[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5139 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5139

  To amend title XVIII of the Social Security Act to provide certain 
  caregivers with access to Medicare benefits, to amend the Internal 
  Revenue Code of 1986 to provide a long-term care tax credit, and to 
provide for programs within the Department of Health and Human Services 
  and Department of Veterans Affairs for patients with fatal chronic 
                                illness.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 16, 2002

 Mr. Oberstar introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
 Ways and Means and Veterans' Affairs, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide certain 
  caregivers with access to Medicare benefits, to amend the Internal 
  Revenue Code of 1986 to provide a long-term care tax credit, and to 
provide for programs within the Department of Health and Human Services 
  and Department of Veterans Affairs for patients with fatal chronic 
                                illness.

    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 ``Living Well with 
Fatal Chronic Illness Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Access to medicare benefits for certain caregivers 55-to-65 
                            years of age.
Sec. 3. Long-term care tax credit.
Sec. 4. Department of Health and Human Services programs for patients 
                            with fatal chronic illnesses.
Sec. 5. Programs through Department of Veterans Affairs regarding 
                            patients with fatal chronic illnesses.

SEC. 2. ACCESS TO MEDICARE BENEFITS FOR CERTAIN CAREGIVERS 55-TO-65 
              YEARS OF AGE.

    (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--Purchase of Medicare Benefits by Certain Caregivers Age 55-
                           to-65 Years of Age

``SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY.

    ``(a) General Description of Program.--This part provides a program 
of medicare eligibility for those age 55 or older who are caring on a 
full-time basis for family members and who are not otherwise eligible 
for group health insurance coverage.
    ``(b) 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.
                    ``(D) Family member.--The term `family member' 
                includes a domestic partner or other significant 
                relationship recognized under law in the State in which 
                the person being cared for resides.
    ``(c) Eligibility.--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) Age.--As of the last day of the month, the individual 
        has attained 55 years of age, but has not attained 65 years of 
        age.
            ``(2) Medicare eligibility (but for age).--The individual 
        would be eligible for benefits under part A or part B for the 
        month if the individual were 65 years of age.
            ``(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 (b)(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.
            ``(4) Caregiver.--The individual is providing the majority 
        of care to a family member who--
                    ``(A) is entitled to benefits under part A, or 
                enrolled under part B; and
                    ``(B) requires substantial supervision due to 
                severe cognitive impairment or is unable to perform at 
                least 2 activities of daily living.
            ``(5) Limitation of 1 caregiver for each disabled eligible 
        beneficiary.--There is no other individual who is enrolled (or 
        enrolling) under this section on the basis of care provided to 
        the family member described in paragraph (4).

``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, and only during an enrollment period 
prescribed by the Secretary consistent with the provisions of this 
section. Such regulations shall provide a process under which 
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in 
subsection (b).
    ``(b) Enrollment Periods.--
            ``(1) In general.--In the case of individuals eligible to 
        enroll under this part under section 1859(c)--
                    ``(A) Individuals eligible at time program 
                begins.--If the individual is eligible to enroll under 
                such section for January 2003, the enrollment period 
                shall begin on November 1, 2002, and shall end on 
                February 28, 2003. Any such enrollment before January 
                1, 2003, is conditioned upon compliance with the 
                conditions of eligibility for January 2003.
                    ``(B) Individuals who become eligible later.--If 
                the individual becomes eligible to enroll under such 
                section for a month after January 2003, the enrollment 
                period shall be  the 4-month period beginning on the 
first day of the second month before the month in which the individual 
first is eligible to so enroll. Any such enrollment before the first 
day of the third month of such enrollment period is conditioned upon 
compliance with the conditions of eligibility for such third month.
            ``(2) Authority to correct for government errors.--The 
        provisions of section 1837(h) apply with respect to enrollment 
        under this part in the same manner as they apply to enrollment 
        under part B.
    ``(c) Date Coverage Begins.--
            ``(1) In general.--The period during which an individual is 
        entitled to benefits under this part shall begin as follows, 
        but in no case earlier than January 1, 2003:
                    ``(A) In the case of an individual who enrolls 
                (including pre-enrolls) before the month in which the 
                individual satisfies eligibility for enrollment under 
                section 1859, the first day of such month of 
                eligibility.
                    ``(B) In the case of an individual who enrolls 
                during or after the month in which the individual first 
                satisfies eligibility for enrollment under such 
                section, the first day of the following month.
            ``(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) General provisions.--
                            ``(i) 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.
                            ``(ii) Nonpayment of premiums.--The 
                        individual fails to make payment of premiums 
                        required for enrollment under this part.
                            ``(iii) Medicare eligibility.--The 
                        individual becomes entitled to benefits under 
                        part A or enrolled under part B (other than by 
                        reason of this part).
                    ``(B) Termination based on age.--The individual 
                attains 65 years of age.
                    ``(C) Obtaining access to employment-based coverage 
                or federal health insurance program.--The individual is 
                covered (or eligible for coverage) as a participant or 
                beneficiary under a group health plan or under a 
                Federal health insurance program.
                    ``(D) Termination of caregiving.--One year after 
                the date that the individual ceases to be providing the 
                caregiving described in section 1859(c)(4) for a period 
                of 4 consecutive weeks.
            ``(2) Effective date of termination.--
                    ``(A) Notice.--The termination of a coverage period 
                under paragraph (1)(A)(i) shall take effect at the 
                close of the month following the month in which the 
                notice is filed.
                    ``(B) Nonpayment of premium.--The termination of a 
                coverage period under paragraph (1)(A)(ii) shall take 
                effect on a date determined under regulations, which 
                may be determined so as to provide a grace period in 
                which overdue premiums may be paid and coverage 
                continued. The grace period determined under the 
                preceding sentence shall not exceed 60 days; except 
                that it may be extended for an additional 30 days in 
                any case where the Secretary determines that there was 
                good cause for failure to pay the overdue premiums 
                within such 60-day period.
                    ``(C) Age or medicare eligibility.--The termination 
                of a coverage period under paragraph (1)(A)(iii) or 
                (1)(B) 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).
                    ``(D) Access to coverage.--The termination of a 
                coverage period under paragraph (1)(C) shall take 
                effect on the date on which the individual is eligible 
                to begin a period of  creditable coverage (as defined 
in section 2701(c) of the Public Health Service Act) under a group 
health plan or under a Federal health insurance program.

``SEC. 1859B. PREMIUMS.

    ``(a) Amount of Monthly Premiums.--The Secretary shall, during 
September of each year (beginning with 2002), determine a premium rate 
which shall apply with respect to coverage provided under this title 
for any month in the succeeding year. Such rate for individuals 
residing in a premium area for most of any month in a year shall be 
equal to \1/12\ of the average, annual per capita amount estimated 
under subsection (b)(1) for the year, adjusted for such area under 
subsection (b)(2).
    ``(b) Annual Premium.--
            ``(1) National, per capita average.--The Secretary shall 
        estimate the average, annual per capita amount that would be 
        payable under this title with respect to individuals residing 
        in the United States who meet the requirement of section 
        1859(c)(1) as if all such individuals were eligible for (and 
        enrolled) under this title during the entire year (and assuming 
        that section 1862(b)(2)(A)(i) did not apply).
            ``(2) Geographic adjustment.--The Secretary shall adjust 
        the amount determined under paragraph (1) for each premium area 
        (specified under subsection (c)) in order to take into account 
        such factors as the Secretary deems appropriate and shall limit 
        the maximum premium under this paragraph in a premium area to 
        assure participation in all areas throughout the United States.
    ``(c) Establishment of Premium Areas.--For purposes of this part, 
the term `premium area' means such an area as the Secretary shall 
specify to carry out this part. The Secretary from time to time may 
change the boundaries of such premium areas. The Secretary shall seek 
to minimize the number of such areas specified under this paragraph.

``SEC. 1859C. PAYMENT OF PREMIUMS.

    ``(a) Payment of Monthly Premium.--
            ``(1) In general.--The Secretary shall provide for payment 
        and collection of the monthly premium, determined under section 
        1859B(a) for the premium area in which the individual 
        principally resides, in the same manner as for payment of 
        monthly premiums under section 1840, except that, for purposes 
        of applying this section, any reference in such section to the 
        Federal Supplementary Medical Insurance Trust Fund is deemed a 
        reference to the Trust Fund established under section 1859D.
            ``(2) Period of payment.--In the case of an individual who 
        participates in the program established by this title, the 
        monthly premium shall be payable for the period commencing with 
        the first month of the individual's coverage period and ending 
        with the month in which the individual's coverage under this 
        title terminates.
    ``(b) Application of Certain Provisions.--The provisions of section 
1840 (other than subsection (h)) shall apply to premiums collected 
under this section in the same manner as they apply to premiums 
collected under part B, except that any reference in such section to 
the Federal Supplementary Medical Insurance Trust Fund is deemed a 
reference to the Trust Fund established under section 1859D.

``SEC. 1859D. 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) Premiums.--Premiums collected under section 1859B 
        shall be transferred to the Trust Fund.
    ``(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. 1859E. OVERSIGHT AND ACCOUNTABILITY.

    ``(a) Through Annual Reports of Trustees.--The Board of Trustees of 
the Medicare Caregiver Trust Fund under section 1859D(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. 1859F. 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 access.--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''.

SEC. 3. LONG-TERM CARE TAX CREDIT.

    (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 25B the 
following new section:

``SEC. 25C. LONG-TERM CARE TAX 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 $3,000 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 (as defined in section 24(b)(1)) 
        exceeds the threshold amount (as defined in section 24(b)(2)).
            ``(2) Limitation based on amount of tax.--The credit 
        allowed under subsection (a) for any taxable year shall not 
        exceed the excess of--
                    ``(A) the sum of the regular tax liability (as 
                defined in section 26(b)) plus the tax imposed by 
                section 55, over
                    ``(B) the sum of the credits allowable under this 
                subpart (other than this section and sections 23 and 
                25B) and section 27 for the taxable year.
    ``(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 lack 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.
                            ``(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 200 
                        percent of the poverty level determined by 
                        using criteria of poverty established by the 
                        Bureau of the Census.
                            ``(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) Paragraph (1) of section 26(a) of such Code is amended 
        by striking ``and 25B'' and inserting ``25B, and 25C''.
            (2) Paragraph (2) of section 6213(g) of such Code is 
        amended by striking ``and'' at the end of subparagraph (L), by 
        striking the period at the end of subparagraph (M) and 
        inserting ``, and'', and by inserting after subparagraph (M) 
        the following new subparagraph:
                    ``(N) an omission of a correct TIN or physician 
                identification required under section 25C(d) (relating 
                to long-term care tax credit) to be included on a 
                return.''
            (3) 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 25B the following new item:

                              ``Sec. 25C. Long-term care tax credit.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2002.

SEC. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAMS FOR PATIENTS 
              WITH FATAL CHRONIC ILLNESSES.

    (a) Establishment of Programs.--The Secretary of Health and Human 
Services shall carry out research, demonstration, and education 
programs with respect to fatal chronic illness through the Public 
Health Service.
    (b) Studies on End-of-Life Care.--The Secretary shall conduct 
studies on end-of-life care through all relevant agencies and through 
the Assistant Secretary for Planning and Evaluation. Such studies shall 
include an examination of the development of practice parameters 
applicable to such care as well as research regarding such care. Such 
studies shall also include an annual report from the Secretary to the 
appropriate committees for oversight in Congress and to the Special 
Committee on Aging in the Senate on service delivery and quality of 
life for persons living through fatal chronic illness and their 
families and professional caregivers.
    (c) Health Resources and Services Administration.--
            (1) In general.--In carrying out subsection (a), the 
        Secretary, acting through the Administrator of the Health 
        Resources and Services Administration, shall carry out 
        research, demonstration, and education programs toward 
        improving the delivery of appropriate health and support 
        services for patients with fatal chronic illnesses.
            (2) Health centers.--As determined appropriate by the 
        Secretary, paragraph (1) may be carried out through the program 
        under section 330 of the Public Health Service Act (relating to 
        community and migrant health centers and health centers 
        regarding homeless individuals and residents of public 
        housing), including by designating individuals with fatal 
        chronic illnesses as medically underserved populations.
            (3) Caregivers.--Programs under paragraph (1) shall include 
        activities regarding appropriate support services for 
caregivers for patients with fatal chronic illness, including respite 
care.
            (4) Health professions training.--Programs under paragraph 
        (1) shall include making awards of grants or contracts to 
        public and nonprofit private entities for the purpose of 
        training health professionals, including students attending 
        health professions schools, in the care of patients with fatal 
        chronic illnesses. Such training shall include training in the 
        provision of appropriate palliative care and appropriate 
        referral to hospices, and training provided as continuing 
        education.
            (5) Initiative.--Programs under paragraph (1) shall include 
        an initiative to coordinate innovation, evaluation, and service 
        delivery relating to fatal chronic illnesses.
    (d) Agency for Healthcare Research and Quality.--
            (1) In general.--In carrying out section 912(c) of the 
        Public Health Service Act, the Secretary, acting through the 
        Director of the Agency for Healthcare Research and Quality, 
        shall, with respect to patients with fatal chronic illnesses--
                    (A) identify the causes of preventable health care 
                errors and patient injury in health care delivery, 
                including errors of inadequate mobilization of services 
                to the home, inadequate continuity of caregivers, 
                inadequate symptom prevention, management, and relief, 
                or inadequate advance care planning;
                    (B) develop, demonstrate, and evaluate strategies 
                for reliable performance of the care system, including 
                reducing errors and improving patient safety and health 
                outcomes; and
                    (C) disseminate such effective strategies 
                throughout the health care industry.
            (2) Grants.--In carrying out paragraph (1)(A), the 
        Secretary shall make grants for the purpose of developing 
        reliable and current data and insight as to the merits and 
        efficiencies of various strategies for providing health care, 
        including palliative and hospice care, and social services for 
        patients with fatal chronic illnesses.
    (e) Centers for Disease Control and Prevention.--The Director of 
the Centers for Disease Control and Prevention shall expand activities 
with respect to epidemiology and public health in fatal chronic 
illness. Such activities may include contracting with the Institute of 
Medicine or another national interest non-profit organization to 
provide a review of the status of care for the end of life, which 
review shall be included by the Secretary in the annual reports to 
Congress under subsection (h).
    (f) National Institutes of Health.--
            (1) Expansion of activities.--The Director of the National 
        Institutes of Health (in this subsection referred to as the 
        ``Director'') shall expand, intensify, and coordinate the 
        activities of the National Institutes of Health with respect to 
        research on fatal chronic illness. Such activities shall 
        include programs, requests for proposals, study section 
        membership, advisory council membership, and training programs 
        to support rapid and substantial improvements in 
        understanding--
                    (A) mechanisms of disability and suffering in fatal 
                chronic illness and the relief and management of that 
                disability and suffering through to end of life; and
                    (B) human resources, service delivery arrangements, 
                technology, and financing that would be most useful in 
                ensuring comfort and dignity for individuals with fatal 
                chronic illness, and in relieving the burden for family 
                and professional caregivers.
            (2) Administration.--The Director shall carry out this 
        subsection acting through the Directors of every Institute 
        within the National Institutes of Health that has at least one 
        fatal chronic illness in its purview.
            (3) Collaboration.--In carrying out this subsection, the 
        Director of the National Institutes of Health shall collaborate 
        with the Department of Veterans Affairs, the Agency for 
        Healthcare Research and Quality, and any other agency that the 
        Director determines appropriate. The Secretary of Veterans 
        Affairs and the Director of the Agency for Healthcare Research 
        and Quality shall assist in such collaboration.
            (4) Responsibilities of institutes.--Each Institute within 
        the National Institutes of Health that has fatal chronic 
        illness in its purview shall establish a plan for improving 
        understanding of the mechanisms of disability and suffering in 
        fatal chronic illness and the relief and management of that 
        disability and suffering through to end of life. Since most 
        Americans now die of chronic heart or lung failure, cancer, 
        stroke, dementia, or multifactorial frailty, each such 
        Institute shall develop and implement a strategic plan and a 
        set of projects that aim primarily to ensure that affected 
        patients and their families can live through advanced illness 
        and death comfortably and meaningfully.
            (5) Centers of excellence.--
                    (A) In general.--In carrying out paragraph (1), the 
                Director shall make awards of grants and contracts to 
                public or nonprofit private entities for the 
                establishment and operation of centers of excellence to 
                carry out research, demonstration, and education 
                programs regarding fatal chronic illness, including 
                programs regarding palliative care.
                    (B) Designation.--In carrying out this subsection, 
                the Director shall designate at least 2 Claude D. 
                Pepper Older Americans Independence Centers (supported 
                by the National Institute on Aging), 2 program projects 
                of the National, Heart, Lung, and Blood Institute, and 
                2 comprehensive cancer centers (supported by the 
                National Cancer Institute) to provide education and 
                information support and research data and methods 
                leadership for substantial and rapid improvements in 
                the understanding of the mechanisms of disability and 
                suffering in fatal chronic illness and the relief and 
                management of that disability and suffering through to 
                the end of life.
                    (C) Research.--Each center established or operated 
                under subparagraph (A) or designated under subparagraph 
                (B) shall conduct basic and clinical research into 
                fatal chronic illness.
                    (D) Certain activities.--The Secretary shall ensure 
                that, with respect to the geographic area in which a 
                center of excellence under subparagraph (A) is located, 
                the activities of the center include--
                            (i) providing information and education 
                        regarding fatal chronic illness to health 
                        professionals and the public;
                            (ii) serving as a resource through which 
                        health professionals, and patients and their 
                        caregivers, can plan and coordinate the 
                        provision of health and support services 
                        regarding fatal chronic illness; and
                            (iii) providing training and support of 
                        implementation of quality improvement.
    (g) Medicare Pilot Programs for Treatment of Fatal Chronic 
Illnesses.--
            (1) Establishment.--The Secretary, in all relevant parts of 
        the Department of Health and Human Services, including the 
        Centers for Medicare & Medicaid Services and the Office of the 
        Assistant Secretary for Planning and Evaluation, shall provide 
        for pilot programs under this subsection. The pilot programs 
        shall be developed under a coordinated national effort in order 
        to demonstrate innovative, effective means of delivering care 
        to Medicare beneficiaries with fatal chronic illnesses under 
        the Medicare program. The pilot programs shall be completed 
        within 5 years after the date that funds are first appropriated 
        under this subsection.
            (2) Design.--The pilot programs under this subsection shall 
        be designed to learn how--
                    (A) to effectively and efficiently deliver quality 
                care to the fatally chronically ill;
                    (B) to provide and maintain continuity of care for 
                the fatally chronically ill;
                    (C) to provide advance care planning to the fatally 
                chronically ill;
                    (D) to determine what rate and strategies for 
                payment are most appropriate;
                    (E) to deliver emergency care for the fatally 
                chronically ill;
                    (F) to facilitate access to hospice care when the 
                Medicare beneficiary becomes eligible for such care;
                    (G) to develop and estimate the effect of potential 
                alternative severity criteria for eligibility of 
                specially tailored programs;
                    (H) to test the effectiveness and costs of new 
                strategies for family caregivers support;
                    (I) to implement a clinical services and payment 
                program that uses thresholds of severity to define the 
                onset of the need for comprehensive end-of-life 
                services;
                    (J) to test the merits of using severity criteria 
                (relating to fatal chronic illness) in determining 
                eligibility for the Medicare hospice program, but only 
                when use of such criteria expands access to hospice 
                care to individuals who are not yet terminally ill (as 
                that term is defined at section 1861(dd)(3)(A) of the 
                Social Security Act); and
                    (K) to arrange financial incentives so that 
                substantially diminished payments arise when care 
                providers fail to ensure timely advance care planning, 
                symptom prevention, management, and relief, or 
                continuity of care across time and settings.
            (3) Conduct of pilot programs.--The Secretary shall conduct 
        pilot programs in at least 6 sites and in at least 3 States.
            (4) Report to congress.--The Secretary shall submit to 
        Congress a report on the pilot programs under this subsection. 
        Such report shall include recommendations regarding whether the 
        pilot programs should become a permanent part of the Medicare 
        program.
    (h) Annual Reports.--The Secretary, in consultation with the 
Secretary of Veterans Affairs and other appropriate Federal agencies, 
shall submit an annual report to Congress on end-of-life care and on 
the research, demonstration, and education programs and studies 
conducted under this section. The Centers for Disease Control and 
Prevention shall be the lead agency for integrating and preparing the 
annual reports under this subsection unless the Secretary designates 
otherwise.
    (i) Definitions.--For purposes of this section:
            (1) The term ``fatal chronic illness'' means a disease (or 
        diseases), condition (or conditions), or disorder (or 
        disorders) that ordinarily worsens and causes death and that 
        causes a physical or mental disability or periodic episodes of 
        significant loss of functional capacity.
            (2) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated--
            (1) such sums as may be necessary to carry out subsections 
        (a), (b), (e), and (f);
            (2) $50,000,000 for the 5-fiscal-year period (beginning 
        with fiscal year 2004) to carry out subsection (c), excluding 
        paragraph (5) of that subsection;
            (3) $100,000,000 for the 3-fiscal-year period (beginning 
        with fiscal year 2004) to carry out subsection (c)(5);
            (4) $20,000,000 for the 5-fiscal-year period (beginning 
        with fiscal year 2004) to carry out subsection (d);
            (5) to carry out subsection (g) for each of fiscal years 
        2003 through 2007--
                    (A) $50,000,000 for the purposes of conducting 
                evaluations of pilot programs; and
                    (B) $50,000,000 for the purpose of providing 
                clinical services under pilot programs; and
            (6) $500,000 for each fiscal year during the 5-fiscal-year 
        period beginning with fiscal year 2004 to carry out subsection 
        (h).

SEC. 5. PROGRAMS THROUGH DEPARTMENT OF VETERANS AFFAIRS REGARDING 
              PATIENTS WITH FATAL CHRONIC ILLNESSES.

    (a) In General.--(1) Chapter 73 of title 38, United States Code, is 
amended by adding at the end of subchapter II the following new 
section:
``Sec. 7324. Programs for patients with fatal chronic illnesses
    ``(a) Establishment of Programs.--(1) The Secretary shall develop 
and carry out programs to improve the delivery of appropriate health 
and support services for patients with fatal chronic illnesses. As part 
of such programs, the Secretary shall seek to develop services in 
collaboration with community service providers serving populations of 
persons other than veterans, especially those populations that use the 
Medicare program.
    ``(2) For purposes of this section, community service providers are 
entities outside the Department that provide health care services to 
persons in the communities in which they are located.
    ``(b) Role of GRECCs and Health Services Research.--The Secretary 
shall take appropriate steps to involve in programs under this section 
both geriatric research, education, and clinical centers under section 
7314 of this title and activities of Health Services research and 
quality improvement initiatives of the Department. As part of such 
steps, the Secretary shall seek to target the work of such centers and 
initiatives to improve care for veterans with fatal chronic illnesses.
    ``(c) Training.--In conducting programs of professional training 
and staff development for health-care personnel of the Department and 
persons being trained through health-care programs conducted by the 
Secretary, the Secretary shall ensure that such programs include 
training in pain relief and end-of-life care for persons with fatal 
chronic illnesses. Such training shall address symptoms, advance care 
planning, and quality improvement for those with fatal chronic 
illnesses.
    ``(d) Annual Report.--The Secretary shall prepare an annual report 
on care for veterans with fatal chronic illnesses and the activities of 
the Secretary under this section. The Secretary shall furnish such 
report to the Secretary of Health and Human Services each year in 
sufficient time for inclusion in the annual report of that Secretary 
under section 4(j) of the Living Well with Fatal Chronic Illness Act of 
2002.
    ``(e) Cooperation With Community Service Providers.--(1) In 
carrying out this section, the Secretary shall, to the extent 
practicable, take appropriate steps, through collaborative agreements 
or otherwise, to cooperate with community service providers that 
provide home and hospice care.
    ``(2) Such steps shall, to the extent practicable, include--
            ``(A) developing documentation of advance care plans for 
        persons with fatal chronic illnesses that are acceptable to all 
        providers of care for those persons;
            ``(B) developing service programs for persons with fatal 
        chronic illnesses under which Department facilities or 
        personnel may be used for part of the array of services 
        provided to such persons; and
            ``(C) developing protocols that facilitate the placement 
        with community service providers supported by the medicare or 
        medicaid programs of veterans with fatal chronic illnesses when 
        such a placement would be more efficient or effective for the 
        timely provision of services for the community in which the 
        facilities are located and for such veterans than the provision 
        of those services directly through Department facilities.
    ``(3) When the Secretary, as part of service programs authorized by 
this subsection, provides services to a person with a fatal chronic 
illness who is not a veteran, the Secretary shall, as a condition of 
providing such services, be reimbursed by appropriate community service 
providers for the costs of such services.
    ``(f) Support for Volunteer and Community Support of Veterans 
Living at Home.--The Secretary shall make grants to support volunteer 
and community support of veterans living at home who have fatal chronic 
illnesses. The Secretary may establish the minimum number of volunteers 
an entity must have in order to be eligible for a grant under this 
subsection.
    ``(g) Definition.--For purposes of this section, the term `fatal 
chronic illness' means a disease (or diseases), condition (or 
conditions), or disorder (or disorders) that ordinarily worsens and 
causes death and that causes a physical or mental disability or 
periodic episodes of significant loss of functional capacity.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 7323 the 
following new item:

``7324. Programs for patients with fatal chronic illnesses.''.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Veterans Affairs to carry out section 
7324 of title 38, United States Code, as added by subsection (a), the 
amount of $5,000,000 for each of fiscal years 2003 through 2007.
                                 <all>