[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1111 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1111

To amend title 5, United States Code, to provide for the establishment 
of a program under which long-term care insurance is made available to 
       Federal employees and annuitants, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 16, 1999

 Mrs. Morella introduced the following bill; which was referred to the 
  Committee on Government Reform, and in addition to the Committee on 
   Armed Services, 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 5, United States Code, to provide for the establishment 
of a program under which long-term care insurance is made available to 
       Federal employees and annuitants, 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 ``Federal Civilian and Uniformed 
Services Long-Term Care Insurance Act of 1999''.

SEC. 2. LONG-TERM CARE INSURANCE.

    Subpart G of part III of title 5, United States Code, is amended by 
adding at the end the following:

                 ``Chapter 90--Long-Term Care Insurance

``Sec.
``9001. Definitions.
``9002. Eligibility to obtain coverage.
``9003. Contracting authority.
``9004. Long-term care benefits.
``9005. Financing.
``9006. Regulations.
``Sec. 9001. Definitions
    ``For purposes of this chapter:
            ``(1) Employee.--The term `employee' means--
                    ``(A) an employee as defined by section 8901(1)(A)-
                (H); and
                    ``(B) an individual described in section 2105(e).
            ``(2) Annuitant.--The term `annuitant' has the meaning such 
        term would have under paragraph (3) of section 8901 if, for 
        purposes of such paragraph, the term `employee' were considered 
        to have the meaning given to it under paragraph (1) of this 
        subsection.
            ``(3) Qualified relative.--The term `qualified relative', 
        as used with respect to a sponsoring individual, means--
                    ``(A) the spouse of such sponsoring individual;
                    ``(B) a parent or parent-in-law of such sponsoring 
                individual; and
                    ``(C) any other person bearing a relationship to 
                such sponsoring individual specified by the Office in 
                regulations.
            ``(4) Sponsoring individual.--The term `sponsoring 
        individual' refers to an individual described in paragraph (1), 
        (2), (3), or (4) of section 9002(b).
            ``(5) Carrier.--The term `carrier' means a voluntary 
        association, corporation, partnership, or other nongovernmental 
        organization which is lawfully engaged in providing, paying 
        for, or reimbursing the cost of, qualified long-term care 
        services under group insurance policies or contracts, or 
        similar group arrangements, in consideration of premiums or 
        other periodic charges payable to the carrier.
            ``(6) Qualified long-term care services.--The term 
        `qualified long-term care services' has the meaning given such 
        term by section 7702B of the Internal Revenue Code of 1986.
            ``(7) Office.--The term `Office' means the Office of 
        Personnel Management.
            ``(8) Appropriate secretary.--The term `appropriate 
        Secretary' means--
                    ``(A) except as otherwise provided in this 
                paragraph, the Secretary of Defense;
                    ``(B) with respect to the Coast Guard when it is 
                not operating as a service of the Navy, the Secretary 
                of Transportation;
                    ``(C) with respect to the commissioned corps of the 
                National Oceanic and Atmospheric Administration, the 
                Secretary of Commerce; and
                    ``(D) with respect to the commissioned corps of the 
                Public Health Service, the Secretary of Health and 
                Human Services.
``Sec. 9002. Eligibility to obtain coverage
    ``(a) In General.--Any eligible individual may obtain long-term 
care insurance coverage under this chapter for himself or herself, in 
accordance with applicable provisions of this chapter.
    ``(b) Eligible Individual Defined.--For purposes of this section, 
the term `eligible individual' means each of the following:
            ``(1) Employee.--An employee who has completed 6 months of 
        continuous service as an employee under other than a temporary 
        appointment limited to 6 months or less.
            ``(2) Annuitant.--An annuitant.
            ``(3) Member of the uniformed services.--A member of the 
        uniformed services on active duty for a period of more than 30 
        days or full-time National Guard duty (as defined in section 
        101(d)(5) of title 10) who satisfies such eligibility 
        requirements as the Office prescribes under section 9006(c).
            ``(4) Retired member of the uniformed services.--A member 
        of the uniformed services entitled to retired or retainer pay 
        (other than under chapter 1223 of title 10) who satisfies such 
        eligibility requirements as the Office prescribes under section 
        9006(c).
            ``(5) Qualified relative.--A qualified relative of a 
        sponsoring individual.
    ``(c) Certification Requirement.--As a condition for obtaining 
long-term care insurance coverage under this chapter based on one's 
status as a qualified relative, certification from the applicant's 
sponsoring individual shall be required as to--
            ``(1) such sponsoring individual's status, as described in 
        paragraph (1), (2), (3), or (4) of subsection (b) (as 
        applicable), as of the time of the qualified relative's 
        application for coverage; and
            ``(2) the existence of the claimed relationship as of that 
        time.
Any such certification shall be submitted at such time and in such form 
and manner as the Office shall by regulation prescribe.
    ``(d) Disqualifying Condition.--Nothing in this chapter shall be 
considered to require that long-term care insurance coverage be made 
available in the case of any individual who would be immediately 
benefit eligible.
``Sec. 9003. Contracting authority
    ``(a) In General.--The Office may, without regard to section 3709 
of the Revised Statutes or other statute requiring competitive bidding, 
contract with qualified carriers to provide group long-term care 
insurance under this chapter, except that the Office may not have 
contracts in effect under this section with more than 3 qualified 
carriers as of any given time.
    ``(b) Qualified Carriers.--To be considered a qualified carrier 
under this chapter, a company must be licensed to issue group long-term 
care insurance in all the States and the District of Columbia.
    ``(c) Terms and Conditions.--
            ``(1) In general.--Each contract under this section shall 
        contain a detailed statement of the benefits offered (including 
        any maximums, limitations, exclusions, and other definitions of 
        benefits), the rates charged (including any limitations or 
        other conditions on their subsequent adjustment), and such 
        other terms and conditions as may be mutually agreed to by the 
        Office and the carrier involved, consistent with the 
        requirements of this chapter.
            ``(2) Rates.--The rates charged under any contract under 
        this section shall reasonably reflect the cost of the benefits 
        provided under such contract.
    ``(d) Noncancelability.--The benefits and coverage made available 
to individuals under any contract under this section shall be 
guaranteed to be renewable and may not be canceled by the carrier 
except for nonpayment of charges.
    ``(e) Payment of Required Benefits; Dispute Resolution.--Each 
contract under this section shall require the carrier to agree--
            ``(1) to pay or provide benefits in an individual case if 
        the Office (or a duly designated third-party administrator) 
        finds that the individual involved is entitled thereto under 
        the terms of the contract; and
            ``(2) to participate in administrative procedures designed 
        to bring about the expeditious resolution of disputes arising 
        under such contract, including, in appropriate circumstances, 
        one or more alternative means of dispute resolution.
    ``(f) Duration.--
            ``(1) In general.--Each contract under this section shall 
        be for a term of 5 years, but may be made automatically 
        renewable from term to term in the absence of notice of 
        termination by either party. However, the rights and 
        responsibilities of the enrolled individual, the insurer, and 
        the Office (or duly designated third-party administrator) under 
        any such contract shall continue until the termination of 
        coverage of the enrolled individual.
            ``(2) Termination of individual coverage.--Group long-term 
        care insurance coverage obtained by an individual under this 
        chapter shall terminate only upon the occurrence of any of the 
        following:
                    ``(A) Death.--The death of the insured.
                    ``(B) Exhaustion of benefits.--Exhaustion of 
                benefits, as determined under the contract.
                    ``(C) Insolvency.--Insolvency of the insurer, as 
                determined under the contract.
                    ``(D) Cancellation.--Any event justifying a 
                cancellation under subsection (d).
            ``(3) Preservation of rights and responsibilities.--Each 
        contract under this section shall include such provisions as 
        may be necessary so as, except as provided in paragraph (2)--
                    ``(A) to effectively preserve all parties' rights 
                and responsibilities under such contract 
                notwithstanding the termination of such contract 
                (whether due to its nonrenewal under the first sentence 
                of paragraph (1) or otherwise); and
                    ``(B) to ensure that, once an individual becomes 
                duly enrolled, long-term care insurance coverage 
                obtained by such individual pursuant to that enrollment 
                shall not be terminated due to any change in status (as 
                described in section 9002(b)), such as separation from 
                Government service or the uniformed services, or 
                ceasing to meet the requirements for being considered a 
                qualified relative (whether due to divorce or 
                otherwise).
``Sec. 9004. Long-term care benefits
    ``(a) In General.--Benefits under this chapter shall be provided 
under qualified long-term care insurance contracts, within the meaning 
of section 7702B of the Internal Revenue Code of 1986.
    ``(b) Specific Matters To Be Included in All Contracts.--Each 
contract under section 9003 shall, in addition to any matter otherwise 
required under this chapter, provide for the following:
            ``(1) Adequate consumer protections (including through 
        establishment of sufficient reserves or reinsurance).
            ``(2) Adequate protections in the event of carrier 
        bankruptcy (or other similar event).
            ``(3) Availability of benefits upon appropriate 
        certification as to an individual's--
                    ``(A) inability (without substantial assistance 
                from another individual) to perform at least 2 
                activities of daily living for a period of at least 90 
                days due to a loss of functional capacity;
                    ``(B) having a level of disability similar (as 
                determined under regulations prescribed by 
the Secretary of the Treasury in consultation with the Secretary of 
Health and Human Services) to the level of disability described in 
subparagraph (A); or
                    ``(C) requiring substantial supervision to protect 
                such individual from threats to health and safety due 
                to severe cognitive impairment.
            ``(4) Choice of cash or service benefits (such as the 
        expense-incurred method or the indemnity method).
            ``(5) Inflation protection (whether through simple or 
        compounded adjustment of benefits).
            ``(6) Portability of benefits (consistent with subsections 
        (d) and (f) of section 9003).
    ``(c) Additional Specific Matters To Be Included in at Least One 
Contract.--To the maximum extent practicable, as of any given time, at 
least 1 of the policies being offered under this chapter shall, in 
addition to any matter otherwise required under this chapter, provide 
for the following:
            ``(1) Length-of-benefit options.
            ``(2) Options relating to the provision of coverage in a 
        variety of settings, including nursing homes, assisted living 
        facilities, and home and community care.
            ``(3) Options relating to elimination periods.
            ``(4) Options relating to nonforfeiture benefits.
            ``(5) Availability of benefits upon appropriate 
        certification of medical necessity (as defined by the Office in 
        consultation with the Secretary of Health and Human Services) 
        not satisfying the requirements of subsection (b)(3).
    ``(d) Governmentwide Plan.--
            ``(1) In general.--The Office shall take all practicable 
        measures to ensure that, of the long-term care benefits plans 
        available under this chapter as of any given time, at least one 
        of them shall be a Governmentwide long-term care benefits plan.
            ``(2) Definition.--For purposes of this subsection, the 
        term `long-term care benefits plan' means a group insurance 
        policy or contract, or similar group arrangement, provided by a 
        carrier for the purpose of providing, paying for, or 
        reimbursing expenses for qualified long-term care services.
            ``(3) Clarification.--Neither subsection (c)(5) nor the 
        exception set forth in the parenthetical matter under 
        subsection (e) shall apply with respect to any Governmentwide 
        plan under this subsection.
    ``(e) Coordination With Internal Revenue Code of 1986.--Nothing in 
this chapter shall be considered to permit or require the inclusion, in 
any contract, of provisions inconsistent with section 7702B or any 
other provision of the Internal Revenue Code of 1986 (except to the 
extent necessary to carry out subsection (c)(5)).
    ``(f) Coordination With State Requirements.--If a State (or the 
District of Columbia) imposes any requirement which is more stringent 
than the analogous requirement imposed by subsection (b)(1), the 
requirement imposed by subsection (b)(1) shall be treated as met if the 
more stringent requirement of the State (or the District of Columbia) 
is met.
    ``(g) Definitions.--For purposes of this section:
            ``(1) Activities of daily living.--Each of the following is 
        an activity of daily living:
                    ``(A) Eating.
                    ``(B) Toileting.
                    ``(C) Transferring.
                    ``(D) Bathing.
                    ``(E) Dressing.
                    ``(F) Continence.
            ``(2) Nursing home.--The term `nursing home' has the 
        meaning given such term by section 1908 of the Social Security 
        Act.
            ``(3) Assisted living facility.--The term `assisted living 
        facility' has the meaning given such term by section 232 of the 
        National Housing Act.
            ``(4) Home and community care.--The term `home and 
        community care' has the meaning given such term by section 1929 
        of the Social Security Act.
``Sec. 9005. Financing
    ``(a) No Government Contribution.--Except as provided in subsection 
(b)(2), each individual having long-term care insurance coverage under 
this chapter shall be responsible for 100 percent of the charges for 
such coverage.
    ``(b) Withholdings.--
            ``(1) In general.--The amount necessary to pay the charges 
        for enrollment shall--
                    ``(A) in the case of an employee, be withheld from 
                the pay of such employee;
                    ``(B) in the case of an annuitant, be withheld from 
                the annuity of such annuitant;
                    ``(C) in the case of a member of the uniformed 
                services described in section 9002(b)(3), be withheld 
                from the basic pay of such member; and
                    ``(D) in the case of a member of the uniformed 
                services described in section 9002(b)(4), be withheld 
                from the retired pay or retainer pay payable to such 
                member.
            ``(2) Voluntary withholdings for qualified relatives.--
        Withholdings to pay the charges for enrollment of a qualified 
        relative may, upon election of the sponsoring individual 
        involved, be withheld under paragraph (1) in the same manner as 
        if enrollment were for such sponsoring individual.
            ``(3) Direct payments.--All amounts withheld under 
        paragraph (1) or (2) shall be paid directly to the carrier.
    ``(c) Other Forms of Payment.--Any enrollee whose pay, annuity, or 
retired or retainer pay (as referred to in subsection (b)(1)) is 
insufficient to cover the withholding required for enrollment (or who 
is not receiving any regular amounts from the Government, as referred 
to in subsection (b)(1), from which any such withholdings may be made) 
shall pay an amount equal to the shortfall (or, in the case of an 
enrollee not receiving any regular amounts, the full amount of those 
charges) directly to the carrier.
    ``(d) Separate Fund Requirement.--Each carrier participating under 
this chapter shall maintain all amounts received under this chapter 
separate and apart from all other funds.
    ``(e) Reimbursements.--Contracts under this chapter shall include 
appropriate provisions under which each carrier shall reimburse the 
Office or other administering entity for the administrative costs 
incurred by such entity under this chapter (such as for dispute 
resolution) which are allocable to such carrier.
``Sec. 9006. Regulations
    ``(a) In General.--The Office shall prescribe regulations necessary 
to carry out this chapter.
    ``(b) Enrollment.--The regulations of the Office shall prescribe 
the time at which and the manner and conditions under which an 
individual may obtain long-term care insurance under this chapter, 
except that, under the regulations, an open enrollment period shall be 
afforded at least once each year (similar to that afforded under 
section 8905(f)).
    ``(c) Consultation.--Any regulations necessary to effect the 
application and operation of this chapter with respect to an eligible 
individual described in paragraph (3) or (4) of section 9002(b), or a 
qualified relative thereof, shall be prescribed by the Office in 
consultation with the appropriate Secretary.''.

SEC. 3. EFFECTIVE DATE.

    The amendments made by this Act shall take effect on the date of 
enactment of this Act, except that no coverage may become effective 
before the first calendar year beginning after the expiration of the 
18-month period beginning on the date of enactment of this Act.
                                 <all>