I
106TH CONGRESS
1ST SESSION
H. R. 2691
To amend the Internal Revenue Code of 1986 and titles XVIII and XIX
of the Social Security Act to provide a range of long-term care services.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 3, 1999
Mr. STARK (for himself, Mr. MARKEY, Mr. MCGOVERN, Mr. MCDERMOTT,
Mr. MOAKLEY, Mr. OLVER, Mr. CAPUANO, and Mr. GORDON) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committees on Commerce, Government Re-
form, and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Internal Revenue Code of 1986 and titles
XVIII and XIX of the Social Security Act to provide
a range of long-term care services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Omnibus Long-Term Care Improvement Act of 1999’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
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Sec. 1. Short title; table of contents.
TITLE I—EXPANSION OF LONG-TERM CARE PROTECTION
Sec. 101. Refundable credit for long-term care.
TITLE II—MEDICARE LONG-TERM CARE IMPROVEMENTS
Subtitle A—Medicare SNF, HHA, and Other Improvements
Sec. 201. Expanded long-term care services under medicare program for de-
pendent individuals.
Sec. 202. Coverage of substitute adult day care services under medicare.
Sec. 203. Establishment of medicare home health care case managers for long
term home health spells of illness.
Sec. 204. Post acute care improvement.
Sec. 205. Additional payments to home health agencies for most expensive
cases.
Sec. 206. Strengthening the post-hospital referral process.
Sec. 207. Clarification of the definition of homebound.
Subtitle B—Encouraging Provision of Hospice Care
Sec. 211. Providing hospice information for certain beneficiaries at time of hos-
pital discharge.
Sec. 212. Encouraging physician education in hospice care.
Sec. 213. Inclusion of hospice care under Federal Employees Health Benefits
Program (FEHBP).
Subtitle C—QMB Improvements
Sec. 221. Mechanism promoting provision of medicare cost-sharing assistance
to eligible low-income medicare beneficiaries.
TITLE III—NURSING HOME QUALITY PROTECTIONS
Sec. 301. Information on nursing facility staffing.
Sec. 302. Assessment of fees to recover costs of resurveying or reinspecting fa-
cilities.
Sec. 303. Establishment of program to prevent abuse of nursing facility resi-
dents.
Sec. 304. Inclusion of abusive nursing facility workers in the database estab-
lished as part of national health care fraud and abuse data col-
lection program.
Sec. 305. Prevention and training demonstration project.
Sec. 306. Effective date.
TITLE IV—ACCESS TO LONG-TERM CARE INSURANCE
Subtitle A—Group Long-Term Care Insurance
Sec. 401. Federal employees group long-term care insurance.
‘‘CHAPTER 90—LONG-TERM CARE INSURANCE
‘‘Sec.
‘‘9001. Definitions.
‘‘9002. Contracting authority.
‘‘9003. Minimum standards for contractors.
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‘‘9004. Long-term care benefits.
‘‘9005. Financing.
‘‘9006. Preemption.
‘‘9007. Studies, reports, and audits.
‘‘9008. Claims for benefits.
‘‘9009. Jurisdiction of courts.
‘‘9010. Regulations.
‘‘9011. Authorization of appropriations.
Sec. 402. Making available group long-term care insurance to others.
Subtitle B—Extension of Consumer Protection Standards to All Long-Term
Care Insurance Policies
Sec. 411. Extension of consumer protection standards to all long-term care in-
surance policies.
TITLE V—ADDITION OF NATIONAL FAMILY CAREGIVER PROGRAM
TO THE OLDER AMERICANS ACT OF 1965
Sec. 501. National family caregiver support program.
‘‘PART D—NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM
‘‘Subpart 1—State Grant Program
‘‘Sec. 341. Program authorized.
‘‘Sec. 342. Maintenance of effort.
‘‘Subpart 2—National Innovation Programs
‘‘Sec. 345. Innovation grant program.
‘‘Sec. 346. Activities of National significance.
Sec. 502. Allotments.
Sec. 503. Availability of title III–D funds for reallotment.
Sec. 504. Conforming amendments.
Sec. 505. Effective date.
TITLE VI—MEDICARE FOR CAREGIVERS
Subtitle A—Access to Medicare Benefits for Caregivers
Sec. 601. Access to medicare benefits for caregivers.
‘‘PART D—MEDICARE BENEFITS FOR CAREGIVERS
‘‘Sec. 1859. Program benefits; eligibility.
‘‘Sec. 1859A. Enrollment process; coverage.
‘‘Sec. 1859B. Medicare Caregiver Trust Fund.
‘‘Sec. 1859C. Oversight and accountability.
‘‘Sec. 1859D. Administration and miscellaneous.
Subtitle B—COBRA Protection for Caregivers
CHAPTER 1—AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME
SECURITY ACT OF 1974
Sec. 611. COBRA continuation benefits for certain caregivers who lost health
coverage.
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CHAPTER 2—AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT
Sec. 612. COBRA continuation benefits for certain caregivers.
CHAPTER 3—AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986
Sec. 613. COBRA continuation benefits for certain caregivers.
Subtitle C—Financing
Sec. 621. Reference to financing provisions.
TITLE VII—SOCIAL SECURITY BENEFIT FOR LONG-TERM
CAREGIVERS
Sec. 701. Social security credit for long-term caregivers.
TITLE I—REFUNDABLE CREDIT
FOR LONG-TERM CARE
SEC. 101. REFUNDABLE CREDIT FOR LONG-TERM CARE.
(a) GENERAL RULE.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of
1986 (relating to refundable credits) is amended by redes-
ignating section 35 as section 36 and by inserting after
section 34 the following new section:
‘‘SEC. 35. FAMILY CARE CREDIT.
‘‘(a) ALLOWANCE OF CREDIT.—There shall be al-
lowed as a credit against the tax imposed by this chapter
for the taxable year an amount equal to the sum of $1,000
multiplied by the number of applicable individuals with re-
spect to whom the taxpayer is an eligible caregiver for the
taxable year.
‘‘(b) LIMITATION BASED ON ADJUSTED GROSS IN-
COME.—
‘‘(1) IN GENERAL.—The amount of the credit
allowable under subsection (a) shall be reduced (but
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not below zero) by $50 for each $1,000 (or fraction
thereof) by which the taxpayer’s modified adjusted
gross income exceeds the threshold amount. For
purposes of the preceding sentence, the term ‘modi-
fied adjusted gross income’ means adjusted gross in-
come increased by any amount excluded from gross
income under section 911, 931, or 933.
‘‘(2) THRESHOLD AMOUNT.—For purposes of
paragraph (1), the term ‘threshold amount’ means—
‘‘(A) $110,000 in the case of a joint re-
turn,
‘‘(B) $75,000 in the case of an individual
who is not married, and
‘‘(C) $55,000 in the case of a married in-
dividual filing a separate return.
For purposes of this paragraph, marital status shall
be determined under section 7703.
‘‘(c) DEFINITIONS.—For purposes of this section—
‘‘(1) APPLICABLE INDIVIDUAL.—
‘‘(A) IN GENERAL.—The term ‘applicable
individual’ means, with respect to any taxable
year, any individual who has been certified, be-
fore the due date for filing the return of tax for
the taxable year (without extensions), by a phy-
sician (as defined in section 1861(r)(1) of the
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Social Security Act) as being an individual with
long-term care needs described in subparagraph
(B) for a period—
‘‘(i) which is at least 180 consecutive
days, and
‘‘(ii) a portion of which occurs within
the taxable year.
Such term shall not include any individual oth-
erwise meeting the requirements of the pre-
ceding sentence unless within the 391⁄2 month
period ending on such due date (or such other
period as the Secretary prescribes) a physician
(as so defined) has certified that such indi-
vidual meets such requirements.
‘‘(B) INDIVIDUALS WITH LONG-TERM CARE
NEEDS.—An individual is described in this sub-
paragraph if the individual meets any of the fol-
lowing requirements:
‘‘(i) The individual is at least 6 years
of age and—
‘‘(I) is unable to perform (with-
out substantial assistance from an-
other individual) at least 3 activities
of daily living (as defined in section
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7702B(c)(2)(B)) due to a loss of
functional capacity, or
‘‘(II) requires substantial super-
vision to protect such individual from
threats to health and safety due to se-
vere cognitive impairment and is un-
able to perform at least 1 activity of
daily living (as so defined) or to the
extent provided in regulations pre-
scribed by the Secretary (in consulta-
tion with the Secretary of Health and
Human Services), is unable to engage
in age appropriate activities, or
‘‘(III) requires substantial super-
vision to protect such individual from
threats to health and safety due to a
severe psychological disability, mental
retardation, or related developmental
disabilities and would otherwise re-
quire residence in a psychiatric hos-
pital, an intermediate care facility for
the mentally retarded, or similar resi-
dential facility approved by the Sec-
retary of Health and Human Services.
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‘‘(ii) The individual is at least 2 but
not 6 years of age and is unable due to a
loss of functional capacity to perform
(without substantial assistance from an-
other individual) at least 2 of the following
activities: eating, transferring, or mobility.
‘‘(iii) The individual is under 2 years
of age and requires specific durable med-
ical equipment by reason of a severe health
condition or requires a skilled practitioner
trained to address the individual’s condi-
tion to be available if the individual’s par-
ents or guardians are absent.
‘‘(C) PSYCHOLOGICAL
DISABILITY
DE-
FINED.—In this section, the term ‘psychological
disability’ shall refer to diagnosable clinical con-
ditions on Axis I or Axis II of the current edi-
tion of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental
Disorders and is of a severity that requires sub-
stantial supervision or residence in a psychiatric
hospital or similar residential facility approved
by the Secretary.
‘‘(D) MENTAL RETARDATION DEFINED.—
In this section, the term ‘mental retardation’
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shall have the same meaning as ‘developmental
disabilities’ as defined in section 102 of the De-
velopmental Disabilities Assistance and Bill of
Rights Act (42 U.S.C. 6000) consistent with
the requirements of section 305(a)(2)(E) and is
of a severity that requires substantial super-
vision or residence in an intermediate care facil-
ity for the mentally retarded, or similar residen-
tial facility approved by the Secretary of Health
and Human Services.
‘‘(2) ELIGIBLE CAREGIVER.—
‘‘(A) IN GENERAL.—A taxpayer shall be
treated as an eligible caregiver for any taxable
year with respect to the following individuals:
‘‘(i) The taxpayer.
‘‘(ii) The taxpayer’s spouse.
‘‘(iii) An individual with respect to
whom the taxpayer is allowed a deduction
under section 151 for the taxable year.
‘‘(iv) An individual who would be de-
scribed in clause (iii) for the taxable year
if section 151(c)(1)(A) were applied by
substituting for the exemption amount an
amount equal to the sum of the exemption
amount, the standard deduction under sec-
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tion 63(c)(2)(C), and any additional stand-
ard deduction under section 63(c)(3) which
would be applicable to the individual if
clause (iii) applied.
‘‘(v) An individual who would be de-
scribed in clause (iii) for the taxable year
if—
‘‘(I) the requirements of clause
(iv) are met with respect to the indi-
vidual, and
‘‘(II) the requirements of sub-
paragraph (B) are met with respect to
the individual in lieu of the support
test of section 152(a).
‘‘(B) RESIDENCY
TEST.—The require-
ments of this subparagraph are met if an indi-
vidual has as his principal place of abode the
home of the taxpayer and—
‘‘(i) in the case of an individual who
is an ancestor or descendant of the tax-
payer or the taxpayer’s spouse, is a mem-
ber of the taxpayer’s household for over
half the taxable year, or
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‘‘(ii) in the case of any other indi-
vidual, is a member of the taxpayer’s
household for the entire taxable year.
‘‘(C) SPECIAL RULES WHERE MORE THAN
1 ELIGIBLE CAREGIVER.—
‘‘(i) IN GENERAL.—If more than 1 in-
dividual is an eligible caregiver with re-
spect to the same applicable individual for
taxable years ending with or within the
same calendar year, a taxpayer shall be
treated as the eligible caregiver if each
such individual (other than the taxpayer)
files a written declaration (in such form
and manner as the Secretary may pre-
scribe) that such individual will not claim
such applicable individual for the credit
under this section.
‘‘(ii) NO AGREEMENT.—If each indi-
vidual required under clause (i) to file a
written declaration under clause (i) does
not do so, the individual with the highest
modified adjusted gross income (as defined
in section 32(c)(5)) shall be treated as the
eligible caregiver.
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‘‘(iii) MARRIED
INDIVIDUALS
FILING
SEPARATELY.—In the case of married indi-
viduals filing separately, the determination
under this subparagraph as to whether the
husband or wife is the eligible caregiver
shall be made under the rules of clause (ii)
(whether or not one of them has filed a
written declaration under clause (i)).
‘‘(d) INDENTIFICATION REQUIREMENT.—No credit
shall be allowed under this section to a taxpayer with re-
spect to any applicable individual unless the taxpayer in-
cludes the name and taxpayer identification number of
such individual, and the identification number of the phy-
sician or licensed independent practitioner licensed by the
State to render relevant diagnosis certifying such indi-
vidual, on the return of tax for the taxable year.
‘‘(e) TAXABLE YEAR MUST BE FULL TAXABLE
YEAR.—Except in the case of a taxable year closed by rea-
son of the death of the taxpayer, no credit shall be allow-
able under this section in the case of a taxable year cov-
ering a period of less than 12 months.’’.
(b) CONFORMING AND CLERICAL AMENDMENTS.—
(1) Paragraph (2) of section 6213(g) of such
Code (relating to mathematical or clerical error) is
amended—
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(A) by striking ‘‘and’’ at the end of sub-
paragraph (K), by striking the period at the
end of subparagraph (L) and inserting ‘‘, and’’,
and by inserting after subparagraph (L) the fol-
lowing new subparagraph:
‘‘(M) an omission of a correct TIN or phy-
sician identification required under section
24(e) (relating to family care credit) to be in-
cluded on a return.’’, and
(B) in the matter preceding clause (i) of
subparagraph (L), by striking ‘‘or 32’’ and in-
serting ‘‘32, or 35’’.
(2) The table of sections for subpart C of part
IV of subchapter A of chapter 1 of such Code is
amended by striking the item relating to section 35
and inserting the following:
‘‘Sec. 35. Family care credit.
‘‘Sec. 36. Overpayments of tax.’’
(c) 
APPROPRIATIONS
FOR
REFUND.—Section
1324(b)(2) of title 31, United States Code, is amended
by inserting before the period ‘‘, or of section 35 of such
Code’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
December 31, 2000.
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TITLE II—MEDICARE LONG-
TERM CARE IMPROVEMENTS
Subtitle A—Medicare SNF, HHA,
and Other Improvements
SEC. 201. EXPANDED LONG-TERM IN-HOME, COMMUNITY-
BASED, AND RESPITE CARE SERVICES UNDER
MEDICARE PROGRAM FOR DEPENDENT INDI-
VIDUALS.
(a) IN GENERAL.—
(1) PART A.—Section 1812 of the Social Secu-
rity Act (42 U.S.C. 1395d) is amended—
(A) in subsection (a)—
(i) in paragraph (2)(B), by striking
‘‘subsection (f),’’ and inserting ‘‘subsection
(f) and section 1889,’’,
(ii) by striking ‘‘and’’ at the end of
paragraph (3),
(iii) by striking the period at the end
of paragraph (4) and inserting ‘‘; and’’,
and
(iv) by adding at the end the following
new paragraph:
‘‘(5) long-term care services consisting of ex-
tended care services (in accordance with section
1889).’’; and
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(B) in subsection (b)(2), by striking ‘‘post-
hospital’’ and inserting ‘‘except as provided in
section 1889, post-hospital’’.
(2) PART B.—Section 1861(s)(2) of such Act
(42 U.S.C. 1395x(s)(2)) is amended—
(A) in subparagraph (S), by striking
‘‘and’’ at the end;
(B) in subparagraph (T), by striking the
period at the end and inserting ‘‘; and’’; and
(C) by inserting after subparagraph (T)
the following new subparagraph:
‘‘(U) long-term care services consisting of
in-home, community-based, and respite care (in
accordance with section 1889);’’.
(b) DESCRIPTION OF SERVICES; ELIGIBILITY.—Title
XVIII of such Act is amended by inserting after section
1888 the following new section:
‘‘LONG-TERM CARE SERVICES FOR DEPENDENT
INDIVIDUALS
‘‘SEC. 1889. (a) IN GENERAL.—An individual enti-
tled to benefits under this part shall be entitled to have
payments made on the individual’s behalf for long-term
care services if—
‘‘(1) the individual is a dependent individual;
and
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‘‘(2) such services are provided in accordance
with a case management plan developed by a case
management agency.
‘‘(b) SERVICES PROVIDED.—In this section, the term
‘long-term care services’ means—
‘‘(1) in-home, community-based, and respite
care (as defined in subsection (e)); and
‘‘(2) extended care services (as defined in sec-
tion 1861(h) (1) and (3) through (7)), but only with
respect to a chronically dependent individual.
‘‘(c) PAYMENT FOR SERVICES.—
‘‘(1) IN GENERAL.—Subject to paragraphs (2)
and (3), the amount payable for long-term care serv-
ices under this section shall be determined in accord-
ance with a fee schedule for such services established
by the Secretary.
‘‘(2) 
IMPOSITION
OF
DEDUCTIBLE.—The
amount otherwise payable for long-term care services
under this section furnished during a calendar year
shall be reduced by an amount equal to the deduct-
ible imposed for Part B Services for the year under
section 1833(b).
‘‘(3) ALTERNATIVE PAYMENT UNDER COMPETI-
TIVE BIDDING.—
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‘‘(A) IN
GENERAL.—Notwithstanding the
preceding provisions of this subsection, to the
maximum extent feasible, the Secretary may, by
region, use a competitive process to contract for
the provision of long-term care services.
‘‘(B) 
PAYMENT.—Payment 
under 
this
paragraph shall be made on the basis of nego-
tiated all-inclusive rates. The amount of pay-
ment made by the Secretary to a provider of
long-term care services for services covered
under a contract shall be less than the aggre-
gate amount of the payments that the Secretary
would have otherwise made for the services.
‘‘(C) CONTRACT PERIOD.—A contract pe-
riod shall be three years (subject to renewal), as
long as the entity continues to meet quality and
other contractual standards.
‘‘(d) DEPENDENT INDIVIDUAL DEFINED.—
‘‘(1) IN GENERAL.—In this section, the term
‘dependent individual’ means an individual—
‘‘(A) who is unable to perform (without
substantial assistance from another individual)
because of physical or cognitive impairment at
least 2 of the following activities of daily living:
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bathing, dressing, continence, toileting, trans-
ferring, and eating; or
‘‘(B) who has a similar level of disability
due to cognitive impairment that requires sub-
stantial direction, instruction, or supervision of
another individual in order—
‘‘(i) to perform 2 or more of the ac-
tivities of daily living described in subpara-
graph (A), or
‘‘(ii) to remain in the community
without causing harm to self or others be-
cause of inappropriate behavioral patterns;
and
‘‘(C) with respect to whom the provision of
in-home, community-based, and respite care
services is likely to reduce or postpone more se-
rious and expensive medical or institutional care
the cost of which would be borne by public pro-
grams (including programs under this title or
title XIX).
‘‘(2) CHRONICALLY DEPENDENT INDIVIDUAL.—
In this section, the term ‘chronically dependent indi-
vidual’ means an individual described in paragraph
(1) who—
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‘‘(A) for purposes of subparagraph (A) of
such paragraph, is unable to perform at least 3
of the activities of daily living described in such
subparagraph; or
(B) for purposes of subparagraph (B)(i) of
such paragraph, has a level of disability that re-
quires direction, instruction, or supervision of
another individual to perform 3 or more of such
activities of daily living;
‘‘(C) with respect to whom the provision of
extended care services is likely to reduce or
postpone more serious and expensive medical or
institutional care the cost of which would be
borne by public programs (including programs
under this title or title XIX).
‘‘(3) ACTIVITIES OF DAILY LIVING DEFINED.—
The ‘activities of daily living’ referred to in this sub-
section are as follows:
‘‘(A) Eating.
‘‘(B) Bathing.
‘‘(C) Dressing.
‘‘(D) Toileting.
‘‘(E) Transferring in and out of a bed or
in and out of a chair.
‘‘(F) Continence.
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‘‘(e) IN-HOME, COMMUNITY-BASED, AND RESPITE
CARE.—
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘in-home, community-based, and res-
pite care’ means the items and services described in
paragraph (2) furnished to an individual by a com-
munity-based, or home care agency (as defined in
section 1861(uu)) or by others under arrangements
with them made by the agency provided in the com-
munity or a place of residence used as such individ-
ual’s home (other than services described in para-
graph (2)(H)).
‘‘(2) SERVICES
DESCRIBED.—The items and
services described in this paragraph are as follows:
‘‘(A) Nursing care provided by or under
the supervision of a registered professional
nurse.
‘‘(B) Services of a homemaker/home health
aide who has successfully completed a training
and competency evaluation program approved
by the Secretary.
‘‘(C) Personal care services.
‘‘(D) Medical social services.
‘‘(E) Physical, occupational, or respiratory
therapy or speech-language pathology.
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‘‘(F) Medical supplies (other than drugs
and biologicals) and durable medical equipment,
while under such a plan.
‘‘(G) Patient and caregiver (including fam-
ily caregiver) education and training to develop
skills necessary to permit the individual to re-
main in the home setting.
‘‘(H) Adult day care and other community
care services furnished outside of the place of
residence.
‘‘(I) Such other community- or home-based
items and services (other than room and board)
as the Secretary may approve.
‘‘(f) CASE MANAGEMENT REQUIREMENTS.—
‘‘(1) REQUESTS FOR ASSESSMENT.—Each indi-
vidual entitled to benefits under this title (or an-
other person on such individual’s behalf) may re-
quest a case management agency to conduct an as-
sessment under this section to determine whether
the individual is a dependent individual or a chron-
ically dependent individual.
‘‘(2) DESCRIPTION OF PLANS.—For purposes of
this section, a ‘case management plan’ means, with
respect to an individual, a written plan of care
which—
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‘‘(A) is established and periodically re-
viewed and revised by a case management agen-
cy; and
‘‘(B) reflects the individual’s needs identi-
fied in the assessment under paragraph (1).
‘‘(3) CASE MANAGEMENT AGENCY DEFINED.—
In this section, the term ‘case management agency’
means a nonprofit or public agency or organization
(or a nonprofit or public subdivision of such an
agency or organization) certified by the Secretary to
conduct assessments and establish case management
plans under this subsection which—
‘‘(A) is experienced in conducting assess-
ments, in establishing and periodically reviewing
and revising case management plans for nurs-
ing facility services and in-home care, and in
coordinating and reviewing the quality of the
provision of such services and care;
‘‘(B) is capable of efficiently and effectively
performing directly or through contracts under
paragraph (4) such duties; and
‘‘(C) does not provide nursing facility serv-
ices or in-home care and does not have a direct
or indirect ownership or control interest in, or
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direct or indirect affiliation or relationship with,
an entity that provides, such services or care.
‘‘(4) 
CONTRACTING
OUT
CERTAIN
FUNC-
TIONS.—The Secretary shall permit a case manage-
ment agency, to the extent necessary to carry out
functions under this section, to provide for assess-
ments and case management plans through con-
tracts with nonprofit or public organizations which
(except as provided by regulation) do not provide
nursing facility services or in-home care and do not
have a direct or indirect ownership or control inter-
est in, or direct or indirect affiliation or relationship
with, an entity that provides, such services or care.’’.
(c) CONFORMING AMENDMENTS.—(1) Section 1833
(a)(1) of such Act (42 U.S.C. 1395l(a)(1)) is amended—
(A) by striking ‘‘and (P)’’ and inserting ‘‘(P)’’;
and
(B) by striking the semicolon at the end and in-
serting the following: ‘‘, and (Q) with respect to ex-
penses incurred for services described in section
1861(s)(2)(P), the amounts paid shall be the
amounts determined under section 1889(c);’’.
(2) Section 1861 of such Act (42 U.S.C. 1395x) is
amended by adding at the end the following new sub-
section:
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‘‘COMMUNITY-BASED OR HOME CARE AGENCY
‘‘(uu) The term ‘community-based or home care
agency’ means a public agency or private organization, or
a subdivision of such an agency or organization, which is
a community-based or home health agency (as defined in
subsection (o)) or—
‘‘(1) is a substitute adult day care services pro-
vider as defined in subsection vv (as added by the
Omnibus Long-Term Care Improvement Act of
1999) or other community-based provider which pro-
vides long-term, caregiver, and respite services as
defined by the Secretary, or
‘‘(2) is engaged in providing services of home-
maker/home health aides and personal care aides;
‘‘(3) maintains clinical records on all patients;
‘‘(4) in the case of an agency or organization in
any State in which State or applicable local law pro-
vides for the licensing of agencies or organizations of
this nature—
‘‘(A) is licensed pursuant to such law or
‘‘(B) is approved, by the agency of such
State or locality, responsible for licensing agen-
cies or organizations of this nature, as meeting
the standards established for such licensing;
and
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‘‘(5) meets such other requirements as the Sec-
retary may find necessary in the interest of the
health and safety of individuals who are furnished
services by such agency or organization and for the
effective and efficient operation of the program.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2001.
SEC. 202. COVERAGE OF SUBSTITUTE ADULT DAY CARE
SERVICES UNDER MEDICARE.
(a) SUBSTITUTE ADULT DAY CARE SERVICES BEN-
EFIT.—
(1) IN GENERAL.—Section 1861(m) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395x(m)) 
is
amended—
(A) in the matter preceding paragraph (1),
by inserting ‘‘or paragraph (8)’’ after ‘‘para-
graph (7)’’;
(B) in paragraph (6), by striking ‘‘and’’ at
the end;
(C) in paragraph (7), by adding ‘‘and’’ at
the end; and
(D) by inserting after paragraph (7), the
following new paragraph:
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‘‘(8) substitute adult day care services (as de-
fined in subsection (vv));’’.
(2) SUBSTITUTE ADULT DAY CARE SERVICES
DEFINED.—Section 1861 of such Act (42 U.S.C.
1395x), as amended by section 201, is further
amended by adding at the end the following new
subsection:
‘‘Substitute Adult Day Care Services; Adult Day Care
Facility
‘‘(vv)(1)(A) The term ‘substitute adult day care serv-
ices’ means the items and services described in subpara-
graph (B) furnished to an individual by an adult day care
facility as a part of a plan under subsection (m) sub-
stituting such services for a portion of the items and serv-
ices described in subparagraph (B)(i) furnished by a home
health agency under the plan, as determined by the physi-
cian establishing the plan.
‘‘(B) The items and services described in this sub-
paragraph are the following items and services:
‘‘(i) Items and services described in paragraphs
(1) through (7) of subsection (m).
‘‘(ii) Transportation of the individual to and
from the adult day care facility in connection with
any such item or service.
‘‘(iii) Meals.
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‘‘(iv) A program of supervised activities de-
signed to promote physical and mental health and
furnished to the individual by the adult day care fa-
cility in a group setting for a period of not fewer
than four and not greater than twelve hours per day.
‘‘(2)(A) Except as provided in subparagraph (B), the
term ‘adult day care facility’ means a public agency or
private organization, or a subdivision of such an agency
or organization, that—
‘‘(i) is engaged in providing skilled nursing
services and other therapeutic services;
‘‘(ii) meets such standards established by the
Secretary to assure quality of care and such other
requirements as the Secretary finds necessary in the
interest of the health and safety of individuals who
are furnished services in the facility; and
‘‘(iii) meets the requirements of paragraphs (2)
through (8) of subsection (o).
‘‘(B) The Secretary may waive the requirement of a
surety bond under paragraph (7) of subsection (o) in the
case of an agency or organization that provides a com-
parable surety bond under State law.
‘‘(C) For purposes of payment for home health serv-
ices consisting of substitute adult day care services fur-
nished under this title, any reference to a home health
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agency is deemed to be a reference to an adult day care
facility.’’.
(3) 
CONFORMING
AMENDMENTS.—Sections
1814(a)(2)(C) and 1835(a)(2)(A)(i) of such Act (42
U.S.C. 
1395f(a)(2)(C) 
and 
U.S.C.
1395f(a)(2)(C)) are each amended by striking ‘‘sec-
tion 1861(m)(7)’’ and inserting ‘‘paragraph (7) or
(8) of section 1861(m)’’.
(b) PAYMENT FOR SUBSTITUTE ADULT DAY CARE
SERVICES.—
(1) REASONABLE COST.—Section 1861(v)(1)(L)
of such Act (42 U.S.C. 1395x(v)(1)(L)) is amended
by adding at the end the following new clause:
‘‘(x) In the case home health services consisting of
substitute adult day care services, the following rules
apply:
‘‘(I) The Secretary shall determine each compo-
nent (as defined by the Secretary) of substitute
adult 
day 
care 
services 
(under 
subsection
(vv)(1)(B)(i)) furnished to an individual under the
plan of care established under subsection (m) with
respect to such services.
‘‘(II) The Secretary shall estimate the amount
that would otherwise be payable under this subpara-
graph for all home health services under that plan
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of care other than substitute adult day care services
for a week or other period specified by the Sec-
retary.
‘‘(III) The total amount payable for home
health services consisting of substitute adult day
care services may not exceed 95 percent of the
amount estimated to be payable under subclause (II)
furnished under the plan by a home health agency.
‘‘(IV) No payment may be made under this title
for home health services consisting of substitute
adult day care services described in clauses (ii), (iii),
and (iv) of subsection (uu)(1)(B).’’.
(2) PROSPECTIVE PAYMENT SYSTEM.—Section
1895 of such Act (42 U.S.C. 1395fff) is amended by
adding at the end the following new subsection:
‘‘(e) PAYMENT RATE FOR SUBSTITUTE ADULT DAY
CARE SERVICES.—In the case home health services con-
sisting of substitute adult day care services, the following
rules apply:
‘‘(1) The Secretary shall determine each compo-
nent (as defined by the Secretary) of substitute
adult 
day 
care 
services 
(under 
section
1861(vv)(1)(B)(i)) furnished to an individual under
the plan of care established under section 1861(m)
with respect to such services.
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‘‘(2) The Secretary shall estimate the amount
that would otherwise be payable under this section
for all home health services under that plan of care
other than substitute adult day care services for a
week or other period specified by the Secretary.
‘‘(3) The total amount payable for home health
services consisting of substitute adult day care serv-
ices may not exceed 95 percent of the amount esti-
mated to be payable under paragraph (2) furnished
under the plan by a home health agency.
‘‘(4) No payment may be made under this title
for home health services consisting of substitute
adult day care services described in clauses (ii), (iii),
and (iv) of section 1861(vv)(1)(B).’’.
(c) ADJUSTMENT IN CASE OF OVERUTILIZATION OF
SUBSTITUTE ADULT DAY CARE SERVICES.—
(1) MONITORING
EXPENDITURES.—The Sec-
retary of Health and Human Services shall monitor
the expenditures made under the Medicare Program
under title XVIII of the Social Security Act for
home health services furnished under section
1861(m) of such Act for a fiscal year beginning with
fiscal year 2002, including substitute adult day care
services under paragraph (8) of such section (as
added by subsection (a)), and compare such expendi-
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(2) the date on which the prospective payment
system, for home health services furnished under the
medicare program, under section 1895 of the Social
Security Act (42 U.S.C. 1395fff) is established and
implemented.
SEC. 203. ESTABLISHMENT OF MEDICARE HOME HEALTH
CARE CASE MANAGERS FOR LONG TERM
HOME HEALTH SPELLS OF ILLNESS.
(a) REQUIREMENT FOR CASE MANAGEMENT PLAN
FOR
BENEFICIARIES
REQUIRING
EXTENDED
HOME
HEALTH SERVICES.—
(1) IN GENERAL.—Section 1861(m) of the So-
cial Security Act (42 U.S.C. 1395x(m)) is amended,
in the matter preceding paragraph (1), by inserting
after ‘‘under a plan (for furnishing such items and
services to such individual) established and periodi-
cally reviewed by a physician’’ the following: ‘‘and,
in the case of such services furnished (or likely to
be required to be furnished) for an extended period
(as defined by the Secretary in regulations), under
a home health case management plan (as defined in
subsection (ww)(2)) established by a home health
case manager (as defined in subsection (ww)(1)) in
consultation with the physician and, if available, the
family of the individual’’.
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(2) DEFINITIONS.—Section 1861 of such Act
(42 U.S.C. 1395x), as amended by sections 201 and
202, is further amended by adding at the end the
following new subsection:
‘‘Home Health Case Manager
‘‘(ww)(1) The term ‘home health case manager’
means a public agency or private organization (or a sub-
division thereof) that—
‘‘(A) develops, coordinates, and monitors the
delivery of home health services by home health
agencies to an individual and may authorize pay-
ment of such home health services;
‘‘(B) has experience and expertise in the fur-
nishing of home health services; and
‘‘(C) meets such other standards as the Sec-
retary finds necessary for the effective and efficient
development and oversight of home health case man-
agement plans and to ensure the health and safety
of individuals furnished services under such a plan.
‘‘(2) The term ‘home health case management plan’
means a structured plan for the delivery of home health
services that is developed by a home health case manager,
after consultation with the physician and, if available, the
family of the individual involved.
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‘‘(3) The term ‘home health case manager services’
means the development, coordination, and monitoring of
a home health case management plan for an individual
furnished (or likely to be required to be furnished) home
health services for an extended period (as defined by the
Secretary in regulations under subsection (m)) and in-
cludes the periodic review of such a plan.’’.
(3) GUIDANCE ON INITIATION OF CASE MAN-
AGER
SERVICES.—The Secretary of Health and
Human Services shall provide guidance on the proc-
ess or processes that may be used to identify Medi-
care beneficiaries requiring home health services for
extended periods and to develop home health case
management plans on a timely basis.
(4) LIMITATION ON REFERRALS.—Section 1877
of the Social Security Act (42 U.S.C. 1395nn) shall
apply to a referral by a home health case manager
to a home health agency in the same manner as
such section applies to a referral by a physician to
an entity described in section 1877(a)(2) of such
Act.
(b) COVERAGE
OF
AND
PAYMENT
FOR
HOME
HEALTH CASE MANAGER SERVICES.—
(1) PART A.—
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(A) COVERAGE.—Section 1812(a)(3) of
such Act (42 U.S.C. 1395d(a)(3)) is amended
by inserting before the semicolon ‘‘, and home
health case manager services (as defined in sec-
tion 1861(ww)(3))’’.
(B) ELIGIBILITY.—Section 1814(a)(2)(C)
of such Act (42 U.S.C. 1395f(a)(2)(C)) is
amended by inserting ‘‘and, in the case of such
services furnished (or likely to be required to be
furnished) for an extended period (as defined
by the Secretary under section 1861(m)), under
a home health case management plan that has
been established and periodically reviewed by a
home health case manager’’ after ‘‘is periodi-
cally reviewed by a physician’’.
(C) PAYMENT.—Section 1812 of such Act
(42 U.S.C. 1395d) is amended by adding at the
end the following new subsection:
‘‘(h)(1) Payment under this part for home health
case manager services (as defined in section 1861(ww)(3))
shall be made pursuant to the fee schedule established by
the Secretary under section 1834(m).
‘‘(2) Payment may be made under this title for home
health case manager services with respect to an individual
only—
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‘‘(A) for the initial development of the home
health case management plan for the individual, and
‘‘(B) for the subsequent review and modifica-
tion of such plan, as provided by the Secretary in
regulations.’’.
(2) PART B.—
(A) COVERAGE.—Section 1832(a)(2)(A) of
such Act (42 U.S.C. 1395k(a)(2)(A)) is amend-
ed by inserting before the semicolon ‘‘, and
home health case manager services (as defined
in section 1861(ww)(3))’’.
(B) ELIGIBILITY.—Section 1835(a)(2) of
such Act (42 U.S.C. 1395n(a)(2)) is amended
by inserting ‘‘and, in the case of such services
furnished (or likely to be required to be fur-
nished) for an extended period (as defined by
the Secretary under section 1861(m)), under a
home health case management plan that has
been established and periodically reviewed by a
home health case manager’’ after ‘‘is periodi-
cally reviewed by a physician’’.
(C) PAYMENT.—Section 1833 of such Act
(42 U.S.C. 1395l) is amended—
(i) in subsection (a)(2)—
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(I) by striking ‘‘and’’ at the end
of subparagraph (F);
(II) by adding ‘‘and’’ at the end
of subparagraph (G); and
(III) by adding after subpara-
graph (G) the following new subpara-
graph:
‘‘(H) subject to subsection (u), with re-
spect to home health case manager services (as
defined in section 1861(ww)(3), the amount de-
termined under the fee schedule established
under section 1834(m);’’, and
(ii) by adding at the end the following
new subsection:
‘‘(u) Payment may be made under this title for home
health case manager services with respect to an individual
only—
‘‘(1) for the initial development of the home
health case management plan for the individual, and
‘‘(2) for the subsequent review and modification
of such plan, as provided by the Secretary in regula-
tions.’’.
(3) ESTABLISHMENT OF FEE SCHEDULE.—Sec-
tion 1834 of such Act (42 U.S.C. 1395m) is amend-
ed by adding at the end the following new section:
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‘‘(m) ESTABLISHMENT
OF FEE SCHEDULE
FOR
HOME HEALTH CASE MANAGER SERVICES.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a fee schedule for payment for home health case
manager services. Such schedule may provide for
rates that differ for such services that comprise the
establishment of a home health case management
plan and that comprise review and modification of
such a plan.
‘‘(2) CONSIDERATIONS.—In establishing such
fee schedule, the Secretary shall consider appro-
priate regional and operational differences and ad-
justments to payment rates to account for inflation
and other relevant factors.
‘‘(3) CONSULTATION.—In establishing the fee
schedule for home health case manager services
under this subsection, the Secretary shall consult
with appropriate organizations representing individ-
uals and entities who furnish referral services for
home health services and share with such organiza-
tions relevant data in establishing such schedule.
‘‘(4) ALTERNATIVE PAYMENT UNDER COMPETI-
TIVE BIDDING.—
‘‘(A) IN
GENERAL.—Notwithstanding the
preceding provisions of this subsection, the Sec-
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retary may, by region, use a competitive process
to contract with home health case managers for
furnishing home health case manager services.
‘‘(B) 
PAYMENT.—Payment 
under 
this
paragraph shall be made on the basis of nego-
tiated all-inclusive rates. The amount of pay-
ment made by the Secretary to a home health
case manager for home health case manager
services under this title for services covered
under a contract shall be less than the aggre-
gate amount of the payments that the Secretary
would have otherwise made for the services.
‘‘(C) CONTRACT PERIOD.—A contract pe-
riod shall be three years (subject to renewal), as
long as the entity continues to meet quality and
other contractual standards.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply with respect to home health services fur-
nished on or after October 1, 2001.
(d) REPORT TO CONGRESS ON FEASIBILITY OF CASE
MANAGERS WITH RESPECT TO OTHER MEDICARE SERV-
ICES.—
(1) STUDY.—The Secretary of Health and
Human Services shall conduct a study of the types
of services consisting of post-acute hospital care fur-
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nished under the Medicare program under title
XVIII of the Social Security Act to determine
whether use of case managers and case management
plans similar to home health case managers (as de-
fined in section 1861(ww)(1)) and home health case
management 
plans 
(as 
defined 
in 
section
1861(ww)(2)) is feasible and appropriate for each
such type of service. In conducting the study, the
Secretary shall also determine whether such case
managers and case management plans may improve
quality of care and patient outcomes under the
Medicare program, may result in cost savings to the
program, and may reduce incidents of waste, fraud
and abuse against the program.
(2) REPORT.—Not later than January 1, 2002,
the Secretary shall submit to Congress a report con-
taining the determinations made pursuant to the
study conducted under paragraph (1) and any rec-
ommendations for legislative and administrative ac-
tion the Secretary deems appropriate.
SEC. 204. POST ACUTE CARE IMPROVEMENT.
(a) IDENTIFICATION
OF CONDITIONS.—The Sec-
retary of Health and Human Services shall identify at
least 10 medical conditions, classified by diagnosis-related
groups under section 1886(d)(4) of the Social Security
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Act, which consistently require an intense level of post-
acute care, either by health care providers or by private
caregivers.
(b) REQUIREMENT FOR COMPREHENSIVE CASE MAN-
AGEMENT PLAN OF CARE.—
(1) IN GENERAL.—Each subsection (d) hospital
shall provide, in the case of an inpatient classified
a voluntary discharge classified within a medical
condition identified under subsection (a) and before
the date of the discharge, a comprehensive case
management plan of care that includes a program of
education, training, and assistance to the private
caregiver, designed to stabilize or improve the indi-
vidual’s health and to reduce the likelihood of hos-
pital readmission.
(2) REDUCTION IN PAYMENT FOR FAILURE.—
Payment under section 1886(d) of the Social Secu-
rity Act for a voluntary discharge classified within a
medical condition identified under subsection (a)
shall be reduced by 50 percent unless there has been
established (before the date of the discharge) the
plan of care and program of assistance described in
paragraph (1).
(c) ADJUSTMENT OF DRG WEIGHTING FACTORS.—
For the medical conditions identified under subsection (a),
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the Secretary shall adjust the weighting factor established
under section 1886(d)(4)(B) of the Social Security Act in
order to compensate for the average reasonable cost to a
hospital for providing (directly or through a contract with
another provider) for the comprehensive case management
plan of care and providing for caregiver education, train-
ing, and assistance described in subsection (b)(1).
SEC. 205. ADDITIONAL PAYMENTS TO HOME HEALTH AGEN-
CIES FOR MOST EXPENSIVE CASES.
(a) PAYMENTS FOR OUTLIERS.—
(1) IN GENERAL.—Subject to paragraph (2),
from amounts appropriated pursuant to subsection
(e), the Secretary of Health and Human Services
shall pay an additional amount to home health agen-
cies furnishing qualified home health services during
a cost reporting period beginning on or after Octo-
ber 1, 1997, under the medicare program (under
title XVIII of the Social Security Act).
(2) LIMITATION OF PAYMENTS.—No payment
shall be made under this section to a home health
agency that, as of the date of the enactment of this
Act, has ceased furnishing home health services for
which payment may be made under the medicare
program (under such title).
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(b) DESCRIPTION
OF QUALIFIED SERVICES.—For
purposes of additional payment amounts under this sec-
tion by the Secretary to home health agencies, qualified
home health services are home health services furnished
under the medicare program for the treatment of condi-
tions within a diagnosis described in subsection (c).
(c) DESCRIPTION OF DIAGNOSIS.—A diagnosis de-
scribed in this subsection is one of the following diagnoses
as classified in St. Anthony’s ICD–9–CM Code Book for
Physician Payment:
(1) diabetes mellitus (ICD–9–CM code 250).
(2) essential hypertension (ICD–9–CM code
401).
(3) other forms of chronic ischemic heart dis-
ease (ICD–9–CM code 414).
(4) heart failure (ICD–9–CM code 428).
(5) acute, but ill-defined cerebrovascular disease
(ICD–9–CM code 436).
(6) pneumonia, organism unspecified (ICD–9–
CM code 486).
(7) chronic airway obstruction, not elsewhere
classified (ICD–9–CM code 496).
(8) chronic ulcer of skin (ICD–9–CM code
707).
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(9) symptoms involving urinary system (ICD–
9–CM code 788).
(10) fracture of neck of femur (ICD–9–CM
code 820).
(d) DETERMINATION
OF AGENCY-SPECIFIC PAY-
MENT AMOUNT.—
(1) CERTIFICATION
OF
QUANTITY
OF
QUALI-
FIED HOME HEALTH SERVICES FURNISHED.—
(A) IN GENERAL.—With respect to a fiscal
year, a home health agency may submit to the
Secretary a certification of the number of pa-
tients to whom the agency furnished qualified
home health services during the agency’s cost
reporting period beginning in that fiscal year.
(B) DEADLINE FOR SUBMISSION.—
(i) IN
GENERAL.—Such certification
shall be submitted to the Secretary during
the 30-day period beginning on the date
the agency submits to the Secretary a cost
report for the cost reporting period begin-
ning in such fiscal year.
(ii) TRANSITION RULE.—In the case
of an agency with a cost reporting period
beginning on or after October 1, 1997,
that ends before the date of the enactment
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of this Act, with respect to such cost re-
porting period, the 30-day period under
clause (i) begins 60 days after the date of
the enactment of this Act.
(2) DETERMINATION
OF
AGGREGATE
QUALI-
FIED HOME HEALTH SERVICES FURNISHED.—From
data contained in certifications submitted under
paragraph (1) with respect to cost reporting periods
beginning in fiscal years 1998, 1999, and 2000, the
Secretary shall determine, with respect to a fiscal
year, the number of patients who have received
qualified home health services furnished by agencies
submitting such certifications for that fiscal year.
The Secretary shall make determination by not later
than 120 days after all cost reports for that fiscal
year have been received.
(3) AGENCY-SPECIFIC PERCENTAGE OF AGGRE-
GATE AMOUNT.—For each home health agency sub-
mitting a certification under paragraph (1) for a fis-
cal year described in paragraph (2), the Secretary
shall determine an agency-specific percentage by di-
viding the number of patients certified by the home
health agency for that fiscal year by the national
total specified in paragraph (2) for that fiscal year.
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(4) PAYMENT
AMOUNT.—The Secretary shall
pay for a fiscal year described in paragraph (2) to
a home health agency making the certification under
paragraph (1) an amount equal to the product of the
percentage determined under paragraph (3) and the
amount appropriated for such fiscal year under sub-
section (e).
(e) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated from the Federal Hospital
Insurance Trust Fund (established under section 1817 of
the Social Security Act (42 U.S.C. 1395i)) for making ad-
ditional payments to home health agencies under this sec-
tion, $250,000,000 in each of the fiscal years 2000
through 2002.
(f) TERMINATION.—The Secretary shall not make ad-
ditional payments under this section for cost reporting pe-
riods, or portions of cost reporting periods, beginning on
or after the date of the implementation of the prospective
payment system for home health services under section
1895 of the Social Security Act (42 U.S.C. 1395fff).
(g) LIMITATION ON JUDICIAL REVIEW.—There shall
be no administrative or judicial review under section 1869
of the Social Security Act (42 U.S.C. 1395ff), section
1878 of such Act (42 U.S.C. 1395oo), or otherwise of any
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action of the Secretary with respect to the determination
of an additional payment amount under this section.
SEC. 206. STRENGTHENING THE POST-HOSPITAL REFER-
RAL PROCESS.
(a) IN GENERAL.—Section 1861(ee)(2)(H)(ii) of the
Social Security Act (42 U.S.C. 1395x(ee)(2)(H)(ii)) is
amended by inserting ‘‘(including any post-acute care hos-
pital provider, such as home health agencies, skilled nurs-
ing facilities, comprehensive outpatient rehabilitation facil-
ity, hospice program, or other hospital)’’ after ‘‘any enti-
ty’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies to discharge plans developed on or
after January 1, 2000.
SEC. 207 CLARIFICATION OF THE DEFINITION OF HOME-
BOUND.
(a) 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—
(1) by striking ‘leave home,’ and inserting
‘leave home and’; and
(2) by striking ‘, and that absences’ and all
that follows before the period.
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(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to items and services provided
on or after the date of enactment of this Act.
Subtitle B—Encouraging Provision
of Hospice Care
SEC. 211. PROVIDING HOSPICE INFORMATION FOR CER-
TAIN BENEFICIARIES AT TIME OF HOSPITAL
DISCHARGE.
(a) IN GENERAL.—Section 1861(ee)(2) of the Social
Security Act (42 U.S.C. 1395x(ee)(2)) is amended by add-
ing at the end the following new subparagraph:
‘‘(I)(i) In the case of a discharge identified
under clause (ii), the discharge plan shall assure
that the patient has been provided counseling and
information about the benefits for hospice care
under this title, including information on hospice
programs that operate in the service area of the hos-
pital.
‘‘(ii) The Secretary shall designate, by diag-
nosis-related 
groups 
established 
under 
section
1886(d)(4), those discharges which are strongly in-
dicative of a chronic terminal condition (such as con-
gestive heart failure, chronic pulmonary disease) for
which hospice care may provide assistance.’’.
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(b) ADJUSTMENT OF PAYMENT.—Section 1886(d)(4)
of such Act (42 U.S.C. 1395ww(d)(4)) is amended by add-
ing at the end the following new subparagraph:
‘‘(D) In establishing weighting factors under this
paragraph with respect to discharges designated under
section clause (ii) of 1861(ee)(2)(I), the Secretary shall
take into account the counseling and information required
under clause (i) of such section.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to discharges occurring on or after Jan-
uary 1, 2002.
SEC. 212. ENCOURAGING PHYSICIAN EDUCATION IN HOS-
PICE CARE.
(a) PERMITTING PAYMENT TO HOSPICE PROGRAMS
FOR
COSTS
OF
MEDICAL
EDUCATION.—Section
1886(k)(2) of the Social Security Act (42 U.S.C.
1395ww(k)(2)) is amended—
(1) by redesignating subparagraphs (C) and
(D) as subparagraphs (D) and (E), respectively; and
(2) by inserting after subparagraph (B) the fol-
lowing new subparagraph:
‘‘(C) a hospice program;’’.
(b) INCLUDING HOSPICE PROGRAMS AMONG QUALI-
FIED
CONSORTIA
FOR
CERTAIN
DEMONSTRATION
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PROJECTS.—Section 4628(b)(1) of the Balanced Budget
Act of 1997 is amended—
(1) by redesignating subparagraph (G) as sub-
paragraph (H); and
(2) by inserting after subparagraph (F) the fol-
lowing new subparagraph:
‘‘(G) A hospice program.’’.
SEC. 213. INCLUSION OF HOSPICE CARE UNDER FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM
(FEHBP).
(a) IN GENERAL.—Section 8902 of title 5, United
States Code, is amended by adding at the end the fol-
lowing new subsection:
‘‘(p) The terms of any contract under this chapter
shall include coverage of hospice care (as described in title
XVIII of the Social Security Act).’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies to contracts as of January 1, 2001.
HR 2691 IH
Subtitle C—QMB Improvements
SEC. 221. MECHANISM PROMOTING PROVISION OF MEDI-
CARE COST-SHARING ASSISTANCE TO ELIGI-
BLE 
LOW-INCOME 
MEDICARE 
BENE-
FICIARIES.
(a) IN GENERAL.—Part A of title XI of the Social
Security Act is amended by adding at the end the fol-
lowing:
‘‘PROMOTING
PROVISION
OF
MEDICARE
COST-SHARING
ASSISTANCE UNDER MEDICAID PROGRAM FOR IDEN-
TIFIED LOW-INCOME MEDICARE BENEFICIARIES
‘‘SEC. 
1148. 
(a) 
REQUIREMENT
FOR
DATA
MATCH.—
‘‘(1) REQUESTING MATCHING INFORMATION.—
The Commissioner of Social Security shall, not less
often than annually beginning with 2001, transmit
to the Secretary of the Treasury a list of the names
and TINs of medicare beneficiaries (as defined in
section 6103(l)(15) of the Internal Revenue Code of
1986) and request that such Secretary disclose to
the Secretary of Health and Human Services the in-
formation described in subparagraph (A) of such
section.
‘‘(2) SPECIFICATION OF INCOME LEVELS.—The
Secretary shall specify—
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‘‘(A) the items that will be included in de-
termination of income for purposes of applying
this section and section 6103(l)(15)(A)(i) of the
Internal Revenue Code of 1986; and
‘‘(B) the levels of such income (based upon
a percentage of the Federal poverty guidelines)
that individuals may have and qualify for med-
ical assistance under section 1902(a)(10)(E)(i)
of the Social Security Act (relating to assist-
ance for medicare cost-sharing benefits under
the medicaid program).
‘‘(b) NOTICE TO INDIVIDUALS IDENTIFIED.—
‘‘(1) 
INITIAL
ELIGIBILITY.—The 
Secretary
promptly shall provide for an appropriate notice to
each individual identified under subsection (a) who
is described in section 6103(l)(15)(A)(i), of the fol-
lowing:
‘‘(A) Subject to subparagraph (B), the in-
dividual is deemed eligible for some form of
medical assistance for some medicare cost-shar-
ing under clause (i) or (iii) of section
1902(a)(10)(E), depending on the individual’s
level of income.
‘‘(B) By accepting such assistance the in-
dividual is obligated to notify the Secretary if
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the individual is not eligible for such assistance
due to—
‘‘(i) the individual having tax-exempt
income;
‘‘(ii) the individual having countable
assets in excess of the maximum permis-
sible assets, if the individual resides in a
State that imposes an asset test for such
eligibility; or
‘‘(iii) the individual otherwise is not
eligible for such assistance.
‘‘(C) if the individual accepts such assist-
ance notwithstanding that the individual is not
eligible, the individual is liable to the State for
the amount of medical assistance provided (with
interest).
‘‘(2) CONTINUED ELIGIBILITY.—The Secretary
shall provide for an appropriate notice to each indi-
vidual identified under subsection (a) who is de-
scribed in section 6103(l)(15)(A)(ii), of the fol-
lowing: ‘Unless the individual declines coverage or
indicates otherwise, the individual will be enrolled
for the appropriate assistance with medicare cost-
sharing under the State plan operated under title
XIX for the State in which the individual resides.’
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‘‘(c) NOTICE TO STATE.—In the case of an individual
who is identified under this section and resides in a State,
the Secretary shall provide for appropriate notice to the
State of the individual’s eligibility for medical assistance
under clause (i) or (iii) of section 1902(a)(10)(E), as the
case may be.’’.
(b) CONFORMING AMENDMENT TO MEDICAID PRO-
GRAM.—Section 1902 of such Act (42 U.S.C. 1396a) is
amended by adding at the end the following:
‘‘(aa) A State shall treat an individual who is identi-
fied under section 1148(b) as being eligible for medical
assistance under clause (i) or (ii) of subsection (a)(10)(E)
as being so eligible, until the Secretary notifies the State
otherwise, with respect to medical assistance for items and
services furnished on or after the date of the notice.’’.
(c) 
AUTHORIZATION
OF
DISCLOSURE.—Section
6103(l) of the Internal Revenue Code of 1986 (relating
to disclosure of returns and return information for pur-
poses other than tax administration) is amended by add-
ing at the end the following new paragraph:
‘‘(15) DISCLOSURE OF CERTAIN INFORMATION
IN ORDER TO QUALIFY FOR MEDICARE COST-SHAR-
ING ASSISTANCE.—
‘‘(A) IN GENERAL.—The Secretary shall,
upon written request from the Commissioner of
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Social Security, disclose to the Secretary of
Health and Human Services, whether with re-
spect to any medicare beneficiary (as defined in
paragraph 
(12)(E)(i)) 
identified 
by 
the
Commissioner—
‘‘(i) there has not been filed an in-
come tax return for the most recent period
for which the Secretary has information; or
there has been such a return filed and the
amount of the gross income (or the sum of
such elements of gross income as the Sec-
retary of Health and Human Services may
specify) is below such level (or levels) as
such Secretary may specify to carry out
section 1148(b) of the Social Security Act,
treating the number of dependents as the
size of the family involved; and
‘‘(ii) whether, for such an individual
who qualified for medicare cost-sharing as-
sistance described in section 1148 at any
time in the previous year, the individual is
still described in clause (i).
‘‘(B) DISCLOSURE BY HEALTH CARE FI-
NANCING
ADMINISTRATION.—With respect to
information disclosed under subparagraph (A),
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TITLE III—NURSING HOME
QUALITY PROTECTIONS
SEC. 301. INFORMATION ON NURSING FACILITY STAFFING.
(a) MEDICARE AMENDMENTS.—Section 1819 of the
Social Security Act (42 U.S.C. 1395i–3) is amended—
(1) in subsection (b), by adding at the end the
following new paragraph:
‘‘(8) INFORMATION
ON
NURSE
STAFFING.—A
skilled nursing facility shall post for each wing or
floor of the facility the names of the licensed and
unlicensed nursing staff on duty at any time and the
number of residents on such wing or floor for whom
they are responsible.’’; and
(2) in subsection (g)(2)(A)(ii)—
(A) by striking ‘‘and’’ at the end of sub-
clause (II);
(B) by striking the period at the end of
subclause (III) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subclause:
‘‘(IV) a review of the adequacy of
staffing in the skilled nursing facility
to meet residents’ needs 24 hours a
day, 7 days a week.’’.
HR 2691 IH
(b) MEDICAID AMENDMENTS.—Section 1919 of the
Social Security Act (42 U.S.C. 1396r) is amended—
(1) in subsection (b), by adding at the end the
following new paragraph:
‘‘(8) INFORMATION
ON
NURSE
STAFFING.—A
nursing facility shall post for each wing or floor of
the facility the names of the licensed and unlicensed
nursing staff on duty at any time and the number
of residents on such wing or floor for whom they are
responsible.’’; and
(2) in subsection (g)(2)(A)(ii)—
(A) by striking ‘‘and’’ at the end of sub-
clause (II);
(B) by striking the period at the end of
subclause (III) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subclause:
‘‘(IV) a review of the adequacy of
staffing in the nursing facility to meet
residents’ needs 24 hours a day, 7
days a week.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section take effect on the first day of the first month
that begins at least 3 months after the date of the enact-
ment of this Act.
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SEC. 302. FEES FOR RESURVEYS AND REINSPECTIONS.
(a) MEDICARE AMENDMENTS.—
(1) IN GENERAL.—Section 1819(g) of the So-
cial Security Act (42 U.S.C. 1395i–3(g)) is amended
by adding at the end the following new paragraph:
‘‘(6) FEES
FOR
RESURVEYS
AND
REINSPEC-
TIONS.—Each State shall assess against a skilled
nursing facility a fee to recover the actual costs and
expenses of the State in conducting any re-surveys
or reinspections that are conducted in addition to
the annual standard survey in those cases in which
violations are found and deficiencies are cited in the
initial survey and the resurvey or reinspection is re-
quired to determine whether the facility has achieved
compliance.’’.
(2) DISALLOWANCE OF MEDICARE PAYMENT TO
COVER ADDITIONAL FEES AND CIVIL MONEY PEN-
ALTIES.—Section 1861(v)(1) of such Act (42 U.S.C.
1395x(v)(1)) is amended by adding at the end the
following new subparagraph:
‘‘(V) In determining the reasonable costs for skilled
nursing facilities, there shall not be included costs in-
curred by the facility—
‘‘(i) because of a fee assessed under subsection
(g)(6) of section 1819 or section 1919;
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‘‘(ii) because of the imposition of any civil
money penalty (whether levied by the Secretary or a
State); or
‘‘(iii) because of any appeal relating to such a
fee or penalty.’’.
(b) MEDICAID AMENDMENTS.—
(1) IN GENERAL.—Section 1919(g) of the So-
cial Security Act (42 U.S.C. 1395i–3(g)) is amended
by adding at the end the following new paragraph:
‘‘(6) FEES
FOR
RESURVEYS
AND
REINSPEC-
TIONS.—Each State shall assess against a nursing
facility a fee to recover the actual costs and expenses
of the State in conducting any re-surveys or re-
inspections that are conducted in addition to the an-
nual standard survey in those cases in which viola-
tions are found and deficiencies are cited in the ini-
tial survey and the resurvey or reinspection is re-
quired to determine whether the facility has achieved
compliance.’’.
(2) DISALLOWANCE OF MEDICAID PAYMENT TO
COVER ADDITIONAL FEES AND CIVIL MONEY PEN-
ALTIES.—Section 1903(i)(8) of such Act (42 U.S.C.
1396b(i)(8)) is amended, in clause (A), by striking
‘‘under section 1919(h)’’ and inserting ‘‘by the Sec-
retary of the State, payment of a fee assessed under
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subsection (g)(6) of section 1819 or section 1919, or
payment of any expenses of an appeal relating to
such a penalty or fee’’.
SEC. 303. ESTABLISHMENT OF PROGRAM TO PREVENT
ABUSE OF NURSING FACILITY RESIDENTS.
(a) NURSING FACILITY AND SKILLED NURSING FA-
CILITY REQUIREMENTS.—
(1) MEDICAID PROGRAM.—Section 1919(b) of
the Social Security Act (42 U.S.C. 1396r(b)) is
amended by adding at the end the following:
‘‘(8) SCREENING OF NURSING FACILITY WORK-
ERS.—
‘‘(A) BACKGROUND
CHECKS
ON
APPLI-
CANTS.—Subject to subparagraph (B)(ii), be-
fore hiring a nursing facility worker, a nursing
facility shall—
‘‘(i) give the worker written notice
that the facility is required to perform
background checks with respect to appli-
cants;
‘‘(ii) require, as a condition of employ-
ment, that such worker—
‘‘(I) provide a written statement
disclosing any conviction for a rel-
HR 2691 IH
evant crime or finding of patient or
resident abuse;
‘‘(II) provide a statement signed
by the worker authorizing the facility
to request the search and exchange of
criminal records;
‘‘(III) provide in person a copy of
the worker’s fingerprints; and
‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the data col-
lection system established under section
1128E in accordance with regulations pro-
mulgated by the Secretary to determine
whether such system contains any disquali-
fying information with respect to such
worker; and
‘‘(iv) if that system does not contain
any such disqualifying information—
‘‘(I) request that the State ini-
tiate a State and national criminal
background check on such worker in
accordance with the provisions of sub-
section (e)(8); and
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‘‘(II) furnish to the State the in-
formation described in subclauses (II)
through (IV) of clause (ii) not more
than 7 days (excluding Saturdays,
Sundays, and legal public holidays
under section 6103(a) of title 5,
United States Code) after completion
of the check against the system initi-
ated under clause (iii).
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE
WORKERS.—
‘‘(i) IN GENERAL.—A nursing facility
may not knowingly employ any nursing fa-
cility worker who has any conviction for a
relevant crime or with respect to whom a
finding of patient or resident abuse has
been made.
‘‘(ii) PROBATIONARY EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A), a nursing facility may provide for a
probationary period of employment for a
nursing facility worker pending completion
of the check against the data collection
system 
described 
under 
subparagraph
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(A)(iii) and the background check de-
scribed under subparagraph (A)(iv). Such
facility shall maintain direct supervision of
the worker during the worker’s proba-
tionary period of employment.
‘‘(C) 
REPORTING
REQUIREMENTS.—A
nursing facility shall report to the State any in-
stance in which the facility determines that a
nursing facility worker has committed an act of
resident neglect or abuse or misappropriation of
resident property in the course of employment
by the facility.
‘‘(D) USE OF INFORMATION.—
‘‘(i) IN GENERAL.—A nursing facility
that obtains information about a nursing
facility worker pursuant to clauses (iii) and
(iv) of subparagraph (A) may use such in-
formation only for the purpose of deter-
mining the suitability of the worker for
employment.
‘‘(ii) IMMUNITY FROM LIABILITY.—A
nursing facility that, in denying employ-
ment for an applicant, reasonably relies
upon information about a nursing facility
worker provided by the State pursuant to
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subsection (e)(8) or section 1128E shall
not be liable in any action brought by the
worker based on the employment deter-
mination resulting from the information.
‘‘(iii) CRIMINAL
PENALTY.—Whoever
knowingly violates the provisions of clause
(i) shall be fined in accordance with title
18, United States Code, imprisoned for not
more than 2 years, or both.
‘‘(E) CIVIL PENALTY.—
‘‘(i) IN GENERAL.—A nursing facility
that violates the provisions of this para-
graph shall be subject to a civil penalty in
an amount not to exceed—
‘‘(I) for the first such violation,
$2,000; and
‘‘(II) for the second and each
subsequent violation within any 5-year
period, $5,000.
‘‘(ii) KNOWING
RETENTION
OF
WORK-
ER.—In addition to any civil penalty under
clause (i), a nursing facility that—
‘‘(I) knowingly continues to em-
ploy a nursing facility worker in viola-
tion of subparagraph (A) or (B); or
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‘‘(II) knowingly fails to report a
nursing facility worker under subpara-
graph (C);
shall be subject to a civil penalty in an
amount not to exceed $5,000 for the first
such violation, and $10,000 for the second
and each subsequent violation within any
5-year period.
‘‘(F) DEFINITIONS.—In this paragraph:
‘‘(i) CONVICTION
FOR
A
RELEVANT
CRIME.—The term ‘conviction for a rel-
evant crime’ means any Federal or State
criminal conviction for—
‘‘(I) any offense described in
paragraphs (1) through (4) of section
1128(a); and
‘‘(II) such other types of offenses
as the Secretary may specify in regu-
lations.
‘‘(ii) DISQUALIFYING INFORMATION.—
The term ‘disqualifying information’ means
information about a conviction for a rel-
evant crime or a finding of patient or resi-
dent abuse.
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‘‘(iii) FINDING OF PATIENT OR RESI-
DENT ABUSE.—The term ‘finding of pa-
tient or resident abuse’ means any sub-
stantiated finding by a State agency under
subsection (g)(1)(C) or a Federal agency
that a nursing facility worker has com-
mitted.—
‘‘(I) an act of patient or resident
abuse or neglect or a misappropriation
of patient or resident property; or
‘‘(II) such other types of acts as
the Secretary may specify in regula-
tions.
‘‘(iv) NURSING FACILITY WORKER.—
The term ‘nursing facility worker’ means
any individual that has direct access to a
patient of a nursing facility under an em-
ployment or other contract with such facil-
ity. Such term includes individuals who are
licensed or certified by the State to provide
such services, and nonlicensed individuals
providing such services, as defined by the
Secretary, 
including 
nurse 
assistants,
nurse aides, home health aides, and per-
sonal care workers and attendants.’’.
HR 2691 IH
(2) MEDICARE PROGRAM.—Section 1819(b) of
the Social Security Act (42 U.S.C. 1395i–3(b)) is
amended by adding at the end the following:
‘‘(8) SCREENING OF SKILLED NURSING FACIL-
ITY WORKERS.—
‘‘(A) BACKGROUND
CHECKS
ON
APPLI-
CANTS.—Subject to subparagraph (B)(ii), be-
fore hiring a skilled nursing facility worker, a
skilled nursing facility shall—
‘‘(i) give the worker written notice
that the facility is required to perform
background checks with respect to appli-
cants;
‘‘(ii) require, as a condition of employ-
ment, that such worker—
‘‘(I) provide a written statement
disclosing any conviction for a rel-
evant crime or finding of patient or
resident abuse;
‘‘(II) provide a statement signed
by the worker authorizing the facility
to request the search and exchange of
criminal records;
‘‘(III) provide in person a copy of
the worker’s fingerprints; and
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‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the data col-
lection system established under section
1128E in accordance with regulations pro-
mulgated by the Secretary to determine
whether such system contains any disquali-
fying information with respect to such
worker; and
‘‘(iv) if that system does not contain
any such disqualifying information—
‘‘(I) request that the State ini-
tiate a State and national criminal
background check on such worker in
accordance with the provisions of sub-
section (e)(6); and
‘‘(II) furnish to the State the in-
formation described in subclauses (II)
through (IV) of clause (ii) not more
than 7 days (excluding Saturdays,
Sundays, and legal public holidays
under section 6103(a) of title 5,
United States Code) after completion
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of the check against the system initi-
ated under clause (iii).
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE
WORKERS.—
(i) IN GENERAL.—A skilled nursing facility may
not knowingly employ any skilled nursing facility
worker who has any conviction for a relevant crime
or with respect to whom a finding of patient or resi-
dent abuse has been made.
‘‘(ii) PROBATIONARY EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A), a skilled nursing facility may provide
for a probationary period of employment
for a skilled nursing facility worker pend-
ing completion of the check against the
data collection system described under sub-
paragraph (A)(iii) and the background
check 
described 
under 
subparagraph
(A)(iv). Such facility shall maintain direct
supervision of the covered individual dur-
ing the worker’s probationary period of
employment.
‘‘(C) 
REPORTING
REQUIREMENTS.—A
skilled nursing facility shall report to the State
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(i) shall be fined in accordance with title
18, United States Code, imprisoned for not
more than 2 years, or both.
‘‘(E) CIVIL PENALTY.—
‘‘(i) IN GENERAL.—A skilled nursing
facility that violates the provisions of this
paragraph shall be subject to a civil pen-
alty in an amount not to exceed—
‘‘(I) for the first such violation,
$2,000; and
‘‘(II) for the second and each
subsequent violation within any 5-year
period, $5,000.
‘‘(ii) KNOWING RETENTION OF WORK-
ER.—In addition to any civil penalty under
clause (i), a skilled nursing facility that—
‘‘(I) knowingly continues to em-
ploy a skilled nursing facility worker
in violation of subparagraph (A) or
(B); or
‘‘(II) knowingly fails to report a
skilled nursing facility worker under
subparagraph (C);
shall be subject to a civil penalty in an
amount not to exceed $5,000 for the first
HR 2691 IH
such violation, and $10,000 for the second
and each subsequent violation within any
5-year period.
‘‘(F) DEFINITIONS.—In this paragraph:
‘‘(i) CONVICTION
FOR
A
RELEVANT
CRIME.—The term ‘conviction for a rel-
evant crime’ means any Federal or State
criminal conviction for—
‘‘(I) any offense described in
paragraphs (1) through (4) of section
1128(a); and
‘‘(II) such other types of offenses
as the Secretary may specify in regu-
lations.
‘‘(ii) DISQUALIFYING INFORMATION.—
The term ‘disqualifying information’ means
information about a conviction for a rel-
evant crime or a finding of patient or resi-
dent abuse.
‘‘(iii) FINDING OF PATIENT OR RESI-
DENT ABUSE.—The term ‘finding of pa-
tient or resident abuse’ means any sub-
stantiated finding by a State agency under
subsection (g)(1)(C) or a Federal agency
HR 2691 IH
that a skilled nursing facility worker has
committed—
‘‘(I) an act of patient or resident
abuse or neglect or a misappropriation
of patient or resident property; or
‘‘(II) such other types of acts as
the Secretary may specify in regula-
tions.
‘‘(iv) SKILLED
NURSING
FACILITY
WORKER.—The term ‘skilled nursing facil-
ity worker’ means any individual that has
direct access to a patient of a skilled nurs-
ing facility under an employment or other
contract with such facility. Such term in-
cludes individuals who are licensed or cer-
tified by the State to provide such services,
and nonlicensed individuals providing such
services, as defined by the Secretary, in-
cluding nurse assistants, nurse aides, home
health aides, and personal care workers
and attendants.’’.
(b) STATE REQUIREMENTS.—
(1) MEDICAID PROGRAM.—
(A) EXPANSION OF STATE REGISTRY TO
COLLECT INFORMATION ABOUT NURSING FACIL-
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ITY EMPLOYEES OTHER THAN NURSE AIDES.—
Section 1919 of the Social Security Act (42
U.S.C. 1396r) is amended—
(i) in subsection (e)(2)—
(I) in the paragraph heading, by
striking ‘‘NURSE AIDE REGISTRY’’ and
inserting ‘‘NURSING
FACILITY
EM-
PLOYEE REGISTRY’’;
(II) in subparagraph (A)—
(aa) by striking ‘‘By not
later than January 1, 1989, the’’
and inserting ‘‘The’’;
(bb) by striking ‘‘a registry
of all indivduals’’ and inserting
‘‘a registry of (I) all individuals’’;
and
(cc) by inserting before the
period ‘‘, and (II) all other nurs-
ing facility employees with re-
spect to whom the State has
made a finding described in sub-
paragraph (B)’’;
(III) in subparagraph (B), by
striking ‘‘involving an individual listed
HR 2691 IH
in the registry’’ and inserting ‘‘involv-
ing a nursing facility employee’’; and
(IV) in subparagraph (C), by
striking ‘‘nurse aide’’ and inserting
‘‘nursing facility employee or appli-
cant for employment’’; and
(ii) in subsection (g)(1)—
(I) in subparagraph (C)—
(aa) in the first sentence, by
striking ‘‘nurse aide’’ and insert-
ing ‘‘nursing facility employee’’;
and
(bb) in the third sentence,
by striking ‘‘nurse aide’’ each
place it appears and inserting
‘‘nursing facility employee’’; and
(II) in subparagraph (D), by
striking ‘‘nurse aide’’ each place it ap-
pears and inserting ‘‘nursing facility
employee’’.
(B) FEDERAL AND STATE REQUIREMENT
TO
CONDUCT
BACKGROUND
CHECKS.—Section
1919(e) of the Social Security Act (42 U.S.C.
1396r(e)) is amended by adding at the end the
following:
HR 2691 IH
‘‘(8) FEDERAL
AND
STATE
REQUIREMENTS
CONCERNING
CRIMINAL
BACKGROUND
CHECKS
ON
NURSING FACILITY EMPLOYEES.—
‘‘(A) IN GENERAL.—Upon receipt of a re-
quest by a nursing facility pursuant to sub-
section (b)(8) that is accompanied by the infor-
mation described in subclauses (II) through
(IV) of subsection (b)(8)(A)(ii), a State, after
checking appropriate State records and finding
no disqualifying information (as defined in sub-
section (b)(8)(F)(ii)), shall submit such request
and information to the Attorney General and
shall request the Attorney General to conduct a
search and exchange of records with respect to
the individual as described in subparagraph
(B).
‘‘(B) 
SEARCH
AND
EXCHANGE
OF
RECORDS BY ATTORNEY GENERAL.—Upon re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
HR 2691 IH
formation resulting from the search to the
State.
‘‘(C) STATE REPORTING OF INFORMATION
TO NURSING FACILITY.—Upon receipt of the in-
formation provided by the Attorney General
pursuant to subparagraph (B), the State
shall—
‘‘(i) review the information to deter-
mine whether the individual has any con-
viction for a relevant crime (as defined in
subsection (b)(8)(F)(i));
‘‘(ii) report to the nursing facility the
results of such review; and
‘‘(iii) in the case of an individual with
a conviction for a relevant crime, report
the existence of such conviction of such in-
dividual to the database established under
section 1128E.
‘‘(D) FEES FOR PERFORMANCE OF CRIMI-
NAL BACKGROUND CHECKS.—
‘‘(i) AUTHORITY TO CHARGE FEES.—
‘‘(I) ATTORNEY GENERAL.—The
Attorney General may charge a fee to
any State requesting a search and ex-
change of records pursuant to this
HR 2691 IH
paragraph and subsection (b)(8) for
conducting the search and providing
the records. The amount of such fee
shall not exceed the lesser of the ac-
tual cost of such activities or $50.
Such fees shall be available to the At-
torney General, or, in the Attorney
General’s discretion, to the Federal
Bureau of Investigation, until ex-
pended.
‘‘(II) 
STATE.—A 
State 
may
charge a nursing facility a fee for ini-
tiating the criminal background check
under this paragraph and subsection
(b)(8), including fees charged by the
Attorney General, and for performing
the review and report required by sub-
paragraph (C). The amount of such
fee shall not exceed the actual cost of
such activities.
‘‘(ii) PROHIBITION ON CHARGING AP-
PLICANTS OR EMPLOYEES.—An entity may
not impose on an applicant for employment
or an employee any charges relating to the
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performance of a background check under
this paragraph.
‘‘(E) REGULATIONS.—
‘‘(i) IN GENERAL.—In addition to the
Secretary’s authority to promulgate regula-
tions under this title, the Attorney Gen-
eral, in consultation with the Secretary,
may promulgate such regulations as are
necessary to carry out the Attorney Gen-
eral’s responsibilities under this paragraph
and subsection (b)(8), including regula-
tions regarding the security, confiden-
tiality, accuracy, use, destruction, and dis-
semination of information, audits and rec-
ordkeeping, and the imposition of fees.
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, in consultation with the
Secretary, shall promulgate such regula-
tions as are necessary to establish proce-
dures by which an applicant or employee
may appeal or dispute the accuracy of the
information obtained in a background
check conducted under this paragraph. Ap-
peals shall be limited to instances in which
an applicant or employee is incorrectly
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identified as the subject of the background
check, or when information about the ap-
plicant or employee has not been updated
to reflect changes in the applicant’s or em-
ployee’s criminal record.
‘‘(F) REPORT.—Not later than 2 years
after the date of enactment of this paragraph,
the Attorney General shall submit a report to
Congress on—
‘‘(i) the number of requests for
searches and exchanges of records made
under this section;
‘‘(ii) the disposition of such requests;
and
‘‘(iii) the cost of responding to such
requests.’’.
(2) MEDICARE PROGRAM.—
(A) EXPANSION OF STATE REGISTRY TO
COLLECT INFORMATION ABOUT SKILLED NURS-
ING FACILITY EMPLOYEES OTHER THAN NURSE
AIDES.—Section 1819 of the Social Security
Act (42 U.S.C. 1395i–3) is amended—
(i) in subsection (e)(2)—
(I) in the paragraph heading, by
striking ‘‘NURSE AIDE REGISTRY’’ and
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inserting ‘‘SKILLED
NURSING
CARE
EMPLOYEE REGISTRY’’;
(II) in subparagraph (A)—
(aa) by striking ‘‘By not
later than January 1, 1989, the’’
and inserting ‘‘The’’;
(bb) by striking ‘‘a registry
of all individuals’’ and inserting
‘‘a registry of (I) all individuals’’;
and
(cc) by inserting before the
period ‘‘; and (II) all other
skilled nursing facility employees
with respect to whom the State
has made a finding described in
subparagraph (B)’’;
(III) in subparagraph (B), by
striking ‘‘involving an individual listed
in the registry’’ and inserting ‘‘involv-
ing a skilled nursing facility em-
ployee’’; and
(IV) in subparagraph (C), by
striking ‘‘nurse aide’’ and inserting
‘‘skilled nursing facility employee or
applicant for employment’’; and
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(ii) in subsection (g)(1)—
(I) in subparagraph (C)—
(aa) in the first sentence, by
striking ‘‘nursing aide’’ and in-
serting ‘‘skilled nursing facility
employee’’; and
(bb) in the third sentence,
by striking ‘‘nurse aide’’ each
place it appears and inserting
‘‘skilled 
nursing 
facility 
em-
ployee’’; and
(II) in subparagraph (D), by
striking ‘‘nurse aide’’ each place it ap-
pears and inserting ‘‘skilled nursing
facility employee’’.
(B) FEDERAL AND STATE REQUIREMENT
TO
CONDUCT
BACKGROUND
CHECKS.—Section
1819(e) of the Social Security Act (42 U.S.C.
1395i–3(e)) is amended by adding at the end
the following:
‘‘(6) FEDERAL
AND
STATE
REQUIREMENTS
CONCERNING
CRIMINAL
BACKGROUND
CHECKS
ON
SKILLED NURSING FACILITY EMPLOYEES.—
‘‘(A) IN GENERAL.—Upon receipt of a re-
quest by a skilled nursing facility pursuant to
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subsection (b)(8) that is accompanied by the in-
formation described in subclauses (II) through
(IV) of subsection (b)(8)(A)(ii), a State, after
checking appropriate State records and finding
no disqualifying information (as defined in sub-
section (b)(8)(F)(ii)), shall submit such request
and information to the Attorney General and
shall request the Attorney General to conduct a
search and exchange of records with respect to
the individual as described in subparagraph
(B).
‘‘(B) 
SEARCH
AND
EXCHANGE
OF
RECORDS BY ATTORNEY GENERAL.—Upon re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
formation resulting from the search to the
State.
‘‘(C) STATE REPORTING OF INFORMATION
TO SKILLED NURSING FACILITY.—Upon receipt
of the information provided by the Attorney
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General pursuant to subparagraph (B), the
State shall—
‘‘(i) review the information to deter-
mine whether the individual has any con-
viction for a relevant crime (as defined in
subsection (b)(8)(F)(i));
‘‘(ii) report to the skilled nursing fa-
cility the results of such review; and
‘‘(iii) in the case of an individual with
a conviction for a relevant crime, report
the existence of such conviction of such in-
dividual to the database established under
section 1128E.
‘‘(D) FEES FOR PERFORMANCE OF CRIMI-
NAL BACKGROUND CHECKS.—
‘‘(i) AUTHORITY TO CHARGE FEES.—
‘‘(I) ATTORNEY GENERAL.—The
Attorney General may charge a fee to
any State requesting a search and ex-
change of records pursuant to this
paragraph and subsection (b)(8) for
conducting the search and providing
the records. The amount of such fee
shall not exceed the lesser of the ac-
tual cost of such activities or $50.
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Such fees shall be available to the At-
torney General, or, in the Attorney
General’s discretion, to the Federal
Bureau of Investigation until ex-
pended.
‘‘(II) 
STATE.—A 
State 
may
charge a skilled nursing facility a fee
for initiating the criminal background
check under this paragraph and sub-
section (b)(8), including fees charged
by the Attorney General, and for per-
forming the review and report re-
quired by subparagraph (C). The
amount of such fee shall not exceed
the actual cost of such activities.
‘‘(ii) PROHIBITION ON CHARGING AP-
PLICANTS OR EMPLOYEES.—An entity may
not impose on an applicant for employment
or an employee any charges relating to the
performance of a background check under
this paragraph.
‘‘(E) REGULATIONS.—
‘‘(i) IN GENERAL.—In addition to the
Secretary’s authority to promulgate regula-
tions under this title, the Attorney Gen-
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eral, in consultation with the Secretary,
may promulgate such regulations as are
necessary to carry out the Attorney Gen-
eral’s responsibilities under this paragraph
and subsection (b)(9), including regula-
tions regarding the security confidentiality,
accuracy, use, destruction, and dissemina-
tion of information, audits and record-
keeping, and the imposition of fees.
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, in consultation with the
Secretary, shall promulgate such regula-
tions as are necessary to establish proce-
dures by which an applicant or employee
may appeal or dispute the accuracy of the
information obtained in a background
check conducted under this paragraph. Ap-
peals shall be limited to instances in which
an applicant or employee is incorrectly
identified as the subject of the background
check, or when information about the ap-
plicant or employee has not been updated
to reflect changes in the applicant’s or em-
ployee’s criminal record.
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‘‘(F) REPORT.—Not later than 2 years
after the date of enactment of this paragraph,
the Attorney General shall submit a report to
Congress on—
‘‘(i) the number of requests for
searches and exchanges of records made
under this section;
‘‘(ii) the disposition of such requests;
and
‘‘(iii) the cost of responding to such
requests.’’.
(c) APPLICATION TO OTHER ENTITIES PROVIDING
LONG-TERM CARE SERVICES.—
(1) MEDICAID.—Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a) is amended—
(A) in paragraph (65), by striking the pe-
riod and inserting ‘‘; and’’; and
(B) by inserting after paragraph (65) the
following:
‘‘(66) provide that any entity that is eligible to
be paid under the State plan for providing long-term
care services for which medical assistance is avail-
able under the State plan to individuals requiring
long-term care complies with the requirements of
subsections (b)(8) and (e)(8) of section 1919.’’.
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(2) MEDICARE.—Part D of title XVIII of the
Social Security Act (42 U.S.C. 1395x et seq.) is
amended by adding at the end the following:
‘‘APPLICATION OF SKILLED NURSING FACILITY PREVEN-
TIVE
ABUSE
PROVISIONS
TO
ANY
PROVIDER
OF
SERVICES OR OTHER ENTITY PROVIDING LONG-TERM
CARE SERVICES
‘‘SEC. 1897. The requirements of subsections (b)(8)
and (e)(6) of section 1819 shall apply to any provider of
services or any other entity that is eligible to be paid under
this title for providing long-term care services to an indi-
vidual entitled to benefits under part A or enrolled under
part B (including an individual provided with a
Medicare+Choice plan offered by a Medicare+Choice or-
ganization under part C).’’.
SEC. 304. INCLUSION OF ABUSIVE NURSING FACILITY
WORKERS IN THE DATABASE ESTABLISHED
AS PART OF NATIONAL HEALTH CARE FRAUD
AND ABUSE DATA COLLECTION PROGRAM.
(a) INCLUSION OF ABUSIVE ACTS WITHIN A LONG-
TERM CARE FACILITY.—Section 1128E(g)(1)(A) of the
Social Security Act (42 U.S.C. 1320a–7e(g)(1)(A)) is
amended—
(1) by redesignating clause (v) as clause (vi);
and
(2) by inserting after clause (iv), the following:
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‘‘(v) A finding of abuse, neglect, or
mistreatment of a patient or a resident of
a long-term care facility, or misappropria-
tion of such a patient’s or resident’s prop-
erty.’’.
(b) COVERAGE OF LONG-TERM CARE FACILITY EM-
PLOYEES.—Section 1128E(g)(2) of the Social Security
Act (42 U.S.C. 1320a–7e(g)(2)) is amended by inserting
‘‘, and includes any employee of a long-term care facility
that has direct access to a patient or resident of such a
facility under an employment or other contract with the
facility (including individuals who are licensed or certified
by the State to provide services at the facility, and non-
licensed individuals, as defined by the Secretary, providing
services at the facility, including nurse assistants, nurse
aides, home health aides, and personal care workers and
attendants)’’ before the period.
(c) REPORTING BY LONG-TERM CARE FACILITIES.—
(1) IN GENERAL.—Section 1128E(b)(1) of the
Social Security Act (42 U.S.C. 1320a–7e(b)(1)) is
amended by striking ‘‘and health plan’’ and insert-
ing ‘‘, health plan, and long-term care facility’’.
(2) CORRECTION
OF
INFORMATION.—Section
1128E(c)(2) of the Social Security Act (42 U.S.C.
1320a–7e(c)(2)) is amended by striking ‘‘and health
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plan’’ and inserting ‘‘, health plan, and long-term
care facility’’.
(3) TREATMENT OF FEES FOR PURPOSES OF
COST REPORTS.—Section 1128E(d)(2) of the Social
Security Act (42 U.S.C. 1320a–7e(d)(2)) is amend-
ed by adding at the end the following: ‘‘A long-term
care facility may not include a fee assessed pursuant
to this subsection as an allowable item on a cost re-
port submitted under title XVIII or XIX.’’.
(d) ACCESS TO REPORTED INFORMATION.—Section
1128E(d)(1) of the Social Security Act (42 U.S.C. 1320a–
7e(d)(1)) is amended by striking ‘‘and health plans’’ and
inserting ‘‘, health plans, long-term care facilities, and em-
ployees of long-term care facilities’’.
(e) MANDATORY CHECK OF DATABASE BY LONG-
TERM CARE FACILITIES.—Section 1128E(d) of the Social
Security Act (42 U.S.C. 1320a–7e(d)) is amended by add-
ing at the end the following:
‘‘(3) MANDATORY
CHECK
OF
DATABASE
BY
LONG-TERM CARE FACILITIES.—A long-term care fa-
cility shall check the database maintained under this
section prior to hiring under an employment or other
contract, any individual as an employee of such a fa-
cility who will have direct access to a patient or resi-
dent of the facility (including individuals who are li-
HR 2691 IH
censed or certified by the State to provide services
at the facility, and nonlicensed individuals, as de-
fined by the Secretary, that will provide services at
the facility, including nurse assistants, nurse aides,
home health aides, and personal care workers and
attendants).’’.
(f) DEFINITION OF LONG-TERM CARE FACILITY.—
Section 1128E(g) of the Social Security Act (42 U.S.C.
1320a–7e(g)) is amended by adding at the end the fol-
lowing:
‘‘(6) LONG-TERM
CARE
FACILITY.—The term
‘long-term care facility’ means a skilled nursing fa-
cility (as defined in section 1819(a)), a nursing facil-
ity (as defined in section 1919(a)), or any other fa-
cility that provides long-term care services, including
a home health agency, an assisted living facility, a
residential facility that provides such services, and a
hospice facility.’’.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out the amend-
ments made by this section, $10,200,000 for fiscal year
2000.
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SEC. 305. PREVENTION AND TRAINING DEMONSTRATION
PROJECT.
(a) ESTABLISHMENT.—The Secretary of Health and
Human Services shall establish a demonstration program
to provide grants to develop information on best practices
in patient abuse prevention training (including behavior
training and interventions) for managers and staff of hos-
pital and health care facilities.
(b) ELIGIBILITY.—To be eligible to receive a grant
under subsection (a), an entity shall be a public or private
nonprofit entity and prepare and submit to the Secretary
of Health and Human Services an application at such
time, in such manner, and containing such information as
the Secretary may require.
(c) USE
OF FUNDS.—Amounts received under a
grant under this section shall be used to—
(1) examine ways to improve collaboration be-
tween State health care survey and provider certifi-
cation agencies, long-term care ombudsman pro-
grams, the long-term care industry, and local com-
munity members;
(2) examine patient care issues relating to regu-
latory oversight, community involvement, and facility
staffing and management with a focus on staff
training, staff stress management, and staff super-
vision;
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(3) examine the use of patient abuse prevention
training programs by long-term care entities, includ-
ing the training program developed by the National
Association of Attorneys General, and the extent to
which such programs are used; and
(4) identify and disseminate best practices for
preventing and reducing patient abuse.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated such sums as may be nec-
essary to carry out this section.
SEC. 306. EFFECTIVE DATE.
The provisions of and amendments made by the Act
shall effective on and after the date of enactment of this
Act, without regard to whether implementing regulations
are in effect.
TITLE IV—ACCESS TO LONG-
TERM CARE INSURANCE
Subtitle A—Group Long-Term Care
Insurance
SEC. 401. FEDERAL EMPLOYEES GROUP LONG-TERM CARE
INSURANCE.
(a) IN GENERAL.—Subpart G of part III of title 5,
United States Code, is amended by adding at the end the
following new chapter:
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‘‘CHAPTER 90—LONG-TERM CARE
INSURANCE
‘‘Sec.
‘‘9001. Definitions.
‘‘9002. Contracting authority.
‘‘9003. Minimum standards for contractors.
‘‘9004. Long-term care benefits.
‘‘9005. Financing.
‘‘9006. Preemption.
‘‘9007. Studies, reports, and audits.
‘‘9008. Claims for benefits.
‘‘9009. Jurisdiction of courts.
‘‘9010. Regulations.
‘‘9011. Authorization of appropriations.
‘‘§ 9001. Definitions
‘‘For the purpose of this chapter, the term—
‘‘(1) ‘annuitant’ means an individual referred to
in section 8901(3);
‘‘(2) ‘employee’ means an individual referred to
in subparagraphs (A) through (D), and (F) through
(I) of section 8901(1); but does not include an em-
ployee excluded by regulation of the Office under
section 9011;
‘‘(3) ‘Office’ means the Office of personnel
Management;
‘‘(4) ‘other eligible individual’ means the
spouse, former spouse, parent or parent-in-law of an
employee or annuitant, or other individual specified
by the Office;
‘‘(5) ‘qualified carrier’ means an insurer li-
censed to do business in each of the States and
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meeting the requirements of a qualified insurer in
each of the of the States;
‘‘(6) ‘qualified contract’ means a contract meet-
ing the conditions prescribed in section 9002; and
‘‘(7) ‘State’ means a State or territory or pos-
session of the United States, and includes the Dis-
trict of Columbia.
‘‘§ 9002. Contracting authority
‘‘(a) The Office may, without regard to section 3709
of the Revised Statutes (41 U.S.C. 5) or any other statute
requiring competitive bidding, purchase from 1 or more
qualified carriers a policy or policies of group long-term
care insurance to provide benefits as specified by this
chapter. The Office shall ensure that each resulting con-
tract is awarded on the basis of contractor qualifications,
price, and reasonable competition to the maximum extent
practicable.
‘‘(b) The Office may design a benefits package or
packages and negotiate final offerings with qualified car-
riers.
‘‘(c) Each contract shall be for a uniform term of 5
years, unless terminated earlier by the Office.
‘‘(d) Premium rates charged under a contract entered
into under this section shall reasonably reflect the cost of
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the benefits provided under that contract as determined
by the Office.
‘‘(e) The coverage and benefits made available to in-
dividuals under a contract entered into under this section
are guaranteed to be renewable and may not be canceled
by the carrier except for nonpayment of premium.
‘‘(f) The Office may withdraw an offering under this
section based on open season participation rates, the com-
position of the risk pool, or both.
‘‘§ 9003. Minimum standards for contractors
‘‘At the minimum, to be a qualified carrier under this
chapter, a company shall—
‘‘(1) be licensed as an insurance company and
approved to issue group long-term care insurance in
all States and to do business in each of the States;
and
‘‘(2) be in compliance with the requirements im-
posed on issuers of qualified long-term care con-
tracts by section 4980C of the Internal Revenue
Code of 1986.
‘‘§ 9004. Long-term care benefits
‘‘The benefits provided under this chapter shall be
long-term care benefits which, at a minimum, shall be
compliant with the most recent standards recommended
by the National Association of Insurance Commissioners.
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‘‘§ 9005. Financing
(a) The amount necessary to pay the premium for
enrollment of an enrolled employee shall be withheld from
the pay of each enrolled employee.
‘‘(b) Except as provided under subsection (d), the
amount necessary to pay the premium for enrollment of
an enrolled of an enrolled annuitant shall be withheld from
the annuity of each enrolled annuitant.
‘‘(c) The amount necessary to pay the premium for
enrollment of a spouse may be withheld from pay or annu-
ity, as appropriate.
‘‘(d) An employee, annuitant, or other eligible indi-
vidual, whose pay or annuity is insufficient to cover the
withholding required for enrollment, shall, at the discre-
tion of the withholding required for enrollment, shall, at
the discretion of the Office, pay the premium for enroll-
ment directly to the carrier.
‘‘(e) Each carrier participating in the program estab-
lished under chapter shall maintain the funds related to
this program separate and apart from funds related to
other contracts and other lines of business.
‘‘(f) The costs of the Office in adjudicating a claims
dispute under section 9008, including costs related to an
inquiry not culminating a dispute, shall be reimbursed by
the carrier involved in the dispute or inquiry. Such funds
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shall be available to the Office for the administration of
this chapter.
‘‘§ 9006. Preemption
‘‘This chapter shall supersede and preempt any State
or local law which is determined by the Office to be incon-
sistent with—
‘‘(1) the provisions of this chapter; or
‘‘(2) after consultation with the National Asso-
ciation of Insurance Commissioners, the efficient
provision of a nationwide long-term care insurance
program for Federal employees.
‘‘§ 9007. Studies, reports, and audits
‘‘(a) Each qualified carrier entering into a contract
under this chapter shall—
‘‘(1) furnish such reasonable reports as the Of-
fice determines to be necessary to enable the carrier
to carry out the functions under this chapter; and
‘‘(2) permit the Office and representatives of
the General Accounting Office to examine such
records of the carrier as may be necessary to carry
out the purposes of this chapter.
‘‘(b) Each Federal agency shall keep such records,
make such certifications, and furnish the Office, the car-
rier, or both, with such information and reports as the
Office may require.
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‘‘§ 9008. Claims for benefits.
‘‘(a) A claim for benefits under this chapter shall be
filed within 4 years after the date on which the reimburs-
able costs was incurred or the service was provided.
‘‘(b) The Office shall adjudicate a claims dispute aris-
ing under this chapter and shall require the contractor to
pay for any benefit or provide any service the Office deter-
mines appropriate under the applicable contract.
‘‘(c)(1) Except as provided under paragraph (2), ben-
efits payable under this chapter for any reimbursable cost
incurred or service provided are secondary to any other
benefit payable for such cost or service. No payment may
be made where there is no legal obligation for such pay-
ment.
‘‘(2)(A) Benefits payable under the programs de-
scribed under subparagraph (B) shall be secondary to ben-
efits payable under this chapter.
‘‘(B) The programs referred to under subparagraph
(A) are—
‘‘(i) the program of medical assistance under
title XIX of the Social Security Act (42 U.S.C.
1396); and
‘‘(ii) any other Federal or State programs that
the Office may specify in regulations that provide
health benefit coverage designed to be secondary to
other insurance coverage.
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‘‘§ 9009. Jurisdiction of courts
‘‘A claimant under this chapter may file suit against
the carrier of the long-term care insurance policy covering
such claimant in the district courts of the United States,
after exhausting all available administrative remedies.
‘‘§ 9010. Regulations
‘‘(a) The office shall prescribe regulations necessary
to carry out this chapter.
‘‘(b) The regulations of the Office may prescribe the
time at which and the conditions under which an eligible
individual may enroll in the program established under
this chapter.
‘‘(c) The Office may not exclude—
‘‘(1) an employee or group of employees solely
on the basis of the hazardous nature of employment;
or
‘‘(2) an employee who is occupying a position
on a part-time career employment basis, as defined
in section 3401(2).
‘‘(d) The regulations of the Office shall provide for
the beginning and ending dates of coverage of employees,
annuitants, former spouses, and other eligible individuals
under this chapter, and any requirements for continuation
or conversion of coverage.
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‘‘§ 9011. Authorization of appropriations
‘‘There are authorized to be appropriated such sums
as may be necessary for the purposes of carrying out sec-
tions 9002 and 9010.’’.
‘‘(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect on the date of enactment
of this Act, except that no coverage may be effective until
the first day of the first applicable pay period in October,
which occurs more than 1 year after the date of enactment
of this Act.
SEC. 402. MAKING AVAILABLE GROUP LONG-TERM CARE IN-
SURANCE TO OTHERS.
(a) PRESIDENTIAL PLAN.—
(1) SUBMISSION.—Not later than 2 years after
the date of the enactment of this Act, the President
shall submit to Congress a plan under which employ-
ees who are not entitled to purchase long-term care
benefits insurance under chapter 90 of title 5,
United States Code, as added by section 401(a) may
purchase insurance of the type offered under such
chapter to Federal employees.
(2) ADMINISTRATION.—Under the plan sub-
mitted under paragraph (1), the President shall des-
ignate an agency or entity that would be responsible
for the administration of the plan.
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(3) FINANCIAL SELF-SUFFICIENCY.—The plan
submitted shall assure that costs of the program
under chapter 90 of title 5, United States Code, are
not affected by the implementation of the plan.
(b) IMPLEMENTATION.—The plan submitted under
subsection (a) shall go into effect on the first January 1
following 3 years after the date of the enactment of this
Act, unless the Congress provides otherwise.
Subtitle B—Extension of Consumer
Protection 
Standards 
to 
All
Long-Term Care Insurance Poli-
cies
SEC. 411. EXTENSION OF CONSUMER PROTECTION STAND-
ARDS TO ALL LONG-TERM CARE INSURANCE
POLICIES.
(a) IN GENERAL.—Any issuer of a long-term care in-
surance contract (other than a qualified long-term care in-
surance contract) that fails to comply with the require-
ments of subsections (c) and (d) of section 4980C of the
Internal Revenue Code of 1986 (insofar as they would
apply to a qualified long-term care insurance contract),
as adjusted to conform with the most recent version avail-
able of the long-term care insurance model regulation and
the long-term care insurance model Act promulgated by
the National Association of Insurance Commissioners, is
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subject to a civil monetary penalty of $100 per insured
for each day of any such failure. Nothing in this section,
shall preclude a State from requiring additional consumer
protections in any long-term care insurance contract.
(b) COLLECTION.—The provisions of section 1128A
of the Social Security Act (other than subsections (a) and
(b)) shall apply to civil money penalties under this section
in the same manner as they apply to a penalty or pro-
ceeding under section 1128A(a) of such Act.
(c) DEFINITIONS.—For purposes of this section, the
term ‘‘qualified long-term care insurance contract’’ has
the meaning given such term in 7702B of the Internal
Revenue Code of 1986.
(d) EFFECTIVE DATE.—The requirement of sub-
section (a) shall apply to actions taken after December
31, 1999.
TITLE 
V—ADDITION 
OF 
NA-
TIONAL FAMILY CAREGIVER
PROGRAM 
TO 
THE 
OLDER
AMERICANS ACT OF 1965
SEC. 501. NATIONAL FAMILY CAREGIVER SUPPORT PRO-
GRAM.
(a) ESTABLISHMENT OF PROGRAM.—Part D of title
III of the Older Americans Act of 1965 (42 U.S.C. 3030h
et seq.) is amended to read as follows:
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‘‘PART D—NATIONAL FAMILY CAREGIVER
SUPPORT PROGRAM
‘‘Subpart 1—State Grant Program
‘‘SEC. 341. PROGRAM AUTHORIZED.
‘‘(a)(1) IN GENERAL.—The Assistant Secretary shall
carry out a program under this subpart for making grants
to States under State plans approved under section 307
for multi-faceted systems of support for families and other
informal providers of in-home and community care to
older individuals.
‘‘(2) AUTHORIZATION.—There are authorized to be
appropriated $125,000,000 for fiscal year 2000, and such
sums as may be necessary for each of the fiscal years 2001
through 2004, to carry out the programs under this part.
‘‘(b) COORDINATION WITH SERVICE PROVIDERS.—
In carrying out this subpart, each area agency on aging
shall coordinate with other community agencies and vol-
untary organizations providing the types of services for
which funding is available under this subpart.
‘‘(c) FAMILY CAREGIVER SUPPORT SERVICES.—The
services to be provided through a State program under
this subpart shall include—
‘‘(1) the provision of information to caregivers
about available services;
‘‘(2) assistance to caregivers in gaining access
to such services;
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‘‘(3) individual counseling, the organization of
support groups, and the provision of caregiver train-
ing to help families make decisions and solve prob-
lems relating to their caregiving roles;
‘‘(4) respite care to enable families and other
informal caregivers to be temporarily relieved from
their caregiving responsibilities; and
‘‘(5) the provision of supplemental services, on
a limited basis, to complement the care provided by
families and other informal caregivers.
‘‘(d) ELIGIBILITY.—In order for a caregiver or care-
givers of an older individual to be eligible to receive serv-
ices provided by a State program under this subpart, the
State must—
‘‘(1) determine that the older individual meets
the condition specified in either subparagraph (A)(i)
or (B) of section 102(28); and
‘‘(2) give priority for services to older individ-
uals and families with the greatest social and eco-
nomic need, consistent with the requirements of sec-
tion 305(a)(2)(E).
‘‘(e) REQUIREMENTS FOR QUALITY STANDARDS AND
ACCOUNTABILITY.—A State receiving assistance under
this subpart shall comply with the following:
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‘‘(1) QUALITY STANDARDS.—A State shall have
in place mechanisms designed to ensure the quality
of services provided with assistance under this sub-
part.
‘‘(2) DATA AND RECORDS.—A State shall col-
lect data and furnish records at the times and in the
standardized format that the Assistant Secretary
may require in order to enable the Assistant Sec-
retary to monitor State program administration and
compliance, and to evaluate and compare the effec-
tiveness of State programs under this subpart.
‘‘(3) REPORTING.—A State shall report to the
Assistant Secretary on the data and information re-
quired under paragraph (2), including the services
and activities funded under this subpart, and stand-
ards and methods by which the quality of services
shall be assured.
‘‘(f) AVAILABILITY OF FUNDS.—
‘‘(1) IN
GENERAL.—The program under this
subpart shall be carried out in each fiscal year using
the balance of funds appropriated under section
341(a) for such fiscal year and remaining after the
reservation of funds under sections 345 and 346 for
carrying out subpart 2.
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‘‘(2) USE OF FUNDS FOR ADMINISTRATION OF
AREA PLANS.—Amounts made available to a State
under this subpart may be used, in addition to
amounts available in accordance with section
303(c)(1), for the costs of the administration of area
plans.
‘‘(3) FEDERAL SHARE.—
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 304(d)(1)(D), amounts made available to a
State under this subpart shall be available to
pay not more than 75 percent of the costs of
services provided under this subpart.
‘‘(B) LIMITATION.—Federal funds and
cost sharing by recipients of services provided
under this subpart cannot be used or the non-
federal share of funds under this subpart.
‘‘SEC. 342. MAINTENANCE OF EFFORT.
‘‘Funds made available under this subpart shall be
in addition to, and may not be used to supplant, any funds
that are or would otherwise be expended under any Fed-
eral, State, or local law by a State or unit of general pur-
pose local government (including area agencies on aging)
which have in their planning and service areas existing
services equivalent to the services which may be funded
under this subpart.
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‘‘Subpart 2—National Innovation Programs
‘‘SEC. 345. INNOVATION GRANT PROGRAM.
‘‘(a) IN GENERAL.—The Assistant Secretary shall
carry out a program for making grants on a competitive
basis to foster the development and testing of new ap-
proaches to sustaining the efforts of families and other
informal caregivers of older individuals, and to serving
particular groups of caregivers of older individuals, includ-
ing minority caregivers and distant caregivers.
‘‘(b) EVALUATION
AND DISSEMINATION
OF RE-
SULTS.—The Assistant Secretary shall provide for the
evaluation of the effectiveness of programs and activities
funded with grants under this subpart, and for the dis-
semination to States of descriptions and evaluations of
such programs and activities, to enable States to incor-
porate successful approaches into their program under
this part.
‘‘(c) AVAILABILITY OF FUNDS.—
‘‘(1) IN
GENERAL.—The Assistant Secretary
shall reserve up to 10 percent of the amount appro-
priated for each fiscal year under section 341(a) to
carry out the program under this section.
‘‘(2) NATIVE
AMERICAN
PROGRAMS.—20 per-
cent of the amounts reserved for each fiscal year
under paragraph (1) shall be made available for pro-
grams and activities for Native Americans.
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‘‘SEC. 346. ACTIVITIES OF NATIONAL SIGNIFICANCE.
‘‘(a) IN GENERAL.—The Assistant Secretary shall,
directly or by grant or contract, carry out activities of na-
tional significance to promote quality and continuous im-
provements in the support provided to family and other
informal caregivers of older individuals through program
evaluation, training, technical assistance and research.
‘‘(b) AVAILABILITY OF FUNDS.—The Assistant Sec-
retary shall reserve up to 2 percent of the amount appro-
priated for each fiscal year under section 341(a) to carry
out the program under this section.’’.
SEC. 502. ALLOTMENTS.
Section 304(a)(1) of the Older Americans Act of
1965 (42 U.S.C. 3024(a)(1)) is amended in the first sen-
tence by inserting ‘‘remaining after reservations of funds
in accordance with sections 345 and 346’’ after ‘‘from the
sums appropriated under section 341(a) for each fiscal
year’’.
SEC. 503. AVAILABILITY OF TITLE III–D FUNDS FOR REAL-
LOTMENT.
Section 304(b) of the Older Americans Act of 1965
(42 U.S.C. 3024(b)) is amended in the first sentence by
striking ‘‘part B or C’’ and inserting ‘‘part B, C, or D’’.
SEC. 504. CONFORMING AMENDMENTS.
(a) RELOCATION OF PROVISIONS CONCERNING IN-
HOME SERVICES FOR FRAIL OLDER INDIVIDUALS.—Sec-
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tion 321(a)(5) of the Older Americans Act of 1965 (42
U.S.C. 3030d(a)(5)) is amended by striking ‘‘including’’
and all that follows and inserting ‘‘including—
‘‘(A) client assessment, case management,
and development and coordination of commu-
nity services;
‘‘(B) in-home services for frail older indi-
viduals (including supportive services for vic-
tims of Alzheimer’s disease and related dis-
orders with neurological and organic brain dys-
function, and for the families of such individ-
uals);
‘‘(C) supportive activities to meet the spe-
cial needs of caregivers, including caretakers
who provide in-home services to frail older indi-
viduals;
‘‘(D) in-home and other community serv-
ices, including home health, homemaker, shop-
ping, escort, reader, and letter writing services,
to assist older individuals to live independently
in a home environment;’’.
SEC. 505. EFFECTIVE DATE.
The amendments made by this title shall take effect
on October 1, 1999.
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TITLE VI—MEDICARE FOR
CAREGIVERS
Subtitle A—Access to Medicare
Benefits for Caregivers
SEC. 601. ACCESS TO MEDICARE BENEFITS FOR CARE-
GIVERS.
‘‘(a) IN GENERAL.—Title XVIII of the Social Secu-
rity Act is amended—
(1) by redesignating section 1859 and part D
as section 1858 and part E, respectively; and
(2) by inserting after such section the following
new part:
‘‘Part D—Medicare Benefits for Caregivers
‘‘SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY.
‘‘(a) ENTITLEMENT TO MEDICARE BENEFITS FOR
ENROLLED INDIVIDUALS.—
‘‘(1) IN
GENERAL.—An individual enrolled
under this part is entitled to the same benefits
under this title as an individual entitled to benefits
under part A and enrolled under part B.
‘‘(2) DEFINITIONS.—For purposes of this part:
‘‘(A) FEDERAL OR STATE COBRA CONTINU-
ATION PROVISION.—The term ‘Federal or State
COBRA continuation provision’ has the mean-
ing given the term ‘COBRA continuation provi-
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sion’ in section 2791(d)(4) of the Public Health
Service Act and includes a comparable State
program, as determined by the Secretary.
‘‘(B) FEDERAL HEALTH INSURANCE PRO-
GRAM DEFINED.—The term ‘Federal health in-
surance program’ means any of the following:
‘‘(i) MEDICARE.—Part A or part B of
this title (other than by reason of this
part).
‘‘(ii) MEDICAID.—A State plan under
title XIX.
‘‘(iii) FEHBP.—The Federal employ-
ees health benefit program under chapter
89 of title 5, United States Code.
‘‘(iv) 
TRICARE.—The 
TRICARE
program (as defined in section 1072(7) of
title 10, United States Code).
‘‘(v) ACTIVE DUTY MILITARY.—Health
benefits under title 10, United States
Code, to an individual as a member of the
uniformed services of the United States.
‘‘(C) GROUP
HEALTH
PLAN.—The term
‘group health plan’ has the meaning given such
term in section 2791(a)(1) of the Public Health
Service Act.
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‘‘(b) ELIGIBILITY OF CAREGIVERS.—An individual
who meets the following requirements with respect to a
month is eligible to enroll under this part with respect to
such month:
‘‘(1) ELIGIBLE FOR CAREGIVER TAX CREDIT.—
The individual is eligible for a caregiver tax credit
under section 35 of the Internal Revenue Code of
1986 by virtue of providing care to a medicare eligi-
ble individual.
‘‘(2) CAREGIVING
PRECLUDING
EMPLOYER-
BASED HEALTH INSURANCE COVERAGE.—The Sec-
retary determines that the caregiving provided by
the individual to the medicare-eligible individual rea-
sonably precludes employment and the obtaining of
employer-provided health insurance and in the ab-
sence of such caregiving there is a likelihood that
there would be an increase in costs under this title,
title XIX, or other public health care programs.
‘‘(3) NOT
ELIGIBLE
FOR
COVERAGE
UNDER
GROUP HEALTH PLANS OR FEDERAL HEALTH INSUR-
ANCE PROGRAMS.—The individual is not eligible for
benefits or coverage under a Federal health insur-
ance program (as defined in subsection (a)(2)(B)) or
under a group health plan (other than such eligi-
bility merely through a Federal or State COBRA
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continuation provision) as of the last day of the
month involved.
‘‘SEC. 1859A. ENROLLMENT PROCESS; COVERAGE.
‘‘(a) IN GENERAL.—An individual may enroll in the
program established under this part only in such manner
and form as may be prescribed by regulations.
‘‘(b) DATE COVERAGE BEGINS.—
‘‘(1) IN GENERAL.—The period during which
an individual is entitled to benefits under this part
shall begin on the first day of the first month that
begins after the date the individual first satisfies eli-
gibility for enrollment under section 1859, but in no
case earlier than July 1, 2001.
‘‘(2) AUTHORITY
TO
PROVIDE
FOR
PARTIAL
MONTHS
OF
COVERAGE.—Under regulations, the
Secretary may, in the Secretary’s discretion, provide
for coverage periods that include portions of a
month in order to avoid lapses of coverage.
‘‘(3) LIMITATION ON PAYMENTS.—No payments
may be made under this title with respect to the ex-
penses of an individual enrolled under this part un-
less such expenses were incurred by such individual
during a period which, with respect to the individual,
is a coverage period under this section.
‘‘(d) TERMINATION OF COVERAGE.—
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‘‘(1) IN
GENERAL.—An individual’s coverage
period under this part shall continue until the indi-
vidual’s enrollment has been terminated at the ear-
liest of the following:
‘‘(A) NOTICE.—The individual files notice
(in a form and manner prescribed by the Sec-
retary) that the individual no longer wishes to
participate in the insurance program under this
part.
‘‘(B) LOSS
OF
ELIGIBILITY.—The indi-
vidual no longer meets the conditions described
in section 1859(b)(1).
‘‘(C) MEDICARE
ELIGIBILITY.—The indi-
vidual becomes entitled to benefits under part A
or enrolled under part B (other than by reason
of this part).
‘‘(2) EFFECTIVE DATE OF TERMINATION.—
‘‘(A) NOTICE.—The termination of a cov-
erage period under paragraph (1)(A) shall take
effect at the close of the month following for
which the notice is filed.
‘‘(B) LOSS OF ELIGIBILITY.—The termi-
nation of a coverage period under paragraph
(1)(B) shall take effect at the close of the
month following the month in which the Sec-
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retary determines that the individual no longer
meets the conditions referred to in such para-
graph.
‘‘(C) MEDICARE ELIGIBILITY.—The termi-
nation of a coverage period under paragraph
(1)(C) shall take effect as of the first day of the
month in which the individual attains 65 years
of age or becomes entitled to benefits under
part A or enrolled for benefits under part B
(other than by reason of this part).
‘‘SEC. 1859B. MEDICARE CAREGIVER TRUST FUND.
‘‘(a) ESTABLISHMENT OF TRUST FUND.—
‘‘(1) IN GENERAL.—There is hereby created on
the books of the Treasury of the United States a
trust fund to be known as the ‘Medicare Caregiver
Trust Fund’ (in this section referred to as the
‘Trust Fund’). The Trust Fund shall consist of such
gifts and bequests as may be made as provided in
section 201(i)(1) and such amounts as may be de-
posited in, or appropriated to, such fund as provided
in this title.
‘‘(2) TRANSFER OF SAVINGS FROM NEW FRAUD
AND ABUSE INITIATIVES.—
‘‘(A) IN GENERAL.—There is hereby trans-
ferred to the Trust Fund from the Federal
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Hospital Insurance Trust Fund and from the
Federal 
Supplementary 
Medical 
Insurance
Trust Fund amounts equivalent to the amounts
(specified under subparagraph (B)) of the re-
ductions in expenditures under such respective
trust fund as may be attributable to the enact-
ment of the Medicare Fraud and Overpayment
Act of 1999.
‘‘(B) USE OF CBO ESTIMATES.—For each
fiscal year during the 10-fiscal-year period be-
ginning with fiscal year 2000, the amounts
under subparagraph (A) shall be the amounts
described in such subparagraph as determined
by the Congressional Budget Office at the time
of, and in connection with the enactment of the
Omnibus Long-Term Care Improvement Act of
1999. For subsequent fiscal years, the amounts
under subparagraph (A) shall be the amount
determined under this subparagraph for the
previous fiscal year increased by the same per-
centage as the percentage increase in aggregate
expenditures under this title from the second
previous fiscal year to the previous fiscal year.
‘‘(b) INCORPORATION OF PROVISIONS.—
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‘‘(1) IN GENERAL.—Subject to paragraph (2),
subsections (b) through (i) of section 1841 shall
apply with respect to the Trust Fund and this title
in the same manner as they apply with respect to
the Federal Supplementary Medical Insurance Trust
Fund and part B, respectively.
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1841 under paragraph
(1)—
‘‘(A) any reference in such section to ‘this
part’ is construed to refer to this part D;
‘‘(B) any reference in section 1841(h) to
section 1840(d) and in section 1841(i) to sec-
tions 1840(b)(1) and 1842(g) are deemed ref-
erences to comparable authority exercised under
this part; and
‘‘(C) payments may be made under section
1841(g) to the Trust Funds under sections
1817 and 1841 as reimbursement to such funds
for payments they made for benefits provided
under this part.
‘‘SEC. 1859C. OVERSIGHT AND ACCOUNTABILITY.
‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—
The Board of Trustees of the Medicare Caregiver Trust
Fund under section 1859B(b)(1) shall report on an an-
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nual basis to Congress concerning the status of the Trust
Fund and the need for adjustments in the program under
this part to maintain financial solvency of the program
under this part.
‘‘(b) PERIODIC GAO REPORTS.—The Comptroller
General of the United States shall periodically submit to
Congress reports on the adequacy of the financing of cov-
erage provided under this part. The Comptroller General
shall include in such report such recommendations for ad-
justments in such financing and coverage as the comp-
troller general deems appropriate in order to maintain fi-
nancial solvency of the program under this part.
‘‘SEC. 1859D. ADMINISTRATION AND MISCELLANEOUS.
‘‘(a) TREATMENT FOR PURPOSES OF TITLE.—Ex-
cept as otherwise provided in this part—
‘‘(1) individuals enrolled under this part shall
be treated for purposes of this title as though the in-
dividual were entitled to benefits under part A and
enrolled under part B; and
‘‘(2) benefits described in section 1859 shall be
payable under this title to such individuals in the
same manner as if such individuals were so entitled
and enrolled.
‘‘(b) NOT TREATED AS MEDICARE PROGRAM FOR
PURPOSES OF MEDICAID PROGRAM.—For purposes of ap-
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plying title XIX (including the provision of medicare cost-
sharing assistance under such title), an individual who is
enrolled under this part shall not be treated as being enti-
tled to benefits under this title.
‘‘(c) NOT TREATED AS MEDICARE PROGRAM FOR
PURPOSES OF COBRA CONTINUATION PROVISIONS.—In
applying a COBRA continuation provision (as defined in
section 2791(d)(4) of the Public Health Service Act), any
reference to an entitlement to benefits under this title
shall not be construed to include entitlement to benefits
under this title pursuant to the operation of this part.’’.
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.—
(1) Section 201(i)(1) of the Social Security Act
(42 U.S.C. 401(i)(1)) is amended by striking ‘‘or the
Federal Supplementary Medical Insurance Trust
Fund’’ and inserting ‘‘the Federal Supplementary
Medical Insurance Trust Fund, and the Medicare
Caregiver Trust Fund’’.
(2) Section 201(g)(1)(A) of such Act (42
U.S.C. 401(g)(1)(A)) is amended by striking ‘‘ and
the Federal Supplementary Medical Insurance Trust
Fund established by title XVIII’’ and inserting ‘‘,
the Federal Supplementary Medical Insurance Trust
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Fund, and the Medicare Caregiver Trust Fund es-
tablished by title XVIII’’.
(3) Section 1820(i) of such Act (42 U.S.C.
1395i–4(i)) is amended by striking ‘‘part D’’ and in-
serting ‘‘part E’’.
(4) Part C of title XVIII of such Act is
amended—
(A) in section 1851(a)(2)(B) (42 U.S.C.
1395w–21(a)(2)(B)), by striking ‘‘ 1859(b)(3)’’
and inserting ‘‘1858(b)(3);
(B) in section 1851(a)(2)(C) (42 U.S.C.
1395w–21(a)(2)(C)), by striking ‘‘1859(b)(2)’’
and inserting ‘‘1858(b)(2)’’;
(C) in section 1852(a)(1) (42 U.S.C.
1395w–22(a)(1)), by striking ‘‘ 1859(b)(3)’’
and inserting ‘‘1858(b)(3)’’;
(D) 
in 
section 
1852(a)(3)(B)(ii) 
(42
U.S.C. 1395w–22(a)(3)(B)(ii)), by striking
‘‘1859(b)(2)(B)’’ 
and 
inserting
‘‘1858(b)(2)(B)’’;
(E) in section 1853(a)(1)(A) (42 U.S.C.
1395w–23(a)(1)(A)), by striking ‘‘1859(e)(4)’’
and inserting ‘‘1858(e)(4)’’; and
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(F) in section 1853(a)(3)(D) (42 U.S.C.
1395w–23(a)(3)(D)), by striking ‘‘1859(e)(4)’’
and inserting ‘‘1858(e)(4)’’.
(5) Section 1853(c) of such Act (42 U.S.C.
1395w–23(c)) is amended—
(A) in paragraph (1), by striking ‘‘or (7)’’
and inserting ‘‘, (7), or (8)’’, and
(B) by adding at the end the following:
‘‘(8) ADJUSTMENT FOR CAREGIVER.—In apply-
ing this subsection with respect to individuals enti-
tled to benefits under part D, the Secretary shall
provide for an appropriate adjustment in the
Medicare+Choice capitation rate as may be appro-
priate to reflect differences between the population
served under such part and the population under
parts A and B.’’.
(c) OTHER CONFORMING AMENDMENTS.—
(1) Section 138(b)(4) of the Internal Revenue
Code of 1986 is amended by striking ‘‘1859(b)(3)’’
and inserting ‘‘1858(b)(3)’’.
(2)(A) Section 602(2)(D)(ii) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1162(2)) is amended by inserting ‘‘(not including an
individual who is so entitled pursuant to enrollment
under section 1859A)’’ after ‘‘Social Security Act’’.
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(B) Section 2202(2)(D)(ii) of the Public Health
Service Act (42 U.S.C. 300bb–2(2)(D)(ii) is amend-
ed by inserting ‘‘(not including an individual who is
so entitled pursuant to enrollment under section
1859A)’’ after ‘‘Social Security Act’’.
(C) Section 4980B(f)(2)(B)(i)(V) of the Inter-
nal Revenue Code of 1986 is amended by inserting
‘‘(not including an individual who is so entitled pur-
suant to enrollment under section 1859A)’’ after
‘‘Social Security Act’’.
Subtitle B—COBRA Protection for
Caregivers
CHAPTER 1—AMENDMENTS TO THE EM-
PLOYEE RETIREMENT INCOME SECU-
RITY ACT OF 1974
SEC. 611. COBRA CONTINUATION BENEFITS FOR CERTAIN
CAREGIVERS WHO LOST HEALTH COVERAGE.
(a) 
ESTABLISHMENT
OF
NEW
QUALIFYING
EVENT.—
(1) IN GENERAL.—Section 603 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1163) is amended by inserting after paragraph (6)
the following new paragraph:
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‘‘(7) The termination of group health plan cov-
erage as a result of the covered employee becoming
a qualified caregiver.’’.
(2) QUALIFIED CAREGIVER DEFINED.—Section
607 of such Act (29 U.S.C. 1167) is amended—
(A) in paragraph (3)—
(i) in subparagraph (A), by inserting
‘‘except as otherwise provided in this para-
graph,’’ after ‘‘means,’’; and
(ii) by adding at the end the following
new subparagraph:
‘‘(D) SPECIAL
RULE
FOR
QUALIFYING
CAREGIVERS.—In the case of a qualifying event
described in section 603(7), the term ‘qualified
beneficiary’ means a qualified caregiver and any
other individual who, on the day before such
qualifying event, is a beneficiary under the plan
on the basis of the individual’s relationship to
such qualified caregiver.’’; and
(B) by adding at the end the following new
paragraph:
‘‘(6) QUALIFIED CAREGIVER.—The term ‘quali-
fied caregiver’ means with respect to a qualifying
event describe in section 603(7), an individual who
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becomes eligible for a caregiver tax credit under sec-
tion 35 of the Internal Revenue Code of 1986.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall apply to qualifying events occurring on
or after January 1, 2001. In the case of a qualifying event
occurring on or after such date and before the date of
the enactment of this Act, such event shall be deemed (for
purposes of such amendments) to have occurred on the
date of the enactment of this Act.
CHAPTER 2—AMENDMENTS TO THE
PUBLIC HEALTH SERVICE ACT
SEC. 612. COBRA CONTINUATION BENEFITS FOR CERTAIN
CAREGIVERS.
(a) 
ESTABLISHMENT
OF
NEW
QUALIFYING
EVENT.—
(1) IN GENERAL.—Section 2203 of the Public
Health Service Act (42 U.S.C. 300bb–3) is amended
by inserting after paragraph (5) the following new
paragraph:
‘‘(6) The termination of group health plan cov-
erage as a result of a covered employee becoming a
qualified caregiver.’’.
(2) QUALIFIED CAREGIVER DEFINED.—Section
2208 of such Act (42 U.S.C. 300bb–8) is
amended—
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‘‘(ii) in the case of an individual who was not
a citizen of the United States throughout the quali-
fying period, has resided in the United States (as
defined in subsection 210(i)) continuously during the
5 years immediately preceding the qualifying period.
‘‘(2) For purposes of paragraph (1)(A), the term
‘United States’ means the 50 States and the District of
Columbia.
‘‘Identification Requirements
‘‘(c) An individual shall not be treated as an eligible
caregiver for purposes of subsection (b) unless such indi-
vidual provides the Secretary with the name and taxpayer
identification number of the applicable individual with re-
spect to whom the individual is an eligible caregiver, and
the identification number of the physician certifying such
individual, on whatever application may be required to ob-
tain benefits under this section.
‘‘Treatment of Multiple Eligible Caregivers
‘‘(d) If more than 1 individual is an eligible caregiver
with respect to the same applicable individual for a period,
the Secretary shall apply rules similar to the rules de-
scribed in section 35(c)(2)(C)(i) of the Internal Revenue
Code of 1986.
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‘‘Annual Reimbursement of Federal Old-Age and
Survivors Insurance Trust Fund
‘‘(e) There are authorized to be appropriated to the
Federal Old-Age and Survivors Insurance Trust Fund for
the fiscal year ending September 30, 2002, and for each
fiscal year thereafter, such sums as the Commissioner of
Social Security deems necessary on account of—
‘‘(1) payments made under this section during
the second preceding fiscal year and all fiscal years
prior thereto to individuals entitled to benefits under
this section,
‘‘(2) the additional administrative expenses re-
sulting from the payments described in paragraph
(1), and
‘‘(3) any loss in interest to such Trust Fund re-
sulting from such payments and expenses,
in order to place such Trust Fund in the same position
at the end of such fiscal year as it would have been in
if such payments had not been made.’’.
Æ