II

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.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

5 ‘‘Omnibus Long-term Care Act of 2000’’.

6 (b) TABLE OF CONTENTS.—The table of contents for

7 this Act is as follows:

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

2 Subtitle A—Tax Incentives

3 SEC. 101. TREATMENT OF PREMIUMS ON QUALIFIED LONG4 TERM CARE INSURANCE CONTRACTS.

5 (a) IN GENERAL.—Part VII of subchapter B of chap6 ter 1 of the Internal Revenue Code of 1986 (relating to

7 additional itemized deductions) is amended by redesig8 nating section 222 as section 223 and by inserting after

9 section 221 the following new section:

10 ‘‘SEC. 222. PREMIUMS ON QUALIFIED LONG-TERM CARE IN11 SURANCE CONTRACTS.

12 ‘‘(a) IN GENERAL.—In the case of an individual,

13 there shall be allowed as a deduction an amount equal to

14 the applicable percentage of the amount of eligible long15 term care premiums (as defined in section 213(d)(10))

16 paid during the taxable year for coverage for the taxpayer,

17 his spouse, and dependents under a qualified long-term

18 care insurance contract (as defined in section 7702B(b)).

19 ‘‘(b) APPLICABLE PERCENTAGE.—For purposes of

20 subsection (a)—

21 ‘‘(1) IN GENERAL.—Except as otherwise pro22 vided in this subsection, the applicable percentage

23 shall be determined in accordance with the following

24 table based on the number of years of continuous

25 coverage (as of the close of the taxable year) of the
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1 individual under any qualified long-term care insur2 ance 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.

3 ‘‘(2) SPECIAL RULES FOR INDIVIDUALS WHO

4 HAVE ATTAINED AGE 55.—In the case of an indi5 vidual who has attained age 55 as of the close of the

6 taxable year, the following table shall be substituted

7 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.

8 ‘‘(3) ONLY COVERAGE AFTER 2000 TAKEN INTO

9 ACCOUNT.—Only coverage for periods after Decem10 ber 31, 2000, shall be taken into account under this

11 subsection.

12 ‘‘(4) CONTINUOUS COVERAGE.—An individual

13 shall not fail to be treated as having continuous cov14 erage if the aggregate breaks in coverage during any

15 1-year period are less than 60 days.

16 ‘‘(c) COORDINATION WITH OTHER DEDUCTIONS.—

17 Any amount paid by a taxpayer for any qualified long18 term care insurance contract to which subsection (a) ap19 plies shall not be taken into account in computing the
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1 amount allowable to the taxpayer as a deduction under

2 section 162(l) or 213(a).’’

3 (b) CONTINGENT NONFORFEITURE REQUIREMENTS

4 ADDED TO CONSUMER PROTECTION PROVISIONS.—

5 (1) Section 7702B(g)(2)(A)(i) of the Internal

6 Revenue Code of 1986 (relating to model regulation)

7 is amended by adding at the end the following new

8 subclause:

9 ‘‘(XII) Section 23 (relating to

10 contingent nonforfeiture benefits), if

11 the policyholder declines the offer of a

12 nonforfeiture provision described in

13 paragraph (4).’’

14 (2) Section 7702B(g)(2)(A)(ii) of such Code

15 (relating to model Act) is amended by adding at the

16 end the following new subclause:

17 ‘‘(III) Section 8 (relating to con18 tingent nonforfeiture benefits), if the

19 policyholder declines the offer of a

20 nonforfeiture provision described in

21 paragraph (4).’’

22 (c) REFERENCE TO NAIC MODEL ACT UPDATED.—

23 Section 7702B(g)(2)(B)(i) of the Internal Revenue Code

24 of 1986 (relating to model provisions) is amended by strik25 ing ‘‘January 1993’’ and inserting ‘‘January 1999’’.
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1 (d) LONG-TERM CARE INSURANCE PERMITTED TO

2 BE OFFERED UNDER CAFETERIA PLANS AND FLEXIBLE

3 SPENDING ARRANGEMENTS.—

4 (1) CAFETERIA PLANS.—Section 125(f) of the

5 Internal Revenue Code of 1986 (defining qualified

6 benefits) is amended by inserting before the period

7 at the end ‘‘; except that such term shall include

8 the payment of premiums for any qualified long9 term care insurance contract (as defined in section

10 7702B) to the extent the amount of such payment

11 does not exceed the eligible long-term care premiums

12 (as defined in section 213(d)(10)) for such con13 tract’’.

14 (2) FLEXIBLE SPENDING ARRANGEMENTS.—

15 Section 106 of such Code (relating to contributions

16 by an employer to accident and health plans) is

17 amended by striking subsection (c).

18 (e) CONFORMING AMENDMENTS.—

19 (1) Section 62(a) of the Internal Revenue Code

20 of 1986 is amended by inserting after paragraph

21 (17) the following new item:

22 ‘‘(18) PREMIUMS ON QUALIFIED LONG-TERM

23 CARE INSURANCE CONTRACTS.—The deduction al24 lowed by section 222.’’
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1 (2) Section 7702B(g)(2)(A)(i) of such Code, as

2 amended by subsection (b)(1), is amended by strik3 ing ‘‘7A’’ both places it appears, ‘‘7B’’, ‘‘7C’’, ‘‘7D’’,

4 ‘‘7E’’, ‘‘8’’, ‘‘9’’, ‘‘9F’’, ‘‘10’’, ‘‘11’’, ‘‘12’’, and ‘‘23’’

5 the first place it appears and inserting ‘‘6A’’, ‘‘6B’’,

6 ‘‘6C’’, ‘‘6D’’, ‘‘6E’’, ‘‘7’’, ‘‘8’’, ‘‘8F’’, ‘‘9’’, ‘‘10’’,

7 ‘‘11’’, and ‘‘22’’, respectively.

8 (3) Section 4980C(c)(1)(A) of such Code is

9 amended by striking ‘‘13’’, ‘‘14’’, ‘‘20’’, ‘‘21’’,

10 ‘‘21C(1)’’, ‘‘21C(6)’’, ‘‘22’’, ‘‘24’’, and ‘‘25’’ and in11 serting ‘‘12’’, ‘‘13’’, ‘‘19’’, ‘‘20C(1)’’, ‘‘20C(6)’’,

12 ‘‘21’’, ‘‘25’’, and ‘‘26’’, respectively.

13 (4) The table of sections for part VII of sub14 chapter B of chapter 1 of such Code is amended by

15 striking the last item and inserting the following

16 new items:

‘‘Sec. 222. Premiums on qualified long-term care insurance contracts.

‘‘Sec. 223. Cross reference.’’

17 (f) EFFECTIVE DATES.—

18 (1) IN GENERAL.—Except as provided in para19 graphs (2) and (3), the amendments made by this

20 section shall apply to taxable years beginning after

21 December 31, 2000.

22 (2) CONSUMER PROTECTION PROVISIONS.—The

23 amendments made by subsections (b), (c), (e)(2),

24 and (e)(3) shall apply to policies issued after the
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1 date which is 1 year after the date of the enactment

2 of this Act.

3 (3) CAFETERIA PLANS AND FLEXIBLE SPEND4 ING ARRANGEMENTS.—The amendments made by

5 subsection (c) shall apply to taxable years beginning

6 after December 31, 2001.

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

8 NEEDS.

9 (a) IN GENERAL.—Subpart A of part IV of sub10 chapter A of chapter 1 of the Internal Revenue Code of

11 1986 (relating to nonrefundable personal credits) is

12 amended by inserting after section 25A the following new

13 section:

14 ‘‘SEC. 25B. CREDIT FOR TAXPAYERS WITH LONG-TERM

15 CARE NEEDS.

16 ‘‘(a) ALLOWANCE OF CREDIT.—

17 ‘‘(1) IN GENERAL.—There shall be allowed as a

18 credit against the tax imposed by this chapter for

19 the taxable year an amount equal to the applicable

20 credit amount multiplied by the number of applica21 ble individuals with respect to whom the taxpayer is

22 an eligible caregiver for the taxable year.

23 ‘‘(2) APPLICABLE CREDIT AMOUNT.—For pur24 poses of paragraph (1), the applicable credit amount
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1 shall be determined in accordance with the following

2 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.

3 ‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN4 COME.—

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

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

7 not below zero) by $100 for each $1,000 (or fraction

8 thereof) by which the taxpayer’s modified adjusted

9 gross income exceeds the threshold amount. For

10 purposes of the preceding sentence, the term ‘modi11 fied adjusted gross income’ means adjusted gross in12 come increased by any amount excluded from gross

13 income under section 911, 931, or 933.

14 ‘‘(2) THRESHOLD AMOUNT.—For purposes of

15 paragraph (1), the term ‘threshold amount’ means—

16 ‘‘(A) $150,000 in the case of a joint re17 turn, and

18 ‘‘(B) $75,000 in any other case.

19 ‘‘(3) INDEXING.—In the case of any taxable

20 year beginning in a calendar year after 2001, each

21 dollar amount contained in paragraph (2) shall be

22 increased by an amount equal to the product of—
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1 ‘‘(A) such dollar amount, and

2 ‘‘(B) the medical care cost adjustment de3 termined under section 213(d)(10)(B)(ii) for

4 the calendar year in which the taxable year be5 gins, determined by substituting ‘August of

6 2000’ for ‘August of 1996’ in subclause (II)

7 thereof.

8 If any increase determined under the preceding sen9 tence is not a multiple of $50, such increase shall

10 be rounded to the next lowest multiple of $50.

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

12 ‘‘(1) APPLICABLE INDIVIDUAL.—

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

14 individual’ means, with respect to any taxable

15 year, any individual who has been certified, be16 fore the due date for filing the return of tax for

17 the taxable year (without extensions), by a phy18 sician (as defined in section 1861(r)(1) of the

19 Social Security Act) as being an individual with

20 long-term care needs described in subparagraph

21 (B) for a period—

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

23 days, and

24 ‘‘(ii) a portion of which occurs within

25 the taxable year.
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1 Such term shall not include any individual oth2 erwise meeting the requirements of the preceding sentence unless within the 391 3 ⁄2 month

4 period ending on such due date (or such other

5 period as the Secretary prescribes) a physician

6 (as so defined) has certified that such indi7 vidual meets such requirements.

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

9 NEEDS.—An individual is described in this sub10 paragraph if the individual meets any of the fol11 lowing requirements:

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

13 of age and—

14 ‘‘(I) is unable to perform (with15 out substantial assistance from an16 other individual) at least 3 activities

17 of daily living (as defined in section

18 7702B(c)(2)(B)) due to a loss of

19 functional capacity, or

20 ‘‘(II) requires substantial super21 vision to protect such individual from

22 threats to health and safety due to se23 vere cognitive impairment and is un24 able to preform, without reminding or

25 cuing assistance, at least 1 activity of
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1 daily living (as so defined) or to the

2 extent provided in regulations pre3 scribed by the Secretary (in consulta4 tion with the Secretary of Health and

5 Human Services), is unable to engage

6 in age appropriate activities.

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

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

9 loss of functional capacity to perform

10 (without substantial assistance from an11 other individual) at least 2 of the following

12 activities: eating, transferring, or mobility.

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

14 of age and requires specific durable med15 ical equipment by reason of a severe health

16 condition or requires a skilled practitioner

17 trained to address the individual’s condi18 tion to be available if the individual’s par19 ents or guardians are absent.

20 ‘‘(2) ELIGIBLE CAREGIVER.—

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

22 treated as an eligible caregiver for any taxable

23 year with respect to the following individuals:

24 ‘‘(i) The taxpayer.

25 ‘‘(ii) The taxpayer’s spouse.
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1 ‘‘(iii) An individual with respect to

2 whom the taxpayer is allowed a deduction

3 under section 151 for the taxable year.

4 ‘‘(iv) An individual who would be de5 scribed in clause (iii) for the taxable year

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

7 substituting for the exemption amount an

8 amount equal to the sum of the exemption

9 amount, the standard deduction under sec10 tion 63(c)(2)(C), and any additional stand11 ard deduction under section 63(c)(3) which

12 would be applicable to the individual if

13 clause (iii) applied.

14 ‘‘(v) An individual who would be de15 scribed in clause (iii) for the taxable year

16 if—

17 ‘‘(I) the requirements of clause

18 (iv) are met with respect to the indi19 vidual, and

20 ‘‘(II) the requirements of sub21 paragraph (B) are met with respect to

22 the individual in lieu of the support

23 test of section 152(a).

24 ‘‘(B) RESIDENCY TEST.—The require25 ments of this subparagraph are met if an indi-
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1 vidual has as his principal place of abode the

2 home of the taxpayer and—

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

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

7 half the taxable year, or

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

10 household for the entire taxable year.

11 ‘‘(C) SPECIAL RULES WHERE MORE THAN

12 1 ELIGIBLE CAREGIVER.—

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

16 taxable years ending with or within the

17 same calendar year, a taxpayer shall be

18 treated as the eligible caregiver if each

19 such individual (other than the taxpayer)

20 files a written declaration (in such form

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

23 such applicable individual for the credit

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

3 written declaration under clause (i) does

4 not do so, the individual with the highest

5 modified adjusted gross income (as defined

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

7 eligible caregiver.

8 ‘‘(iii) MARRIED INDIVIDUALS FILING

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

11 under this subparagraph as to whether the

12 husband or wife is the eligible caregiver

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

14 (whether or not one of them has filed a

15 written declaration under clause (i)).

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

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

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

22 the taxable year.

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

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

3 (b) CONFORMING AMENDMENTS.—

4 (1) Section 6213(g)(2) of the Internal Revenue

5 Code of 1986 is amended by striking ‘‘and’’ at the

6 end of subparagraph (K), by striking the period at

7 the end of subparagraph (L) and inserting ‘‘, and’’,

8 and by inserting after subparagraph (L) the fol9 lowing new subparagraph:

10 ‘‘(M) an omission of a correct TIN or phy11 sician identification required under section

12 25B(d) (relating to credit for taxpayers with

13 long-term care needs) to be included on a re14 turn.’’

15 (2) The table of sections for subpart A of part

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

17 amended by inserting after the item relating to sec18 tion 25A the following new item:

‘‘Sec. 25B. Credit for taxpayers with long-term care needs.’’

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

20 this section shall apply to taxable years beginning after

21 December 31, 2000.
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1 Subtitle B—Federal Employees and

2 Uniformed Services Group

3 Long-Term Care Insurance

4 SEC. 111. SHORT TITLE.

5 This subtitle may be cited as the ‘‘Long-Term Care

6 Security Act’’.

7 SEC. 112. LONG-TERM CARE INSURANCE.

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

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

10 following:

11 ‘‘CHAPTER 90—LONG-TERM CARE

12 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.

13 ‘‘§ 9001. Definitions

14 For purposes of this chapter:

15 ‘‘(1) EMPLOYEE.—The term ‘employee’

16 means—

17 ‘‘(A) an employee as defined by section

18 8901(1); and

19 ‘‘(B) an individual described in section

20 2105(e);
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1 but does not include an individual employed by the

2 government of the District of Columbia.

3 ‘‘(2) ANNUITANT.—The term ‘annuitant’ has

4 the meaning such term would have under paragraph

5 (3) of section 8901 if, for purposes of such para6 graph, the term ‘employee’ were considered to have

7 the meaning given to it under paragraph (1) of this

8 subsection.

9 ‘‘(3) MEMBER OF THE UNIFORMED SERV10 ICES.—The term ‘member of the uniformed services’

11 means a member of the uniformed services, other

12 than a retired member of the uniformed services.

13 ‘‘(4) RETIRED MEMBER OF THE UNIFORMED

14 SERVICES.—The term ‘retired member of the uni15 formed services’ means a member or former member

16 of the uniformed services entitled to retired or re17 tainer pay.

18 ‘‘(5) QUALIFIED RELATIVE.—The term ‘quali19 fied relative’ means each of the following:

20 ‘‘(A) The spouse of an individual described

21 in paragraph (1), (2), (3), or (4).

22 ‘‘(B) A parent, stepparent, or parent-in23 law of an individual described in paragraph (1)

24 or (3).
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1 ‘‘(C) A child (including an adopted child, a

2 stepchild, or, to the extent the Office of Per3 sonnel Management by regulation provides, a

4 foster child) of an individual described in para5 graph (1), (2), (3), or (4), if such child is at

6 least 18 years of age.

7 ‘‘(D) An individual having such other rela8 tionship to an individual described in paragraph

9 (1), (2), (3), or (4) as the Office may by regula10 tion prescribe.

11 ‘‘(6) ELIGIBLE INDIVIDUAL.—The term ‘eligible

12 individual’ refers to an individual described in para13 graph (1), (2), (3), (4), or (5).

14 ‘‘(7) QUALIFIED CARRIER.—The term ‘qualified

15 carrier’ means an insurance company (or consortium

16 of insurance companies) that is licensed to issue

17 long-term care insurance in all States, taking any

18 subsidiaries of such a company into account (and, in

19 the case of a consortium, considering the member

20 companies and any subsidiaries thereof, collectively).

21 ‘‘(8) STATE.—The term ‘State’ includes the

22 District of Columbia.

23 ‘‘(9) QUALIFIED LONG-TERM CARE INSURANCE

24 CONTRACT.—The term ‘qualified long-term care in25 surance contract’ has the meaning given such term
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1 by section 7702B of the Internal Revenue Code of

2 1986.

3 ‘‘(10) APPROPRIATE SECRETARY.—The term

4 ‘appropriate Secretary’ means—

5 ‘‘(A) except as otherwise provided in this

6 paragraph, the Secretary of Defense;

7 ‘‘(B) with respect to the Coast Guard when

8 it is not operating as a service of the Navy, the

9 Secretary of Transportation;

10 ‘‘(C) with respect to the commissioned

11 corps of the National Oceanic and Atmospheric

12 Administration, the Secretary of Commerce;

13 and

14 ‘‘(D) with respect to the commissioned

15 corps of the Public Health Service, the Sec16 retary of Health and Human Services.

17 ‘‘§ 9002. Availability of insurance

18 ‘‘(a) IN GENERAL.—The Office of Personnel Manage19 ment shall establish and, in consultation with the appro20 priate Secretaries, administer a program through which

21 an individual described in paragraph (1), (2), (3), (4), or

22 (5) of section 9001 may obtain long-term care insurance

23 coverage under this chapter for such individual.

24 ‘‘(b) GENERAL REQUIREMENTS.—Long-term care in25 surance may not be offered under this chapter unless—
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1 ‘‘(1) the only coverage provided is under quali2 fied long-term care insurance contracts; and

3 ‘‘(2) each insurance contract under which any

4 such coverage is provided is issued by a qualified

5 carrier.

6 ‘‘(c) DOCUMENTATION REQUIREMENT.—As a condi7 tion for obtaining long-term care insurance coverage under

8 this chapter based on one’s status as a qualified relative,

9 an applicant shall provide documentation to demonstrate

10 the relationship, as prescribed by the Office.

11 ‘‘(d) UNDERWRITING STANDARDS.—

12 ‘‘(1) DISQUALIFYING CONDITION.—Nothing in

13 this chapter shall be considered to require that long14 term care insurance coverage be made available in

15 the case of any individual who would be eligible for

16 benefits immediately.

17 ‘‘(2) SPOUSAL PARITY.—For the purpose of un18 derwriting standards, a spouse of an individual de19 scribed in paragraph (1), (2), (3), or (4) of section

20 9001 shall, as nearly as practicable, be treated like

21 that individual.

22 ‘‘(3) GUARANTEED ISSUE.—Nothing in this

23 chapter shall be considered to require that long-term

24 care insurance coverage be guaranteed to an eligible

25 individual.
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1 ‘‘(4) REQUIREMENT THAT CONTRACT BE FULLY

2 INSURED.—In addition to the requirements other3 wise applicable under section 9001(9), in order to be

4 considered a qualified long-term care insurance con5 tract for purposes of this chapter, a contract shall

6 be fully insured, whether through reinsurance with

7 other companies or otherwise.

8 ‘‘(5) HIGHER STANDARDS ALLOWABLE.—Noth9 ing in this chapter shall, in the case of an individual

10 applying for long-term care insurance coverage

11 under this chapter after the expiration of such indi12 vidual’s first opportunity to enroll, preclude the ap13 plication of underwriting standards more stringent

14 than those that would have applied if that oppor15 tunity had not yet expired.

16 ‘‘(e) GUARANTEED RENEWABILITY.—The benefits

17 and coverage made available to eligible individuals under

18 any insurance contract under this chapter shall be guaran19 teed renewable (as defined by section 7A(2) of the model

20 regulations described in section 7702B(g)(2) of the Inter21 nal Revenue Code of 1986), including the right to have

22 insurance remain in effect so long as premiums continue

23 to be timely made. However, the authority to revise pre24 miums under this chapter shall be available only on a class
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1 basis and only to the extent otherwise allowable under sec2 tion 9003(b).

3 ‘‘§ 9003. Contracting authority

4 ‘‘(a) IN GENERAL.—Without regard to section 3709

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

6 requiring competitive bidding, the Office of Personnel

7 Management shall contract with 1 or more qualified car8 riers for a policy or policies of long-term care insurance.

9 The Office shall ensure that each resulting contract (in

10 this chapter referred to as a ‘master contract’) is awarded

11 on the basis of contractor qualifications, price, and reason12 able competition.

13 ‘‘(b) TERMS AND CONDITIONS.—

14 ‘‘(1) IN GENERAL.—Each master contract

15 under this chapter shall contain—

16 ‘‘(A) a detailed statement of the benefits

17 offered (including any maximums, limitations,

18 exclusions, and other definitions of benefits);

19 ‘‘(B) the premiums charged (including any

20 limitations or other conditions on their subse21 quent adjustment);

22 ‘‘(C) the terms of the enrollment period;

23 and

24 ‘‘(D) such other terms and conditions as

25 may be mutually agreed to by the Office and
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1 the carrier involved, consistent with the require2 ments of this chapter.

3 ‘‘(2) PREMIUMS.—Premiums charged under

4 each master contract entered into under this section

5 shall reasonably and equitably reflect the cost of the

6 benefits provided, as determined by the Office. The

7 premiums shall not be adjusted during the term of

8 the contract unless mutually agreed to by the Office

9 and the carrier.

10 ‘‘(3) NONRENEWABILITY.—Master contracts

11 under this chapter may not be made automatically

12 renewable.

13 ‘‘(c) PAYMENT OF REQUIRED BENEFITS; DISPUTE

14 RESOLUTION.—

15 ‘‘(1) IN GENERAL.—Each master contract

16 under this chapter shall require the carrier to

17 agree—

18 ‘‘(A) to provide payments or benefits to an

19 eligible individual if such individual is entitled

20 to such payments or benefits under the terms

21 of the contract; and

22 ‘‘(B) with respect to disputes regarding

23 claims for payments or benefits under the terms

24 of the contract—
25

•S 2935 IS

1 ‘‘(i) to establish internal procedures

2 designed to expeditiously resolve such dis3 putes; and

4 ‘‘(ii) to establish, for disputes not re5 solved through procedures under clause (i),

6 procedures for 1 or more alternative means

7 of dispute resolution involving independent

8 third-party review under appropriate cir9 cumstances by entities mutually acceptable

10 to the Office and the carrier.

11 ‘‘(2) ELIGIBILITY.—A carrier’s determination

12 as to whether or not a particular individual is eligi13 ble to obtain long-term care insurance coverage

14 under this chapter shall be subject to review only to

15 the extent and in the manner provided in the appli16 cable master contract.

17 ‘‘(3) OTHER CLAIMS.—For purposes of apply18 ing the Contract Disputes Act of 1978 to disputes

19 arising under this chapter between a carrier and the

20 Office—

21 ‘‘(A) the agency board having jurisdiction

22 to decide an appeal relative to such a dispute

23 shall be such board of contract appeals as the

24 Director of the Office of Personnel Management

25 shall specify in writing (after appropriate ar-
26

•S 2935 IS

1 rangements, as described in section 8(c) of such

2 Act); and

3 ‘‘(B) the district courts of the United

4 States shall have original jurisdiction, concur5 rent with the United States Court of Federal

6 Claims, of any action described in section

7 10(a)(1) of such Act relative to such a dispute.

8 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in

9 this chapter shall be considered to grant authority

10 for the Office or a third-party reviewer to change the

11 terms of any contract under this chapter.

12 ‘‘(d) DURATION.—

13 ‘‘(1) IN GENERAL.—Each master contract

14 under this chapter shall be for a term of 7 years,

15 unless terminated earlier by the Office in accordance

16 with the terms of such contract. However, the rights

17 and responsibilities of the enrolled individual, the in18 surer, and the Office (or duly designated third-party

19 administrator) under such contract shall continue

20 with respect to such individual until the termination

21 of coverage of the enrolled individual or the effective

22 date of a successor contract.

23 ‘‘(2) EXCEPTION.—

24 ‘‘(A) SHORTER DURATION.—In the case of

25 a master contract entered into before the end of
27

•S 2935 IS

1 the period described in subparagraph (B), para2 graph (1) shall be applied by substituting ‘end3 ing on the last day of the 7-year period de4 scribed in paragraph (2)(B)’ for ‘of 7 years’.

5 ‘‘(B) DEFINITION.—The period described

6 in this subparagraph is the 7-year period begin7 ning on the earliest date as of which any long8 term care insurance coverage under this chapter

9 becomes effective.

10 ‘‘(3) CONGRESSIONAL NOTIFICATION.—No later

11 than 180 days after receiving the second report re12 quired under section 9006(c), the President (or his

13 designee) shall submit to the Committees on Govern14 ment Reform and on Armed Services of the House

15 of Representatives and the Committees on Govern16 mental Affairs and on Armed Services of the Senate,

17 a written recommendation as to whether the pro18 gram under this chapter should be continued with19 out modification, terminated, or restructured. Dur20 ing the 180-day period following the date on which

21 the President (or his designee) submits the rec22 ommendation required under the preceding sentence,

23 the Office of Personnel Management may not take

24 any steps to rebid or otherwise contract for any cov25 erage to be available at any time following the expi-
28

•S 2935 IS

1 ration of the 7-year period described in paragraph

2 (2)(B).

3 ‘‘(4) FULL PORTABILITY.—Each master con4 tract under this chapter shall include such provisions

5 as may be necessary to ensure that, once an indi6 vidual becomes duly enrolled, long-term care insur7 ance coverage obtained by such individual pursuant

8 to that enrollment shall not be terminated due to

9 any change in status (such as separation from Gov10 ernment service or the uniformed services) or ceas11 ing to meet the requirements for being considered a

12 qualified relative (whether as a result of dissolution

13 of marriage or otherwise).

14 ‘‘§ 9004. Financing

15 ‘‘(a) IN GENERAL.—Each eligible individual obtain16 ing long-term care insurance coverage under this chapter

17 shall be responsible for 100 percent of the premiums for

18 such coverage.

19 ‘‘(b) WITHHOLDINGS.—

20 ‘‘(1) IN GENERAL.—The amount necessary to

21 pay the premiums for enrollment may—

22 ‘‘(A) in the case of an employee, be with23 held from the pay of such employee;

24 ‘‘(B) in the case of an annuitant, be with25 held from the annuity of such annuitant;
29

•S 2935 IS

1 ‘‘(C) in the case of a member of the uni2 formed services described in section 9001(3), be

3 withheld from the basic pay of such member;

4 and

5 ‘‘(D) in the case of a retired member of

6 the uniformed services described in section

7 9001(4), be withheld from the retired pay or re8 tainer pay payable to such member.

9 ‘‘(2) VOLUNTARY WITHHOLDINGS FOR QUALI10 FIED RELATIVES.—Withholdings to pay the pre11 miums for enrollment of a qualified relative may,

12 upon election of the appropriate eligible individual

13 (described in section 9001 (1) through (4)), be with14 held under paragraph (1) to the same extent and in

15 the same manner as if enrollment were for such in16 dividual.

17 ‘‘(c) DIRECT PAYMENTS.—All amounts withheld

18 under this section shall be paid directly to the carrier.

19 ‘‘(d) OTHER FORMS OF PAYMENT.—Any enrollee

20 who does not elect to have premiums withheld under sub21 section (b) or whose pay, annuity, or retired or retainer

22 pay (as referred to in subsection (b)(1)) is insufficient to

23 cover the withholding required for enrollment (or who is

24 not receiving any regular amounts from the Government,

25 as referred to in subsection (b)(1), from which any such
30

•S 2935 IS

1 withholdings may be made, and whose premiums are not

2 otherwise being provided for under subsection (b)(2)) shall

3 pay an amount equal to the full amount of those charges

4 directly to the carrier.

5 ‘‘(e) SEPARATE ACCOUNTING REQUIREMENT.—Each

6 carrier participating under this chapter shall maintain

7 records that permit it to account for all amounts received

8 under this chapter (including investment earnings on

9 those amounts) separate and apart from all other funds.

10 ‘‘(f) REIMBURSEMENTS.—

11 ‘‘(1) REASONABLE INITIAL COSTS.—

12 ‘‘(A) IN GENERAL.—The Employees’ Life

13 Insurance Fund is available, without fiscal year

14 limitation, for reasonable expenses incurred by

15 the Office of Personnel Management in admin16 istering this chapter before the start of the 7-

17 year period described in section 9003(d)(2)(B),

18 including reasonable implementation costs.

19 ‘‘(B) REIMBURSEMENT REQUIREMENT.—

20 Such Fund shall be reimbursed, before the end

21 of the first year of that 7-year period, for all

22 amounts obligated or expended under subpara23 graph (A) (including lost investment income).

24 Such reimbursement shall be made by carriers,

25 on a pro rata basis, in accordance with appro-
31

•S 2935 IS

1 priate provisions which shall be included in

2 master contracts under this chapter.

3 ‘‘(2) SUBSEQUENT COSTS.—

4 ‘‘(A) IN GENERAL.—There is established in

5 the Employees’ Life Insurance Fund a Long6 Term Care Administrative Account, which shall

7 be available to the Office, without fiscal year

8 limitation, to defray reasonable expenses in9 curred by the Office in administering this chap10 ter after the start of the 7-year period described

11 in section 9003(d)(2)(B).

12 ‘‘(B) REIMBURSEMENT REQUIREMENT.—

13 Each master contract under this chapter shall

14 include appropriate provisions under which the

15 carrier involved shall, during each year, make

16 such periodic contributions to the Long-Term

17 Care Administrative Account as necessary to

18 ensure that the reasonable anticipated expenses

19 of the Office in administering this chapter dur20 ing such year (adjusted to reconcile for any ear21 lier overestimates or underestimates under this

22 subparagraph) are defrayed.

23 ‘‘§ 9005. Preemption

24 ‘‘The terms of any contract under this chapter which

25 relate to the nature, provision, or extent of coverage or
32

•S 2935 IS

1 benefits (including payments with respect to benefits)

2 shall supersede and preempt any State or local law, or

3 any regulation issued under such law, which relates to

4 long-term care insurance or contracts.

5 ‘‘§ 9006. Studies, reports, and audits

6 ‘‘(a) PROVISIONS RELATING TO CARRIERS.—Each

7 master contract under this chapter shall contain provi8 sions requiring the carrier—

9 ‘‘(1) to furnish such reasonable reports as the

10 Office of Personnel Management determines to be

11 necessary to enable it to carry out its functions

12 under this chapter; and

13 ‘‘(2) to permit the Office and representatives of

14 the General Accounting Office to examine such

15 records of the carrier as may be necessary to carry

16 out the purposes of this chapter.

17 ‘‘(b) PROVISIONS RELATING TO FEDERAL AGEN18 CIES.—Each Federal agency shall keep such records,

19 make such certifications, and furnish the Office, the car20 rier, or both, with such information and reports as the

21 Office may require.

22 ‘‘(c) REPORTS BY THE GENERAL ACCOUNTING OF23 FICE.—The General Accounting Office shall prepare and

24 submit to the President, the Office of Personnel Manage25 ment, and each House of Congress, before the end of the
33

•S 2935 IS

1 third and fifth years during which the program under this

2 chapter is in effect, a written report evaluating such pro3 gram. Each such report shall include an analysis of the

4 competitiveness of the program, as compared to both

5 group and individual coverage generally available to indi6 viduals in the private insurance market. The Office shall

7 cooperate with the General Accounting Office to provide

8 periodic evaluations of the program.

9 ‘‘§ 9007. Jurisdiction of courts

10 ‘‘The district courts of the United States have origi11 nal jurisdiction of a civil action or claim described in para12 graph (1) or (2) of section 9003(c), after such administra13 tive remedies as required under such paragraph (1) or (2)

14 (as applicable) have been exhausted, but only to the extent

15 judicial review is not precluded by any dispute resolution

16 or other remedy under this chapter.

17 ‘‘§ 9008. Administrative functions

18 ‘‘(a) IN GENERAL.—The Office of Personnel Manage19 ment shall prescribe regulations necessary to carry out

20 this chapter.

21 ‘‘(b) ENROLLMENT PERIODS.—The Office shall pro22 vide for periodic coordinated enrollment, promotion, and

23 education efforts in consultation with the carriers.

24 ‘‘(c) CONSULTATION.—Any regulations necessary to

25 effect the application and operation of this chapter with
34

•S 2935 IS

1 respect to an eligible individual described in paragraph (3)

2 or (4) of section 9001, or a qualified relative of such an

3 individual, shall be prescribed by the Office in consultation

4 with the appropriate Secretary.

5 ‘‘(d) INFORMED DECISIONMAKING.—The Office shall

6 ensure that each eligible individual applying for long-term

7 care insurance under this chapter is furnished the infor8 mation necessary to enable that individual to evaluate the

9 advantages and disadvantages of obtaining long-term care

10 insurance under this chapter, including the following:

11 ‘‘(1) The principal long-term care benefits and

12 coverage available under this chapter, and how those

13 benefits and coverage compare to the range of long14 term care benefits and coverage otherwise generally

15 available.

16 ‘‘(2) Representative examples of the cost of

17 long-term care, and the sufficiency of the benefits

18 available under this chapter relative to those costs.

19 The information under this paragraph shall also

20 include—

21 ‘‘(A) the projected effect of inflation on the

22 value of those benefits; and

23 ‘‘(B) a comparison of the inflation-adjusted

24 value of those benefits to the projected future

25 costs of long-term care.
35

•S 2935 IS

1 ‘‘(3) Any rights individuals under this chapter

2 may have to cancel coverage, and to receive a total

3 or partial refund of premiums. The information

4 under this paragraph shall also include—

5 ‘‘(A) the projected number or percentage

6 of individuals likely to fail to maintain their

7 coverage (determined based on lapse rates expe8 rienced under similar group long-term care in9 surance programs and, when available, this

10 chapter); and

11 ‘‘(B)(i) a summary description of how and

12 when premiums for long-term care insurance

13 under this chapter may be raised;

14 ‘‘(ii) the premium history during the last

15 10 years for each qualified carrier offering long16 term care insurance under this chapter; and

17 ‘‘(iii) if cost increases are anticipated, the

18 projected premiums for a typical insured indi19 vidual at various ages.

20 ‘‘(4) The advantages and disadvantages of long21 term care insurance generally, relative to other

22 means of accumulating or otherwise acquiring the

23 assets that may be needed to meet the costs of long24 term care, such as through tax-qualified retirement

25 programs or other investment vehicles.
36

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1 ‘‘§ 9009. Cost accounting standards

2 ‘‘The cost accounting standards issued under section

3 26(f) of the Office of Federal Procurement Policy Act (41

4 U.S.C. 422(f)) shall not apply with respect to a long-term

5 care insurance contract under this chapter.’’.

6 (b) CONFORMING AMENDMENT.—The analysis for

7 part III of title 5, United States Code, is amended by add8 ing at the end of subpart G the following:

‘‘90. Long-Term Care Insurance ......................................................... 9001.’’.

9 SEC. 113. EFFECTIVE DATE.

10 The Office of Personnel Management shall take such

11 measures as may be necessary to ensure that long-term

12 care insurance coverage under title 5, United States Code,

13 as amended by this subtitle, may be obtained in time to

14 take effect not later than the first day of the first applica15 ble pay period of the first fiscal year which begins after

16 the end of the 18-month period beginning on the date of

17 enactment of this Act.

18 Subtitle C—Seniors’ Access to

19 Continuing Care

20 SEC. 121. SHORT TITLE.

21 This subtitle may be cited as the ‘‘Seniors’ Access

22 to Continuing Care Act of 2000’’.
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•S 2935 IS

1 SEC. 122. AMENDMENTS TO THE EMPLOYEE RETIREMENT

2 INCOME SECURITY ACT OF 1974.

3 (a) IN GENERAL.—Subpart B of part 7 of subtitle

4 B of title I of the Employee Retirement Income Security

5 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add6 ing at the end the following new section:

7 ‘‘SEC. 714. ENSURING CHOICE FOR CONTINUING CARE.

8 ‘‘(a) IN GENERAL.—With respect to health insurance

9 coverage provided to participants or beneficiaries through

10 a managed care organization under a group health plan,

11 or through a health insurance issuer providing health in12 surance coverage in connection with a group health plan,

13 such plan or issuer may not deny coverage for services

14 provided to such participant or beneficiary by a continuing

15 care retirement community, skilled nursing facility, or

16 other qualified facility in which the participant or bene17 ficiary resided prior to a hospitalization, regardless of

18 whether such organization is under contract with such

19 community or facility if the requirements described in sub20 section (b) are met.

21 ‘‘(b) REQUIREMENTS.—The requirements of this sub22 section are that—

23 ‘‘(1) the service involved is a service for which

24 the managed care organization involved would be re25 quired to provide or pay for under its contract with

26 the participant or beneficiary if the continuing care
38

•S 2935 IS

1 retirement community, skilled nursing facility, or

2 other qualified facility were under contract with the

3 organization;

4 ‘‘(2) the participant or beneficiary involved—

5 ‘‘(A) resided in the continuing care retire6 ment community, skilled nursing facility, or

7 other qualified facility prior to being hospital8 ized;

9 ‘‘(B) had a contractual or other right to

10 return to the facility after hospitalization; and

11 ‘‘(C) elects to return to the facility after

12 hospitalization, whether or not the residence of

13 the participant or beneficiary after returning

14 from the hospital is the same part of the facility

15 in which the beneficiary resided prior to hos16 pitalization;

17 ‘‘(3) the continuing care retirement community,

18 skilled nursing facility, or other qualified facility has

19 the capacity to provide the services the participant

20 or beneficiary needs;

21 ‘‘(4) the continuing care retirement community,

22 skilled nursing facility, or other qualified facility is

23 willing to accept substantially similar payment under

24 the same terms and conditions that apply to simi-
39

•S 2935 IS

1 larly situated health care facility providers under

2 contract with the organization involved.

3 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

4 group health plan or health insurance issuer to which this

5 section applies may not deny payment for a skilled nursing

6 service provided to a participant or beneficiary by a con7 tinuing care retirement community, skilled nursing facil8 ity, or other qualified facility in which the participant or

9 beneficiary resides, without a preceding hospital stay, re10 gardless of whether the organization is under contract

11 with such community or facility, if—

12 ‘‘(1) the plan or issuer has determined that the

13 service is necessary to prevent the hospitalization of

14 the participant or beneficiary; and

15 ‘‘(2) the service to prevent hospitalization is

16 provided as an additional benefit as described in sec17 tion 417.594 of title 42, Code of Federal Regula18 tions, and would otherwise be covered as provided

19 for in subsection (b)(1).

20 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

21 health insurance issuer to which this section applies shall

22 not deny payment for services provided by a skilled nurs23 ing facility for the care of a participant or beneficiary, re24 gardless of whether the plan or issuer is under contract

25 with such facility, if the spouse of the participant or bene-
40

•S 2935 IS

1 ficiary is already a resident of such facility and the re2 quirements described in subsection (b) are met.

3 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—

4 ‘‘(1) where the attending acute care provider

5 and the participant or beneficiary (or a designated

6 representative of the participant or beneficiary where

7 the participant or beneficiary is physically or men8 tally incapable of making an election under this

9 paragraph) do not elect to pursue a course of treat10 ment necessitating continuing care; or

11 ‘‘(2) unless the community or facility involved—

12 ‘‘(A) meets all applicable licensing and cer13 tification requirements of the State in which it

14 is located; and

15 ‘‘(B) agrees to reimbursement for the care

16 of the participant or beneficiary at a rate simi17 lar to the rate negotiated by the managed care

18 organization with similar providers of care for

19 similar services.

20 ‘‘(f) PROHIBITIONS.—A group health plan and a

21 health insurance issuer providing health insurance cov22 erage in connection with a group health plan may not—

23 ‘‘(1) deny to an individual eligibility, or contin24 ued eligibility, to enroll or to renew coverage with a

25 managed care organization under the plan, solely for
41

•S 2935 IS

1 the purpose of avoiding the requirements of this sec2 tion;

3 ‘‘(2) provide monetary payments or rebates to

4 enrollees to encourage such enrollees to accept less

5 than the minimum protections available under this

6 section;

7 ‘‘(3) penalize or otherwise reduce or limit the

8 reimbursement of an attending physician because

9 such physician provided care to a participant or ben10 eficiary in accordance with this section; or

11 ‘‘(4) provide incentives (monetary or otherwise)

12 to an attending physician to induce such physician

13 to provide care to a participant or beneficiary in a

14 manner inconsistent with this section.

15 ‘‘(g) RULES OF CONSTRUCTION.—

16 ‘‘(1) HMO NOT OFFERING BENEFITS.—This

17 section shall not apply with respect to any managed

18 care organization under a group health plan, or

19 through a health insurance issuer providing health

20 insurance coverage in connection with a group health

21 plan, that does not provide benefits for stays in a

22 continuing care retirement community, skilled nurs23 ing facility, or other qualified facility.

24 ‘‘(2) COST-SHARING.—Nothing in this section

25 shall be construed as preventing a managed care or-
42

•S 2935 IS

1 ganization under a group health plan, or through a

2 health insurance issuer providing health insurance

3 coverage in connection with a group health plan,

4 from imposing deductibles, coinsurance, or other

5 cost-sharing in relation to benefits for care in a con6 tinuing care facility.

7 ‘‘(h) PREEMPTION; EXCEPTION FOR HEALTH INSUR8 ANCE COVERAGE IN CERTAIN STATES.—

9 ‘‘(1) IN GENERAL.—The requirements of this

10 section shall not apply with respect to health insur11 ance coverage to the extent that a State law (as de12 fined in section 2723(d)(1) of the Public Health

13 Service Act) applies to such coverage and is de14 scribed in any of the following subparagraphs:

15 ‘‘(A) Such State law requires such cov16 erage to provide for referral to a continuing

17 care retirement community, skilled nursing fa18 cility, or other qualified facility in a manner

19 that is more protective of participants or bene20 ficiaries than the provisions of this section.

21 ‘‘(B) Such State law expands the range of

22 services or facilities covered under this section

23 and is otherwise more protective of the rights of

24 participants or beneficiaries than the provisions

25 of this section.
43

•S 2935 IS

1 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

2 not be construed to provide that any requirement of

3 this section applies with respect to health insurance

4 coverage, to the extent that a State law described in

5 paragraph (1) applies to such coverage.

6 ‘‘(i) PENALTIES.—A participant or beneficiary may

7 enforce the provisions of this section in an appropriate

8 Federal district court. An action for injunctive relief or

9 damages may be commenced on behalf of the participant

10 or beneficiary by the participant’s or beneficiary’s legal

11 representative. The court may award reasonable attorneys’

12 fees to the prevailing party. If a beneficiary dies before

13 conclusion of an action under this section, the action may

14 be maintained by a representative of the participant’s or

15 beneficiary’s estate.

16 ‘‘(j) DEFINITIONS.—In this section:

17 ‘‘(1) ATTENDING ACUTE CARE PROVIDER.—The

18 term ‘attending acute care provider’ means anyone

19 licensed or certified under State law to provide

20 health care services who is operating within the

21 scope of such license and who is primarily respon22 sible for the care of the enrollee.

23 ‘‘(2) CONTINUING CARE RETIREMENT COMMU24 NITY.—The term ‘continuing care retirement com25 munity’ means an organization that provides or ar-
44

•S 2935 IS

1 ranges for the provision of housing and health-re2 lated services to an older person under an agreement

3 effective for the life of the person or for a specified

4 period greater than 1 year.

5 ‘‘(3) MANAGED CARE ORGANIZATION.—The

6 term ‘managed care organization’ means an organi7 zation that provides comprehensive health services to

8 participants or beneficiaries, directly or under con9 tract or other agreement, on a prepayment basis to

10 such individuals. For purposes of this section, the

11 following shall be considered as managed care orga12 nizations:

13 ‘‘(A) A Medicare+Choice plan authorized

14 under section 1851(a) of the Social Security

15 Act (42 U.S.C. 1395w–21(a)).

16 ‘‘(B) Any other entity that manages the

17 cost, utilization, and delivery of health care

18 through the use of predetermined periodic pay19 ments to health care providers employed by or

20 under contract or other agreement, directly or

21 indirectly, with the entity.

22 ‘‘(4) OTHER QUALIFIED FACILITY.—The term

23 ‘other qualified facility’ means any facility that can

24 provide the services required by the participant or

25 beneficiary consistent with State and Federal law.
45

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1 ‘‘(5) SKILLED NURSING FACILITY.—The term

2 ‘skilled nursing facility’ means a facility that meets

3 the requirements of section 1819 of the Social Secu4 rity Act (42 U.S.C. 1395i–3).’’.

5 (b) CLERICAL AMENDMENT.—The table of contents

6 in section 1 of the Employee Retirement Income Security

7 Act of 1974 is amended by inserting after the items relat8 ing to subpart B of part 7 of subtitle B of title I the fol9 lowing new item:

‘‘Sec. 714. Ensuring choice for continuing care.’’.

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

11 this section shall apply with respect to plan years begin12 ning on or after January 1, 2001.

13 SEC. 123. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

14 ACT RELATING TO THE GROUP MARKET.

15 (a) IN GENERAL.—Subpart 2 of part A of title

16 XXVII of the Public Health Service Act (42 U.S.C.

17 300gg–4 et seq.) is amended by adding at the end the

18 following new section:

19 ‘‘SEC. 2707. ENSURING CHOICE FOR CONTINUING CARE.

20 ‘‘(a) IN GENERAL.—With respect to health insurance

21 coverage provided to enrollees through a managed care or22 ganization under a group health plan, or through a health

23 insurance issuer providing health insurance coverage in

24 connection with a group health plan, such plan or issuer

25 may not deny coverage for services provided to such en-
46

•S 2935 IS

1 rollee by a continuing care retirement community, skilled

2 nursing facility, or other qualified facility in which the en3 rollee resided prior to a hospitalization, regardless of

4 whether such organization is under contract with such

5 community or facility if the requirements described in sub6 section (b) are met.

7 ‘‘(b) REQUIREMENTS.—The requirements of this sub8 section are that—

9 ‘‘(1) the service involved is a service for which

10 the managed care organization involved would be re11 quired to provide or pay for under its contract with

12 the enrollee if the continuing care retirement com13 munity, skilled nursing facility, or other qualified fa14 cility were under contract with the organization;

15 ‘‘(2) the enrollee involved—

16 ‘‘(A) resided in the continuing care retire17 ment community, skilled nursing facility, or

18 other qualified facility prior to being hospital19 ized;

20 ‘‘(B) had a contractual or other right to

21 return to the facility after hospitalization; and

22 ‘‘(C) elects to return to the facility after

23 hospitalization, whether or not the residence of

24 the enrollee after returning from the hospital is
47

•S 2935 IS

1 the same part of the facility in which the bene2 ficiary resided prior to hospitalization;

3 ‘‘(3) the continuing care retirement community,

4 skilled nursing facility, or other qualified facility has

5 the capacity to provide the services the enrollee

6 needs;

7 ‘‘(4) the continuing care retirement community,

8 skilled nursing facility, or other qualified facility is

9 willing to accept substantially similar payment under

10 the same terms and conditions that apply to simi11 larly situated health care facility providers under

12 contract with the organization involved.

13 ‘‘(c) SERVICES TO PREVENT HOSPITALIZATION.—A

14 group health plan or health insurance issuer to which this

15 section applies may not deny payment for a skilled nursing

16 service provided to an enrollee by a continuing care retire17 ment community, skilled nursing facility, or other quali18 fied facility in which the enrollee resides, without a pre19 ceding hospital stay, regardless of whether the plan or

20 issuer is under contract with such community or facility,

21 if—

22 ‘‘(1) the plan or issuer has determined that the

23 service is necessary to prevent the hospitalization of

24 the enrollee; and
48

•S 2935 IS

1 ‘‘(2) the service to prevent hospitalization is

2 provided as an additional benefit as described in sec3 tion 417.594 of title 42, Code of Federal Regula4 tions, and would be covered as provided for in sub5 section (b)(1).

6 ‘‘(d) RIGHTS OF SPOUSES.—A group health plan or

7 health insurance issuer to which this section applies shall

8 not deny payment for services provided by a skilled nurs9 ing facility for the care of an enrollee, regardless of wheth10 er the plan or issuer is under contract with such facility,

11 if the spouse of the enrollee is already a resident of such

12 facility and the requirements described in subsection (b)

13 are met.

14 ‘‘(e) EXCEPTIONS.—Subsection (a) shall not apply—

15 ‘‘(1) where the attending acute care provider

16 and the enrollee (or a designated representative of

17 the enrollee where the enrollee is physically or men18 tally incapable of making an election under this

19 paragraph) do not elect to pursue a course of treat20 ment necessitating continuing care; or

21 ‘‘(2) unless the community or facility involved—

22 ‘‘(A) meets all applicable licensing and cer23 tification requirements of the State in which it

24 is located; and
49

•S 2935 IS

1 ‘‘(B) agrees to reimbursement for the care

2 of the enrollee at a rate similar to the rate ne3 gotiated by the managed care organization with

4 similar providers of care for similar services.

5 ‘‘(f) PROHIBITIONS.—A group health plan and a

6 health insurance issuer providing health insurance cov7 erage in connection with a group health plan may not—

8 ‘‘(1) deny to an individual eligibility, or contin9 ued eligibility, to enroll or to renew coverage with a

10 managed care organization under the plan, solely for

11 the purpose of avoiding the requirements of this sec12 tion;

13 ‘‘(2) provide monetary payments or rebates to

14 enrollees to encourage such enrollees to accept less

15 than the minimum protections available under this

16 section;

17 ‘‘(3) penalize or otherwise reduce or limit the

18 reimbursement of an attending physician because

19 such physician provided care to an enrollee in ac20 cordance with this section; or

21 ‘‘(4) provide incentives (monetary or otherwise)

22 to an attending physician to induce such physician

23 to provide care to an enrollee in a manner incon24 sistent with this section.

25 ‘‘(g) RULES OF CONSTRUCTION.—
50

•S 2935 IS

1 ‘‘(1) HMO NOT OFFERING BENEFITS.—This

2 section shall not apply with respect to any managed

3 care organization under a group health plan, or

4 through a health insurance issuer providing health

5 insurance coverage in connection with a group health

6 plan, that does not provide benefits for stays in a

7 continuing care retirement community, skilled nurs8 ing facility, or other qualified facility.

9 ‘‘(2) COST-SHARING.—Nothing in this section

10 shall be construed as preventing a managed care or11 ganization under a group health plan, or through a

12 health insurance issuer providing health insurance

13 coverage in connection with a group health plan,

14 from imposing deductibles, coinsurance, or other

15 cost-sharing in relation to benefits for care in a con16 tinuing care facility.

17 ‘‘(h) PREEMPTION; EXCEPTION FOR HEALTH INSUR18 ANCE COVERAGE IN CERTAIN STATES.—

19 ‘‘(1) IN GENERAL.—The requirements of this

20 section shall not apply with respect to health insur21 ance coverage to the extent that a State law (as de22 fined in section 2723(d)(1)) applies to such coverage

23 and is described in any of the following subpara24 graphs:
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1 ‘‘(A) Such State law requires such cov2 erage to provide for referral to a continuing

3 care retirement community, skilled nursing fa4 cility, or other qualified facility in a manner

5 that is more protective of the enrollee than the

6 provisions of this section.

7 ‘‘(B) Such State law expands the range of

8 services or facilities covered under this section

9 and is otherwise more protective of enrollee

10 rights than the provisions of this section.

11 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

12 not be construed to provide that any requirement of

13 this section applies with respect to health insurance

14 coverage, to the extent that a State law described in

15 paragraph (1) applies to such coverage.

16 ‘‘(i) PENALTIES.—An enrollee may enforce the provi17 sions of this section in an appropriate Federal district

18 court. An action for injunctive relief or damages may be

19 commenced on behalf of the enrollee by the enrollee’s legal

20 representative. The court may award reasonable attorneys’

21 fees to the prevailing party. If a beneficiary dies before

22 conclusion of an action under this section, the action may

23 be maintained by a representative of the enrollee’s estate.

24 ‘‘(j) DEFINITIONS.—In this section:
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1 ‘‘(1) ATTENDING ACUTE CARE PROVIDER.—The

2 term ‘attending acute care provider’ means anyone

3 licensed or certified under State law to provide

4 health care services who is operating within the

5 scope of such license and who is primarily respon6 sible for the care of the enrollee.

7 ‘‘(2) CONTINUING CARE RETIREMENT COMMU8 NITY.—The term ‘continuing care retirement com9 munity’ means an organization that provides or ar10 ranges for the provision of housing and health-re11 lated services to an older person under an agreement

12 effective for the life of the person or for a specified

13 period greater than 1 year.

14 ‘‘(3) MANAGED CARE ORGANIZATION.—The

15 term ‘managed care organization’ means an organi16 zation that provides comprehensive health services to

17 enrollees, directly or under contract or other agree18 ment, on a prepayment basis to such individuals.

19 For purposes of this section, the following shall be

20 considered as managed care organizations:

21 ‘‘(A) A Medicare+Choice plan authorized

22 under section 1851(a) of the Social Security

23 Act (42 U.S.C. 1395w–21(a)).

24 ‘‘(B) Any other entity that manages the

25 cost, utilization, and delivery of health care
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1 through the use of predetermined periodic pay2 ments to health care providers employed by or

3 under contract or other agreement, directly or

4 indirectly, with the entity.

5 ‘‘(4) OTHER QUALIFIED FACILITY.—The term

6 ‘other qualified facility’ means any facility that can

7 provide the services required by the enrollee con8 sistent with State and Federal law.

9 ‘‘(5) SKILLED NURSING FACILITY.—The term

10 ‘skilled nursing facility’ means a facility that meets

11 the requirements of section 1819 of the Social Secu12 rity Act (42 U.S.C. 1395i–3).’’.

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

14 this section shall apply with respect to group health plans

15 for plan years beginning on or after January 1, 2001.

16 SEC. 124. AMENDMENT TO THE PUBLIC HEALTH SERVICE

17 ACT RELATING TO THE INDIVIDUAL MARKET.

18 (a) IN GENERAL.—The first subpart 3 of part B of

19 title XXVII of the Public Health Service Act (42 U.S.C.

20 300gg–51 et seq.) (relating to other requirements) is

21 amended—

22 (1) by redesignating such subpart as subpart 2;

23 and

24 (2) by adding at the end the following new sec25 tion:
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1 ‘‘SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.

2 ‘‘The provisions of section 2707 shall apply to health

3 maintenance organization coverage offered by a health in4 surance issuer in the individual market in the same man5 ner as they apply to such coverage offered by a health

6 insurance issuer in connection with a group health plan

7 in the small or large group market.’’.

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

9 this section shall apply with respect to health insurance

10 coverage offered, sold, issued, renewed, in effect, or oper11 ated in the individual market on or after January 1, 2001.

12 SEC. 125. SENSE OF THE SENATE CONCERNING THE CARE

13 OF OLDER AMERICANS.

14 It is the sense of the Senate that—

15 (1) in the coming decade, people who are over

16 the age of 65 will constitute 20 percent or more of

17 the population of the United States;

18 (2) in the coming decade, the number of people

19 who are over the age of 85 and will most likely need

20 long-term care may double or triple;

21 (3) the number of persons who are age 65 or

22 older who have difficulty carrying out at least 1 ac23 tivity of daily living is estimated to increase between

24 the year 2000 and 2024 by 42 percent, or from 5.2

25 million persons to 7.4 million persons;
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1 (4) women rely on long-term care services for

2 more years than men do since women live longer;

3 (5) women who are age 65 or older are twice

4 as likely as men who are age 65 or older to have an

5 income of less than $10,000 per year;

6 (6) long-term care expenses can have a cata7 strophic effect on families, in that a lifetime of sav8 ings may be spent for long-term care expenses for a

9 spouse, parent, or grandparent before such spouse,

10 parent, or grandparent becomes eligible for govern11 mental assistance; and

12 (7) the Federal Government should be com13 mitted to providing benefits that are designed to en14 sure the physical, emotional, and financial well being

15 of older Americans in the new century.

16 Subtitle D—Expansion of Home17 Based Long-Term Care Services

18 Under the Social Services Block

19 Grant

20 SEC. 131. RESTORATION OF AUTHORITY TO TRANSFER UP

21 TO 10 PERCENT OF TANF FUNDS TO THE SO22 CIAL SERVICES BLOCK GRANT.

23 (a) IN GENERAL.—Section 404(d)(2) of the Social

24 Security Act (42 U.S.C. 604(d)(2)) is amended to read

25 as follows:
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1 ‘‘(2) LIMITATION ON AMOUNT TRANSFERABLE

2 TO TITLE XX PROGRAMS.—A State may use not

3 more than 10 percent of the amount of any grant

4 made to the State under section 403(a) for a fiscal

5 year to carry out State programs pursuant to title

6 XX.’’.

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

8 subsection (a) applies to amounts made available for fiscal

9 year 2001 and each fiscal year thereafter.

10 SEC. 132. RESTORATION OF FUNDS FOR THE SOCIAL SERV11 ICES BLOCK GRANT.

12 (a) IN GENERAL.—Section 2003(c)(11) of the Social

13 Security Act (42 U.S.C. 1397b(c)(11)) is amended to read

14 as follows:

15 ‘‘(11) $2,380,000,000 for the fiscal year 2001

16 and each fiscal year thereafter.’’.

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

18 subsection (a) applies to amounts made available for fiscal

19 year 2001 and each fiscal year thereafter.

20 SEC. 133. APPROPRIATION OF ADDITIONAL FUNDS FOR EX21 PANSION OF HOME-BASED LONG-TERM CARE

22 SERVICES.

23 (a) IN GENERAL.—Section 2003 of the Social Secu24 rity Act (42 U.S.C. 1397b) is amended by adding at the

25 end the following:
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1 ‘‘(d) With respect to any fiscal year in which the

2 amount appropriated to carry out this title equals or ex3 ceeds the amount specified in subsection (c) for such fiscal

4 year, an additional amount equal to 10 percent of the

5 amount so appropriated is hereby appropriated for such

6 fiscal year out of any funds in the Treasury not otherwise

7 appropriated. The additional amount appropriated under

8 this subsection shall be allotted among the States and ju9 risdictions described in subsections (a) and (b) in the same

10 manner as the allotments for such States and jurisdictions

11 are determined under such subsections. Amounts allotted

12 under this subsection shall be used to expand the provision

13 of home-based services for elderly or disabled individ14 uals.’’.

15 TITLE II—SUPPORT AND PLAN16 NING FOR LONG-TERM CARE

17 Subtitle A—Support and Surveys

18 SEC. 201. NATIONAL FAMILY CAREGIVER SUPPORT GRANT

19 PROGRAM.

20 (a) IN-HOME SERVICES.—Part D of title III of the

21 Older Americans Act of 1965 (42 U.S.C. 3030h et seq.)

22 is amended to read as follows:
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1 ‘‘PART D—NATIONAL FAMILY CAREGIVER

2 SUPPORT GRANT PROGRAM

3 ‘‘Subpart 1—State Grant Program

4 ‘‘SEC. 341. PROGRAM AUTHORIZED.

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

6 award grants to States with State plans approved under

7 section 307, to pay for the Federal share of the cost of

8 carrying out State programs and enable eligible area agen9 cies on aging to provide multifaceted systems of support

10 services for family caregivers and other caregivers who are

11 informal providers of in-home services and community

12 care for older individuals.

13 ‘‘(b) FAMILY CAREGIVER SUPPORT SERVICES.—In

14 providing services under this part, an area agency on

15 aging shall provide support services, including providing—

16 ‘‘(1) information to eligible caregivers about

17 available services;

18 ‘‘(2) assistance to eligible caregivers in gaining

19 access to the services;

20 ‘‘(3) individual counseling, organization of sup21 port groups, and caregiver training to eligible care22 givers to assist the caregivers in making decisions

23 and solving problems relating to their caregiving

24 roles;
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1 ‘‘(4) respite care to enable eligible caregivers to

2 be temporarily relieved from their caregiving respon3 sibilities; and

4 ‘‘(5) supplemental services, on a limited basis,

5 to complement the care provided by eligible care6 givers.

7 ‘‘(c) ELIGIBILITY AND PRIORITY.—

8 ‘‘(1) ELIGIBILITY.—In order for a caregiver of

9 an older individual to be eligible to receive services

10 provided by a State program under this part, the

11 State shall—

12 ‘‘(A) find that the caregiver is a caregiver

13 as described in subsection (a); and

14 ‘‘(B) determine that the older individual

15 meets the condition specified in subparagraph

16 (A)(i) of (B) of section 102(28).

17 ‘‘(2) PRIORITY.—In providing the services, the

18 State shall give priority for services to older individ19 uals with greatest social need and greatest economic

20 need, and older individuals providing care and sup21 ports to persons with mental retardation and related

22 developmental disabilities (as defined in section 102

23 of the Developmental Disabilities Assistance and Bill

24 of Rights Act (42 U.S.C. 6001) (referred to in this

25 part as ‘developmental disabilities’)) consistent with
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1 the requirements of section 305(a)(2)(E), and their

2 caregivers.

3 ‘‘(d) COORDINATION WITH SERVICE PROVIDERS.—

4 In carrying out this part, each area agency on aging shall

5 coordinate the activities of the agency with the activities

6 of other community agencies and voluntary organizations

7 providing the types of services described in subsection (b).

8 ‘‘(e) QUALITY STANDARDS AND MECHANISMS AND

9 ACCOUNTABILITY.—

10 ‘‘(1) QUALITY STANDARDS AND MECHANISMS.—

11 The State shall establish standards and mechanisms

12 designed to assure the quality of services provided

13 with assistance made available under this part.

14 ‘‘(2) DATA AND RECORDS.—The State shall col15 lect data and maintain records relating to the State

16 program in a standardized format specified by the

17 Assistant Secretary. The State shall furnish the

18 records to the Assistant Secretary, at such time as

19 the Assistant Secretary may require, in order to en20 able the Assistant Secretary to monitor State pro21 gram administration and compliance, and to evalu22 ate and compare the effectiveness of the State pro23 grams.

24 ‘‘(3) REPORTS.—The State shall prepare and

25 submit to the Assistant Secretary reports on the
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1 data and records required under paragraph (2), in2 cluding information on the services funded under

3 this part, and standards and mechanisms by which

4 the quality of the services shall be assured.

5 ‘‘(f) AVAILABILITY OF FUNDS.—

6 ‘‘(1) IN GENERAL.—A State shall use the por7 tion of the State allotment under section 304 that

8 is from amounts appropriated under section 303(d)

9 to carry out the State program under this part.

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

11 AREA PLANS.—Amounts made available to a State to

12 carry out the State program under this part may be

13 used, in addition to amounts available in accordance

14 with section 303(c)(1), for costs of administration of

15 area plans.

16 ‘‘(3) FEDERAL SHARE.—

17 ‘‘(A) IN GENERAL.—Notwithstanding sec18 tion 304(d)(1)(D), the Federal share of the cost

19 of carrying out a State program under this part

20 shall be 75 percent.

21 ‘‘(B) NON-FEDERAL SHARE.—The non22 Federal share of the costs shall be provided

23 from State and local sources.
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1 ‘‘SEC. 342. MAINTENANCE OF EFFORT.

2 ‘‘Funds made available under this part shall supple3 ment, and not supplant, any Federal, State, or local funds

4 expended by a State or unit of general purpose local gov5 ernment (including an area agency on aging) to provide

6 services described in section 341(b).

7 ‘‘Subpart 2—National Innovation Programs

8 ‘‘SEC. 346. INNOVATION GRANT PROGRAM.

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

10 carry out a program for making grants to appropriate en11 tities on a competitive basis to foster the development and

12 testing of new approaches to—

13 ‘‘(1) sustaining the efforts of family caregivers

14 and other informal caregivers of older individuals;

15 ‘‘(2) serving the needs of particular groups of

16 caregivers of older individuals, including minority

17 caregivers and distant caregivers; and

18 ‘‘(3) linking family support programs with the

19 State entity or agency that administers or funds

20 programs for persons with mental retardation or re21 lated developmental disabilities and their families.

22 ‘‘(b) EVALUATION AND DISSEMINATION OF RE23 SULTS.—The Assistant Secretary shall provide for evalua24 tion of the effectiveness of programs and activities funded

25 with grants made under this section, and for dissemina26 tion to States of descriptions and evaluations of the pro-
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1 grams and activities, to enable States to incorporate suc2 cessful approaches into their individual State programs

3 under this part.

4 ‘‘(c) AVAILABILITY OF FUNDS.—

5 ‘‘(1) IN GENERAL.—The Assistance Secretary

6 shall reserve not more than 10 percent of the

7 amount appropriated under section 303(d) for a fis8 cal year to carry out the program of the Assistant

9 Secretary under this section.

10 ‘‘(2) NATIVE AMERICAN PROGRAMS AND ACTIVI11 TIES.—Twenty percent of the amount reserved

12 under paragraph (1) shall be available for programs

13 and activities under this section for caregivers serv14 ing Indians and Native Hawaiians, as defined in sec15 tion 625.

16 ‘‘SEC. 347. ACTIVITIES OF NATIONAL SIGNIFICANCE.

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

18 directly or by grant or contract, carry out activities of na19 tional significance to promote quality and continuous im20 provement in the support services provided to family care21 givers and other informal caregivers of older individuals,

22 through program evaluation, training, technical assist23 ance, and research.

24 ‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec25 retary shall reserve not more than 2 percent of the amount
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1 appropriated under section 303(d) to carry out the activi2 ties under this section.’’.

3 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

4 303(d) of the Older Americans Act of 1965 (42 U.S.C.

5 3032(d)) is amended to read as follows:

6 ‘‘(d) There are authorized to be appropriated

7 $125,000,000 for fiscal year 2001, and such sums as may

8 be necessary for each of fiscal years 2002 through 2005,

9 to carry out part D (relating to the national family care10 giver support grant program).’’.

11 (c) CONFORMING AMENDMENT.—

12 (1) TRANSFER OF DEFINITION.—Section 102 of

13 the Older Americans Act of 1965 (42 U.S.C. 3002)

14 is amended by adding at the end the following:

15 ‘‘(45) The term ‘in-home services’ includes—

16 ‘‘(A) services of homemakers and home

17 health aides;

18 ‘‘(B) visiting and telephone reassurance;

19 ‘‘(C) chore maintenance;

20 ‘‘(D) in-home respite care for families, and

21 adult day care as a respite service for families;

22 ‘‘(E) minor modification of homes that is

23 necessary to facilitate the ability of older indi24 viduals to remain at home, that is not available
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1 under another program (other than a program

2 carried out under this Act);

3 ‘‘(F) personal care services; and

4 ‘‘(G) other in-home services as defined—

5 ‘‘(i) by the State agency in the State

6 plan submitted in accordance with section

7 307; and

8 ‘‘(ii) by the area agency on aging in

9 the area plan submitted in accordance with

10 section 306.’’.

11 (2) REFERENCES.—

12 (A) Section 307(a)(10) of such Act (42

13 U.S.C. 3027(a)(10)) is amended by striking

14 ‘‘(as defined in section 342)’’.

15 (B) Sections 382 and 383 of such Act (42

16 U.S.C. 3030q, 3030r) are repealed.

17 (C) Section 429F(a) of such Act (42

18 U.S.C. 30305n) is amended—

19 (i) by striking paragraph (2); and

20 (ii) by striking ‘‘this section:’’ and all

21 that follows through ‘‘The term’’ and in22 serting ‘‘this section, the term’’.

23 SEC. 202. COMMUNITY SURVEY.

24 (a) IN GENERAL.—The Secretary of Health and

25 Human Services shall conduct a multi-city and county sur-
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1 vey to determine if communities are elder-ready, or pre2 pared to accommodate the needs of aging baby boomers.

3 (b) PURPOSE.—The Secretary shall conduct the sur4 vey described in subsection (a) to determine if cities and

5 counties across the United States are prepared to accom6 modate the needs of aging baby boomers regarding hous7 ing, safety, health care, transportation, and access to com8 munity services and leisure activities.

9 (c) TITLE OF SURVEY.—The survey described in sub10 section (a) shall be entitled ‘‘Is Your Community Elder11 Ready?’’.

12 (d) REPORT.—

13 (1) IN GENERAL.—The Secretary of Health and

14 Human Services shall prepare and submit a report

15 to the appropriate committees of Congress and cities

16 and counties that the Secretary determines should

17 receive such report regarding the findings of such

18 survey described in subsection (a).

19 (2) CONTENT.—The report described in para20 graph (1) shall identify existing resources and chal21 lenging areas for cities or counties to resolve or ad22 dress in order for such cities or counties to become

23 elder ready. Such report shall also include rec24 ommendations, action plans, and timetables for deal25 ing with deficiencies.
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1 Subtitle B—Education and Studies

2 SEC. 211. LONG-TERM CARE COVERAGE EDUCATIONAL

3 CAMPAIGN.

4 (a) IN GENERAL.—The Secretary of Labor, in con5 junction with the Secretary of Health and Human Services

6 and the Administrator of the Small Business Administra7 tion, shall establish and carry out a national public infor8 mation campaign to provide employers and employees with

9 information concerning the benefits of long-term health

10 care coverage.

11 (b) AUTHORIZATION OF APPROPRIATIONS.—There is

12 authorized to be appropriated, such sums as may be nec13 essary to carry out subsection (a).

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

15 Not later than 24 months after the date of enactment

16 of this Act, the Comptroller General of the General Ac17 counting Office shall prepare and submit to the appro18 priate committees of Congress a report concerning the

19 long-term care programs of the Veterans Administration,

20 including—

21 (1) a description of the long-term care services

22 provided under such programs;

23 (2) data concerning the utilization and financ24 ing of such programs;
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1 (3) information concerning the quality assur2 ance processes used under such programs;

3 (4) a description of any recent modifications to

4 such programs; and

5 (5) a description of the management challenges

6 faced in administering such programs.

7 SEC. 213. AGING STUDY AND REPORT.

8 (a) STUDIES.—The Secretary of Health and Human

9 Services shall conduct not less than 1 study to

10 determine—

11 (1) activities or programs to conduct to improve

12 the quality of life for the elderly;

13 (2) measures to be taken to prevent or delay

14 the onset of age-related functional decline and dis15 ease and disability among the elderly;

16 (3) whether medicare health promotion and dis17 ease prevention benefits reduce or delay the need by

18 seniors for long-term care services; and

19 (4) the manner in which the aging of the popu20 lation in the United States will impact the adminis21 tration and solvency of Federal programs, such as

22 programs under titles XVIII, XIX, and XX of the

23 Social Security Act (42 U.S.C. 1395 et seq., 1396

24 et seq., and 1397 et seq.) and programs established
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1 under the Older Americans Act of 1965 (42 U.S.C.

2 3001 et seq.).

3 (b) REPORT.—Not later than January 1, 2003, the

4 Secretary of Health and Human Services shall prepare

5 and submit to Congress a report regarding the study de6 scribed in subsection (a).

Æ