[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3585 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3585

To amend title XVIII of the Social Security Act to provide for coverage 
of respite care services under part B of the Medicare program, to amend 
  the Internal Revenue Code of 1986 to treat qualified long-term care 
           services as medical care, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 5, 1996

Mrs. Lowey (for herself and Mr. Gilman) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
     to the Committee on Commerce, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
of respite care services under part B of the Medicare program, to amend 
  the Internal Revenue Code of 1986 to treat qualified long-term care 
           services as medical care, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Family Caregiver Support and 
Protection Act of 1996''.

SEC. 2. COVERAGE OF RESPITE CARE SERVICES UNDER MEDICARE.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (N);
            (2) by striking ``and'' at the end of subparagraph (O); and
            (3) by inserting after subparagraph (O) the following new 
        subparagraph:
            ``(P) respite care services (as defined in subsection 
        (oo)); and''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

                        ``Respite Care Services

    ``(oo)(1)(A) Subject to subparagraph (C), the term `respite care 
services' means any of the services described in subparagraph (B) which 
are furnished to an eligible individual (as described in paragraph (2)) 
for the support of a caregiver described in paragraph (2) at the 
individual's home or in the community on a short-term, intermittent, or 
emergency basis by an individual or entity who meets such standards as 
the Secretary may establish.
    ``(B) The services described in this subparagraph are as follows:
            ``(i) Companion services.
            ``(ii) Homemaker services.
            ``(iii) Personal assistance.
            ``(iv) Community day services.
            ``(v) Temporary care in an accredited or licensed 
        residential facility.
    ``(C) In establishing standards pursuant to subparagraph (A) for 
individuals and entities providing respite care services, the Secretary 
shall consult with organizations representing providers of the services 
described in such paragraph and organizations representing individuals 
who typically receive such services.
    ``(D) The term `respite care services' does not include any 
services furnished to an individual during a 12-month period after the 
individual has been furnished 120 hours of such services during such 
period.
    ``(2) An `eligible individual' described in this paragraph is an 
individual with functional limitations (as described in paragraph (3)) 
who is dependent on a daily basis on a caregiver who--
            ``(A) has primary responsibility for providing care to the 
        individual;
            ``(B) does not receive financial remuneration for providing 
        such care; and
            ``(C) has provided such care for a period of not less than 
        3 consecutive months.
    ``(3)(A) In paragraph (2), an `individual with functional 
limitations' is an individual who is certified (in accordance with such 
criteria as the Secretary may establish consistent with subparagraph 
(C)) as--
            ``(i) being unable to perform without substantial 
        assistance from another individual (including assistance 
        involving verbal reminding or physical cueing) at least 2 of 
        the activities of daily living described in subparagraph (B) 
        for a period of at least 90 days due to a loss of functional 
        capacity or to cognitive or other mental impairment;
            ``(ii) requiring substantial supervision to protect the 
        individual from threats to the individual's health or safety 
        due to substantial cognitive or other mental impairment; or
            ``(iii) having a level of disability similar (as determined 
        by the Secretary) to the level of disability described in 
        clause (i) or (ii).
    ``(B) The activities of daily living described in this subparagraph 
are as follows:
            ``(i) Eating.
            ``(ii) Toileting.
            ``(iii) Transferring.
            ``(iv) Bathing.
            ``(v) Dressing.
            ``(vi) Continence.
    ``(C) In establishing criteria pursuant to subparagraph (A) for the 
certification of individuals with functional limitations, the Secretary 
may not require that such certification be performed only by a 
physician.''.
    (c) Payment on Hourly Basis.--Section 1833 of such Act (42 U.S.C. 
1395l) is amended by inserting after subsection (o) the following new 
subsection:
    ``(p) Payment for respite care services shall be paid on the basis 
of an hour of such services provided.''.
    (d) Conforming Amendment.--Section 1862(a) of such Act (42 U.S.C. 
1395y(a)) is amended--
            (1) by striking ``or'' at the end of paragraph (14);
            (2) by striking the period at the end of paragraph (15) and 
        inserting ``; or''; and
            (3) by inserting after paragraph (15) the following new 
        paragraph:
            ``(16) in the case of respite care services, which are 
        furnished to an individual during a 12-month period after the 
        individual has been furnished 120 hours of such services during 
        such period.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1997.

SEC. 3. TREATMENT OF LONG-TERM CARE SERVICES AS MEDICAL CARE.

    (a) General Rule.--Paragraph (1) of section 213(d) (defining 
medical care) is amended by striking ``or'' at the end of subparagraph 
(B), by striking the period at the end of subparagraph (C) and 
inserting ``, or'', and by adding at the end the following new 
subparagraph:
                    ``(D) for qualified long-term care services (as 
                defined in subsection (f)).''
    (b) Definition of Qualified Long-Term Care Services.--Section 213 
of such Code is amended by adding at the end the following new 
subsection:
    ``(f) Qualified Long-Term Care Services.--For purposes of this 
section--
            ``(1) In general.--The term `qualified long-term care 
        services' means necessary diagnostic, preventive, therapeutic, 
        curing, treating, mitigating, and rehabilitative services, and 
        maintenance or personal care services, which--
                    ``(A) are required by a chronically ill individual, 
                and
                    ``(B) are provided pursuant to a plan of care 
                prescribed by a licensed health care practitioner.
            ``(2) Chronically ill individual.--
                    ``(A) In general.--The term `chronically ill 
                individual' means any individual who has been certified 
                by a licensed health care practitioner as--
                            ``(i) being unable to perform (without 
                        substantial assistance from another individual) 
                        at least 2 activities of daily living for a 
                        period of at least 90 days due to a loss of 
                        functional capacity or to cognitive impairment,
                            ``(ii) requiring substantial supervision to 
                        protect such individual from threats to health 
                        or safety due to substantial cognitive 
                        impairment, or
                            ``(iii) having a level of disability 
                        similar (as determined by the Secretary in 
                        consultation with the Secretary of Health and 
                        Human Services) to the level of disability 
                        described in clause (i) or (ii).
                Such term shall not include any individual otherwise 
                meeting the requirements of the preceding sentence 
                unless within the preceding 12-month period a licensed 
                health care practitioner has certified that such 
                individual meets such requirements.
                    ``(B) Activities of daily living.--For purposes of 
                subparagraph (A), each of the following is an activity 
                of daily living:
                            ``(i) Eating.
                            ``(ii) Toileting.
                            ``(iii) Transferring.
                            ``(iv) Bathing.
                            ``(v) Dressing.
                            ``(vi) Continence.
                    ``(C) Substantial assistance.--For purposes of 
                subparagraph (A)(i), the term `substantial assistance' 
                includes verbal reminding or physical cuing.
            ``(3) Maintenance or personal care services.--The term 
        `maintenance or personal care services' means any care the 
        primary purpose of which is the provision of needed assistance 
        with any of the disabilities as a result of which the 
        individual is a chronically ill individual (including the 
        protection from threats to health and safety due to severe 
        cognitive impairment).
            ``(4) Licensed health care practitioner.--The term 
        `licensed health care practitioner' means any physician (as 
        defined in section 1861(r)(1) of the Social Security Act) and 
        any registered professional nurse, licensed social worker, or 
        other individual who meets such requirements as may be 
        prescribed by the Secretary.''
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1995.
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