Ronald Reagan Alzheimer's Breakthrough Act of 2004 - Amends the Public Health Service Act to make Alzheimer's disease research a priority within the National Institute on Aging. Requires the Director of the Institute to: (1) undertake an Alzheimer's Disease Prevention Initiative to accelerate the discovery of new risk and protective factors, to rapidly identify therapies and preventive interventions, and to implement effective prevention and treatment strategies; (2) conduct and support cooperative clinical research regarding Alzheimer's; and (3) conduct research concerning early detection and diagnosis, the relationship between Alzheimer's and vascular disease, and interventions designed to help caregivers. Authorizes the Director to establish a National Alzheimer's Coordinating Center to facilitate collaboration among Alzheimer's Disease Centers and Alzheimer's Disease Research Centers.
Requires the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention (CDC), to educate the public and public health community regarding Alzheimer's disease.
Authorizes the Secretary to award grants or cooperative agreements to develop coordinated respite care programs on a statewide basis. Defines "respite care" to mean 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 such child or adult. Directs the Secretary to award a grant or cooperative agreement to a public or private nonprofit entity to establish a National Resource Center on Lifespan Respite Care.
Amends the Internal Revenue Code to allow: (1) a nonrefundable tax credit for each individual certified as having long-term care needs and for whom the taxpayer is acting as a caregiver; (2) a tax deduction for long-term care premiums paid under a qualified insurance contract; and (3) qualified long-term care insurance to be offered in a cafeteria plan and flexible spending arrangements.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4595 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 4595
To amend the Public Health Service Act to fund breakthroughs in
Alzheimer's disease research while providing more help to caregivers
and increasing public education about prevention.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 16, 2004
Mr. Markey (for himself, Mr. Smith of New Jersey, Mr. Menendez, Ms.
Jackson-Lee of Texas, Mr. Green of Texas, Mr. Kildee, Mr. Manzullo, Ms.
McCarthy of Missouri, Mr. Meehan, Mr. Neal of Massachusetts, Mr. Kind,
Mr. Kennedy of Rhode Island, and Mr. McDermott) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Education and the
Workforce and Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to fund breakthroughs in
Alzheimer's disease research while providing more help to caregivers
and increasing public education about prevention.
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 ``Ronald Reagan
Alzheimer's Breakthrough Act of 2004''.
(b) Table of Contents.--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.
SEC. 2. FINDINGS.
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.
TITLE I--INCREASING THE FEDERAL COMMITMENT TO ALZHEIMER'S RESEARCH
SEC. 101. DOUBLING NIH FUNDING FOR ALZHEIMER'S DISEASE RESEARCH.
(a) In General.--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 Public Health Service Act (42
U.S.C. 285e et seq.) 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.
(b) Aging Process Regarding Women.--Section 445H(b) of the Public
Health Service Act (42 U.S.C. 285e-10(b)) is amended by striking
``2003'' and inserting ``2009''.
(c) Clinical Research and Training Awards.--Section 445I(d) of the
Public Health Service Act (42 U.S.C. 285e-10a(d)) is amended by
striking ``2005'' and inserting ``2009''.
SEC. 102. PRIORITY TO ALZHEIMER'S DISEASE RESEARCH.
Section 443 of the Public Health Service Act (42 U.S.C. 285e) is
amended--
(1) by striking ``The general'' and inserting ``(a) In
General.--The general''; and
(2) by adding at the end the following:
``(b) Priorities.--The Director of the Institute shall, in
expending amounts appropriated under this subpart, give priority to
conducting and supporting Alzheimer's disease research.''.
SEC. 103. ALZHEIMER'S DISEASE PREVENTION INITIATIVE.
Section 444 of the Public Health Service Act (42 U.S.C. 285e-1) is
amended--
(1) in subsection (d), by inserting ``and training'' after
``conduct research''; and
(2) by adding at the end the following:
``(e) 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--
``(1) accelerate the discovery of new risk and protective
factors for Alzheimer's disease;
``(2) rapidly identify candidate diagnostics, therapies, or
preventive interventions or agents for clinical investigation
and trials relating to Alzheimer's disease;
``(3) support or undertake such investigations and trials;
and
``(4) implement effective prevention and treatment
strategies, including strategies to improve patient care and
alleviate caregiver burdens relating to Alzheimer's disease.''.
SEC. 104. ALZHEIMER'S DISEASE CLINICAL RESEARCH.
(a) Clinical Research.--Section 445F of the Public Health Service
Act (42 U.S.C. 285e-8) is amended to read as follows:
``SEC. 445F. ALZHEIMER'S DISEASE CLINICAL RESEARCH.
``(a) In General.--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--
``(1) investigating therapies, interventions, and agents to
detect, treat, slow the progression of, or prevent Alzheimer's
disease;
``(2) enhancing the national infrastructure for the conduct
of clinical trials;
``(3) developing and testing novel approaches to the design
and analysis of such trials;
``(4) facilitating the enrollment of patients for such
trials, including patients from diverse populations;
``(5) developing improved diagnostics and means of patient
assessment for Alzheimer's disease; and
``(6) as determined appropriate by the Director of the
Institute, the Alzheimer's Disease Centers and Alzheimer's
Disease Research Centers established under section 445.
``(b) Early Diagnosis and Detection Research.--
``(1) In general.--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.
``(2) Evaluation.--The research described in paragraph (1)
may include the evaluation of diagnostic tests and imaging
techniques.
``(c) Vascular Disease.--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.
``(d) National Alzheimer's Coordinating Center.--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.''.
(b) Alzheimer's Disease Centers.--Section 445(a)(1) of the Public
Health Service Act (42 U.S.C. 285e-2(a)(1)) is amended by inserting ``,
and outcome measures and disease management'' after ``treatment
methods''.
SEC. 105. RESEARCH ON ALZHEIMER'S DISEASE CAREGIVING.
Section 445C of the Public Health Service Act (42 U.S.C. 285e-5) is
amended--
(1) by striking ``Sec. 445C. (a)'' and inserting the
following:
``SEC. 445C. RESEARCH ON ALZHEIMER'S DISEASE SERVICES AND CAREGIVING.
``(a) Services Research.--'';
(2) by striking subsections (b), (c), and (e);
(3) by inserting after subsection (a) the following:
``(b) Interventions Research.--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.''; and
(4) in subsection (d) by striking ``(d) the Director'' and
inserting ``(c) Model Curricula and Techniques. --The
Director''.
SEC. 106. NATIONAL SUMMIT ON ALZHEIMER'S DISEASE.
(a) In General.--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 ``Secretary'') 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.
(b) Focus Areas.--The summit convened under subsection (a) shall
focus on--
(1) a broad range of Alzheimer's disease research
activities relating to biomedical research, prevention
research, and caregiving issues;
(2) clinical research for the development and evaluation of
new treatments for the disease;
(3) translational research on evidence-based and cost-
effective best practices in the treatment and prevention of the
disease;
(4) information and education programs for health care
professionals and the public relating to the disease;
(5) priorities among the programs and activities of the
various Federal agencies regarding such diseases; and
(6) challenges and opportunities for scientists,
clinicians, patients, and voluntary organizations relating to
the disease.
(c) Report.--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.
(d) Public Information.--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.
(e) Authorization of Appropriations.--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.
TITLE II--PUBLIC EDUCATION ABOUT ALZHEIMER'S DISEASE
SEC. 201. PUBLIC EDUCATION CAMPAIGN.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399O. ALZHEIMER'S DISEASE PUBLIC EDUCATION CAMPAIGN.
``(a) In General.--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--
``(1) diagnosis and early warning signs of Alzheimer's
disease; and
``(2) how healthy lifestyles could maintain cognitive
function and brain health.
``(b) Education of Health Professionals and Partnerships.--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.
``(c) Authorization of Appropriations.--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.''.
TITLE III--ASSISTANCE FOR CAREGIVERS
SEC. 301. INCREASED FUNDING FOR NATIONAL FAMILY CAREGIVER SUPPORT
PROGRAM.
(a) In General.--Section 303(e)(1) of the Older Americans Act of
1965 (42 U.S.C. 3023(e)(1)) is amended by striking ``$125,000,000 for
fiscal year 2001'' and inserting ``$250,000,000 for fiscal year 2005''.
(b) Native Americans.--Section 643(2) of the Older Americans Act of
1965 (42 U.S.C. 3057n(2)) is amended by striking ``$5,000,000 for
fiscal year 2001'' and inserting ``$10,000,000 for fiscal year 2005''.
SEC. 302. ALZHEIMER'S DISEASE DEMONSTRATION GRANTS.
Section 398B(e) of the Public Health Service Act (42 U.S.C. 280c-
5(e)) is amended--
(1) by striking ``and such'' and inserting ``such''; and
(2) by inserting before the period ``, $25,000,000 for
fiscal year 2005, and such sums as may be necessary for each of
the fiscal years 2006 through 2009''.
SEC. 303. SAFE RETURN PROGRAM.
Section 240001(d) of the Violent Crime Control and Law Enforcement
Act of 1994 (42 U.S.C. 14181(d)) is amended to read as follows:
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $1,000,000 for fiscal year
2005.''.
SEC. 304. LIFESPAN RESPITE CARE.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXIX--LIFESPAN RESPITE CARE
``SEC. 2901. FINDINGS AND PURPOSES.
``(a) Findings.--Congress finds that--
``(1) 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;
``(2) 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;
``(3) nearly 4,000,000 individuals in the United States of
all ages who have mental retardation or another developmental
disability live with their families;
``(4) 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;
``(5) every year, approximately 600,000 Americans die at
home and many of these individuals rely on extensive family
caregiving before their death;
``(6) of all individuals in the United States needing
assistance in daily living, 42 percent are under age 65;
``(7) there are insufficient resources to replace family
caregivers with paid workers;
``(8) if services provided by family caregivers had to be
replaced with paid services, it would cost approximately
$200,000,000,000 annually;
``(9) the family caregiver role is personally rewarding but
can result in substantial emotional, physical, and financial
hardship;
``(10) approximately 75 percent of family caregivers are
women;
``(11) family caregivers often do not know where to find
information about available respite care or how to access it;
``(12) 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
``(13) the limited number of available respite care
programs find it difficult to recruit appropriately trained
respite workers.
``(b) Purposes.--The purposes of this title are--
``(1) to encourage States to establish State and local
lifespan respite care programs;
``(2) to improve and coordinate the dissemination of
respite care information and resources to family caregivers;
``(3) to provide, supplement, or improve respite care
services to family caregivers;
``(4) to promote innovative, flexible, and comprehensive
approaches to--
``(A) the delivery of respite care;
``(B) respite care worker and volunteer recruitment
and training programs; and
``(C) training programs for family caregivers to
assist such family caregivers in making informed
decisions about respite care services;
``(5) to support evaluative research to identify effective
respite care services that alleviate, reduce, or minimize any
negative consequences of caregiving; and
``(6) 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.
``SEC. 2902. DEFINITIONS.
``In this title:
``(1) Eligible recipient.--The term `eligible recipient'
means--
``(A) a State agency;
``(B) any other public entity that is capable of
operating on a statewide basis;
``(C) a private, nonprofit organization that is
capable of operating on a statewide basis;
``(D) a political subdivision of a State that has a
population of not less than 3,000,000 individuals; or
``(E) any recognized State respite coordinating
agency that has--
``(i) a demonstrated ability to work with
other State and community-based agencies;
``(ii) an understanding of respite care and
family caregiver issues; and
``(iii) the capacity to ensure meaningful
involvement of family members, family
caregivers, and care recipients.
``(2) Adult with a special need.--The term `adult with a
special need' means a person 18 years of age or older who
requires care or supervision to--
``(A) meet the person's basic needs; or
``(B) prevent physical self-injury or injury to
others.
``(3) Child with a special need.--The term `child with a
special need' means a person less than 18 years of age who
requires care or supervision beyond that required of children
generally to--
``(A) meet the child's basic needs; or
``(B) prevent physical self-injury or injury to
others.
``(4) Family caregiver.--The term `family caregiver' 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.
``(5) Respite care.--The term `respite care' 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.
``(6) Lifespan respite care.--The term `lifespan respite
care' means a coordinated system of accessible, community-based
respite care services for family caregivers of children or
adults with special needs.
``SEC. 2903. LIFESPAN RESPITE CARE GRANTS AND COOPERATIVE AGREEMENTS.
``(a) Purposes.--The purposes of this section are--
``(1) to expand and enhance respite care services to family
caregivers;
``(2) to improve the statewide dissemination and
coordination of respite care; and
``(3) to provide, supplement, or improve access and quality
of respite care services to family caregivers, thereby reducing
family caregiver strain.
``(b) Authorization.--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).
``(c) Federal Lifespan Approach.--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.
``(d) Application.--
``(1) Submission.--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.
``(2) Contents.--Each application submitted under this
section shall include--
``(A) a description of the applicant's--
``(i) understanding of respite care and
family caregiver issues;
``(ii) capacity to ensure meaningful
involvement of family members, family
caregivers, and care recipients; and
``(iii) collaboration with other State and
community-based public, nonprofit, or private
agencies;
``(B) 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--
``(i) the population of family caregivers;
``(ii) the extent and nature of the respite
care needs of that population;
``(iii) existing respite care services for
that population, including numbers of family
caregivers being served and extent of unmet
need;
``(iv) 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;
``(v) 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;
``(vi) 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;
``(vii) 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;
``(viii) 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;
``(ix) 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;
``(x) the criteria used to identify family
caregivers eligible for respite care services;
``(xi) 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
``(xii) the results expected from proposed
respite care activities and the procedures to
be used for evaluating those results; and
``(C) assurances that, where appropriate, the
applicant shall have a system for maintaining the
confidentiality of care recipient and family caregiver
records.
``(e) Review of Applications.--
``(1) Establishment of review panel.--The Secretary shall
establish a panel to review applications submitted under this
section.
``(2) Meetings.--The panel shall meet as often as may be
necessary to facilitate the expeditious review of applications.
``(3) Function of panel.--The panel shall--
``(A) review and evaluate each application
submitted under this section; and
``(B) make recommendations to the Secretary
concerning whether the application should be approved.
``(f) Awarding of Grants or Cooperative Agreements.--
``(1) In general.--The Secretary shall award grants or
cooperative agreements from among the applications approved by
the panel under subsection (e)(3).
``(2) Priority.--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.
``(g) Use of Grant or Cooperative Agreement Funds.--
``(1) In general.--
``(A) Mandatory uses of funds.--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--
``(i) the development of lifespan respite
care at the State and local levels; and
``(ii) an evaluation of the effectiveness
of such care.
``(B) Discretionary uses of funds.--Each eligible
recipient that is awarded a grant or cooperative
agreement under this section may use the funds for--
``(i) respite care services for family
caregivers of children and adults with special
needs;
``(ii) respite care worker and volunteer
training programs; or
``(iii) training programs for family
caregivers to assist such family caregivers in
making informed decisions about respite care
services.
``(C) Evaluation.--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.
``(2) Subcontracts.--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).
``(h) Term of Grants or Cooperative Agreements.--
``(1) In general.--The Secretary shall award grants or
cooperative agreements under this section for terms that do not
exceed 5 years.
``(2) Renewal.--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).
``(i) Supplement, not Supplant.--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.
``(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
``(1) $90,500,000 for fiscal year 2005; and
``(2) such sums as are necessary for fiscal years 2006
through 2009.
``SEC. 2904. NATIONAL LIFESPAN RESPITE RESOURCE CENTER.
``(a) Establishment.--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 `center').
``(b) Purposes of the Center.--The center shall--
``(1) maintain a national database on lifespan respite
care;
``(2) provide training and technical assistance to State,
community, and nonprofit respite care programs; and
``(3) provide information, referral, and educational
programs to the public on lifespan respite care.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $500,000 for each of fiscal
years 2005 through 2009.''.
SEC. 305. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.
(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. CREDIT FOR TAXPAYERS WITH LONG-TERM CARE NEEDS.
``(a) Allowance of Credit.--
``(1) In general.--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) Applicable credit amount.--For purposes of paragraph
(1), the applicable credit amount shall be determined in
accordance with the following table:
``(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 $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) Threshold amount.--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) Indexing.--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) 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 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) Chronic condition.--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) 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(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) 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) 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:
``25C. Credit for taxpayers with long-term care needs.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2003.
SEC. 306. TREATMENT OF PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE
CONTRACTS.
(a) In General.--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:
``SEC. 224. PREMIUMS ON QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS.
``(a) In General.--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) Applicable Percentage.--For purposes of subsection (a)--
``(1) In general.--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)):
``(2) Special rules for individuals who have attained age
55.--In 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):
``(3) Only coverage after 2003 taken into account.--Only
coverage for periods after December 31, 2003, shall be taken
into account under this subsection.
``(4) Continuous coverage.--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 Deductions.--Any 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) Conforming Amendments.--
(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
contracts.--The 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:
``224. Premiums on qualified long-term care insurance contracts.
``225. Cross reference.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2003.
SEC. 307. ADDITIONAL CONSUMER PROTECTIONS FOR LONG-TERM CARE INSURANCE.
(a) Additional Protections Applicable to Long-Term Care
Insurance.--Subparagraphs (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) In general.--The requirements of this
paragraph are met with respect to any contract if such
contract meets--
``(i) Model regulation.--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) Model act.--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) Definitions.--For purposes of this
paragraph--
``(i) Model provisions.--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) Coordination.--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) Determination.--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) Excise Tax.--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) Model regulation.--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) Model act.--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) Definitions.--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) Effective Date.--The amendments made by this section shall
apply to policies issued more than 1 year after the date of the
enactment of this Act.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1143-1144)
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line
Referred to the Subcommittee on Select Education.