I

104TH CONGRESS

2D SESSION H. R. 3585

To amend title XVIII of the Social Security Act to provide for coverage

of respite care services under part B of the Medicare program, to

amend the Internal Revenue Code of 1986 to treat qualified long-term

care services as medical care, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 5, 1996

Mrs. LOWEY (for herself and Mr. GILMAN) introduced the following bill; which

was referred to the Committee on Ways and Means, and in addition to

the Committee on Commerce, for a period to be subsequently determined

by the Speaker, in each case for consideration of such provisions as fall

within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to provide

for coverage of respite care services under part B of

the Medicare program, to amend the Internal Revenue

Code of 1986 to treat qualified long-term care services

as medical 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.

4 This Act may be cited as the ‘‘Family Caregiver Sup5 port and Protection Act of 1996’’.
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1 SEC. 2. COVERAGE OF RESPITE CARE SERVICES UNDER

2 MEDICARE.

3 (a) IN GENERAL.—Section 1861(s)(2) of the Social

4 Security Act (42 U.S.C. 1395x(s)(2)) is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (N);

7 (2) by striking ‘‘and’’ at the end of subpara8 graph (O); and

9 (3) by inserting after subparagraph (O) the fol10 lowing new subparagraph:

11 ‘‘(P) respite care services (as defined in sub12 section (oo)); and’’.

13 (b) SERVICES DESCRIBED.—Section 1861 of such

14 Act (42 U.S.C. 1395x) is amended by adding at the end

15 the following new subsection:

16 ‘‘Respite Care Services

17 ‘‘(oo)(1)(A) Subject to subparagraph (C), the term

18 ‘respite care services’ means any of the services described

19 in subparagraph (B) which are furnished to an eligible in20 dividual (as described in paragraph (2)) for the support

21 of a caregiver described in paragraph (2) at the individ22 ual’s home or in the community on a short-term, intermit23 tent, or emergency basis by an individual or entity who

24 meets such standards as the Secretary may establish.

25 ‘‘(B) The services described in this subparagraph are

26 as follows:
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1 ‘‘(i) Companion services.

2 ‘‘(ii) Homemaker services.

3 ‘‘(iii) Personal assistance.

4 ‘‘(iv) Community day services.

5 ‘‘(v) Temporary care in an accredited or li6 censed residential facility.

7 ‘‘(C) In establishing standards pursuant to subpara8 graph (A) for individuals and entities providing respite

9 care services, the Secretary shall consult with organiza10 tions representing providers of the services described in

11 such paragraph and organizations representing individuals

12 who typically receive such services.

13 ‘‘(D) The term ‘respite care services’ does not include

14 any services furnished to an individual during a 12-month

15 period after the individual has been furnished 120 hours

16 of such services during such period.

17 ‘‘(2) An ‘eligible individual’ described in this para18 graph is an individual with functional limitations (as de19 scribed in paragraph (3)) who is dependent on a daily

20 basis on a caregiver who—

21 ‘‘(A) has primary responsibility for providing

22 care to the individual;

23 ‘‘(B) does not receive financial remuneration for

24 providing such care; and
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1 ‘‘(C) has provided such care for a period of not

2 less than 3 consecutive months.

3 ‘‘(3)(A) In paragraph (2), an ‘individual with func4 tional limitations’ is an individual who is certified (in ac5 cordance with such criteria as the Secretary may establish

6 consistent with subparagraph (C)) as—

7 ‘‘(i) being unable to perform without substantial

8 assistance from another individual (including assist9 ance involving verbal reminding or physical cueing)

10 at least 2 of the activities of daily living described

11 in subparagraph (B) for a period of at least 90 days

12 due to a loss of functional capacity or to cognitive

13 or other mental impairment;

14 ‘‘(ii) requiring substantial supervision to protect

15 the individual from threats to the individual’s health

16 or safety due to substantial cognitive or other men17 tal impairment; or

18 ‘‘(iii) having a level of disability similar (as de19 termined by the Secretary) to the level of disability

20 described in clause (i) or (ii).

21 ‘‘(B) The activities of daily living described in this

22 subparagraph are as follows:

23 ‘‘(i) Eating.

24 ‘‘(ii) Toileting.

25 ‘‘(iii) Transferring.
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1 ‘‘(iv) Bathing.

2 ‘‘(v) Dressing.

3 ‘‘(vi) Continence.

4 ‘‘(C) In establishing criteria pursuant to subpara5 graph (A) for the certification of individuals with func6 tional limitations, the Secretary may not require that such

7 certification be performed only by a physician.’’.

8 (c) PAYMENT ON HOURLY BASIS.—Section 1833 of

9 such Act (42 U.S.C. 1395l) is amended by inserting after

10 subsection (o) the following new subsection:

11 ‘‘(p) Payment for respite care services shall be paid

12 on the basis of an hour of such services provided.’’.

13 (d) CONFORMING AMENDMENT.—Section 1862(a) of

14 such Act (42 U.S.C. 1395y(a)) is amended—

15 (1) by striking ‘‘or’’ at the end of paragraph

16 (14);

17 (2) by striking the period at the end of para18 graph (15) and inserting ‘‘; or’’; and

19 (3) by inserting after paragraph (15) the fol20 lowing new paragraph:

21 ‘‘(16) in the case of respite care services, which

22 are furnished to an individual during a 12-month pe23 riod after the individual has been furnished 120

24 hours of such services during such period.’’.
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1 (e) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to services furnished on or after

3 January 1, 1997.

4 SEC. 3. TREATMENT OF LONG-TERM CARE SERVICES AS

5 MEDICAL CARE.

6 (a) GENERAL RULE.—Paragraph (1) of section

7 213(d) (defining medical care) is amended by striking

8 ‘‘or’’ at the end of subparagraph (B), by striking the pe9 riod at the end of subparagraph (C) and inserting ‘‘, or’’,

10 and by adding at the end the following new subparagraph:

11 ‘‘(D) for qualified long-term care services

12 (as defined in subsection (f)).’’

13 (b) DEFINITION OF QUALIFIED LONG-TERM CARE

14 SERVICES.—Section 213 of such Code is amended by add15 ing at the end the following new subsection:

16 ‘‘(f) QUALIFIED LONG-TERM CARE SERVICES.—For

17 purposes of this section—

18 ‘‘(1) IN GENERAL.—The term ‘qualified long19 term care services’ means necessary diagnostic, pre20 ventive, therapeutic, curing, treating, mitigating, and

21 rehabilitative services, and maintenance or personal

22 care services, which—

23 ‘‘(A) are required by a chronically ill indi24 vidual, and
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1 ‘‘(B) are provided pursuant to a plan of

2 care prescribed by a licensed health care practi3 tioner.

4 ‘‘(2) CHRONICALLY ILL INDIVIDUAL.—

5 ‘‘(A) IN GENERAL.—The term ‘chronically

6 ill individual’ means any individual who has

7 been certified by a licensed health care practi8 tioner as—

9 ‘‘(i) being unable to perform (without

10 substantial assistance from another indi11 vidual) at least 2 activities of daily living

12 for a period of at least 90 days due to a

13 loss of functional capacity or to cognitive

14 impairment,

15 ‘‘(ii) requiring substantial supervision

16 to protect such individual from threats to

17 health or safety due to substantial cog18 nitive impairment, or

19 ‘‘(iii) having a level of disability simi20 lar (as determined by the Secretary in con21 sultation with the Secretary of Health and

22 Human Services) to the level of disability

23 described in clause (i) or (ii).

24 Such term shall not include any individual oth25 erwise meeting the requirements of the preced-
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1 ing sentence unless within the preceding 12-

2 month period a licensed health care practitioner

3 has certified that such individual meets such re4 quirements.

5 ‘‘(B) ACTIVITIES OF DAILY LIVING.—For

6 purposes of subparagraph (A), each of the fol7 lowing is an activity of daily living:

8 ‘‘(i) Eating.

9 ‘‘(ii) Toileting.

10 ‘‘(iii) Transferring.

11 ‘‘(iv) Bathing.

12 ‘‘(v) Dressing.

13 ‘‘(vi) Continence.

14 ‘‘(C) SUBSTANTIAL ASSISTANCE.—For

15 purposes of subparagraph (A)(i), the term ‘sub16 stantial assistance’ includes verbal reminding or

17 physical cuing.

18 ‘‘(3) MAINTENANCE OR PERSONAL CARE SERV19 ICES.—The term ‘maintenance or personal care serv20 ices’ means any care the primary purpose of which

21 is the provision of needed assistance with any of the

22 disabilities as a result of which the individual is a

23 chronically ill individual (including the protection

24 from threats to health and safety due to severe cog25 nitive impairment).
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1 ‘‘(4) LICENSED HEALTH CARE PRACTI2 TIONER.—The term ‘licensed health care practi3 tioner’ means any physician (as defined in section

4 1861(r)(1) of the Social Security Act) and any reg5 istered professional nurse, licensed social worker, or

6 other individual who meets such requirements as

7 may be prescribed by the Secretary.’’

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

9 this section shall apply to taxable years beginning after

10 December 31, 1995.

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