H.R.5139 - Living Well with Fatal Chronic Illness Act of 2002107th Congress (2001-2002)
Bill
Hide Overview| Sponsor: | Rep. Oberstar, James L. [D-MN-8] (Introduced 07/16/2002) |
|---|---|
| Committees: | House - Energy and Commerce; Ways and Means; Veterans' Affairs |
| Latest Action: | House - 08/09/2002 Referred to the Subcommittee on Health. (All Actions) |
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Introduced in House (07/16/2002)
[Congressional Bills 107th Congress]
[From the U.S. Government Printing Office]
[H.R. 5139 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 5139
To amend title XVIII of the Social Security Act to provide certain
caregivers with access to Medicare benefits, to amend the Internal
Revenue Code of 1986 to provide a long-term care tax credit, and to
provide for programs within the Department of Health and Human Services
and Department of Veterans Affairs for patients with fatal chronic
illness.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 16, 2002
Mr. Oberstar introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means and Veterans' Affairs, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide certain
caregivers with access to Medicare benefits, to amend the Internal
Revenue Code of 1986 to provide a long-term care tax credit, and to
provide for programs within the Department of Health and Human Services
and Department of Veterans Affairs for patients with fatal chronic
illness.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Living Well with
Fatal Chronic Illness Act of 2002''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Access to medicare benefits for certain caregivers 55-to-65
years of age.
Sec. 3. Long-term care tax credit.
Sec. 4. Department of Health and Human Services programs for patients
with fatal chronic illnesses.
Sec. 5. Programs through Department of Veterans Affairs regarding
patients with fatal chronic illnesses.
SEC. 2. ACCESS TO MEDICARE BENEFITS FOR CERTAIN CAREGIVERS 55-TO-65
YEARS OF AGE.
(a) In General.--Title XVIII of the Social Security Act is
amended--
(1) by redesignating section 1859 and part D as section
1858 and part E, respectively; and
(2) by inserting after such section the following new part:
``Part D--Purchase of Medicare Benefits by Certain Caregivers Age 55-
to-65 Years of Age
``SEC. 1859. PROGRAM BENEFITS; ELIGIBILITY.
``(a) General Description of Program.--This part provides a program
of medicare eligibility for those age 55 or older who are caring on a
full-time basis for family members and who are not otherwise eligible
for group health insurance coverage.
``(b) Entitlement to Medicare Benefits For Enrolled Individuals.--
``(1) In general.--An individual enrolled under this part
is entitled to the same benefits under this title as an
individual entitled to benefits under part A and enrolled under
part B.
``(2) Definitions.--For purposes of this part:
``(A) Federal or state cobra continuation
provision.--The term `Federal or State COBRA
continuation provision' has the meaning given the term
`COBRA continuation provision' in section 2791(d)(4) of
the Public Health Service Act and includes a comparable
State program, as determined by the Secretary.
``(B) Federal health insurance program defined.--
The term `Federal health insurance program' means any
of the following:
``(i) Medicare.--Part A or part B of this
title (other than by reason of this part).
``(ii) Medicaid.--A State plan under title
XIX.
``(iii) FEHBP.--The Federal employees
health benefit program under chapter 89 of
title 5, United States Code.
``(iv) TRICARE.--The TRICARE program (as
defined in section 1072(7) of title 10, United
States Code).
``(v) Active duty military.--Health
benefits under title 10, United States Code, to
an individual as a member of the uniformed
services of the United States.
``(C) Group health plan.--The term `group health
plan' has the meaning given such term in section
2791(a)(1) of the Public Health Service Act.
``(D) Family member.--The term `family member'
includes a domestic partner or other significant
relationship recognized under law in the State in which
the person being cared for resides.
``(c) Eligibility.--An individual who meets the following
requirements with respect to a month is eligible to enroll under this
part with respect to such month:
``(1) Age.--As of the last day of the month, the individual
has attained 55 years of age, but has not attained 65 years of
age.
``(2) Medicare eligibility (but for age).--The individual
would be eligible for benefits under part A or part B for the
month if the individual were 65 years of age.
``(3) Not eligible for coverage under group health plans or
federal health insurance programs.--The individual is not
eligible for benefits or coverage under a Federal health
insurance program (as defined in subsection (b)(2)(B)) or under
a group health plan (other than such eligibility merely through
a Federal or State COBRA continuation provision) as of the last
day of the month involved.
``(4) Caregiver.--The individual is providing the majority
of care to a family member who--
``(A) is entitled to benefits under part A, or
enrolled under part B; and
``(B) requires substantial supervision due to
severe cognitive impairment or is unable to perform at
least 2 activities of daily living.
``(5) Limitation of 1 caregiver for each disabled eligible
beneficiary.--There is no other individual who is enrolled (or
enrolling) under this section on the basis of care provided to
the family member described in paragraph (4).
``SEC. 1859A. ENROLLMENT PROCESS; COVERAGE.
``(a) In General.--An individual may enroll in the program
established under this part only in such manner and form as may be
prescribed by regulations, and only during an enrollment period
prescribed by the Secretary consistent with the provisions of this
section. Such regulations shall provide a process under which
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in
subsection (b).
``(b) Enrollment Periods.--
``(1) In general.--In the case of individuals eligible to
enroll under this part under section 1859(c)--
``(A) Individuals eligible at time program
begins.--If the individual is eligible to enroll under
such section for January 2003, the enrollment period
shall begin on November 1, 2002, and shall end on
February 28, 2003. Any such enrollment before January
1, 2003, is conditioned upon compliance with the
conditions of eligibility for January 2003.
``(B) Individuals who become eligible later.--If
the individual becomes eligible to enroll under such
section for a month after January 2003, the enrollment
period shall be the 4-month period beginning on the
first day of the second month before the month in which the individual
first is eligible to so enroll. Any such enrollment before the first
day of the third month of such enrollment period is conditioned upon
compliance with the conditions of eligibility for such third month.
``(2) Authority to correct for government errors.--The
provisions of section 1837(h) apply with respect to enrollment
under this part in the same manner as they apply to enrollment
under part B.
``(c) Date Coverage Begins.--
``(1) In general.--The period during which an individual is
entitled to benefits under this part shall begin as follows,
but in no case earlier than January 1, 2003:
``(A) In the case of an individual who enrolls
(including pre-enrolls) before the month in which the
individual satisfies eligibility for enrollment under
section 1859, the first day of such month of
eligibility.
``(B) In the case of an individual who enrolls
during or after the month in which the individual first
satisfies eligibility for enrollment under such
section, the first day of the following month.
``(2) Authority to provide for partial months of
coverage.--Under regulations, the Secretary may, in the
Secretary's discretion, provide for coverage periods that
include portions of a month in order to avoid lapses of
coverage.
``(3) Limitation on payments.--No payments may be made
under this title with respect to the expenses of an individual
enrolled under this part unless such expenses were incurred by
such individual during a period which, with respect to the
individual, is a coverage period under this section.
``(d) Termination of Coverage.--
``(1) In general.--An individual's coverage period under
this part shall continue until the individual's enrollment has
been terminated at the earliest of the following:
``(A) General provisions.--
``(i) Notice.--The individual files notice
(in a form and manner prescribed by the
Secretary) that the individual no longer wishes
to participate in the insurance program under
this part.
``(ii) Nonpayment of premiums.--The
individual fails to make payment of premiums
required for enrollment under this part.
``(iii) Medicare eligibility.--The
individual becomes entitled to benefits under
part A or enrolled under part B (other than by
reason of this part).
``(B) Termination based on age.--The individual
attains 65 years of age.
``(C) Obtaining access to employment-based coverage
or federal health insurance program.--The individual is
covered (or eligible for coverage) as a participant or
beneficiary under a group health plan or under a
Federal health insurance program.
``(D) Termination of caregiving.--One year after
the date that the individual ceases to be providing the
caregiving described in section 1859(c)(4) for a period
of 4 consecutive weeks.
``(2) Effective date of termination.--
``(A) Notice.--The termination of a coverage period
under paragraph (1)(A)(i) shall take effect at the
close of the month following the month in which the
notice is filed.
``(B) Nonpayment of premium.--The termination of a
coverage period under paragraph (1)(A)(ii) shall take
effect on a date determined under regulations, which
may be determined so as to provide a grace period in
which overdue premiums may be paid and coverage
continued. The grace period determined under the
preceding sentence shall not exceed 60 days; except
that it may be extended for an additional 30 days in
any case where the Secretary determines that there was
good cause for failure to pay the overdue premiums
within such 60-day period.
``(C) Age or medicare eligibility.--The termination
of a coverage period under paragraph (1)(A)(iii) or
(1)(B) shall take effect as of the first day of the
month in which the individual attains 65 years of age
or becomes entitled to benefits under part A or
enrolled for benefits under part B (other than by
reason of this part).
``(D) Access to coverage.--The termination of a
coverage period under paragraph (1)(C) shall take
effect on the date on which the individual is eligible
to begin a period of creditable coverage (as defined
in section 2701(c) of the Public Health Service Act) under a group
health plan or under a Federal health insurance program.
``SEC. 1859B. PREMIUMS.
``(a) Amount of Monthly Premiums.--The Secretary shall, during
September of each year (beginning with 2002), determine a premium rate
which shall apply with respect to coverage provided under this title
for any month in the succeeding year. Such rate for individuals
residing in a premium area for most of any month in a year shall be
equal to \1/12\ of the average, annual per capita amount estimated
under subsection (b)(1) for the year, adjusted for such area under
subsection (b)(2).
``(b) Annual Premium.--
``(1) National, per capita average.--The Secretary shall
estimate the average, annual per capita amount that would be
payable under this title with respect to individuals residing
in the United States who meet the requirement of section
1859(c)(1) as if all such individuals were eligible for (and
enrolled) under this title during the entire year (and assuming
that section 1862(b)(2)(A)(i) did not apply).
``(2) Geographic adjustment.--The Secretary shall adjust
the amount determined under paragraph (1) for each premium area
(specified under subsection (c)) in order to take into account
such factors as the Secretary deems appropriate and shall limit
the maximum premium under this paragraph in a premium area to
assure participation in all areas throughout the United States.
``(c) Establishment of Premium Areas.--For purposes of this part,
the term `premium area' means such an area as the Secretary shall
specify to carry out this part. The Secretary from time to time may
change the boundaries of such premium areas. The Secretary shall seek
to minimize the number of such areas specified under this paragraph.
``SEC. 1859C. PAYMENT OF PREMIUMS.
``(a) Payment of Monthly Premium.--
``(1) In general.--The Secretary shall provide for payment
and collection of the monthly premium, determined under section
1859B(a) for the premium area in which the individual
principally resides, in the same manner as for payment of
monthly premiums under section 1840, except that, for purposes
of applying this section, any reference in such section to the
Federal Supplementary Medical Insurance Trust Fund is deemed a
reference to the Trust Fund established under section 1859D.
``(2) Period of payment.--In the case of an individual who
participates in the program established by this title, the
monthly premium shall be payable for the period commencing with
the first month of the individual's coverage period and ending
with the month in which the individual's coverage under this
title terminates.
``(b) Application of Certain Provisions.--The provisions of section
1840 (other than subsection (h)) shall apply to premiums collected
under this section in the same manner as they apply to premiums
collected under part B, except that any reference in such section to
the Federal Supplementary Medical Insurance Trust Fund is deemed a
reference to the Trust Fund established under section 1859D.
``SEC. 1859D. MEDICARE CAREGIVER TRUST FUND.
``(a) Establishment of Trust Fund.--
``(1) In general.--There is hereby created on the books of
the Treasury of the United States a trust fund to be known as
the `Medicare Caregiver Trust Fund' (in this section referred
to as the `Trust Fund'). The Trust Fund shall consist of such
gifts and bequests as may be made as provided in section
201(i)(1) and such amounts as may be deposited in, or
appropriated to, such fund as provided in this title.
``(2) Premiums.--Premiums collected under section 1859B
shall be transferred to the Trust Fund.
``(b) Incorporation of Provisions.--
``(1) In general.--Subject to paragraph (2), subsections
(b) through (i) of section 1841 shall apply with respect to the
Trust Fund and this title in the same manner as they apply with
respect to the Federal Supplementary Medical Insurance Trust
Fund and part B, respectively.
``(2) Miscellaneous references.--In applying provisions of
section 1841 under paragraph (1)--
``(A) any reference in such section to `this part'
is construed to refer to this part D;
``(B) any reference in section 1841(h) to section
1840(d) and in section 1841(i) to sections 1840(b)(1)
and 1842(g) are deemed references to comparable
authority exercised under this part; and
``(C) payments may be made under section 1841(g) to
the Trust Funds under sections 1817 and 1841 as
reimbursement to such funds for payments they made for
benefits provided under this part.
``SEC. 1859E. OVERSIGHT AND ACCOUNTABILITY.
``(a) Through Annual Reports of Trustees.--The Board of Trustees of
the Medicare Caregiver Trust Fund under section 1859D(b)(1) shall
report on an annual basis to Congress concerning the status of the
Trust Fund and the need for adjustments in the program under this part
to maintain financial solvency of the program under this part.
``(b) Periodic GAO Reports.--The Comptroller General of the United
States shall periodically submit to Congress reports on the adequacy of
the financing of coverage provided under this part. The Comptroller
General shall include in such report such recommendations for
adjustments in such financing and coverage as the Comptroller General
deems appropriate in order to maintain financial solvency of the
program under this part.
``SEC. 1859F. ADMINISTRATION AND MISCELLANEOUS.
``(a) Treatment for Purposes of Title.--Except as otherwise
provided in this part--
``(1) individuals enrolled under this part shall be treated
for purposes of this title as though the individual were
entitled to benefits under part A and enrolled under part B;
and
``(2) benefits described in section 1859 shall be payable
under this title to such individuals in the same manner as if
such individuals were so entitled and enrolled.
``(b) Not Treated As Medicare Program for Purposes of Medicaid
Program.--For purposes of applying title XIX (including the provision
of medicare cost-sharing assistance under such title), an individual
who is enrolled under this part shall not be treated as being entitled
to benefits under this title.
``(c) Not Treated As Medicare Program for Purposes of COBRA
Continuation Provisions.--In applying a COBRA continuation provision
(as defined in section 2791(d)(4) of the Public Health Service Act),
any reference to an entitlement to benefits under this title shall not
be construed to include entitlement to benefits under this title
pursuant to the operation of this part.''.
(b) Conforming Amendments to Social Security Act Provisions.--
(1) Section 201(i)(1) of the Social Security Act (42 U.S.C.
401(i)(1)) is amended by striking ``or the Federal
Supplementary Medical Insurance Trust Fund'' and inserting
``the Federal Supplementary Medical Insurance Trust Fund, and
the Medicare Caregiver Trust Fund''.
(2) Section 201(g)(1)(A) of such Act (42 U.S.C.
401(g)(1)(A)) is amended by striking ``and the Federal
Supplementary Medical Insurance Trust Fund established by title
XVIII'' and inserting ``, the Federal Supplementary Medical
Insurance Trust Fund, and the Medicare Caregiver Trust Fund
established by title XVIII''.
(3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is
amended by striking ``part D'' and inserting ``part E''.
(4) Part C of title XVIII of such Act is amended--
(A) in section 1851(a)(2)(B) (42 U.S.C. 1395w-
21(a)(2)(B)), by striking ``1859(b)(3)'' and inserting
``1858(b)(3)'';
(B) in section 1851(a)(2)(C) (42 U.S.C. 1395w-
21(a)(2)(C)), by striking ``1859(b)(2)'' and inserting
``1858(b)(2)'';
(C) in section 1852(a)(1) (42 U.S.C. 1395w-
22(a)(1)), by striking ``1859(b)(3)'' and inserting
``1858(b)(3)'';
(D) in section 1852(a)(3)(B)(ii) (42 U.S.C. 1395w-
22(a)(3)(B)(ii)), by striking ``1859(b)(2)(B)'' and
inserting ``1858(b)(2)(B)'';
(E) in section 1853(a)(1)(A) (42 U.S.C. 1395w-
23(a)(1)(A)), by striking ``1859(e)(4)'' and inserting
``1858(e)(4)''; and
(F) in section 1853(a)(3)(D) (42 U.S.C. 1395w-
23(a)(3)(D)), by striking ``1859(e)(4)'' and inserting
``1858(e)(4)''.
(5) Section 1853(c) of such Act (42 U.S.C. 1395w-23(c)) is
amended--
(A) in paragraph (1), by striking ``or (7)'' and
inserting ``, (7), or (8)'', and
(B) by adding at the end the following:
``(8) Adjustment for caregiver access.--In applying this
subsection with respect to individuals entitled to benefits
under part D, the Secretary shall provide for an appropriate
adjustment in the Medicare+Choice capitation rate as may be
appropriate to reflect differences between the population
served under such part and the population under parts A and
B.''.
(c) Other Conforming Amendments.--
(1) Section 138(b)(4) of the Internal Revenue Code of 1986
is amended by striking ``1859(b)(3)'' and inserting
``1858(b)(3)''.
(2)(A) Section 602(2)(D)(ii) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1162(2)) is amended by
inserting ``(not including an individual who is so entitled
pursuant to enrollment under section 1859A)'' after ``Social
Security Act''.
(B) Section 2202(2)(D)(ii) of the Public Health Service Act
(42 U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not
including an individual who is so entitled pursuant to
enrollment under section 1859A)'' after ``Social Security
Act''.
(C) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue
Code of 1986 is amended by inserting ``(not including an
individual who is so entitled pursuant to enrollment under
section 1859A)'' after ``Social Security Act''.
SEC. 3. LONG-TERM CARE TAX CREDIT.
(a) In General.--Subpart A of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to nonrefundable
personal credits) is amended by inserting after section 25B the
following new section:
``SEC. 25C. LONG-TERM CARE TAX CREDIT.
``(a) Allowance of Credit.--There shall be allowed as a credit
against the tax imposed by this chapter for the taxable year an amount
equal to $3,000 multiplied by the number of applicable individuals with
respect to whom the taxpayer is an eligible caregiver for the taxable
year.
``(b) Limitation Based on Adjusted Gross Income.--
``(1) In general.--The amount of the credit allowable under
subsection (a) shall be reduced (but not below zero) by $50 for
each $1,000 (or fraction thereof) by which the taxpayer's
modified adjusted gross income (as defined in section 24(b)(1))
exceeds the threshold amount (as defined in section 24(b)(2)).
``(2) Limitation based on amount of tax.--The credit
allowed under subsection (a) for any taxable year shall not
exceed the excess of--
``(A) the sum of the regular tax liability (as
defined in section 26(b)) plus the tax imposed by
section 55, over
``(B) the sum of the credits allowable under this
subpart (other than this section and sections 23 and
25B) and section 27 for the taxable year.
``(c) Definitions.--For purposes of this section--
``(1) Applicable individual.--
``(A) In general.--The term `applicable individual'
means, with respect to any taxable year, any individual
who has been certified, before the due date for filing
the return of tax for the taxable year (without
extensions), by a physician (as defined in section
1861(r)(1) of the Social Security Act) as being an
individual with long-term care needs described in
subparagraph (B) for a period--
``(i) which is at least 180 consecutive
days, and
``(ii) a portion of which occurs within the
taxable year.
Such term shall not include any individual otherwise
meeting the requirements of the preceding sentence
unless within the 39\1/2\ month period ending on such
due date (or such other period as the Secretary
prescribes) a physician (as so defined) has certified
that such individual meets such requirements.
``(B) Individuals with long-term care needs.--An
individual is described in this subparagraph if the
individual meets any of the following requirements:
``(i) The individual is at least 6 years of
age and--
``(I) is unable to perform (without
substantial assistance from another
individual) at least 3 activities of
daily living (as defined in section
7702B(c)(2)(B)) due to a lack of
functional capacity, or
``(II) requires substantial
supervision to protect such individual
from threats to health and safety due
to severe cognitive impairment and is
unable to perform at least 1 activity
of daily living (as so defined) or to
the extent provided in regulations
prescribed by the Secretary (in
consultation with the Secretary of
Health and Human Services), is unable
to engage in age appropriate
activities.
``(ii) The individual is at least 2 but not
6 years of age and is unable due to a loss of
functional capacity to perform (without
substantial assistance from another individual)
at least 2 of the following activities: eating,
transferring, or mobility.
``(iii) The individual is under 2 years of
age and requires specific durable medical
equipment by reason of a severe health
condition or requires a skilled practitioner
trained to address the individual's condition
to be available if the individual's parents or
guardians are absent.
``(2) Eligible caregiver.--
``(A) In general.--A taxpayer shall be treated as
an eligible caregiver for any taxable year with respect
to the following individuals:
``(i) The taxpayer.
``(ii) The taxpayer's spouse.
``(iii) An individual with respect to whom
the taxpayer is allowed a deduction under
section 151 for the taxable year.
``(iv) An individual who would be described
in clause (iii) for the taxable year if section
151(c)(1)(A) were applied by substituting for
the exemption amount an amount equal to 200
percent of the poverty level determined by
using criteria of poverty established by the
Bureau of the Census.
``(v) An individual who would be described
in clause (iii) for the taxable year if--
``(I) the requirements of clause
(iv) are met with respect to the
individual, and
``(II) the requirements of
subparagraph (B) are met with respect
to the individual in lieu of the
support test of section 152(a).
``(B) Residency test.--The requirements of this
subparagraph are met if an individual has as his
principal place of abode the home of the taxpayer and--
``(i) in the case of an individual who is
an ancestor or descendant of the taxpayer or
the taxpayer's spouse, is a member of the
taxpayer's household for over half the taxable
year, or
``(ii) in the case of any other individual,
is a member of the taxpayer's household for the
entire taxable year.
``(C) Special rules where more than 1 eligible
caregiver.--
``(i) In general.--If more than 1
individual is an eligible caregiver with
respect to the same applicable individual for
taxable years ending with or within the same
calendar year, a taxpayer shall be treated as
the eligible caregiver if each such individual
(other than the taxpayer) files a written
declaration (in such form and manner as the
Secretary may prescribe) that such individual
will not claim such applicable individual for
the credit under this section.
``(ii) No agreement.--If each individual
required under clause (i) to file a written
declaration under clause (i) does not do so,
the individual with the highest modified
adjusted gross income (as defined in section
32(c)(5)) shall be treated as the eligible
caregiver.
``(iii) Married individuals filing
separately.--In the case of married individuals
filing separately, the determination under this
subparagraph as to whether the husband or wife
is the eligible caregiver shall be made under
the rules of clause (ii) (whether or not one of
them has filed a written declaration under
clause (i)).
``(d) Identification Requirement.--No credit shall be allowed under
this section to a taxpayer with respect to any applicable individual
unless the taxpayer includes the name and taxpayer identification
number of such individual, and the identification number of the
physician certifying such individual, on the return of tax for the
taxable year.
``(e) Taxable Year Must Be Full Taxable Year.--Except in the case
of a taxable year closed by reason of the death of the taxpayer, no
credit shall be allowable under this section in the case of a taxable
year covering a period of less than 12 months.''.
(b) Conforming Amendments.--
(1) Paragraph (1) of section 26(a) of such Code is amended
by striking ``and 25B'' and inserting ``25B, and 25C''.
(2) Paragraph (2) of section 6213(g) of such Code is
amended by striking ``and'' at the end of subparagraph (L), by
striking the period at the end of subparagraph (M) and
inserting ``, and'', and by inserting after subparagraph (M)
the following new subparagraph:
``(N) an omission of a correct TIN or physician
identification required under section 25C(d) (relating
to long-term care tax credit) to be included on a
return.''
(3) The table of sections for subpart A of part IV of
subchapter A of chapter 1 of such Code is amended by inserting
after the item relating to section 25B the following new item:
``Sec. 25C. Long-term care tax credit.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2002.
SEC. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAMS FOR PATIENTS
WITH FATAL CHRONIC ILLNESSES.
(a) Establishment of Programs.--The Secretary of Health and Human
Services shall carry out research, demonstration, and education
programs with respect to fatal chronic illness through the Public
Health Service.
(b) Studies on End-of-Life Care.--The Secretary shall conduct
studies on end-of-life care through all relevant agencies and through
the Assistant Secretary for Planning and Evaluation. Such studies shall
include an examination of the development of practice parameters
applicable to such care as well as research regarding such care. Such
studies shall also include an annual report from the Secretary to the
appropriate committees for oversight in Congress and to the Special
Committee on Aging in the Senate on service delivery and quality of
life for persons living through fatal chronic illness and their
families and professional caregivers.
(c) Health Resources and Services Administration.--
(1) In general.--In carrying out subsection (a), the
Secretary, acting through the Administrator of the Health
Resources and Services Administration, shall carry out
research, demonstration, and education programs toward
improving the delivery of appropriate health and support
services for patients with fatal chronic illnesses.
(2) Health centers.--As determined appropriate by the
Secretary, paragraph (1) may be carried out through the program
under section 330 of the Public Health Service Act (relating to
community and migrant health centers and health centers
regarding homeless individuals and residents of public
housing), including by designating individuals with fatal
chronic illnesses as medically underserved populations.
(3) Caregivers.--Programs under paragraph (1) shall include
activities regarding appropriate support services for
caregivers for patients with fatal chronic illness, including respite
care.
(4) Health professions training.--Programs under paragraph
(1) shall include making awards of grants or contracts to
public and nonprofit private entities for the purpose of
training health professionals, including students attending
health professions schools, in the care of patients with fatal
chronic illnesses. Such training shall include training in the
provision of appropriate palliative care and appropriate
referral to hospices, and training provided as continuing
education.
(5) Initiative.--Programs under paragraph (1) shall include
an initiative to coordinate innovation, evaluation, and service
delivery relating to fatal chronic illnesses.
(d) Agency for Healthcare Research and Quality.--
(1) In general.--In carrying out section 912(c) of the
Public Health Service Act, the Secretary, acting through the
Director of the Agency for Healthcare Research and Quality,
shall, with respect to patients with fatal chronic illnesses--
(A) identify the causes of preventable health care
errors and patient injury in health care delivery,
including errors of inadequate mobilization of services
to the home, inadequate continuity of caregivers,
inadequate symptom prevention, management, and relief,
or inadequate advance care planning;
(B) develop, demonstrate, and evaluate strategies
for reliable performance of the care system, including
reducing errors and improving patient safety and health
outcomes; and
(C) disseminate such effective strategies
throughout the health care industry.
(2) Grants.--In carrying out paragraph (1)(A), the
Secretary shall make grants for the purpose of developing
reliable and current data and insight as to the merits and
efficiencies of various strategies for providing health care,
including palliative and hospice care, and social services for
patients with fatal chronic illnesses.
(e) Centers for Disease Control and Prevention.--The Director of
the Centers for Disease Control and Prevention shall expand activities
with respect to epidemiology and public health in fatal chronic
illness. Such activities may include contracting with the Institute of
Medicine or another national interest non-profit organization to
provide a review of the status of care for the end of life, which
review shall be included by the Secretary in the annual reports to
Congress under subsection (h).
(f) National Institutes of Health.--
(1) Expansion of activities.--The Director of the National
Institutes of Health (in this subsection referred to as the
``Director'') shall expand, intensify, and coordinate the
activities of the National Institutes of Health with respect to
research on fatal chronic illness. Such activities shall
include programs, requests for proposals, study section
membership, advisory council membership, and training programs
to support rapid and substantial improvements in
understanding--
(A) mechanisms of disability and suffering in fatal
chronic illness and the relief and management of that
disability and suffering through to end of life; and
(B) human resources, service delivery arrangements,
technology, and financing that would be most useful in
ensuring comfort and dignity for individuals with fatal
chronic illness, and in relieving the burden for family
and professional caregivers.
(2) Administration.--The Director shall carry out this
subsection acting through the Directors of every Institute
within the National Institutes of Health that has at least one
fatal chronic illness in its purview.
(3) Collaboration.--In carrying out this subsection, the
Director of the National Institutes of Health shall collaborate
with the Department of Veterans Affairs, the Agency for
Healthcare Research and Quality, and any other agency that the
Director determines appropriate. The Secretary of Veterans
Affairs and the Director of the Agency for Healthcare Research
and Quality shall assist in such collaboration.
(4) Responsibilities of institutes.--Each Institute within
the National Institutes of Health that has fatal chronic
illness in its purview shall establish a plan for improving
understanding of the mechanisms of disability and suffering in
fatal chronic illness and the relief and management of that
disability and suffering through to end of life. Since most
Americans now die of chronic heart or lung failure, cancer,
stroke, dementia, or multifactorial frailty, each such
Institute shall develop and implement a strategic plan and a
set of projects that aim primarily to ensure that affected
patients and their families can live through advanced illness
and death comfortably and meaningfully.
(5) Centers of excellence.--
(A) In general.--In carrying out paragraph (1), the
Director shall make awards of grants and contracts to
public or nonprofit private entities for the
establishment and operation of centers of excellence to
carry out research, demonstration, and education
programs regarding fatal chronic illness, including
programs regarding palliative care.
(B) Designation.--In carrying out this subsection,
the Director shall designate at least 2 Claude D.
Pepper Older Americans Independence Centers (supported
by the National Institute on Aging), 2 program projects
of the National, Heart, Lung, and Blood Institute, and
2 comprehensive cancer centers (supported by the
National Cancer Institute) to provide education and
information support and research data and methods
leadership for substantial and rapid improvements in
the understanding of the mechanisms of disability and
suffering in fatal chronic illness and the relief and
management of that disability and suffering through to
the end of life.
(C) Research.--Each center established or operated
under subparagraph (A) or designated under subparagraph
(B) shall conduct basic and clinical research into
fatal chronic illness.
(D) Certain activities.--The Secretary shall ensure
that, with respect to the geographic area in which a
center of excellence under subparagraph (A) is located,
the activities of the center include--
(i) providing information and education
regarding fatal chronic illness to health
professionals and the public;
(ii) serving as a resource through which
health professionals, and patients and their
caregivers, can plan and coordinate the
provision of health and support services
regarding fatal chronic illness; and
(iii) providing training and support of
implementation of quality improvement.
(g) Medicare Pilot Programs for Treatment of Fatal Chronic
Illnesses.--
(1) Establishment.--The Secretary, in all relevant parts of
the Department of Health and Human Services, including the
Centers for Medicare & Medicaid Services and the Office of the
Assistant Secretary for Planning and Evaluation, shall provide
for pilot programs under this subsection. The pilot programs
shall be developed under a coordinated national effort in order
to demonstrate innovative, effective means of delivering care
to Medicare beneficiaries with fatal chronic illnesses under
the Medicare program. The pilot programs shall be completed
within 5 years after the date that funds are first appropriated
under this subsection.
(2) Design.--The pilot programs under this subsection shall
be designed to learn how--
(A) to effectively and efficiently deliver quality
care to the fatally chronically ill;
(B) to provide and maintain continuity of care for
the fatally chronically ill;
(C) to provide advance care planning to the fatally
chronically ill;
(D) to determine what rate and strategies for
payment are most appropriate;
(E) to deliver emergency care for the fatally
chronically ill;
(F) to facilitate access to hospice care when the
Medicare beneficiary becomes eligible for such care;
(G) to develop and estimate the effect of potential
alternative severity criteria for eligibility of
specially tailored programs;
(H) to test the effectiveness and costs of new
strategies for family caregivers support;
(I) to implement a clinical services and payment
program that uses thresholds of severity to define the
onset of the need for comprehensive end-of-life
services;
(J) to test the merits of using severity criteria
(relating to fatal chronic illness) in determining
eligibility for the Medicare hospice program, but only
when use of such criteria expands access to hospice
care to individuals who are not yet terminally ill (as
that term is defined at section 1861(dd)(3)(A) of the
Social Security Act); and
(K) to arrange financial incentives so that
substantially diminished payments arise when care
providers fail to ensure timely advance care planning,
symptom prevention, management, and relief, or
continuity of care across time and settings.
(3) Conduct of pilot programs.--The Secretary shall conduct
pilot programs in at least 6 sites and in at least 3 States.
(4) Report to congress.--The Secretary shall submit to
Congress a report on the pilot programs under this subsection.
Such report shall include recommendations regarding whether the
pilot programs should become a permanent part of the Medicare
program.
(h) Annual Reports.--The Secretary, in consultation with the
Secretary of Veterans Affairs and other appropriate Federal agencies,
shall submit an annual report to Congress on end-of-life care and on
the research, demonstration, and education programs and studies
conducted under this section. The Centers for Disease Control and
Prevention shall be the lead agency for integrating and preparing the
annual reports under this subsection unless the Secretary designates
otherwise.
(i) Definitions.--For purposes of this section:
(1) The term ``fatal chronic illness'' means a disease (or
diseases), condition (or conditions), or disorder (or
disorders) that ordinarily worsens and causes death and that
causes a physical or mental disability or periodic episodes of
significant loss of functional capacity.
(2) The term ``Secretary'' means the Secretary of Health
and Human Services.
(j) Authorization of Appropriations.--There are authorized to be
appropriated--
(1) such sums as may be necessary to carry out subsections
(a), (b), (e), and (f);
(2) $50,000,000 for the 5-fiscal-year period (beginning
with fiscal year 2004) to carry out subsection (c), excluding
paragraph (5) of that subsection;
(3) $100,000,000 for the 3-fiscal-year period (beginning
with fiscal year 2004) to carry out subsection (c)(5);
(4) $20,000,000 for the 5-fiscal-year period (beginning
with fiscal year 2004) to carry out subsection (d);
(5) to carry out subsection (g) for each of fiscal years
2003 through 2007--
(A) $50,000,000 for the purposes of conducting
evaluations of pilot programs; and
(B) $50,000,000 for the purpose of providing
clinical services under pilot programs; and
(6) $500,000 for each fiscal year during the 5-fiscal-year
period beginning with fiscal year 2004 to carry out subsection
(h).
SEC. 5. PROGRAMS THROUGH DEPARTMENT OF VETERANS AFFAIRS REGARDING
PATIENTS WITH FATAL CHRONIC ILLNESSES.
(a) In General.--(1) Chapter 73 of title 38, United States Code, is
amended by adding at the end of subchapter II the following new
section:
``Sec. 7324. Programs for patients with fatal chronic illnesses
``(a) Establishment of Programs.--(1) The Secretary shall develop
and carry out programs to improve the delivery of appropriate health
and support services for patients with fatal chronic illnesses. As part
of such programs, the Secretary shall seek to develop services in
collaboration with community service providers serving populations of
persons other than veterans, especially those populations that use the
Medicare program.
``(2) For purposes of this section, community service providers are
entities outside the Department that provide health care services to
persons in the communities in which they are located.
``(b) Role of GRECCs and Health Services Research.--The Secretary
shall take appropriate steps to involve in programs under this section
both geriatric research, education, and clinical centers under section
7314 of this title and activities of Health Services research and
quality improvement initiatives of the Department. As part of such
steps, the Secretary shall seek to target the work of such centers and
initiatives to improve care for veterans with fatal chronic illnesses.
``(c) Training.--In conducting programs of professional training
and staff development for health-care personnel of the Department and
persons being trained through health-care programs conducted by the
Secretary, the Secretary shall ensure that such programs include
training in pain relief and end-of-life care for persons with fatal
chronic illnesses. Such training shall address symptoms, advance care
planning, and quality improvement for those with fatal chronic
illnesses.
``(d) Annual Report.--The Secretary shall prepare an annual report
on care for veterans with fatal chronic illnesses and the activities of
the Secretary under this section. The Secretary shall furnish such
report to the Secretary of Health and Human Services each year in
sufficient time for inclusion in the annual report of that Secretary
under section 4(j) of the Living Well with Fatal Chronic Illness Act of
2002.
``(e) Cooperation With Community Service Providers.--(1) In
carrying out this section, the Secretary shall, to the extent
practicable, take appropriate steps, through collaborative agreements
or otherwise, to cooperate with community service providers that
provide home and hospice care.
``(2) Such steps shall, to the extent practicable, include--
``(A) developing documentation of advance care plans for
persons with fatal chronic illnesses that are acceptable to all
providers of care for those persons;
``(B) developing service programs for persons with fatal
chronic illnesses under which Department facilities or
personnel may be used for part of the array of services
provided to such persons; and
``(C) developing protocols that facilitate the placement
with community service providers supported by the medicare or
medicaid programs of veterans with fatal chronic illnesses when
such a placement would be more efficient or effective for the
timely provision of services for the community in which the
facilities are located and for such veterans than the provision
of those services directly through Department facilities.
``(3) When the Secretary, as part of service programs authorized by
this subsection, provides services to a person with a fatal chronic
illness who is not a veteran, the Secretary shall, as a condition of
providing such services, be reimbursed by appropriate community service
providers for the costs of such services.
``(f) Support for Volunteer and Community Support of Veterans
Living at Home.--The Secretary shall make grants to support volunteer
and community support of veterans living at home who have fatal chronic
illnesses. The Secretary may establish the minimum number of volunteers
an entity must have in order to be eligible for a grant under this
subsection.
``(g) Definition.--For purposes of this section, the term `fatal
chronic illness' means a disease (or diseases), condition (or
conditions), or disorder (or disorders) that ordinarily worsens and
causes death and that causes a physical or mental disability or
periodic episodes of significant loss of functional capacity.''.
(2) The table of sections at the beginning of such chapter is
amended by inserting after the item relating to section 7323 the
following new item:
``7324. Programs for patients with fatal chronic illnesses.''.
(b) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Veterans Affairs to carry out section
7324 of title 38, United States Code, as added by subsection (a), the
amount of $5,000,000 for each of fiscal years 2003 through 2007.
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