the eligible caregiver

15 shall be made under the rules of clause (ii)

16 (whether or not one of them has filed a

17 written declaration under clause (i)).’’.

18 (c) IDENTIFICATION REQUIREMENTS.—

19 (1) IN GENERAL.—Section 24(e) of the Internal

20 Revenue Code of 1986 is amended by adding at the

21 end the following new sentence: ‘‘No credit shall be

22 allowed under this section to a taxpayer with respect

23 to any applicable individual unless the taxpayer in24 cludes the name and taxpayer identification number

25 of such individual, and the identification number of
65

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1 the physician certifying such individual, on the re2 turn of tax for the taxable year.’’.

3 (2) ASSESSMENT.—Section 6213(g)(2)(I) of

4 such Code is amended—

5 (A) by inserting ‘‘or physician identifica6 tion’’ after ‘‘correct TIN’’, and

7 (B) by striking ‘‘child’’ and inserting

8 ‘‘family care’’.

9 (d) EFFECTIVE DATE.—The amendments made by

10 this section shall apply to taxable years beginning after

11 December 31, 1999.

12 SEC. 202. FEDERAL EMPLOYEES GROUP LONG-TERM CARE

13 INSURANCE.

14 (a) IN GENERAL.—Subpart G of part III of title 5,

15 United States Code, is amended by adding at the end the

16 following new chapter:

17 ‘‘Chapter 90—Long-Term Care Insurance

‘‘Sec.

‘‘9001. Definitions.

‘‘9002. Contracting authority.

‘‘9003. Minimum standards for contractors.

‘‘9004. Long-term care benefits.

‘‘9005. Financing.

‘‘9006. Preemption.

‘‘9007. Studies, reports, and audits.

‘‘9008. Claims for benefits.

‘‘9009. Jurisdiction of courts.

‘‘9010. Regulations.

‘‘9011. Authorization of appropriations.

18 ‘‘§ 9001. Definitions

19 ‘‘For the purpose of this chapter, the term—
66

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1 ‘‘(1) ‘annuitant’ means an individual referred to

2 in section 8901(3);

3 ‘‘(2) ‘employee’ means an individual referred to

4 in subparagraphs (A) through (D), and (F) through

5 (I) of section 8901(1); but does not include an em6 ployee excluded by regulation of the Office under

7 section 9011;

8 ‘‘(3) ‘Office’ means the Office of Personnel

9 Management;

10 ‘‘(4) ‘other eligible individual’ means the

11 spouse, former spouse, parent or parent-in-law of an

12 employee or annuitant, or other individual specified

13 by the Office;

14 ‘‘(5) ‘qualified carrier’ means an insurer li15 censed to do business in each of the States and

16 meeting the requirements of a qualified insurer in

17 each of the States;

18 ‘‘(6) ‘qualified contract’ means a contract meet19 ing the conditions prescribed in section 9002; and

20 ‘‘(7) ‘State’ means a State or territory or pos21 session of the United States, and includes the Dis22 trict of Columbia.

23 ‘‘§ 9002. Contracting authority

24 ‘‘(a) The Office may, without regard to section 3709

25 of the Revised Statutes (41 U.S.C. 5) or any other statute
67

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1 requiring competitive bidding, purchase from 1 or more

2 qualified carriers a policy or policies of group long-term

3 care insurance to provide benefits as specified by this

4 chapter. The Office shall ensure that each resulting con5 tract is awarded on the basis of contractor qualifications,

6 price, and reasonable competition to the maximum extent

7 practicable.

8 ‘‘(b) The Office may design a benefits package or

9 packages and negotiate final offerings with qualified car10 riers.

11 ‘‘(c) Each contract shall be for a uniform term of 5

12 years, unless terminated earlier by the Office.

13 ‘‘(d) Premium rates charged under a contract entered

14 into under this section shall reasonably reflect the cost of

15 the benefits provided under that contract as determined

16 by the Office.

17 ‘‘(e) The coverage and benefits made available to in18 dividuals under a contract entered into under this section

19 are guaranteed to be renewable and may not be canceled

20 by the carrier except for nonpayment of premium.

21 ‘‘(f) The Office may withdraw an offering under this

22 section based on open season participation rates, the com23 position of the risk pool, or both.
68

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1 ‘‘§ 9003. Minimum standards for contractors

2 ‘‘At the minimum, to be a qualified carrier under this

3 chapter, a company shall—

4 ‘‘(1) be licensed as an insurance company and

5 approved to issue group long-term care insurance in

6 all States and to do business in each of the States;

7 and

8 ‘‘(2) be in compliance with the requirements im9 posed on issuers of qualified long-term care con10 tracts by section 4980C of the Internal Revenue

11 Code of 1986.

12 ‘‘§ 9004. Long-term care benefits

13 ‘‘The benefits provided under this chapter shall be

14 long-term care benefits which, at a minimum, shall be

15 compliant with the most recent standards recommended

16 by the National Association of Insurance Commissioners.

17 ‘‘§ 9005. Financing

18 ‘‘(a) The amount necessary to pay the premium for

19 enrollment of an enrolled employee shall be withheld from

20 the pay of each enrolled employee.

21 ‘‘(b) Except as provided under subsection (d), the

22 amount necessary to pay the premium for enrollment of

23 an enrolled annuitant shall be withheld from the annuity

24 of each enrolled annuitant.
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1 ‘‘(c) The amount necessary to pay the premium for

2 enrollment of a spouse may be withheld from pay or annu3 ity, as appropriate.

4 ‘‘(d) An employee, annuitant, or other eligible individ5 ual, whose pay or annuity is insufficient to cover the with6 holding required for enrollment, shall, at the discretion of

7 the Office, pay the premium for enrollment directly to the

8 carrier.

9 ‘‘(e) Each carrier participating in the program estab10 lished under chapter shall maintain the funds related to

11 this program separate and apart from funds related to

12 other contracts and other lines of business.

13 ‘‘(f) The costs of the Office in adjudicating a claims

14 dispute under section 9008, including costs related to an

15 inquiry not culminating in a dispute, shall be reimbursed

16 by the carrier involved in the dispute or inquiry. Such

17 funds shall be available to the Office for the administra18 tion of this chapter.

19 ‘‘§ 9006. Preemption

20 ‘‘This chapter shall supersede and preempt any State

21 or local law which is determined by the Office to be incon22 sistent with—

23 ‘‘(1) the provisions of this chapter; or

24 ‘‘(2) after consultation with the National Asso25 ciation of Insurance Commissioners, the efficient
70

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1 provision of a nationwide long-term care insurance

2 program for Federal employees.

3 ‘‘§ 9007. Studies, reports, and audits

4 ‘‘(a) Each qualified carrier entering into a contract

5 under this chapter shall—

6 ‘‘(1) furnish such reasonable reports as the Of7 fice determines to be necessary to enable the carrier

8 to carry out the functions under this chapter; and

9 ‘‘(2) permit the Office and representatives of

10 the General Accounting Office to examine such

11 records of the carrier as may be necessary to carry

12 out the purposes of this chapter.

13 ‘‘(b) Each Federal agency shall keep such records,

14 make such certifications, and furnish the Office, the car15 rier, or both, with such information and reports as the

16 Office may require.

17 ‘‘§ 9008. Claims for benefits

18 ‘‘(a) A claim for benefits under this chapter shall be

19 filed within 4 years after the date on which the reimburs20 able cost was incurred or the service was provided.

21 ‘‘(b) The Office shall adjudicate a claims dispute aris22 ing under this chapter and shall require the contractor to

23 pay for any benefit or provide any service the Office deter24 mines appropriate under the applicable contract.
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1 ‘‘(c)(1) Except as provided under paragraph (2), ben2 efits payable under this chapter for any reimbursable cost

3 incurred or service provided are secondary to any other

4 benefit payable for such cost or service. No payment may

5 be made where there is no legal obligation for such pay6 ment.

7 ‘‘(2)(A) Benefits payable under the programs de8 scribed under subparagraph (B) shall be secondary to ben9 efits payable under this chapter.

10 ‘‘(B) The programs referred to under subparagraph

11 (A) are—

12 ‘‘(i) the program of medical assistance under

13 title XIX of the Social Security Act (42 U.S.C.

14 1396); and

15 ‘‘(ii) any other Federal or State programs that

16 the Office may specify in regulations that provide

17 health benefit coverage designed to be secondary to

18 other insurance coverage.

19 ‘‘§ 9009. Jurisdiction of courts

20 ‘‘A claimant under this chapter may file suit against

21 the carrier of the long-term care insurance policy covering

22 such claimant in the district courts of the United States,

23 after exhausting all available administrative remedies.
72

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1 ‘‘§ 9010. Regulations

2 ‘‘(a) The Office shall prescribe regulations necessary

3 to carry out this chapter.

4 ‘‘(b) The regulations of the Office may prescribe the

5 time at which and the conditions under which an eligible

6 individual may enroll in the program established under

7 this chapter.

8 ‘‘(c) The Office may not exclude—

9 ‘‘(1) an employee or group of employees solely

10 on the basis of the hazardous nature of employment;

11 or

12 ‘‘(2) an employee who is occupying a position

13 on a part-time career employment basis, as defined

14 in section 3401(2).

15 ‘‘(d) The regulations of the Office shall provide for

16 the beginning and ending dates of coverage of employees,

17 annuitants, former spouses, and other eligible individuals

18 under this chapter, and any requirements for continuation

19 or conversion of coverage.

20 ‘‘§ 9011. Authorization of appropriations

21 ‘‘There are authorized to be appropriated such sums

22 as may be necessary for the purposes of carrying out sec23 tions 9002 and 9010.’’.

24 (b) EFFECTIVE DATE.—The amendments made by

25 subsection (a) shall take effect on the date of enactment

26 of this Act, except that no coverage may be effective until
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1 the first day of the first applicable pay period in October,

2 which occurs more than 1 year after the date of enactment

3 of this Act.

4 TITLE III—REAUTHORIZATION

5 OF THE OLDER AMERICANS

6 ACT OF 1965

7 SEC. 301. AUTHORIZATIONS OF APPROPRIATIONS.

8 (a) FEDERAL COUNCIL ON THE AGING.—Section

9 204(g) of the Older Americans Act of 1965 (42 U.S.C.

10 3015(g)) is amended by striking ‘‘$300,000 for fiscal year

11 1992 and such sums as may be necessary for fiscal years

12 1993, 1994, and 1995’’ and inserting ‘‘such sums as may

13 be necessary for fiscal years 2000 through 2002’’.

14 (b) ADMINISTRATION.—Section 215 of the Older

15 Americans Act of 1965 (42 U.S.C. 3020f) is amended—

16 (1) in subsection (a), by striking ‘‘fiscal years

17 1992, 1993, 1994, and 1995’’ and inserting ‘‘fiscal

18 years 2000 through 2002’’; and

19 (2) in subsection (b), by striking paragraph (1)

20 and inserting the following:

21 ‘‘(1) such sums as may be necessary for each

22 of fiscal years 2000 through 2002; and’’.

23 (c) GRANTS FOR STATE AND COMMUNITY PROGRAMS

24 ON AGING.—Section 303 of the Older Americans Act of

25 1965 (42 U.S.C. 3023) is amended—
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1 (1) in subsection (a)(1), by striking

2 ‘‘$461,376,000 for fiscal year 1992 and such sums

3 as may be necessary for fiscal years 1993, 1994, and

4 1995’’ and inserting ‘‘such sums as may be nec5 essary for fiscal years 2000 through 2002’’;

6 (2) in subsection (b)—

7 (A) in paragraph (1), by striking

8 ‘‘$505,000,000 for fiscal year 1992 and such

9 sums as may be necessary for fiscal years 1993,

10 1994, and 1995’’ and inserting ‘‘such sums as

11 may be necessary for fiscal years 2000 through

12 2002’’;

13 (B) in paragraph (2), by striking

14 ‘‘$120,000,000 for fiscal year 1992 and such

15 sums as may be necessary for fiscal years 1993,

16 1994, and 1995’’ and inserting ‘‘such sums as

17 may be necessary for fiscal years 2000 through

18 2002’’; and

19 (C) in paragraph (3), by striking

20 ‘‘$15,000,000 for fiscal year 1992 and such

21 sums as may be necessary for fiscal years 1993,

22 1994, and 1995’’ and inserting ‘‘such sums as

23 may be necessary for fiscal years 2000 through

24 2002’’;

25 (3) in subsection (d), to read as follows:
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1 ‘‘(d) NATIONAL FAMILY CAREGIVER PROGRAM.—

2 There are authorized to be appropriated $125,000,000 for

3 fiscal year 2000, and such sums as may be necessary for

4 each of the fiscal years 2001 through 2004, to carry out

5 the programs under part D (relating to the national family

6 caregiver program).’’;

7 (4) in subsection (e), by striking ‘‘the fiscal

8 years 1992, 1993, 1994, and 1995’’ and inserting

9 ‘‘fiscal years 2000 through 2002’’; and

10 (5) in subsection (f), by striking ‘‘$25,000,000

11 for fiscal year 1992 and such sums as may be nec12 essary for fiscal years 1993, 1994, and 1995’’ and

13 inserting ‘‘such sums as may be necessary for fiscal

14 years 2000 through 2002’’.

15 (d) AVAILABILITY OF SURPLUS COMMODITIES.—Sec16 tion 311(c)(1)(A) of the Older Americans Act of 1965 (42

17 U.S.C. 3030a(c)(1)(A)) is amended by striking

18 ‘‘$250,000,000 for fiscal year 1992, $310,000,000 for fis19 cal year 1993, $380,000,000 for fiscal year 1994, and

20 $460,000,000 for fiscal year 1995’’ and inserting ‘‘such

21 sums as may be necessary for each of fiscal years 2000

22 through 2002’’.

23 (e) TRAINING, RESEARCH, AND DISCRETIONARY

24 PROJECTS AND PROGRAMS.—Section 431 of the Older

25 Americans Act of 1965 (42 U.S.C. 3037) is amended—
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1 (1) in subsection (a)(1), by striking

2 ‘‘$72,000,000 for fiscal year 1992, and such sums

3 as may be necessary for fiscal years 1993, 1994, and

4 1995’’ and inserting ‘‘such sums as may be nec5 essary for fiscal years 2000 through 2002’’; and

6 (2) in subsection (b), by striking ‘‘$450,000 for

7 each of fiscal years 1992, 1993, 1994, and 1995’’

8 and inserting ‘‘such sums as may be necessary for

9 each of fiscal years 2000 through 2002’’.

10 (f) COMMUNITY SERVICE EMPLOYMENT FOR OLDER

11 AMERICANS.—Section 508(a)(1) of the Older Americans

12 Act of 1965 (42 U.S.C. 3056f(a)(1)) is amended by strik13 ing ‘‘$470,671,000 for fiscal year 1992, and such sums

14 as may be necessary for fiscal years 1993, 1994, and

15 1995’’ and inserting ‘‘such sums as may be necessary for

16 fiscal years 2000 through 2002’’.

17 (g) GRANTS FOR NATIVE AMERICANS.—Section

18 633(a) of the Older Americans Act of 1965 (42 U.S.C.

19 3057n(a)) is amended by striking ‘‘$30,000,000 for fiscal

20 year 1992 and such sums as may be necessary for fiscal

21 years 1993, 1994, and 1995’’ and inserting ‘‘such sums

22 as may be necessary for fiscal years 2000 through 2002’’.

23 (h) ALLOTMENTS FOR VULNERABLE ELDER RIGHTS

24 PROTECTION ACTIVITIES.—Section 702 of the Older

25 Americans Act of 1965 (42 U.S.C. 3058a) is amended—
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1 (1) in subsection (a), by striking ‘‘$40,000,000

2 for fiscal year 1992 and such sums as may be nec3 essary for fiscal years 1993, 1994, and 1995’’ and

4 inserting ‘‘such sums as may be necessary for fiscal

5 years 2000 through 2002’’;

6 (2) in subsection (b), by striking ‘‘$15,000,000

7 for fiscal year 1992 and such sums as may be nec8 essary for fiscal years 1993, 1994, and 1995’’ and

9 inserting ‘‘such sums as may be necessary for fiscal

10 years 2000 through 2002’’;

11 (3) in subsection (c), by striking ‘‘$10,000,000

12 for fiscal year 1992 and such sums as may be nec13 essary for fiscal years 1993, 1994, and 1995’’ and

14 inserting ‘‘such sums as may be necessary for fiscal

15 years 2000 through 2002’’; and

16 (4) in subsection (d), by striking ‘‘$15,000,000

17 for fiscal year 1992 and such sums as may be nec18 essary for fiscal years 1993, 1994, and 1995’’ and

19 inserting ‘‘such sums as may be necessary for fiscal

20 years 2000 through 2002’’.

21 (i) NATIVE AMERICAN PROGRAM.—Section 751(d) of

22 the Older Americans Act of 1965 (42 U.S.C. 3058aa(d))

23 is amended by striking ‘‘$5,000,000 for fiscal year 1992,

24 and such sums as may be necessary for fiscal years 1993,
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1 1994, and 1995’’ and inserting ‘‘such sums as may be nec2 essary for fiscal years 2000 through 2002’’.

3 SEC. 302. NATIONAL FAMILY CAREGIVER SUPPORT PRO4 GRAM.

5 (a) ESTABLISHMENT OF PROGRAM.—Part D of title

6 III of the Older Americans Act of 1965 (42 U.S.C. 3030h

7 et seq.) is amended to read as follows:

8 ‘‘PART D— NATIONAL FAMILY CAREGIVER

9 SUPPORT PROGRAM

10 ‘‘Subpart 1—State Grant Program

11 ‘‘SEC. 341. PROGRAM AUTHORIZED.

12 ‘‘(a) IN GENERAL.—The Assistant Secretary shall

13 carry out a program under this subpart for making grants

14 to States under State plans approved under section 307

15 for multi-faceted systems of support for families and other

16 informal providers of in-home and community care to

17 older individuals.

18 ‘‘(b) COORDINATION WITH SERVICE PROVIDERS.—In

19 carrying out this subpart, each area agency on aging shall

20 coordinate with other community agencies and voluntary

21 organizations providing the types of services for which

22 funding is available under this subpart.

23 ‘‘(c) FAMILY CAREGIVER SUPPORT SERVICES.—The

24 services to be provided through a State program under

25 this subpart shall include—
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1 ‘‘(1) the provision of information to caregivers

2 about available services;

3 ‘‘(2) assistance to caregivers in gaining access

4 to such services;

5 ‘‘(3) individual counseling, the organization of

6 support groups, and the provision of caregiver train7 ing to help families make decisions and solve prob8 lems relating to their caregiving roles;

9 ‘‘(4) respite care to enable families and other

10 informal caregivers to be temporarily relieved from

11 their caregiving responsibilities; and

12 ‘‘(5) the provision of supplemental services, on

13 a limited basis, to complement the care provided by

14 families and other informal caregivers.

15 ‘‘(d) ELIGIBILITY.—In order for a caregiver or care16 givers of an older individual to be eligible to receive serv17 ices provided by a State program under this subpart, the

18 State must—

19 ‘‘(1) determine that the older individual meets

20 the condition specified in either subparagraph (A)(i)

21 or (B) of section 102(28); and

22 ‘‘(2) give priority for services to older individ23 uals and families with the greatest social and eco24 nomic need, consistent with the requirements of sec25 tion 305(a)(2)(E).
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1 ‘‘(e) REQUIREMENTS FOR QUALITY STANDARDS AND

2 ACCOUNTABILITY.—A State receiving assistance under

3 this subpart shall comply with the following:

4 ‘‘(1) QUALITY STANDARDS.—A State shall have

5 in place mechanisms designed to ensure the quality

6 of services provided with assistance under this sub7 part.

8 ‘‘(2) DATA AND RECORDS.—A State shall col9 lect data and furnish records at the times and in the

10 standardized format that the Assistant Secretary

11 may require in order to enable the Assistant Sec12 retary to monitor State program administration and

13 compliance, and to evaluate and compare the effec14 tiveness of State programs under this subpart.

15 ‘‘(3) REPORTING.—A State shall report to the

16 Assistant Secretary on the data and information re17 quired under paragraph (2), including the services

18 and activities funded under this subpart, and stand19 ards and methods by which the quality of services

20 shall be assured.

21 ‘‘(f) AVAILABILITY OF FUNDS.—

22 ‘‘(1) IN GENERAL.—The program under this

23 subpart shall be carried out in each fiscal year using

24 the balance of funds appropriated under section

25 303(d) for such fiscal year and remaining after the
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1 reservation of funds under sections 345 and 346 for

2 carrying out subpart 2.

3 ‘‘(2) USE OF FUNDS FOR ADMINISTRATION OF

4 AREA PLANS.—Amounts made available to a State

5 under this subpart may be used, in addition to

6 amounts available in accordance with section

7 303(c)(1), for the costs of the administration of area

8 plans.

9 ‘‘(3) FEDERAL SHARE.—

10 ‘‘(A) IN GENERAL.—Notwithstanding sec11 tion 304(d)(1)(D), amounts made available to a

12 State under this subpart shall be available to

13 pay not more than 75 percent of the costs of

14 services provided under this subpart.

15 ‘‘(B) LIMITATION.—Federal funds and

16 cost sharing by recipients of services provided

17 under this subpart cannot be used for the non18 Federal share of funds under this subpart.

19 ‘‘SEC. 342. MAINTENANCE OF EFFORT.

20 ‘‘Funds made available under this subpart shall be

21 in addition to, and may not be used to supplant, any funds

22 that are or would otherwise be expended under any Fed23 eral, State, or local law by a State or unit of general pur24 pose local government (including area agencies on aging)

25 which have in their planning and service areas existing
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1 services equivalent to the services which may be funded

2 under this subpart.

3 ‘‘Subpart 2—National Innovation Programs

4 ‘‘SEC. 345. INNOVATION GRANT PROGRAM.

5 ‘‘(a) IN GENERAL.—The Assistant Secretary shall

6 carry out a program for making grants on a competitive

7 basis to foster the development and testing of new ap8 proaches to sustaining the efforts of families and other

9 informal caregivers of older individuals, and to serving

10 particular groups of caregivers of older individuals, includ11 ing minority caregivers and distant caregivers.

12 ‘‘(b) EVALUATION AND DISSEMINATION OF RE13 SULTS.—The Assistant Secretary shall provide for the

14 evaluation of the effectiveness of programs and activities

15 funded with grants under this subpart, and for the dis16 semination to States of descriptions and evaluations of

17 such programs and activities, to enable States to incor18 porate successful approaches into their program under

19 this part.

20 ‘‘(c) AVAILABILITY OF FUNDS.—

21 ‘‘(1) IN GENERAL.—The Assistant Secretary

22 shall reserve up to 10 percent of the amount appro23 priated for each fiscal year under section 303(d) to

24 carry out the program under this section.
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1 ‘‘(2) NATIVE AMERICAN PROGRAMS.—20 per2 cent of the amounts reserved for each fiscal year

3 under paragraph (1) shall be made available for pro4 grams and activities for Native Americans.

5 ‘‘SEC. 346. ACTIVITIES OF NATIONAL SIGNIFICANCE.

6 ‘‘(a) IN GENERAL.—The Assistant Secretary shall,

7 directly or by grant or contract, carry out activities of na8 tional significance to promote quality and continuous im9 provement in the support provided to family and other in10 formal caregivers of older individuals through program

11 evaluation, training, technical assistance and research.

12 ‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec13 retary shall reserve up to 2 percent of the amount appro14 priated for each fiscal year under section 303(d) to carry

15 out the program under this section.’’.

16 SEC. 303. ALLOTMENTS.

17 Section 304(a)(1) of the Older Americans Act of

18 1965 (42 U.S.C. 3024(a)(1)) is amended in the first sen19 tence by inserting ‘‘remaining after reservations of funds

20 in accordance with sections 345 and 346’’ after ‘‘from the

21 sums appropriated under section 303 for each fiscal year’’.
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1 SEC. 304. AVAILABILITY OF TITLE III-D FUNDS FOR REAL2 LOTMENT.

3 Section 304(b) of the Older Americans Act of 1965

4 (42 U.S.C. 3024(b)) is amended in the first sentence by

5 striking ‘‘part B or C’’ and inserting ‘‘part B, C, or D’’.

6 SEC. 305. CONFORMING AMENDMENTS.

7 (a) RELOCATION OF PROVISIONS CONCERNING IN8 HOME SERVICES FOR FRAIL OLDER INDIVIDUALS.—Sec9 tion 321(a)(5) of the Older Americans Act of 1965 (42

10 U.S.C. 3030d(a)(5)) is amended by striking ‘‘including’’

11 and all that follows and inserting ‘‘including—

12 ‘‘(A) client assessment, case management,

13 and development and coordination of commu14 nity services;

15 ‘‘(B) in-home services for frail older indi16 viduals (including supportive services for vic17 tims of Alzheimer’s disease and related dis18 orders with neurological and organic brain dys19 function, and for the families of such individ20 uals);

21 ‘‘(C) supportive activities to meet the spe22 cial needs of caregivers, including caretakers

23 who provide in-home services to frail older indi24 viduals;

25 ‘‘(D) in-home and other community serv26 ices, including home health, homemaker, shop-
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1 ping, escort, reader, and letter writing services,

2 to assist older individuals to live independently

3 in a home environment;’’.

4 (b) REPEAL OF PART G.—Part G of title III of the

5 Older Americans Act of 1965 (42 U.S.C. 3030q et seq.)

6 is repealed.

7 (c) ELIMINATION OF OBSOLETE REFERENCES.—Sec8 tion 303 of the Older Americans Act of 1965 (42 U.S.C.

9 3023) is amended by striking subsection (g).

10 SEC. 306. EFFECTIVE DATE.

11 The amendments made by this title shall take effect

12 on October 1, 1999.

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