I
106TH CONGRESS
2D SESSION
H. R. 4029
To amend the Public Health Service Act to provide for Alzheimer’s clinical
research and training awards, to amend title XVIII of the Social Security
Act to expand the definition of homebound for purposes of receiving
home health services under the medicare program to allow medicare
beneficiaries to attend adult day care programs for treatment of Alz-
heimer’s disease and other conditions, to amend the Internal Revenue
Code of 1986 to allow individuals a deduction for qualified long-term
care insurance premiums, use of such insurance under cafeteria plans
and flexible spending arrangements, and a credit for individuals with
long-term care needs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 16, 2000
Mr. SMITH of New Jersey (for himself and Mr. MARKEY) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Commerce, for a period to be subse-
quently 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 provide for
Alzheimer’s clinical research and training awards, to
amend title XVIII of the Social Security Act to expand
the definition of homebound for purposes of receiving
home health services under the medicare program to
allow medicare beneficiaries to attend adult day care
programs for treatment of Alzheimer’s disease and other
conditions, to amend the Internal Revenue Code of 1986
to allow individuals a deduction for qualified long-term
care insurance premiums, use of such insurance under
cafeteria plans and flexible spending arrangements, and
a credit for individuals with long-term care needs, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Long Term Care and
Alzheimer’s Disease Advancement Act of 2000’’.
SEC. 2. ALZHEIMER’S CLINICAL RESEARCH AND TRAINING
AWARDS.
Subpart 5 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285e et seq.) is amended—
(1) by redesignating section 445I as section
445J; and
(2) by inserting after section 445H the fol-
lowing section:
‘‘ALZHEIMER’S CLINICAL RESEARCH AND TRAINING
AWARDS
‘‘SEC. 445I. (a) The Director of the Institute is au-
thorized to establish and maintain the Alzheimer’s disease
Physician-Scientist program to enhance and promote the
translation of new scientific knowledge into clinical prac-
tice toward the diagnosis, care and treatment of individ-
uals with Alzheimer’s disease.
‘‘(b) In order to foster the application of the latest
developments in Alzheimer’s diagnosis, treatment and
care, funds under this program shall be directed to sup-
port promising clinicians through awards for research,
study, and practice at centers of excellence in Alzheimer
research and treatment.
‘‘(c) Research awards under subsection (b) shall be
carried out in environments of demonstrated excellence in
neuroscience, neurobiology, geriatric medicine, psychiatry
and foster innovation and integration of these disciplines
or other environments determined suitable by the Director
of the Institute.
‘‘(d) In addition to any other authorization of appro-
priations available for the purpose of carrying out this sec-
tion, there are authorized to be appropriated for such pur-
pose $2,250,000 for each of fiscal years 2001 through
2005.’’.
SEC. 3. MEDPAC STUDY ON MEDICARE PHYSICIAN REIM-
BURSEMENT RATES FOR ALZHEIMER’S DIS-
EASE.
(a) STUDY.—The Medicare Payment Advisory Com-
mission, established under section 1805 of the Social Se-
curity Act (42 U.S.C. 1395b–6), shall conduct a study of
reimbursement rates under the medicare program (under
title XVIII of that Act (42 U.S.C. 1395 et seq.) to physi-
cians for Alzheimer services, including a determination of
the adequacy of such reimbursement rates. The study
shall include the following analyses:
(1) 
COMPREHENSIVE
CLINICAL
ASSESS-
MENTS.—An analysis of whether payment policy
under the medicare program for Alzheimer services
encourages or discourages physicians to conduct
comprehensive clinical assessments for medicare
beneficiaries who exhibit symptoms of possible de-
mentia.
(2) 
CLINICAL
PRACTICE
GUIDELINES.—An
analysis of whether payment policy under the medi-
care program encourages or discourages physicians
to provide diagnostic and management services for
Alzheimer’s disease or a related dementia as speci-
fied in generally accepted clinical practice guidelines
and protocols.
(3) ONGOING PHYSICIAN CONSULTATION.—An
analysis of whether payment policy under the medi-
care program for Alzheimer services encourages or
discourages ongoing physician consultation with the
medicare beneficiary’s caregivers, as specified in
generally accepted diagnosis and practice guidelines.
(4) CAREER CHOICE.—An analysis of whether
payment rates under the medicare program for phy-
sicians encourages or discourages physicians from
choosing a career with a speciality in the treatment
and management of Alzheimer’s disease and related
dementia.
(b) DEFINITIONS.—In this section:
(1) The term ‘‘Alzheimer services’’ means the
evaluation, diagnosis, and management of a medi-
care beneficiary with Alzheimer’s disease or a related
dementia, including ongoing consultation between
the physician and caregivers of the beneficiary, con-
sistent with generally accepted diagnosis and prac-
tice guidelines.
(2) The term ‘‘medicare beneficiary’’ means an
individual entitled to benefits under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.).
(c) REPORT.—Not later than 1 year after the date
of the enactment of this Act, the Medicare Payment Advi-
sory Commission shall submit to Congress a report on the
results of the study conducted under this section, together
with any recommendations for legislation that the Com-
mission determines to be appropriate as a result of such
study.
SEC. 4. CLARIFICATION OF MEDICARE DEFINITION OF
HOMEBOUND 
FOR 
PURPOSES 
OF 
HOME
HEALTH SERVICES.
(a) FINDINGS.—Congress finds the following:
(1) Home health services are a vital component
of the benefits that are furnished to beneficiaries
under the medicare program under title XVIII of the
Social Security Act.
(2) Home health services under the medicare
program enable homebound individuals who are at
great risk for costly institutionalized care to stay in
their own homes and communities.
(3) Existing medicare regulations and practices
inadvertently penalize medicare beneficiaries (includ-
ing those with Alzheimer’s disease, a related demen-
tia, or both) who participate in an adult day care
program. Under those regulations, if a medicare
beneficiary attends a privately funded adult day care
program as part of their Alzheimer’s treatment re-
gime, including an Alzheimer’s treatment regime,
they may lose eligibility for the medicare home
health benefit because the absences of the individual
from home are not infrequent or short duration.
(4) Adult day care programs can be a valuable
and medically beneficial part of a treatment regime
for a person with Alzheimer’s disease or a related
dementia. These programs can provide structured
activities and health monitoring to maintain func-
tion, manage behavioral symptoms and prevent
health care crises and premature institutionalization.
(5) The Health Care Financing Administration
and its various medicare contractors and fiscal inter-
mediaries have misinterpreted the intent of Congress
with respect to eligibility for home health services.
Participation by medicare beneficiaries in privately
funded adult day care programs is not intended to
preclude eligiblity for home health services for those
medicare beneficiaries under the medicare program.
(b) CLARIFICATION OF THE DEFINITION OF HOME-
BOUND.—
(1) IN GENERAL.—The last sentence of sections
1814(a) and 1835(a) of the Social Security Act (42
U.S.C. 1395f(a); 1395n(a)) are each amended by
striking the period and inserting ‘‘Including partici-
pating in an audit day care program licensed by a
State to furnish adult day care services in the State,
for the purpose of therapeutic treatment for Alz-
heimer’s disease or a related dementia, or for med-
ical treatment furnished in an adult day care pro-
gram.’’.
(2) EFFECTIVE DATE.—The amendments made
by paragraph (1) shall apply to items and services
provided on or after the date of enactment of this
Act.
SEC. 5. TREATMENT OF PREMIUMS ON QUALIFIED LONG-
TERM CARE INSURANCE CONTRACTS.
(a) IN GENERAL.—Part VII of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 (relating to
additional itemized deductions) is amended by redesig-
nating section 222 as section 223 and by inserting after
section 221 the following new section:
‘‘SEC. 222. PREMIUMS ON QUALIFIED LONG-TERM CARE IN-
SURANCE CONTRACTS.
‘‘(a) IN GENERAL.—In the case of an individual,
there shall be allowed as a deduction an amount equal to
the applicable percentage of the amount of eligible long-
term care premiums (as defined in section 213(d)(10))
paid during the taxable year for coverage for the taxpayer,
his spouse, and dependents under a qualified long-term
care insurance contract (as defined in section 7702B(b)).
‘‘(b) APPLICABLE PERCENTAGE.—For purposes of
subsection (a)—
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this subsection, the applicable percentage
shall be determined in accordance with the following
table based on the number of years of continuous
coverage (as of the close of the taxable year) of the
individual under any qualified long-term care insur-
ance contracts (as defined in section 7702B(b)):
‘‘If the number of years of
The applicable long-term
continuous coverage is—
care percentage is—
Less than 1 ..................................................................
At least 1 but less than 2 .............................................
At least 2 but less than 3 .............................................
At least 3 but less than 4 .............................................
At least 4 ......................................................................
100.
‘‘(2) SPECIAL
RULES
FOR
INDIVIDUALS
WHO
HAVE ATTAINED AGE 55.—In the case of an indi-
vidual who has attained age 55 as of the close of the
taxable year, the following table shall be substituted
for the table in paragraph (1).
‘‘If the number of years of
The applicable long-term
continuous coverage is—
care percentage is—
Less than 1 ..................................................................
At least 1 but less than 2 .............................................
At least 2 ......................................................................
100.
‘‘(3) ONLY COVERAGE AFTER 1999 TAKEN INTO
ACCOUNT.—Only coverage for periods after Decem-
ber 31, 1999, shall be taken into account under this
subsection.
‘‘(4) CONTINUOUS
COVERAGE.—An individual
shall not fail to be treated as having continuous cov-
erage if the aggregate breaks in coverage during any
1-year period are less than 60 days.
‘‘(c) COORDINATION WITH OTHER DEDUCTIONS.—
Any amount paid by a taxpayer for any qualified long-
term care insurance contract to which subsection (a) ap-
plies shall not be taken into account in computing the
amount allowable to the taxpayer as a deduction under
section 162(l) or 213(a).’’
(b) CONTINGENT NONFORFEITURE REQUIREMENTS
ADDED TO CONSUMER PROTECTION PROVISIONS.—
(1) Section 7702B(g)(2)(A)(i) of the Internal
Revenue Code of 1986 (relating to model regulation)
is amended by adding at the end the following new
subclause:
‘‘(XII) Section 23 (relating to
contingent nonforfeiture benefits), if
the policyholder declines the offer of a
nonforfeiture provision described in
paragraph (4).’’
(2) Section 7702B(g)(2)(A)(ii) of such Code
(relating to model Act) is amended by adding at the
end the following new subclause:
‘‘(III) Section 8 (relating to con-
tingent nonforfeiture benefits), if the
policyholder declines the offer of a
nonforfeiture provision described in
paragraph (4).’’
(c) REFERENCE TO NAIC MODEL ACT UPDATED.—
Section 7702B(g)(2)(B)(i) of the Internal Revenue Code