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SEC. 704. SUB-ACUTE AND LONG-TERM CARE PROGRAM RE-
FORM.
(a) IN GENERAL.—(1) Chapter 55 of title 10, United
States Code, is amended by inserting after section 1074i
the following new section:
‘‘§ 1074j. Sub-acute care program
‘‘(a) ESTABLISHMENT.—The Secretary of Defense
shall establish an effective, efficient, and integrated sub-
acute care benefits program under this chapter (herein-
after referred to in this section as the ‘program’). Except
as otherwise provided in this section, the types of health
care authorized under the program shall be the same as
those provided under section 1079 of this title. The Sec-
retary, after consultation with the other administering
Secretaries, shall promulgate regulations to carry out this
section.
‘‘(b) BENEFITS.—(1) The program shall include a
uniform skilled nursing facility benefit that shall be pro-
vided in the manner and under the conditions described
in section 1861(h) and (i) of the Social Security Act (42
U.S.C. 1395x(h) and (i)), except that the limitation on
the number of days of coverage under section 1812(a) and
(b) of such Act (42 U.S.C. 1395d(a) and (b)) shall not
be applicable under the program. Skilled nursing facility
care for each spell of illness shall continue to be provided
for as long as medically necessary and appropriate.
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‘‘(2) In this subsection:
‘‘(A) The term ‘skilled nursing facility’ has the
meaning given such term in section 1819(a) of the
Social Security Act (42 U.S.C. 1395i–3(a)).
‘‘(B) The term ‘spell of illness’ has the meaning
given such term in section 1861(a) of such Act (42
U.S.C. 1395x(a)).
‘‘(3) The program shall include a comprehensive,
intermittent home health care benefit that shall be pro-
vided in the manner and under the conditions described
in section 1861(m) of the Social Security Act (42 U.S.C.
1395x(m)).’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1074i the following new item:
‘‘1074j. Sub-acute care program.’’.
(b) EXTENDED BENEFITS FOR CERTAIN DEPEND-
ENTS.—Section 1079 of such title is amended by striking
subsections (d), (e), and (f) and inserting the following
new subsections:
‘‘(d)(1) The Secretary of Defense shall establish a
program to provide extended benefits for eligible depend-
ents, which may include the provision of comprehensive
health care services, including case management services,
to assist in the reduction of the disabling effects of a quali-
236
fying condition of an eligible dependent. Registration shall
be required to receive the extended benefits.
‘‘(2) The Secretary of Defense, after consultation
with the other administering Secretaries, shall promulgate
regulations to carry out this subsection.
‘‘(3) In this subsection:
‘‘(A) The term ‘eligible dependent’ means a de-
pendent of a member of the uniformed services on
active duty for a period of more than 30 days, as
described in subparagraph (A), (D), or (I) of section
1072(2) of this title, who has a qualifying condition.
‘‘(B) The term ‘qualifying condition’ means the
condition of a dependent who is moderately or se-
verely mentally retarded, has a serious physical dis-
ability, or has an extraordinary physical or psycho-
logical condition.
‘‘(e) Extended benefits for eligible dependents under
subsection (d) may include comprehensive health care
services with respect to the qualifying condition of such
a dependent, and include, to the extent such benefits are
not provided under provisions of this chapter other than
under this section, the following:
‘‘(1) Diagnosis.
‘‘(2) Inpatient, outpatient, and comprehensive
home health care supplies and services.
237
‘‘(3) Training, rehabilitation, and special edu-
cation.
‘‘(4) Institutional care in private nonprofit,
public, and State institutions and facilities and, if
appropriate, transportation to and from such institu-
tions and facilities.
‘‘(5) Custodial care, notwithstanding the prohi-
bition in section 1077(b)(1) of this title.
‘‘(6) Respite care for the primary caregiver of
the eligible dependent.
‘‘(7) Such other services and supplies as deter-
mined appropriate by the Secretary, notwithstanding
the limitations in subsection (a)(13).
‘‘(f) Members shall be required to share in the cost
of any benefits provided to their dependents under sub-
section (d) as follows:
‘‘(1) Members in the lowest enlisted pay grade
shall be required to pay the first $25 incurred each
month, and members in the highest commissioned
pay grade shall be required to pay the first $250 in-
curred each month. The amounts to be paid by
members in all other pay grades shall be determined
under regulations to be prescribed by the Secretary
of Defense in consultation with the administering
Secretaries.
238
‘‘(2) A member who has more than one depend-
ent incurring expenses in a given month under a
plan covered by subsection (d) shall not be required
to pay an amount greater than would be required if
the member had only one such dependent.’’.
(c) DEFINITIONS OF CUSTODIAL CARE AND DOMI-
CILIARY CARE.—Section 1072 of title 10, United States
Code, is amended by adding at the end the following new
paragraphs:
‘‘(8) The term ‘custodial care’ means treatment
or services, regardless of who recommends such
treatment or services or where such treatment or
services are provided, that—
‘‘(A) can be rendered safely and reasonably
by a person who is not medically skilled; or
‘‘(B) is or are designed mainly to help the
patient with the activities of daily living.
‘‘(9) The term ‘domiciliary care’ means care
provided to a patient in an institution or homelike
environment because—
‘‘(A) providing support for the activities of
daily living in the home is not available or is
unsuitable; or
‘‘(B) members of the patient’s family are
unwilling to provide the care.’’.
239
(d) CONFORMING AMENDMENT.—Section 1079 of
title 10, United States Code, is amended in subsection (a)
by striking paragraph (17).
(e) CONTINUATION OF INDIVIDUAL CASE MANAGE-
MENT
SERVICES
FOR
CERTAIN
ELIGIBLE
BENE-
FICIARIES.—(1) Notwithstanding the termination of the
Individual Case Management Program by subsection (d),
the Secretary of Defense shall, in any case in which the
Secretary makes the determination described in paragraph
(2), continue to provide payment as if such program were
in effect for home health care or custodial care services
provided to an eligible beneficiary that would otherwise be
excluded from coverage under regulations implementing
chapter 55 of title 10, United States Code.
(2) The determination referred to in paragraph (1)
is a determination that discontinuation of payment for
services not otherwise provided under such chapter would
result in the provision of services inadequate to meet the
needs of the eligible beneficiary and would be unjust to
such beneficiary.
(3) For purposes of this subsection, ‘‘eligible bene-
ficiary’’ means a covered beneficiary (as that term is de-
fined in section 1072 of title 10, United States Code) who,
before the effective date of this section, was provided cus-