I 

108TH CONGRESS 

2D SESSION H. R. 4595 

To amend the Public Health Service Act to fund breakthroughs in Alzheimer’s 

disease research while providing more help to caregivers and increasing 

public education about prevention. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 16, 2004 

Mr. MARKEY (for himself, Mr. SMITH of New Jersey, Mr. MENENDEZ, Ms. 

JACKSON-LEE of Texas, Mr. GREEN of Texas, Mr. KILDEE, Mr. MANZULLO, Ms. MCCARTHY of Missouri, Mr. MEEHAN, Mr. NEAL of Massachusetts, Mr. KIND, Mr. KENNEDY of Rhode Island, and Mr. 

MCDERMOTT) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committees 

on Education and the Workforce and Ways and Means, for a period to 

be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To amend the Public Health Service Act to fund breakthroughs in Alzheimer’s disease research while providing 

more help to caregivers and increasing public education 

about prevention. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Ronald Reagan Alzheimer’s Breakthrough Act of 2004’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—INCREASING THE FEDERAL COMMITMENT TO 

ALZHEIMER’S RESEARCH 

Sec. 101. Doubling NIH funding for Alzheimer’s disease research. 

Sec. 102. Priority to Alzheimer’s disease research. 

Sec. 103. Alzheimer’s disease prevention initiative. 

Sec. 104. Alzheimer’s disease clinical research. 

Sec. 105. Research on Alzheimer’s disease caregiving. 

Sec. 106. National summit on Alzheimer’s disease. 

TITLE II—PUBLIC EDUCATION ABOUT ALZHEIMER’S DISEASE 

Sec. 201. Public education campaign. 

TITLE III—ASSISTANCE FOR CAREGIVERS 

Sec. 301. Increased funding for National Family Caregiver Support Program. 

Sec. 302. Alzheimer’s disease demonstration grants. 

Sec. 303. Safe return program. 

Sec. 304. Lifespan respite care. 

Sec. 305. Credit for taxpayers with long-term care needs. 

Sec. 306. Treatment of premiums on qualified long-term care insurance contracts. 

Sec. 307. Additional consumer protections for long-term care insurance. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Alzheimer’s disease is a disorder that de9 stroys cells in the brain. The disease is the leading 

10 cause of dementia, a condition that involves gradual 

11 memory loss, decline in the ability to perform rou12 tine tasks, disorientation, difficulty in learning, loss 

13 of language skills, impairment of judgment, and per-
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1 sonality changes. As the disease progresses, people 

2 with Alzheimer’s disease become unable to care for 

3 themselves. The loss of brain cells eventually leads 

4 to the failure of other systems in the body. 

5 (2) An estimated 4,500,000 Americans have 

6 Alzheimer’s disease and 1 in 10 people have a family 

7 member with the disease. By 2050, the number of 

8 individuals with the disease could range from 

9 13,000,000 to 16,000,000 unless science finds a way 

10 to prevent or cure the disease. 

11 (3) One in 10 people over the age of 65, and 

12 nearly half of those over the age of 85 have Alz13 heimer’s disease. Younger people also get the dis14 ease. 

15 (4) The Alzheimer’s disease process may begin 

16 in the brain as many as 20 years before the symp17 toms of Alzheimer’s disease appear. A person will 

18 live an average of 8 years and as many as 20 once 

19 the symptoms of Alzheimer’s disease appear. 

20 (5) The average lifetime cost of care for an in21 dividual with Alzheimer’s disease is $170,000. 

22 (6) In 2000, medicare alone spent 

23 $31,900,000,000 for the care of individuals with 

24 Alzheimer’s disease and this amount is projected to 

25 increase to $49,300,000,000 in 2010. 
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1 (7) Forty-nine percent of medicare beneficiaries 

2 who have Alzheimer’s disease also receive medicaid. 

3 Of the total population dually eligible for medicare 

4 and medicaid, 22 percent have Alzheimer’s disease. 

5 (8) Seven in 10 people with Alzheimer’s disease 

6 live at home. While almost 75 percent of home care 

7 is provided by family and friends, the average an8 nual cost of paid care for people with Alzheimer’s 

9 disease at home is $12,500 per year. Almost all fam10 ilies pay this cost out of pocket. 

11 (9) Half of all nursing home residents have Alz12 heimer’s disease or a related disorder. The average 

13 annual cost of Alzheimer’s disease nursing home 

14 care is nearly $64,000. Medicaid pays nearly half of 

15 the total nursing home bill and helps 2 out of 3 resi16 dents pay for their care. Medicaid expenditures for 

17 nursing home care for people with Alzheimer’s dis18 ease are estimated to increase from $18,200,000,000 

19 in 2000 to $33,000,000,000 in 2010. 

20 (10) In fiscal year 2004, the Federal Govern21 ment will spend an estimated $680,000,000 on Alz22 heimer’s disease research. If our Nation achieves its 

23 research goals (preventing the onset of Alzheimer’s 

24 disease in those at risk and treating and delaying 

25 progression of the disease in those who have symp-
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1 toms), the projected number of cases of Alzheimer’s 

2 disease can be reduced by more than one-third by 

3 the middle of the century. The number of baby 

4 boomers with moderate to severe Alzheimer’s disease 

5 can be reduced by 60 percent. 

6 (11) A study commissioned by the United Hos7 pital Fund estimated that the annual value of this 

8 informal care system is $257,000,000,000. Family 

9 caregiving comes at enormous physical, emotional, 

10 and financial sacrifice, putting the whole system at 

11 risk. 

12 (12) One in 8 Alzheimer’s disease caregivers be13 comes ill or injured as a direct result of caregiving. 

14 One in 3 uses medication for problems related to 

15 caregiving. Older caregivers are 3 times more likely 

16 to become clinically depressed than others in their 

17 age group. 

18 (13) Elderly spouses strained by caregiving are 

19 63 percent more likely to die during a given 4-year 

20 period than other spouses their age. 

21 (14) Almost 3 of 4 caregivers are women. One 

22 in 3 has children or grandchildren under the age of 

23 18 living at home. Caregiving leaves them less time 

24 for other family members and they are much more 
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1 likely to report family conflicts because of their 

2 caregiving role. 

3 (15) Most Alzheimer’s disease caregivers work 

4 outside the home before beginning their caregiving 

5 careers, but caregiving forces them to miss work, cut 

6 back to part-time, take less demanding jobs, choose 

7 early retirement, or give up work altogether. As a 

8 result, in 2002, Alzheimer’s disease cost American 

9 business an estimated $36,500,000,000 in lost pro10 ductivity, as well as an additional $24,600,000,000 

11 in business contributions to the total cost of care. 

12 TITLE I—INCREASING THE FED13 ERAL COMMITMENT TO ALZ14 HEIMER’S RESEARCH 

15 SEC. 101. DOUBLING NIH FUNDING FOR ALZHEIMER’S DIS16 EASE RESEARCH. 

17 (a) IN GENERAL.—For the purpose of conducting 

18 and supporting research on Alzheimer’s disease (including 

19 related activities under subpart 5 of part C of title IV of 

20 the Public Health Service Act (42 U.S.C. 285e et seq.) 

21 there is authorized to be appropriated $1,400,000,000 for 

22 fiscal year 2005, and such sums as may be necessary for 

23 each of fiscal years 2006 through 2009. 

24 (b) AGING PROCESS REGARDING WOMEN.—Section 

25 445H(b) of the Public Health Service Act (42 U.S.C. 
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1 285e–10(b)) is amended by striking ‘‘2003’’ and inserting 

2 ‘‘2009’’. 

3 (c) CLINICAL RESEARCH AND TRAINING AWARDS.— 

4 Section 445I(d) of the Public Health Service Act (42 

5 U.S.C. 285e–10a(d)) is amended by striking ‘‘2005’’ and 

6 inserting ‘‘2009’’. 

7 SEC. 102. PRIORITY TO ALZHEIMER’S DISEASE RESEARCH. 

8 Section 443 of the Public Health Service Act (42 

9 U.S.C. 285e) is amended— 

10 (1) by striking ‘‘The general’’ and inserting 

11 ‘‘(a) IN GENERAL.—The general’’; and 

12 (2) by adding at the end the following: 

13 ‘‘(b) PRIORITIES.—The Director of the Institute 

14 shall, in expending amounts appropriated under this sub15 part, give priority to conducting and supporting Alz16 heimer’s disease research.’’. 

17 SEC. 103. ALZHEIMER’S DISEASE PREVENTION INITIATIVE. 

18 Section 444 of the Public Health Service Act (42 

19 U.S.C. 285e–1) is amended— 

20 (1) in subsection (d), by inserting ‘‘and train21 ing’’ after ‘‘conduct research’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(e) The Director of the National Institutes of 

24 Health shall, in collaboration with the Director of the In25 stitute, the directors of other relevant institutes, and with 
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1 volunteer organizations and other stakeholders, undertake 

2 an Alzheimer’s Disease Prevention Initiative to— 

3 ‘‘(1) accelerate the discovery of new risk and 

4 protective factors for Alzheimer’s disease; 

5 ‘‘(2) rapidly identify candidate diagnostics, 

6 therapies, or preventive interventions or agents for 

7 clinical investigation and trials relating to Alz8 heimer’s disease; 

9 ‘‘(3) support or undertake such investigations 

10 and trials; and 

11 ‘‘(4) implement effective prevention and treat12 ment strategies, including strategies to improve pa13 tient care and alleviate caregiver burdens relating to 

14 Alzheimer’s disease.’’. 

15 SEC. 104. ALZHEIMER’S DISEASE CLINICAL RESEARCH. 

16 (a) CLINICAL RESEARCH.—Section 445F of the Pub17 lic Health Service Act (42 U.S.C. 285e–8) is amended to 

18 read as follows: 

19 ‘‘SEC. 445F. ALZHEIMER’S DISEASE CLINICAL RESEARCH. 

20 ‘‘(a) IN GENERAL.—The Director of the Institute, 

21 pursuant to subsections (d) and (e) of section 444, shall 

22 conduct and support cooperative clinical research regard23 ing Alzheimer’s disease. Such research shall include— 
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1 ‘‘(1) investigating therapies, interventions, and 

2 agents to detect, treat, slow the progression of, or 

3 prevent Alzheimer’s disease; 

4 ‘‘(2) enhancing the national infrastructure for 

5 the conduct of clinical trials; 

6 ‘‘(3) developing and testing novel approaches to 

7 the design and analysis of such trials; 

8 ‘‘(4) facilitating the enrollment of patients for 

9 such trials, including patients from diverse popu10 lations; 

11 ‘‘(5) developing improved diagnostics and 

12 means of patient assessment for Alzheimer’s disease; 

13 and 

14 ‘‘(6) as determined appropriate by the Director 

15 of the Institute, the Alzheimer’s Disease Centers 

16 and Alzheimer’s Disease Research Centers estab17 lished under section 445. 

18 ‘‘(b) EARLY DIAGNOSIS AND DETECTION RE19 SEARCH.— 

20 ‘‘(1) IN GENERAL.—The Director of the Insti21 tute, in consultation with the directors of other rel22 evant institutes and centers of the National Insti23 tutes of Health, shall conduct, or make grants for 

24 the conduct of, research related to the early detec25 tion and diagnosis of Alzheimer’s disease and of 
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1 mild cognitive impairment or other potential precur2 sors to Alzheimer’s disease. 

3 ‘‘(2) EVALUATION.—The research described in 

4 paragraph (1) may include the evaluation of diag5 nostic tests and imaging techniques. 

6 ‘‘(c) VASCULAR DISEASE.—The Director of the Insti7 tute, in consultation with the directors of other relevant 

8 institutes and centers of the National Institutes of Health, 

9 shall conduct, or make grants for the conduct of, research 

10 related to the relationship of vascular disease and Alz11 heimer’s disease, including clinical trials to determine 

12 whether drugs developed to prevent cerebrovascular dis13 ease can prevent the onset or progression of Alzheimer’s 

14 disease. 

15 ‘‘(d) NATIONAL ALZHEIMER’S COORDINATING CEN16 TER.—The Director of the Institute may establish a Na17 tional Alzheimer’s Coordinating Center to facilitate col18 laborative research among the Alzheimer’s Disease Cen19 ters and Alzheimer’s Disease Research Centers established 

20 under section 445.’’. 

21 (b) ALZHEIMER’S DISEASE CENTERS.—Section 

22 445(a)(1) of the Public Health Service Act (42 U.S.C. 

23 285e–2(a)(1)) is amended by inserting ‘‘, and outcome 

24 measures and disease management’’ after ‘‘treatment 

25 methods’’. 
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1 SEC. 105. RESEARCH ON ALZHEIMER’S DISEASE 

2 CAREGIVING. 

3 Section 445C of the Public Health Service Act (42 

4 U.S.C. 285e–5) is amended— 

5 (1) by striking ‘‘Sec. 445C. (a)’’ and inserting 

6 the following: 

7 ‘‘SEC. 445C. RESEARCH ON ALZHEIMER’S DISEASE SERV8 ICES AND CAREGIVING. 

9 ‘‘(a) SERVICES RESEARCH.—’’; 

10 (2) by striking subsections (b), (c), and (e); 

11 (3) by inserting after subsection (a) the fol12 lowing: 

13 ‘‘(b) INTERVENTIONS RESEARCH.—The Director 

14 shall, in collaboration with the directors of the other rel15 evant institutes and centers of the National Institutes of 

16 Health, conduct, or make grants for the conduct of, clin17 ical, social, and behavioral research related to interven18 tions designed to help caregivers of patients with Alz19 heimer’s disease and related disorders and improve patient 

20 outcomes.’’; and 

21 (4) in subsection (d) by striking ‘‘(d) the Direc22 tor’’ and inserting ‘‘(c) MODEL CURRICULA AND

23 TECHNIQUES. —The Director’’. 

24 SEC. 106. NATIONAL SUMMIT ON ALZHEIMER’S DISEASE. 

25 (a) IN GENERAL.—Not later than 1 year after the 

26 date of enactment of this Act, the Secretary of Health and 
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1 Human Services (referred to in this section as the ‘‘Sec2 retary’’) shall convene a summit of researchers, represent3 atives of academic institutions, Federal and State policy4 makers, public health professionals, and representatives of 

5 voluntary health agencies to provide a detailed overview 

6 of current research activities at the National Institutes of 

7 Health, as well as to discuss and solicit input related to 

8 potential areas of collaboration between the National In9 stitutes of Health and other Federal health agencies, in10 cluding the Centers for Disease Control and Prevention, 

11 the Administration on Aging, the Agency for Healthcare 

12 Research and Quality, and the Health Resources and 

13 Services Administration, related to research, prevention, 

14 and treatment of Alzheimer’s disease. 

15 (b) FOCUS AREAS.—The summit convened under 

16 subsection (a) shall focus on— 

17 (1) a broad range of Alzheimer’s disease re18 search activities relating to biomedical research, pre19 vention research, and caregiving issues; 

20 (2) clinical research for the development and 

21 evaluation of new treatments for the disease; 

22 (3) translational research on evidence-based and 

23 cost-effective best practices in the treatment and 

24 prevention of the disease; 
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1 (4) information and education programs for 

2 health care professionals and the public relating to 

3 the disease; 

4 (5) priorities among the programs and activities 

5 of the various Federal agencies regarding such dis6 eases; and 

7 (6) challenges and opportunities for scientists, 

8 clinicians, patients, and voluntary organizations re9 lating to the disease. 

10 (c) REPORT.—Not later than 180 days after the date 

11 on which the National Summit on Alzheimer’s Disease is 

12 convened under subsection (a), the Director of National 

13 Institutes of Health shall prepare and submit to the ap14 propriate committees of Congress a report that includes 

15 a summary of the proceedings of the summit and a de16 scription of Alzheimer’s research, education, and other ac17 tivities that are conducted or supported through the na18 tional research institutes. 

19 (d) PUBLIC INFORMATION.—The Secretary shall 

20 make readily available to the public information about the 

21 research, education, and other activities relating to Alz22 heimer’s disease and other related dementias, conducted 

23 or supported by the National Institutes of Health. 

24 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for each of fiscal years 

2 2005 through 2009. 

3 TITLE II—PUBLIC EDUCATION 

4 ABOUT ALZHEIMER’S DISEASE 

5 SEC. 201. PUBLIC EDUCATION CAMPAIGN. 

6 Part P of title III of the Public Health Service Act 

7 (42 U.S.C. 280g et seq.) is amended by adding at the end 

8 the following: 

9 ‘‘SEC. 399O. ALZHEIMER’S DISEASE PUBLIC EDUCATION 

10 CAMPAIGN. 

11 ‘‘(a) IN GENERAL.—The Secretary, acting through 

12 the Director of the Centers for Disease Control and Pre13 vention, shall carry out a program to educate the public 

14 and public health community regarding— 

15 ‘‘(1) diagnosis and early warning signs of Alz16 heimer’s disease; and 

17 ‘‘(2) how healthy lifestyles could maintain cog18 nitive function and brain health. 

19 ‘‘(b) EDUCATION OF HEALTH PROFESSIONALS AND

20 PARTNERSHIPS.—The program carried out under sub21 section (a) shall include activities to educate health profes22 sionals about the diagnosis, care, and management of Alz23 heimer’s disease and dementia, and the development of 

24 partnerships between State health departments, area 
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1 agencies on aging, and local organizations serving people 

2 with Alzheimer’s disease. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out this section, there are authorized 

5 to be appropriated $7,000,000 for fiscal year 2005, and 

6 such sums as may be necessary for each of fiscal years 

7 2006 through 2009.’’. 

8 TITLE III—ASSISTANCE FOR 

9 CAREGIVERS 

10 SEC. 301. INCREASED FUNDING FOR NATIONAL FAMILY 

11 CAREGIVER SUPPORT PROGRAM. 

12 (a) IN GENERAL.—Section 303(e)(1) of the Older 

13 Americans Act of 1965 (42 U.S.C. 3023(e)(1)) is amend14 ed by striking ‘‘$125,000,000 for fiscal year 2001’’ and 

15 inserting ‘‘$250,000,000 for fiscal year 2005’’. 

16 (b) NATIVE AMERICANS.—Section 643(2) of the 

17 Older Americans Act of 1965 (42 U.S.C. 3057n(2)) is 

18 amended by striking ‘‘$5,000,000 for fiscal year 2001’’ 

19 and inserting ‘‘$10,000,000 for fiscal year 2005’’. 

20 SEC. 302. ALZHEIMER’S DISEASE DEMONSTRATION 

21 GRANTS. 

22 Section 398B(e) of the Public Health Service Act (42 

23 U.S.C. 280c–5(e)) is amended— 

24 (1) by striking ‘‘and such’’ and inserting 

25 ‘‘such’’; and 
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1 (2) by inserting before the period ‘‘, 

2 $25,000,000 for fiscal year 2005, and such sums as 

3 may be necessary for each of the fiscal years 2006 

4 through 2009’’. 

5 SEC. 303. SAFE RETURN PROGRAM. 

6 Section 240001(d) of the Violent Crime Control and 

7 Law Enforcement Act of 1994 (42 U.S.C. 14181(d)) is 

8 amended to read as follows: 

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section, 

11 $1,000,000 for fiscal year 2005.’’. 

12 SEC. 304. LIFESPAN RESPITE CARE. 

13 The Public Health Service Act (42 U.S.C. 201 et 

14 seq.) is amended by adding at the end the following: 

15 ‘‘TITLE XXIX—LIFESPAN 

16 RESPITE CARE 

17 ‘‘SEC. 2901. FINDINGS AND PURPOSES. 

18 ‘‘(a) FINDINGS.—Congress finds that— 

19 ‘‘(1) an estimated 26,000,000 individuals in the 

20 United States care each year for 1 or more adult 

21 family members or friends who are chronically ill, 

22 disabled, or terminally ill; 

23 ‘‘(2) an estimated 18,000,000 children in the 

24 United States have chronic physical, developmental, 

25 behavioral, or emotional conditions that demand 
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1 caregiver monitoring, management, supervision, or 

2 treatment beyond that required of children generally; 

3 ‘‘(3) nearly 4,000,000 individuals in the United 

4 States of all ages who have mental retardation or 

5 another developmental disability live with their fami6 lies; 

7 ‘‘(4) almost 25 percent of the Nation’s elders 

8 experience multiple chronic disabling conditions that 

9 make it necessary to rely on others for help in meet10 ing their daily needs; 

11 ‘‘(5) every year, approximately 600,000 Ameri12 cans die at home and many of these individuals rely 

13 on extensive family caregiving before their death; 

14 ‘‘(6) of all individuals in the United States 

15 needing assistance in daily living, 42 percent are 

16 under age 65; 

17 ‘‘(7) there are insufficient resources to replace 

18 family caregivers with paid workers; 

19 ‘‘(8) if services provided by family caregivers 

20 had to be replaced with paid services, it would cost 

21 approximately $200,000,000,000 annually; 

22 ‘‘(9) the family caregiver role is personally re23 warding but can result in substantial emotional, 

24 physical, and financial hardship; 
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1 ‘‘(10) approximately 75 percent of family care2 givers are women; 

3 ‘‘(11) family caregivers often do not know 

4 where to find information about available respite 

5 care or how to access it; 

6 ‘‘(12) available respite care programs are insuf7 ficient to meet the need and are directed at pri8 marily lower income populations and family care9 givers of the elderly, leaving large numbers of family 

10 caregivers without adequate support; and 

11 ‘‘(13) the limited number of available respite 

12 care programs find it difficult to recruit appro13 priately trained respite workers. 

14 ‘‘(b) PURPOSES.—The purposes of this title are— 

15 ‘‘(1) to encourage States to establish State and 

16 local lifespan respite care programs; 

17 ‘‘(2) to improve and coordinate the dissemina18 tion of respite care information and resources to 

19 family caregivers; 

20 ‘‘(3) to provide, supplement, or improve respite 

21 care services to family caregivers; 

22 ‘‘(4) to promote innovative, flexible, and com23 prehensive approaches to— 

24 ‘‘(A) the delivery of respite care; 
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1 ‘‘(B) respite care worker and volunteer re2 cruitment and training programs; and 

3 ‘‘(C) training programs for family care4 givers to assist such family caregivers in mak5 ing informed decisions about respite care serv6 ices; 

7 ‘‘(5) to support evaluative research to identify 

8 effective respite care services that alleviate, reduce, 

9 or minimize any negative consequences of caregiving; 

10 and 

11 ‘‘(6) to promote the dissemination of results, 

12 findings, and information from programs and re13 search projects relating to respite care delivery, fam14 ily caregiver strain, respite care worker and volun15 teer recruitment and training, and training pro16 grams for family caregivers that assist such family 

17 caregivers in making informed decisions about res18 pite care services. 

19 ‘‘SEC. 2902. DEFINITIONS. 

20 ‘‘In this title: 

21 ‘‘(1) ELIGIBLE RECIPIENT.—The term ‘eligible 

22 recipient’ means— 

23 ‘‘(A) a State agency; 

24 ‘‘(B) any other public entity that is capa25 ble of operating on a statewide basis; 
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1 ‘‘(C) a private, nonprofit organization that 

2 is capable of operating on a statewide basis; 

3 ‘‘(D) a political subdivision of a State that 

4 has a population of not less than 3,000,000 in5 dividuals; or 

6 ‘‘(E) any recognized State respite coordi7 nating agency that has— 

8 ‘‘(i) a demonstrated ability to work 

9 with other State and community-based 

10 agencies; 

11 ‘‘(ii) an understanding of respite care 

12 and family caregiver issues; and 

13 ‘‘(iii) the capacity to ensure meaning14 ful involvement of family members, family 

15 caregivers, and care recipients. 

16 ‘‘(2) ADULT WITH A SPECIAL NEED.—The term 

17 ‘adult with a special need’ means a person 18 years 

18 of age or older who requires care or supervision to— 

19 ‘‘(A) meet the person’s basic needs; or 

20 ‘‘(B) prevent physical self-injury or injury 

21 to others. 

22 ‘‘(3) CHILD WITH A SPECIAL NEED.—The term 

23 ‘child with a special need’ means a person less than 

24 18 years of age who requires care or supervision be25 yond that required of children generally to— 
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1 ‘‘(A) meet the child’s basic needs; or 

2 ‘‘(B) prevent physical self-injury or injury 

3 to others. 

4 ‘‘(4) FAMILY CAREGIVER.—The term ‘family 

5 caregiver’ means an unpaid family member, a foster 

6 parent, or another unpaid adult, who provides in7 home monitoring, management, supervision, or 

8 treatment of a child or adult with a special need. 

9 ‘‘(5) RESPITE CARE.—The term ‘respite care’ 

10 means planned or emergency care provided to a 

11 child or adult with a special need in order to provide 

12 temporary relief to the family caregiver of that child 

13 or adult. 

14 ‘‘(6) LIFESPAN RESPITE CARE.—The term ‘life15 span respite care’ means a coordinated system of ac16 cessible, community-based respite care services for 

17 family caregivers of children or adults with special 

18 needs. 

19 ‘‘SEC. 2903. LIFESPAN RESPITE CARE GRANTS AND COOP20 ERATIVE AGREEMENTS. 

21 ‘‘(a) PURPOSES.—The purposes of this section are— 

22 ‘‘(1) to expand and enhance respite care serv23 ices to family caregivers; 

24 ‘‘(2) to improve the statewide dissemination and 

25 coordination of respite care; and 
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1 ‘‘(3) to provide, supplement, or improve access 

2 and quality of respite care services to family care3 givers, thereby reducing family caregiver strain. 

4 ‘‘(b) AUTHORIZATION.—Subject to subsection (f), the 

5 Secretary is authorized to award grants or cooperative 

6 agreements to eligible recipients who submit an applica7 tion pursuant to subsection (d). 

8 ‘‘(c) FEDERAL LIFESPAN APPROACH.—In carrying 

9 out this section, the Secretary shall work in cooperation 

10 with the National Family Caregiver Support Program Of11 ficer of the Administration on Aging, and respite care pro12 gram officers in the Administration for Children and Fam13 ilies, the Administration on Developmental Disabilities, 

14 the Maternal and Child Health Bureau of the Health Re15 sources and Services Administration, and the Substance 

16 Abuse and Mental Health Services Administration, to en17 sure coordination of respite care services for family care18 givers of children and adults with special needs. 

19 ‘‘(d) APPLICATION.— 

20 ‘‘(1) SUBMISSION.—Each eligible recipient de21 siring to receive a grant or cooperative agreement 

22 under this section shall submit an application to the 

23 Secretary at such time, in such manner, and con24 taining such information as the Secretary shall re25 quire. 
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1 ‘‘(2) CONTENTS.—Each application submitted 

2 under this section shall include— 

3 ‘‘(A) a description of the applicant’s— 

4 ‘‘(i) understanding of respite care and 

5 family caregiver issues; 

6 ‘‘(ii) capacity to ensure meaningful in7 volvement of family members, family care8 givers, and care recipients; and 

9 ‘‘(iii) collaboration with other State 

10 and community-based public, nonprofit, or 

11 private agencies; 

12 ‘‘(B) with respect to the population of fam13 ily caregivers to whom respite care information 

14 or services will be provided or for whom respite 

15 care workers and volunteers will be recruited 

16 and trained, a description of— 

17 ‘‘(i) the population of family care18 givers; 

19 ‘‘(ii) the extent and nature of the res20 pite care needs of that population; 

21 ‘‘(iii) existing respite care services for 

22 that population, including numbers of fam23 ily caregivers being served and extent of 

24 unmet need; 
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1 ‘‘(iv) existing methods or systems to 

2 coordinate respite care information and 

3 services to the population at the State and 

4 local level and extent of unmet need; 

5 ‘‘(v) how respite care information dis6 semination and coordination, respite care 

7 services, respite care worker and volunteer 

8 recruitment and training programs, or 

9 training programs for family caregivers 

10 that assist such family caregivers in mak11 ing informed decisions about respite care 

12 services will be provided using grant or co13 operative agreement funds; 

14 ‘‘(vi) a plan for collaboration and co15 ordination of the proposed respite care ac16 tivities with other related services or pro17 grams offered by public or private, non18 profit entities, including area agencies on 

19 aging; 

20 ‘‘(vii) how the population, including 

21 family caregivers, care recipients, and rel22 evant public or private agencies, will par23 ticipate in the planning and implementa24 tion of the proposed respite care activities; 
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1 ‘‘(viii) how the proposed respite care 

2 activities will make use, to the maximum 

3 extent feasible, of other Federal, State, 

4 and local funds, programs, contributions, 

5 other forms of reimbursements, personnel, 

6 and facilities; 

7 ‘‘(ix) respite care services available to 

8 family caregivers in the applicant’s State 

9 or locality, including unmet needs and how 

10 the applicant’s plan for use of funds will 

11 improve the coordination and distribution 

12 of respite care services for family care13 givers of children and adults with special 

14 needs; 

15 ‘‘(x) the criteria used to identify fam16 ily caregivers eligible for respite care serv17 ices; 

18 ‘‘(xi) how the quality and safety of 

19 any respite care services provided will be 

20 monitored, including methods to ensure 

21 that respite care workers and volunteers 

22 are appropriately screened and possess the 

23 necessary skills to care for the needs of the 

24 care recipient in the absence of the family 

25 caregiver; and 
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1 ‘‘(xii) the results expected from pro2 posed respite care activities and the proce3 dures to be used for evaluating those re4 sults; and 

5 ‘‘(C) assurances that, where appropriate, 

6 the applicant shall have a system for maintain7 ing the confidentiality of care recipient and 

8 family caregiver records. 

9 ‘‘(e) REVIEW OF APPLICATIONS.— 

10 ‘‘(1) ESTABLISHMENT OF REVIEW PANEL.— 

11 The Secretary shall establish a panel to review appli12 cations submitted under this section. 

13 ‘‘(2) MEETINGS.—The panel shall meet as often 

14 as may be necessary to facilitate the expeditious re15 view of applications. 

16 ‘‘(3) FUNCTION OF PANEL.—The panel shall— 

17 ‘‘(A) review and evaluate each application 

18 submitted under this section; and 

19 ‘‘(B) make recommendations to the Sec20 retary concerning whether the application 

21 should be approved. 

22 ‘‘(f) AWARDING OF GRANTS OR COOPERATIVE

23 AGREEMENTS.— 

24 ‘‘(1) IN GENERAL.—The Secretary shall award 

25 grants or cooperative agreements from among the 
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1 applications approved by the panel under subsection 

2 (e)(3). 

3 ‘‘(2) PRIORITY.—When awarding grants or co4 operative agreements under this subsection, the Sec5 retary shall give priority to applicants that show the 

6 greatest likelihood of implementing or enhancing 

7 lifespan respite care statewide. 

8 ‘‘(g) USE OF GRANT OR COOPERATIVE AGREEMENT

9 FUNDS.— 

10 ‘‘(1) IN GENERAL.— 

11 ‘‘(A) MANDATORY USES OF FUNDS.—Each 

12 eligible recipient that is awarded a grant or co13 operative agreement under this section shall use 

14 the funds for, unless such a program is in exist15 ence— 

16 ‘‘(i) the development of lifespan res17 pite care at the State and local levels; and 

18 ‘‘(ii) an evaluation of the effectiveness 

19 of such care. 

20 ‘‘(B) DISCRETIONARY USES OF FUNDS.— 

21 Each eligible recipient that is awarded a grant 

22 or cooperative agreement under this section 

23 may use the funds for— 
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1 ‘‘(i) respite care services for family 

2 caregivers of children and adults with spe3 cial needs; 

4 ‘‘(ii) respite care worker and volunteer 

5 training programs; or 

6 ‘‘(iii) training programs for family 

7 caregivers to assist such family caregivers 

8 in making informed decisions about respite 

9 care services. 

10 ‘‘(C) EVALUATION.—If an eligible recipient 

11 uses funds awarded under this section for an 

12 activity described in subparagraph (B), the eli13 gible recipient shall use funds for an evaluation 

14 of the effectiveness of the activity. 

15 ‘‘(2) SUBCONTRACTS.—Each eligible recipient 

16 that is awarded a grant or cooperative agreement 

17 under this section may use the funds to subcontract 

18 with a public or nonprofit agency to carry out the 

19 activities described in paragraph (1). 

20 ‘‘(h) TERM OF GRANTS OR COOPERATIVE AGREE21 MENTS.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall award 

23 grants or cooperative agreements under this section 

24 for terms that do not exceed 5 years. 
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1 ‘‘(2) RENEWAL.—The Secretary may renew a 

2 grant or cooperative agreement under this section at 

3 the end of the term of the grant or cooperative 

4 agreement determined under paragraph (1). 

5 ‘‘(i) SUPPLEMENT, NOT SUPPLANT.—Funds made 

6 available under this section shall be used to supplement 

7 and not supplant other Federal, State, and local funds 

8 available for respite care services. 

9 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this sec11 tion— 

12 ‘‘(1) $90,500,000 for fiscal year 2005; and 

13 ‘‘(2) such sums as are necessary for fiscal years 

14 2006 through 2009. 

15 ‘‘SEC. 2904. NATIONAL LIFESPAN RESPITE RESOURCE CEN16 TER. 

17 ‘‘(a) ESTABLISHMENT.—From funds appropriated 

18 under subsection (c), the Secretary shall award a grant 

19 or cooperative agreement to a public or private nonprofit 

20 entity to establish a National Resource Center on Lifespan 

21 Respite Care (referred to in this section as the ‘center’). 

22 ‘‘(b) PURPOSES OF THE CENTER.—The center 

23 shall— 

24 ‘‘(1) maintain a national database on lifespan 

25 respite care; 
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1 ‘‘(2) provide training and technical assistance 

2 to State, community, and nonprofit respite care pro3 grams; and 

4 ‘‘(3) provide information, referral, and edu5 cational programs to the public on lifespan respite 

6 care. 

7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 $500,000 for each of fiscal years 2005 through 2009.’’. 

10 SEC. 305. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE 

11 NEEDS. 

12 (a) IN GENERAL.—Subpart A of part IV of sub13 chapter A of chapter 1 of the Internal Revenue Code of 

14 1986 (relating to nonrefundable personal credits) is 

15 amended by inserting after section 25B the following new 

16 section: 

17 ‘‘SEC. 25C. CREDIT FOR TAXPAYERS WITH LONG-TERM 

18 CARE NEEDS. 

19 ‘‘(a) ALLOWANCE OF CREDIT.— 

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

21 credit against the tax imposed by this chapter for 

22 the taxable year an amount equal to the applicable 

23 credit amount multiplied by the number of applica24 ble individuals with respect to whom the taxpayer is 

25 an eligible caregiver for the taxable year. 
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1 ‘‘(2) APPLICABLE CREDIT AMOUNT.—For pur2 poses of paragraph (1), the applicable credit amount 

3 shall be determined in accordance with the following 

4 table: 

5 ‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN6 COME.— 

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

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

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

10 thereof) by which the taxpayer’s modified adjusted 

11 gross income exceeds the threshold amount. For 

12 purposes of the preceding sentence, the term ‘modi13 fied adjusted gross income’ means adjusted gross in14 come increased by any amount excluded from gross 

15 income under section 911, 931, or 933. 

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

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

18 ‘‘(A) $150,000 in the case of a joint re19 turn, and 

20 ‘‘(B) $75,000 in any other case. 

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

22 year beginning in a calendar year after 2004, each 

23 dollar amount contained in paragraph (2) shall be 

24 increased by an amount equal to the product of— 

25 ‘‘(A) such dollar amount, and 
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1 ‘‘(B) the medical care cost adjustment de2 termined under section 213(d)(10)(B)(ii) for 

3 the calendar year in which the taxable year be4 gins, determined by substituting ‘2003’ for 

5 ‘1996’ in subclause (II) thereof. 

6 If any increase determined under the preceding sen7 tence is not a multiple of $50, such increase shall 

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

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

10 ‘‘(1) APPLICABLE INDIVIDUAL.— 

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

12 individual’ means, with respect to any taxable 

13 year, any individual who has been certified, be14 fore the due date for filing the return of tax for 

15 the taxable year (without extensions), by a phy16 sician (as defined in section 1861(r)(1) of the 

17 Social Security Act) as being an individual with 

18 long-term care needs described in subparagraph 

19 (B) for a period— 

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

21 days, and 

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

23 the taxable year. 

24 Such term shall not include any individual oth25 erwise meeting the requirements of the pre-
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ceding sentence unless within the 391 1 ⁄2 month 

2 period ending on such due date (or such other 

3 period as the Secretary prescribes) a physician 

4 (as so defined) has certified that such indi5 vidual meets such requirements. 

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

7 NEEDS.—An individual is described in this sub8 paragraph if the individual meets any of the fol9 lowing requirements: 

10 ‘‘(i) The individual is at least 18 years 

11 of age and— 

12 ‘‘(I) is unable to perform (with13 out substantial assistance from an14 other individual) at least 3 activities 

15 of daily living (as defined in section 

16 7702B(c)(2)(B)) due to a loss of 

17 functional capacity, or 

18 ‘‘(II) requires substantial super19 vision to protect such individual from 

20 threats to health and safety due to se21 vere cognitive impairment and is un22 able to perform at least 1 activity of 

23 daily living (as so defined) or to the 

24 extent provided in regulations pre25 scribed by the Secretary (in consulta-
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1 tion with the Secretary of Health and 

2 Human Services), is unable to engage 

3 in age appropriate activities. 

4 ‘‘(ii) The individual is at least 6 but 

5 not 18 years of age and— 

6 ‘‘(I) is unable to perform (with7 out substantial assistance from an8 other individual) at least 3 activities 

9 of daily living (as defined in section 

10 7702B(c)(2)(B)) due to a loss of 

11 functional capacity, 

12 ‘‘(II) requires substantial super13 vision to protect such individual from 

14 threats to health and safety due to se15 vere cognitive impairment and is un16 able to perform at least 1 activity of 

17 daily living (as so defined) or to the 

18 extent provided in regulations pre19 scribed by the Secretary (in consulta20 tion with the Secretary of Health and 

21 Human Services), is unable to engage 

22 in age appropriate activities, 

23 ‘‘(III) has a level of disability 

24 similar to the level of disability de25 scribed in subclause (I) (as deter-
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1 mined under regulations promulgated 

2 by the Secretary), or 

3 ‘‘(IV) has a complex medical con4 dition (as defined by the Secretary) 

5 that requires medical management 

6 and coordination of care. 

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

8 not 6 years of age and— 

9 ‘‘(I) is unable due to a loss of 

10 functional capacity to perform (with11 out substantial assistance from an12 other individual) at least 2 of the fol13 lowing activities: eating, transferring, 

14 or mobility, 

15 ‘‘(II) has a level of disability 

16 similar to the level of disability de17 scribed in subclause (I) (as deter18 mined under regulations promulgated 

19 by the Secretary), or 

20 ‘‘(III) has a complex medical con21 dition (as defined by the Secretary) 

22 that requires medical management 

23 and coordination of care. 

24 ‘‘(iv) The individual is under 2 years 

25 of age and— 
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1 ‘‘(I) requires specific durable 

2 medical equipment by reason of a se3 vere health condition or requires a 

4 skilled practitioner trained to address 

5 the individual’s condition to be avail6 able if the individual’s parents or 

7 guardians are absent, 

8 ‘‘(II) has a level of disability 

9 similar to the level of disability de10 scribed in subclause (I) (as deter11 mined under regulations promulgated 

12 by the Secretary), or 

13 ‘‘(III) has a complex medical con14 dition (as defined by the Secretary) 

15 that requires medical management 

16 and coordination of care. 

17 ‘‘(v) The individual has 5 or more 

18 chronic conditions (as defined in subpara19 graph (C)) and is unable to perform (with20 out substantial assistance from another in21 dividual) at least 1 activity of daily living 

22 (as so defined) due to a loss of functional 

23 capacity. 

24 ‘‘(C) CHRONIC CONDITION.—For purposes 

25 of this paragraph, the term ‘chronic condition’ 
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1 means a condition that lasts for at least 6 con2 secutive months and requires ongoing medical 

3 care. 

4 ‘‘(2) ELIGIBLE CAREGIVER.— 

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

6 treated as an eligible caregiver for any taxable 

7 year with respect to the following individuals: 

8 ‘‘(i) The taxpayer. 

9 ‘‘(ii) The taxpayer’s spouse. 

10 ‘‘(iii) An individual with respect to 

11 whom the taxpayer is allowed a deduction 

12 under section 151(c) for the taxable year. 

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

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

16 substituting for the exemption amount an 

17 amount equal to the sum of the exemption 

18 amount, the standard deduction under sec19 tion 63(c)(2)(C), and any additional stand20 ard deduction under section 63(c)(3) which 

21 would be applicable to the individual if 

22 clause (iii) applied. 

23 ‘‘(v) An individual who would be de24 scribed in clause (iii) for the taxable year 

25 if— 
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1 ‘‘(I) the requirements of clause 

2 (iv) are met with respect to the indi3 vidual, and 

4 ‘‘(II) the requirements of sub5 paragraph (B) are met with respect to 

6 the individual in lieu of the support 

7 test of section 152(a). 

8 ‘‘(B) RESIDENCY TEST.—The require9 ments of this subparagraph are met if an indi10 vidual has as his principal place of abode the 

11 home of the taxpayer and— 

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

13 is an ancestor or descendant of the tax14 payer or the taxpayer’s spouse, is a mem15 ber of the taxpayer’s household for over 

16 half the taxable year, or 

17 ‘‘(ii) in the case of any other indi18 vidual, is a member of the taxpayer’s 

19 household for the entire taxable year. 

20 ‘‘(C) SPECIAL RULES WHERE MORE THAN

21 1 ELIGIBLE CAREGIVER.— 

22 ‘‘(i) IN GENERAL.—If more than 1 in23 dividual is an eligible caregiver with re24 spect to the same applicable individual for 

25 taxable years ending with or within the 
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1 same calendar year, a taxpayer shall be 

2 treated as the eligible caregiver if each 

3 such individual (other than the taxpayer) 

4 files a written declaration (in such form 

5 and manner as the Secretary may pre6 scribe) that such individual will not claim 

7 such applicable individual for the credit 

8 under this section. 

9 ‘‘(ii) NO AGREEMENT.—If each indi10 vidual required under clause (i) to file a 

11 written declaration under clause (i) does 

12 not do so, the individual with the highest 

13 modified adjusted gross income (as defined 

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

15 eligible caregiver. 

16 ‘‘(iii) MARRIED INDIVIDUALS FILING

17 SEPARATELY.—In the case of married indi18 viduals filing separately, the determination 

19 under this subparagraph as to whether the 

20 husband or wife is the eligible caregiver 

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

22 (whether or not one of them has filed a 

23 written declaration under clause (i)). 

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

25 shall be allowed under this section to a taxpayer with re-
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1 spect to any applicable individual unless the taxpayer in2 cludes the name and taxpayer identification number of 

3 such individual, and the identification number of the phy4 sician certifying such individual, on the return of tax for 

5 the taxable year. 

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

7 YEAR.—Except in the case of a taxable year closed by rea8 son of the death of the taxpayer, no credit shall be allow9 able under this section in the case of a taxable year cov10 ering a period of less than 12 months.’’. 

11 (b) CONFORMING AMENDMENTS.— 

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

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

14 end of subparagraph (L), by striking the period at 

15 the end of subparagraph (M) and inserting ‘‘, and’’, 

16 and by inserting after subparagraph (M) the fol17 lowing new subparagraph: 

18 ‘‘(N) an omission of a correct TIN or phy19 sician identification required under section 

20 25C(d) (relating to credit for taxpayers with 

21 long-term care needs) to be included on a re22 turn.’’. 

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

24 IV of subchapter A of chapter 1 of such Code is 
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1 amended by inserting after the item relating to sec2 tion 25B the following new item: 

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

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

4 this section shall apply to taxable years beginning after 

5 December 31, 2003. 

6 SEC. 306. TREATMENT OF PREMIUMS ON QUALIFIED LONG7 TERM CARE INSURANCE CONTRACTS. 

8 (a) IN GENERAL.—Part VII of subchapter B of chap9 ter 1 of the Internal Revenue Code of 1986 (relating to 

10 additional itemized deductions) is amended by redesig11 nating section 224 as section 225 and by inserting after 

12 section 223 the following new section: 

13 ‘‘SEC. 224. PREMIUMS ON QUALIFIED LONG-TERM CARE IN14 SURANCE CONTRACTS. 

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

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

17 the applicable percentage of the amount of eligible long18 term care premiums (as defined in section 213(d)(10)) 

19 paid during the taxable year for coverage for the taxpayer 

20 and the taxpayer’s spouse and dependents under a quali21 fied long-term care insurance contract (as defined in sec22 tion 7702B(b)). 

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

24 subsection (a)— 
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1 ‘‘(1) IN GENERAL.—Except as otherwise pro2 vided in this subsection, the applicable percentage 

3 shall be determined in accordance with the following 

4 table based on the number of years of continuous 

5 coverage (as of the close of the taxable year) of the 

6 individual under any qualified long-term care insur7 ance contracts (as defined in section 7702B(b)): 

8 ‘‘(2) SPECIAL RULES FOR INDIVIDUALS WHO

9 HAVE ATTAINED AGE 55.—In the case of an indi10 vidual who has attained age 55 as of the close of the 

11 taxable year, the following table shall be substituted 

12 for the table in paragraph (1): 

13 ‘‘(3) ONLY COVERAGE AFTER 2003 TAKEN INTO

14 ACCOUNT.—Only coverage for periods after Decem15 ber 31, 2003, shall be taken into account under this 

16 subsection. 

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

18 shall not fail to be treated as having continuous cov19 erage if the aggregate breaks in coverage during any 

20 1-year period are less than 60 days. 

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

22 Any amount paid by a taxpayer for any qualified long23 term care insurance contract to which subsection (a) ap24 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) CONFORMING AMENDMENTS.— 

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

5 of 1986 is amended by inserting after paragraph 

6 (19) the following new paragraph: 

7 ‘‘(20) PREMIUMS ON QUALIFIED LONG-TERM

8 CARE INSURANCE CONTRACTS.—The deduction al9 lowed by section 224.’’. 

10 (2) The table of sections for part VII of sub11 chapter B of chapter 1 of such Code is amended by 

12 striking the last item and inserting the following 

13 new items: 

‘‘224. Premiums on qualified long-term care insurance contracts. 

‘‘225. Cross reference.’’. 

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

15 this section shall apply to taxable years beginning after 

16 December 31, 2003. 

17 SEC. 307. ADDITIONAL CONSUMER PROTECTIONS FOR 

18 LONG-TERM CARE INSURANCE. 

19 (a) ADDITIONAL PROTECTIONS APPLICABLE TO

20 LONG-TERM CARE INSURANCE.—Subparagraphs (A) and 

21 (B) of section 7702B(g)(2) of the Internal Revenue Code 

22 of 1986 (relating to requirements of model regulation and 

23 Act) are amended to read as follows: 
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1 ‘‘(A) IN GENERAL.—The requirements of 

2 this paragraph are met with respect to any con3 tract if such contract meets— 

4 ‘‘(i) MODEL REGULATION.—The fol5 lowing requirements of the model regula6 tion: 

7 ‘‘(I) Section 6A (relating to guar8 anteed renewal or noncancellability), 

9 and the requirements of section 6B of 

10 the model Act relating to such section 

11 6A. 

12 ‘‘(II) Section 6B (relating to pro13 hibitions on limitations and exclu14 sions). 

15 ‘‘(III) Section 6C (relating to ex16 tension of benefits). 

17 ‘‘(IV) Section 6D (relating to 

18 continuation or conversion of cov19 erage). 

20 ‘‘(V) Section 6E (relating to dis21 continuance and replacement of poli22 cies). 

23 ‘‘(VI) Section 7 (relating to unin24 tentional lapse). 
45 

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1 ‘‘(VII) Section 8 (relating to dis2 closure), other than section 8F there3 of. 

4 ‘‘(VIII) Section 11 (relating to 

5 prohibitions against post-claims un6 derwriting). 

7 ‘‘(IX) Section 12 (relating to 

8 minimum standards). 

9 ‘‘(X) Section 13 (relating to re10 quirement to offer inflation protec11 tion), except that any requirement for 

12 a signature on a rejection of inflation 

13 protection shall permit the signature 

14 to be on an application or on a sepa15 rate form. 

16 ‘‘(XI) Section 25 (relating to pro17 hibition against preexisting conditions 

18 and probationary periods in replace19 ment policies or certificates). 

20 ‘‘(XII) The provisions of section 

21 26 relating to contingent nonforfeiture 

22 benefits, if the policyholder declines 

23 the offer of a nonforfeiture provision 

24 described in paragraph (4). 
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1 ‘‘(ii) MODEL ACT.—The following re2 quirements of the model Act: 

3 ‘‘(I) Section 6C (relating to pre4 existing conditions). 

5 ‘‘(II) Section 6D (relating to 

6 prior hospitalization). 

7 ‘‘(III) The provisions of section 8 

8 relating to contingent nonforfeiture 

9 benefits, if the policyholder declines 

10 the offer of a nonforfeiture provision 

11 described in paragraph (4). 

12 ‘‘(B) DEFINITIONS.—For purposes of this 

13 paragraph— 

14 ‘‘(i) MODEL PROVISIONS.—The terms 

15 ‘model regulation’ and ‘model Act’ mean 

16 the long-term care insurance model regula17 tion, and the long-term care insurance 

18 model Act, respectively, promulgated by 

19 the National Association of Insurance 

20 Commissioners (as adopted as of Sep21 tember 2000). 

22 ‘‘(ii) COORDINATION.—Any provision 

23 of the model regulation or model Act listed 

24 under clause (i) or (ii) of subparagraph 

25 (A) shall be treated as including any other 
47 

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1 provision of such regulation or Act nec2 essary to implement the provision. 

3 ‘‘(iii) DETERMINATION.—For pur4 poses of this section and section 4980C, 

5 the determination of whether any require6 ment of a model regulation or the model 

7 Act has been met shall be made by the 

8 Secretary.’’. 

9 (b) EXCISE TAX.—Paragraph (1) of section 

10 4980C(c) of the Internal Revenue Code of 1986 (relating 

11 to requirements of model provisions) is amended to read 

12 as follows: 

13 ‘‘(1) REQUIREMENTS OF MODEL PROVISIONS.— 

14 ‘‘(A) MODEL REGULATION.—The following 

15 requirements of the model regulation must be 

16 met: 

17 ‘‘(i) Section 9 (relating to required 

18 disclosure of rating practices to consumer). 

19 ‘‘(ii) Section 14 (relating to applica20 tion forms and replacement coverage). 

21 ‘‘(iii) Section 15 (relating to reporting 

22 requirements), except that the issuer shall 

23 also report at least annually the number of 

24 claims denied during the reporting period 

25 for each class of business (expressed as a 
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1 percentage of claims denied), other than 

2 claims denied for failure to meet the wait3 ing period or because of any applicable 

4 preexisting condition. 

5 ‘‘(iv) Section 22 (relating to filing re6 quirements for marketing). 

7 ‘‘(v) Section 23 (relating to standards 

8 for marketing), including inaccurate com9 pletion of medical histories, other than 

10 paragraphs (1), (6), and (9) of section 

11 23C, except that— 

12 ‘‘(I) in addition to such require13 ments, no person shall, in selling or 

14 offering to sell a qualified long-term 

15 care insurance contract, misrepresent 

16 a material fact; and 

17 ‘‘(II) no such requirements shall 

18 include a requirement to inquire or 

19 identify whether a prospective appli20 cant or enrollee for long-term care in21 surance has accident and sickness in22 surance. 

23 ‘‘(vi) Section 24 (relating to suit24 ability). 
49 

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1 ‘‘(vii) Section 29 (relating to standard 

2 format outline of coverage). 

3 ‘‘(viii) Section 30 (relating to require4 ment to deliver shopper’s guide). 

5 The requirements referred to in clause (vi) shall 

6 not include those portions of the personal work7 sheet described in Appendix B relating to con8 sumer protection requirements not imposed by 

9 section 4980C or 7702B. 

10 ‘‘(B) MODEL ACT.—The following require11 ments of the model Act must be met: 

12 ‘‘(i) Section 6F (relating to right to 

13 return), except that such section shall also 

14 apply to denials of applications and any re15 fund shall be made within 30 days of the 

16 return or denial. 

17 ‘‘(ii) Section 6G (relating to outline of 

18 coverage). 

19 ‘‘(iii) Section 6H (relating to require20 ments for certificates under group plans). 

21 ‘‘(iv) Section 6I (relating to policy 

22 summary). 

23 ‘‘(v) Section 6J (relating to monthly 

24 reports on accelerated death benefits). 
50 

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1 ‘‘(vi) Section 7 (relating to incontest2 ability period). 

3 ‘‘(C) DEFINITIONS.—For purposes of this 

4 paragraph, the terms ‘model regulation’ and 

5 ‘model Act’ have the meanings given such terms 

6 by section 7702B(g)(2)(B).’’. 

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

8 this section shall apply to policies issued more than 1 year 

9 after the date of the enactment of this Act. 

Æ