I 

108TH CONGRESS 

1ST SESSION H. R. 2883

To amend the Internal Revenue Code of 1986 to provide a refundable longterm care tax credit, and to provide for programs within the Department 

of Health and Human Services and Department of Veterans Affairs 

for patients with fatal chronic illness. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 24, 2003

Mr. OBERSTAR (for himself and Mr. RAMSTAD) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce and Veterans’ Affairs, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL

To amend the Internal Revenue Code of 1986 to provide 

a refundable long-term care tax credit, and to provide 

for programs within the Department of Health and 

Human Services and Department of Veterans Affairs 

for patients with fatal chronic illness.

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 ‘‘Living Well with Fatal Chronic Illness Act of 2003’’. 
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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. 

Sec. 2. Refundable long-term care tax credit. 

Sec. 3. Department of Health and Human Services programs for patients with 

fatal chronic illnesses. 

Sec. 4. Programs through Department of Veterans Affairs regarding patients 

with fatal chronic illnesses.

3 SEC. 2. REFUNDABLE LONG-TERM CARE TAX CREDIT. 

4 (a) IN GENERAL.—Subpart C of part IV of sub5 chapter A of chapter 1 of the Internal Revenue Code of 

6 1986 (relating to refundable credits) is amended by insert7 ing after section 35 the following new section: 

8 ‘‘SEC. 35A. LONG-TERM CARE TAX CREDIT. 

9 ‘‘(a) ALLOWANCE OF CREDIT.—There shall be al10 lowed as a credit against the tax imposed by this subtitle 

11 for the taxable year an amount equal to $3,000 multiplied 

12 by the number of applicable individuals with respect to 

13 whom the taxpayer is an eligible caregiver for the taxable 

14 year. 

15 ‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN16 COME.—

17 ‘‘(1) IN GENERAL.—The amount of the credit 

18 allowable under subsection (a) shall be reduced (but 

19 not below zero) by $50 for each $1,000 (or fraction 

20 thereof) by which the taxpayer’s modified adjusted 

21 gross income (as defined in section 24(b)(1)) exceeds 
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1 the threshold amount (as defined in section 

2 24(b)(2)). 

3 ‘‘(2) LIMITATION BASED ON AMOUNT OF

4 TAX.—The credit allowed under subsection (a) for 

5 any taxable year shall not exceed the excess of—

6 ‘‘(A) the sum of the regular tax liability 

7 (as defined in section 26(b)) plus the tax im8 posed by section 55, over 

9 ‘‘(B) the sum of the credits allowable 

10 under this subpart (other than this section and 

11 sections 23 and 25B) and section 27 for the 

12 taxable year. 

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

14 ‘‘(1) 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 

6 period ending on such due date (or such other 

7 period as the Secretary prescribes) a physician 

8 (as so defined) has certified that such indi9 vidual 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 lack 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-
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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 med16 ical 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 ‘‘(2) 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.
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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 200 percent of the pov10 erty level determined by using criteria of 

11 poverty established by the Bureau of the 

12 Census. 

13 ‘‘(v) An individual who would be de14 scribed in clause (iii) for the taxable year 

15 if—

16 ‘‘(I) the requirements of clause 

17 (iv) are met with respect to the indi18 vidual, and 

19 ‘‘(II) the requirements of sub20 paragraph (B) are met with respect to 

21 the individual in lieu of the support 

22 test of section 152(a). 

23 ‘‘(B) RESIDENCY TEST.—The require24 ments of this subparagraph are met if an indi-
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1 vidual has as his principal place of abode the 

2 home of the taxpayer and—

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

4 is an ancestor or descendant of the tax5 payer or the taxpayer’s spouse, is a mem6 ber of the taxpayer’s household for over 

7 half the taxable year, or 

8 ‘‘(ii) in the case of any other indi9 vidual, is a member of the taxpayer’s 

10 household for the entire taxable year. 

11 ‘‘(C) SPECIAL RULES WHERE MORE THAN

12 1 ELIGIBLE CAREGIVER.—

13 ‘‘(i) IN GENERAL.—If more than 1 in14 dividual is an eligible caregiver with re15 spect to the same applicable individual for 

16 taxable years ending with or within the 

17 same calendar year, a taxpayer shall be 

18 treated as the eligible caregiver if each 

19 such individual (other than the taxpayer) 

20 files a written declaration (in such form 

21 and manner as the Secretary may pre22 scribe) that such individual will not claim 

23 such applicable individual for the credit 

24 under this section. 
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1 ‘‘(ii) NO AGREEMENT.—If each indi2 vidual required under clause (i) to file a 

3 written declaration under clause (i) does 

4 not do so, the individual with the highest 

5 modified adjusted gross income (as defined 

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

7 eligible caregiver. 

8 ‘‘(iii) MARRIED INDIVIDUALS FILING

9 SEPARATELY.—In the case of married indi10 viduals filing separately, the determination 

11 under this subparagraph as to whether the 

12 husband or wife is the eligible caregiver 

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

14 (whether or not one of them has filed a 

15 written declaration under clause (i)). 

16 ‘‘(d) IDENTIFICATION REQUIREMENT.—No credit 

17 shall be allowed under this section to a taxpayer with re18 spect to any applicable individual unless the taxpayer in19 cludes the name and taxpayer identification number of 

20 such individual, and the identification number of the phy21 sician certifying such individual, on the return of tax for 

22 the taxable year. 

23 ‘‘(e) TAXABLE YEAR MUST BE FULL TAXABLE

24 YEAR.—Except in the case of a taxable year closed by rea25 son of the death of the taxpayer, no credit shall be allow-
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1 able under this section in the case of a taxable year cov2 ering a period of less than 12 months.’’. 

3 (b) CONFORMING AMENDMENTS.—

4 (1) Paragraph (2) of section 1324(b) of title 

5 31, United States Code, is amended by inserting be6 fore the period ‘‘, or from section 35A of such 

7 Code’’. 

8 (2) Paragraph (2) of section 6213(g) of such 

9 Code is amended by striking ‘‘and’’ at the end of 

10 subparagraph (L), by striking the period at the end 

11 of subparagraph (M) and inserting ‘‘, and’’, and by 

12 inserting after subparagraph (M) the following new 

13 subparagraph: 

14 ‘‘(N) an omission of a correct TIN or phy15 sician identification required under section 

16 25C(d) (relating to long-term care tax credit) to 

17 be included on a return.’’

18 (3) The table of sections for subpart C of part 

19 IV of subchapter A of chapter 1 of such Code is 

20 amended by inserting after the item relating to sec21 tion 35 the following new item:

‘‘Sec. 35A. Long-term care tax credit.’’

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to taxable years beginning after 

24 December 31, 2002. 
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1 SEC. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

2 PROGRAMS FOR PATIENTS WITH FATAL 

3 CHRONIC ILLNESSES. 

4 (a) ESTABLISHMENT OF PROGRAMS.—The Secretary 

5 of Health and Human Services shall carry out research, 

6 demonstration, and education programs with respect to 

7 fatal chronic illness through the Public Health Service. 

8 (b) STUDIES ON END-OF-LIFE CARE.—The Sec9 retary shall conduct studies on end-of-life care through all 

10 relevant agencies and through the Assistant Secretary for 

11 Planning and Evaluation. Such studies shall include an 

12 examination of the development of practice parameters ap13 plicable to such care as well as research regarding such 

14 care. Such studies shall also include an annual report from 

15 the Secretary to the appropriate committees for oversight 

16 in Congress and to the Special Committee on Aging in 

17 the Senate on service delivery and quality of life for per18 sons living through fatal chronic illness and their families 

19 and professional caregivers. 

20 (c) HEALTH RESOURCES AND SERVICES ADMINIS21 TRATION.—

22 (1) IN GENERAL.—In carrying out subsection 

23 (a), the Secretary, acting through the Administrator 

24 of the Health Resources and Services Administra25 tion, shall carry out research, demonstration, and 

26 education programs toward improving the delivery of
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1 appropriate health and support services for patients 

2 with fatal chronic illnesses. 

3 (2) HEALTH CENTERS.—As determined appro4 priate by the Secretary, paragraph (1) may be car5 ried out through the program under section 330 of 

6 the Public Health Service Act (relating to commu7 nity and migrant health centers and health centers 

8 regarding homeless individuals and residents of pub9 lic housing), including by designating individuals 

10 with fatal chronic illnesses as medically underserved 

11 populations. 

12 (3) CAREGIVERS.—Programs under paragraph 

13 (1) shall include activities regarding appropriate 

14 support services for caregivers for patients with fatal 

15 chronic illness, including respite care. 

16 (4) HEALTH PROFESSIONS TRAINING.—Pro17 grams under paragraph (1) shall include making 

18 awards of grants or contracts to public and non19 profit private entities for the purpose of training 

20 health professionals, including students attending 

21 health professions schools, in the care of patients 

22 with fatal chronic illnesses. Such training shall in23 clude training in the provision of appropriate pallia24 tive care and appropriate referral to hospices, and 

25 training provided as continuing education. 
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1 (5) INITIATIVE.—Programs under paragraph 

2 (1) shall include an initiative to coordinate innova3 tion, evaluation, and service delivery relating to fatal 

4 chronic illnesses. 

5 (d) AGENCY FOR HEALTHCARE RESEARCH AND

6 QUALITY.—

7 (1) IN GENERAL.—In carrying out section 

8 912(c) of the Public Health Service Act, the Sec9 retary, acting through the Director of the Agency 

10 for Healthcare Research and Quality, shall, with re11 spect to patients with fatal chronic illnesses—

12 (A) identify the causes of preventable 

13 health care errors and patient injury in health 

14 care delivery, including errors of inadequate 

15 mobilization of services to the home, inadequate 

16 continuity of caregivers, inadequate symptom 

17 prevention, management, and relief, or inad18 equate advance care planning; 

19 (B) develop, demonstrate, and evaluate 

20 strategies for reliable performance of the care 

21 system, including reducing errors and improv22 ing patient safety and health outcomes; and 

23 (C) disseminate such effective strategies 

24 throughout the health care industry. 
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1 (2) GRANTS.—In carrying out paragraph 

2 (1)(A), the Secretary shall make grants for the pur3 pose of developing reliable and current data and in4 sight as to the merits and efficiencies of various 

5 strategies for providing health care, including pallia6 tive and hospice care, and social services for patients 

7 with fatal chronic illnesses. 

8 (e) CENTERS FOR DISEASE CONTROL AND PREVEN9 TION.—The Director of the Centers for Disease Control 

10 and Prevention shall expand activities with respect to epi11 demiology and public health in fatal chronic illness. Such 

12 activities may include contracting with the Institute of 

13 Medicine or another national interest non-profit organiza14 tion to provide a review of the status of care for the end 

15 of life, which review shall be included by the Secretary in 

16 the annual reports to Congress under subsection (h). 

17 (f) NATIONAL INSTITUTES OF HEALTH.—

18 (1) EXPANSION OF ACTIVITIES.—The Director 

19 of the National Institutes of Health (in this sub20 section referred to as the ‘‘Director’’) shall expand, 

21 intensify, and coordinate the activities of the Na22 tional Institutes of Health with respect to research 

23 on fatal chronic illness. Such activities shall include 

24 programs, requests for proposals, study section 

25 membership, advisory council membership, and 
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1 training programs to support rapid and substantial 

2 improvements in understanding—

3 (A) mechanisms of disability and suffering 

4 in fatal chronic illness and the relief and man5 agement of that disability and suffering 

6 through to end of life; and 

7 (B) human resources, service delivery ar8 rangements, technology, and financing that 

9 would be most useful in ensuring comfort and 

10 dignity for individuals with fatal chronic illness, 

11 and in relieving the burden for family and pro12 fessional caregivers. 

13 (2) ADMINISTRATION.—The Director shall 

14 carry out this subsection acting through the Direc15 tors of every Institute within the National Institutes 

16 of Health that has at least one fatal chronic illness 

17 in its purview. 

18 (3) COLLABORATION.—In carrying out this sub19 section, the Director of the National Institutes of 

20 Health shall collaborate with the Department of Vet21 erans Affairs, the Agency for Healthcare Research 

22 and Quality, and any other agency that the Director 

23 determines appropriate. The Secretary of Veterans 

24 Affairs and the Director of the Agency for 
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1 Healthcare Research and Quality shall assist in such 

2 collaboration. 

3 (4) RESPONSIBILITIES OF INSTITUTES.—Each 

4 Institute within the National Institutes of Health 

5 that has fatal chronic illness in its purview shall es6 tablish a plan for improving understanding of the 

7 mechanisms of disability and suffering in fatal 

8 chronic illness and the relief and management of 

9 that disability and suffering through to end of life. 

10 Since most Americans now die of chronic heart or 

11 lung failure, cancer, stroke, dementia, or multifacto12 rial frailty, each such Institute shall develop and im13 plement a strategic plan and a set of projects that 

14 aim primarily to ensure that affected patients and 

15 their families can live through advanced illness and 

16 death comfortably and meaningfully. 

17 (5) CENTERS OF EXCELLENCE.—

18 (A) IN GENERAL.—In carrying out para19 graph (1), the Director shall make awards of 

20 grants and contracts to public or nonprofit pri21 vate entities for the establishment and oper22 ation of centers of excellence to carry out re23 search, demonstration, and education programs 

24 regarding fatal chronic illness, including pro25 grams regarding palliative care.
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1 (B) DESIGNATION.—In carrying out this 

2 subsection, the Director shall designate at least 

3 2 Claude D. Pepper Older Americans Independ4 ence Centers (supported by the National Insti5 tute on Aging), 2 program projects of the Na6 tional, Heart, Lung, and Blood Institute, and 2 

7 comprehensive cancer centers (supported by the 

8 National Cancer Institute) to provide education 

9 and information support and research data and 

10 methods leadership for substantial and rapid 

11 improvements in the understanding of the 

12 mechanisms of disability and suffering in fatal 

13 chronic illness and the relief and management 

14 of that disability and suffering through to the 

15 end of life. 

16 (C) RESEARCH.—Each center established 

17 or operated under subparagraph (A) or des18 ignated under subparagraph (B) shall conduct 

19 basic and clinical research into fatal chronic ill20 ness. 

21 (D) CERTAIN ACTIVITIES.—The Secretary 

22 shall ensure that, with respect to the geographic 

23 area in which a center of excellence under sub24 paragraph (A) is located, the activities of the 

25 center include—
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1 (i) providing information and edu2 cation regarding fatal chronic illness to 

3 health professionals and the public; 

4 (ii) serving as a resource through 

5 which health professionals, and patients 

6 and their caregivers, can plan and coordi7 nate the provision of health and support 

8 services regarding fatal chronic illness; and 

9 (iii) providing training and support of 

10 implementation of quality improvement. 

11 (g) MEDICARE PILOT PROGRAMS FOR TREATMENT

12 OF FATAL CHRONIC ILLNESSES.—

13 (1) ESTABLISHMENT.—The Secretary, in all 

14 relevant parts of the Department of Health and 

15 Human Services, including the Centers for Medicare 

16 & Medicaid Services and the Office of the Assistant 

17 Secretary for Planning and Evaluation, shall provide 

18 for pilot programs under this subsection. The pilot 

19 programs shall be developed under a coordinated na20 tional effort in order to demonstrate innovative, ef21 fective means of delivering care to Medicare bene22 ficiaries with fatal chronic illnesses under the Medi23 care program. The pilot programs shall be completed 

24 within 5 years after the date that funds are first ap25 propriated under this subsection. 
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1 (2) DESIGN.—The pilot programs under this 

2 subsection shall be designed to learn how—

3 (A) to effectively and efficiently deliver 

4 quality care to the fatally chronically ill; 

5 (B) to provide and maintain continuity of 

6 care for the fatally chronically ill; 

7 (C) to provide advance care planning to 

8 the fatally chronically ill; 

9 (D) to determine what rate and strategies 

10 for payment are most appropriate; 

11 (E) to deliver emergency care for the fa12 tally chronically ill; 

13 (F) to facilitate access to hospice care 

14 when the Medicare beneficiary becomes eligible 

15 for such care; 

16 (G) to develop and estimate the effect of 

17 potential alternative severity criteria for eligi18 bility of specially tailored programs; 

19 (H) to test the effectiveness and costs of 

20 new strategies for family caregivers support; 

21 (I) to implement a clinical services and 

22 payment program that uses thresholds of sever23 ity to define the onset of the need for com24 prehensive end-of-life services; 
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1 (J) to test the merits of using severity cri2 teria (relating to fatal chronic illness) in deter3 mining eligibility for the Medicare hospice pro4 gram, but only when use of such criteria ex5 pands access to hospice care to individuals who 

6 are not yet terminally ill (as that term is de7 fined at section 1861(dd)(3)(A) of the Social 

8 Security Act); and 

9 (K) to arrange financial incentives so that 

10 substantially diminished payments arise when 

11 care providers fail to ensure timely advance 

12 care planning, symptom prevention, manage13 ment, and relief, or continuity of care across 

14 time and settings. 

15 (3) CONDUCT OF PILOT PROGRAMS.—The Sec16 retary shall conduct pilot programs in at least 6 

17 sites and in at least 3 States. 

18 (4) REPORT TO CONGRESS.—The Secretary 

19 shall submit to Congress a report on the pilot pro20 grams under this subsection. Such report shall in21 clude recommendations regarding whether the pilot 

22 programs should become a permanent part of the 

23 Medicare program. 

24 (h) ANNUAL REPORTS.—The Secretary, in consulta25 tion with the Secretary of Veterans Affairs and other ap-
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1 propriate Federal agencies, shall submit an annual report 

2 to Congress on end-of-life care and on the research, dem3 onstration, and education programs and studies conducted 

4 under this section. The Centers for Disease Control and 

5 Prevention shall be the lead agency for integrating and 

6 preparing the annual reports under this subsection unless 

7 the Secretary designates otherwise. 

8 (i) DEFINITIONS.—For purposes of this section: 

9 (1) The term ‘‘fatal chronic illness’’ means a 

10 disease (or diseases), condition (or conditions), or 

11 disorder (or disorders) that ordinarily worsens and 

12 causes death and that causes a physical or mental 

13 disability or periodic episodes of significant loss of 

14 functional capacity. 

15 (2) The term ‘‘Secretary’’ means the Secretary 

16 of Health and Human Services. 

17 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated—

19 (1) such sums as may be necessary to carry out 

20 subsections (a), (b), (e), and (f); 

21 (2) $50,000,000 for the 5-fiscal-year period (be22 ginning with fiscal year 2004) to carry out sub23 section (c), excluding paragraph (5) of that sub24 section;
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1 (3) $100,000,000 for the 3-fiscal-year period 

2 (beginning with fiscal year 2004) to carry out sub3 section (c)(5); 

4 (4) $20,000,000 for the 5-fiscal-year period (be5 ginning with fiscal year 2004) to carry out sub6 section (d); 

7 (5) to carry out subsection (g) for each of fiscal 

8 years 2003 through 2007—

9 (A) $50,000,000 for the purposes of con10 ducting evaluations of pilot programs; and 

11 (B) $50,000,000 for the purpose of pro12 viding clinical services under pilot programs; 

13 and 

14 (6) $500,000 for each fiscal year during the 5-

15 fiscal-year period beginning with fiscal year 2004 to 

16 carry out subsection (h).

17 SEC. 4. PROGRAMS THROUGH DEPARTMENT OF VETERANS 

18 AFFAIRS REGARDING PATIENTS WITH FATAL 

19 CHRONIC ILLNESSES. 

20 (a) IN GENERAL.—(1) Chapter 73 of title 38, United 

21 States Code, is amended by adding at the end of sub22 chapter II the following new section:
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1 ‘‘§ 7324. Programs for patients with fatal chronic ill2 nesses 

3 ‘‘(a) ESTABLISHMENT OF PROGRAMS.—(1) The Sec4 retary shall develop and carry out programs to improve 

5 the delivery of appropriate health and support services for 

6 patients with fatal chronic illnesses. As part of such pro7 grams, the Secretary shall seek to develop services in col8 laboration with community service providers serving popu9 lations of persons other than veterans, especially those 

10 populations that use the Medicare program. 

11 ‘‘(2) For purposes of this section, community service 

12 providers are entities outside the Department that provide 

13 health care services to persons in the communities in 

14 which they are located. 

15 ‘‘(b) ROLE OF GRECCS AND HEALTH SERVICES RE16 SEARCH.—The Secretary shall take appropriate steps to 

17 involve in programs under this section both geriatric re18 search, education, and clinical centers under section 7314 

19 of this title and activities of Health Services research and 

20 quality improvement initiatives of the Department. As 

21 part of such steps, the Secretary shall seek to target the 

22 work of such centers and initiatives to improve care for 

23 veterans with fatal chronic illnesses. 

24 ‘‘(c) TRAINING.—In conducting programs of profes25 sional training and staff development for health-care per26 sonnel of the Department and persons being trained 
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1 through health-care programs conducted by the Secretary, 

2 the Secretary shall ensure that such programs include 

3 training in pain relief and end-of-life care for persons with 

4 fatal chronic illnesses. Such training shall address symp5 toms, advance care planning, and quality improvement for 

6 those with fatal chronic illnesses. 

7 ‘‘(d) ANNUAL REPORT.—The Secretary shall prepare 

8 an annual report on care for veterans with fatal chronic 

9 illnesses and the activities of the Secretary under this sec10 tion. The Secretary shall furnish such report to the Sec11 retary of Health and Human Services each year in suffi12 cient time for inclusion in the annual report of that Sec13 retary under section 3(j) of the Living Well with Fatal 

14 Chronic Illness Act of 2003. 

15 ‘‘(e) COOPERATION WITH COMMUNITY SERVICE PRO16 VIDERS.—(1) In carrying out this section, the Secretary 

17 shall, to the extent practicable, take appropriate steps, 

18 through collaborative agreements or otherwise, to cooper19 ate with community service providers that provide home 

20 and hospice care. 

21 ‘‘(2) Such steps shall, to the extent practicable, in22 clude—

23 ‘‘(A) developing documentation of advance care 

24 plans for persons with fatal chronic illnesses that are 

25 acceptable to all providers of care for those persons; 
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1 ‘‘(B) developing service programs for persons 

2 with fatal chronic illnesses under which Department 

3 facilities or personnel may be used for part of the 

4 array of services provided to such persons; and 

5 ‘‘(C) developing protocols that facilitate the 

6 placement with community service providers sup7 ported by the medicare or medicaid programs of vet8 erans with fatal chronic illnesses when such a place9 ment would be more efficient or effective for the 

10 timely provision of services for the community in 

11 which the facilities are located and for such veterans 

12 than the provision of those services directly through 

13 Department facilities. 

14 ‘‘(3) When the Secretary, as part of service programs 

15 authorized by this subsection, provides services to a person 

16 with a fatal chronic illness who is not a veteran, the Sec17 retary shall, as a condition of providing such services, be 

18 reimbursed by appropriate community service providers 

19 for the costs of such services. 

20 ‘‘(f) SUPPORT FOR VOLUNTEER AND COMMUNITY

21 SUPPORT OF VETERANS LIVING AT HOME.—The Sec22 retary shall make grants to support volunteer and commu23 nity support of veterans living at home who have fatal 

24 chronic illnesses. The Secretary may establish the min-
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1 imum number of volunteers an entity must have in order 

2 to be eligible for a grant under this subsection. 

3 ‘‘(g) DEFINITION.—For purposes of this section, the 

4 term ‘fatal chronic illness’ means a disease (or diseases), 

5 condition (or conditions), or disorder (or disorders) that 

6 ordinarily worsens and causes death and that causes a 

7 physical or mental disability or periodic episodes of signifi8 cant loss of functional capacity.’’.

9 (2) The table of sections at the beginning of such 

10 chapter is amended by inserting after the item relating 

11 to section 7323 the following new item:

‘‘7324. Programs for patients with fatal chronic illnesses.’’.

12 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to the Secretary of Vet14 erans Affairs to carry out section 7324 of title 38, United 

15 States Code, as added by subsection (a), the amount of 

16 $5,000,000 for each of fiscal years 2003 through 2007.

Æ