[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2883 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2883

  To amend the Internal Revenue Code of 1986 to provide a refundable 
   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 24, 2003

  Mr. Oberstar (for himself and Mr. Ramstad) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
    addition to the Committees on Energy and Commerce 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 the Internal Revenue Code of 1986 to provide a refundable 
   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 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Refundable long-term care tax credit.
Sec. 3. Department of Health and Human Services programs for patients 
                            with fatal chronic illnesses.
Sec. 4. Programs through Department of Veterans Affairs regarding 
                            patients with fatal chronic illnesses.

SEC. 2. REFUNDABLE LONG-TERM CARE TAX CREDIT.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable credits) 
is amended by inserting after section 35 the following new section:

``SEC. 35A. LONG-TERM CARE TAX CREDIT.

    ``(a) Allowance of Credit.--There shall be allowed as a credit 
against the tax imposed by this subtitle 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 (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting before the period ``, or 
        from section 35A of such Code''.
            (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 C of part IV of 
        subchapter A of chapter 1 of such Code is amended by inserting 
        after the item relating to section 35 the following new item:

                              ``Sec. 35A. 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. 3. 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. 4. 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 3(j) of the Living Well with Fatal Chronic Illness Act of 
2003.
    ``(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.
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