II 

★(Star Print)

109TH CONGRESS 

2D SESSION S. 3815 

To improve the quality of, and access to, long-term care. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 3, 2006 

Mr. SMITH (for himself and Mrs. LINCOLN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To improve the quality of, and access to, long-term care. 

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 ‘‘Long-term Care Quality and Modernization Act of 

6 2006’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE AND MEDICAID MODERNIZATION 

Sec. 101. Joint training of surveyors and providers. 

Sec. 102. Facility-based training for new surveyors. 

Sec. 103. Resumption of nurse aide training program after correction of deficiencies. 


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Sec. 104. Clarifying and eliminating the distinction between physician supervision requirements for skilled nursing facilities and nursing facilities. 

Sec. 105. Permitting split or shared billing by physicians and nurse practitioners in skilled nursing facilities. 

Sec. 106. Permitting nurse practitioners employed by skilled nursing facilities 

to certify skilled care. 

Sec. 107. Modernization of therapy caps. 

Sec. 108. Establishment of a Medicare skilled nursing facility specific wage 

index. 

Sec. 109. Update of the Medicare skilled nursing facility market basket index 

. 

Sec. 110. Authority to exclude high cost and low probability drugs used in the 

treatment of cancer from the Medicare prospective payment 

system for skilled nursing facilities. 

Sec. 111. Exclusion of all ambulance services from the Medicare prospective 

payment system for skilled nursing facilities. 

Sec. 112. Authority to exclude additional items and services from the Medicare 

prospective payment system for skilled nursing facilities. 

TITLE II—WORKFORCE SUPPORT 

Sec. 201. Nursing loan repayment program. 

Sec. 202. National nursing database. 

Sec. 203. Reports on nursing levels. 

TITLE III—TAX INCENTIVES 

Sec. 301. 10-year recovery period for qualified long-term care improvement 

property. 

Sec. 302. Investment tax credit for long-term care facility information technology. 

Sec. 303. Long-Term Care Trust Accounts. 

Sec. 304. Refundable credit for contributions to Long-Term Care Trust Accounts. 

TITLE IV—DISASTER PREPAREDNESS AND RESPONSE 

Sec. 401. Disaster preparedness and response. 

1 TITLE I—MEDICARE AND 

2 MEDICAID MODERNIZATION 

3 SEC. 101. JOINT TRAINING OF SURVEYORS AND PRO4 VIDERS. 

5 (a) MEDICARE PROGRAM.—Section 1819(e) of the 

6 Social Security Act (42 U.S.C. 1395i–3(e)) is amended by 

7 adding at the end the following new paragraph: 


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1 ‘‘(6) JOINT SURVEYOR/PROVIDER TRAINING.— 

2 The Secretary shall require the State to establish a 

3 process for joint training and education of surveyors 

4 and providers at least annually and periodically as 

5 changes to regulations, guidelines, and policy gov6 erning nursing facility operations are implemented 

7 and used in surveys of participating facilities.’’. 

8 (b) MEDICAID PROGRAM.—Section 1919(e) of the 

9 Social Security Act (42 U.S.C. 1396r(e)) is amended by 

10 adding at the end the following new paragraph: 

11 ‘‘(8) JOINT SURVEYOR/PROVIDER TRAINING.— 

12 The State shall establish a process for joint training 

13 and education to surveyors and providers at least 

14 annually and periodically as changes to regulations, 

15 guidelines, and policy governing nursing facility op16 erations are implemented and used in surveys of 

17 participating facilities.’’ 

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

19 this section shall take effect on January 1, 2007. 

20 SEC. 102. FACILITY-BASED TRAINING FOR NEW SUR21 VEYORS. 

22 (a) MEDICARE PROGRAM.—Section 1819(e) of the 

23 Social Security Act (42 U.S.C. 1395i–3(e)), as amended 

24 by section 101(a), is amended by adding at the end the 

25 following new paragraph: 


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1 ‘‘(7) FACILITY-BASED TRAINING FOR NEW SUR2 VEYORS.—The Secretary shall require the State to 

3 establish a process for assuring that— 

4 ‘‘(A) each individual newly hired as a nurs5 ing home surveyor, as part of the individual’s 

6 basic training, is assigned full-time to a partici7 pating nursing facility for at least 5 days within 

8 a 7-day period to observe actual operations out9 side of the survey process before the individual 

10 begins oversight responsibilities; 

11 ‘‘(B) such individual shall not assume 

12 oversight responsibility during this training pe13 riod and such observations may not be the sole 

14 basis of a deficiency citation against the facility; 

15 and 

16 ‘‘(C) such individual shall not be assigned 

17 as a member of a survey team for the facility 

18 in which the individual received training for two 

19 standard surveys following the training period 

20 in the facility.’’. 

21 (b) MEDICAID PROGRAM.—Section 1919(e) of the 

22 Social Security Act (42 U.S.C. 1396r(e)), as amended by 

23 section 101(b), is amended by adding at the end the fol24 lowing new paragraph: 


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1 ‘‘(9) FACILITY-BASED TRAINING FOR NEW SUR2 VEYORS.—The State shall establish a process for as3 suring that— 

4 ‘‘(A) each individual newly hired as a nurs5 ing home surveyor, as part of the individual’s 

6 basic training, is assigned full-time to a partici7 pating nursing facility for at least 5 days within 

8 a 7-day period to observe actual operations out9 side of the survey process before the individual 

10 begins oversight responsibilities; 

11 ‘‘(B) such individual shall not assume 

12 oversight responsibility during this training pe13 riod and such observations may not be the sole 

14 basis of a deficiency citation against the facility; 

15 and 

16 ‘‘(C) such individual shall not be assigned 

17 as a member of a survey team for the facility 

18 in which the individual received training for two 

19 standard surveys following the training period 

20 in the facility.’’. 

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

22 this section shall take effect on January 1, 2007. 


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1 SEC. 103. RESUMPTION OF NURSE AIDE TRAINING PRO2 GRAM AFTER CORRECTION OF DEFI3 CIENCIES. 

4 (a) RESUMPTION OF NURSE AIDE TRAINING PRO5 GRAM FOR SKILLED NURSING FACILITIES.—Section 

6 1819(f)(2) of the Social Security Act (42 U.S.C. 1395i– 

7 3(f)(2)) is amended— 

8 (1) in paragraph (B)(iii), in the matter pre9 ceding subclause (I), by striking ‘‘(C) and (D)’’ and 

10 inserting ‘‘(C), (D), and (E)’’; and 

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(E) RESUMPTION OF NURSE AIDE TRAIN14 ING PROGRAM AFTER CORRECTION OF DEFI15 CIENCIES.—Clause (iii)(I) of subparagraph (B) 

16 shall not apply to a program offered by or in 

17 a skilled nursing facility if the facility has— 

18 ‘‘(i) corrected any deficiencies that re19 sulted in the prohibition of approval of 

20 such program; and 

21 ‘‘(ii) demonstrated compliance with 

22 the requirements of subsections (b), (c), 

23 and (d) of this section.’’. 

24 (b) RESUMPTION OF NURSE AIDE TRAINING PRO25 GRAM FOR NURSING FACILITIES.—Section 1919(f)(2) of 


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1 the Social Security Act (42 U.S.C. 1396r(f)(2)) is amend2 ed— 

3 (1) in paragraph (B)(iii), in the matter pre4 ceding subclause (I), by striking ‘‘(C) and (D)’’ and 

5 inserting ‘‘(C), (D), and (E)’’; and 

6 (2) by adding at the end the following new sub7 paragraph: 

8 ‘‘(E) RESUMPTION OF NURSE AIDE TRAIN9 ING PROGRAM AFTER CORRECTION OF DEFI10 CIENCIES.—Clause (iii)(I) of subparagraph (B) 

11 shall not apply to a program offered by or in 

12 a nursing facility if the facility has— 

13 ‘‘(i) corrected any deficiencies that re14 sulted in the prohibition of approval of 

15 such program; and 

16 ‘‘(ii) been determined to be in compli17 ance with the requirements of subsections 

18 (b), (c), and (d) of this section.’’. 

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

20 this section shall take effect on January 1, 2007. 


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1 SEC. 104. CLARIFYING AND ELIMINATING THE DISTINC2 TION BETWEEN PHYSICIAN SUPERVISION RE3 QUIREMENTS FOR SKILLED NURSING FACILI4 TIES AND NURSING FACILITIES. 

5 (a) PHYSICIAN SUPERVISION REQUIREMENTS FOR

6 SKILLED NURSING FACILITIES.—Section 1819(b)(6)(A) 

7 of the Social Security Act (42 U.S.C. 1395i–3(b)(6)(A)) 

8 is amended by inserting ‘‘(or, at the option of a State, 

9 under the supervision of a nurse practitioner, clinical 

10 nurse specialist, or physician assistant who is working in 

11 collaboration with a physician)’’ before the semicolon at 

12 the end. 

13 (b) CLARIFYING PHYSICIAN SUPERVISION REQUIRE14 MENTS FOR NURSING FACILITIES.—Section 

15 1919(b)(6)(A) of the Social Security Act (42 U.S.C. 

16 1396r(b)(6)(A)) is amended by striking ‘‘who is not an 

17 employee of the facility but’’. 

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

19 this section shall take effect on January 1, 2007. 

20 SEC. 105. PERMITTING SPLIT OR SHARED BILLING BY PHY21 SICIANS AND NURSE PRACTITIONERS IN 

22 SKILLED NURSING FACILITIES. 

23 (a) IN GENERAL.—Section 1888(e) of the Social Se24 curity Act (42 U.S.C. 1395yy(e)) is amended by adding 

25 at the end the following new paragraph: 


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1 ‘‘(13) PERMITTING SPLIT OR SHARED BILLING

2 BY PHYSICIANS AND NURSE PRACTITIONERS IN

3 SKILLED NURSING FACILITIES.—Notwithstanding 

4 section 1861(s)(2)(K)(ii), a physician and a nurse 

5 practitioner may each submit a claim for payment 

6 for their portion of a service provided to a resident 

7 of a skilled nursing facility, except that, in no case 

8 may the total amount paid under this title be great9 er than it would have been if only one person had 

10 submitted a claim for such service.’’. 

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

12 this section shall apply to services furnished on or after 

13 January 1, 2007. 

14 SEC. 106. PERMITTING NURSE PRACTITIONERS EMPLOYED 

15 BY SKILLED NURSING FACILITIES TO CER16 TIFY SKILLED CARE. 

17 (a) IN GENERAL.—Section 1814(a)(2) of the Social 

18 Security Act (42 U.S.C. 1395f(a)(2)) is amended by strik19 ing ‘‘or a nurse practitioner or’’ and inserting ‘‘a nurse 

20 practitioner, or a’’. 

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

22 this section shall take effect on January 1, 2007. 

23 SEC. 107. MODERNIZATION OF THERAPY CAPS. 

24 Section 1833(g) of the Social Security Act (42 U.S.C. 

25 1395l(g)) is amended— 


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1 (1) in paragraph (4)— 

2 (A) by striking ‘‘This subsection’’ and in3 serting ‘‘Except as provided in paragraph (6), 

4 this subsection’’; and 

5 (B) by inserting ‘‘and with respect to serv6 ices furnished on or after January 1, 2009’’ be7 fore the period at the end; and 

8 (2) by adding at the end the following new 

9 paragraph: 

10 ‘‘(6) In the case of services described in para11 graph (1), with respect to such services furnished on 

12 or after January 1, 2009, the Secretary shall estab13 lish and implement a condition-based system based 

14 on medical necessity for necessary and clinically ap15 propriate services. Such system shall utilize a stand16 ardized patient assessment tool to evaluate the level 

17 of such services that are needed by an individual and 

18 impose a limitation on coverage of such services 

19 under this part based on such tool.’’. 

20 SEC. 108. ESTABLISHMENT OF A MEDICARE SKILLED NURS21 ING FACILITY SPECIFIC WAGE INDEX. 

22 Section 1888(e)(4)(G)(ii) of the Social Security Act 

23 (42 U.S.C. 1395yy(e)(4)(G)(ii)) is amended by inserting 

24 after the first sentence the following new sentence: ‘‘For 

25 services furnished on or after October 1, 2008, in making 


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1 the adjustment under the preceding sentence, the Sec2 retary shall utilize an area wage index for skilled nursing 

3 facilities based on wage data from such facilities and not 

4 from hospitals.’’ 

5 SEC. 109. UPDATE OF THE MEDICARE SKILLED NURSING 

6 FACILITY MARKET BASKET INDEX . 

7 Section 1888(e) of the Social Security Act (42 U.S.C. 

8 1395yy(e)) is amended by adding at the end the following 

9 new paragraph: 

10 ‘‘(13) UPDATE OF THE SKILLED NURSING FA11 CILITY MARKET BASKET INDEX.— 

12 ‘‘(A) IN GENERAL.—Not later than Octo13 ber 1, 2007, the Secretary shall develop and im14 plement a process for updating the calculation 

15 of the skilled nursing facility market basket 

16 index under paragraph (5)(A), including the 

17 weights used in such index. 

18 ‘‘(B) REQUIREMENT.—Such process shall 

19 ensure that such index— 

20 ‘‘(i) includes a separate weight for 

21 professional liability costs; 

22 ‘‘(ii) is updated at least as frequently 

23 as the hospital market basket is updated 

24 under section 1886(b)(3)(B)(iii); and 


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1 ‘‘(iii) reflects the most current data 

2 available. 

3 ‘‘(C) CONSIDERATION.—In developing and 

4 implementing the process under subparagraph 

5 (A), the Secretary shall consider methodologies 

6 for measuring changes in the price of wages 

7 and salaries other than the methodologies being 

8 used by the Secretary as of the date of enact9 ment of this paragraph. 

10 ‘‘(D) STUDY.—The Secretary shall conduct 

11 a study to determine the appropriate frequency 

12 for updating the skilled nursing facility market 

13 basket index under the process developed and 

14 implemented under subparagraph (A).’’. 

15 SEC. 110. AUTHORITY TO EXCLUDE HIGH COST AND LOW 

16 PROBABILITY DRUGS USED IN THE TREAT17 MENT OF CANCER FROM THE MEDICARE 

18 PROSPECTIVE PAYMENT SYSTEM FOR 

19 SKILLED NURSING FACILITIES. 

20 (a) IN GENERAL.—Section 1888(e)(2)(A)(iii) of the 

21 Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is 

22 amended— 

23 (1) by redesignating subclauses (IV) and (V) as 

24 subclauses (V) and (VI), respectively; and 


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1 (2) by inserting after subclause (III) the fol2 lowing new subclause: 

3 ‘‘(IV) Any drugs (not otherwise 

4 described in subclause (II)) used in 

5 the treatment of cancer, including 

6 antineoplastic drugs, antiemetics, and 

7 supportive medications, that the Sec8 retary determines to be appropriate.’’. 

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

10 subsection (a) shall apply to drugs furnished on or after 

11 October 1, 2007. 

12 SEC. 111. EXCLUSION OF ALL AMBULANCE SERVICES FROM 

13 THE MEDICARE PROSPECTIVE PAYMENT SYS14 TEM FOR SKILLED NURSING FACILITIES. 

15 (a) IN GENERAL.—Section 1888(e)(2)(A)(iii)(I) of 

16 the Social Security Act (42 U.S.C. 

17 1395yy(e)(2)(A)(iii)(I)) is amended by striking ‘‘furnished 

18 to’’ and all that follows before the period. 

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

20 subsection (a) shall apply to services furnished on or after 

21 October 1, 2007. 


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1 SEC. 112. AUTHORITY TO EXCLUDE ADDITIONAL ITEMS 

2 AND SERVICES FROM THE MEDICARE PRO3 SPECTIVE PAYMENT SYSTEM FOR SKILLED 

4 NURSING FACILITIES. 

5 (a) AUTHORITY.—Section 1888(e)(2)(A) of the So6 cial Security Act (42 U.S.C. 1395yy(e)(2)(A)) is amend7 ed— 

8 (1) in clause (i)(II), by striking ‘‘and (iv)’’ and 

9 inserting ‘‘(iv), and (v)(I)’’; and 

10 (2) by adding at the end the following new 

11 clause: 

12 ‘‘(v) EXCLUSION OF ADDITIONAL

13 ITEMS AND SERVICES DETERMINED APPRO14 PRIATE BY THE SECRETARY.— 

15 ‘‘(I) IN GENERAL.—Items and 

16 services described in this clause are 

17 any items and services not otherwise 

18 described in clauses (ii), (iii), or (iv), 

19 that the Secretary determines to be 

20 appropriate. 

21 ‘‘(II) ANNUAL UPDATE.—The 

22 Secretary shall annually update the 

23 items and services described in sub24 clause (I) to take into account 

25 changes in the practice of medicine.’’. 


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1 (b) CLARIFICATION.—Items and services described in 

2 section 1888(e)(2)(A)(v)(I) of the Social Security Act (42 

3 U.S.C. 1395yy(e)(2)(A)(v)(I)), as added by subsection (a), 

4 may include items and services furnished in a freestanding 

5 clinic to an individual who is a resident of a skilled nursing 

6 facility. 

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

8 subsection (a) shall take effect on October 1, 2007. 

9 TITLE II—WORKFORCE SUPPORT 

10 SEC. 201. NURSING LOAN REPAYMENT PROGRAM. 

11 Section 846(a) of the Public Health Service Act (42 

12 U.S.C. 297n(a)) is amended by striking the last sentence. 

13 SEC. 202. NATIONAL NURSING DATABASE. 

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

15 Human Services shall provide for the establishment of a 

16 national nursing database to be used to predict future 

17 nursing shortages. 

18 (b) INFORMATION IN DATABASE.—The database es19 tablished under subsection (a) shall be designed to include 

20 nursing workforce data across all healthcare provider set21 tings, including nursing educators, as determined by the 

22 Secretary of Health and Human Services to be appro23 priate for use in the analysis of trends in the supply and 

24 demand of nurses and to create an educational model to 

25 predict future nursing workforce needs. 


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1 (c) FUNDING.—The Secretary of Health and Human 

2 Services may transfer, from amounts appropriated for the 

3 National Center for Health Workforce Analysis, such 

4 sums as may be necessary to carry out this section. 

5 SEC. 203. REPORTS ON NURSING LEVELS. 

6 Section 806 of the Public Health Service Act (42 

7 U.S.C. 296e), as amended by section 202, is further 

8 amended by adding at the end the following: 

9 ‘‘(j) REPORTS CONCERNING NURSING LEVELS.— 

10 ‘‘(1) IN GENERAL.—The entities described in 

11 paragraph (2) shall annually submit to the Secretary 

12 a report concerning how assistance under this title 

13 is being used by such entities to increase the number 

14 of nurses, nursing educators, and nurse education 

15 enrollment slots. 

16 ‘‘(2) ENTITIES DESCRIBED.—An entity is de17 scribed in this paragraph if such entity is— 

18 ‘‘(A) an entity that receives a grant or con19 tract under this title; 

20 ‘‘(B) a school of nursing that receives stu21 dent loan funds under this title; 

22 ‘‘(C) a school of nursing that receives 

23 nurse faculty student loan funds under this 

24 title; and 


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1 ‘‘(D) any other entity that receives assist2 ance under this title.’’. 

3 TITLE III—TAX INCENTIVES 

4 SEC. 301. 10-YEAR RECOVERY PERIOD FOR QUALIFIED 

5 LONG-TERM CARE IMPROVEMENT PROP6 ERTY. 

7 (a) IN GENERAL.—Subparagraph (D) of section 

8 168(e)(3) of the Internal Revenue Code of 1986 (relating 

9 to 10-year property) is amended by striking ‘‘and’’ at the 

10 end of clause (i), by striking the period at the end of 

11 clause (ii) and inserting ‘‘, and’’, and by adding at the 

12 end the following new clause: 

13 ‘‘(iii) any qualified long-term care im14 provement property.’’. 

15 (b) QUALIFIED LONG-TERM CARE IMPROVEMENT

16 PROPERTY.—Section 168(e) of the Internal Revenue Code 

17 of 1986 (relating to classification of property) is amended 

18 by adding at the end the following new paragraph: 

19 ‘‘(8) QUALIFIED LONG-TERM CARE IMPROVE20 MENT PROPERTY.—The term ‘qualified long-term 

21 care improvement property’ means any section 1250 

22 property which is an improvement to a building if— 

23 ‘‘(A) such improvement is placed in service 

24 more than 3 years after the date such building 

25 was first placed in service, and 


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1 ‘‘(B) such building is, or is a part of, a 

2 nursing facility, assisted living facility, residen3 tial care facility, intermediate care facility for 

4 the mentally retarded, or similar facility de5 signed to provide housing and healthcare for 

6 the elderly and disabled.’’. 

7 (c) ALTERNATIVE SYSTEM.—The table contained in 

8 section 168(g)(3)(B) of the Internal Revenue Code of 

9 1986 (relating to special rule for certain property assigned 

10 to classes) is amended by inserting after the item relating 

11 to subparagraph (D)(ii) the following: 

‘‘(D)(iii) ................................................................................... 10’’. 

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

13 this section shall apply to property placed in service after 

14 the date of the enactment of this Act. 

15 SEC. 302. INVESTMENT TAX CREDIT FOR LONG-TERM CARE 

16 FACILITY INFORMATION TECHNOLOGY. 

17 (a) IN GENERAL.—Section 46 of the Internal Rev18 enue Code of 1986 (relating to amount of credit) is 

19 amended by striking ‘‘and’’ at the end of paragraph (3), 

20 by striking the period at the end of paragraph (4) and 

21 inserting ‘‘, and’’, and by adding at the end the following 

22 new paragraph: 


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1 ‘‘(5) the qualifying long-term care facility infor2 mation technology credit.’’. 

3 (b) AMOUNT OF CREDIT.—Subpart E of part IV of 

4 subchapter A of chapter 1 of the Internal Revenue Code 

5 of 1986 (relating to rules for computing investment credit) 

6 is amended by inserting after section 48B the following 

7 new section: 

8 ‘‘SEC. 48C. QUALIFYING LONG-TERM CARE FACILITY TECH9 NOLOGY CREDIT. 

10 ‘‘(a) IN GENERAL.—For purposes of section 46, the 

11 qualifying long-term care facility technology credit for any 

12 taxable year is an amount equal to 20 percent of the quali13 fied investment for such taxable year. 

14 ‘‘(b) QUALIFIED INVESTMENT.— 

15 ‘‘(1) IN GENERAL.—For purposes of subsection 

16 (a), the qualified investment for any taxable year is 

17 the basis of property placed in service by the tax18 payer during such taxable year which is part of a 

19 qualifying long-term care facility technology sys20 tem— 

21 ‘‘(A)(i) the construction, reconstruction, or 

22 erection of which is completed by the taxpayer, 

23 or 


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1 ‘‘(ii) which is acquired by the taxpayer if 

2 the original use of such property commences 

3 with the taxpayer, and 

4 ‘‘(B) with respect to which depreciation (or 

5 amortization in lieu of depreciation) is allow6 able. 

7 ‘‘(2) APPLICABLE RULES.—For purposes of this 

8 section, rules similar to the rules of subsection 

9 (a)(4) and (b) of section 48 shall apply. 

10 ‘‘(c) QUALIFYING LONG-TERM CARE FACILITY

11 TECHNOLOGY SYSTEM.—For purposes of this section, the 

12 term ‘qualifying long-term care facility technology system’ 

13 means any computers, related equipment, and software for 

14 a healthcare information system of a nursing facility, as15 sisted living facility, residential care facility, intermediate 

16 care facility for the mentally retarded, or similar facility 

17 designed to provide housing and healthcare for the elderly 

18 and disabled. 

19 ‘‘(d) DENIAL OF DOUBLE BENEFIT.—No deduction 

20 or other credit shall be allowed with respect to the basis 

21 of any property taken into account in determining the 

22 credit allowed under this section.’’. 

23 (c) CONFORMING AMENDMENTS.— 

24 (1) Section 49(a)(1)(C) of the Internal Revenue 

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


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1 end of clause (iii), by striking the period at the end 

2 of clause (iv) and inserting ‘‘, and’’, and by adding 

3 after clause (iv) the following new clause: 

4 ‘‘(v) the basis of any property which 

5 is part of a qualifying long-term care facil6 ity technology system under section 48C.’’. 

7 (2) The table of sections for subpart E of part 

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

9 amended by inserting after the item relating to sec10 tion 48B the following new item: 

‘‘48C. Qualifying long-term care facility technology credit.’’. 

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

12 this section shall apply to periods after the date of the 

13 enactment of this Act, under rules similar to the rules of 

14 section 48(m) of the Internal Revenue Code of 1986 (as 

15 in effect on the day before the date of the enactment of 

16 the Revenue Reconciliation Act of 1990). 

17 SEC. 303. LONG-TERM CARE TRUST ACCOUNTS. 

18 (a) IN GENERAL.—Subchapter F of chapter 1 of the 

19 Internal Revenue Code of 1986 (relating to exempt organi20 zations) is amended by adding at the end the following 

21 new part: 

22 ‘‘PART IX—LONG-TERM CARE TRUST ACCOUNTS 

23 ‘‘SEC. 530A. LONG-TERM CARE TRUST ACCOUNTS. 

24 ‘‘(a) GENERAL RULE.—A Long-Term Care Trust Ac25 count shall be exempt from taxation under this subtitle. 


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1 Notwithstanding the preceding sentence, such account 

2 shall be subject to the taxes imposed by section 511 (relat3 ing to imposition of tax on unrelated business income of 

4 charitable organizations). 

5 ‘‘(b) LONG-TERM CARE TRUST ACCOUNT.—For pur6 poses of this section, the term ‘Long-Term Care Trust Ac7 count’ means a trust created or organized in the United 

8 States for the exclusive benefit of an individual who is the 

9 designated beneficiary of the trust and which is designated 

10 (in such manner as the Secretary shall prescribe) at the 

11 time of the establishment of the trust as a Long-Term 

12 Care Trust Account, but only if the written governing in13 strument creating the trust meets the following require14 ments: 

15 ‘‘(1) Except in the case of a qualified rollover 

16 contribution described in subsection (d)— 

17 ‘‘(A) no contribution will be accepted un18 less it is in cash, and 

19 ‘‘(B) contributions will not be accepted for 

20 the calendar year in excess of the contribution 

21 limit specified in subsection (c)(1). 

22 ‘‘(2) The trustee is a bank (as defined in sec23 tion 408(n)), an insurance company (as defined in 

24 section 816), or another person who demonstrates to 

25 the satisfaction of the Secretary that the manner in 


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1 which that person will administer the trust will be 

2 consistent with the requirements of this section or 

3 who has so demonstrated with respect to any indi4 vidual retirement plan. 

5 ‘‘(3) No part of the trust assets will be invested 

6 in life insurance contracts. 

7 ‘‘(4) The interest of an individual in the bal8 ance of his account is nonforfeitable. 

9 ‘‘(5) The assets of the trust shall not be com10 mingled with other property except in a common 

11 trust fund or common investment fund. 

12 ‘‘(6) Except as provided in subsection (e)(2), no 

13 distribution will be allowed if at the time of such dis14 tribution the designated beneficiary is not a chron15 ically ill individual (as defined in section 

16 7702B(c)(2)). 

17 ‘‘(c) TAX TREATMENT OF CONTRIBUTIONS.— 

18 ‘‘(1) CONTRIBUTION LIMIT.— 

19 ‘‘(A) IN GENERAL.—The aggregate 

20 amount of contributions (other than qualified 

21 rollover contributions described in subsection 

22 (d)) for any taxable year to all Long-Term Care 

23 Trust Accounts maintained for the benefit of 

24 the designated beneficiary shall not exceed 

25 $5,000. 


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•S 3815 IS1S 

1 ‘‘(B) INFLATION ADJUSTMENT.—In the 

2 case of any taxable year beginning in a calendar 

3 year after 2006, the dollar amount under sub4 paragraph (A) shall be increased by an amount 

5 equal to— 

6 ‘‘(i) such dollar amount, multiplied by 

7 ‘‘(ii) the medical care cost adjustment 

8 determined under section 213(d)(10)(B)(ii) 

9 for the calendar year in which the taxable 

10 year begins, determined by substituting 

11 ‘2005’ for ‘1996’ in subclause (II) thereof. 

12 If any amount as adjusted under the preceding 

13 sentence is not a multiple of $10, such amount 

14 shall be rounded to the next lowest multiple of 

15 $10. 

16 ‘‘(2) GIFT TAX TREATMENT OF CONTRIBU17 TIONS.—For purposes of chapters 12 and 13— 

18 ‘‘(A) IN GENERAL.—Any contribution to a 

19 Long-Term Care Trust Account on behalf of 

20 any designated beneficiary— 

21 ‘‘(i) shall be treated as a completed 

22 gift to such beneficiary which is not a fu23 ture interest in property, and 

24 ‘‘(ii) shall not be treated as a qualified 

25 transfer under section 2503(e). 


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•S 3815 IS1S 

1 ‘‘(B) TREATMENT OF EXCESS CONTRIBU2 TIONS.—If the aggregate amount of contribu3 tions described in subparagraph (A) during the 

4 calendar year by a donor exceeds the limitation 

5 for such year under section 2503(b), such ag6 gregate amount shall, at the election of the 

7 donor, be taken into account for purposes of 

8 such section ratably over the 5-year period be9 ginning with such calendar year. 

10 ‘‘(d) QUALIFIED ROLLOVER CONTRIBUTION.—For 

11 purposes of this section, the term ‘qualified rollover con12 tribution’ means a contribution to a Long-Term Care 

13 Trust Account— 

14 ‘‘(1) from another such account of the same 

15 beneficiary, but only if such amount is contributed 

16 not later than the 60th day after the distribution 

17 from such other account, and 

18 ‘‘(2) from a Long-Term Care Trust Account of 

19 a spouse of the beneficiary of the account to which 

20 the contribution is made, but only if such amount is 

21 contributed not later than the 60th day after the 

22 distribution from such other account. 

23 ‘‘(e) TAX TREATMENT OF DISTRIBUTIONS.— 

24 ‘‘(1) IN GENERAL.—Any distribution from a 

25 Long-Term Care Trust Account shall be includible 


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•S 3815 IS1S 

1 in the gross income of the distributee in the manner 

2 as provided under section 72 to the extent not ex3 cluded from gross income under any other provision 

4 of this subsection. 

5 ‘‘(2) LONG-TERM CARE INSURANCE PRE6 MIUMS.—If at the time of any distribution, the des7 ignated beneficiary is not a chronically ill individual 

8 (as defined in section 7702B(c)(2)), no amount shall 

9 be includible in gross income under paragraph (1) if 

10 the aggregate premiums for any qualified long-term 

11 care insurance contract for such beneficiary during 

12 the taxable year are not less than the aggregate dis13 tributions during the taxable year. 

14 ‘‘(3) DISTRIBUTIONS FOR QUALIFIED LONG15 TERM CARE SERVICES.—For purposes of this sub16 section, if at the time of any distribution, the des17 ignated beneficiary is a chronically ill individual (as 

18 so defined)— 

19 ‘‘(A) IN-KIND DISTRIBUTIONS.—No 

20 amount shall be includible in gross income 

21 under paragraph (1) by reason of a distribution 

22 which consists of providing a benefit to the dis23 tributee which, if paid for by the distributee, 

24 would constitute expenses for any qualified 


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•S 3815 IS1S 

1 long-term care services (as defined in section 

2 7702B(c)). 

3 ‘‘(B) CASH DISTRIBUTIONS.—In the case 

4 of distributions not described in subparagraph 

5 (A), if— 

6 ‘‘(i) such distributions do not exceed 

7 the expenses for qualified long-term care 

8 services (as so defined), reduced by ex9 penses described in subparagraph (A), no 

10 amount shall be includible in gross income, 

11 and 

12 ‘‘(ii) in any other case, the amount 

13 otherwise includible in gross income shall 

14 be reduced by an amount which bears the 

15 same ratio to such amount as such ex16 penses bear to such distributions. 

17 ‘‘(4) CHANGE IN BENEFICIARIES OR AC18 COUNTS.—Paragraph (1) shall not apply to that 

19 portion of any distribution which, within 60 days of 

20 such distribution, is transferred— 

21 ‘‘(A) to another Long-Term Care Trust 

22 Account for the benefit of the designated bene23 ficiary, or 

24 ‘‘(B) to the credit of another designated 

25 beneficiary under a Long-Term Care Trust AcVerDate Aug 31 2005 01:49 Sep 13, 2006 Jkt 049196 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S3815.IS S3815

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•S 3815 IS1S 

1 count who is a spouse of the designated bene2 ficiary with respect to which the distribution 

3 was made. 

4 ‘‘(5) OPERATING RULES.—For purposes of ap5 plying section 72— 

6 ‘‘(A) to the extent provided by the Sec7 retary, all Long-Term Care Trust Accounts of 

8 which an individual is a designated beneficiary 

9 shall be treated as one account, 

10 ‘‘(B) except to the extent provided by the 

11 Secretary, all distributions during a taxable 

12 year shall be treated as one distribution, and 

13 ‘‘(C) except to the extent provided by the 

14 Secretary, the value of the contract, income on 

15 the contract, and investment in the contract 

16 shall be computed as of the close of the cal17 endar year in which the taxable year begins. 

18 ‘‘(6) SPECIAL RULES FOR DEATH AND DI19 VORCE.— 

20 ‘‘(A) IN GENERAL.—Rules similar to the 

21 rules of paragraphs (7) and (8) of section 

22 220(f) shall apply. 

23 ‘‘(B) AMOUNTS INCLUDIBLE IN ESTATE OF

24 DONOR MAKING EXCESS CONTRIBUTIONS.—In 

25 the case of a donor who makes the election deVerDate Aug 31 2005 01:49 Sep 13, 2006 Jkt 049196 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S3815.IS S3815

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•S 3815 IS1S 

1 scribed in subsection (c)(2)(B) and who dies be2 fore the close of the 5-year period referred to 

3 in such subsection, the gross estate of the donor 

4 shall include the portion of such contributions 

5 properly allocable to periods after the date of 

6 death of the donor. 

7 ‘‘(7) ADDITIONAL TAX.—The tax imposed by 

8 this chapter for any taxable year on any taxpayer 

9 who receives a payment or distribution from a Long10 Term Care Trust Account which is includible in 

11 gross income shall be increased by 25 percent of the 

12 amount which is so includible under rules similar to 

13 the rules of section 530(d)(4). 

14 ‘‘(8) DENIAL OF DOUBLE BENEFIT.—For pur15 poses of determining the amount of any deduction 

16 under this chapter, any payment or distribution out 

17 of a Long-Term Care Trust Account shall not be 

18 treated as an expense paid for medical care. 

19 ‘‘(f) DESIGNATED BENEFICIARY.—For purposes of 

20 this section, the term ‘designated beneficiary’ means the 

21 individual designated at the commencement of participa22 tion in the Long-Term Care Trust Account as the bene23 ficiary of amounts paid (or to be paid) to the account. 

24 ‘‘(g) LOSS OF TAXATION EXEMPTION OF ACCOUNT

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•S 3815 IS1S 

1 ACTION.—Rules similar to the rules of paragraph (2) of 

2 section 408(e) shall apply to any Long-Term Care Trust 

3 Account. 

4 ‘‘(h) CUSTODIAL ACCOUNTS.—For purposes of this 

5 section, a custodial account or an annuity contract issued 

6 by an insurance company qualified to do business in a 

7 State shall be treated as a trust under this section if— 

8 ‘‘(1) the custodial account or annuity contract 

9 would, except for the fact that it is not a trust, con10 stitute a trust which meets the requirements of sub11 section (b), and 

12 ‘‘(2) in the case of a custodial account, the as13 sets of such account are held by a bank (as defined 

14 in section 408(n)) or another person who dem15 onstrates, to the satisfaction of the Secretary, that 

16 the manner in which he will administer the account 

17 will be consistent with the requirements of this sec18 tion. 

19 For purposes of this title, in the case of a custodial ac20 count or annuity contract treated as a trust by reason of 

21 the preceding sentence, the person holding the assets of 

22 such account or holding such annuity contract shall be 

23 treated as the trustee thereof. 

24 ‘‘(i) REPORTS.—The trustee of a Long-Term Care 

25 Trust Account shall make such reports regarding such acVerDate Aug 31 2005 01:49 Sep 13, 2006 Jkt 049196 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S3815.IS S3815

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•S 3815 IS1S 

1 count to the Secretary and to the beneficiary of the ac2 count with respect to contributions, distributions, and 

3 such other matters as the Secretary may require. The re4 ports required by this subsection shall be filed at such time 

5 and in such manner and furnished to such individuals at 

6 such time and in such manner as may be required.’’. 

7 (b) TAX ON EXCESS CONTRIBUTIONS.— 

8 (1) IN GENERAL.—Subsection (a) of section 

9 4973 of the Internal Revenue Code of 1986 (relating 

10 to tax on excess contributions to certain tax-favored 

11 accounts and annuities) is amended by striking ‘‘or’’ 

12 at the end of paragraph (4), by inserting ‘‘or’’ at the 

13 end of paragraph (5), and by inserting after para14 graph (5) the following new paragraph: 

15 ‘‘(6) a Long-Term Care Trust Account (as de16 fined in section 530A),’’. 

17 (2) EXCESS CONTRIBUTION.—Section 4973 of 

18 such Code is amended by adding at the end the fol19 lowing new subsection: 

20 ‘‘(h) EXCESS CONTRIBUTIONS TO LONG-TERM CARE

21 TRUST ACCOUNTS.—For purposes of this section— 

22 ‘‘(1) IN GENERAL.—In the case of Long-Term 

23 Care Trust Accounts (within the meaning of section 

24 530A), the term ‘excess contributions’ means the 

25 sum of— 


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•S 3815 IS1S 

1 ‘‘(A) the amount by which the amount con2 tributed for the calendar year to such accounts 

3 (other than qualified rollover contributions (as 

4 defined in section 530A(d))) exceeds the con5 tribution limit under section 530A(c)(1), and 

6 ‘‘(B) the amount determined under this 

7 subsection for the preceding calendar year, re8 duced by the excess (if any) of the maximum 

9 amount allowable as a contribution under sec10 tion 530A(c)(1) for the calendar year over the 

11 amount contributed to the accounts for the cal12 endar year. 

13 ‘‘(2) SPECIAL RULE.—A contribution shall not 

14 be taken into account under paragraph (1) if such 

15 contribution (together with the amount of net in16 come attributable to such contribution) is returned 

17 to the beneficiary before June 1 of the year fol18 lowing the year in which the contribution is made.’’. 

19 (c) FAILURE TO PROVIDE REPORTS ON LONG-TERM

20 CARE TRUST ACCOUNTS.—Paragraph (2) of section 

21 6693(a) of the Internal Revenue Code of 1986 (relating 

22 to failure to provide reports on individual retirement ac23 counts or annuities) is amended by striking ‘‘and’’ at the 

24 end of subparagraph (D), by striking the period at the 


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•S 3815 IS1S 

1 end of subparagraph (E) and inserting ‘‘, and’’, and by 

2 adding at the end the following new subparagraph: 

3 ‘‘(F) section 530A(i) (relating to Long4 Term Care Trust Accounts).’’. 

5 (d) CONFORMING AMENDMENT.—The table of parts 

6 for subchapter F of chapter 1 of the Internal Revenue 

7 Code of 1986 is amended by adding at the end the fol8 lowing new item: 

‘‘PART IX. LONG-TERM CARE TRUST ACCOUNTS’’. 

9 (e) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to taxable years beginning after 

11 December 31, 2005. 

12 SEC. 304. REFUNDABLE CREDIT FOR CONTRIBUTIONS TO 

13 LONG-TERM CARE TRUST ACCOUNTS. 

14 (a) IN GENERAL.—Subpart C of part IV of sub15 chapter A of chapter 1 of the Internal Revenue Code of 

16 1986 (relating to refundable credits) is amended by insert17 ing after section 35 the following new section: 

18 ‘‘SEC. 35A. CONTRIBUTIONS TO LONG-TERM CARE TRUST 

19 ACCOUNTS. 

20 ‘‘(a) GENERAL RULE.—In the case of an individual, 

21 there shall be allowed as a credit against the tax imposed 

22 by this subtitle for the taxable year an amount equal to 

23 10 percent of the contributions to any Long-Term Care 

24 Trust Account allowed under section 530A for such tax25 able year. 


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•S 3815 IS1S 

1 ‘‘(b) REDUCTION BASED ON ADJUSTED GROSS IN2 COME.— 

3 ‘‘(1) IN GENERAL.—The percentage which 

4 would (but for this subsection) be taken into account 

5 under subsection (a) for the taxable year shall be re6 duced (but not below zero) by the percentage deter7 mined under paragraph (2). 

8 ‘‘(2) AMOUNT OF REDUCTION.—The percentage 

9 determined under this paragraph is the percentage 

10 which bears the same ratio to the percentage which 

11 would be so taken into account as— 

12 ‘‘(A) the excess of— 

13 ‘‘(i) the taxpayer’s adjusted gross in14 come for such taxable year, over 

15 ‘‘(ii) $95,000 ($190,000 in the case of 

16 a joint return), bears to 

17 ‘‘(B) $10,000 ($20,000 in the case of a 

18 joint return). 

19 ‘‘(3) ADJUSTED GROSS INCOME.—For purposes 

20 of this subsection, adjusted gross income shall be de21 termined without regard to sections 911, 931, and 

22 933. 

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

24 shall be allowed under this chapter for any amount taken 

25 into account in determining the credit under this section.’’. 


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•S 3815 IS1S 

1 (b) CONFORMING AMENDMENTS.— 

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

3 31, United States Code, is amended by inserting be4 fore the period ‘‘, or from section 35A of such 

5 Code’’. 

6 (2) The table of sections of subpart C of part 

7 IV of subchapter A of chapter 1 of the Internal Rev8 enue Code of 1986 is amended by inserting after the 

9 item relating to section 35 the following new item: 

‘‘Sec. 35A. Contributions to Long-Term Care Trust Accounts.’’. 

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

11 this section shall apply to amounts paid or incurred in tax12 able years beginning after December 31, 2005. 

13 TITLE IV—DISASTER 

14 PREPAREDNESS AND RESPONSE 

15 SEC. 401. DISASTER PREPAREDNESS AND RESPONSE. 

16 (a) IN GENERAL.—Section 406(a) of the Robert T. 

17 Stafford Disaster Relief and Emergency Assistance Act 

18 (42 U.S.C. 5172(a)) is amended— 

19 (1) in paragraph (1)— 

20 (A) in subparagraph (A), by striking 

21 ‘‘and’’ at the end; 

22 (B) in subparagraph (B), by striking the 

23 period and inserting ‘‘; and’’; and 

24 (C) by adding at the end the following: 


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•S 3815 IS1S 

1 ‘‘(C) subject to paragraph (5), to a person 

2 that owns or operates a long-term care facility 

3 damaged or destroyed by a major disaster for 

4 the repair, restoration, reconstruction, or re5 placement of the facility and for associated ex6 penses incurred by the person.’’; and 

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

8 ‘‘(5) CONDITIONS FOR ASSISTANCE TO LONG9 TERM CARE FACILITIES.—The President may make 

10 contributions to a long-term care facility under para11 graph (1)(C) only if the owner or operator of the fa12 cility— 

13 ‘‘(A) has applied for a disaster loan under 

14 section 7(b) of the Small Business Act (15 

15 U.S.C. 636(b)); and 

16 ‘‘(B) either— 

17 ‘‘(i) has been determined to be ineli18 gible for such a loan; or 

19 ‘‘(ii) has obtained such a loan in the 

20 maximum amount for which the Small 

21 Business Administration determines the fa22 cility is eligible.’’. 

23 (b) DEFINITION.—Section 102 of the Robert T. Staf24 ford Disaster Relief and Emergency Assistance Act (42 


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•S 3815 IS1S 

1 U.S.C. 5122) is amended by adding at the end the fol2 lowing: 

3 ‘‘(10) LONG-TERM CARE FACILITY.—The term 

4 ‘long-term care facility’ means the following facilities 

5 or providers which receive payment for services 

6 under title XVIII or XIX of the Social Security Act: 

7 ‘‘(A) A skilled nursing facility (as defined 

8 in section 1819(a) of the Social Security Act 

9 (42 U.S.C. 1395i–3(a))). 

10 ‘‘(B) A nursing facility (as defined in sec11 tion 1919(a) of the Social Security Act (42 

12 U.S.C. 1396r(a))). 

13 ‘‘(C) A home health agency (as defined in 

14 section 1861(o) of the Social Security Act (42 

15 U.S.C. 1395x(o))). 

16 ‘‘(D) A provider of hospice care (as defined 

17 in section 1861(dd)(1) of the Social Security 

18 Act (42 U.S.C. 1395x(dd)(1))). 

19 ‘‘(E) A long-term care hospital (as de20 scribed in section 1886(d)(1)(B)(iv) of the So21 cial Security Act (42 U.S.C. 

22 1395ww(d)(1)(B)(iv))). 

23 ‘‘(F) A provider of personal care services. 


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•S 3815 IS1S 

1 ‘‘(G) A residential care provider that ar2 ranges for, or directly provides, long-term care 

3 services. 

4 ‘‘(H) An intermediate care facility for the 

5 mentally retarded (as defined in section 

6 1905(d) of the Social Security Act (42 U.S.C. 

7 1396d(d))). 

8 ‘‘(I) An assisted living facility or a resident 

9 care program facility (as defined by the Sec10 retary of Health and Human Services). 

11 ‘‘(J) A board and care facility (as defined 

12 in section 1903(q)(4)(B) of the Social Security 

13 Act (42 U.S.C. 1396b(q)(4)(B))). 

14 ‘‘(K) Any other licensed facility determined 

15 appropriate by the Secretary of Health and 

16 Human Services, including a psychiatric health 

17 facility, a mental health rehabilitation center, 

18 and a mental retardation developmental dis19 ability facility.’’. 

Æ 


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