[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4029 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4029

   To amend the Public Health Service Act to provide for Alzheimer's 
  clinical research and training awards, to amend title XVIII of the 
Social Security Act to expand the definition of homebound for purposes 
 of receiving home health services under the medicare program to allow 
medicare beneficiaries to attend adult day care programs for treatment 
  of Alzheimer's disease and other conditions, to amend the Internal 
  Revenue Code of 1986 to allow individuals a deduction for qualified 
    long-term care insurance premiums, use of such insurance under 
 cafeteria plans and flexible spending arrangements, and a credit for 
     individuals with long-term care needs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 16, 2000

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

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to provide for Alzheimer's 
  clinical research and training awards, to amend title XVIII of the 
Social Security Act to expand the definition of homebound for purposes 
 of receiving home health services under the medicare program to allow 
medicare beneficiaries to attend adult day care programs for treatment 
  of Alzheimer's disease and other conditions, to amend the Internal 
  Revenue Code of 1986 to allow individuals a deduction for qualified 
    long-term care insurance premiums, use of such insurance under 
 cafeteria plans and flexible spending arrangements, and a credit for 
     individuals with long-term care needs, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Long Term Care and Alzheimer's 
Disease Advancement Act of 2000''.

SEC. 2. ALZHEIMER'S CLINICAL RESEARCH AND TRAINING AWARDS.

    Subpart 5 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285e et seq.) is amended--
            (1) by redesignating section 445I as section 445J; and
            (2) by inserting after section 445H the following section:

          ``alzheimer's clinical research and training awards

    ``Sec. 445I. (a) The Director of the Institute is authorized to 
establish and maintain the Alzheimer's disease Physician-Scientist 
program to enhance and promote the translation of new scientific 
knowledge into clinical practice toward the diagnosis, care and 
treatment of individuals with Alzheimer's disease.
    ``(b) In order to foster the application of the latest developments 
in Alzheimer's diagnosis, treatment and care, funds under this program 
shall be directed to support promising clinicians through awards for 
research, study, and practice at centers of excellence in Alzheimer 
research and treatment.
    ``(c) Research awards under subsection (b) shall be carried out in 
environments of demonstrated excellence in neuroscience, neurobiology, 
geriatric medicine, psychiatry and foster innovation and integration of 
these disciplines or other environments determined suitable by the 
Director of the Institute.
    ``(d) In addition to any other authorization of appropriations 
available for the purpose of carrying out this section, there are 
authorized to be appropriated for such purpose $2,250,000 for each of 
fiscal years 2001 through 2005.''.

SEC. 3. MEDPAC STUDY ON MEDICARE PHYSICIAN REIMBURSEMENT RATES FOR 
              ALZHEIMER'S DISEASE.

    (a) Study.--The Medicare Payment Advisory Commission, established 
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6), 
shall conduct a study of reimbursement rates under the medicare program 
(under title XVIII of that Act (42 U.S.C. 1395 et seq.) to physicians 
for Alzheimer services, including a determination of the adequacy of 
such reimbursement rates. The study shall include the following 
analyses:
            (1) Comprehensive clinical assessments.--An analysis of 
        whether payment policy under the medicare program for Alzheimer 
        services encourages or discourages physicians to conduct 
        comprehensive clinical assessments for medicare beneficiaries 
        who exhibit symptoms of possible dementia.
            (2) Clinical practice guidelines.--An analysis of whether 
        payment policy under the medicare program encourages or 
        discourages physicians to provide diagnostic and management 
        services for Alzheimer's disease or a related dementia as 
        specified in generally accepted clinical practice guidelines 
        and protocols.
            (3) Ongoing physician consultation.--An analysis of whether 
        payment policy under the medicare program for Alzheimer 
        services encourages or discourages ongoing physician 
        consultation with the medicare beneficiary's caregivers, as 
        specified in generally accepted diagnosis and practice 
        guidelines.
            (4) Career choice.--An analysis of whether payment rates 
        under the medicare program for physicians encourages or 
        discourages physicians from choosing a career with a speciality 
        in the treatment and management of Alzheimer's disease and 
        related dementia.
    (b) Definitions.--In this section:
            (1) The term ``Alzheimer services'' means the evaluation, 
        diagnosis, and management of a medicare beneficiary with 
        Alzheimer's disease or a related dementia, including ongoing 
        consultation between the physician and caregivers of the 
        beneficiary, consistent with generally accepted diagnosis and 
        practice guidelines.
            (2) The term ``medicare beneficiary'' means an individual 
        entitled to benefits under title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.).
    (c) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Medicare Payment Advisory Commission shall submit to 
Congress a report on the results of the study conducted under this 
section, together with any recommendations for legislation that the 
Commission determines to be appropriate as a result of such study.

SEC. 4. CLARIFICATION OF MEDICARE DEFINITION OF HOMEBOUND FOR PURPOSES 
              OF HOME HEALTH SERVICES.

    (a) Findings.--Congress finds the following:
            (1) Home health services are a vital component of the 
        benefits that are furnished to beneficiaries under the medicare 
        program under title XVIII of the Social Security Act.
            (2) Home health services under the medicare program enable 
        homebound individuals who are at great risk for costly 
        institutionalized care to stay in their own homes and 
        communities.
            (3) Existing medicare regulations and practices 
        inadvertently penalize medicare beneficiaries (including those 
        with Alzheimer's disease, a related dementia, or both) who 
        participate in an adult day care program. Under those 
        regulations, if a medicare beneficiary attends a privately 
        funded adult day care program as part of their Alzheimer's 
        treatment regime, including an Alzheimer's treatment regime, 
        they may lose eligibility for the medicare home health benefit 
        because the absences of the individual from home are not 
        infrequent or short duration.
            (4) Adult day care programs can be a valuable and medically 
        beneficial part of a treatment regime for a person with 
        Alzheimer's disease or a related dementia. These programs can 
        provide structured activities and health monitoring to maintain 
        function, manage behavioral symptoms and prevent health care 
        crises and premature institutionalization.
            (5) The Health Care Financing Administration and its 
        various medicare contractors and fiscal intermediaries have 
        misinterpreted the intent of Congress with respect to 
        eligibility for home health services. Participation by medicare 
        beneficiaries in privately funded adult day care programs is 
        not intended to preclude eligiblity for home health services 
        for those medicare beneficiaries under the medicare program.
    (b) Clarification of the Definition of Homebound.--
            (1) In general.--The last sentence of sections 1814(a) and 
        1835(a) of the Social Security Act (42 U.S.C. 1395f(a); 
        1395n(a)) are each amended by striking the period and inserting 
        ``Including participating in an audit day care program licensed 
        by a State to furnish adult day care services in the State, for 
        the purpose of therapeutic treatment for Alzheimer's disease or 
        a related dementia, or for medical treatment furnished in an 
        adult day care program.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services provided on or after the date 
        of enactment of this Act.

SEC. 5. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE 
              CONTRACTS.

    (a) In General.--Part VII of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to additional itemized 
deductions) is amended by redesignating section 222 as section 223 and 
by inserting after section 221 the following new section:

``SEC. 222. PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a deduction an amount equal to the applicable percentage of 
the amount of eligible long-term care premiums (as defined in section 
213(d)(10)) paid during the taxable year for coverage for the taxpayer, 
his spouse, and dependents under a qualified long-term care insurance 
contract (as defined in section 7702B(b)).
    ``(b) Applicable Percentage.--For purposes of subsection (a)--
            ``(1) In general.--Except as otherwise provided in this 
        subsection, the applicable percentage shall be determined in 
        accordance with the following table based on the number of 
        years of continuous coverage (as of the close of the taxable 
        year) of the individual under any qualified long-term care 
        insurance contracts (as defined in section 7702B(b)):

                ``If the number of years of
                                               The applicable long-term
                  continuous coverage is--
                                                 care percentage is--  
                    Less than 1............................      60    
                    At least 1 but less than 2.............      70    
                    At least 2 but less than 3.............      80    
                    At least 3 but less than 4.............      90    
                    At least 4.............................    100.    
            ``(2) Special rules for individuals who have attained age 
        55.--In the case of an individual who has attained age 55 as of 
        the close of the taxable year, the following table shall be 
        substituted for the table in paragraph (1).

                ``If the number of years of
                                               The applicable long-term
                  continuous coverage is--
                                                 care percentage is--  
                    Less than 1............................      70    
                    At least 1 but less than 2.............      85    
                    At least 2.............................    100.    
            ``(3) Only coverage after 1999 taken into account.--Only 
        coverage for periods after December 31, 1999, shall be taken 
        into account under this subsection.
            ``(4) Continuous coverage.--An individual shall not fail to 
        be treated as having continuous coverage if the aggregate 
        breaks in coverage during any 1-year period are less than 60 
        days.
    ``(c) Coordination With Other Deductions.--Any amount paid by a 
taxpayer for any qualified long-term care insurance contract to which 
subsection (a) applies shall not be taken into account in computing the 
amount allowable to the taxpayer as a deduction under section 162(l) or 
213(a).''
    (b) Contingent Nonforfeiture Requirements Added to Consumer 
Protection Provisions.--
            (1) Section 7702B(g)(2)(A)(i) of the Internal Revenue Code 
        of 1986 (relating to model regulation) is amended by adding at 
        the end the following new subclause:
                                    ``(XII) Section 23 (relating to 
                                contingent nonforfeiture benefits), if 
                                the policyholder declines the offer of 
                                a nonforfeiture provision described in 
                                paragraph (4).''
            (2) Section 7702B(g)(2)(A)(ii) of such Code (relating to 
        model Act) is amended by adding at the end the following new 
        subclause:
                                    ``(III) Section 8 (relating to 
                                contingent nonforfeiture benefits), if 
                                the policyholder declines the offer of 
                                a nonforfeiture provision described in 
                                paragraph (4).''
    (c) Reference to NAIC Model Act Updated.--Section 7702B(g)(2)(B)(i) 
of the Internal Revenue Code of 1986 (relating to model provisions) is 
amended by striking ``January 1993'' and inserting ``January 1999''.
    (d) Long-Term Care Insurance Permitted To Be Offered Under 
Cafeteria Plans and Flexible Spending Arrangements.--
            (1) Cafeteria plans.--Section 125(f) of the Internal 
        Revenue Code of 1986 (defining qualified benefits) is amended 
        by inserting before the period at the end ``; except that such 
        term shall include the payment of premiums for any qualified 
        long-term care insurance contract (as defined in section 7702B) 
        to the extent the amount of such payment does not exceed the 
        eligible long-term care premiums (as defined in section 
        213(d)(10)) for such contract''.
            (2) Flexible spending arrangements.--Section 106 of such 
        Code (relating to contributions by an employer to accident and 
        health plans) is amended by striking subsection (c).
    (e) Conforming Amendments.--
            (1) Section 62(a) of the Internal Revenue Code of 1986 is 
        amended by inserting after paragraph (17) the following new 
        item:
            ``(18) Premiums on qualified long-term care insurance 
        contracts.--The deduction allowed by section 222.''
            (2) Section 7702B(g)(2)(A)(i) of such Code, as amended by 
        subsection (b)(1), is amended by striking ``7A'' both places it 
        appears, ``7B'', ``7C'', ``7D'', ``7E'', ``8'', ``9'', ``9F'', 
        ``10'', ``11'', ``12'', and ``23'' the first place it appears 
        and inserting ``6A'', ``6B'', ``6C'', ``6D'', ``6E'', ``7'', 
        ``8'', ``8F'', ``9'', ``10'', ``11'', and ``22'', respectively.
            (3) Section 4980C(c)(1)(A) of such Code is amended by 
        striking ``13'', ``14'', ``20'', ``21'', ``21C(1)'', 
        ``21C(6)'', ``22'', ``24'', and ``25'' and inserting ``12'', 
        ``13'', ``19'', ``20C(1)'', ``20C(6)'', ``21'', ``25'', and 
        ``26'', respectively.
            (4) The table of sections for part VII of subchapter B of 
        chapter 1 of such Code is amended by striking the last item and 
        inserting the following new items:

                              ``Sec. 222. Premiums on qualified long-
                                        term care insurance contracts.
                              ``Sec. 223. Cross reference.''
    (f) Effective Dates.--
            (1) In general.--Except as provided in paragraphs (2) and 
        (3), the amendments made by this section shall apply to taxable 
        years beginning after December 31, 1999.
            (2) Consumer protection provisions.--The amendments made by 
        subsections (b), (c), (e)(2), and (e)(3) shall apply to 
        policies issued after the date which is 1 year after the date 
        of the enactment of this Act.
            (3) Cafeteria plans and flexible spending arrangements.--
        The amendments made by subsection (c) shall apply to taxable 
        years beginning after December 31, 2001.

SEC. 6. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.

    (a) In General.--Subpart A of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to nonrefundable 
personal credits) is amended by inserting after section 25A the 
following new section:

``SEC. 25B. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.

    ``(a) Allowance of Credit.--
            ``(1) In general.--There shall be allowed as a credit 
        against the tax imposed by this chapter for the taxable year an 
        amount equal to the applicable credit amount multiplied by the 
        number of applicable individuals with respect to whom the 
        taxpayer is an eligible caregiver for the taxable year.
            ``(2) Applicable credit amount.--For purposes of paragraph 
        (1), the applicable credit amount shall be determined in 
        accordance with the following table:

        ``For taxable years beginning
                                                         The applicable
          in calendar year--
                                                     credit amount is--
            2000...........................................  $1,000    
            2001...........................................   1,500    
            2002...........................................   2,000    
            2003...........................................   2,500    
            2004 or thereafter.............................  3,000.    
    ``(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 $100 
        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) $150,000 in the case of a joint return, and
                    ``(B) $75,000 in any other case.
            ``(3) Indexing.--In the case of any taxable year beginning 
        in a calendar year after 2000, each dollar amount contained in 
        paragraph (2) shall be increased by an amount equal to the 
        product of--
                    ``(A) such dollar amount, and
                    ``(B) the medical care cost adjustment determined 
                under section 213(d)(10)(B)(ii) for the calendar year 
                in which the taxable year begins, determined by 
                substituting `August 1999' for `August 1996' in 
                subclause (II) thereof.
        If any increase determined under the preceding sentence is not 
        a multiple of $50, such increase shall be rounded to the next 
        lowest multiple of $50.
    ``(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 preform, without reminding or 
                                cuing assistance, 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.
                            ``(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.
            ``(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) Identification 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 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 Amendments.--
            (1) Section 6213(g)(2) of the Internal Revenue Code of 1986 
        is amended 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 25B(d) (relating 
                to credit for taxpayers with long-term care needs) to 
                be included on a return.''
            (2) The table of sections for subpart A of part IV of 
        subchapter A of chapter 1 of such Code is amended by inserting 
        after the item relating to section 25A the following new item:

                              ``Sec. 25B. Credit for taxpayers with 
                                        long-term care needs.''
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.
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