I 

111TH CONGRESS 

1ST SESSION H. R. 1721 

To amend the Public Health Service Act to help individuals with functional 

impairments and their families pay for services and supports that they 

need to maximize their functionality and independence and have choices 

about community participation, education, and employment, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 25, 2009 

Mr. PALLONE (for himself, Mr. DINGELL, and Mr. KENNEDY) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Rules, 

and the Budget, 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 Public Health Service Act to help individuals 

with functional impairments and their families pay for 

services and supports that they need to maximize their 

functionality and independence and have choices about 

community participation, education, and employment, 

and for other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Community Living As3 sistance Services and Supports Act’’ or the ‘‘CLASS Act’’. 

4 SEC. 2. PURPOSES. 

5 The purposes of this Act are as follows: 

6 (1) To provide individuals with functional limi7 tations with tools that will allow them to maintain 

8 their personal and financial independence and live in 

9 the community through a new financing strategy for 

10 community living assistance services and supports. 

11 (2) To establish an infrastructure that will help 

12 address America’s community living assistance serv13 ices and supports needs. 

14 (3) To alleviate burdens on family caregivers. 

15 SEC. 3. TABLE OF CONTENTS. 

16 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Purposes. 

Sec. 3. Table of contents. 

TITLE I—COMMUNITY LIVING ASSISTANCE SERVICES AND 

SUPPORTS 

Sec. 101. Establishment of national voluntary insurance program for purchasing community living assistance services and support. 

TITLE II—AMENDMENTS TO THE INTERNAL REVENUE CODE OF 

1986 

Sec. 201. Above-the-line deduction for premium costs. 

Sec. 202. Credit for premium costs of CLASS enrollees with low-income. 

Sec. 203. Credit for costs of employers who elect to automatically enroll employees and withhold class premiums from wages. 

Sec. 204. Long-term care insurance includible in cafeteria plans. 

TITLE III—EFFECTIVE DATE 

Sec. 301. Effective date. 


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1 TITLE I—COMMUNITY LIVING 

2 ASSISTANCE SERVICES AND 

3 SUPPORTS 

4 SEC. 101. ESTABLISHMENT OF NATIONAL VOLUNTARY IN5 SURANCE PROGRAM FOR PURCHASING COM6 MUNITY LIVING ASSISTANCE SERVICES AND 

7 SUPPORT. 

8 (a) ESTABLISHMENT OF PROGRAM.— 

9 (1) IN GENERAL.—The Public Health Service 

10 Act (42 U.S.C. 201 et seq.) is amended by adding 

11 at the end the following: 

12 ‘‘TITLE XXXI—COMMUNITY LIV13 ING ASSISTANCE SERVICES 

14 AND SUPPORTS 

15 ‘‘SEC. 3101. DEFINITIONS. 

16 ‘‘In this title: 

17 ‘‘(1) ACTIVE ENROLLEE.—The term ‘active en18 rollee’ means an individual who is enrolled in the 

19 CLASS program in accordance with section 3102 

20 and who has paid any premiums due to maintain 

21 such enrollment in accordance with section 3103. 

22 ‘‘(2) ACTIVELY AT WORK.—The term ‘actively 

23 at work’ means an individual who— 

24 ‘‘(A) is reporting for work at the individ25 ual’s usual place of employment or at another 


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1 location to which the individual’s employer re2 quires the individual to travel (or in the case of 

3 an individual who is a member of the uniformed 

4 services, is on active duty and is physically able 

5 to perform the duties of the individual’s posi6 tion); 

7 ‘‘(B) is able to perform all the usual and 

8 customary duties of the individual’s employment 

9 on the individual’s regular work schedule; and 

10 ‘‘(C) is not absent from work due to sick11 ness, injury, annual leave, sick leave or any 

12 other leave. 

13 ‘‘(3) ACTIVITIES OF DAILY LIVING.—The term 

14 ‘activities of daily living’ means each of the following 

15 activities specified in section 7702B(c)(2)(B) of the 

16 Internal Revenue Code of 1986: 

17 ‘‘(A) Eating. 

18 ‘‘(B) Toileting. 

19 ‘‘(C) Transferring. 

20 ‘‘(D) Bathing. 

21 ‘‘(E) Dressing. 

22 ‘‘(F) Continence. 

23 ‘‘(4) CLASS PROGRAM.—The term ‘CLASS 

24 program’ means the program established under this 

25 title. 


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1 ‘‘(5) DISABILITY DETERMINATION SERVICE.— 

2 The term ‘Disability Determination Service’ means, 

3 with respect to each State, the entity that has an 

4 agreement with the Commissioner of Social Security 

5 to make disability determinations for purposes of 

6 title II or XVI of the Social Security Act (42 U.S.C. 

7 401 et seq., 1381 et seq.). 

8 ‘‘(6) ELIGIBLE TIER I BENEFICIARY.— 

9 ‘‘(A) IN GENERAL.—The term ‘eligible tier 

10 I beneficiary’ means any individual who is an 

11 active enrollee in the CLASS program and, as 

12 of the date described in subparagraph (B)— 

13 ‘‘(i) has paid premiums for enrollment 

14 in such program for at least 60 months; 

15 and 

16 ‘‘(ii) except as provided in section 

17 3103(e)(2), has paid premiums for enroll18 ment in such program for at least 12 con19 secutive months if a lapse in premium pay20 ments of more than 3 months has occurred 

21 during the period that begins on the date 

22 of the individual’s enrollment and ends on 

23 the date of such determination. 

24 ‘‘(B) DATE DESCRIBED.—For purpose of 

25 subparagraph (A), the date described in this 


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1 subparagraph is the date on which the indi2 vidual is determined— 

3 ‘‘(i) to be unable to perform at least 

4 2 activities of daily living or to require su5 pervision, cueing, or hands-on assistance to 

6 plan or perform at least 2 such activities; 

7 or 

8 ‘‘(ii) due to a cognitive or psychiatric 

9 impairment, to require supervision, cueing, 

10 or hands-on assistance to engage in activi11 ties that will enable the individual to per12 form at least 2 of the following critical life 

13 functions: 

14 ‘‘(I) Communicating. 

15 ‘‘(II) Taking medications. 

16 ‘‘(III) Household management. 

17 ‘‘(IV) Basic money management. 

18 ‘‘(7) ELIGIBLE TIER II BENEFICIARY.—The 

19 term ‘eligible tier II beneficiary’ means any indi20 vidual who is an eligible tier I beneficiary who has 

21 been determined— 

22 ‘‘(A) to be unable to perform at least 4 ac23 tivities of daily living or to require supervision, 

24 cueing, or hands-on assistance to plan or per25 form at least 4 such activities; or 


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1 ‘‘(B) due to a cognitive or psychiatric im2 pairment, to require supervision, cueing, or 

3 hands-on assistance to engage in activities that 

4 will enable the individual to perform at least 4 

5 of the following critical life functions: 

6 ‘‘(i) Communicating. 

7 ‘‘(ii) Taking medications. 

8 ‘‘(iii) Household management. 

9 ‘‘(iv) Basic money management. 

10 ‘‘(8) HOSPITAL; NURSING FACILITY; INTER11 MEDIATE CARE FACILITY FOR THE MENTALLY RE12 TARDED; INSTITUTION FOR MENTAL DISEASES.— 

13 The terms ‘hospital’, ‘nursing facility’, ‘intermediate 

14 care facility for the mentally retarded’, and ‘institu15 tion for mental diseases’ have the meanings given 

16 such terms for purposes of Medicaid. 

17 ‘‘(9) INDEPENDENCE FUND.—The term ‘Inde18 pendence Fund’ or ‘Fund’ means the fund estab19 lished under section 3105. 

20 ‘‘(10) MEDICAID.—The term ‘Medicaid’ means 

21 the program established under title XIX of the So22 cial Security Act (42 U.S.C. 1396 et seq.). 

23 ‘‘(11) POVERTY LINE.—The term ‘poverty line’ 

24 has the meaning given that term in section 


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1 2110(c)(5) of the Social Security Act (42 U.S.C. 

2 1397jj(c)(5)). 

3 ‘‘(12) PROTECTION AND ADVOCACY SYSTEM.— 

4 The term ‘Protection and Advocacy System’ means 

5 the system for each State established under section 

6 143 of the Developmental Disabilities Assistance 

7 and Bill of Rights Act of 2000 (42 U.S.C. 15043). 

8 ‘‘SEC. 3102. AUTOMATIC ENROLLMENT WITH OPT-OUT 

9 ELECTION. 

10 ‘‘(a) AUTOMATIC ENROLLMENT.— 

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

12 the Secretary shall establish procedures under which 

13 each individual described in subsection (c) shall be 

14 automatically enrolled in the CLASS program by an 

15 employer of such individual in the same manner as 

16 an employer may elect to automatically enroll em17 ployees in a plan under section 401(k), 403(b), or 

18 457 of the Internal Revenue Code of 1986. 

19 ‘‘(2) ALTERNATIVE ENROLLMENT PROCE20 DURES.—The procedures established under para21 graph (1) shall provide for an alternative enrollment 

22 process for an individual described in subsection (c) 

23 in the case of such an individual— 

24 ‘‘(A) who is self-employed; 

25 ‘‘(B) who has more than 1 employer; 


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1 ‘‘(C) whose employer does not elect to par2 ticipate in the automatic enrollment process es3 tablished by the Secretary; or 

4 ‘‘(D) who is a spouse described in para5 graph (2) of such subsection who is not subject 

6 to automatic enrollment. 

7 ‘‘(3) ADMINISTRATION.— 

8 ‘‘(A) IN GENERAL.—The Secretary shall, 

9 by regulation, establish procedures to— 

10 ‘‘(i) ensure that an individual is not 

11 automatically enrolled in the CLASS pro12 gram by more than 1 employer; and 

13 ‘‘(ii) allow for an individual’s em14 ployer to deduct a premium for a spouse 

15 described in subsection (c)(1)(B) who is 

16 not subject to automatic enrollment. 

17 ‘‘(B) FORM.—Enrollment in the CLASS 

18 program shall be made in such manner as the 

19 Secretary may prescribe in order to ensure ease 

20 of administration. 

21 ‘‘(b) ELECTION TO OPT-OUT.—An individual de22 scribed in subsection (c) may elect to waive enrollment 

23 under the CLASS program at any time in such form and 

24 manner as the Secretary shall prescribe. 


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1 ‘‘(c) INDIVIDUAL DESCRIBED.—For purposes of en2 rolling in the CLASS program, an individual described in 

3 this subsection is— 

4 ‘‘(1) an individual— 

5 ‘‘(A) who has attained age 18; 

6 ‘‘(B) who— 

7 ‘‘(i) receives wages on which there is 

8 imposed a tax under section 3101(a) of the 

9 Internal Revenue Code of 1986; or 

10 ‘‘(ii) derives self-employment income 

11 on which there is imposed a tax under sec12 tion 1401(a) of the Internal Revenue Code 

13 of 1986; 

14 ‘‘(C) who is actively at work; and 

15 ‘‘(D) who is not— 

16 ‘‘(i) a patient in a hospital or nursing 

17 facility, an intermediate care facility for 

18 the mentally retarded, or an institution for 

19 mental diseases and receiving medical as20 sistance under Medicaid; or 

21 ‘‘(ii) confined in a jail, prison, other 

22 penal institution or correctional facility, or 

23 by court order pursuant to conviction of a 

24 criminal offense or in connection with a 

25 verdict or finding described in section 


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1 202(x)(1)(A)(ii) of the Social Security Act 

2 (42 U.S.C. 402(x)(1)(A)(ii)); or 

3 ‘‘(2) the spouse of an individual described in 

4 paragraph (1) and who would be an individual so de5 scribed but for subparagraph (B) or (C) of that 

6 paragraph. 

7 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this title 

8 shall be construed as requiring an active enrollee to con9 tinue to satisfy subparagraph (B) or (C) of subsection 

10 (c)(1) in order to maintain enrollment in the CLASS pro11 gram. 

12 ‘‘SEC. 3103. PREMIUMS. 

13 ‘‘(a) MONTHLY PREMIUMS.—Except as provided in 

14 subsection (e), each individual who is enrolled in the 

15 CLASS program shall pay the Secretary a monthly pre16 mium to maintain enrollment in the program. 

17 ‘‘(b) AMOUNT OF PREMIUM.— 

18 ‘‘(1) $30 MONTHLY PREMIUM FOR ENROLL19 MENT IN THE FIRST YEAR OF THE PROGRAM.—Sub20 ject to the succeeding provisions of this subsection, 

21 the monthly premium for enrollment in the CLASS 

22 program of any individual who enrolls during the 

23 first year in which the program is in effect under 

24 this title shall be $30 for every such enrollee, re25 gardless of their age at enrollment. 


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1 ‘‘(2) INFLATION ADJUSTED PREMIUM FOR EN2 ROLLMENT IN FIRST YEAR IN WHICH AN INDIVIDUAL

3 IS ELIGIBLE TO ENROLL AFTER FIRST YEAR OF THE

4 PROGRAM.—The monthly premium for enrollment in 

5 the CLASS program of any individual who enrolls 

6 during the first year in which the individual is eligi7 ble to enroll in the program but that occurs after the 

8 first year in which the program is in effect under 

9 this title, shall be $30, increased with respect to 

10 each year that the program is in effect under this 

11 title until the year of such enrollment, by the per12 centage increase in the consumer price index for all 

13 urban consumers (U.S. city average) over each such 

14 preceding year. 

15 ‘‘(3) AGE-ADJUSTED PREMIUMS FOR ENROLL16 MENT IN OTHER YEARS.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 determine for each year that is not a year de19 scribed in paragraph (1) or (2), an annual 

20 monthly premium for enrollment in the CLASS 

21 program of an individual during the year that 

22 adjusts the monthly premium that would apply 

23 to the individual under paragraph (2) if the in24 dividual had enrolled during the first year in 


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1 which the individual was eligible to enroll in the 

2 program based on the following: 

3 ‘‘(i) AGE AT ENROLLMENT.—Subject 

4 to paragraph (4), the age of an individual 

5 upon the individual’s initial enrollment in 

6 the program. 

7 ‘‘(ii) ADMINISTRATIVE EXPENSES.— 

8 The administrative expenses for the pro9 gram. 

10 ‘‘(B) LIMITATION ON ADMINISTRATIVE EX11 PENSES.— 

12 ‘‘(i) START-UP ADMINISTRATIVE EX13 PENSES.—The total amount of annual ex14 penditures incurred for administering the 

15 CLASS program during each of the first 5 

16 years in which the program is in effect 

17 under this title shall not exceed the sum of 

18 an amount equal to 3 percent of all pre19 miums paid during that year. 

20 ‘‘(ii) SUBSEQUENT ADMINISTRATIVE

21 EXPENSES.—With respect to any year 

22 after the first 5 years in which the CLASS 

23 program is in effect under this title, the 

24 total amount of annual expenditures in25 curred for administering the CLASS proVerDate Nov 24 2008 22:04 Mar 26, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1721.IH H1721

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1 gram shall not exceed the lesser of an 

2 amount equal to— 

3 ‘‘(I) 5 percent of the total 

4 amount of all expenditures (including 

5 benefits paid) under this title with re6 spect to that year; or 

7 ‘‘(II) the percentage of expendi8 tures incurred under the medicare 

9 program under title XVIII of the So10 cial Security Act (42 U.S.C. 1395 et 

11 seq.) for that year that is attributable 

12 to administering that program. 

13 ‘‘(4) NOMINAL PREMIUM FOR INDIVIDUAL’S

14 WITH INCOME THAT DOES NOT EXCEED 150 PER15 CENT OF THE POVERTY LINE.— 

16 ‘‘(A) IN GENERAL.—In the case of an indi17 vidual whose income does not exceed 150 per18 cent of the poverty line, the monthly premium 

19 for enrollment in the CLASS program shall be 

20 the applicable amount under subparagraph (B). 

21 ‘‘(B) APPLICABLE AMOUNT.—The Sec22 retary shall establish premium amounts which 

23 shall apply to an individual described in sub24 paragraph (A) in lieu of the premium amount 

25 which would otherwise apply to the individual 


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1 under paragraph (1), (2), or (3) (whichever is 

2 applicable). Such amounts shall be nominal 

3 and, in the case of an individual who, but for 

4 this paragraph, would be subject to the pre5 mium imposed under paragraph (3), may be ad6 justed in accordance with the factors described 

7 in that paragraph. 

8 ‘‘(C) SELF-ATTESTATION AND

9 VERIFICATION OF INCOME.—The Secretary 

10 shall establish procedures to— 

11 ‘‘(i) permit an individual, as part of 

12 their automatic enrollment in the CLASS 

13 program, to self-attest that their income 

14 does not exceed 150 percent of the poverty 

15 line; and 

16 ‘‘(ii) verify the validity of such self-at17 testation. 

18 ‘‘(5) ADJUSTMENT OF PREMIUMS.— 

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

20 subparagraphs (C) and (D), the amount of the 

21 monthly premium determined for an individual 

22 upon such individual’s enrollment in the 

23 CLASS program shall remain the same for as 

24 long as the individual is an active enrollee in 

25 the program. 


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1 ‘‘(B) PROGRAM SOLVENCY PROJEC2 TIONS.—Beginning with 2012 and every year 

3 thereafter, the Secretary shall determine with 

4 respect to the 20-year period that begins with 

5 that year, the amount of funds held (or pro6 jected to be held) in the Independence Fund es7 tablished under section 3105 that are required 

8 to pay tier I and tier II benefits under section 

9 3104 during each year of that period. 

10 ‘‘(C) RECALCULATED PREMIUM IF RE11 QUIRED FOR PROGRAM SOLVENCY.— 

12 ‘‘(i) IN GENERAL.—Subject to clauses 

13 (ii) and (iii), beginning with 2017 and 

14 every year thereafter, if the Secretary de15 termines as a result of making the pro16 gram solvency projections required under 

17 subparagraph (B) that, with respect to the 

18 20-year period that begins with that year, 

19 more than 40 percent of the amount of 

20 funds held (or projected to be held) in the 

21 Independence Fund established under sec22 tion 3105 are required to pay tier I and 

23 tier II benefits under section 3104 during 

24 each year of that period, the Secretary 


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1 shall adjust the monthly premiums for in2 dividuals enrolled in the CLASS program. 

3 ‘‘(ii) REQUIREMENTS.—In adjusting 

4 monthly premiums under clause (i), the 

5 Secretary shall increase the premiums by 

6 such an amount as will ensure that— 

7 ‘‘(I) the aggregate amount of 

8 such premiums collected will result in 

9 not more than 20 percent of the 

10 amounts held in the Independence 

11 Fund being required to pay tier I and 

12 tier II benefits for any one year occur13 ring during the applicable 20-year pe14 riod; 

15 ‘‘(II) with respect to any indi16 vidual enrolled in the program— 

17 ‘‘(aa) the amount of the in18 crease in the individual’s monthly 

19 premium does not exceed the 

20 amount equal to 50 percent of 

21 the premium prior to such in22 crease; and 

23 ‘‘(bb) the individual’s 

24 monthly premium does not ex25 ceed the amount equal to 200 


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1 percent of the initial premium 

2 amount paid by the individual 

3 during their first year of enroll4 ment in the program; and 

5 ‘‘(III) the requirements of clause 

6 (iii) are met. 

7 The Secretary shall immediately notify 

8 Congress if the Secretary determines that 

9 the requirements of this clause cannot be 

10 satisfied and shall include in such notifica11 tion recommendations for such legislative 

12 action as the Secretary determines to be 

13 appropriate. 

14 ‘‘(iii) EXEMPTION FROM INCREASE.— 

15 Any increase in a monthly premium im16 posed as result of a determination de17 scribed in clause (i) shall not apply with 

18 respect to the monthly premium of any ac19 tive enrollee who— 

20 ‘‘(I) has attained age 65; 

21 ‘‘(II) has paid premiums for en22 rollment in the program for at least 

23 20 years; and 

24 ‘‘(III) is not actively at work. 


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1 ‘‘(D) RECALCULATED PREMIUM IF RE2 ENROLLMENT AFTER MORE THAN A 3-MONTH

3 LAPSE.— 

4 ‘‘(i) IN GENERAL.—Except as pro5 vided in subsection (e)(2), the reenrollment 

6 of an individual after a 90-day period dur7 ing which the individual failed to pay the 

8 monthly premium required to maintain the 

9 individual’s enrollment in the CLASS pro10 gram shall be treated as an initial enroll11 ment for purposes of age-adjusting the 

12 premium for enrollment in the program. 

13 ‘‘(ii) CREDIT FOR PRIOR MONTHS.— 

14 An individual who reenrolls in the CLASS 

15 program after such a 90-day period shall 

16 be— 

17 ‘‘(I) credited with any months of 

18 paid premiums that accrued prior to 

19 the individual’s lapse in enrollment; 

20 and 

21 ‘‘(II) notwithstanding the total 

22 amount of any such credited months, 

23 required to satisfy section 

24 3101(6)(B)(ii) before being eligible to 

25 receive a tier I or tier II benefit. 


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1 ‘‘(6) NO UNDERWRITING REQUIREMENTS.—No 

2 underwriting shall be used to— 

3 ‘‘(A) determine the monthly premium for 

4 enrollment in the CLASS program; or 

5 ‘‘(B) prevent an individual from enrolling 

6 in the program. 

7 ‘‘(c) PAYMENT.— 

8 ‘‘(1) PAYROLL DEDUCTION.—An amount equal 

9 to the monthly premium for the enrollment in the 

10 CLASS program of an individual shall be deducted 

11 from the wages or self-employment income of such 

12 individual in accordance with such procedures as the 

13 Secretary, in consultation with the Secretary of the 

14 Treasury, shall establish for employers who elect to 

15 deduct and withhold such premiums on behalf of en16 rolled employees. 

17 ‘‘(2) ALTERNATIVE PAYMENT MECHANISM.— 

18 The Secretary shall establish alternative procedures 

19 for the payment of monthly premiums by an indi20 vidual enrolled in the CLASS program— 

21 ‘‘(A) who does not have an employer who 

22 elects to deduct and withhold premiums in ac23 cordance with paragraph (1); or 

24 ‘‘(B) who does not earn wages or derive 

25 self-employment income. 


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1 ‘‘(d) TRANSFER OF PREMIUMS COLLECTED.— 

2 ‘‘(1) IN GENERAL.—During each calendar year 

3 the Secretary of the Treasury shall deposit into the 

4 Independence Fund a total amount equal, in the ag5 gregate, to 100 percent of the premiums collected 

6 during that year. 

7 ‘‘(2) TRANSFERS BASED ON ESTIMATES.—The 

8 amount deposited pursuant to paragraph (1) shall be 

9 transferred in at least monthly payments to the 

10 Independence Fund on the basis of estimates by the 

11 Secretary and certified to the Secretary of the 

12 Treasury of the amounts collected in accordance 

13 with paragraphs (1) and (2) of subsection (c). Prop14 er adjustments shall be made in amounts subse15 quently transferred to the Fund to the extent prior 

16 estimates were in excess of, or were less than, actual 

17 amounts collected. 

18 ‘‘(e) CONTRIBUTION PERIOD.— 

19 ‘‘(1) IN GENERAL.—An individual shall not be 

20 required to pay a monthly premium to maintain the 

21 individual’s enrollment in the CLASS program dur22 ing the following periods: 

23 ‘‘(A) RECEIVING BENEFITS WHILE UNEM24 PLOYED.—Any period during which the indi25 vidual is— 


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1 ‘‘(i) receiving tier I or tier II benefits; 

2 and 

3 ‘‘(ii) the individual does not have 

4 wages or income derived from self-employ5 ment. 

6 ‘‘(B) FULL-TIME STUDENT WHO IS AC7 TIVELY AT WORK.—Any period during which 

8 the individual is a full-time student (as deter9 mined by the Secretary) who has not attained 

10 age 22 and is actively at work. 

11 ‘‘(2) APPLICATION OF PREMIUM AMOUNT PRIOR

12 TO START OF PERIOD.—Upon the conclusion of a pe13 riod described in paragraph (1) for an individual, 

14 the individual shall resume paying the monthly pre15 mium amount that applied to the individual imme16 diately prior to the start of such period in order to 

17 maintain enrollment in the program. 

18 ‘‘SEC. 3104. BENEFITS. 

19 ‘‘(a) DETERMINATION OF ELIGIBILITY.— 

20 ‘‘(1) APPLICATION FOR RECEIPT OF BENE21 FITS.—The Secretary shall establish procedures 

22 under which an active enrollee shall apply for receipt 

23 of tier I or tier II benefits. 

24 ‘‘(2) ELIGIBILITY ASSESSMENTS.— 


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1 ‘‘(A) IN GENERAL.—Not later than Octo2 ber 1, 2012, the Secretary shall enter into 

3 agreements with— 

4 ‘‘(i) the Disability Determination 

5 Service for each State to provide for eligi6 bility assessments of active enrollees who 

7 apply for receipt of benefits; 

8 ‘‘(ii) the Protection and Advocacy 

9 System for each State to provide advocacy 

10 services in accordance with subsection (e); 

11 and 

12 ‘‘(iii) public and private entities to 

13 provide advice and assistance counseling in 

14 accordance with subsection (f). 

15 ‘‘(B) 30-DAY PERIOD FOR APPROVAL OR

16 DISAPPROVAL.—An agreement under subpara17 graph (A) shall require that a Disability Deter18 mination Service determine within 30 days of 

19 the receipt of an application for benefits under 

20 the CLASS program whether an applicant is an 

21 eligible tier I beneficiary or an eligible tier II 

22 beneficiary. An application that is pending after 

23 45 days shall be deemed approved. 

24 ‘‘(C) PRESUMPTIVE ELIGIBILITY FOR CER25 TAIN INSTITUTIONALIZED ENROLLEES PLANVerDate Nov 24 2008 22:04 Mar 26, 2009 Jkt 079200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H1721.IH H1721

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1 NING TO DISCHARGE.—An active enrollee shall 

2 be deemed presumptively eligible if the en3 rollee— 

4 ‘‘(i) has applied for receipt of tier II 

5 benefits; 

6 ‘‘(ii) is a patient in a hospital, nursing 

7 facility, intermediate care facility for the 

8 mentally retarded, or an institution for 

9 mental diseases; and 

10 ‘‘(iii) is in the process of, or about to 

11 begin the process of, planning to discharge 

12 from the hospital, facility, or institution. 

13 ‘‘(D) APPEALS.—The Secretary shall es14 tablish procedures under which an applicant for 

15 benefits under the CLASS program shall be 

16 guaranteed the right to appeal an adverse de17 termination. 

18 ‘‘(b) TIER I BENEFITS.—An eligible tier I beneficiary 

19 shall receive the following tier I benefits: 

20 ‘‘(1) DAILY CASH BENEFIT.—A daily cash ben21 efit in the amount of $50 per day. 

22 ‘‘(2) ANNUAL BENEFIT.—An annual benefit in 

23 an amount not to exceed the amount equal to the 

24 daily benefit applicable under paragraph (1) (after 

25 the application of subsection (g)) multiplied by 365. 


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1 ‘‘(3) ADVOCACY SERVICES.—Advocacy services 

2 in accordance with subsection (e). 

3 ‘‘(4) ADVICE AND ASSISTANCE COUNSELING.— 

4 Advice and assistance counseling in accordance with 

5 subsection (f). 

6 ‘‘(5) NO LIFETIME LIMIT.—There shall be no 

7 lifetime limit on the aggregate tier I benefits that an 

8 eligible tier I beneficiary may receive. 

9 ‘‘(c) TIER II BENEFITS.—An eligible tier II bene10 ficiary shall receive the following tier II benefits: 

11 ‘‘(1) DAILY CASH BENEFIT.—A daily cash ben12 efit in the amount of $100 per day. 

13 ‘‘(2) ANNUAL BENEFIT.—An annual benefit in 

14 an amount not to exceed the amount equal to the 

15 daily benefit applicable under paragraph (1) (after 

16 the application of subsection (g)) multiplied by 365. 

17 ‘‘(3) ADVOCACY SERVICES.—Advocacy services 

18 in accordance with subsection (e). 

19 ‘‘(4) ADVICE AND ASSISTANCE COUNSELING.— 

20 Advice and assistance counseling in accordance with 

21 subsection (f). 

22 ‘‘(5) NO LIFETIME LIMIT.—There shall be no 

23 lifetime limit on the aggregate tier II benefits that 

24 an eligible tier II beneficiary may receive. 

25 ‘‘(d) PAYMENT OF BENEFITS.— 


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1 ‘‘(1) LIFE INDEPENDENCE ACCOUNTS.— 

2 ‘‘(A) IN GENERAL.—The Secretary shall 

3 establish procedures under which tier I daily 

4 cash benefits and tier II daily cash benefits 

5 shall be paid on a monthly basis into a Life 

6 Independence Account established by the Sec7 retary on behalf of each eligible tier I bene8 ficiary or eligible tier II beneficiary. 

9 ‘‘(B) USE OF CASH BENEFITS.—Daily cash 

10 benefits paid into a Life Independence Account 

11 of an eligible tier I beneficiary or an eligible tier 

12 II beneficiary shall be used to purchase non13 medical services and supports that the bene14 ficiary needs to maintain his or her independ15 ence at home or in another residential setting 

16 of their choice in the community, such as home 

17 modifications, assistive technology, accessible 

18 transportation, homemaker services, respite 

19 care, personal assistance services, and home 

20 care aides. 

21 ‘‘(C) ELECTRONIC MANAGEMENT OF

22 FUNDS.—The procedures established in accord23 ance with subparagraph (A) shall provide for— 


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1 ‘‘(i) crediting an account established 

2 on behalf of a beneficiary with the bene3 ficiary’s cash daily benefit; 

4 ‘‘(ii) accessing such account through 

5 debit cards; and 

6 ‘‘(iii) accounting for withdrawals by 

7 the beneficiary from such account. 

8 ‘‘(D) PRIMARY PAYOR RULES FOR BENE9 FICIARIES WHO ARE ENROLLED IN MEDICAID.— 

10 In the case of an eligible tier I beneficiary or 

11 an eligible tier II beneficiary who is enrolled in 

12 Medicaid, the following payment rules shall 

13 apply: 

14 ‘‘(i) INSTITUTIONALIZED BENE15 FICIARY.—If the beneficiary is a patient in 

16 a hospital, nursing facility, intermediate 

17 care facility for the mentally retarded, or 

18 an institution for mental diseases, the ben19 eficiary shall retain an amount equal to 5 

20 percent of the beneficiary’s daily cash ben21 efit (which shall be in addition to the 

22 amount of the beneficiary’s personal needs 

23 allowance provided under Medicaid), and 

24 the remainder of such benefit shall be ap25 plied toward the facility’s cost of providing 


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1 the beneficiary’s care, and Medicaid shall 

2 provide secondary coverage for such care. 

3 ‘‘(ii) BENEFICIARIES RECEIVING

4 HOME AND COMMUNITY-BASED SERV5 ICES.— 

6 ‘‘(I) 50 PERCENT OF DAILY BEN7 EFIT RETAINED BY BENEFICIARY.—If 

8 a beneficiary is receiving medical as9 sistance under Medicaid for home and 

10 community-based services, the bene11 ficiary shall retain an amount equal to 

12 50 percent of the beneficiary’s daily 

13 cash benefit, subject to subclause (II), 

14 and the remainder of the daily cash 

15 benefit shall be applied toward the 

16 cost to the State of providing such as17 sistance (and shall not be used to 

18 claim Federal matching funds under 

19 Medicaid), and Medicaid shall provide 

20 secondary coverage for the remainder 

21 of any costs incurred in providing 

22 such assistance. 

23 ‘‘(II) REQUIREMENT FOR STATE

24 OFFSET.—A State shall be paid the 

25 remainder of a beneficiary’s daily cash 


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1 benefit under subclause (I) only if the 

2 State home and community-based 

3 waiver under section 1115 of the So4 cial Security Act (42 U.S.C. 1315) or 

5 subsection (c) or (d) of section 1915 

6 of such Act (42 U.S.C. 1396n) does 

7 not include a waiver of the require8 ments of section 1902(a)(1) of the So9 cial Security Act (relating to 

10 statewideness) or of section 

11 1902(a)(10)(B) of such Act (relating 

12 to comparability) and the State offers 

13 at a minimum case management serv14 ices, personal care services, habili15 tation services, and respite care under 

16 such a waiver. 

17 ‘‘(III) DEFINITION OF HOME AND

18 COMMUNITY-BASED SERVICES.—In 

19 this clause, the term ‘home and com20 munity-based services’ means any 

21 services which may be offered under a 

22 home and community-based waiver 

23 authorized for a State under section 

24 1115 of the Social Security Act (42 

25 U.S.C. 1315) or subsection (c) or (d) 


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1 of section 1915 of such Act (42 

2 U.S.C. 1396n). 

3 ‘‘(2) AUTHORIZED REPRESENTATIVES.— 

4 ‘‘(A) IN GENERAL.—The procedures estab5 lished under paragraph (1)(A) shall allow for 

6 access to tier I daily benefits or tier II daily 

7 benefits by an authorized representative of the 

8 eligible tier I beneficiary or eligible tier II bene9 ficiary on whose behalf such benefits are paid. 

10 ‘‘(B) QUALITY ASSURANCE AND PROTEC11 TION AGAINST FRAUD AND ABUSE.—The Sec12 retary shall include in the procedures estab13 lished under paragraph (1) standards of con14 duct for authorized representatives of eligible 

15 tier I beneficiaries and eligible tier II bene16 ficiaries to ensure that authorized representa17 tives provide quality services on behalf of such 

18 beneficiaries, do not have conflicts of interest, 

19 and do not misuse benefits paid on behalf of 

20 such beneficiaries or otherwise engage in fraud 

21 or abuse. 

22 ‘‘(3) COMMENCEMENT OF BENEFITS.—Tier I 

23 benefits or tier II benefits, as applicable, shall be 

24 paid to, or on behalf of, an eligible tier I beneficiary 

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1 ning with the first month in which an application for 

2 such benefits is approved. 

3 ‘‘(4) ROLLOVER OPTION FOR LUMP-SUM PAY4 MENT.—An eligible tier I beneficiary or an eligible 

5 tier II beneficiary may elect to— 

6 ‘‘(A) defer payment of their daily benefit 

7 and to rollover any such deferred benefits from 

8 month-to-month, but not from year-to-year; and 

9 ‘‘(B) receive a lump-sum payment of such 

10 deferred benefits in an amount that may not 

11 exceed the lesser of— 

12 ‘‘(i) the total amount of the accrued 

13 deferred benefits; or 

14 ‘‘(ii) the applicable annual benefit. 

15 ‘‘(5) PERIOD FOR DETERMINATION OF ANNUAL

16 BENEFITS.— 

17 ‘‘(A) IN GENERAL.—The applicable period 

18 for determining with respect to an eligible tier 

19 I beneficiary or an eligible tier II beneficiary 

20 the applicable annual benefit and the amount of 

21 any accrued deferred benefits is the 12-month 

22 period that commences with the first month in 

23 which the beneficiary began to receive such ben24 efits, and each 12-month period thereafter. 


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1 ‘‘(B) INCLUSION OF TIER I BENEFITS.— 

2 The Secretary shall establish procedures under 

3 which benefits paid to an eligible tier I bene4 ficiary who becomes an eligible tier II bene5 ficiary before the end of a 12-month benefit pe6 riod shall be included in the determination of 

7 the applicable annual benefit paid to the eligible 

8 tier II beneficiary. 

9 ‘‘(C) RECOUPMENT OF UNPAID, ACCRUED

10 BENEFITS.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall recoup any accrued benefits in the 

13 event of— 

14 ‘‘(I) the death of a beneficiary; or 

15 ‘‘(II) the failure of a beneficiary 

16 to elect under paragraph (4)(B) to re17 ceive such benefits as a lump-sum 

18 payment before the end of the 12- 

19 month period in which such benefits 

20 accrued. 

21 ‘‘(ii) PAYMENT INTO INDEPENDENCE

22 FUND.—Any benefits recouped in accord23 ance with clause (i) shall be paid into the 

24 Independence Fund and used in accord25 ance with section 3105. 


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1 ‘‘(6) REQUIREMENT TO RECERTIFY ELIGIBILITY

2 FOR RECEIPT OF BENEFITS AND TO NOTIFY THE

3 SECRETARY IF NOT EARNING WAGES OR INCOME.— 

4 The procedures established under paragraph (1)(A) 

5 shall provide for an eligible tier I beneficiary or an 

6 eligible tier II beneficiary to— 

7 ‘‘(A) annually— 

8 ‘‘(i) recertify by submission of medical 

9 evidence the beneficiary’s continued eligi10 bility for receipt of tier I or tier II benefits 

11 (as applicable); and 

12 ‘‘(ii) submit records of expenditures 

13 attributable to the aggregate daily cash 

14 benefit received by the beneficiary during 

15 the preceding year; and 

16 ‘‘(B) notify the Secretary if the beneficiary 

17 is not earning wages or deriving self-employ18 ment income and should not have to pay a 

19 monthly premium to maintain enrollment in the 

20 CLASS program in accordance with section 

21 3103(e)(2). 

22 ‘‘(7) SUPPLEMENT, NOT SUPPLANT OTHER

23 HEALTH CARE BENEFITS.—Subject to the Medicaid 

24 payment rules under paragraph (1)(C), benefits re25 ceived by an eligible tier I beneficiary or an eligible 


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1 tier II beneficiary shall supplement, but not sup2 plant, other health care benefits for which the bene3 ficiary is eligible under Medicaid or any other feder4 ally funded program that provides health care bene5 fits or assistance. 

6 ‘‘(e) ADVOCACY SERVICES.—An agreement entered 

7 into under subsection (a)(2)(A)(ii) shall require the Pro8 tection and Advocacy System for the State to— 

9 ‘‘(1) assign, as needed, an advocacy counselor 

10 to each eligible tier I beneficiary or eligible tier II 

11 beneficiary that is covered by such agreement and 

12 who provides an eligible tier I beneficiary or an eligi13 ble tier II beneficiary with— 

14 ‘‘(A) information regarding how to access 

15 the appeals process established for the program; 

16 ‘‘(B) assistance with respect to the annual 

17 recertification and notification required under 

18 subsection (d)(6); and 

19 ‘‘(C) such other services as the Secretary, 

20 by regulation, shall require; and 

21 ‘‘(2) ensure that the System and such coun22 selors comply with the requirements of subsection 

23 (i). 

24 ‘‘(f) ADVICE AND ASSISTANCE COUNSELING.—An 

25 agreement entered into under subsection (a)(2)(A)(iii) 


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1 shall require the entity to assign, as requested by an eligi2 ble tier I beneficiary or an eligible tier II beneficiary that 

3 is covered by such agreement, an advice and assistance 

4 counselor who provides an eligible tier I beneficiary or an 

5 eligible tier II beneficiary with information regarding— 

6 ‘‘(1) accessing and coordinating long-term serv7 ices and supports in the most integrated setting; 

8 ‘‘(2) possible eligibility for other benefits and 

9 services; 

10 ‘‘(3) development of a service and support plan; 

11 ‘‘(4) information about programs established 

12 under the Assistive Technology Act of 1998 and the 

13 services offered under such programs; and 

14 ‘‘(5) such other services as the Secretary, by 

15 regulation, may require. 

16 ‘‘(g) NO EFFECT ON ELIGIBILITY FOR OTHER BENE17 FITS.—Benefits paid to an eligible tier I beneficiary or an 

18 eligible tier II beneficiary under the CLASS program shall 

19 be disregarded for purposes of determining or continuing 

20 the beneficiary’s eligibility for receipt of benefits under 

21 any other Federal, State, or locally funded assistance pro22 gram, including benefits paid under titles II, XVI, XVIII, 

23 XIX, or XXI of the Social Security Act (42 U.S.C. 401 

24 et seq., 1381 et seq., 1395 et seq., 1396 et seq., 1397aa 

25 et seq.), under the laws administered by the Secretary of 


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1 Veterans Affairs, under low-income housing assistance 

2 programs, or under the food stamp program established 

3 under the Food Stamp Act of 1977 (7 U.S.C. 2011). 

4 ‘‘(h) COST-OF-LIVING AND OTHER ADJUSTMENTS.— 

5 ‘‘(1) IN GENERAL.—Beginning with 2011, the 

6 dollar amounts specified in subsections (b)(1) and 

7 (c)(1) shall be annually increased by the percentage 

8 increase in the consumer price index for all urban 

9 consumers (U.S. city average) over the previous 

10 year. 

11 ‘‘(2) ADDITIONAL ADJUSTMENT.—With respect 

12 to any year for which the Secretary has determined 

13 under section 3103(b)(4)(C) that an adjustment to 

14 the monthly premium amounts is necessary to en15 sure program solvency, the Secretary shall decrease 

16 the increase in the dollar amounts specified in sub17 sections (b)(1) and (c)(1) that would otherwise be 

18 applicable under paragraph (1) for that year, by 

19 such amount as the Secretary determines is appro20 priate for that year (but shall ensure that there is 

21 an increase in such dollar amounts for that year). 

22 ‘‘(i) RULE OF CONSTRUCTION.—Nothing in this title 

23 shall be construed as prohibiting tier I or tier II benefits 

24 paid under the CLASS program from being used to com25 pensate a family caregiver for providing community living 


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1 assistance services and supports to an eligible tier I bene2 ficiary or an eligible tier II beneficiary. 

3 ‘‘(j) PROTECTION AGAINST CONFLICT OF INTER4 ESTS.—The Secretary shall establish procedures to ensure 

5 that the Disability Determination Service and Protection 

6 and Advocacy System for a State, advocacy counselors for 

7 eligible tier I or eligible tier II beneficiaries, and any other 

8 entities that provide services to active enrollees and eligi9 ble tier I or eligible tier II beneficiaries under the CLASS 

10 program comply with the following: 

11 ‘‘(1) If the entity provides counseling or plan12 ning services, such services are provided in a manner 

13 that fosters the best interests of the active enrollee 

14 or beneficiary. 

15 ‘‘(2) The entity has established operating proce16 dures that are designed to avoid or minimize con17 flicts of interest between the entity and an active en18 rollee or beneficiary. 

19 ‘‘(3) The entity provides information about all 

20 services and options available to the active enrollee 

21 or beneficiary, to the best of its knowledge, including 

22 services available through other entities or providers. 

23 ‘‘(4) The entity assists the active enrollee or 

24 beneficiary to access desired services, regardless of 

25 the provider. 


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1 ‘‘(5) The entity reports the number of active 

2 enrollees and beneficiaries provided with assistance 

3 by age, disability, and whether such enrollees and 

4 beneficiaries received services from the entity or an5 other entity. 

6 ‘‘(6) If the entity provides counseling or plan7 ning services, the entity ensures that an active en8 rollee or beneficiary is informed of any financial in9 terest that the entity has in a service provider. 

10 ‘‘(7) The entity provides an active enrollee or 

11 beneficiary with a list of available service providers 

12 that can meet the needs of the active enrollee or 

13 beneficiary. 

14 ‘‘SEC. 3105. INDEPENDENCE FUND. 

15 ‘‘(a) ESTABLISHMENT OF INDEPENDENCE FUND.— 

16 There is established in the Treasury of the United States 

17 a trust fund to be known as the ‘Independence Fund’. The 

18 Secretary shall serve as Managing Trustee of such Fund. 

19 The Fund shall consist of all amounts derived from pay20 ments into the Fund under sections 3103(d) and 

21 3104(d)(5)(C)(ii), and remaining after investment of such 

22 amounts under subsection (b), including additional 

23 amounts derived as income from such investments. The 

24 amounts held in the Fund are appropriated and shall re25 main available without fiscal year limitation— 


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1 ‘‘(1) to be held for investment on behalf of indi2 viduals enrolled in the CLASS program; 

3 ‘‘(2) to pay the administrative expenses related 

4 to the Fund and to investment under subsection (b); 

5 and 

6 ‘‘(3) to pay tier I and tier II benefits under sec7 tion 3104. 

8 ‘‘(b) INVESTMENT OF FUND BALANCE.—The Sec9 retary, through the Secretary of the Treasury, shall invest 

10 the Independence Fund in the same manner, and to the 

11 same extent, as the Federal Old-Age and Survivors Trust 

12 Fund and the Federal Disability Insurance Trust Fund 

13 may be invested under section 201(d) of the Social Secu14 rity Act (42 U.S.C. 401(d)). 

15 ‘‘(c) OFF-BUDGET STATUS; LOCK-BOX PROTEC16 TION.— 

17 ‘‘(1) EXCLUSION OF TRUST FUNDS FROM ALL

18 BUDGETS.—Notwithstanding any other provision of 

19 law, the amounts derived from payments into the 

20 Fund and amounts paid from the Fund shall not be 

21 counted as new budget authority, outlays, receipts, 

22 or deficit or surplus for purposes of— 

23 ‘‘(A) the budget of the United States Gov24 ernment, as submitted by the President; 

25 ‘‘(B) the congressional budget; or 


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1 ‘‘(C) the Balanced Budget and Emergency 

2 Deficit Control Act of 1985. 

3 ‘‘(2) LOCK-BOX PROTECTION.— 

4 ‘‘(A) IN GENERAL.—Notwithstanding any 

5 other provision of law, it shall not be in order 

6 in the Senate or the House of Representatives 

7 to consider any measure that would authorize 

8 the payment or use of amounts in the Fund for 

9 any purpose other than a purpose authorized 

10 under this title. 

11 ‘‘(B) 60-VOTE WAIVER REQUIRED IN THE

12 SENATE.— 

13 ‘‘(i) IN GENERAL.—Subparagraph (A) 

14 may be waived or suspended in the Senate 

only by the affirmative vote of 3 15 ⁄5 of the 

16 Members, duly chosen and sworn. 

17 ‘‘(ii) APPEALS.— 

18 ‘‘(I) PROCEDURE.—Appeals in 

19 the Senate from the decisions of the 

20 Chair relating to clause (i) shall be 

21 limited to 1 hour, to be equally di22 vided between, and controlled by, the 

23 mover and the manager of the meas24 ure that would authorize the payment 

25 or use of amounts in the Fund for a 


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1 purpose other than a purpose author2 ized under this title. 

3 ‘‘(II) 60-VOTES REQUIRED.—An 

affirmative vote of 3 4 ⁄5 of the Members, 

5 duly chosen and sworn, shall be re6 quired in the Senate to sustain an ap7 peal of the ruling of the Chair on a 

8 point of order raised in relation to 

9 clause (i). 

10 ‘‘(C) RULES OF THE SENATE AND HOUSE

11 OF REPRESENTATIVES.—This section is enacted 

12 by Congress— 

13 ‘‘(i) as an exercise of the rulemaking 

14 power of the Senate and House of Rep15 resentatives, respectively, and is deemed to 

16 be part of the rules of each House, respec17 tively, but applicable only with respect to 

18 the procedure to be followed in that House 

19 in the case of a measure described in sub20 paragraph (A), and it supersedes other 

21 rules only to the extent that it is incon22 sistent with such rules; and 

23 ‘‘(ii) with full recognition of the con24 stitutional right of either House to change 

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1 cedure of that House) at any time, in the 

2 same manner, and to the same extent as in 

3 the case of any other rule of that House. 

4 ‘‘(d) ADDITIONAL APPROPRIATIONS TO ENSURE

5 SOLVENCY DURING INITIAL BENEFIT YEARS.—In addi6 tion to the amounts appropriated to the Fund under sub7 section (a), out of any money in the Treasury of the 

8 United States not otherwise appropriated, there are ap9 propriated to the Fund, for each of fiscal years 2013 

10 through 2017, such sums as are necessary for each such 

11 fiscal year (and which, in the case of each of fiscal years 

12 2014 through 2017, shall be less than the amount appro13 priated for the preceding fiscal year) to ensure the sol14 vency of the Fund during the first 5 years in which tier 

15 I or tier II benefits are paid from the Fund. Amounts ap16 propriated under this subsection shall remain available 

17 without fiscal year limitation for the purposes specified in 

18 paragraphs (1), (2), and (3) of subsection (a). 

19 ‘‘SEC. 3106. REGULATIONS; ANNUAL REPORT. 

20 ‘‘(a) REGULATIONS.—The Secretary shall promulgate 

21 such regulations as are necessary to carry out the CLASS 

22 program in accordance with this title. Such regulations 

23 shall include provisions to prevent fraud and abuse under 

24 the program. 


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1 ‘‘(b) ANNUAL REPORT.—Beginning with fiscal year 

2 2013, the Secretary shall submit an annual report to Con3 gress on the CLASS program. Each report shall include 

4 the following: 

5 ‘‘(1) The total amount of enrollees in the pro6 gram. 

7 ‘‘(2) The total number of eligible tier I bene8 ficiaries and eligible tier II beneficiaries during the 

9 fiscal year. 

10 ‘‘(3) The total amount of tier I and tier II ben11 efits provided during the fiscal year. 

12 ‘‘(4) A description of instances of fraud or 

13 abuse identified during the fiscal year. 

14 ‘‘(5) Recommendations for such administrative 

15 or legislative action as the Secretary determines is 

16 necessary to improve the program or to prevent the 

17 occurrence of fraud or abuse. 

18 ‘‘SEC. 3107. TAX TREATMENT OF PROGRAM. 

19 ‘‘The CLASS program shall be treated for purposes 

20 of the Internal Revenue Code of 1986 in the same manner 

21 as a qualified long-term care insurance contract for quali22 fied long-term care services.’’. 

23 (2) CONFORMING AMENDMENTS TO MED24 ICAID.—Section 1902(a) of the Social Security Act 

25 (42 U.S.C. 1396a(a)), as amended by section 


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1 5006(e)(2)(A) of division B of Public Law 111–5, is 

2 amended— 

3 (A) in paragraph (72), by striking ‘‘and’’ 

4 at the end; 

5 (B) in paragraph (73)(B), by striking the 

6 period and inserting ‘‘; and’’; and 

7 (C) by inserting after paragraph (73) the 

8 following: 

9 ‘‘(74) provide that the State will comply with 

10 such regulations regarding the application of pri11 mary and secondary payor rules with respect to indi12 viduals who are eligible for medical assistance under 

13 this title and are eligible tier I beneficiaries or eligi14 ble tier II beneficiaries under the CLASS program 

15 established under title XXIX of the Public Health 

16 Service Act as the Secretary shall establish.’’. 

17 (b) ASSURANCE OF ADEQUATE INFRASTRUCTURE

18 FOR THE PROVISION OF PERSONAL CARE ATTENDANT

19 WORKERS.—Section 1902(a) of the Social Security Act 

20 (42 U.S.C. 1396a(a)), as amended by subsection (a)(2), 

21 is amended— 

22 (1) in paragraph (73)(B), by striking ‘‘and’’ at 

23 the end; 

24 (2) in paragraph (74), by striking the period at 

25 the end and inserting ‘‘; and’’; and 


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1 (3) by inserting after paragraph (74), the fol2 lowing: 

3 ‘‘(75) provide that, not later than 2 years after 

4 the date of enactment of the Community Living As5 sistance Services and Supports Act, each State 

6 shall— 

7 ‘‘(A) assess the extent to which entities 

8 such as providers of home care, home health 

9 services, home and community service providers, 

10 public authorities created to provide personal 

11 care services to individuals eligible for medical 

12 assistance under the State plan, and nonprofit 

13 organizations, are serving or have the capacity 

14 to serve as fiscal agents for, employers of, and 

15 providers of employment-related benefits for, 

16 personal care attendant workers who provide 

17 personal care services to individuals receiving 

18 benefits under the CLASS program established 

19 under title XXIX of the Public Health Service 

20 Act, including in rural and underserved areas; 

21 ‘‘(B) designate or create such entities to 

22 serve as fiscal agents for, employers of, and 

23 providers of employment-related benefits for, 

24 such workers to ensure an adequate supply of 

25 the workers for individuals receiving benefits 


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1 under the CLASS program, including in rural 

2 and underserved areas; and 

3 ‘‘(C) ensure that the designation or cre4 ation of such entities will not negatively alter or 

5 impede existing programs, models, methods, or 

6 administration of service delivery that provide 

7 for consumer controlled or self-directed home 

8 and community services and further ensure that 

9 such entities will not impede the ability of indi10 viduals to direct and control their home and 

11 community services, including the ability to se12 lect, manage, dismiss, co-employ, or employ 

13 such workers or inhibit such individuals from 

14 relying on family members for the provision of 

15 personal care services.’’. 

16 (c) PERSONAL CARE ATTENDANTS WORKFORCE AD17 VISORY PANEL.— 

18 (1) ESTABLISHMENT.—Not later than 90 days 

19 after the date of enactment of this Act, the Sec20 retary of Health and Human Services shall establish 

21 a Personal Care Attendants Workforce Advisory 

22 Panel for the purpose of examining and advising the 

23 Secretary and Congress on workforce issues related 

24 to personal care attendant workers, including with 

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1 ers, the salaries, wages, and benefits of such work2 ers, and access to the services provided by such 

3 workers. 

4 (2) MEMBERSHIP.—In appointing members to 

5 the Personal Care Attendants Workforce Advisory 

6 Panel, the Secretary shall ensure that such members 

7 include the following: 

8 (A) Individuals with disabilities of all ages. 

9 (B) Senior individuals. 

10 (C) Representatives of individuals with dis11 abilities. 

12 (D) Representatives of senior individuals. 

13 (E) Representatives of workforce and labor 

14 organizations. 

15 (F) Representatives of home and commu16 nity-based service providers. 

17 (G) Representatives of assisted living pro18 viders. 

19 TITLE II—AMENDMENTS TO THE 

20 INTERNAL REVENUE CODE 

21 OF 1986 

22 SEC. 201. ABOVE-THE-LINE DEDUCTION FOR PREMIUM 

23 COSTS. 

24 (a) IN GENERAL.—Section 62(a) of the Internal Rev25 enue Code of 1986 (defining adjusted gross income) is 


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1 amended by inserting after paragraph (21) the following 

2 new paragraph: 

3 ‘‘(22) CLASS PROGRAM PREMIUMS.—The deduc4 tion allowed by section 213 (determined without re5 gard to any adjusted gross income limitation) which 

6 consists of amounts paid by the taxpayer for enroll7 ment in the CLASS program (as defined in section 

8 36B(d)) for eligible enrollment months (as defined 

9 in section 36(b)) beginning in the taxable year.’’. 

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

11 this section shall apply to taxable years beginning after 

12 December 31, 2009. 

13 SEC. 202. CREDIT FOR PREMIUM COSTS OF CLASS ENROLL14 EES WITH LOW-INCOME. 

15 (a) IN GENERAL.—Subpart C of part IV of sub16 chapter A of chapter 1 of the Internal Revenue Code of 

17 1986 (relating to refundable credits) is amended by insert18 ing after section 36A the following new section: 

19 ‘‘SEC. 36B. PREMIUM COSTS OF CLASS ENROLLEES WITH 

20 LOW-INCOME. 

21 ‘‘(a) IN GENERAL.—In the case of a CLASS enrollee 

22 with low-income, there shall be allowed as a credit against 

23 the tax imposed by subtitle A an amount equal to 50 per24 cent of the amount paid by the taxpayer for enrollment 

25 of the taxpayer and the taxpayer’s spouse in the CLASS 


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1 program for eligible enrollment months beginning in the 

2 taxable year. 

3 ‘‘(b) ELIGIBLE ENROLLMENT MONTH.—For pur4 poses of this section— 

5 ‘‘(1) IN GENERAL.—The term ‘eligible enroll6 ment month’ means any month if, as of the first day 

7 of such month, the taxpayer is a CLASS enrollee 

8 with low-income enrolled in the CLASS program, the 

9 premium for which is paid by the taxpayer. 

10 ‘‘(2) JOINT RETURNS.—In the case of a joint 

11 return, the requirements of paragraph (1) shall be 

12 treated as met with respect to any month if at least 

13 1 spouse satisfies such requirements. 

14 ‘‘(c) CLASS ENROLLEE WITH LOW-INCOME.—For 

15 purposes of this section, the term ‘CLASS enrollee with 

16 low-income’ means an individual— 

17 ‘‘(1) who is an active enrollee in the CLASS 

18 program (as defined in section 3101(1) of the Public 

19 Health Service Act); and 

20 ‘‘(2) whose gross income does not exceed 250 

21 percent of the poverty line. 

22 ‘‘(d) CLASS PROGRAM.—For purposes of this sec23 tion, the term ‘CLASS program’ means the program for 

24 community living assistance services and supports estab25 lished under title XXIX of the Public Health Service Act. 


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1 ‘‘(e) SPECIAL RULES.— 

2 ‘‘(1) COORDINATION WITH OTHER DEDUC3 TIONS.—Amounts taken into account under sub4 section (a) shall not be taken into account in deter5 mining any deduction allowed under section 

6 62(a)(22), 162(l), or 213. 

7 ‘‘(2) MSA DISTRIBUTIONS.—Amounts distrib8 uted from an Archer MSA (as defined in section 

9 220(d)) shall not be taken into account under sub10 section (a). 

11 ‘‘(3) DENIAL OF CREDIT TO DEPENDENTS.—No 

12 credit shall be allowed under this section to any indi13 vidual with respect to whom a deduction under sec14 tion 151 is allowable to another taxpayer for a tax15 able year beginning in the calendar year in which 

16 such individual’s taxable year begins. 

17 ‘‘(4) BOTH SPOUSES ELIGIBLE INDIVIDUALS.— 

18 For purposes of subsection (a), the amount paid for 

19 enrollment of the taxpayer’s spouse shall be dis20 regarded if— 

21 ‘‘(A) the taxpayer is married at the close 

22 of the taxable year, 

23 ‘‘(B) the taxpayer and the taxpayer’s 

24 spouse are both CLASS enrollee with low-in25 come during the taxable year, and 


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1 ‘‘(C) the taxpayer files a separate return 

2 for the taxable year. 

3 ‘‘(5) MARITAL STATUS; CERTAIN MARRIED IN4 DIVIDUALS LIVING APART.—Rules similar to the 

5 rules of paragraph (3) and (4) of section 21(e) shall 

6 apply for purposes of this section. 

7 ‘‘(f) REGULATIONS.—The Secretary may prescribe 

8 such regulations and guidance as may be necessary or ap9 propriate to carry out this section.’’. 

10 (b) CONFORMING AMENDMENTS.— 

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

12 31, United States Code, is amended by striking 

13 ‘‘section 35’’ and all that follows through ‘‘53(e)’’ 

14 and inserting ‘‘section 35, 36, 36A, 36B, 53(e), or 

15 6428’’. 

16 (2) Section 6211(b)(4)(A) is amended by insert17 ing ‘‘36B,’’ after ‘‘36A,’’. 

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

19 IV of chapter 1 of the Internal Revenue Code of 

20 1986 is amended by inserting after the item relating 

21 to section 36A the following new item: 

‘‘Sec. 36B. Premiums costs of CLASS enrollees with low-income.’’. 

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

23 this section shall apply to taxable years beginning after 

24 December 31, 2009. 


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1 SEC. 203. CREDIT FOR COSTS OF EMPLOYERS WHO ELECT 

2 TO AUTOMATICALLY ENROLL EMPLOYEES 

3 AND WITHHOLD CLASS PREMIUMS FROM 

4 WAGES. 

5 (a) IN GENERAL.—Subpart D of part IV of sub6 chapter A of chapter 1 of the Internal Revenue Code of 

7 1986 (relating to business credits) is amended by inserting 

8 after section 45Q the following: 

9 ‘‘SEC. 45R. CREDIT FOR COSTS OF AUTOMATICALLY EN10 ROLLING EMPLOYEES AND WITHHOLDING 

11 CLASS PREMIUMS FROM WAGES. 

12 ‘‘(a) GENERAL RULE.—For purposes of section 38, 

13 the CLASS automatic enrollment and premium with14 holding credit determined under this section for the tax15 able year is an amount equal to 25 percent of the total 

16 amount paid or incurred by the taxpayer during the tax17 able year to— 

18 ‘‘(1) automatically enroll employees in the 

19 CLASS program established under title XXIX of the 

20 Public Health Service Act, and 

21 ‘‘(2) withhold monthly CLASS premiums on be22 half of an employee who is enrolled in that program. 

23 ‘‘(b) DENIAL OF DOUBLE BENEFIT.—No deduction 

24 shall be allowed under this chapter for any amount taken 

25 into account in determining the credit under this section. 


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1 ‘‘(c) ELECTION NOT TO CLAIM CREDIT.—This sec2 tion shall not apply to a taxpayer for any taxable year 

3 if such taxpayer elects to have this section not apply for 

4 such taxable year.’’. 

5 (b) CREDIT MADE PART OF GENERAL BUSINESS

6 CREDIT.—Subsection (b) of section 38 of the Internal 

7 Revenue Code of 1986 (relating to general business credit) 

8 is amended by striking ‘‘plus’’ at the end of paragraph 

9 (34), by striking the period at the end of paragraph (35) 

10 and inserting ‘‘, plus’’, and by inserting after paragraph 

11 (35) the following new paragraph: 

12 ‘‘(36) the CLASS automatic enrollment and 

13 premium withholding credit determined under sec14 tion 45R(a).’’. 

15 (c) CLERICAL AMENDMENT.—The table of sections 

16 for subpart D of part IV of subchapter A of chapter 1 

17 of the Internal Revenue Code of 1986 is amended by in18 serting after the item relating to section 45Q the following 

19 new item: 

‘‘Sec. 45R. Credit for costs of automatically enrolling employees and withholding CLASS premiums from wages.’’. 

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

21 this section shall apply to expenses paid or incurred after 

22 December 31, 2009, in taxable years ending after such 

23 date. 


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1 SEC. 204. LONG-TERM CARE INSURANCE INCLUDIBLE IN 

2 CAFETERIA PLANS. 

3 (a) IN GENERAL.—Section 125(f) of the Internal 

4 Revenue Code of 1986 is amended by striking the last sen5 tence. 

6 (b) EFFECTIVE DATE.—The amendment made by 

7 subsection (a) shall apply to taxable years beginning after 

8 December 31, 2009. 

9 TITLE III—EFFECTIVE DATE 

10 SEC. 301. EFFECTIVE DATE. 

11 Except as provided in sections 201(b), 202(c), 

12 203(d), and 204(b), this Act and the amendments made 

13 by this Act take effect on January 1, 2010. 

Æ 


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