[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2691 Introduced in House (IH)]







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 Reform, and 
Education and the Workforce, 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 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 Representatives 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:

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 
                            dependent 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 hospital 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 facilities.
Sec. 303. Establishment of program to prevent abuse of nursing facility 
                            residents.
Sec. 304. Inclusion of abusive nursing facility workers in the database 
                            established as part of national health care 
                            fraud and abuse data collection 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.
                              ``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 insurance 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.
         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 subchapter A of chapter 
1 of the Internal Revenue Code of 1986 (relating to refundable credits) 
is amended by redesignating 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 allowed 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 respect to whom the taxpayer is an eligible caregiver 
for the taxable year.
    ``(b) Limitation Based on Adjusted Gross Income.--
            ``(1) In general.--The amount of the credit allowable under 
        subsection (a) shall be reduced (but 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 `modified 
        adjusted gross income' means adjusted gross income 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 return,
                    ``(B) $75,000 in the case of an individual who is 
                not married, and
                    ``(C) $55,000 in the case of a married individual 
                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, before the due date for filing 
                the return of tax for the taxable year (without 
                extensions), by a physician (as defined in section 
                1861(r)(1) of the 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 otherwise 
                meeting the requirements of the preceding sentence 
                unless within the 39\1/2\ month period ending on such 
                due date (or such other period as the Secretary 
                prescribes) a physician (as so defined) has certified 
                that such individual meets such requirements.
                    ``(B) Individuals with long-term care needs.--An 
                individual is described in this subparagraph if the 
                individual meets any of the following requirements:
                            ``(i) The individual is at least 6 years of 
                        age and--
                                    ``(I) is unable to perform (without 
                                substantial assistance from another 
                                individual) at least 3 activities of 
                                daily living (as defined in section 
                                7702B(c)(2)(B)) due to a loss of 
                                functional capacity, or
                                    ``(II) requires substantial 
                                supervision to protect such individual 
                                from threats to health and safety due 
                                to severe cognitive impairment and is 
                                unable to perform at least 1 activity 
                                of daily living (as so defined) or to 
                                the extent provided in regulations 
                                prescribed by the Secretary (in 
                                consultation with the Secretary of 
                                Health and Human Services), is unable 
                                to engage in age appropriate 
                                activities, or
                                    ``(III) requires substantial 
                                supervision 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 require residence in a 
                                psychiatric hospital, an intermediate 
                                care facility for the mentally 
                                retarded, or similar residential 
                                facility approved by the Secretary of 
                                Health and Human Services.
                            ``(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 another 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 medical 
                        equipment by reason of a severe health 
                        condition or requires a skilled practitioner 
                        trained to address the individual's condition 
to be available if the individual's parents or guardians are absent.
                    ``(C) Psychological disability defined.--In this 
                section, the term `psychological disability' shall 
                refer to diagnosable clinical conditions on Axis I or 
                Axis II of the current edition of the American 
                Psychiatric Association's Diagnostic and Statistical 
                Manual of Mental Disorders and is of a severity that 
                requires substantial 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' shall have the same 
                meaning as `developmental disabilities' as defined in 
                section 102 of the Developmental 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 supervision or residence in an intermediate 
                care facility for the mentally retarded, or similar 
                residential 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 described 
                        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 section 63(c)(2)(C), and any additional 
                        standard deduction under section 63(c)(3) which 
                        would be applicable to the individual if clause 
                        (iii) applied.
                            ``(v) An individual who would be described 
                        in clause (iii) for the taxable year if--
                                    ``(I) the requirements of clause 
                                (iv) are met with respect to the 
                                individual, and
                                    ``(II) the requirements of 
                                subparagraph (B) are met with respect 
                                to the individual in lieu of the 
                                support test of section 152(a).
                    ``(B) Residency test.--The requirements of this 
                subparagraph are met if an individual 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 taxpayer or 
                        the taxpayer's spouse, is a member of the 
                        taxpayer's household for over half the taxable 
                        year, or
                            ``(ii) in the case of any other individual, 
                        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 
                        individual is an eligible caregiver with 
                        respect 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 prescribe) 
that such individual will not claim such applicable individual for the 
credit under this section.
                            ``(ii) No agreement.--If each individual 
                        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.
                            ``(iii) Married individuals filing 
                        separately.--In the case of married individuals 
                        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 respect to any applicable 
individual unless the taxpayer includes the name and taxpayer 
identification number of such individual, and the identification number 
of the physician or licensed independent practitioner licensed by the 
State to render relevant diagnosis certifying such individual, 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 reason of the death of the taxpayer, no 
credit shall be allowable under this section in the case of a taxable 
year covering 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--
                    (A) by striking ``and'' at the end of subparagraph 
                (K), by striking the period at the end of subparagraph 
                (L) and inserting ``, and'', and by inserting after 
                subparagraph (L) the following new subparagraph:
                    ``(M) an omission of a correct TIN or physician 
                identification required under section 24(e) (relating 
                to family care credit) to be included on a return.'', 
                and
                    (B) in the matter preceding clause (i) of 
                subparagraph (L), by striking ``or 32'' and inserting 
                ``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.

             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 
              INDIVIDUALS.

    (a) In General.--
            (1) Part a.--Section 1812 of the Social Security 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 extended care 
        services (in accordance with section 1889).''; and
                    (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 entitled 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
            ``(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 section 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 services under this section 
        shall be determined in accordance 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 deductible imposed for Part B Services for the 
        year under section 1833(b).
            ``(3) Alternative payment under competitive bidding.--
                    ``(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 negotiated all-inclusive rates. 
                The amount of payment made by the Secretary to a 
provider of long-term care services for services covered under a 
contract shall be less than the aggregate amount of the payments that 
the Secretary would have otherwise made for the services.
                    ``(C) Contract period.--A contract period 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: bathing, dressing, 
                continence, toileting, transferring, and eating; or
                    ``(B) who has a similar level of disability due to 
                cognitive impairment that requires substantial 
                direction, instruction, or supervision of another 
                individual in order--
                            ``(i) to perform 2 or more of the 
                        activities of daily living described in 
                        subparagraph (A), or
                            ``(ii) to remain in the community without 
                        causing harm to self or others because 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 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).
            ``(2) Chronically dependent individual.--In this section, 
        the term `chronically dependent individual' means an individual 
        described in paragraph (1) who--
                    ``(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 requires 
                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 subsection 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.
    ``(e) In-Home, Community-based, and Respite Care.--
            ``(1) In general.--For purposes of this section, the term 
        `in-home, community-based, and respite care' means the items 
        and services described in paragraph (2) furnished to an 
        individual by a community-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 community or a 
        place of residence used as such individual's home (other than 
        services described in paragraph (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.
                    ``(F) Medical supplies (other than drugs and 
                biologicals) and durable medical equipment, while under 
                such a plan.
                    ``(G) Patient and caregiver (including family 
                caregiver) education and training to develop skills 
                necessary to permit the individual to remain 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 individual entitled to 
        benefits under this title (or another person on such 
        individual's behalf) may request a case management agency to 
        conduct an assessment under this section to determine whether 
        the individual is a dependent individual or a chronically 
        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--
                    ``(A) is established and periodically reviewed and 
                revised by a case management agency; and
                    ``(B) reflects the individual's needs identified 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 assessments, in 
                establishing and periodically reviewing and revising 
                case management plans for nursing 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 services or 
                in-home care and does not have a direct or indirect 
                ownership or control interest in, or direct or indirect 
                affiliation or relationship with, an entity that 
                provides, such services or care.
            ``(4) Contracting out certain functions.--The Secretary 
        shall permit a case management agency, to the extent necessary 
        to carry out functions under this section, to provide for 
        assessments and case management plans through contracts 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 
        interest 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 inserting the 
        following: ``, and (Q) with respect to expenses 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 subsection:

                 ``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 provider as 
        defined in subsection vv (as added by the Omnibus Long-Term 
        Care Improvement Act of 1999) or other community-based provider 
        which provides long-term, caregiver, and respite services as 
        defined by the Secretary, or
            ``(2) is engaged in providing services of homemaker/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 provides 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 agencies or 
                organizations of this nature, as meeting the standards 
                established for such licensing; and
            ``(5) meets such other requirements as the Secretary 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 Benefit.--
            (1) In general.--Section 1861(m) of the Social Security Act 
        (42 U.S.C. 1395x(m)) is amended--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``or paragraph (8)'' after ``paragraph (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:
            ``(8) substitute adult day care services (as defined 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 services' means 
the items and services described in subparagraph (B) furnished to an 
individual by an adult day care facility as a part of a plan under 
subsection (m) substituting such services for a portion of the items 
and services described in subparagraph (B)(i) furnished by a home 
health agency under the plan, as determined by the physician 
establishing the plan.
    ``(B) The items and services described in this subparagraph 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.
            ``(iv) A program of supervised activities designed to 
        promote physical and mental health and furnished to the 
        individual by the adult day care facility 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 comparable surety bond under State law.
    ``(C) For purposes of payment for home health services consisting 
of substitute adult day care services furnished under this title, any 
reference to a home health 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 42 
        U.S.C. 1395f(a)(2)(C)) are each amended by striking ``section 
        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 component (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 subparagraph 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.
            ``(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 consisting of substitute adult day care 
services, the following rules apply:
            ``(1) The Secretary shall determine each component (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.
            ``(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 services may not exceed 
        95 percent of the amount estimated 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 Secretary 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 expenditures to expenditures that the Secretary estimates 
        would have been made for home health services for that fiscal 
        year if subsection (a) had not been enacted.
            (2) Required reduction in payment rate.--If the Secretary 
        determines, after making the comparison under paragraph (1) and 
        making such adjustments for changes in demographics and age of 
        the Medicare beneficiary population as the Secretary determines 
        appropriate, that expenditures for home health services 
including such substitute adult day care services exceed expenditures 
that would have been made for home health services furnished under 
section 1861(m) of such Act for a year if subsection (a) had not been 
enacted, then the Secretary shall adjust the rate of payment to adult 
day care facilities so that total expenditures for home health services 
furnished under such section in a fiscal year does not exceed the 
Secretary's estimate of such expenditures if subsection (a) had not 
been enacted.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date that is the 
earlier of--
            (1) January 1, 2001, or
            (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 Social 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 periodically 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''.
            (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 subdivision thereof) that--
            ``(A) develops, coordinates, and monitors the delivery of 
        home health services by home health agencies to an individual 
        and may authorize payment of such home health services;
            ``(B) has experience and expertise in the furnishing of 
        home health services; and
            ``(C) meets such other standards as the Secretary finds 
        necessary for the effective and efficient development and 
        oversight of home health case management 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.
    ``(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 
includes the periodic review of such a plan.''.
            (3) Guidance on initiation of case manager services.--The 
        Secretary of Health and Human Services shall provide guidance 
        on the process or processes that may be used to identify 
        Medicare 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.--
                    (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 section 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 periodically 
                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--
            ``(A) for the initial development of the home health case 
        management plan for the individual, and
            ``(B) for the subsequent review and modification 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 amended 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 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 periodically reviewed by a 
                physician''.
                    (C) Payment.--Section 1833 of such Act (42 U.S.C. 
                1395l) is amended--
                            (i) in subsection (a)(2)--
                                    (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 subparagraph 
                                (G) the following new subparagraph:
                    ``(H) subject to subsection (u), with respect to 
                home health case manager services (as defined in 
                section 1861(ww)(3), the amount determined 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 regulations.''.
            (3) Establishment of fee schedule.--Section 1834 of such 
        Act (42 U.S.C. 1395m) is amended by adding at the end the 
        following new section:
    ``(m) Establishment of Fee Schedule for Home Health Case Manager 
Services.--
            ``(1) In general.--The Secretary shall establish 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 appropriate regional and 
        operational differences and adjustments 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 individuals and entities who furnish referral 
        services for home health services and share with such 
        organizations relevant data in establishing such schedule.
            ``(4) Alternative payment under competitive bidding.--
                    ``(A) In general.--Notwithstanding the preceding 
                provisions of this subsection, the Secretary 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 negotiated all-inclusive rates. 
                The amount of payment 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 aggregate amount of the 
                payments that the Secretary would have otherwise made 
                for the services.
                    ``(C) Contract period.--A contract period 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 furnished on or after October 1, 2001.
    (d) Report to Congress on Feasibility of Case Managers With Respect 
to Other Medicare Services.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study of the types of services consisting of 
        post-acute hospital care furnished 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 defined 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 containing the determinations 
        made pursuant to the study conducted under paragraph (1) and 
        any recommendations for legislative and administrative action 
        the Secretary deems appropriate.

SEC. 204. POST ACUTE CARE IMPROVEMENT.

    (a) Identification of Conditions.--The Secretary 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 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 Management 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 individual's 
        health and to reduce the likelihood of hospital readmission.
            (2) Reduction in payment for failure.--Payment under 
        section 1886(d) of the Social Security 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), 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, training, and assistance 
described in subsection (b)(1).

SEC. 205. ADDITIONAL PAYMENTS TO HOME HEALTH AGENCIES 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 agencies furnishing qualified home health services 
        during a cost reporting period beginning on or after October 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).
    (b) Description of Qualified Services.--For purposes of additional 
payment amounts under this section by the Secretary to home health 
agencies, qualified home health services are home health services 
furnished under the medicare program for the treatment of conditions 
within a diagnosis described in subsection (c).
    (c) Description of Diagnosis.--A diagnosis described 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 disease (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).
            (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 Payment Amount.--
            (1) Certification of quantity of qualified 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 patients 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 beginning 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 of this Act, with 
                        respect to such cost reporting period, the 30-
                        day period under clause (i) begins 60 days 
                        after the date of the enactment of this Act.
            (2) Determination of aggregate qualified 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 aggregate amount.--For 
        each home health agency submitting a certification under 
        paragraph (1) for a fiscal year described in paragraph (2), the 
        Secretary shall determine an agency-specific percentage by 
        dividing 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.
            (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 subsection 
        (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 additional payments to home health agencies under 
this section, $250,000,000 in each of the fiscal years 2000 through 
2002.
    (f) Termination.--The Secretary shall not make additional payments 
under this section for cost reporting periods, 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 action of the Secretary with respect to 
the determination of an additional payment amount under this section.

SEC. 206. STRENGTHENING THE POST-HOSPITAL REFERRAL 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 hospital provider, such as home health 
agencies, skilled nursing facilities, comprehensive outpatient 
rehabilitation facility, hospice program, or other hospital)'' after 
``any entity''.
    (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 HOMEBOUND.

    (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.
    (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 CERTAIN 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 adding 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 hospital.
            ``(ii) The Secretary shall designate, by diagnosis-related 
        groups established under section 1886(d)(4), those discharges 
        which are strongly indicative of a chronic terminal condition 
        (such as congestive heart failure, chronic pulmonary disease) 
        for which hospice care may provide assistance.''.
    (b) Adjustment of Payment.--Section 1886(d)(4) of such Act (42 
U.S.C. 1395ww(d)(4)) is amended by adding 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 January 1, 2002.

SEC. 212. ENCOURAGING PHYSICIAN EDUCATION IN HOSPICE 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 following new 
        subparagraph:
                    ``(C) a hospice program;''.
    (b) Including Hospice Programs Among Qualified Consortia for 
Certain Demonstration Projects.--Section 4628(b)(1) of the Balanced 
Budget Act of 1997 is amended--
            (1) by redesignating subparagraph (G) as subparagraph (H); 
        and
            (2) by inserting after subparagraph (F) the following 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 following 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.

                      Subtitle C--QMB Improvements

SEC. 221. MECHANISM PROMOTING PROVISION OF MEDICARE COST-SHARING 
              ASSISTANCE TO ELIGIBLE LOW-INCOME MEDICARE BENEFICIARIES.

    (a) In General.--Part A of title XI of the Social Security Act is 
amended by adding at the end the following:

    ``promoting provision of medicare cost-sharing assistance under 
   medicaid program for identified 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 
information described in subparagraph (A) of such section.
            ``(2) Specification of income levels.--The Secretary shall 
        specify--
                    ``(A) the items that will be included in 
                determination 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 medical assistance 
                under section 1902(a)(10)(E)(i) of the Social Security 
                Act (relating to assistance 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 following:
                    ``(A) Subject to subparagraph (B), the individual 
                is deemed eligible for some form of medical assistance 
                for some medicare cost-sharing 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 individual 
                is obligated to notify the Secretary if 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 permissible 
                        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 assistance 
                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 individual identified under 
        subsection (a) who is described in section 6103(l)(15)(A)(ii), 
        of the following: `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.'
    ``(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 Program.--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 identified 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 purposes other than tax administration) is amended by 
adding at the end the following new paragraph:
            ``(15) Disclosure of certain information in order to 
        qualify for medicare cost-sharing assistance.--
                    ``(A) In general.--The Secretary shall, upon 
                written request from the Commissioner of Social 
                Security, disclose to the Secretary of Health and Human 
                Services, whether with respect to any medicare 
                beneficiary (as defined in paragraph (12)(E)(i)) 
                identified by the Commissioner--
                            ``(i) there has not been filed an income 
                        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 Secretary 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 assistance 
                        described in section 1148 at any time in the 
                        previous year, the individual is still 
                        described in clause (i).
                    ``(B) Disclosure by health care financing 
                administration.--With respect to information disclosed 
                under subparagraph (A), the Administrator of the Health 
                Care Financing Administration may disclose to the 
                appropriate officials of a State responsible for 
                administration of a State plan under title XIX of the 
                Social Security Act the name, address, and TIN of the 
                preliminary eligibility determination.
                    ``(C) Special rules.--
                            ``(i) Restrictions on disclosure.--
                        Information may be disclosed under this 
                        paragraph only for purposes of, and to the 
                        extent necessary in, determining the extent to 
                        which an individual beneficiary is entitled to 
                        medical assistance under a State plan under 
                        title XIX of the Social Security Act for some 
                        or all medicare cost-sharing.
                            ``(ii) Timely responses to requests.--Any 
                        request made under subparagraph (A) shall be 
                        complied with as soon as possible but in no 
                        event later than 60 days after the date the 
                        report was made.''.

              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 subclause 
                (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.''.
    (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 subclause 
                (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 enactment of this Act.

SEC. 302. FEES FOR RESURVEYS AND REINSPECTIONS.

    (a) Medicare Amendments.--
            (1) In general.--Section 1819(g) of the Social 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 reinspections.--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 required to 
        determine whether the facility has achieved compliance.''.
            (2) Disallowance of medicare payment to cover additional 
        fees and civil money penalties.--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 incurred by the 
facility--
            ``(i) because of a fee assessed under subsection (g)(6) of 
        section 1819 or section 1919;
            ``(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 Social 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 reinspections.--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 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 required to determine whether the 
        facility has achieved compliance.''.
            (2) Disallowance of Medicaid payment to cover additional 
        fees and civil money penalties.--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 Secretary of 
        the State, payment of a fee assessed under 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 Facility 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 workers.--
                    ``(A) Background checks on applicants.--Subject to 
                subparagraph (B)(ii), before 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 applicants;
                            ``(ii) require, as a condition of 
                        employment, that such worker--
                                    ``(I) provide a written statement 
                                disclosing any conviction for a 
                                relevant 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 
                                identification information the 
                                Secretary may specify in regulation;
                            ``(iii) initiate a check of the data 
                        collection system established under section 
                        1128E in accordance with regulations 
                        promulgated by the Secretary to determine 
                        whether such system contains any disqualifying 
                        information with respect to such worker; and
                            ``(iv) if that system does not contain any 
                        such disqualifying information--
                                    ``(I) request that the State 
                                initiate a State and national criminal 
                                background check on such worker in 
                                accordance with the provisions of 
                                subsection (e)(8); and
                                    ``(II) furnish to the State the 
                                information 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 initiated 
                                under clause (iii).
                    ``(B) Prohibition on hiring of abusive workers.--
                            ``(i) In general.--A nursing facility may 
                        not knowingly employ any nursing facility 
                        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 (A)(iii) and the background check 
                        described under subparagraph (A)(iv). Such 
                        facility shall maintain direct supervision of 
                        the worker during the worker's probationary 
                        period of employment.
                    ``(C) Reporting requirements.--A nursing facility 
                shall report to the State any instance 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 information only 
                        for the purpose of determining the suitability 
                        of the worker for employment.
                            ``(ii) Immunity from liability.--A nursing 
                        facility that, in denying employment for an 
                        applicant, reasonably relies upon information 
                        about a nursing facility worker provided by the 
                        State pursuant to subsection (e)(8) or section 
                        1128E shall not be liable in any action brought 
                        by the worker based on the employment 
                        determination 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 paragraph 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 worker.--In 
                        addition to any civil penalty under clause (i), 
                        a nursing facility that--
                                    ``(I) knowingly continues to employ 
                                a nursing facility worker in violation 
                                of subparagraph (A) or (B); or
                                    ``(II) knowingly fails to report a 
                                nursing facility worker under 
                                subparagraph (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 relevant 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 
                                regulations.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Finding of patient or resident 
                        abuse.--The term `finding of patient or 
                        resident abuse' means any substantiated finding 
                        by a State agency under subsection (g)(1)(C) or 
                        a Federal agency that a 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 
                                regulations.
                            ``(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 employment or other 
                        contract with such facility. 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 personal care workers and 
                        attendants.''.
            (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 facility workers.--
                    ``(A) Background checks on applicants.--Subject to 
                subparagraph (B)(ii), before 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 applicants;
                            ``(ii) require, as a condition of 
                        employment, that such worker--
                                    ``(I) provide a written statement 
                                disclosing any conviction for a 
                                relevant 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 
                                identification information the 
                                Secretary may specify in regulation;
                            ``(iii) initiate a check of the data 
                        collection system established under section 
                        1128E in accordance with regulations 
                        promulgated by the Secretary to determine 
                        whether such system contains any disqualifying 
                        information with respect to such worker; and
                            ``(iv) if that system does not contain any 
                        such disqualifying information--
                                    ``(I) request that the State 
                                initiate a State and national criminal 
                                background check on such worker in 
                                accordance with the provisions of 
                                subsection (e)(6); and
                                    ``(II) furnish to the State the 
                                information 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 initiated 
                                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 resident 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 pending completion of the check 
                        against the data collection system described 
                        under subparagraph (A)(iii) and the background 
                        check described under subparagraph (A)(iv). 
                        Such facility shall maintain direct supervision 
                        of the covered individual during the worker's 
                        probationary period of employment.
                    ``(C) Reporting requirements.--A skilled nursing 
                facility shall report to the State any instance in 
                which the facility determines that a skilled 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 skilled nursing 
                        facility that obtains information about a 
                        skilled nursing facility worker pursuant to 
                        clauses (iii) and (iv) of subparagraph (A) may 
                        use such information only for the purpose of 
                        determining the suitability of the worker for 
                        employment.
                            ``(ii) Immunity from liability.--A skilled 
                        nursing facility that, in denying employment 
                        for an applicant, reasonably relies upon 
                        information about a skilled nursing facility 
                        worker provided by the State pursuant to 
                        subsection (e)(6) or section 1128E shall not be 
                        liable in any action brought by the worker 
                        based on the employment determination 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 skilled nursing 
                        facility that violates the provisions of this 
                        paragraph 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 worker.--In 
                        addition to any civil penalty under clause (i), 
                        a skilled nursing facility that--
                                    ``(I) knowingly continues to employ 
                                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 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 relevant 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 
                                regulations.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Finding of patient or resident 
                        abuse.--The term `finding of patient or 
                        resident abuse' means any substantiated finding 
                        by a State agency under subsection (g)(1)(C) or 
                        a Federal agency 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 
                                regulations.
                            ``(iv) Skilled nursing facility worker.--
                        The term `skilled nursing facility worker' 
                        means any individual that has direct access to 
                        a patient of a skilled nursing facility under 
                        an employment or other contract with such 
                        facility. 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 personal 
                        care workers and attendants.''.
    (b) State Requirements.--
            (1) Medicaid program.--
                    (A) Expansion of state registry to collect 
                information about nursing facility 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 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 indivduals'' 
                                        and inserting ``a registry of 
                                        (I) all individuals''; and
                                            (cc) by inserting before 
                                        the period ``, and (II) all 
                                        other 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 
                                ``involving a nursing facility 
                                employee''; and
                                    (IV) in subparagraph (C), by 
                                striking ``nurse aide'' and 
inserting ``nursing facility employee or applicant for employment''; 
and
                            (ii) in subsection (g)(1)--
                                    (I) in subparagraph (C)--
                                            (aa) in the first sentence, 
                                        by striking ``nurse aide'' and 
                                        inserting ``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 
                                appears 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:
            ``(8) Federal and state requirements concerning criminal 
        background checks on nursing facility employees.--
                    ``(A) In general.--Upon receipt of a request by a 
                nursing facility pursuant to subsection (b)(8) that is 
                accompanied by the information 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 subsection 
                (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 receipt of a submission pursuant to 
                subparagraph (A), the Attorney General shall direct a 
                search of the records of the Federal Bureau of 
                Investigation for any criminal history records 
                corresponding to the fingerprints or other positive 
                identification information submitted. The Attorney 
                General shall provide any corresponding information 
                resulting from the search to the State.
                    ``(C) State reporting of information to nursing 
                facility.--Upon receipt of the information provided by 
                the Attorney General pursuant to subparagraph (B), the 
                State shall--
                            ``(i) review the information to determine 
                        whether the individual has any conviction 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 individual 
                        to the database established under section 
                        1128E.
                    ``(D) Fees for performance of criminal background 
                checks.--
                            ``(i) Authority to charge fees.--
                                    ``(I) Attorney general.--The 
                                Attorney General may charge a fee to 
                                any State requesting a search and 
                                exchange 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 
actual cost of such activities or $50. Such fees shall be available to 
the Attorney General, or, in the Attorney General's discretion, to the 
Federal Bureau of Investigation, until expended.
                                    ``(II) State.--A State may charge a 
                                nursing facility a fee for initiating 
                                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 subparagraph 
                                (C). The amount of such fee shall not 
                                exceed the actual cost of such 
                                activities.
                            ``(ii) Prohibition on charging applicants 
                        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 regulations 
                        under this title, the Attorney General, in 
                        consultation with the Secretary, may promulgate 
                        such regulations as are necessary to carry out 
                        the Attorney General's responsibilities under 
                        this paragraph and subsection (b)(8), including 
                        regulations regarding the security, 
                        confidentiality, accuracy, use, destruction, 
                        and dissemination of information, audits and 
                        recordkeeping, and the imposition of fees.
                            ``(ii) Appeal procedures.--The Attorney 
                        General, in consultation with the Secretary, 
                        shall promulgate such regulations as are 
                        necessary to establish procedures by which an 
                        applicant or employee may appeal or dispute the 
                        accuracy of the information obtained in a 
                        background check conducted under this 
                        paragraph. Appeals 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 
                        applicant or employee has not been updated to 
                        reflect changes in the applicant's or 
                        employee'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 nursing 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 
                                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 
                                ``involving a skilled nursing facility 
                                employee''; and
                                    (IV) in subparagraph (C), by 
                                striking ``nurse aide'' and inserting 
                                ``skilled nursing facility employee or 
                                applicant for employment''; and
                            (ii) in subsection (g)(1)--
                                    (I) in subparagraph (C)--
                                            (aa) in the first sentence, 
                                        by striking ``nursing aide'' 
                                        and inserting ``skilled nursing 
                                        facility employee''; and
                                            (bb) in the third sentence, 
                                        by striking ``nurse aide'' each 
                                        place it appears and inserting 
                                        ``skilled nursing facility 
                                        employee''; and
                                    (II) in subparagraph (D), by 
                                striking ``nurse aide'' each place it 
                                appears 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 request by a 
                skilled nursing facility pursuant to subsection (b)(8) 
                that is accompanied by the information 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 subsection (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 receipt of a submission pursuant to 
                subparagraph (A), the Attorney General shall direct a 
                search of the records of the Federal Bureau of 
                Investigation for any criminal history records 
                corresponding to the fingerprints or other 
positive identification information submitted. The Attorney General 
shall provide any corresponding information 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 General pursuant to 
                subparagraph (B), the State shall--
                            ``(i) review the information to determine 
                        whether the individual has any conviction for a 
                        relevant crime (as defined in subsection 
                        (b)(8)(F)(i));
                            ``(ii) report to the skilled 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 individual 
                        to the database established under section 
                        1128E.
                    ``(D) Fees for performance of criminal background 
                checks.--
                            ``(i) Authority to charge fees.--
                                    ``(I) Attorney general.--The 
                                Attorney General may charge a fee to 
                                any State requesting a search and 
                                exchange 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 actual 
                                cost of such activities or $50. Such 
                                fees shall be available to the Attorney 
                                General, or, in the Attorney General's 
                                discretion, to the Federal Bureau of 
                                Investigation until expended.
                                    ``(II) State.--A State may charge a 
                                skilled nursing facility a fee for 
                                initiating 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 subparagraph (C). The 
                                amount of such fee shall not exceed the 
                                actual cost of such activities.
                            ``(ii) Prohibition on charging applicants 
                        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 regulations 
                        under this title, the Attorney General, in 
                        consultation with the Secretary, may promulgate 
                        such regulations as are necessary to carry out 
                        the Attorney General's responsibilities under 
                        this paragraph and subsection (b)(9), including 
                        regulations regarding the security 
                        confidentiality, accuracy, use, destruction, 
                        and dissemination of information, audits and 
                        recordkeeping, and the imposition of fees.
                            ``(ii) Appeal procedures.--The Attorney 
                        General, in consultation with the Secretary, 
                        shall promulgate such regulations as are 
                        necessary to establish procedures by which an 
applicant or employee may appeal or dispute the accuracy of the 
information obtained in a background check conducted under this 
paragraph. Appeals 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 applicant or employee has not been 
updated to reflect changes in the applicant's or employee'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.''.
    (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 period 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 available under the State plan to 
        individuals requiring long-term care complies with the 
        requirements of subsections (b)(8) and (e)(8) of section 
        1919.''.
            (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 preventive 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 individual 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 organization 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:
                            ``(v) A finding of abuse, neglect, or 
                        mistreatment of a patient or a resident of a 
                        long-term care facility, or misappropriation of 
                        such a patient's or resident's property.''.
    (b) Coverage of Long-Term Care Facility Employees.--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 nonlicensed 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 inserting ``, 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 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 amended 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 
        report 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 employees 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 adding at the end the following:
            ``(3) Mandatory check of database by long-term care 
        facilities.--A long-term care facility 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 facility who will have direct access to a patient or 
        resident of the facility (including individuals who are 
        licensed or certified by the State to provide services at the 
        facility, and nonlicensed individuals, as defined 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 following:
            ``(6) Long-term care facility.--The term `long-term care 
        facility' means a skilled nursing facility (as defined in 
        section 1819(a)), a nursing facility (as defined in section 
        1919(a)), or any other facility 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 amendments made by this section, 
$10,200,000 for fiscal year 2000.

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 hospital 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 between State 
        health care survey and provider certification agencies, long-
        term care ombudsman programs, the long-term care industry, and 
        local community members;
            (2) examine patient care issues relating to regulatory 
        oversight, community involvement, and facility staffing and 
        management with a focus on staff training, staff stress 
        management, and staff supervision;
            (3) examine the use of patient abuse prevention training 
        programs by long-term care entities, including 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 necessary 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:

                 ``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.
``Sec. 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 employee 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 licensed to do 
        business in each of the States and meeting the requirements of 
        a qualified insurer in each of the of the States;
            ``(6) `qualified contract' means a contract meeting the 
        conditions prescribed in section 9002; and
            ``(7) `State' means a State or territory or possession of 
        the United States, and includes the District of Columbia.
``Sec. 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 
contract 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 carriers.
    ``(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 the benefits provided 
under that contract as determined by the Office.
    ``(e) The coverage and benefits made available to individuals 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 composition of the risk pool, 
or both.
``Sec. 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 imposed on 
        issuers of qualified long-term care contracts by section 4980C 
        of the Internal Revenue Code of 1986.
``Sec. 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.
``Sec. 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 annuity, as appropriate.
    ``(d) An employee, annuitant, or other eligible individual, whose 
pay or annuity is insufficient to cover the withholding required for 
enrollment, shall, at the discretion of the withholding required for 
enrollment, shall, at the discretion of the Office, pay the premium for 
enrollment directly to the carrier.
    ``(e) Each carrier participating in the program established 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 shall be available to the Office for 
the administration of this chapter.
``Sec. 9006. Preemption
    ``This chapter shall supersede and preempt any State or local law 
which is determined by the Office to be inconsistent with--
            ``(1) the provisions of this chapter; or
            ``(2) after consultation with the National Association of 
        Insurance Commissioners, the efficient provision of a 
        nationwide long-term care insurance program for Federal 
        employees.
``Sec. 9007. Studies, reports, and audits
    ``(a) Each qualified carrier entering into a contract under this 
chapter shall--
            ``(1) furnish such reasonable reports as the Office 
        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 carrier, or both, with such 
information and reports as the Office may require.
``Sec. 9008. Claims for benefits.
    ``(a) A claim for benefits under this chapter shall be filed within 
4 years after the date on which the reimbursable costs was incurred or 
the service was provided.
    ``(b) The Office shall adjudicate a claims dispute arising under 
this chapter and shall require the contractor to pay for any benefit or 
provide any service the Office determines appropriate under the 
applicable contract.
    ``(c)(1) Except as provided under paragraph (2), benefits 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 payment.
    ``(2)(A) Benefits payable under the programs described under 
subparagraph (B) shall be secondary to benefits 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.
``Sec. 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.
``Sec. 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.
``Sec. 9011. Authorization of appropriations
    ``There are authorized to be appropriated such sums as may be 
necessary for the purposes of carrying out sections 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 INSURANCE 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 employees 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 submitted under 
        paragraph (1), the President shall designate an agency or 
        entity that would be responsible for the administration of the 
        plan.
            (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 Policies

SEC. 411. EXTENSION OF CONSUMER PROTECTION STANDARDS TO ALL LONG-TERM 
              CARE INSURANCE POLICIES.

    (a) In General.--Any issuer of a long-term care insurance contract 
(other than a qualified long-term care insurance contract) that fails 
to comply with the requirements 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 available 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 
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 proceeding 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 subsection (a) shall apply 
to actions taken after December 31, 1999.

  TITLE V--ADDITION OF NATIONAL FAMILY CAREGIVER PROGRAM TO THE OLDER 
                         AMERICANS ACT OF 1965

SEC. 501. NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM.

    (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:

          ``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 voluntary 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;
            ``(3) individual counseling, the organization of support 
        groups, and the provision of caregiver training to help 
        families make decisions and solve problems 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 caregivers of an 
older individual to be eligible to receive services 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 individuals and 
        families with the greatest social and economic need, consistent 
        with the requirements of section 305(a)(2)(E).
    ``(e) Requirements for Quality Standards and Accountability.--A 
State receiving assistance under this subpart shall comply with the 
following:
            ``(1) Quality standards.--A State shall have in place 
        mechanisms designed to ensure the quality of services provided 
        with assistance under this subpart.
            ``(2) Data and records.--A State shall collect data and 
        furnish records at the times and in the standardized format 
        that the Assistant Secretary may require in order to enable the 
        Assistant Secretary to monitor State program administration and 
        compliance, and to evaluate and compare the effectiveness of 
State programs under this subpart.
            ``(3) Reporting.--A State shall report to the Assistant 
        Secretary on the data and information required under paragraph 
        (2), including the services and activities funded under this 
        subpart, and standards 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.
            ``(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 section 
                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 Federal, State, or local law by a State or unit 
of general purpose 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.

               ``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 approaches to sustaining the efforts of 
families and other informal caregivers of older individuals, and to 
serving particular groups of caregivers of older individuals, including 
minority caregivers and distant caregivers.
    ``(b) Evaluation and Dissemination of Results.--The Assistant 
Secretary shall provide for the evaluation of the effectiveness of 
programs and activities funded with grants under this subpart, and for 
the dissemination to States of descriptions and evaluations of such 
programs and activities, to enable States to incorporate 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 appropriated for each fiscal year 
        under section 341(a) to carry out the program under this 
        section.
            ``(2) Native american programs.--20 percent of the amounts 
        reserved for each fiscal year under paragraph (1) shall be made 
        available for programs and activities for Native Americans.

``SEC. 346. ACTIVITIES OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--The Assistant Secretary shall, directly or by 
grant or contract, carry out activities of national significance to 
promote quality and continuous improvements 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 Secretary shall reserve 
up to 2 percent of the amount appropriated 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 sentence 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 REALLOTMENT.

    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.--Section 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 community services;
                    ``(B) in-home services for frail older individuals 
                (including supportive services for victims of 
                Alzheimer's disease and related disorders with 
                neurological and organic brain dysfunction, and for the 
                families of such individuals);
                    ``(C) supportive activities to meet the special 
                needs of caregivers, including caretakers who provide 
                in-home services to frail older individuals;
                    ``(D) in-home and other community services, 
                including home health, homemaker, shopping, 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.

                   TITLE VI--MEDICARE FOR CAREGIVERS

         Subtitle A--Access to Medicare Benefits for Caregivers

SEC. 601. ACCESS TO MEDICARE BENEFITS FOR CAREGIVERS.

    ``(a) In General.--Title XVIII of the Social Security 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 continuation 
                provision.--The term `Federal or State COBRA 
                continuation provision' has the meaning given the term 
                `COBRA continuation provision' 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 program defined.--
                The term `Federal health insurance 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 employees 
                        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.
    ``(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 eligible individual.
            ``(2) Caregiving precluding employer-based health insurance 
        coverage.--The Secretary determines that the caregiving 
        provided by the individual to the medicare-eligible individual 
        reasonably precludes employment and the obtaining of employer-
        provided health insurance and in the absence 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 insurance programs.--The individual is not 
        eligible for benefits or coverage under a Federal health 
        insurance program (as defined in subsection (a)(2)(B)) or under 
        a group health plan (other than such eligibility merely through 
        a Federal or State COBRA 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 eligibility 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 expenses of an individual 
        enrolled under this part unless 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.--
            ``(1) In general.--An individual's coverage period under 
        this part shall continue until the individual's enrollment has 
        been terminated at the earliest of the following:
                    ``(A) Notice.--The individual files notice (in a 
                form and manner prescribed by the Secretary) that the 
                individual no longer wishes to participate in the 
                insurance program under this part.
                    ``(B) Loss of eligibility.--The individual no 
                longer meets the conditions described in section 
                1859(b)(1).
                    ``(C) Medicare eligibility.--The individual 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 coverage 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 termination of a 
                coverage period under paragraph (1)(B) shall take 
                effect at the close of the month following the month in 
                which the Secretary determines that the individual no 
                longer meets the conditions referred to in such 
                paragraph.
                    ``(C) Medicare eligibility.--The termination 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 deposited 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 transferred to 
                the Trust Fund from the Federal Hospital Insurance 
                Trust Fund and from the Federal Supplementary Medical 
                Insurance Trust Fund amounts equivalent to the amounts 
                (specified under subparagraph (B)) of the reductions in 
                expenditures under such respective trust fund as may be 
                attributable to the enactment of the Medicare Fraud and 
                Overpayment Act of 1999.
                    ``(B) Use of cbo estimates.--For each fiscal year 
                during the 10-fiscal-year period beginning 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 percentage 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.--
            ``(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 applying 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 sections 1840(b)(1) 
                and 1842(g) are deemed references 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 annual 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 coverage provided under this part. The Comptroller 
General shall include in such report such recommendations for 
adjustments in such financing and coverage as the comptroller general 
deems appropriate in order to maintain financial solvency of the 
program under this part.

``SEC. 1859D. ADMINISTRATION AND MISCELLANEOUS.

    ``(a) Treatment for Purposes of Title.--Except as otherwise 
provided in this part--
            ``(1) individuals enrolled under this part shall be treated 
        for purposes of this title as though the individual 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 applying 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 entitled 
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 Security 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 Fund, and the Medicare Caregiver Trust Fund 
        established by title XVIII''.
            (3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is 
        amended by striking ``part D'' and inserting ``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
                    (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 applying this 
        subsection with respect to individuals entitled to 
benefits under part D, the Secretary shall provide for an appropriate 
adjustment in the Medicare+Choice capitation rate as may be appropriate 
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''.
            (B) Section 2202(2)(D)(ii) of the Public Health Service Act 
        (42 U.S.C. 300bb-2(2)(D)(ii) is amended 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 Internal Revenue 
        Code of 1986 is amended by inserting ``(not including an 
        individual who is so entitled pursuant to enrollment under 
        section 1859A)'' after ``Social Security Act''.

              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.

    (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:
            ``(7) The termination of group health plan coverage 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 
                        paragraph,'' 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 `qualified caregiver' 
        means with respect to a qualifying event describe in section 
        603(7), an individual who becomes eligible for a caregiver tax 
        credit under section 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 coverage 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--
                    (A) in paragraph (3)--
                            (i) in subparagraph (A), by inserting 
                        ``except as otherwise provided in this 
                        paragraph,'' after ``means,''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(C) Special rule for qualifying caregivers.--In 
                the case of a qualifying event described in section 
                2203(6), 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:
            ``(5) Qualified caregiver.--The term `qualified caregiver' 
        means, with respect to a qualifying event described in section 
        2203(6), an individual who becomes eligible for a caregiver tax 
        credit under section 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 3--AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986

SEC. 613. COBRA CONTINUATION BENEFITS FOR CERTAIN CAREGIVERS.

    (a) Establishment of New Qualifying Event.--
            (1) In general.--Section 4980B(f)(3) of the Internal 
        Revenue Code of 1986 is amended by inserting after subparagraph 
        (F) the following new subparagraph:
                    ``(G) The termination of group health plan coverage 
                as a result of a covered employee becoming a qualified 
                caregiver.''.
            (2) Qualified caregiver defined.--Section 4980B(g) of such 
        Code is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by inserting 
                        ``except as otherwise provided in this 
                        paragraph,'' after ``means,''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(E) Special rule for qualified caregivers.--In 
                the case of a qualifying event described in subsection 
                (f)(3)(G), 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:
            ``(5) Qualified caregiver.--The term `qualified caregiver' 
        means, with respect to a qualifying event described in 
        subsection (f)(3)(G), an individual who becomes eligible for a 
        caregiver tax credit under section 35.''.
    (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.

                         Subtitle C--Financing

SEC. 621. REFERENCE TO FINANCING PROVISIONS.

    Any increase in payments under the medicare program under title 
XVIII of the Social Security Act that results from the enactment of 
this title shall be offset by reductions in payments under such program 
pursuant to the anti-fraud and anti-abuse provisions enacted as part of 
the Medicare Fraud and Overpayment Act of 1999.

      TITLE VII--SOCIAL SECURITY BENEFIT FOR LONG-TERM CAREGIVERS

SEC. 701. SOCIAL SECURITY CREDIT FOR LONG-TERM CAREGIVERS.

    (a) In General.--Title II of the Social Security Act is amended by 
adding after section 233 (42 U.S.C. 433) the following new section:

           ``benefits in case of certain long-term caregivers

                    ``Definitions and Related Rules

    ``Sec. 234. (a) For the purposes of this section--
            ``(1) The term `eligible caregiver' has the meaning given 
        such term in section 35(c)(3) of the Internal Revenue Code of 
        1986.
            ``(2) The term `applicable individual' has the meaning 
        given such term in section 35(c)(1)(A) of the Internal Revenue 
        Code of 1986.
            ``(3) The term `qualifying period' means, in connection 
        with any individual, any period of leave of not less than 84 
        consecutive days for which such individual has been principally 
        engaged in providing service as an eligible caregiver to an 
        applicable individual.
            ``(4) The term `period of leave' means a period in which 
        the eligible caregiver is not employed and which is preceded by 
        a continuous period of at least 60 months in which the 
        individual was employed at least 20 hours per week on average.

                  ``Deemed Wages of Eligible Caregiver

    ``(b)(1) For purposes of determining entitlement to and the amount 
of any monthly benefit for any month after December 1999, or 
entitlement to and the amount of any lump-sum death payment in the case 
of a death after such month, payable under this title on the basis of 
the wages and self-employment income of any individual, and for 
purposes of section 216(i)(3), such individual shall be deemed to have 
been paid during each month ending during any qualifying period 
commencing after he or she attained age 18 wages (in addition to any 
wages actually paid to him or her) at an amount per month equal to the 
greater of the amount of wages or self-employment income actually paid 
or derived during such month or the monthly rate of wages and self-
employment income derived by dividing--
            ``(A) the arithmetic mean of the total wages and self-
        employment income credited to such individual for each of the 
        last 3 calendar years ending at least one year before the 
commencement of such qualifying period, by
            ``(B) 12 months.
    ``(2) This subsection shall not be applicable in the case of any 
monthly benefit or lump-sum death payment if a larger such benefit or 
payment, as the case may be, would be payable without its application.

                ``Citizenship and Residency Requirements

    ``(c)(1) An individual shall not be treated as an eligible 
caregiver for purposes of subsection (b) unless such individual--
            ``(A) is throughout the qualifying period a resident of the 
        United States (as defined in paragraph (2)), and
            ``(B)(i) is throughout the qualifying period a citizen of 
        the United States or an alien lawfully admitted for permanent 
        residence, and
            ``(ii) in the case of an individual who was not a citizen 
        of the United States throughout the qualifying 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 individual provides the 
Secretary with the name and taxpayer identification number of the 
applicable individual with respect 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 
obtain 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 described in section 
35(c)(2)(C)(i) of the Internal Revenue Code of 1986.

``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 resulting from 
        the payments described in paragraph (1), and
            ``(3) any loss in interest to such Trust Fund resulting 
        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.''.
                                 <all>