[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 894 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 894

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 28, 1999

  Mr. Cleland introduced the following bill; which was read twice and 
           referred to the Committee on Governmental Affairs

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Federal Civilian and Uniformed 
Services Long-Term Care Insurance Act of 1999''.

SEC. 2. LONG-TERM CARE INSURANCE.

    Subpart G of part III of title 5, United States Code, is amended by 
adding after chapter 89 the following:

                 ``Chapter 90--Long-Term Care Insurance

``Sec.
``9001. Definitions.
``9002. Eligibility to obtain coverage.
``9003. Contracting authority.
``9004. Long-term care benefits.
``9005. Financing.
``9006. Regulations.
``Sec. 9001. Definitions
    ``For purposes of this chapter, the term--
            ``(1) `activities of daily living' includes--
                    ``(A) eating;
                    ``(B) toileting;
                    ``(C) transferring;
                    ``(D) bathing;
                    ``(E) dressing; and
                    ``(F) continence;
            ``(2) `annuitant' has the meaning such term would have 
        under section 8901(3) if, for purposes of such paragraph, the 
        term `employee' were considered to have the meaning under 
        paragraph (7) of this section;
            ``(3) `appropriate Secretary' means--
                    ``(A) except as otherwise provided in this 
                paragraph, the Secretary of Defense;
                    ``(B) with respect to the United States Coast Guard 
                when it is not operating as a service of the Navy, the 
                Secretary of Transportation;
                    ``(C) with respect to the commissioned corps of the 
                National Oceanic and Atmospheric Administration, the 
                Secretary of Commerce;
                    ``(D) with respect to the commissioned corps of the 
                Public Health Service, the Secretary of Health and 
                Human Services; and
                    ``(E) with respect to members of the Foreign 
                Service, the Secretary of State;
            ``(4) `assisted living facility' has the meaning given such 
        term under section 232 of the National Housing Act (12 U.S.C. 
        1715w);
            ``(5) `carrier' means a voluntary association, corporation, 
        partnership, or other nongovernmental organization that is 
        lawfully engaged in providing, paying for, or reimbursing the 
        cost of, qualified long-term care services under group 
        insurance policies or contracts, or similar group arrangements, 
        in consideration of premiums or other periodic charges payable 
        to the carrier;
            ``(6) `eligible individual' means--
                    ``(A) an employee who has completed 6 months of 
                continuous service as an employee under other than a 
                temporary appointment limited to 6 months or less;
                    ``(B) an annuitant;
                    ``(C) a member of the uniformed services on active 
                duty for a period of more than 30 days or full-time 
                National Guard duty (as defined under section 101(d)(5) 
                of title 10) who satisfies such eligibility 
                requirements as the Office prescribes under section 
                9006(c);
                    ``(D) a member of the uniformed services entitled 
                to retired or retainer pay (other than under chapter 
                1223 of title 10) who satisfies such eligibility 
                requirements as the Office prescribes under section 
                9006(c);
                    ``(E) a member of the Foreign Service who--
                            ``(i) is described under section 103(1), 
                        (2), (3), (4), or (5) of the Foreign Service 
                        Act of 1980 (22 U.S.C. 3903(1), (2), (3), (4), 
                        or (5); and
                            ``(ii) satisfies such eligibility 
                        requirements as the Office prescribes under 
                        sanction 9006(c);
                    ``(F) a member of the Foreign Service entitled to 
                an annuity under the Foreign Service Retirement and 
                Disability System or the Foreign Service Pension System 
                who satisfies such eligibility requirements as the 
                Office prescribes under section 9006(c); or
                    ``(G) a qualified relative of a sponsoring 
                individual;
            ``(7) `employee' means--
                    ``(A) an employee as defined under section 8901(1) 
                (A) through (H); and
                    ``(B) an individual described under section 
                2105(e);
            ``(8) `home and community care' has the meaning given such 
        term under section 1929 of the Social Security Act (42 U.S.C. 
        1396t(a));
            ``(9) `long-term care benefits plan' means a group 
        insurance policy or contract, or similar group arrangement, 
        provided by a carrier for the purpose of providing, paying for, 
        or reimbursing expenses for qualified long-term care services;
            ``(10) `nursing home' has the meaning given such term under 
        section 1908 of the Social Security Act (42 U.S.C. 
        1396g(e)(1));
            ``(11) `Office' means the Office of Personnel Management;
            ``(12) `qualified long-term care services' has the meaning 
        given such term under section 7702B of the Internal Revenue 
        Code of 1986;
            ``(13) `qualified relative', as used with respect to a 
        sponsoring individual, means--
                    ``(A) the spouse of such sponsoring individual;
                    ``(B) a parent or parent-in-law of such sponsoring 
                individual; and
                    ``(C) any other person bearing a relationship to 
                such sponsoring individual specified by the Office in 
                regulations; and
            ``(14) `sponsoring individual' refers to an individual 
        described under paragraph (6)(A), (B), (C), or (D).
``Sec. 9002. Eligibility to obtain coverage
    ``(a) Any eligible individual may obtain long-term care insurance 
coverage under this chapter for such individual.
    ``(b)(1) As a condition for obtaining long-term care insurance 
coverage under this chapter based on an individual's status as a 
qualified relative, certification from the applicant's sponsoring 
individual shall be required as to--
            ``(A) such sponsoring individual's status, as described 
        under section 9001(6)(A), (B), (C), or (D) (as applicable), as 
        of the time of the qualified relative's application for 
        coverage; and
            ``(B) the existence of the claimed relationship as of that 
        time.
    ``(2) Any certification under paragraph (1) shall be submitted at 
such time and in such form and manner as the Office shall by regulation 
prescribe.
    ``(c) Nothing in this chapter shall be considered to require that 
long-term care insurance coverage be made available in the case of any 
individual who would be immediately benefit eligible.
``Sec. 9003. Contracting authority
    ``(a) Without regard to section 3709 of the Revised Statutes or 
other statute requiring competitive bidding, the Office may contract 
with qualified carriers to provide group long-term care insurance under 
this chapter, except that the Office may not have contracts in effect 
under this section with more than 3 qualified carriers.
    ``(b) To be considered a qualified carrier under this chapter, a 
company shall be licensed to issue group long-term care insurance in 
all the States and the District of Columbia.
    ``(c)(1) Each contract under this section shall contain a detailed 
statement of the benefits offered (including any maximums, limitations, 
exclusions, and other definitions of benefits), the rates charged 
(including any limitations or other conditions on any subsequent 
adjustment), and such other terms and conditions as may be mutually 
agreed to by the Office and the carrier involved, consistent with the 
requirements of this chapter.
    ``(2) The rates charged under any contract under this section shall 
reasonably reflect the cost of the benefits provided under such 
contract.
    ``(d) The benefits and coverage made available to individuals under 
any contract under this section shall be guaranteed to be renewable and 
may not be canceled by the carrier except for nonpayment of charges.
    ``(e) Each contract under this section shall require the carrier to 
agree to--
            ``(1) pay or provide benefits in an individual case if the 
        Office (or a duly designated third-party administrator) finds 
        that the individual involved is entitled to such payment or 
        benefit under the contract; and
            ``(2) participate in administrative procedures designed to 
        bring about the expeditious resolution of disputes arising 
        under such contract, including, in appropriate circumstances, 1 
        or more alternative means of dispute resolution.
    ``(f)(1)(A) Subject to subparagraph (B), each contract under this 
section shall be for a term of 5 years, but may be made automatically 
renewable from term to term in the absence of notice of termination by 
either party.
    ``(B) The rights and responsibilities of the enrolled individual, 
the insurer, and the Office (or duly designated third-party 
administrator) under any such contract shall continue until the 
termination of coverage of the enrolled individual.
    ``(2) Group long-term care insurance coverage obtained by an 
individual under this chapter shall terminate only upon the occurrence 
of--
            ``(A) the death of the insured;
            ``(B) exhaustion of benefits, as determined under the 
        contract;
            ``(C) insolvency of the insurer, as determined under the 
        contract; or
            ``(D) any event justifying a cancellation under subsection 
        (d).
    ``(3) Subject to paragraph (2), each contract under this section 
shall include such provisions as may be necessary to--
            ``(A) effectively preserve all parties' rights and 
        responsibilities under such contract notwithstanding the 
        termination of such contract (whether due to nonrenewal under 
        paragraph (1) or otherwise); and
            ``(B) ensure that, once an individual becomes duly 
        enrolled, long-term care insurance coverage obtained by such 
        individual under that enrollment shall not be terminated due to 
        any change in status (as described under section 9001(6)), such 
        as separation from Government service or the uniformed 
        services, or ceasing to meet the requirements for being 
        considered a qualified relative (whether due to divorce or 
        otherwise).
``Sec. 9004. Long-term care benefits
    ``(a) Benefits under this chapter shall be provided under qualified 
long-term care insurance contracts, within the meaning of section 7702B 
of the Internal Revenue Code of 1986.
    ``(b) Each contract under section 9003, in addition to any matter 
otherwise required under this chapter, shall provide for--
            ``(1) adequate consumer protections (including through 
        establishment of sufficient reserves or reinsurance);
            ``(2) adequate protections in the event of carrier 
        bankruptcy (or other similar event);
            ``(3) availability of benefits upon appropriate 
        certification as to an individual's--
                    ``(A) inability (without substantial assistance 
                from another individual) to perform at least 2 
                activities of daily living for a period of at least 90 
                days due to a loss of functional capacity;
                    ``(B) having a level of disability similar (as 
                determined under regulations prescribed by the 
                Secretary of the Treasury in consultation with the 
                Secretary of Health and Human Services) to the level of 
                disability described in subparagraph (A); or
                    ``(C) requiring substantial supervision to protect 
                such individual from threats to health and safety due 
                to severe cognitive impairment;
            ``(4) choice of cash or service benefits (such as the 
        expense-incurred method or the indemnity method);
            ``(5) inflation protection (whether through simple or 
        compounded adjustment of benefits); and
            ``(6) portability of benefits (consistent with section 9003 
        (d) and (f)).
    ``(c) To the maximum extent practicable, at least 1 of the policies 
being offered under this chapter shall, in addition to any matter 
otherwise required under this chapter, provide for--
            ``(1) length-of-benefit options;
            ``(2) options relating to the provision of coverage in a 
        variety of settings, including nursing homes, assisted living 
        facilities, and home and community care;
            ``(3) options relating to elimination periods;
            ``(4) options relating to nonforfeiture benefits; and
            ``(5) availability of benefits upon appropriate 
        certification of medical necessity (as defined by the Office in 
        consultation with the Secretary of Health and Human Services) 
        not satisfying the requirements of subsection (b)(3).
    ``(d)(1) The Office shall take all practicable measures to ensure 
that, at least 1 of the long-term care benefits plans available under 
this chapter shall be a Governmentwide long-term care benefits plan.
    ``(2) Neither subsection (c)(5) nor the exception under subsection 
(e) shall apply with respect to any Governmentwide plan under this 
subsection.
    ``(e) Nothing in this chapter shall be considered to permit or 
require the inclusion, in any contract, of provisions inconsistent with 
section 7702B of the Internal Revenue Code of 1986 or any other 
provision of such Code (except to the extent necessary to carry out 
subsection (c)(5)).
    ``(f) If a State (or the District of Columbia) imposes any 
requirement which is more stringent than the requirement imposed by 
subsection (b)(1), the requirement imposed by subsection (b)(1) shall 
be treated as met if the more stringent requirement of the State (or 
the District of Columbia) is met.
``Sec. 9005. Financing
    ``(a) Except as provided in subsection (b)(2), each individual 
having long-term care insurance coverage under this chapter shall be 
responsible for 100 percent of the charges for such coverage.
    ``(b)(1) The amount necessary to pay the charges for enrollment 
shall--
            ``(A) in the case of an employee, be withheld from the pay 
        of such employee;
            ``(B) in the case of an annuitant, be withheld from the 
        annuity of such annuitant;
            ``(C) in the case of a member of the uniformed services 
        described under section 9001(6)(C), be withheld from the basic 
        pay of such member; and
            ``(D) in the case of a member of the uniformed services 
        described in section 9001(6)(D), be withheld from the retired 
pay or retainer pay payable to such member.
    ``(2) Withholdings to pay the charges for enrollment of a qualified 
relative may, upon election of the sponsoring individual involved, be 
withheld under paragraph (1) in the same manner as if enrollment were 
for such sponsoring individual.
    ``(3) All amounts withheld under paragraph (1) or (2) shall be paid 
directly to the carrier.
    ``(c)(1) Any enrollee whose pay, annuity, or retired or retainer 
pay (as referred to in subsection (b)(1)) is insufficient to cover the 
withholding required for enrollment (or who is not receiving any 
regular amounts from the Government, as referred to in subsection 
(b)(1), from which any such withholdings may be made) shall pay an 
amount described under paragraph (2) (or, in the case of an enrollee 
not receiving any regular amounts, the full amount of those charges) 
directly to the carrier.
    ``(2) The amount referred to under paragraph (1) is the amount 
equal to the difference between the amount of withholding required for 
the enrollment and the amount actually withheld.
    ``(d) Each carrier participating under this chapter shall maintain 
all amounts received under this chapter separate from all other funds.
    ``(e) Contracts under this chapter shall include appropriate 
provisions under which each carrier shall reimburse the Office or other 
administering entity for the administrative costs incurred by the 
Office or such entity under this chapter (such as for dispute 
resolution) which are allocable to such carrier.
``Sec. 9006. Regulations
    ``(a) The Office shall prescribe regulations necessary to carry out 
this chapter.
    ``(b)(1) Subject to paragraph (2), the regulations of the Office 
shall prescribe the time at which and the manner and conditions under 
which an individual may obtain long-term care insurance under this 
chapter.
    ``(2) The regulations prescribed under this section shall provide 
for an open enrollment period at least once each year (similar to the 
open enrollment period provided under section 8905(f)).
    ``(c) Any regulations necessary to effect the application and 
operation of this chapter with respect to an eligible individual or a 
qualified relative of such individual shall be prescribed by the Office 
in consultation with the appropriate Secretary.''.

SEC. 3. EFFECTIVE DATE.

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