1.Short title; table of contents
(a)This Act may be cited as the Ronald Reagan Alzheimer’s Breakthrough Act of 2004
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents
Sec. 2. Findings
Title I—Increasing the Federal commitment to alzheimer’s research
Sec. 101. Doubling NIH funding for Alzheimer’s disease research
Sec. 102. Priority to Alzheimer’s disease research
Sec. 103. Alzheimer’s disease prevention initiative
Sec. 104. Alzheimer’s disease clinical research
Sec. 105. Research on Alzheimer’s disease caregiving
Sec. 106. National summit on Alzheimer’s disease
Title II—Public education about alzheimer’s disease
Sec. 201. Public education campaign
Title III—Assistance for caregivers
Sec. 301. Increased funding for National Family Caregiver Support Program
Sec. 302. Alzheimer’s disease demonstration grants
Sec. 303. Safe return program
Sec. 304. Lifespan respite care
Sec. 305. Credit for taxpayers with long-term care needs
Sec. 306. Treatment of premiums on qualified long-term care insurance contracts
Sec. 307. Additional consumer protections for long-term care insurance
2.Congress makes the following findings:
(1)Alzheimer’s disease is a disorder that destroys cells in the brain. The disease is the leading cause of dementia, a condition that involves gradual memory loss, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impairment of judgment, and personality changes. As the disease progresses, people with Alzheimer’s disease become unable to care for themselves. The loss of brain cells eventually leads to the failure of other systems in the body.
(2)An estimated 4,500,000 Americans have Alzheimer’s disease and 1 in 10 people have a family member with the disease. By 2050, the number of individuals with the disease could range from 13,000,000 to 16,000,000 unless science finds a way to prevent or cure the disease.
(3)One in 10 people over the age of 65, and nearly half of those over the age of 85 have Alzheimer’s disease. Younger people also get the disease.
(4)The Alzheimer’s disease process may begin in the brain as many as 20 years before the symptoms of Alzheimer’s disease appear. A person will live an average of 8 years and as many as 20 once the symptoms of Alzheimer’s disease appear.
(5)The average lifetime cost of care for an individual with Alzheimer’s disease is $170,000.
(6)In 2000, medicare alone spent $31,900,000,000 for the care of individuals with Alzheimer’s disease and this amount is projected to increase to $49,300,000,000 in 2010.
(7)Forty-nine percent of medicare beneficiaries who have Alzheimer’s disease also receive medicaid. Of the total population dually eligible for medicare and medicaid, 22 percent have Alzheimer’s disease.
(8)Seven in 10 people with Alzheimer’s disease live at home. While almost 75 percent of home care is provided by family and friends, the average annual cost of paid care for people with Alzheimer’s disease at home is $12,500 per year. Almost all families pay this cost out of pocket.
(9)Half of all nursing home residents have Alzheimer’s disease or a related disorder. The average annual cost of Alzheimer’s disease nursing home care is nearly $64,000. Medicaid pays nearly half of the total nursing home bill and helps 2 out of 3 residents pay for their care. Medicaid expenditures for nursing home care for people with Alzheimer’s disease are estimated to increase from $18,200,000,000 in 2000 to $33,000,000,000 in 2010.
(10)In fiscal year 2004, the Federal Government will spend an estimated $680,000,000 on Alzheimer’s disease research. If our Nation achieves its research goals (preventing the onset of Alzheimer’s disease in those at risk and treating and delaying progression of the disease in those who have symptoms), the projected number of cases of Alzheimer’s disease can be reduced by more than one-third by the middle of the century. The number of baby boomers with moderate to severe Alzheimer’s disease can be reduced by 60 percent.
(11)A study commissioned by the United Hospital Fund estimated that the annual value of this informal care system is $257,000,000,000. Family caregiving comes at enormous physical, emotional, and financial sacrifice, putting the whole system at risk.
(12)One in 8 Alzheimer’s disease caregivers becomes ill or injured as a direct result of caregiving. One in 3 uses medication for problems related to caregiving. Older caregivers are 3 times more likely to become clinically depressed than others in their age group.
(13)Elderly spouses strained by caregiving are 63 percent more likely to die during a given 4-year period than other spouses their age.
(14)Almost 3 of 4 caregivers are women. One in 3 has children or grandchildren under the age of 18 living at home. Caregiving leaves them less time for other family members and they are much more likely to report family conflicts because of their caregiving role.
(15)Most Alzheimer’s disease caregivers work outside the home before beginning their caregiving careers, but caregiving forces them to miss work, cut back to part-time, take less demanding jobs, choose early retirement, or give up work altogether. As a result, in 2002, Alzheimer’s disease cost American business an estimated $36,500,000,000 in lost productivity, as well as an additional $24,600,000,000 in business contributions to the total cost of care.
<enum>I</enum><header>Increasing the Federal commitment to alzheimer’s research</header>
<section id="HDEB4FD44039A49E48D51873218F446F6"><enum>101.</enum><header>Doubling NIH funding for alzheimer’s disease research</header>
<subsection id="HB56D1524E61341BA9F8C69CA4EE3ACE3"><enum>(a)</enum><header>In General</header><text>For the purpose of conducting and supporting research on Alzheimer’s disease (including related activities under subpart 5 of part C of title IV of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e">42 U.S.C. 285e et seq.</external-xref>) there is authorized to be appropriated $1,400,000,000 for fiscal year 2005, and such sums as may be necessary for each of fiscal years 2006 through 2009.</text></subsection>
<subsection id="H65A5B4D0D6A743A1A26074BB03735F54"><enum>(b)</enum><header>Aging process regarding women</header><text>Section 445H(b) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e-10">42 U.S.C. 285e–10(b)</external-xref>) is amended by striking <quote>2003</quote> and inserting <quote>2009</quote>.</text></subsection>
<subsection id="H1D0CC86F0CF94614A1472DB4338950F"><enum>(c)</enum><header>Clinical research and training awards</header><text>Section 445I(d) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C. 285e–10a(d)) is amended by striking <quote>2005</quote> and inserting <quote>2009</quote>.</text></subsection></section>
<section id="H084B7B6F4563408DB949BF009EA03900"><enum>102.</enum><header>Priority to alzheimer’s disease research</header><text display-inline="no-display-inline">Section 443 of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e">42 U.S.C. 285e</external-xref>) is amended—</text>
<paragraph id="HCB9B164280194070BD18FD7E7BBAEF52"><enum>(1)</enum><text>by striking <quote>The general</quote> and inserting <quote>(a) <header-in-text level="subsection">In General</header-in-text>.—The general</quote>; and</text></paragraph>
<paragraph id="H478C43F427C742A1009F3FB8B5A36339"><enum>(2)</enum><text>by adding at the end the following:</text>
<quoted-block id="H32E23A1A3CD4451B987484E0AEBF34CD">
<subsection id="H030AA17567AB41698681163EE7788440"><enum>(b)</enum><header>Priorities</header><text>The Director of the Institute shall, in expending amounts appropriated under this subpart, give priority to conducting and supporting Alzheimer’s disease research.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section id="H121FDBFA601C4D1292FBCD6D4B6D093"><enum>103.</enum><header>Alzheimer’s disease prevention initiative</header><text display-inline="no-display-inline">Section 444 of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e-1">42 U.S.C. 285e–1</external-xref>) is amended—</text>
<paragraph id="H685AEFFBE6514BF6966333F652A3D100"><enum>(1)</enum><text>in subsection (d), by inserting <quote>and training</quote> after <quote>conduct research</quote>; and</text></paragraph>
<paragraph id="H9AF8FFE24B9B4822A513EC4B92039189"><enum>(2)</enum><text>by adding at the end the following:</text>
<quoted-block id="HB2578F40D0E841C4BBBD56D65FBDDEF6">
<subsection id="HD43F83F22E12416084F10073E91CE564"><enum>(e)</enum><text>The Director of the National Institutes of Health shall, in collaboration with the Director of the Institute, the directors of other relevant institutes, and with volunteer organizations and other stakeholders, undertake an Alzheimer’s Disease Prevention Initiative to—</text>
<paragraph id="H3A8C6D8EB2194C11813317855515D3A9"><enum>(1)</enum><text>accelerate the discovery of new risk and protective factors for Alzheimer’s disease;</text></paragraph>
<paragraph id="H6AA40B9580F040129C4E76EE09D90200"><enum>(2)</enum><text>rapidly identify candidate diagnostics, therapies, or preventive interventions or agents for clinical investigation and trials relating to Alzheimer’s disease;</text></paragraph>
<paragraph id="HEA306E05689645B5BB782EC6FA2DDDA5"><enum>(3)</enum><text>support or undertake such investigations and trials; and</text></paragraph>
<paragraph id="HA7631AB45E7D4D97BA4B8E179E4FE571"><enum>(4)</enum><text>implement effective prevention and treatment strategies, including strategies to improve patient care and alleviate caregiver burdens relating to Alzheimer’s disease.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section id="HC1E3488B6B934290B246B81D6EAEAEB9"><enum>104.</enum><header>Alzheimer’s disease clinical research</header>
<subsection id="HF8C4EFAA26F44F0899E9C282446151AC"><enum>(a)</enum><header>Clinical research</header><text>Section 445F of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e-8">42 U.S.C. 285e–8</external-xref>) is amended to read as follows:</text>
<quoted-block act-name="Public Health Service Act" id="HBE93148E90C5416BA613A535260404F1">
<section id="HE11AF04B07E84D55AF2033EF3064436E"><enum>445F.</enum><header>Alzheimer’s disease clinical research</header>
<subsection id="H00A38F2CACB64140A287404CCBAAE2E"><enum>(a)</enum><header>In General</header><text>The Director of the Institute, pursuant to subsections (d) and (e) of section 444, shall conduct and support cooperative clinical research regarding Alzheimer’s disease. Such research shall include—</text>
<paragraph id="HEA8ED180DE874FB6B602641C0477AB9B"><enum>(1)</enum><text>investigating therapies, interventions, and agents to detect, treat, slow the progression of, or prevent Alzheimer’s disease;</text></paragraph>
<paragraph id="HD58A5BD09C454B8BB042B9323211A854"><enum>(2)</enum><text>enhancing the national infrastructure for the conduct of clinical trials;</text></paragraph>
<paragraph id="H17941033494D4C5DB5803000EF2EAAA"><enum>(3)</enum><text>developing and testing novel approaches to the design and analysis of such trials;</text></paragraph>
<paragraph id="H106DA0B887A54EB5B95BFCE91A6FFE7"><enum>(4)</enum><text>facilitating the enrollment of patients for such trials, including patients from diverse populations;</text></paragraph>
<paragraph id="H2EA97B89A7644D26BA10C2469094039"><enum>(5)</enum><text>developing improved diagnostics and means of patient assessment for Alzheimer’s disease; and</text></paragraph>
<paragraph id="H88ED0A7FA78541DDA3B6CB3B4361F249"><enum>(6)</enum><text>as determined appropriate by the Director of the Institute, the Alzheimer’s Disease Centers and Alzheimer’s Disease Research Centers established under section 445.</text></paragraph></subsection>
<subsection id="H425002E5988C46D380302BFF7D1C7973"><enum>(b)</enum><header>Early diagnosis and detection research</header>
<paragraph id="HCBB9F86691404E519B9C11A4341E6BE6"><enum>(1)</enum><header>In General</header><text>The Director of the Institute, in consultation with the directors of other relevant institutes and centers of the National Institutes of Health, shall conduct, or make grants for the conduct of, research related to the early detection and diagnosis of Alzheimer’s disease and of mild cognitive impairment or other potential precursors to Alzheimer’s disease.</text></paragraph>
<paragraph id="H52F00121C9464AC1A75FE70629E74948"><enum>(2)</enum><header>Evaluation</header><text>The research described in paragraph (1) may include the evaluation of diagnostic tests and imaging techniques.</text></paragraph></subsection>
<subsection id="H602443442AC245C395BC8E46B5DEC000"><enum>(c)</enum><header>Vascular disease</header><text>The Director of the Institute, in consultation with the directors of other relevant institutes and centers of the National Institutes of Health, shall conduct, or make grants for the conduct of, research related to the relationship of vascular disease and Alzheimer’s disease, including clinical trials to determine whether drugs developed to prevent cerebrovascular disease can prevent the onset or progression of Alzheimer’s disease.</text></subsection>
<subsection id="HAC3F201DD7264524AB4121397E72A128"><enum>(d)</enum><header>National alzheimer’s coordinating center</header><text>The Director of the Institute may establish a National Alzheimer’s Coordinating Center to facilitate collaborative research among the Alzheimer’s Disease Centers and Alzheimer’s Disease Research Centers established under section 445.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H771817BB76B54BB1AB441CB67285E819"><enum>(b)</enum><header>Alzheimer’s disease Centers</header><text>Section 445(a)(1) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e-2">42 U.S.C. 285e–2(a)(1)</external-xref>) is amended by inserting <quote>, and outcome measures and disease management</quote> after <quote>treatment methods</quote>.</text></subsection></section>
<section id="H715EF534D7EC4639882CDB166371376"><enum>105.</enum><header>Research on alzheimer’s disease caregiving</header><text display-inline="no-display-inline">Section 445C of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/285e-5">42 U.S.C. 285e–5</external-xref>) is amended—</text>
<paragraph id="HB14834D13B4A42DD89F91EA4155F5E71"><enum>(1)</enum><text>by striking <quote>Sec. 445C. (a)</quote> and inserting the following:</text>
<quoted-block id="H99066EB79F284B77B28885E900595624">
<section id="H2D18EFFD197447EF99D00D38C7446AD"><enum>445C.</enum><header>Research on alzheimer’s disease services and caregiving</header>
<subsection id="H0B8782D584C14BF4B316185836E1E500"><enum>(a)</enum><header>Services research</header></subsection></section><after-quoted-block>;</after-quoted-block></quoted-block></paragraph>
<paragraph id="HA1C680D1374046898995B7BADC1EA340"><enum>(2)</enum><text>by striking subsections (b), (c), and (e);</text></paragraph>
<paragraph id="H3B69481032AD49BA85FB8E9C0149D3C"><enum>(3)</enum><text>by inserting after subsection (a) the following:</text>
<quoted-block id="H4AF69DE422DE442E81D403DEF4EF8DF3">
<subsection id="HE7A0C717E7CA4753A0556F11E76EE9AE"><enum>(b)</enum><header>Interventions research</header><text>The Director shall, in collaboration with the directors of the other relevant institutes and centers of the National Institutes of Health, conduct, or make grants for the conduct of, clinical, social, and behavioral research related to interventions designed to help caregivers of patients with Alzheimer’s disease and related disorders and improve patient outcomes.</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph id="H2C7D3FE57CC94268AF063EA5E8E19AA"><enum>(4)</enum><text>in subsection (d) by striking <quote>(d) the Director</quote> and inserting <quote>(c)<header-in-text level="subsection">Model Curricula and Techniques</header-in-text>. —The Director</quote>.</text></paragraph></section>
<section id="H58FC98D81CF8400ABE025FD891CBE736"><enum>106.</enum><header>National summit on alzheimer’s disease</header>
<subsection id="HFFF1A00BD2DB4E808CDD997BE633CAF"><enum>(a)</enum><header>In General</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the <quote>Secretary</quote>) shall convene a summit of researchers, representatives of academic institutions, Federal and State policymakers, public health professionals, and representatives of voluntary health agencies to provide a detailed overview of current research activities at the National Institutes of Health, as well as to discuss and solicit input related to potential areas of collaboration between the National Institutes of Health and other Federal health agencies, including the Centers for Disease Control and Prevention, the Administration on Aging, the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration, related to research, prevention, and treatment of Alzheimer’s disease.</text></subsection>
<subsection id="HF78F77753F1C4D8AAA2EE9FA3CE4C1D"><enum>(b)</enum><header>Focus areas</header><text>The summit convened under subsection (a) shall focus on—</text>
<paragraph id="H9750DC11DE8C4D54A2B6B89E64E25C8B"><enum>(1)</enum><text>a broad range of Alzheimer’s disease research activities relating to biomedical research, prevention research, and caregiving issues;</text></paragraph>
<paragraph id="HD8A8B974726E49588E778F33F11C8DA1"><enum>(2)</enum><text>clinical research for the development and evaluation of new treatments for the disease;</text></paragraph>
<paragraph id="H4475049A528B4A928B813B71D975EEC"><enum>(3)</enum><text>translational research on evidence-based and cost-effective best practices in the treatment and prevention of the disease;</text></paragraph>
<paragraph id="H9DE3A2736E284D2A9B0745BF71E6971E"><enum>(4)</enum><text>information and education programs for health care professionals and the public relating to the disease;</text></paragraph>
<paragraph id="H97C1AC588E84408BB5B829256F4EBD65"><enum>(5)</enum><text>priorities among the programs and activities of the various Federal agencies regarding such diseases; and</text></paragraph>
<paragraph id="H75FFBB048CDD4136A06BC41B101E63CC"><enum>(6)</enum><text>challenges and opportunities for scientists, clinicians, patients, and voluntary organizations relating to the disease.</text></paragraph></subsection>
<subsection id="HDB72D7318D3A4E63B701CFD29B05A5F6"><enum>(c)</enum><header>Report</header><text>Not later than 180 days after the date on which the National Summit on Alzheimer’s Disease is convened under subsection (a), the Director of National Institutes of Health shall prepare and submit to the appropriate committees of Congress a report that includes a summary of the proceedings of the summit and a description of Alzheimer’s research, education, and other activities that are conducted or supported through the national research institutes.</text></subsection>
<subsection id="H07811C8F06D1471A92ACEA7C62F16F2E"><enum>(d)</enum><header>Public information</header><text>The Secretary shall make readily available to the public information about the research, education, and other activities relating to Alzheimer’s disease and other related dementias, conducted or supported by the National Institutes of Health.</text></subsection>
<subsection id="H375D405BE6084200A55155A807837436"><enum>(e)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2005 through 2009.</text></subsection></section>
<enum>II</enum><header>Public education about alzheimer’s disease</header>
<section id="H3A79A029BB8F47F9A900FC704DE3D8C6"><enum>201.</enum><header>Public education campaign</header><text display-inline="no-display-inline">Part P of title III of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/280g">42 U.S.C. 280g et seq.</external-xref>) is amended by adding at the end the following:</text>
<quoted-block act-name="Public Health Service Act" id="HD3EBCEAE8D7E4DD1A41BDF6F8DAE144">
<section id="HF8515A4EFA4E4A7EBC48DDB62082FA4"><enum>399O.</enum><header>Alzheimer’s disease public education campaign</header>
<subsection id="H4C161E783DA94714888FD159028862F"><enum>(a)</enum><header>In General</header><text>The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall carry out a program to educate the public and public health community regarding—</text>
<paragraph id="H9234A4BB24624AC7B5285BB36ECEF3C"><enum>(1)</enum><text>diagnosis and early warning signs of Alzheimer’s disease; and</text></paragraph>
<paragraph id="H4444A7696A29493584D36083F8A6A9AC"><enum>(2)</enum><text>how healthy lifestyles could maintain cognitive function and brain health.</text></paragraph></subsection>
<subsection id="HA0E47C27D3A14AA0AD8EF65B504F3E13"><enum>(b)</enum><header>Education of health professionals and partnerships</header><text>The program carried out under subsection (a) shall include activities to educate health professionals about the diagnosis, care, and management of Alzheimer’s disease and dementia, and the development of partnerships between State health departments, area agencies on aging, and local organizations serving people with Alzheimer’s disease.</text></subsection>
<subsection id="HDE93C3BB185645A6A426FB007D6BD319"><enum>(c)</enum><header>Authorization of appropriations</header><text>For the purpose of carrying out this section, there are authorized to be appropriated $7,000,000 for fiscal year 2005, and such sums as may be necessary for each of fiscal years 2006 through 2009.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section>
<enum>III</enum><header>Assistance for caregivers</header>
<section id="HE4F9F98C0C9C45A38ED6424ABEC00BA"><enum>301.</enum><header>Increased funding for National Family Caregiver Support Program</header>
<subsection id="H49AF6F8E6CD1495AABBF12758052C500"><enum>(a)</enum><header>In General</header><text>Section 303(e)(1) of the <act-name parsable-cite="OAA65">Older Americans Act of 1965</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/3023">42 U.S.C. 3023(e)(1)</external-xref>) is amended by striking <quote>$125,000,000 for fiscal year 2001</quote> and inserting <quote>$250,000,000 for fiscal year 2005</quote>.</text></subsection>
<subsection id="H894765C503A64CA7B563E4F248A47F4"><enum>(b)</enum><header>Native Americans</header><text>Section 643(2) of the <act-name parsable-cite="OAA65">Older Americans Act of 1965</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/3057n">42 U.S.C. 3057n(2)</external-xref>) is amended by striking <quote>$5,000,000 for fiscal year 2001</quote> and inserting <quote>$10,000,000 for fiscal year 2005</quote>.</text></subsection></section>
<section id="H53344F881D87487984182393AA591343"><enum>302.</enum><header>Alzheimer’s disease demonstration grants</header><text display-inline="no-display-inline">Section 398B(e) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/280c-5">42 U.S.C. 280c–5(e)</external-xref>) is amended—</text>
<paragraph id="HC0E9195DE9414787BC37934EE7C1FFC5"><enum>(1)</enum><text>by striking <quote>and such</quote> and inserting <quote>such</quote>; and</text></paragraph>
<paragraph id="H236C080401AD451CAC7B70912800163E"><enum>(2)</enum><text>by inserting before the period <quote>, $25,000,000 for fiscal year 2005, and such sums as may be necessary for each of the fiscal years 2006 through 2009</quote>.</text></paragraph></section>
<section id="H1893EEE5E6C248EA88C8E35067ADF769"><enum>303.</enum><header>Safe return program</header><text display-inline="no-display-inline">Section 240001(d) of the <act-name parsable-cite="VCCLEA94">Violent Crime Control and Law Enforcement Act of 1994</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/14181">42 U.S.C. 14181(d)</external-xref>) is amended to read as follows:</text>
<quoted-block act-name="Violent Crime Control and Law Enforcement Act of 1994" id="HC400964D715343C4B77E376FD2FDB1A9">
<subsection id="H6B0F68C6B14B41239507F680402EDE21"><enum>(d)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section, $1,000,000 for fiscal year 2005.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H9C52AD87902D4069BBD90908AB5215AC"><enum>304.</enum><header>Lifespan respite care</header><text display-inline="no-display-inline">The <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/201">42 U.S.C. 201 et seq.</external-xref>) is amended by adding at the end the following:</text>
<quoted-block act-name="Public Health Service Act" id="HF87A2B8B158B4BD8A8A6F29969B36342">
<title id="HB7D1C7EA7D124D9F8E48A75BB1BF1537"><enum>XXIX</enum><header>Lifespan respite care</header>
<section id="H85AF6B2068F142E8AD4DEC52E16200D0"><enum>2901.</enum><header>Findings and purposes</header>
<subsection id="H03566EC3693B4CA6B55F1056F7D50852"><enum>(a)</enum><header>Findings</header><text>Congress finds that—</text>
<paragraph id="HF56861AF3A554F6EBD03A96CD439674D"><enum>(1)</enum><text>an estimated 26,000,000 individuals in the United States care each year for 1 or more adult family members or friends who are chronically ill, disabled, or terminally ill;</text></paragraph>
<paragraph id="H7C8CA984505A410ABBA4EA8C81E50000"><enum>(2)</enum><text>an estimated 18,000,000 children in the United States have chronic physical, developmental, behavioral, or emotional conditions that demand caregiver monitoring, management, supervision, or treatment beyond that required of children generally;</text></paragraph>
<paragraph id="H5C457F5312F3400B84119CFC4144D13D"><enum>(3)</enum><text>nearly 4,000,000 individuals in the United States of all ages who have mental retardation or another developmental disability live with their families;</text></paragraph>
<paragraph id="HF2D37A86AA6340589B08CEE285FC5CA0"><enum>(4)</enum><text>almost 25 percent of the Nation’s elders experience multiple chronic disabling conditions that make it necessary to rely on others for help in meeting their daily needs;</text></paragraph>
<paragraph id="H154CB85191354AD2A730F54E4D96240"><enum>(5)</enum><text>every year, approximately 600,000 Americans die at home and many of these individuals rely on extensive family caregiving before their death;</text></paragraph>
<paragraph id="HC8344206AD00488B9EE0008BF605B00"><enum>(6)</enum><text>of all individuals in the United States needing assistance in daily living, 42 percent are under age 65;</text></paragraph>
<paragraph id="H2F7B3890DAF04C8A86952FB93406D500"><enum>(7)</enum><text>there are insufficient resources to replace family caregivers with paid workers;</text></paragraph>
<paragraph id="H79FF280EA8354F409B00433FCDF9AAAB"><enum>(8)</enum><text>if services provided by family caregivers had to be replaced with paid services, it would cost approximately $200,000,000,000 annually;</text></paragraph>
<paragraph id="H9226419C7C0B413A883E5FDFC4B300D9"><enum>(9)</enum><text>the family caregiver role is personally rewarding but can result in substantial emotional, physical, and financial hardship;</text></paragraph>
<paragraph id="H71B7DA2A8DD847CFBE90C2D7F7651631"><enum>(10)</enum><text>approximately 75 percent of family caregivers are women;</text></paragraph>
<paragraph id="H9FCFF2C480634390A66DF096E645C213"><enum>(11)</enum><text>family caregivers often do not know where to find information about available respite care or how to access it;</text></paragraph>
<paragraph id="HB1FD0E97655242FB97EDF642F05E4DE"><enum>(12)</enum><text>available respite care programs are insufficient to meet the need and are directed at primarily lower income populations and family caregivers of the elderly, leaving large numbers of family caregivers without adequate support; and</text></paragraph>
<paragraph id="HFADB5793336446D68047892FBE53907D"><enum>(13)</enum><text>the limited number of available respite care programs find it difficult to recruit appropriately trained respite workers.</text></paragraph></subsection>
<subsection id="HE5ECC6BD66B24990A1A68903598516A8"><enum>(b)</enum><header>Purposes</header><text>The purposes of this title are—</text>
<paragraph id="HA0A0AB5056624B448363DA6C3BA06B13"><enum>(1)</enum><text>to encourage States to establish State and local lifespan respite care programs;</text></paragraph>
<paragraph id="H872746D7CE364529B4B4B5AE53860796"><enum>(2)</enum><text>to improve and coordinate the dissemination of respite care information and resources to family caregivers;</text></paragraph>
<paragraph id="HF19C0B17095B4CDDB7E7C57E7B059D74"><enum>(3)</enum><text>to provide, supplement, or improve respite care services to family caregivers;</text></paragraph>
<paragraph id="H4C582FE9B05B4879A5CB74F9BE164E02"><enum>(4)</enum><text>to promote innovative, flexible, and comprehensive approaches to—</text>
<subparagraph id="HB30A7FF90DDE468B96A502C0D99B4733"><enum>(A)</enum><text>the delivery of respite care;</text></subparagraph>
<subparagraph id="HDD7604750FA94EA09FE97B2D1FFA1C2E"><enum>(B)</enum><text>respite care worker and volunteer recruitment and training programs; and</text></subparagraph>
<subparagraph id="H897B620E0AF746EB819DBA1F03709BFA"><enum>(C)</enum><text>training programs for family caregivers to assist such family caregivers in making informed decisions about respite care services;</text></subparagraph></paragraph>
<paragraph id="H245C4EC85C9E47B4996B678584DC6815"><enum>(5)</enum><text>to support evaluative research to identify effective respite care services that alleviate, reduce, or minimize any negative consequences of caregiving; and</text></paragraph>
<paragraph id="H825CA135759E4D00B22B91CD00E7EC18"><enum>(6)</enum><text>to promote the dissemination of results, findings, and information from programs and research projects relating to respite care delivery, family caregiver strain, respite care worker and volunteer recruitment and training, and training programs for family caregivers that assist such family caregivers in making informed decisions about respite care services.</text></paragraph></subsection></section>
<section id="HDA8312F367CE4B588D95A59CA6CD9004"><enum>2902.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="HCA7258F545334E22B9E5A0E2460058B8"><enum>(1)</enum><header>Eligible recipient</header><text>The term <term>eligible recipient</term> means—</text>
<subparagraph id="H451B5BCCD9904765A276424D93B36F23"><enum>(A)</enum><text>a State agency;</text></subparagraph>
<subparagraph id="HA8B142156248490B98BC942D131C18F6"><enum>(B)</enum><text>any other public entity that is capable of operating on a statewide basis;</text></subparagraph>
<subparagraph id="HC37F8DF11B544680BDC000DAAC96605"><enum>(C)</enum><text>a private, nonprofit organization that is capable of operating on a statewide basis;</text></subparagraph>
<subparagraph id="HC1B9CC09883E4FB289CA32F7C978B685"><enum>(D)</enum><text>a political subdivision of a State that has a population of not less than 3,000,000 individuals; or</text></subparagraph>
<subparagraph id="HA50114447A474CAAB007471B79113108"><enum>(E)</enum><text>any recognized State respite coordinating agency that has—</text>
<clause id="H824FB233EA1849ADBC21002BDBBDA27B"><enum>(i)</enum><text>a demonstrated ability to work with other State and community-based agencies;</text></clause>
<clause id="HF81537A7037E4A2094F045EB1046E2E9"><enum>(ii)</enum><text>an understanding of respite care and family caregiver issues; and</text></clause>
<clause id="H45B93A23E7CC49B1BB28D7F29651F5E0"><enum>(iii)</enum><text>the capacity to ensure meaningful involvement of family members, family caregivers, and care recipients.</text></clause></subparagraph></paragraph>
<paragraph id="H923142BB1C5E4B118E89DB36BA00A111"><enum>(2)</enum><header>Adult with a special need</header><text>The term <term>adult with a special need</term> means a person 18 years of age or older who requires care or supervision to—</text>
<subparagraph id="H024469EF9D2142B3A9139471B29452C0"><enum>(A)</enum><text>meet the person’s basic needs; or</text></subparagraph>
<subparagraph id="H0CB15E0059AB4678A8A067C5FC304E2E"><enum>(B)</enum><text>prevent physical self-injury or injury to others.</text></subparagraph></paragraph>
<paragraph id="H28BA41088C9C482D9C61662CF143BCB5"><enum>(3)</enum><header>Child with a special need</header><text>The term <term>child with a special need</term> means a person less than 18 years of age who requires care or supervision beyond that required of children generally to—</text>
<subparagraph id="HDEF7446F95514E298000C737CBC9DEA0"><enum>(A)</enum><text>meet the child’s basic needs; or</text></subparagraph>
<subparagraph id="HA015EA2146FD4625B76E99899F15D44E"><enum>(B)</enum><text>prevent physical self-injury or injury to others.</text></subparagraph></paragraph>
<paragraph id="H98CE1E2CE92B4EE99FB28E03767910C7"><enum>(4)</enum><header>Family caregiver</header><text>The term <term>family caregiver</term> means an unpaid family member, a foster parent, or another unpaid adult, who provides in-home monitoring, management, supervision, or treatment of a child or adult with a special need.</text></paragraph>
<paragraph id="HB53A6918F4874DA698D17100241918D5"><enum>(5)</enum><header>Respite care</header><text>The term <term>respite care</term> means planned or emergency care provided to a child or adult with a special need in order to provide temporary relief to the family caregiver of that child or adult.</text></paragraph>
<paragraph id="HB631C422D9B641A7907F29D76514C2B9"><enum>(6)</enum><header>Lifespan respite care</header><text>The term <term>lifespan respite care</term> means a coordinated system of accessible, community-based respite care services for family caregivers of children or adults with special needs.</text></paragraph></section>
<section id="H3278F7BC26CF456183C800E2026B20A9"><enum>2903.</enum><header>Lifespan respite care grants and cooperative agreements</header>
<subsection id="H60123859BBF641C6B572A6A48DCF6F00"><enum>(a)</enum><header>Purposes</header><text>The purposes of this section are—</text>
<paragraph id="H588CD2B47A0049DBA200D79B41BEADE"><enum>(1)</enum><text>to expand and enhance respite care services to family caregivers;</text></paragraph>
<paragraph id="HE34A9B8C47A9456CB52897E7FF9B4E90"><enum>(2)</enum><text>to improve the statewide dissemination and coordination of respite care; and</text></paragraph>
<paragraph id="HB4DAD6C7C3244969985ECC3C56D7DB8D"><enum>(3)</enum><text>to provide, supplement, or improve access and quality of respite care services to family caregivers, thereby reducing family caregiver strain.</text></paragraph></subsection>
<subsection id="H50101A3A238C489AAF78A714B267EDFB"><enum>(b)</enum><header>Authorization</header><text>Subject to subsection (f), the Secretary is authorized to award grants or cooperative agreements to eligible recipients who submit an application pursuant to subsection (d).</text></subsection>
<subsection id="H8A8BEE0F4A8B4C098DC20025F8816BCC"><enum>(c)</enum><header>Federal lifespan approach</header><text>In carrying out this section, the Secretary shall work in cooperation with the National Family Caregiver Support Program Officer of the Administration on Aging, and respite care program officers in the Administration for Children and Families, the Administration on Developmental Disabilities, the Maternal and Child Health Bureau of the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration, to ensure coordination of respite care services for family caregivers of children and adults with special needs.</text></subsection>
<subsection id="HC58420A3BFA54DEA8E7346C18072B3F9"><enum>(d)</enum><header>Application</header>
<paragraph id="H9F574BEE72BF4B8597E7645DD8D9A369"><enum>(1)</enum><header>Submission</header><text>Each eligible recipient desiring to receive a grant or cooperative agreement under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary shall require.</text></paragraph>
<paragraph id="H7BBDC00FA13B413E93EFF1B2E208002E"><enum>(2)</enum><header>Contents</header><text>Each application submitted under this section shall include—</text>
<subparagraph id="H9027850FAC8C4A22AB39D42C4E1652AC"><enum>(A)</enum><text>a description of the applicant’s—</text>
<clause id="HF30209772AE344818E2E29474D005F95"><enum>(i)</enum><text>understanding of respite care and family caregiver issues;</text></clause>
<clause id="HAD1D0FE7DE3F4E9DB8B63C78DC004302"><enum>(ii)</enum><text>capacity to ensure meaningful involvement of family members, family caregivers, and care recipients; and</text></clause>
<clause id="H8301C7721BDA477BA4EFE5D403F23429"><enum>(iii)</enum><text>collaboration with other State and community-based public, nonprofit, or private agencies;</text></clause></subparagraph>
<subparagraph id="HDA9944214F40415DBD6D8C67638469DF"><enum>(B)</enum><text>with respect to the population of family caregivers to whom respite care information or services will be provided or for whom respite care workers and volunteers will be recruited and trained, a description of—</text>
<clause id="HDFC7BA8AF1F94914A1F9D1F86FE9B084"><enum>(i)</enum><text>the population of family caregivers;</text></clause>
<clause id="H1A2FDB172CCA4C9ABA6F5F979B4BF03E"><enum>(ii)</enum><text>the extent and nature of the respite care needs of that population;</text></clause>
<clause id="H56462A5925674D1A852311DE2FE1F2CB"><enum>(iii)</enum><text>existing respite care services for that population, including numbers of family caregivers being served and extent of unmet need;</text></clause>
<clause id="HED7D434D4F624B77A781F087EA3B8C3C"><enum>(iv)</enum><text>existing methods or systems to coordinate respite care information and services to the population at the State and local level and extent of unmet need;</text></clause>
<clause id="H31BC98232D9140F28DA38B01B428F3F3"><enum>(v)</enum><text>how respite care information dissemination and coordination, respite care services, respite care worker and volunteer recruitment and training programs, or training programs for family caregivers that assist such family caregivers in making informed decisions about respite care services will be provided using grant or cooperative agreement funds;</text></clause>
<clause id="H181FCC69F13E4A7086BDD8807246FB05"><enum>(vi)</enum><text>a plan for collaboration and coordination of the proposed respite care activities with other related services or programs offered by public or private, nonprofit entities, including area agencies on aging;</text></clause>
<clause id="H2CB2F252E8184A77B7408BC21026204F"><enum>(vii)</enum><text>how the population, including family caregivers, care recipients, and relevant public or private agencies, will participate in the planning and implementation of the proposed respite care activities;</text></clause>
<clause id="HEAA0A260E7AA43B4AAC4DFFCC0ECE3A9"><enum>(viii)</enum><text>how the proposed respite care activities will make use, to the maximum extent feasible, of other Federal, State, and local funds, programs, contributions, other forms of reimbursements, personnel, and facilities;</text></clause>
<clause id="HD5D94121174C48939BE4C66124DC0E5"><enum>(ix)</enum><text>respite care services available to family caregivers in the applicant’s State or locality, including unmet needs and how the applicant’s plan for use of funds will improve the coordination and distribution of respite care services for family caregivers of children and adults with special needs;</text></clause>
<clause id="H56652A93B7F54F5985F3FED00040FFD6"><enum>(x)</enum><text>the criteria used to identify family caregivers eligible for respite care services;</text></clause>
<clause id="HFF35A829979044E8A302E48CDCACB666"><enum>(xi)</enum><text>how the quality and safety of any respite care services provided will be monitored, including methods to ensure that respite care workers and volunteers are appropriately screened and possess the necessary skills to care for the needs of the care recipient in the absence of the family caregiver; and</text></clause>
<clause id="H3F20CA721DEC4A1A8C6F6F864C6419B5"><enum>(xii)</enum><text>the results expected from proposed respite care activities and the procedures to be used for evaluating those results; and</text></clause></subparagraph>
<subparagraph id="H511BA015E6F0467F80074B936E801BE2"><enum>(C)</enum><text>assurances that, where appropriate, the applicant shall have a system for maintaining the confidentiality of care recipient and family caregiver records.</text></subparagraph></paragraph></subsection>
<subsection id="H146C4E4BEBFF4D1D84076F98FEEFDA00"><enum>(e)</enum><header>Review of applications</header>
<paragraph id="HFF4D84864D2246A79F704DB163341834"><enum>(1)</enum><header>Establishment of review panel</header><text>The Secretary shall establish a panel to review applications submitted under this section.</text></paragraph>
<paragraph id="H0094139DF001449CB9FD47F558B8E04"><enum>(2)</enum><header>Meetings</header><text>The panel shall meet as often as may be necessary to facilitate the expeditious review of applications.</text></paragraph>
<paragraph id="H181892D1308A4A0A9DF1688BA495449F"><enum>(3)</enum><header>Function of panel</header><text>The panel shall—</text>
<subparagraph id="H8DFBE990FF22489EBEC194E1EFA99532"><enum>(A)</enum><text>review and evaluate each application submitted under this section; and</text></subparagraph>
<subparagraph id="HBD87AA313B1C443EB842C0A1A1315763"><enum>(B)</enum><text>make recommendations to the Secretary concerning whether the application should be approved.</text></subparagraph></paragraph></subsection>
<subsection id="HAE99AEBF2F4D4FAC9660152028CAE01B"><enum>(f)</enum><header>Awarding of grants or cooperative agreements</header>
<paragraph id="HE6AAE77A9D9E4199B07952F6D95BA2B"><enum>(1)</enum><header>In General</header><text>The Secretary shall award grants or cooperative agreements from among the applications approved by the panel under subsection (e)(3).</text></paragraph>
<paragraph id="H0236281FE6544E11B3D1E900388F45DA"><enum>(2)</enum><header>Priority</header><text>When awarding grants or cooperative agreements under this subsection, the Secretary shall give priority to applicants that show the greatest likelihood of implementing or enhancing lifespan respite care statewide.</text></paragraph></subsection>
<subsection id="H09789298EDC44215A37D83C91D27E842"><enum>(g)</enum><header>Use of grant or cooperative agreement funds</header>
<paragraph id="H5AA7FFAB6FE247C48B13A32198D46B4F"><enum>(1)</enum><header>In General</header>
<subparagraph id="HB4C7FDA89C434B30B1225ECE917F677E"><enum>(A)</enum><header>Mandatory uses of funds</header><text>Each eligible recipient that is awarded a grant or cooperative agreement under this section shall use the funds for, unless such a program is in existence—</text>
<clause id="HC89460996114484A868BE07C1C4F363E"><enum>(i)</enum><text>the development of lifespan respite care at the State and local levels; and</text></clause>
<clause id="H7D013F7696D344A4B2E520004578006F"><enum>(ii)</enum><text>an evaluation of the effectiveness of such care.</text></clause></subparagraph>
<subparagraph id="HA0EBAD91DCD84DDC98C934B5757C4E23"><enum>(B)</enum><header>Discretionary uses of funds</header><text>Each eligible recipient that is awarded a grant or cooperative agreement under this section may use the funds for—</text>
<clause id="H91CFA6EBD2F241F7836FF2A396BC8F9"><enum>(i)</enum><text>respite care services for family caregivers of children and adults with special needs;</text></clause>
<clause id="HC4F25DF38E704B8EB896DB66B1FD1B08"><enum>(ii)</enum><text>respite care worker and volunteer training programs; or</text></clause>
<clause id="H0A7526F8D96E44ED9700C5E3F9B8FAF2"><enum>(iii)</enum><text>training programs for family caregivers to assist such family caregivers in making informed decisions about respite care services.</text></clause></subparagraph>
<subparagraph id="H06BA39F2BC0E49949106EEBE43AEAA0"><enum>(C)</enum><header>Evaluation</header><text>If an eligible recipient uses funds awarded under this section for an activity described in subparagraph (B), the eligible recipient shall use funds for an evaluation of the effectiveness of the activity.</text></subparagraph></paragraph>
<paragraph id="H89B7581F709741CAA38C80A705350024"><enum>(2)</enum><header>Subcontracts</header><text>Each eligible recipient that is awarded a grant or cooperative agreement under this section may use the funds to subcontract with a public or nonprofit agency to carry out the activities described in paragraph (1).</text></paragraph></subsection>
<subsection id="H5B07A0D007EC45EEB4B593CC5994D625"><enum>(h)</enum><header>Term of grants or cooperative agreements</header>
<paragraph id="H3DA0607F9A3E4DF4A6A00081760087E3"><enum>(1)</enum><header>In General</header><text>The Secretary shall award grants or cooperative agreements under this section for terms that do not exceed 5 years.</text></paragraph>
<paragraph id="H06755E45E1474CEE817CEF37522D7D1"><enum>(2)</enum><header>Renewal</header><text>The Secretary may renew a grant or cooperative agreement under this section at the end of the term of the grant or cooperative agreement determined under paragraph (1).</text></paragraph></subsection>
<subsection id="HC3A97F9A7EE5462FB73B0086DE74D416"><enum>(i)</enum><header>Supplement, not supplant</header><text>Funds made available under this section shall be used to supplement and not supplant other Federal, State, and local funds available for respite care services.</text></subsection>
<subsection id="H9ACB6422570F4A24951F6F99DB03C3BB"><enum>(j)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section—</text>
<paragraph id="HDDA4112594EA4AC1A2803E85DC2278D5"><enum>(1)</enum><text>$90,500,000 for fiscal year 2005; and</text></paragraph>
<paragraph id="H89CB753FE49A4138ACBB734BE6E5CE7B"><enum>(2)</enum><text>such sums as are necessary for fiscal years 2006 through 2009.</text></paragraph></subsection></section>
<section id="H0C4FABD9D22D4915BE11AE7B77CC09E5"><enum>2904.</enum><header>National lifespan respite resource center</header>
<subsection id="HA59C25CAAD7246A2B2F42DEB83A006D9"><enum>(a)</enum><header>Establishment</header><text>From funds appropriated under subsection (c), the Secretary shall award a grant or cooperative agreement to a public or private nonprofit entity to establish a National Resource Center on Lifespan Respite Care (referred to in this section as the <quote>center</quote>).</text></subsection>
<subsection id="HF99CEB136ACC4D1FBE3185CF5006C24C"><enum>(b)</enum><header>Purposes of the center</header><text>The center shall—</text>
<paragraph id="H433D4222864746D4BAB1AB39849EE494"><enum>(1)</enum><text>maintain a national database on lifespan respite care;</text></paragraph>
<paragraph id="H61D78026DB7349EBB350335FEDD49F7C"><enum>(2)</enum><text>provide training and technical assistance to State, community, and nonprofit respite care programs; and</text></paragraph>
<paragraph id="HDAFB50DA346740AB81D8228E7824B822"><enum>(3)</enum><text>provide information, referral, and educational programs to the public on lifespan respite care.</text></paragraph></subsection>
<subsection id="H6ECEF1536AB946A7B40029F651746655"><enum>(c)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section $500,000 for each of fiscal years 2005 through 2009.</text></subsection></section>.
305.Credit for taxpayers with long-term care needs
(a)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:
25C.Credit for taxpayers with long-term care needs
(a)
(1)There shall be allowed as a credit against the tax imposed by this chapter for the taxable year an amount equal to the applicable credit amount multiplied by the number of applicable individuals with respect to whom the taxpayer is an eligible caregiver for the taxable year.
(2)For purposes of paragraph (1), the applicable credit amount shall be determined in accordance with the following table:
“For taxable years beginning in calendar year—The applicable credit amount is—
2004$1,000
2005 1,500
2006 2,000
2007 2,500
2008 or thereafter 3,000.
(b)Limitation based on adjusted gross income
(1)The amount of the credit allowable under subsection (a) shall be reduced (but not below zero) by $100 for each $1,000 (or fraction thereof) by which the taxpayer’s modified adjusted gross income exceeds the threshold amount. For purposes of the preceding sentence, the term modified adjusted gross income means adjusted gross income increased by any amount excluded from gross income under section 911, 931, or 933.
(2)For purposes of paragraph (1), the term threshold amount means—
(A)$150,000 in the case of a joint return, and
(B)$75,000 in any other case.
(3)In the case of any taxable year beginning in a calendar year after 2004, each dollar amount contained in paragraph (2) shall be increased by an amount equal to the product of—
(A)such dollar amount, and
(B)the medical care cost adjustment determined under section 213(d)(10)(B)(ii) for the calendar year in which the taxable year begins, determined by substituting 2003
for 1996
in subclause (II) thereof.If any increase determined under the preceding sentence is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.
(c)For purposes of this section—
(1)
(A)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 391/2 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 needsAn individual is described in this subparagraph if the individual meets any of the following requirements:
(i)The individual is at least 18 years of age and—
(I)is unable to perform (without substantial assistance from another individual) at least 3 activities of daily living (as defined in section 7702B(c)(2)(B)) due to a loss of functional capacity, or
(II)requires substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairment and is unable to perform at least 1 activity of daily living (as so defined) or to the extent provided in regulations prescribed by the Secretary (in consultation with the Secretary of Health and Human Services), is unable to engage in age appropriate activities.
(ii)The individual is at least 6 but not 18 years of age and—
(I)is unable to perform (without substantial assistance from another individual) at least 3 activities of daily living (as defined in section 7702B(c)(2)(B)) due to a loss of functional capacity,
(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,
(III)has a level of disability similar to the level of disability described in subclause (I) (as determined under regulations promulgated by the Secretary), or
(IV)has a complex medical condition (as defined by the Secretary) that requires medical management and coordination of care.
(iii)The individual is at least 2 but not 6 years of age and—
(I)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,
(II)has a level of disability similar to the level of disability described in subclause (I) (as determined under regulations promulgated by the Secretary), or
(III)has a complex medical condition (as defined by the Secretary) that requires medical management and coordination of care.
(iv)The individual is under 2 years of age and—
(I)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,
(II)has a level of disability similar to the level of disability described in subclause (I) (as determined under regulations promulgated by the Secretary), or
(III)has a complex medical condition (as defined by the Secretary) that requires medical management and coordination of care.
(v)The individual has 5 or more chronic conditions (as defined in subparagraph (C)) and is unable to perform (without substantial assistance from another individual) at least 1 activity of daily living (as so defined) due to a loss of functional capacity.
(C)For purposes of this paragraph, the term chronic condition means a condition that lasts for at least 6 consecutive months and requires ongoing medical care.
(2)
(A)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(c) for the taxable year.
(iv)An individual who would be described in clause (iii) for the taxable year if section 151(c)(1)(A) were applied by substituting for the exemption amount an amount equal to the sum of the exemption amount, the standard deduction under section 63(c)(2)(C), and any additional standard deduction under section 63(c)(3) which would be applicable to the individual if clause (iii) applied.
(v)An individual who would be described in clause (iii) for the taxable year if—
(I)the requirements of clause (iv) are met with respect to the individual, and
(II)the requirements of subparagraph (B) are met with respect to the individual in lieu of the support test of section 152(a).
(B)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)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)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 separatelyIn 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 requirementNo 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 yearExcept 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)
(1)Section 6213(g)(2) of the Internal Revenue Code of 1986 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 credit for taxpayers with long-term care needs) to be included on a return..
(2)The table of sections for subpart A of part IV of subchapter A of chapter 1 of such Code is amended by inserting after the item relating to section 25B the following new item:
Sec. 25C. Credit for taxpayers with long-term care needs.
(c)The amendments made by this section shall apply to taxable years beginning after December 31, 2003.
306.Treatment of premiums on qualified long-term care insurance contracts
(a)Part VII of subchapter B of chapter 1 of the Internal Revenue Code of 1986 (relating to additional itemized deductions) is amended by redesignating section 224 as section 225 and by inserting after section 223 the following new section:
224.Premiums on qualified long-term care insurance contracts
(a)In the case of an individual, there shall be allowed as a deduction an amount equal to the applicable percentage of the amount of eligible long-term care premiums (as defined in section 213(d)(10)) paid during the taxable year for coverage for the taxpayer and the taxpayer’s spouse and dependents under a qualified long-term care insurance contract (as defined in section 7702B(b)).
(b)For purposes of subsection (a)—
(1)Except as otherwise provided in this subsection, the applicable percentage shall be determined in accordance with the following table based on the number of years of continuous coverage (as of the close of the taxable year) of the individual under any qualified long-term care insurance contracts (as defined in section 7702B(b)):
“If the number of years ofThe applicable
continuous coverage is—percentage is—
Less than 160
At least 1 but less than 270
At least 2 but less than 380
At least 3 but less than 490
At least 4100.
(2)Special rules for individuals who have attained age 55In the case of an individual who has attained age 55 as of the close of the taxable year, the following table shall be substituted for the table in paragraph (1):
“If the number of years ofThe applicable
continuous coverage is—percentage is—
Less than 170
At least 1 but less than 285
At least 2100.
(3)Only coverage after 2003 taken into accountOnly coverage for periods after December 31, 2003, shall be taken into account under this subsection.
(4)An individual shall not fail to be treated as having continuous coverage if the aggregate breaks in coverage during any 1-year period are less than 60 days.
(c)Coordination with other deductionsAny amount paid by a taxpayer for any qualified long-term care insurance contract to which subsection (a) applies shall not be taken into account in computing the amount allowable to the taxpayer as a deduction under section 162(l) or 213(a)..
(b)
(1)Section 62(a) of the Internal Revenue Code of 1986 is amended by inserting after paragraph (19) the following new paragraph:
(20)Premiums on qualified long-term care insurance contractsThe deduction allowed by section 224..
(2)The table of sections for part VII of subchapter B of chapter 1 of such Code is amended by striking the last item and inserting the following new items:
Sec. 224. Premiums on qualified long-term care insurance contracts
Sec. 225. Cross reference.
(c)The amendments made by this section shall apply to taxable years beginning after December 31, 2003.
307.Additional consumer protections for long-term care insurance
(a)Additional protections applicable to long-term care insuranceSubparagraphs (A) and (B) of section 7702B(g)(2) of the Internal Revenue Code of 1986 (relating to requirements of model regulation and Act) are amended to read as follows:
(A)The requirements of this paragraph are met with respect to any contract if such contract meets—
(i)The following requirements of the model regulation:
(I)Section 6A (relating to guaranteed renewal or noncancellability), and the requirements of section 6B of the model Act relating to such section 6A.
(II)Section 6B (relating to prohibitions on limitations and exclusions).
(III)Section 6C (relating to extension of benefits).
(IV)Section 6D (relating to continuation or conversion of coverage).
(V)Section 6E (relating to discontinuance and replacement of policies).
(VI)Section 7 (relating to unintentional lapse).
(VII)Section 8 (relating to disclosure), other than section 8F thereof.
(VIII)Section 11 (relating to prohibitions against post-claims underwriting).
(IX)Section 12 (relating to minimum standards).
(X)Section 13 (relating to requirement to offer inflation protection), except that any requirement for a signature on a rejection of inflation protection shall permit the signature to be on an application or on a separate form.
(XI)Section 25 (relating to prohibition against preexisting conditions and probationary periods in replacement policies or certificates).
(XII)The provisions of section 26 relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in paragraph (4).
(ii)The following requirements of the model Act:
(I)Section 6C (relating to preexisting conditions).
(II)Section 6D (relating to prior hospitalization).
(III)The provisions of section 8 relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in paragraph (4).
(B)For purposes of this paragraph—
(i)The terms model regulation and model Act mean the long-term care insurance model regulation, and the long-term care insurance model Act, respectively, promulgated by the National Association of Insurance Commissioners (as adopted as of September 2000).
(ii)Any provision of the model regulation or model Act listed under clause (i) or (ii) of subparagraph (A) shall be treated as including any other provision of such regulation or Act necessary to implement the provision.
(iii)For purposes of this section and section 4980C, the determination of whether any requirement of a model regulation or the model Act has been met shall be made by the Secretary..
(b)Paragraph (1) of section 4980C(c) of the Internal Revenue Code of 1986 (relating to requirements of model provisions) is amended to read as follows:
(1)Requirements of model provisions
(A)The following requirements of the model regulation must be met:
(i)Section 9 (relating to required disclosure of rating practices to consumer).
(ii)Section 14 (relating to application forms and replacement coverage).
(iii)Section 15 (relating to reporting requirements), except that the issuer shall also report at least annually the number of claims denied during the reporting period for each class of business (expressed as a percentage of claims denied), other than claims denied for failure to meet the waiting period or because of any applicable preexisting condition.
(iv)Section 22 (relating to filing requirements for marketing).
(v)Section 23 (relating to standards for marketing), including inaccurate completion of medical histories, other than paragraphs (1), (6), and (9) of section 23C, except that—
(I)in addition to such requirements, no person shall, in selling or offering to sell a qualified long-term care insurance contract, misrepresent a material fact; and
(II)no such requirements shall include a requirement to inquire or identify whether a prospective applicant or enrollee for long-term care insurance has accident and sickness insurance.
(vi)Section 24 (relating to suitability).
(vii)Section 29 (relating to standard format outline of coverage).
(viii)Section 30 (relating to requirement to deliver shopper’s guide).The requirements referred to in clause (vi) shall not include those portions of the personal worksheet described in Appendix B relating to consumer protection requirements not imposed by section 4980C or 7702B.
(B)The following requirements of the model Act must be met:
(i)Section 6F (relating to right to return), except that such section shall also apply to denials of applications and any refund shall be made within 30 days of the return or denial.
(ii)Section 6G (relating to outline of coverage).
(iii)Section 6H (relating to requirements for certificates under group plans).
(iv)Section 6I (relating to policy summary).
(v)Section 6J (relating to monthly reports on accelerated death benefits).
(vi)Section 7 (relating to incontestability period).
(C)For purposes of this paragraph, the terms model regulation and model Act have the meanings given such terms by section 7702B(g)(2)(B)..
(c)The amendments made by this section shall apply to policies issued more than 1 year after the date of the enactment of this Act.