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Calendar No. 685
106th CONGRESS
2d Session
S. 2420
[Report No. 106-344]
To amend title 5, United States Code, to provide for the establishment
of a program under which long-term care insurance is made available to
Federal employees, members of the uniformed services, and civilian and
military retirees, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 13, 2000
Mr. Grassley (for himself, Ms. Mikulski, Ms. Collins, Mr. Cleland, Mr.
Sarbanes, Mr. Akaka, Mr. Graham, Mr. Durbin, Mr. Hagel, and Mr. Robb)
introduced the following bill; which was read twice and referred to the
Committee on Governmental Affairs
July 14, 2000
Reported by Mr. Thompson, with an amendment and an amendment to the
title
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend title 5, United States Code, to provide for the establishment
of a program under which long-term care insurance is made available to
Federal employees, members of the uniformed services, and civilian and
military retirees, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Long-Term Care Security
Act''.</DELETED>
<DELETED>SEC. 2. LONG-TERM CARE INSURANCE.</DELETED>
<DELETED> (a) In General.--Subpart G of part III of title 5, United
States Code, is amended by adding at the end the following:</DELETED>
<DELETED>``CHAPTER 90--LONG-TERM CARE INSURANCE</DELETED>
<DELETED>``Sec.
<DELETED>``9001. Definitions.
<DELETED>``9002. Availability of insurance.
<DELETED>``9003. Contracting authority.
<DELETED>``9004. Financing.
<DELETED>``9005. Preemption.
<DELETED>``9006. Studies, reports, and audits.
<DELETED>``9007. Jurisdiction of courts.
<DELETED>``9008. Administrative functions.
<DELETED>``9009. Cost accounting standards.
<DELETED>``Sec. 9001. Definitions</DELETED>
<DELETED> For purposes of this chapter:</DELETED>
<DELETED> ``(1) Employee.--The term `employee' means--
</DELETED>
<DELETED> ``(A) an employee as defined by section
8901(1); and</DELETED>
<DELETED> ``(B) an individual described in section
2105(e);</DELETED>
<DELETED>but does not include an individual employed by the
government of the District of Columbia.</DELETED>
<DELETED> ``(2) Annuitant.--The term `annuitant' has the
meaning such term would have under paragraph (3) of section
8901 if, for purposes of such paragraph, the term `employee'
were considered to have the meaning given to it under paragraph
(1) of this subsection.</DELETED>
<DELETED> ``(3) Member of the uniformed services.--The term
`member of the uniformed services' means a member of the
uniformed services, other than a retired member of the
uniformed services.</DELETED>
<DELETED> ``(4) Retired member of the uniformed services.--
The term `retired member of the uniformed services' means a
member or former member of the uniformed services entitled to
retired or retainer pay.</DELETED>
<DELETED> ``(5) Qualified relative.--The term `qualified
relative' means each of the following:</DELETED>
<DELETED> ``(A) The spouse of an individual
described in paragraph (1), (2), (3), or (4).</DELETED>
<DELETED> ``(B) A parent, stepparent, or parent-in-
law of an individual described in paragraph (1) or
(3).</DELETED>
<DELETED> ``(C) A child (including an adopted child,
a stepchild, or, to the extent the Office of Personnel
Management by regulation provides, a foster child) of
an individual described in paragraph (1), (2), (3), or
(4), if such child is at least 18 years of
age.</DELETED>
<DELETED> ``(D) An individual having such other
relationship to an individual described in paragraph
(1), (2), (3), or (4) as the Office may by regulation
prescribe.</DELETED>
<DELETED> ``(6) Eligible individual.--The term `eligible
individual' refers to an individual described in paragraph (1),
(2), (3), (4), or (5).</DELETED>
<DELETED> ``(7) Qualified carrier.--The term `qualified
carrier' means an insurance company (or consortium of insurance
companies) that is licensed to issue long-term care insurance
in all States, taking any subsidiaries of such a company into
account (and, in the case of a consortium, considering the
member companies and any subsidiaries thereof,
collectively).</DELETED>
<DELETED> ``(8) State.--The term `State' includes the
District of Columbia.</DELETED>
<DELETED> ``(9) Qualified long-term care insurance
contract.--The term `qualified long-term care insurance
contract' has the meaning given such term by section 7702B of
the Internal Revenue Code of 1986.</DELETED>
<DELETED> ``(10) Appropriate secretary.--The term
`appropriate Secretary' means--</DELETED>
<DELETED> ``(A) except as otherwise provided in this
paragraph, the Secretary of Defense;</DELETED>
<DELETED> ``(B) with respect to the Coast Guard when
it is not operating as a service of the Navy, the
Secretary of Transportation;</DELETED>
<DELETED> ``(C) with respect to the commissioned
corps of the National Oceanic and Atmospheric
Administration, the Secretary of Commerce;
and</DELETED>
<DELETED> ``(D) with respect to the commissioned
corps of the Public Health Service, the Secretary of
Health and Human Services.</DELETED>
<DELETED>``Sec. 9002. Availability of insurance</DELETED>
<DELETED> ``(a) In General.--The Office of Personnel Management
shall establish and, in consultation with the appropriate Secretaries,
administer a program through which an individual described in paragraph
(1), (2), (3), (4), or (5) of section 9001 may obtain long-term care
insurance coverage under this chapter for such individual.</DELETED>
<DELETED> ``(b) General Requirements.--Long-term care insurance may
not be offered under this chapter unless--</DELETED>
<DELETED> ``(1) the only coverage provided is under
qualified long-term care insurance contracts; and</DELETED>
<DELETED> ``(2) each insurance contract under which any such
coverage is provided is issued by a qualified
carrier.</DELETED>
<DELETED> ``(c) Documentation Requirement.--As a condition for
obtaining long-term care insurance coverage under this chapter based on
one's status as a qualified relative, an applicant shall provide
documentation to demonstrate the relationship, as prescribed by the
Office.</DELETED>
<DELETED> ``(d) Underwriting Standards.--</DELETED>
<DELETED> ``(1) Disqualifying condition.--Nothing in this
chapter shall be considered to require that long-term care
insurance coverage be made available in the case of any
individual who would be eligible for benefits
immediately.</DELETED>
<DELETED> ``(2) Spousal parity.--For the purpose of
underwriting standards, a spouse of an individual described in
paragraph (1), (2), (3), or (4) of section 9001 shall, as
nearly as practicable, be treated like that
individual.</DELETED>
<DELETED> ``(3) Guaranteed issue.--Nothing in this chapter
shall be considered to require that long-term care insurance
coverage be guaranteed to an eligible individual.</DELETED>
<DELETED> ``(4) Requirement that contract be fully
insured.--In addition to the requirements otherwise applicable
under section 9001(9), in order to be considered a qualified
long-term care insurance contract for purposes of this chapter,
a contract must be fully insured, whether through reinsurance
with other companies or otherwise.</DELETED>
<DELETED> ``(5) Higher standards allowable.--Nothing in this
chapter shall, in the case of an individual applying for long-
term care insurance coverage under this chapter after the
expiration of such individual's first opportunity to enroll,
preclude the application of underwriting standards more
stringent than those that would have applied if that
opportunity had not yet expired.</DELETED>
<DELETED> ``(e) Guaranteed Renewability.--The benefits and coverage
made available to eligible individuals under any insurance contract
under this chapter shall be guaranteed renewable (as defined by section
7A(2) of the model regulations described in section 7702B(g)(2) of the
Internal Revenue Code of 1986), including the right to have insurance
remain in effect so long as premiums continue to be timely made.
However, the authority to revise premiums under this chapter shall be
available only on a class basis and only to the extent otherwise
allowable under section 9003(b).</DELETED>
<DELETED>``Sec. 9003. Contracting authority</DELETED>
<DELETED> ``(a) In General.--The Office of Personnel Management
shall, without regard to section 5 of title 41 or any other statute
requiring competitive bidding, contract with 1 or more qualified
carriers for a policy or policies of long-term care insurance. The
Office shall ensure that each resulting contract (hereinafter in this
chapter referred to as a `master contract') is awarded on the basis of
contractor qualifications, price, and reasonable competition.</DELETED>
<DELETED> ``(b) Terms and Conditions.--</DELETED>
<DELETED> ``(1) In general.--Each master contract under this
chapter shall contain--</DELETED>
<DELETED> ``(A) a detailed statement of the benefits
offered (including any maximums, limitations,
exclusions, and other definitions of
benefits);</DELETED>
<DELETED> ``(B) the premiums charged (including any
limitations or other conditions on their subsequent
adjustment);</DELETED>
<DELETED> ``(C) the terms of the enrollment period;
and</DELETED>
<DELETED> ``(D) such other terms and conditions as
may be mutually agreed to by the Office and the carrier
involved, consistent with the requirements of this
chapter.</DELETED>
<DELETED> ``(2) Premiums.--Premiums charged under each
master contract entered into under this section shall
reasonably and equitably reflect the cost of the benefits
provided, as determined by the Office. The premiums shall not
be adjusted during the term of the contract unless mutually
agreed to by the Office and the carrier.</DELETED>
<DELETED> ``(3) Nonrenewability.--Master contracts under
this chapter may not be made automatically renewable.</DELETED>
<DELETED> ``(c) Payment of Required Benefits; Dispute Resolution.--
</DELETED>
<DELETED> ``(1) In general.--Each master contract under this
chapter shall require the carrier to agree--</DELETED>
<DELETED> ``(A) to provide payments or benefits to
an eligible individual if such individual is entitled
thereto under the terms of the contract; and</DELETED>
<DELETED> ``(B) with respect to disputes regarding
claims for payments or benefits under the terms of the
contract--</DELETED>
<DELETED> ``(i) to establish internal
procedures designed to expeditiously resolve
such disputes; and</DELETED>
<DELETED> ``(ii) to establish, for disputes
not resolved through procedures under clause
(i), procedures for 1 or more alternative means
of dispute resolution involving independent
third-party review under appropriate
circumstances by entities mutually acceptable
to the Office and the carrier.</DELETED>
<DELETED> ``(2) Eligibility.--A carrier's determination as
to whether or not a particular individual is eligible to obtain
long-term care insurance coverage under this chapter shall be
subject to review only to the extent and in the manner provided
in the applicable master contract.</DELETED>
<DELETED> ``(3) Other claims.--For purposes of applying the
Contract Disputes Act of 1978 to disputes arising under this
chapter between a carrier and the Office--</DELETED>
<DELETED> ``(A) the agency board having jurisdiction
to decide an appeal relative to such a dispute shall be
such board of contract appeals as the Director of the
Office of Personnel Management shall specify in writing
(after appropriate arrangements, as described in
section 8(c) of such Act); and</DELETED>
<DELETED> ``(B) the district courts of the United
States shall have original jurisdiction, concurrent
with the United States Court of Federal Claims, of any
action described in section 10(a)(1) of such Act
relative to such a dispute.</DELETED>
<DELETED> ``(4) Rule of construction.--Nothing in this
chapter shall be considered to grant authority for the Office
or a third-party reviewer to change the terms of any contract
under this chapter.</DELETED>
<DELETED> ``(d) Duration.--</DELETED>
<DELETED> ``(1) In general.--Each master contract under this
chapter shall be for a term of 7 years, unless terminated
earlier by the Office in accordance with the terms of such
contract. However, the rights and responsibilities of the
enrolled individual, the insurer, and the Office (or duly
designated third-party administrator) under such contract shall
continue with respect to such individual until the termination
of coverage of the enrolled individual or the effective date of
a successor contract thereto.</DELETED>
<DELETED> ``(2) Exception.--</DELETED>
<DELETED> ``(A) Shorter duration.--In the case of a
master contract entered into before the end of the
period described in subparagraph (B), paragraph (1)
shall be applied by substituting `ending on the last
day of the 7-year period described in paragraph (2)(B)'
for `of 7 years'.</DELETED>
<DELETED> ``(B) Definition.--The period described in
this subparagraph is the 7-year period beginning on the
earliest date as of which any long-term care insurance
coverage under this chapter becomes
effective.</DELETED>
<DELETED> ``(3) Congressional notification.--No later than
180 days after receiving the second report required under
section 9006(c), the President (or his designee) shall submit
to the Committees on Government Reform and on Armed Services of
the House of Representatives and the Committees on Governmental
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