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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2935 Introduced in Senate (IS)]

106th CONGRESS
  2d Session
                                S. 2935

   To amend the Employee Retirement Income Security Act of 1974, the 
  Internal Revenue Code of 1986, and the Public Health Service Act to 
  increase Americans' access to long term health care, and for other 
                               purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 26, 2000

  Mr. Graham (for himself, Mr. Grassley, Ms. Mikulski, Mr. Bayh, Mr. 
  Breaux, Ms. Collins, and Mr. Akaka) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
   To amend the Employee Retirement Income Security Act of 1974, the 
  Internal Revenue Code of 1986, and the Public Health Service Act to 
  increase Americans' access to long term health care, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Omnibus Long-term 
Care Act of 2000''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1.  Short title; table of contents.
                        TITLE I--LONG TERM CARE

                       Subtitle A--Tax Incentives

Sec. 101. Treatment of premiums on qualified long-term care insurance 
                            contracts.
Sec. 102. Credit for taxpayers with long-term care needs.
 Subtitle B--Federal Employees and Uniformed Services Group Long-Term 
                             Care Insurance

Sec. 111. Short title.
Sec. 112. Long-term care insurance.
Sec. 113. Effective date.
             Subtitle C--Seniors' Access to Continuing Care

Sec. 121. Short title.
Sec. 122. Amendments to the Employee Retirement Income Security Act of 
                            1974.
Sec. 123. Amendments to the Public Health Service Act relating to the 
                            group market.
Sec. 124. Amendment to the Public Health Service Act relating to the 
                            individual market.
Sec. 125. Sense of the Senate concerning the care of older Americans.
 Subtitle D--Expansion of Home-Based Long-Term Care Services Under the 
                      Social Services Block Grant

Sec. 131. Restoration of authority to transfer up to 10 percent of TANF 
                            funds to the Social Services Block Grant.
Sec. 132. Restoration of funds for the Social Services Block Grant.
Sec. 133. Appropriation of additional funds for expansion of home-based 
                            long-term care services.
           TITLE II--SUPPORT AND PLANNING FOR LONG-TERM CARE

                    Subtitle A--Support and Surveys

Sec. 201. National Family Caregiver Support Grant Program.
Sec. 202. Community survey.
                   Subtitle B--Education and Studies

Sec. 211. Long-term care coverage educational campaign.
Sec. 212. Report on long-term care.
Sec. 213. Aging study and report.

                        TITLE I--LONG TERM CARE

                       Subtitle A--Tax Incentives

SEC. 101. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE 
              CONTRACTS.

    (a) In General.--Part VII of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to additional itemized 
deductions) is amended by redesignating section 222 as section 223 and 
by inserting after section 221 the following new section:

``SEC. 222. PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a deduction an amount equal to the applicable percentage of 
the amount of eligible long-term care premiums (as defined in section 
213(d)(10)) paid during the taxable year for coverage for the taxpayer, 
his spouse, and dependents under a qualified long-term care insurance 
contract (as defined in section 7702B(b)).
    ``(b) Applicable Percentage.--For purposes of subsection (a)--
            ``(1) In general.--Except as otherwise provided in this 
        subsection, the applicable percentage shall be determined in 
        accordance with the following table based on the number of 
        years of continuous coverage (as of the close of the taxable 
        year) of the individual under any qualified long-term care 
        insurance contracts (as defined in section 7702B(b)):

                ``If the number of years of
                                               The applicable long-term
                  continuous coverage is--
                                                 care percentage is--  
                    Less than 1............................      60    
                    At least 1 but less than 2.............      70    
                    At least 2 but less than 3.............      80    
                    At least 3 but less than 4.............      90    
                    At least 4.............................    100.    
            ``(2) Special rules for individuals who have attained age 
        55.--In the case of an individual who has attained age 55 as of 
        the close of the taxable year, the following table shall be 
        substituted for the table in paragraph (1).

                ``If the number of years of
                                               The applicable long-term
                  continuous coverage is--
                                                 care percentage is--  
                    Less than 1............................      70    
                    At least 1 but less than 2.............      85    
                    At least 2.............................    100.    
            ``(3) Only coverage after 2000 taken into account.--Only 
        coverage for periods after December 31, 2000, shall be taken 
        into account under this subsection.
            ``(4) Continuous coverage.--An individual shall not fail to 
        be treated as having continuous coverage if the aggregate 
        breaks in coverage during any 1-year period are less than 60 
        days.
    ``(c) Coordination With Other Deductions.--Any amount paid by a 
taxpayer for any qualified long-term care insurance contract to which 
subsection (a) applies shall not be taken into account in computing the 
amount allowable to the taxpayer as a deduction under section 162(l) or 
213(a).''
    (b) Contingent Nonforfeiture Requirements Added to Consumer 
Protection Provisions.--
            (1) Section 7702B(g)(2)(A)(i) of the Internal Revenue Code 
        of 1986 (relating to model regulation) is amended by adding at 
        the end the following new subclause:
                                    ``(XII) Section 23 (relating to 
                                contingent nonforfeiture benefits), if 
                                the policyholder declines the offer of 
                                a nonforfeiture provision described in 
                                paragraph (4).''
            (2) Section 7702B(g)(2)(A)(ii) of such Code (relating to 
        model Act) is amended by adding at the end the following new 
        subclause:
                                    ``(III) Section 8 (relating to 
                                contingent nonforfeiture benefits), if 
                                the policyholder declines the offer of 
                                a nonforfeiture provision described in 
                                paragraph (4).''
    (c) Reference to NAIC Model Act Updated.--Section 7702B(g)(2)(B)(i) 
of the Internal Revenue Code of 1986 (relating to model provisions) is 
amended by striking ``January 1993'' and inserting ``January 1999''.
    (d) Long-Term Care Insurance Permitted To Be Offered Under 
Cafeteria Plans and Flexible Spending Arrangements.--
            (1) Cafeteria plans.--Section 125(f) of the Internal 
        Revenue Code of 1986 (defining qualified benefits) is amended 
        by inserting before the period at the end ``; except that such 
term shall include the payment of premiums for any qualified long-term 
care insurance contract (as defined in section 7702B) to the extent the 
amount of such payment does not exceed the eligible long-term care 
premiums (as defined in section 213(d)(10)) for such contract''.
            (2) Flexible spending arrangements.--Section 106 of such 
        Code (relating to contributions by an employer to accident and 
        health plans) is amended by striking subsection (c).
    (e) Conforming Amendments.--
            (1) Section 62(a) of the Internal Revenue Code of 1986 is 
        amended by inserting after paragraph (17) the following new 
        item:
            ``(18) Premiums on qualified long-term care insurance 
        contracts.--The deduction allowed by section 222.''
            (2) Section 7702B(g)(2)(A)(i) of such Code, as amended by 
        subsection (b)(1), is amended by striking ``7A'' both places it 
        appears, ``7B'', ``7C'', ``7D'', ``7E'', ``8'', ``9'', ``9F'', 
        ``10'', ``11'', ``12'', and ``23'' the first place it appears 
        and inserting ``6A'', ``6B'', ``6C'', ``6D'', ``6E'', ``7'', 
        ``8'', ``8F'', ``9'', ``10'', ``11'', and ``22'', respectively.
            (3) Section 4980C(c)(1)(A) of such Code is amended by 
        striking ``13'', ``14'', ``20'', ``21'', ``21C(1)'', 
        ``21C(6)'', ``22'', ``24'', and ``25'' and inserting ``12'', 
        ``13'', ``19'', ``20C(1)'', ``20C(6)'', ``21'', ``25'', and 
        ``26'', respectively.
            (4) The table of sections for part VII of subchapter B of 
        chapter 1 of such Code is amended by striking the last item and 
        inserting the following new items:

                              ``Sec. 222. Premiums on qualified long-
                                        term care insurance contracts.
                              ``Sec. 223. Cross reference.''
    (f) Effective Dates.--
            (1) In general.--Except as provided in paragraphs (2) and 
        (3), the amendments made by this section shall apply to taxable 
        years beginning after December 31, 2000.
            (2) Consumer protection provisions.--The amendments made by 
        subsections (b), (c), (e)(2), and (e)(3) shall apply to 
        policies issued after the date which is 1 year after the date 
        of the enactment of this Act.
            (3) Cafeteria plans and flexible spending arrangements.--
        The amendments made by subsection (c) shall apply to taxable 
        years beginning after December 31, 2001.

SEC. 102. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.

    (a) In General.--Subpart A of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to nonrefundable 
personal credits) is amended by inserting after section 25A the 
following new section:

``SEC. 25B. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.

    ``(a) Allowance of Credit.--
            ``(1) In general.--There shall be allowed as a credit 
        against the tax imposed by this chapter for the taxable year an 
        amount equal to the applicable credit amount multiplied by the 
        number of applicable individuals with respect to whom the 
        taxpayer is an eligible caregiver for the taxable year.
            ``(2) Applicable credit amount.--For purposes of paragraph 
        (1), the applicable credit amount shall be determined in 
        accordance with the following table:

        ``For taxable years beginning
                                                         The applicable
          in calendar year--
                                                     credit amount is--
            2001...........................................  $1,000    
            2002...........................................   1,500    
            2003...........................................   2,000    
            2004...........................................   2,500    
            2005 or thereafter.............................  3,000.    
    ``(b) Limitation Based on Adjusted Gross Income.--
            ``(1) In general.--The amount of the credit allowable under 
        subsection (a) shall be reduced (but not below zero) by $100 
        for each $1,000 (or fraction thereof) by which the taxpayer's 
        modified adjusted gross income exceeds the threshold amount. 
        For purposes of the preceding sentence, the term `modified 
        adjusted gross income' means adjusted gross income increased by 
        any amount excluded from gross income under section 911, 931, 
        or 933.
            ``(2) Threshold amount.--For purposes of paragraph (1), the 
        term `threshold amount' means--
                    ``(A) $150,000 in the case of a joint return, and
                    ``(B) $75,000 in any other case.
            ``(3) Indexing.--In the case of any taxable year beginning 
        in a calendar year after 2001, each dollar amount contained in 
        paragraph (2) shall be increased by an amount equal to the 
        product of--
                    ``(A) such dollar amount, and
                    ``(B) the medical care cost adjustment determined 
                under section 213(d)(10)(B)(ii) for the calendar year 
                in which the taxable year begins, determined by 
                substituting `August of 2000' for `August of 1996' in 
                subclause (II) thereof.
        If any increase determined under the preceding sentence is not 
        a multiple of $50, such increase shall be rounded to the next 
        lowest multiple of $50.
    ``(c) Definitions.--For purposes of this section--
            ``(1) Applicable individual.--
                    ``(A) In general.--The term `applicable individual' 
                means, with respect to any taxable year, any individual 
                who has been certified, before the due date for filing 
                the return of tax for the taxable year (without 
                extensions), by a physician (as defined in section 
                1861(r)(1) of the Social Security Act) as being an 
                individual with long-term care needs described in 
                subparagraph (B) for a period--
                            ``(i) which is at least 180 consecutive 
                        days, and
                            ``(ii) a portion of which occurs within the 
                        taxable year.
                Such term shall not include any individual otherwise 
                meeting the requirements of the preceding sentence 
                unless within the 39\1/2\ month period ending on such 
                due date (or such other period as the Secretary 
                prescribes) a physician (as so defined) has certified 
                that such individual meets such requirements.
                    ``(B) Individuals with long-term care needs.--An 
                individual is described in this subparagraph if the 
                individual meets any of the following requirements:
                            ``(i) The individual is at least 6 years of 
                        age and--
                                    ``(I) is unable to perform (without 
                                substantial assistance from another 
                                individual) at least 3 activities of 
                                daily living (as defined in section 
                                7702B(c)(2)(B)) due to a loss of 
                                functional capacity, or
                                    ``(II) requires substantial 
                                supervision to protect such individual 
                                from threats to health and safety due 
                                to severe cognitive impairment and is 
                                unable to preform, without reminding or 
                                cuing assistance, at least 1 activity 
                                of daily living (as so defined) or to 
                                the extent provided in regulations 
                                prescribed by the Secretary (in 
                                consultation with the Secretary of 
                                Health and Human Services), is unable 
                                to engage in age appropriate 
                                activities.
                            ``(ii) The individual is at least 2 but not 
                        6 years of age and is unable due to a loss of 
                        functional capacity to perform (without 
                        substantial assistance from another individual) 
                        at least 2 of the following activities: eating, 
                        transferring, or mobility.
                            ``(iii) The individual is under 2 years of 
                        age and requires specific durable medical 
                        equipment by reason of a severe health 
                        condition or requires a skilled practitioner 
                        trained to address the individual's condition 
                        to be available if the individual's parents or 
                        guardians are absent.
            ``(2) Eligible caregiver.--
                    ``(A) In general.--A taxpayer shall be treated as 
                an eligible caregiver for any taxable year with respect 
                to the following individuals:
                            ``(i) The taxpayer.
                            ``(ii) The taxpayer's spouse.
                            ``(iii) An individual with respect to whom 
                        the taxpayer is allowed a deduction under 
                        section 151 for the taxable year.
                            ``(iv) An individual who would be described 
                        in clause (iii) for the taxable year if section 
                        151(c)(1)(A) were applied by substituting for 
                        the exemption amount an amount equal to the sum 
                        of the exemption amount, the standard deduction 
                        under section 63(c)(2)(C), and any additional 
                        standard deduction under section 63(c)(3) which 
                        would be applicable to the individual if clause 
                        (iii) applied.
                            ``(v) An individual who would be described 
                        in clause (iii) for the taxable year if--
                                    ``(I) the requirements of clause 
                                (iv) are met with respect to the 
                                individual, and
                                    ``(II) the requirements of 
                                subparagraph (B) are met with respect 
                                to the individual in lieu of the 
                                support test of section 152(a).
                    ``(B) Residency test.--The requirements of this 
                subparagraph are met if an individual has as his 
                principal place of abode the home of the taxpayer and--
                            ``(i) in the case of an individual who is 
                        an ancestor or descendant of the taxpayer or 
                        the taxpayer's spouse, is a member of the 
                        taxpayer's household for over half the taxable 
                        year, or
                            ``(ii) in the case of any other individual, 
                        is a member of the taxpayer's household for the 
                        entire taxable year.
                    ``(C) Special rules where more than 1 eligible 
                caregiver.--
                            ``(i) In general.--If more than 1 
                        individual is an eligible caregiver with 
                        respect to the same applicable individual for 
                        taxable years ending with or within the same 
                        calendar year, a taxpayer shall be treated as 
                        the eligible caregiver if each such individual 
                        (other than the taxpayer) files a written 
                        declaration (in such form and manner as the 
                        Secretary may prescribe) that such individual 
                        will not claim such applicable individual for 
                        the credit under this section.
                            ``(ii) No agreement.--If each individual 
                        required under clause (i) to file a written 
                        declaration under clause (i) does not do so, 
                        the individual with the highest modified 
                        adjusted gross income (as defined in section 
                        32(c)(5)) shall be treated as the eligible 
                        caregiver.
                            ``(iii) Married individuals filing 
                        separately.--In the case of married individuals 
                        filing separately, the determination under this 
                        subparagraph as to whether the husband or wife 
                        is the eligible caregiver shall be made under 
                        the rules of clause (ii) (whether or not one of 
                        them has filed a written declaration under 
                        clause (i)).
    ``(d) Identification Requirement.--No credit shall be allowed under 
this section to a taxpayer with respect to any applicable individual 
unless the taxpayer includes the name and taxpayer identification 
number of such individual, and the identification number of the 
physician certifying such individual, on the return of tax for the 
taxable year.
    ``(e) Taxable Year Must Be Full Taxable Year.--Except in the case 
of a taxable year closed by reason of the death of the taxpayer, no 
credit shall be allowable under this section in the case of a taxable 
year covering a period of less than 12 months.''
    (b) Conforming Amendments.--
            (1) Section 6213(g)(2) of the Internal Revenue Code of 1986 
        is amended by striking ``and'' at the end of subparagraph (K), 
by striking the period at the end of subparagraph (L) and inserting ``, 
and'', and by inserting after subparagraph (L) the following new 
subparagraph:
                    ``(M) an omission of a correct TIN or physician 
                identification required under section 25B(d) (relating 
                to credit for taxpayers with long-term care needs) to 
                be included on a return.''
            (2) The table of sections for subpart A of part IV of 
        subchapter A of chapter 1 of such Code is amended by inserting 
        after the item relating to section 25A the following new item:

                              ``Sec. 25B. Credit for taxpayers with 
                                        long-term care needs.''
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2000.

 Subtitle B--Federal Employees and Uniformed Services Group Long-Term 
                             Care Insurance

SEC. 111. SHORT TITLE.

    This subtitle may be cited as the ``Long-Term Care Security Act''.

SEC. 112. LONG-TERM CARE INSURANCE.

    (a) In General.--Subpart G of part III of title 5, United States 
Code, is amended by adding at the end the following:

                 ``CHAPTER 90--LONG-TERM CARE INSURANCE

``Sec.
``9001. Definitions.
``9002. Availability of insurance.
``9003. Contracting authority.
``9004. Financing.
``9005. Preemption.
``9006. Studies, reports, and audits.
``9007. Jurisdiction of courts.
``9008. Administrative functions.
``9009. Cost accounting standards.
``Sec. 9001. Definitions
    For purposes of this chapter:
            ``(1) Employee.--The term `employee' means--
                    ``(A) an employee as defined by section 8901(1); 
                and
                    ``(B) an individual described in section 2105(e);
        but does not include an individual employed by the government 
        of the District of Columbia.
            ``(2) Annuitant.--The term `annuitant' has the meaning such 
        term would have under paragraph (3) of section 8901 if, for 
        purposes of such paragraph, the term `employee' were considered 
        to have the meaning given to it under paragraph (1) of this 
        subsection.
            ``(3) Member of the uniformed services.--The term `member 
        of the uniformed services' means a member of the uniformed 
        services, other than a retired member of the uniformed 
        services.
            ``(4) Retired member of the uniformed services.--The term 
        `retired member of the uniformed services' means a member or 
        former member of the uniformed services entitled to retired or 
        retainer pay.
            ``(5) Qualified relative.--The term `qualified relative' 
        means each of the following:
                    ``(A) The spouse of an individual described in 
                paragraph (1), (2), (3), or (4).
                    ``(B) A parent, stepparent, or parent-in-law of an 
                individual described in paragraph (1) or (3).
                    ``(C) A child (including an adopted child, a 
                stepchild, or, to the extent the Office of Personnel 
                Management by regulation provides, a foster child) of 
                an individual described in paragraph (1), (2), (3), or 
                (4), if such child is at least 18 years of age.
                    ``(D) An individual having such other relationship 
                to an individual described in paragraph (1), (2), (3), 
                or (4) as the Office may by regulation prescribe.
            ``(6) Eligible individual.--The term `eligible individual' 
        refers to an individual described in paragraph (1), (2), (3), 
        (4), or (5).
            ``(7) Qualified carrier.--The term `qualified carrier' 
        means an insurance company (or consortium of insurance 
        companies) that is licensed to issue long-term care insurance 
        in all States, taking any subsidiaries of such a company into 
        account (and, in the case of a consortium, considering the 
        member companies and any subsidiaries thereof, collectively).
            ``(8) State.--The term `State' includes the District of 
        Columbia.
            ``(9) Qualified long-term care insurance contract.--The 
        term `qualified long-term care insurance contract' has the 
        meaning given such term by section 7702B of the Internal 
        Revenue Code of 1986.
            ``(10) Appropriate secretary.--The term `appropriate 
        Secretary' means--
                    ``(A) except as otherwise provided in this 
                paragraph, the Secretary of Defense;
                    ``(B) with respect to the Coast Guard when it is 
                not operating as a service of the Navy, the Secretary 
                of Transportation;
                    ``(C) with respect to the commissioned corps of the 
                National Oceanic and Atmospheric Administration, the 
                Secretary of Commerce; and
                    ``(D) with respect to the commissioned corps of the 
                Public Health Service, the Secretary of Health and 
                Human Services.
``Sec. 9002. Availability of insurance
    ``(a) In General.--The Office of Personnel Management shall 
establish and, in consultation with the appropriate Secretaries, 
administer a program through which an individual described in paragraph 
(1), (2), (3), (4), or (5) of section 9001 may obtain long-term care 
insurance coverage under this chapter for such individual.
    ``(b) General Requirements.--Long-term care insurance may not be 
offered under this chapter unless--
            ``(1) the only coverage provided is under qualified long-
        term care insurance contracts; and
            ``(2) each insurance contract under which any such coverage 
        is provided is issued by a qualified carrier.
    ``(c) Documentation Requirement.--As a condition for obtaining 
long-term care insurance coverage under this chapter based on one's 
status as a qualified relative, an applicant shall provide 
documentation to demonstrate the relationship, as prescribed by the 
Office.
    ``(d) Underwriting Standards.--
            ``(1) Disqualifying condition.--Nothing in this chapter 
        shall be considered to require that long-term care insurance 
        coverage be made available in the case of any individual who 
        would be eligible for benefits immediately.
            ``(2) Spousal parity.--For the purpose of underwriting 
        standards, a spouse of an individual described in paragraph 
        (1), (2), (3), or (4) of section 9001 shall, as nearly as 
        practicable, be treated like that individual.
            ``(3) Guaranteed issue.--Nothing in this chapter shall be 
        considered to require that long-term care insurance coverage be 
        guaranteed to an eligible individual.
            ``(4) Requirement that contract be fully insured.--In 
        addition to the requirements otherwise applicable under section 
        9001(9), in order to be considered a qualified long-term care 
        insurance contract for purposes of this chapter, a contract 
        shall be fully insured, whether through reinsurance with other 
        companies or otherwise.
            ``(5) Higher standards allowable.--Nothing in this chapter 
        shall, in the case of an individual applying for long-term care 
        insurance coverage under this chapter after the expiration of 
        such individual's first opportunity to enroll, preclude the 
        application of underwriting standards more stringent than those 
        that would have applied if that opportunity had not yet 
        expired.
    ``(e) Guaranteed Renewability.--The benefits and coverage made 
available to eligible individuals under any insurance contract under 
this chapter shall be guaranteed renewable (as defined by section 7A(2) 
of the model regulations described in section 7702B(g)(2) of the 
Internal Revenue Code of 1986), including the right to have insurance 
remain in effect so long as premiums continue to be timely made. 
However, the authority to revise premiums under this chapter shall be 
available only on a class basis and only to the extent otherwise 
allowable under section 9003(b).
``Sec. 9003. Contracting authority
    ``(a) In General.--Without regard to section 3709 of the Revised 
Statutes (41 U.S.C. 5) or any other statute requiring competitive 
bidding, the Office of Personnel Management shall contract with 1 or 
more qualified carriers for a policy or policies of long-term care 
insurance. The Office shall ensure that each resulting contract (in 
this chapter referred to as a `master contract') is awarded on the 
basis of contractor qualifications, price, and reasonable competition.
    ``(b) Terms and Conditions.--
            ``(1) In general.--Each master contract under this chapter 
        shall contain--
                    ``(A) a detailed statement of the benefits offered 
                (including any maximums, limitations, exclusions, and 
                other definitions of benefits);
                    ``(B) the premiums charged (including any 
                limitations or other conditions on their subsequent 
                adjustment);
                    ``(C) the terms of the enrollment period; and
                    ``(D) such other terms and conditions as may be 
                mutually agreed to by the Office and the carrier 
                involved, consistent with the requirements of this 
                chapter.
            ``(2) Premiums.--Premiums charged under each master 
        contract entered into under this section shall reasonably and 
        equitably reflect the cost of the benefits provided, as 
        determined by the Office. The premiums shall not be adjusted 
        during the term of the contract unless mutually agreed to by 
        the Office and the carrier.
            ``(3) Nonrenewability.--Master contracts under this chapter 
        may not be made automatically renewable.
    ``(c) Payment of Required Benefits; Dispute Resolution.--
            ``(1) In general.--Each master contract under this chapter 
        shall require the carrier to agree--
                    ``(A) to provide payments or benefits to an 
                eligible individual if such individual is entitled to 
                such payments or benefits under the terms of the 
                contract; and
                    ``(B) with respect to disputes regarding claims for 
                payments or benefits under the terms of the contract--
                            ``(i) to establish internal procedures 
                        designed to expeditiously resolve such 
                        disputes; and
                            ``(ii) to establish, for disputes not 
                        resolved through procedures under clause (i), 
                        procedures for 1 or more alternative means of 
                        dispute resolution involving independent third-
                        party review under appropriate circumstances by 
                        entities mutually acceptable to the Office and 
                        the carrier.
            ``(2) Eligibility.--A carrier's determination as to whether 
        or not a particular individual is eligible to obtain long-term 
        care insurance coverage under this chapter shall be subject to 
        review only to the extent and in the manner provided in the 
        applicable master contract.
            ``(3) Other claims.--For purposes of applying the Contract 
        Disputes Act of 1978 to disputes arising under this chapter 
        between a carrier and the Office--
                    ``(A) the agency board having jurisdiction to 
                decide an appeal relative to such a dispute shall be 
                such board of contract appeals as the Director of the 
                Office of Personnel Management shall specify in writing 
                (after appropriate arrangements, as described in 
                section 8(c) of such Act); and
                    ``(B) the district courts of the United States 
                shall have original jurisdiction, concurrent with the 
                United States Court of Federal Claims, of any action 
                described in section 10(a)(1) of such Act relative to 
                such a dispute.
            ``(4) Rule of construction.--Nothing in this chapter shall 
        be considered to grant authority for the Office or a third-
        party reviewer to change the terms of any contract under this 
        chapter.
    ``(d) Duration.--
            ``(1) In general.--Each master contract under this chapter 
        shall be for a term of 7 years, unless terminated earlier by 
        the Office in accordance with the terms of such contract. 
        However, the rights and responsibilities of the enrolled 
        individual, the insurer, and the Office (or duly designated 
        third-party administrator) under such contract shall continue 
        with respect to such individual until the termination of 
        coverage of the enrolled individual or the effective date of a 
        successor contract.
            ``(2) Exception.--
                    ``(A) Shorter duration.--In the case of a master 
                contract entered into before the end of the period 
                described in subparagraph (B), paragraph (1) shall be 
                applied by substituting `ending on the last day of the 
                7-year period described in paragraph (2)(B)' for `of 7 
                years'.
                    ``(B) Definition.--The period described in this 
                subparagraph is the 7-year period beginning on the 
                earliest date as of which any long-term care insurance 
                coverage under this chapter becomes effective.
            ``(3) Congressional notification.--No later than 180 days 
        after receiving the second report required under section 
        9006(c), the President (or his designee) shall submit to the 
        Committees on Government Reform and on Armed Services of the 
        House of Representatives and the Committees on Governmental 
        Affairs and on Armed Services of the Senate, a written 
        recommendation as to whether the program under this chapter 
        should be continued without modification, terminated, or 
        restructured. During the 180-day period following the date on 
        which the President (or his designee) submits the 
        recommendation required under the preceding sentence, the 
        Office of Personnel Management may not take any steps to rebid 
        or otherwise contract for any coverage to be available at any 
        time following the expiration of the 7-year period described in 
        paragraph (2)(B).
            ``(4) Full portability.--Each master contract under this 
        chapter shall include such provisions as may be necessary to 
        ensure that, once an individual becomes duly enrolled, long-
        term care insurance coverage obtained by such individual 
        pursuant to that enrollment shall not be terminated due to any 
        change in status (such as separation from Government service or 
        the uniformed services) or ceasing to meet the requirements for 
        being considered a qualified relative (whether as a result of 
        dissolution of marriage or otherwise).
``Sec. 9004. Financing
    ``(a) In General.--Each eligible individual obtaining long-term 
care insurance coverage under this chapter shall be responsible for 100 
percent of the premiums for such coverage.
    ``(b) Withholdings.--
            ``(1) In general.--The amount necessary to pay the premiums 
        for enrollment may--
                    ``(A) in the case of an employee, be withheld from 
                the pay of such employee;
                    ``(B) in the case of an annuitant, be withheld from 
                the annuity of such annuitant;
                    ``(C) in the case of a member of the uniformed 
                services described in section 9001(3), be withheld from 
                the basic pay of such member; and
                    ``(D) in the case of a retired member of the 
                uniformed services described in section 9001(4), be 
                withheld from the retired pay or retainer pay payable 
                to such member.
            ``(2) Voluntary withholdings for qualified relatives.--
        Withholdings to pay the premiums for enrollment of a qualified 
        relative may, upon election of the appropriate eligible 
        individual (described in section 9001 (1) through (4)), be 
        withheld under paragraph (1) to the same extent and in the same 
        manner as if enrollment were for such individual.
    ``(c) Direct Payments.--All amounts withheld under this section 
shall be paid directly to the carrier.
    ``(d) Other Forms of Payment.--Any enrollee who does not elect to 
have premiums withheld under subsection (b) or whose pay, annuity, or 
retired or retainer pay (as referred to in subsection (b)(1)) is 
insufficient to cover the withholding required for enrollment (or who 
is not receiving any regular amounts from the Government, as referred 
to in subsection (b)(1), from which any such withholdings may be made, 
and whose premiums are not otherwise being provided for under 
subsection (b)(2)) shall pay an amount equal to the full amount of 
those charges directly to the carrier.
    ``(e) Separate Accounting Requirement.--Each carrier participating 
under this chapter shall maintain  records that permit it to account 
for all amounts received under this chapter (including investment 
earnings on those amounts) separate and apart from all other funds.
    ``(f) Reimbursements.--
            ``(1) Reasonable initial costs.--
                    ``(A) In general.--The Employees' Life Insurance 
                Fund is available, without fiscal year limitation, for 
                reasonable expenses incurred by the Office of Personnel 
                Management in administering this chapter before the 
                start of the 7-year period described in section 
                9003(d)(2)(B), including reasonable implementation 
                costs.
                    ``(B) Reimbursement requirement.--Such Fund shall 
                be reimbursed, before the end of the first year of that 
                7-year period, for all amounts obligated or expended 
                under subparagraph (A) (including lost investment 
                income). Such reimbursement shall be made by carriers, 
                on a pro rata basis, in accordance with appropriate 
                provisions which shall be included in master contracts 
                under this chapter.
            ``(2) Subsequent costs.--
                    ``(A) In general.--There is established in the 
                Employees' Life Insurance Fund a Long-Term Care 
                Administrative Account, which shall be available to the 
Office, without fiscal year limitation, to defray reasonable expenses 
incurred by the Office in administering this chapter after the start of 
the 7-year period described in section 9003(d)(2)(B).
                    ``(B) Reimbursement requirement.--Each master 
                contract under this chapter shall include appropriate 
                provisions under which the carrier involved shall, 
                during each year, make such periodic contributions to 
                the Long-Term Care Administrative Account as necessary 
                to ensure that the reasonable anticipated expenses of 
                the Office in administering this chapter during such 
                year (adjusted to reconcile for any earlier 
                overestimates or underestimates under this 
                subparagraph) are defrayed.
``Sec. 9005. Preemption
    ``The terms of any contract under this chapter which relate to the 
nature, provision, or extent of coverage or benefits (including 
payments with respect to benefits) shall supersede and preempt any 
State or local law, or any regulation issued under such law, which 
relates to long-term care insurance or contracts.
``Sec. 9006. Studies, reports, and audits
    ``(a) Provisions Relating to Carriers.--Each master contract under 
this chapter shall contain provisions requiring the carrier--
            ``(1) to furnish such reasonable reports as the Office of 
        Personnel Management determines to be necessary to enable it to 
        carry out its functions under this chapter; and
            ``(2) to permit the Office and representatives of the 
        General Accounting Office to examine such records of the 
        carrier as may be necessary to carry out the purposes of this 
        chapter.
    ``(b) Provisions Relating to Federal Agencies.--Each Federal agency 
shall keep such records, make such certifications, and furnish the 
Office, the carrier, or both, with such information and reports as the 
Office may require.
    ``(c) Reports by the General Accounting Office.--The General 
Accounting Office shall prepare and submit to the President, the Office 
of Personnel Management, and each House of Congress, before the end of 
the third and fifth years during which the program under this chapter 
is in effect, a written report evaluating such program. Each such 
report shall include an analysis of the competitiveness of the program, 
as compared to both group and individual coverage generally available 
to individuals in the private insurance market. The Office shall 
cooperate with the General Accounting Office to provide periodic 
evaluations of the program.
``Sec. 9007. Jurisdiction of courts
    ``The district courts of the United States have original 
jurisdiction of a civil action or claim described in paragraph (1) or 
(2) of section 9003(c), after such administrative remedies as required 
under such paragraph (1) or (2) (as applicable) have been exhausted, 
but only to the extent judicial review is not precluded by any dispute 
resolution or other remedy under this chapter.
``Sec. 9008. Administrative functions
    ``(a) In General.--The Office of Personnel Management shall 
prescribe regulations necessary to carry out this chapter.
    ``(b) Enrollment Periods.--The Office shall provide for periodic 
coordinated enrollment, promotion, and education efforts in 
consultation with the carriers.
    ``(c) Consultation.--Any regulations necessary to effect the 
application and operation of this chapter with respect to an eligible 
individual described in paragraph (3) or (4) of section 9001, or a 
qualified relative of such an individual, shall be prescribed by the 
Office in consultation with the appropriate Secretary.
    ``(d) Informed Decisionmaking.--The Office shall ensure that each 
eligible individual applying for long-term care insurance under this 
chapter is furnished the information necessary to enable that 
individual to evaluate the advantages and disadvantages of obtaining 
long-term care insurance under this chapter, including the following:
            ``(1) The principal long-term care benefits and coverage 
        available under this chapter, and how those benefits and 
        coverage compare to the range of long-term care benefits and 
        coverage otherwise generally available.
            ``(2) Representative examples of the cost of long-term 
        care, and the sufficiency of the benefits available under this 
        chapter relative to those costs. The information under this 
        paragraph shall also include--
                    ``(A) the projected effect of inflation on the 
                value of those benefits; and
                    ``(B) a comparison of the inflation-adjusted value 
                of those benefits to the projected future costs of 
                long-term care.
            ``(3) Any rights individuals under this chapter may have to 
        cancel coverage, and to receive a total or partial refund of 
        premiums. The information under this paragraph shall also 
        include--
                    ``(A) the projected number or percentage of 
                individuals likely to fail to maintain their coverage 
                (determined based on lapse rates experienced under 
                similar group long-term care insurance programs and, 
                when available, this chapter); and
                    ``(B)(i) a summary description of how and when 
                premiums for long-term care insurance under this 
                chapter may be raised;
                    ``(ii) the premium history during the last 10 years 
                for each qualified carrier offering long-term care 
                insurance under this chapter; and
                    ``(iii) if cost increases are anticipated, the 
                projected premiums for a typical insured individual at 
                various ages.
            ``(4) The advantages and disadvantages of long-term care 
        insurance generally, relative to other means of accumulating or 
        otherwise acquiring the assets that may be needed to meet the 
        costs of long-term care, such as through tax-qualified 
        retirement programs or other investment vehicles.
``Sec. 9009. Cost accounting standards
    ``The cost accounting standards issued under section 26(f) of the 
Office of Federal Procurement Policy Act (41 U.S.C. 422(f)) shall not 
apply with respect to a long-term care insurance contract under this 
chapter.''.
    (b) Conforming Amendment.--The analysis for part III of title 5, 
United States Code, is amended by adding at the end of subpart G the 
following:

``90. Long-Term Care Insurance.............................    9001.''.

SEC. 113. EFFECTIVE DATE.

    The Office of Personnel Management shall take such measures as may 
be necessary to ensure that long-term care insurance coverage under 
title 5, United States Code, as amended by this subtitle, may be 
obtained in time to take effect not later than the first day of the 
first applicable pay period of the first fiscal year which begins after 
the end of the 18-month period beginning on the date of enactment of 
this Act.

             Subtitle C--Seniors' Access to Continuing Care

SEC. 121. SHORT TITLE.

    This subtitle may be cited as the ``Seniors' Access to Continuing 
Care Act of 2000''.

SEC. 122. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.) is amended by adding at the end the following new section:

``SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.

    ``(a) In General.--With respect to health insurance coverage 
provided to participants or beneficiaries through a managed care 
organization under a group health plan, or through a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, such plan or issuer may not deny coverage for services 
provided to such participant or beneficiary by a continuing care 
retirement community, skilled nursing facility, or other qualified 
facility in which the participant or beneficiary resided prior to a 
hospitalization, regardless of whether such organization is under 
contract with such community or facility if the requirements described 
in subsection (b) are met.
    ``(b) Requirements.--The requirements of this subsection are that--
            ``(1) the service involved is a service for which the 
        managed care organization involved would be required to provide 
        or pay for under its contract with the participant or 
        beneficiary if the continuing care retirement community, 
        skilled nursing facility, or other qualified facility were 
        under contract with the organization;
            ``(2) the participant or beneficiary involved--
                    ``(A) resided in the continuing care retirement 
                community, skilled nursing facility, or other qualified 
                facility prior to being hospitalized;
                    ``(B) had a contractual or other right to return to 
                the facility after hospitalization; and
                    ``(C) elects to return to the facility after 
                hospitalization, whether or not the residence of the 
                participant or beneficiary after returning from the 
                hospital is the same part of the facility in which the 
                beneficiary resided prior to hospitalization;
            ``(3) the continuing care retirement community, skilled 
        nursing facility, or other qualified facility has the capacity 
        to provide the services the participant or beneficiary needs;
            ``(4) the continuing care retirement community, skilled 
        nursing facility, or other qualified facility is willing to 
        accept substantially similar payment under the same terms and 
        conditions that apply to similarly situated health care 
        facility providers under contract with the organization 
        involved.
    ``(c) Services To Prevent Hospitalization.--A group health plan or 
health insurance issuer to which this section applies may not deny 
payment for a skilled nursing service provided to a participant or 
beneficiary by a continuing care retirement community, skilled nursing 
facility, or other qualified facility in which the participant or 
beneficiary resides, without a preceding hospital stay, regardless of 
whether the organization is under contract with such community or 
facility, if--
            ``(1) the plan or issuer has determined that the service is 
        necessary to prevent the hospitalization of the participant or 
        beneficiary; and
            ``(2) the service to prevent hospitalization is provided as 
        an additional benefit as described in section 417.594 of title 
        42, Code of Federal Regulations, and would otherwise be covered 
        as provided for in subsection (b)(1).
    ``(d) Rights of Spouses.--A group health plan or health insurance 
issuer to which this section applies shall not deny payment for 
services provided by a skilled nursing facility for the care of a 
participant or beneficiary, regardless of whether the plan or issuer is 
under contract with such facility, if the spouse of the participant or 
beneficiary is already a resident of such facility and the requirements 
described in subsection (b) are met.
    ``(e) Exceptions.--Subsection (a) shall not apply--
            ``(1) where the attending acute care provider and the 
        participant or beneficiary (or a designated representative of 
        the participant or beneficiary where the participant or 
        beneficiary is physically or mentally incapable of making an 
        election under this paragraph) do not elect to pursue a course 
        of treatment necessitating continuing care; or
            ``(2) unless the community or facility involved--
                    ``(A) meets all applicable licensing and 
                certification requirements of the State in which it is 
                located; and
                    ``(B) agrees to reimbursement for the care of the 
                participant or beneficiary at a rate similar to the 
                rate negotiated by the managed care organization with 
                similar providers of care for similar services.
    ``(f) Prohibitions.--A group health plan and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage with a managed care 
        organization under the plan, solely for the purpose of avoiding 
        the requirements of this section;
            ``(2) provide monetary payments or rebates to enrollees to 
        encourage such enrollees to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of an attending physician because such physician 
        provided care to a participant or beneficiary in accordance 
        with this section; or
            ``(4) provide incentives (monetary or otherwise) to an 
        attending physician to induce such physician to provide care to 
        a participant or beneficiary in a manner inconsistent with this 
        section.
    ``(g) Rules of Construction.--
            ``(1) HMO not offering benefits.--This section shall not 
        apply with respect to any managed care organization under a 
        group health plan, or through a health insurance issuer 
        providing health insurance coverage in connection with a group 
        health plan, that does not provide benefits for stays in a 
        continuing care retirement community, skilled nursing facility, 
        or other qualified facility.
            ``(2) Cost-sharing.--Nothing in this section shall be 
        construed as preventing a managed care organization under a 
        group health plan, or through a health insurance issuer 
        providing health insurance coverage in connection with a group 
        health plan, from imposing deductibles, coinsurance, or other 
        cost-sharing in relation to benefits for care in a continuing 
        care facility.
    ``(h) Preemption; Exception for Health Insurance Coverage in 
Certain States.--
            ``(1) In general.--The requirements of this section shall 
        not apply with respect to health insurance coverage to the 
        extent that a State law (as defined in section 2723(d)(1) of 
        the Public Health Service Act) applies to such coverage and is 
        described in any of the following subparagraphs:
                    ``(A) Such State law requires such coverage to 
                provide for referral to a continuing care retirement 
                community, skilled nursing facility, or other qualified 
                facility in a manner that is more protective of 
                participants or beneficiaries than the provisions of 
                this section.
                    ``(B) Such State law expands the range of services 
                or facilities covered under this section and is 
                otherwise more protective of the rights of participants 
                or beneficiaries than the provisions of this section.
            ``(2) Construction.--Section 731(a)(1) shall not be 
        construed to provide that any requirement of this section 
        applies with respect to health insurance coverage, to the 
        extent that a State law described in paragraph (1) applies to 
        such coverage.
    ``(i) Penalties.--A participant or beneficiary may enforce the 
provisions of this section in an appropriate Federal district court. An 
action for injunctive relief or damages may be commenced on behalf of 
the participant or beneficiary by the participant's or beneficiary's 
legal representative. The court may award reasonable attorneys' fees to 
the prevailing party. If a beneficiary dies before conclusion of an 
action under this section, the action may be maintained by a 
representative of the participant's or beneficiary's estate.
    ``(j) Definitions.--In this section:
            ``(1) Attending acute care provider.--The term `attending 
        acute care provider' means anyone licensed or certified under 
        State law to provide health care services who is operating 
        within the scope of such license and who is primarily 
        responsible for the care of the enrollee.
            ``(2) Continuing care retirement community.--The term 
        `continuing care retirement community' means an organization 
        that provides or arranges for the provision of housing and 
        health-related services to an older person under an 
agreement effective for the life of the person or for a specified 
period greater than 1 year.
            ``(3) Managed care organization.--The term `managed care 
        organization' means an organization that provides comprehensive 
        health services to participants or beneficiaries, directly or 
        under contract or other agreement, on a prepayment basis to 
        such individuals. For purposes of this section, the following 
        shall be considered as managed care organizations:
                    ``(A) A Medicare+Choice plan authorized under 
                section 1851(a) of the Social Security Act (42 U.S.C. 
                1395w-21(a)).
                    ``(B) Any other entity that manages the cost, 
                utilization, and delivery of health care through the 
                use of predetermined periodic payments to health care 
                providers employed by or under contract or other 
                agreement, directly or indirectly, with the entity.
            ``(4) Other qualified facility.--The term `other qualified 
        facility' means any facility that can provide the services 
        required by the participant or beneficiary consistent with 
        State and Federal law.
            ``(5) Skilled nursing facility.--The term `skilled nursing 
        facility' means a facility that meets the requirements of 
        section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 is amended by inserting 
after the items relating to subpart B of part 7 of subtitle B of title 
I the following new item:

``Sec. 714. Ensuring choice for continuing care.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2001.

SEC. 123. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE 
              GROUP MARKET.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at 
the end the following new section:

``SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.

    ``(a) In General.--With respect to health insurance coverage 
provided to enrollees through a managed care organization under a group 
health plan, or through a health insurance issuer providing health 
insurance coverage in connection with a group health plan, such plan or 
issuer may not deny coverage for services provided to such enrollee by 
a continuing care retirement community, skilled nursing facility, or 
other qualified facility in which the enrollee resided prior to a 
hospitalization, regardless of whether such organization is under 
contract with such community or facility if the requirements described 
in subsection (b) are met.
    ``(b) Requirements.--The requirements of this subsection are that--
            ``(1) the service involved is a service for which the 
        managed care organization involved would be required to provide 
        or pay for under its contract with the enrollee if the 
        continuing care retirement community, skilled nursing facility, 
        or other qualified facility were under contract with the 
        organization;
            ``(2) the enrollee involved--
                    ``(A) resided in the continuing care retirement 
                community, skilled nursing facility, or other qualified 
                facility prior to being hospitalized;
                    ``(B) had a contractual or other right to return to 
                the facility after hospitalization; and
                    ``(C) elects to return to the facility after 
                hospitalization, whether or not the residence of the 
                enrollee after returning from the hospital is the same 
                part of the facility in which the beneficiary resided 
                prior to hospitalization;
            ``(3) the continuing care retirement community, skilled 
        nursing facility, or other qualified facility has the capacity 
        to provide the services the enrollee needs;
            ``(4) the continuing care retirement community, skilled 
        nursing facility, or other qualified facility is willing to 
        accept substantially similar payment under the same terms and 
        conditions that apply to similarly situated health care 
        facility providers under contract with the organization 
        involved.
    ``(c) Services To Prevent Hospitalization.--A group health plan or 
health insurance issuer to which this section applies may not deny 
payment for a skilled nursing service provided to an enrollee by a 
continuing care retirement community, skilled nursing facility, or 
other qualified facility in which the enrollee resides, without a 
preceding hospital stay, regardless of whether the plan or issuer is 
under contract with such community or facility, if--
            ``(1) the plan or issuer has determined that the service is 
        necessary to prevent the hospitalization of the enrollee; and
            ``(2) the service to prevent hospitalization is provided as 
        an additional benefit as described in section 417.594 of title 
        42, Code of Federal Regulations, and would be covered as 
        provided for in subsection (b)(1).
    ``(d) Rights of Spouses.--A group health plan or health insurance 
issuer to which this section applies shall not deny payment for 
services provided by a skilled nursing facility for the care of an 
enrollee, regardless of whether the plan or issuer is under contract 
with such facility, if the spouse of the enrollee is already a resident 
of such facility and the requirements described in subsection (b) are 
met.
    ``(e) Exceptions.--Subsection (a) shall not apply--
            ``(1) where the attending acute care provider and the 
        enrollee (or a designated representative of the enrollee where 
        the enrollee is physically or mentally incapable of making an 
        election under this paragraph) do not elect to pursue a course 
        of treatment necessitating continuing care; or
            ``(2) unless the community or facility involved--
                    ``(A) meets all applicable licensing and 
                certification requirements of the State in which it is 
                located; and
                    ``(B) agrees to reimbursement for the care of the 
                enrollee at a rate similar to the rate negotiated by 
                the managed care organization with similar providers of 
                care for similar services.
    ``(f) Prohibitions.--A group health plan and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage with a managed care 
        organization under the plan, solely for the purpose of avoiding 
        the requirements of this section;
            ``(2) provide monetary payments or rebates to enrollees to 
        encourage such enrollees to accept less than the minimum 
        protections available under this section;
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of an attending physician because such physician 
        provided care to an enrollee in accordance with this section; 
        or
            ``(4) provide incentives (monetary or otherwise) to an 
        attending physician to induce such physician to provide care to 
        an enrollee in a manner inconsistent with this section.
    ``(g) Rules of Construction.--
            ``(1) HMO not offering benefits.--This section shall not 
        apply with respect to any managed care organization under a 
        group health plan, or through a health insurance issuer 
        providing health insurance coverage in connection with a group 
        health plan, that does not provide benefits for stays in a 
        continuing care retirement community, skilled nursing facility, 
        or other qualified facility.
            ``(2) Cost-sharing.--Nothing in this section shall be 
        construed as preventing a managed care organization under a 
        group health plan, or through a health insurance issuer 
        providing health insurance coverage in connection with a group 
        health plan, from imposing deductibles, coinsurance, or other 
        cost-sharing in relation to benefits for care in a continuing 
        care facility.
    ``(h) Preemption; Exception for Health Insurance Coverage in 
Certain States.--
            ``(1) In general.--The requirements of this section shall 
        not apply with respect to health insurance coverage to the 
        extent that a State law (as defined in section 2723(d)(1)) 
        applies to such coverage and is described in any of the 
        following subparagraphs:
                    ``(A) Such State law requires such coverage to 
                provide for referral to a continuing care retirement 
                community, skilled nursing facility, or other qualified 
                facility in a manner that is more protective of the 
enrollee than the provisions of this section.
                    ``(B) Such State law expands the range of services 
                or facilities covered under this section and is 
                otherwise more protective of enrollee rights than the 
                provisions of this section.
            ``(2) Construction.--Section 2723(a)(1) shall not be 
        construed to provide that any requirement of this section 
        applies with respect to health insurance coverage, to the 
        extent that a State law described in paragraph (1) applies to 
        such coverage.
    ``(i) Penalties.--An enrollee may enforce the provisions of this 
section in an appropriate Federal district court. An action for 
injunctive relief or damages may be commenced on behalf of the enrollee 
by the enrollee's legal representative. The court may award reasonable 
attorneys' fees to the prevailing party. If a beneficiary dies before 
conclusion of an action under this section, the action may be 
maintained by a representative of the enrollee's estate.
    ``(j) Definitions.--In this section:
            ``(1) Attending acute care provider.--The term `attending 
        acute care provider' means anyone licensed or certified under 
        State law to provide health care services who is operating 
        within the scope of such license and who is primarily 
        responsible for the care of the enrollee.
            ``(2) Continuing care retirement community.--The term 
        `continuing care retirement community' means an organization 
        that provides or arranges for the provision of housing and 
        health-related services to an older person under an agreement 
        effective for the life of the person or for a specified period 
        greater than 1 year.
            ``(3) Managed care organization.--The term `managed care 
        organization' means an organization that provides comprehensive 
        health services to enrollees, directly or under contract or 
        other agreement, on a prepayment basis to such individuals. For 
        purposes of this section, the following shall be considered as 
        managed care organizations:
                    ``(A) A Medicare+Choice plan authorized under 
                section 1851(a) of the Social Security Act (42 U.S.C. 
                1395w-21(a)).
                    ``(B) Any other entity that manages the cost, 
                utilization, and delivery of health care through the 
                use of predetermined periodic payments to health care 
                providers employed by or under contract or other 
                agreement, directly or indirectly, with the entity.
            ``(4) Other qualified facility.--The term `other qualified 
        facility' means any facility that can provide the services 
        required by the enrollee consistent with State and Federal law.
            ``(5) Skilled nursing facility.--The term `skilled nursing 
        facility' means a facility that meets the requirements of 
        section 1819 of the Social Security Act (42 U.S.C. 1395i-3).''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to group health plans for plan years beginning on or 
after January 1, 2001.

SEC. 124. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE 
              INDIVIDUAL MARKET.

    (a) In General.--The first subpart 3 of part B of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg-51 et seq.) (relating to 
other requirements) is amended--
            (1) by redesignating such subpart as subpart 2; and
            (2) by adding at the end the following new section:

``SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.

    ``The provisions of section 2707 shall apply to health maintenance 
organization coverage offered by a health insurance issuer in the 
individual market in the same manner as they apply to such coverage 
offered by a health insurance issuer in connection with a group health 
plan in the small or large group market.''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market on or after 
January 1, 2001.

SEC. 125. SENSE OF THE SENATE CONCERNING THE CARE OF OLDER AMERICANS.

    It is the sense of the Senate that--
            (1) in the coming decade, people who are over the age of 65 
        will constitute 20 percent or more of the population of the 
        United States;
            (2) in the coming decade, the number of people who are over 
        the age of 85 and will most likely need long-term care may 
        double or triple;
            (3) the number of persons who are age 65 or older who have 
        difficulty carrying out at least 1 activity of daily living is 
        estimated to increase between the year 2000 and 2024 by 42 
        percent, or from 5.2 million persons to 7.4 million persons;
            (4) women rely on long-term care services for more years 
        than men do since women live longer;
            (5) women who are age 65 or older are twice as likely as 
        men who are age 65 or older to have an income of less than 
        $10,000 per year;
            (6) long-term care expenses can have a catastrophic effect 
        on families, in that a lifetime of savings may be spent for 
        long-term care expenses for a spouse, parent, or grandparent 
        before such spouse, parent, or grandparent becomes eligible for 
        governmental assistance; and
            (7) the Federal Government should be committed to providing 
        benefits that are designed to ensure the physical, emotional, 
        and financial well being of older Americans in the new century.

 Subtitle D--Expansion of Home-Based Long-Term Care Services Under the 
                      Social Services Block Grant

SEC. 131. RESTORATION OF AUTHORITY TO TRANSFER UP TO 10 PERCENT OF TANF 
              FUNDS TO THE SOCIAL SERVICES BLOCK GRANT.

    (a) In General.--Section 404(d)(2) of the Social Security Act (42 
U.S.C. 604(d)(2)) is amended to read as follows:
            ``(2) Limitation on amount transferable to title xx 
        programs.--A State may use not more than 10 percent of the 
amount of any grant made to the State under section 403(a) for a fiscal 
year to carry out State programs pursuant to title XX.''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
to amounts made available for fiscal year 2001 and each fiscal year 
thereafter.

SEC. 132. RESTORATION OF FUNDS FOR THE SOCIAL SERVICES BLOCK GRANT.

    (a) In General.--Section 2003(c)(11) of the Social Security Act (42 
U.S.C. 1397b(c)(11)) is amended to read as follows:
            ``(11) $2,380,000,000 for the fiscal year 2001 and each 
        fiscal year thereafter.''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
to amounts made available for fiscal year 2001 and each fiscal year 
thereafter.

SEC. 133. APPROPRIATION OF ADDITIONAL FUNDS FOR EXPANSION OF HOME-BASED 
              LONG-TERM CARE SERVICES.

    (a) In General.--Section 2003 of the Social Security Act (42 U.S.C. 
1397b) is amended by adding at the end the following:
    ``(d) With respect to any fiscal year in which the amount 
appropriated to carry out this title equals or exceeds the amount 
specified in subsection (c) for such fiscal year, an additional amount 
equal to 10 percent of the amount so appropriated is hereby 
appropriated for such fiscal year out of any funds in the Treasury not 
otherwise appropriated. The additional amount appropriated under this 
subsection shall be allotted among the States and jurisdictions 
described in subsections (a) and (b) in the same manner as the 
allotments for such States and jurisdictions are determined under such 
subsections. Amounts allotted under this subsection shall be used to 
expand the provision of home-based services for elderly or disabled 
individuals.''.

           TITLE II--SUPPORT AND PLANNING FOR LONG-TERM CARE

                    Subtitle A--Support and Surveys

SEC. 201. NATIONAL FAMILY CAREGIVER SUPPORT GRANT PROGRAM.

    (a) In-Home Services.--Part D of title III of the Older Americans 
Act of 1965 (42 U.S.C. 3030h et seq.) is amended to read as follows:

       ``PART D--NATIONAL FAMILY CAREGIVER SUPPORT GRANT PROGRAM

                    ``Subpart 1--State Grant Program

``SEC. 341. PROGRAM AUTHORIZED.

    ``(a) In General.--The Assistant Secretary shall award grants to 
States with State plans approved under section 307, to pay for the 
Federal share of the cost of carrying out State programs and enable 
eligible area agencies on aging to provide multifaceted systems of 
support services for family caregivers and other caregivers who are 
informal providers of in-home services and community care for older 
individuals.
    ``(b) Family Caregiver Support Services.--In providing services 
under this part, an area agency on aging shall provide support 
services, including providing--
            ``(1) information to eligible caregivers about available 
        services;
            ``(2) assistance to eligible caregivers in gaining access 
        to the services;
            ``(3) individual counseling, organization of support 
        groups, and caregiver training to eligible caregivers to assist 
        the caregivers in making decisions and solving problems 
        relating to their caregiving roles;
            ``(4) respite care to enable eligible caregivers to be 
        temporarily relieved from their caregiving responsibilities; 
        and
            ``(5) supplemental services, on a limited basis, to 
        complement the care provided by eligible caregivers.
    ``(c) Eligibility and Priority.--
            ``(1) Eligibility.--In order for a caregiver of an older 
        individual to be eligible to receive services provided by a 
        State program under this part, the State shall--
                    ``(A) find that the caregiver is a caregiver as 
                described in subsection (a); and
                    ``(B) determine that the older individual meets the 
                condition specified in subparagraph (A)(i) of (B) of 
                section 102(28).
            ``(2) Priority.--In providing the services, the State shall 
        give priority for services to older individuals with greatest 
        social need and greatest economic need, and older individuals 
        providing care and supports to persons with mental retardation 
        and related developmental disabilities (as defined in section 
        102 of the Developmental Disabilities Assistance and Bill of 
        Rights Act (42 U.S.C. 6001) (referred to in this part as 
        `developmental disabilities')) consistent with the requirements 
        of section 305(a)(2)(E), and their caregivers.
    ``(d) Coordination With Service Providers.--In carrying out this 
part, each area agency on aging shall coordinate the activities of the 
agency with the activities of other community agencies and voluntary 
organizations providing the types of services described in subsection 
(b).
    ``(e) Quality Standards and Mechanisms and Accountability.--
            ``(1) Quality standards and mechanisms.--The State shall 
        establish standards and mechanisms designed to assure the 
        quality of services provided with assistance made available 
        under this part.
            ``(2) Data and records.--The State shall collect data and 
        maintain records relating to the State program in a 
        standardized format specified by the Assistant Secretary. The 
        State shall furnish the records to the Assistant Secretary, at 
        such time as the Assistant Secretary may require, in order to 
        enable the Assistant Secretary to monitor State program 
        administration and compliance, and to evaluate and compare the 
        effectiveness of the State programs.
            ``(3) Reports.--The State shall prepare and submit to the 
        Assistant Secretary reports on the data and records required 
under paragraph (2), including information on the services funded under 
this part, and standards and mechanisms by which the quality of the 
services shall be assured.
    ``(f) Availability of Funds.--
            ``(1) In general.--A State shall use the portion of the 
        State allotment under section 304 that is from amounts 
        appropriated under section 303(d) to carry out the State 
        program under this part.
            ``(2) Use of funds for administration of area plans.--
        Amounts made available to a State to carry out the State 
        program under this part may be used, in addition to amounts 
        available in accordance with section 303(c)(1), for costs of 
        administration of area plans.
            ``(3) Federal share.--
                    ``(A) In general.--Notwithstanding section 
                304(d)(1)(D), the Federal share of the cost of carrying 
                out a State program under this part shall be 75 
                percent.
                    ``(B) Non-federal share.--The non-Federal share of 
                the costs shall be provided from State and local 
                sources.

``SEC. 342. MAINTENANCE OF EFFORT.

    ``Funds made available under this part shall supplement, and not 
supplant, any Federal, State, or local funds expended by a State or 
unit of general purpose local government (including an area agency on 
aging) to provide services described in section 341(b).

               ``Subpart 2--National Innovation Programs

``SEC. 346. INNOVATION GRANT PROGRAM.

    ``(a) In General.--The Assistant Secretary shall carry out a 
program for making grants to appropriate entities on a competitive 
basis to foster the development and testing of new approaches to--
            ``(1) sustaining the efforts of family caregivers and other 
        informal caregivers of older individuals;
            ``(2) serving the needs of particular groups of caregivers 
        of older individuals, including minority caregivers and distant 
        caregivers; and
            ``(3) linking family support programs with the State entity 
        or agency that administers or funds programs for persons with 
        mental retardation or related developmental disabilities and 
        their families.
    ``(b) Evaluation and Dissemination of Results.--The Assistant 
Secretary shall provide for evaluation of the effectiveness of programs 
and activities funded with grants made under this section, and for 
dissemination to States of descriptions and evaluations of the programs 
and activities, to enable States to incorporate successful approaches 
into their individual State programs under this part.
    ``(c) Availability of funds.--
            ``(1) In general.--The Assistance Secretary shall reserve 
        not more than 10 percent of the amount appropriated under 
        section 303(d) for a fiscal year to carry out the program of 
        the Assistant Secretary under this section.
            ``(2) Native american programs and activities.--Twenty 
        percent of the amount reserved under paragraph (1) shall be 
        available for programs and activities under this section for 
        caregivers serving Indians and Native Hawaiians, as defined in 
        section 625.

``SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--The Assistant Secretary shall, directly or by 
grant or contract, carry out activities of national significance to 
promote quality and continuous improvement in the support services 
provided to family caregivers and other informal caregivers of older 
individuals, through program evaluation, training, technical 
assistance, and research.
    ``(b) Availability of Funds.--The Assistant Secretary shall reserve 
not more than 2 percent of the amount appropriated under section 303(d) 
to carry out the activities under this section.''.
    (b) Authorization of Appropriations.--Section 303(d) of the Older 
Americans Act of 1965 (42 U.S.C. 3032(d)) is amended to read as 
follows:
    ``(d) There are authorized to be appropriated $125,000,000 for 
fiscal year 2001, and such sums as may be necessary for each of fiscal 
years 2002 through 2005, to carry out part D (relating to the national 
family caregiver support grant program).''.
    (c) Conforming Amendment.--
            (1) Transfer of definition.--Section 102 of the Older 
        Americans Act of 1965 (42 U.S.C. 3002) is amended by adding at 
        the end the following:
            ``(45) The term `in-home services' includes--
                    ``(A) services of homemakers and home health aides;
                    ``(B) visiting and telephone reassurance;
                    ``(C) chore maintenance;
                    ``(D) in-home respite care for families, and adult 
                day care as a respite service for families;
                    ``(E) minor modification of homes that is necessary 
                to facilitate the ability of older individuals to 
                remain at home, that is not available under another 
program (other than a program carried out under this Act);
                    ``(F) personal care services; and
                    ``(G) other in-home services as defined--
                            ``(i) by the State agency in the State plan 
                        submitted in accordance with section 307; and
                            ``(ii) by the area agency on aging in the 
                        area plan submitted in accordance with section 
                        306.''.
            (2) References.--
                    (A) Section 307(a)(10) of such Act (42 U.S.C. 
                3027(a)(10)) is amended by striking ``(as defined in 
                section 342)''.
                    (B) Sections 382 and 383 of such Act (42 U.S.C. 
                3030q, 3030r) are repealed.
                    (C) Section 429F(a) of such Act (42 U.S.C. 30305n) 
                is amended--
                            (i) by striking paragraph (2); and
                            (ii) by striking ``this section:'' and all 
                        that follows through ``The term'' and inserting 
                        ``this section, the term''.

SEC. 202. COMMUNITY SURVEY.

    (a) In General.--The Secretary of Health and Human Services shall 
conduct a multi-city and county survey to determine if communities are 
elder-ready, or prepared to accommodate the needs of aging baby 
boomers.
    (b) Purpose.--The Secretary shall conduct the survey described in 
subsection (a) to determine if cities and counties across the United 
States are prepared to accommodate the needs of aging baby boomers 
regarding housing, safety, health care, transportation, and access to 
community services and leisure activities.
    (c) Title of Survey.--The survey described in subsection (a) shall 
be entitled ``Is Your Community Elder-Ready?''.
    (d) Report.--
            (1) In general.--The Secretary of Health and Human Services 
        shall prepare and submit a report to the appropriate committees 
        of Congress and cities and counties that the Secretary 
        determines should receive such report regarding the findings of 
        such survey described in subsection (a).
            (2) Content.--The report described in paragraph (1) shall 
        identify existing resources and challenging areas for cities or 
        counties to resolve or address in order for such cities or 
        counties to become elder ready. Such report shall also include 
        recommendations, action plans, and timetables for dealing with 
        deficiencies.

                   Subtitle B--Education and Studies

SEC. 211. LONG-TERM CARE COVERAGE EDUCATIONAL CAMPAIGN.

    (a) In General.--The Secretary of Labor, in conjunction with the 
Secretary of Health and Human Services and the Administrator of the 
Small Business Administration, shall establish and carry out a national 
public information campaign to provide employers and employees with 
information concerning the benefits of long-term health care coverage.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out subsection 
(a).

SEC. 212. GAO REPORT ON LONG-TERM CARE.

    Not later than 24 months after the date of enactment of this Act, 
the Comptroller General of the General Accounting Office shall prepare 
and submit to the appropriate committees of Congress a report 
concerning the long-term care programs of the Veterans Administration, 
including--
            (1) a description of the long-term care services provided 
        under such programs;
            (2) data concerning the utilization and financing of such 
        programs;
            (3) information concerning the quality assurance processes 
        used under such programs;
            (4) a description of any recent modifications to such 
        programs; and
            (5) a description of the management challenges faced in 
        administering such programs.

SEC. 213. AGING STUDY AND REPORT.

    (a) Studies.--The Secretary of Health and Human Services shall 
conduct not less than 1 study to determine--
            (1) activities or programs to conduct to improve the 
        quality of life for the elderly;
            (2) measures to be taken to prevent or delay the onset of 
        age-related functional decline and disease and disability among 
        the elderly;
            (3) whether medicare health promotion and disease 
        prevention benefits reduce or delay the need by seniors for 
        long-term care services; and
            (4) the manner in which the aging of the population in the 
        United States will impact the administration and solvency of 
        Federal programs, such as programs under titles XVIII, XIX, and 
        XX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et 
        seq., and 1397 et seq.) and programs established under the 
        Older Americans Act of 1965 (42 U.S.C. 3001 et seq.).
    (b) Report.--Not later than January 1, 2003, the Secretary of 
Health and Human Services shall prepare and submit to Congress a report 
regarding the study described in subsection (a).
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