Improving Long-Term Care Choices Act of 2005
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Read twice and referred to the Committee on Finance.
July 29, 2005
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Introduced in Senate
July 29, 2005
Sponsor introductory remarks on measure. (CR S9520-9523)
July 29, 2005
Read twice and referred to the Committee on Finance.
July 29, 2005
Floor Debate
23 membersWhat members said about S. 1602 on the floor




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Floor Debate
23 membersWhat members said about S. 1602 on the floor
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Bill Text
Latest available legislative text
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1602 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1602
To amend title XIX of the Social Security Act to require States to
disregard benefits paid under long-term care insurance for purposes of
determining medicaid eligibility, to expand long-term care insurance
partnerships between States and insurers, to amend the Internal Revenue
Code of 1986 to allow individuals a deduction for qualified long-term
care insurance premiums, the use of such insurance under cafeteria
plans and flexible spending arrangements, and a credit for individuals
with long-term care needs, to establish home and community-based
services as an optional medicaid benefit, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 29, 2005
Mr. Grassley (for himself, Mr. Bayh, and Mrs. Clinton) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require States to
disregard benefits paid under long-term care insurance for purposes of
determining medicaid eligibility, to expand long-term care insurance
partnerships between States and insurers, to amend the Internal Revenue
Code of 1986 to allow individuals a deduction for qualified long-term
care insurance premiums, the use of such insurance under cafeteria
plans and flexible spending arrangements, and a credit for individuals
with long-term care needs, to establish home and community-based
services as an optional medicaid benefit, and for other purposes.
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 ``Improving Long-
Term Care Choices Act of 2005''.
(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--LONG-TERM CARE INSURANCE
Subtitle A--Consumer Protections
Sec. 101. Disregard of benefits paid under long-term care insurance for
purposes of determining medicaid
eligibility.
Sec. 102. Additional consumer protections for long-term care insurance.
Sec. 103. Expansion of State long-term care partnerships.
Sec. 104. National clearinghouse for long-term care information.
Subtitle B--Amendments to the Internal Revenue Code of 1986
Sec. 121. Treatment of premiums on qualified long-term care insurance
contracts.
Sec. 122. Credit for taxpayers with long-term care needs.
Sec. 123. Treatment of exchanges of long-term care insurance contracts.
TITLE II--MEDICAID HOME AND COMMUNITY-BASED SERVICES OPTIONAL BENEFIT
Sec. 201. Medicaid home and community-based services optional benefit.
TITLE III--INTEGRATED ACUTE AND LONG-TERM CARE SERVICES FOR DUALLY
ELIGIBLE INDIVIDUALS.
Sec. 301. Removal of barriers to integrated acute and long-term care
services for dually eligible individuals.
TITLE IV--EFFECTIVE DATE
Sec. 401. Effective date.
SEC. 2. FINDINGS.
Congress finds that--
(1) The Medicaid program is designed to assist low-income
individuals with few resources obtain health care, including
long-term care.
(2) The average daily cost of a private room in a nursing
home in the United States is more than $70,000 per year, with
an average length of stay of 2.4 years.
(3) Many individuals deplete their savings and resources
paying for long-term care or qualifying for Medicaid in order
to receive that care.
(4) Encouraging individuals to purchase private long-term
care insurance that meets minimum Federal standards would help
ensure that Medicaid is able to continue to offer long-term
care to low-income individuals who cannot afford that
insurance.
(5) Requiring consumer protections and standards for long-
term care insurance will help ensure that Federal, State, and
individual resources are used to purchase high-quality long-
term care coverage that meets individual needs.
(6) In 1999, the United States Supreme Court, in Olmstead
v. L.C. (527 U.S. 581) held that the medically unnecessary
institutionalization of individuals with disabilities
constitutes discrimination in violation of the provisions of
the Americans with Disabilities Act of 1990 (ADA).
(7) The Olmstead decision has had the effect of broadening
State efforts to revise their Medicaid plans to develop
alternatives to institutional care, but certain limitations in
Medicaid's structure constrain these efforts, in particular,
the lack of certain coverage and benefit options related to
community care, which in turn force States to rely on a more
cumbersome Federal waiver process.
(8) Based on preliminary 2002 data, total Medicaid
expenditures for that year for long-term care services were
$92,800,000,000 ($66,100,000,000 for services in institutions
and $26,700,000,000 for services provided in home and
community-based settings).
(9) Nationally, only 33 percent of public long-term care
spending is spent for home and community-based services and
supports. Among the elderly, over 84 percent of long-term care
funding is spent for nursing facility and other institutional
care.
(10) In order to live independently, individuals with
disabilities need access to home and community-based services
and supports.
(11) Most Americans would prefer to receive long-term care
services in their homes and communities.
(12) States are currently operating a complicated system of
over 261 different home and community-based waivers.
(13) There is a need to build upon the progress made by the
New Freedom Initiative, which was announced in 2001, and is a
continuing nationwide effort to remove barriers to community
living for people of all ages with disabilities and long-term
illnesses.
TITLE I--LONG-TERM CARE INSURANCE
Subtitle A--Consumer Protections
SEC. 101. DISREGARD OF BENEFITS PAID UNDER LONG-TERM CARE INSURANCE FOR
PURPOSES OF DETERMINING MEDICAID ELIGIBILITY.
(a) Medicaid State Plan Requirement.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (66), by striking ``and'' at the end;
(2) in paragraph (67), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (67), the following:
``(68) provide that, with respect to benefits (including
assigned benefits) paid under any insurance contract for
coverage of qualified long-term care services (as defined in in
section 7702B(c) of the Internal Revenue Code of 1986), the
State does not treat such benefits as income for purposes of
determining an individual's eligibility for medical assistance
under the State plan.''.
(b) Consumer Education.--Not later than January 1, 2009, the
Secretary of Health and Human Services shall establish a program for
educating consumers regarding--
(1) the advisability of obtaining a qualified long-term
care insurance contract (as defined in section 7702B(b) of the
Internal Revenue Code of 1986); and
(2) the potential interaction between coverage under such
an insurance contract and coverage of long-term care under
Federal and State health insurance programs, (including under a
long-term care partnership under section 1917(b)(1)(C)(ii) of
the Social Security Act (42 U.S.C. 1396p(b)(1)(C)(ii)).
SEC. 102. 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), other than
paragraph (5) thereof, 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) other than paragraph (7)
thereof.
``(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 sections 8F,
8G, 8H, and 8I 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).
``(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
October 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).
``(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.
``(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).
``(ii) Section 6G (relating to outline of
coverage).
``(iii) Section 6H (relating to
requirements for certificates under group
plans).
``(iv) Section 6J (relating to policy
summary).
``(v) Section 6K (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 enactment
of this Act.
SEC. 103. EXPANSION OF STATE LONG-TERM CARE PARTNERSHIPS.
(a) In General.--Section 1917(b)(1)(C)(ii) of the Social Security
Act (42 U.S.C. 1396p(b)(1)(C)(ii)) is amended to read as follows:
``(ii) Clause (i) shall not apply in the case of an
individual who received medical assistance under--
``(I) a Qualified State Long-Term Care Insurance
Partnership (as defined in paragraph (6)); or
``(II) under a State plan of a State which--
``(aa) had a State plan amendment approved
as of May 14, 1993, which provided for the
disregard of any assets or resources to the
extent that payments are made under a long-term
care insurance policy or because an individual
has received (or is entitled to receive)
benefits under a long-term care insurance
policy; and
``(bb) has a State plan amendment which
satisfies the requirements of subparagraphs (B)
through (F) of paragraph (6).''.
(b) Satisfaction of Minimum Federal Standards, Tax-Qualifications,
Inflation Protection, and Other Requirements for Long-Term Care
Insurance Partnerships.--Section 1917(e) of the Social Security Act (42
U.S.C. 1396p(e)) is amended by inserting at the end the following:
``(6) The term `Qualified State Long-Term Care Insurance
Partnership' means a State with an approved State plan
amendment that provides for the following:
``(A) The disregard of any assets or resources in
an amount equal to the amount of payments made to, or
on behalf of, an individual who is a beneficiary under
any long-term care insurance policy (including a
certificate issued under a group insurance contract)
sold under such plan amendment.
``(B) A requirement that the State will treat
benefits paid under any long-term care insurance policy
(including a certificate issued under a group insurance
contract) sold under a plan amendment of a State that
maintains a Qualified Long-Term Care Insurance
Partnership or is described in subsection
(b)(1)(C)(ii)(II) the same as the State treats benefits
paid under such a policy sold under the State's plan
amendment.
``(C) A requirement that any long-term care
insurance policy (including a certificate issued under
a group insurance contract) sold under such plan
amendment be a qualified long-term care insurance
contract within the meaning of section 7702B(b) of the
Internal Revenue Code of 1986.
``(D) A requirement that any such policy sold under
the State plan amendment shall provide for compound
annual inflation protection.
``(E) A requirement that any individual who sells
such a policy receive training, and demonstrate
evidence of an understanding of, the policy and how the
policy relates to other public and private coverage of
long-term care.
``(F) A requirement that the issuer of any such
policy report--
``(i) to the Secretary, such information or
data as the Secretary may require; and
``(ii) to the State, the information or
data reported to the Secretary (if any), the
information or data required under the minimum
reporting requirements developed under section
103(c)(1)(B) of the Improving Long-Term Care
Choices Act of 2005, and such additional
information or data as the State may require.
For purposes of applying this paragraph, if a long-term care
insurance policy is exchanged for another such policy, the date
coverage became effective under the first policy shall
determine when coverage first becomes effective.''.
(c) Development of Reciprocity and Uniform Data Standards.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services, in consultation with the National Association of
Insurance Commissioners, issuers of long-term care insurance
policies, States with experience with long-term care insurance
partnership plans, and other States shall develop the following
standards:
(A) Reciprocity.--Standards for ensuring that long-
term care insurance policies issued under a State long-
term care insurance partnership under section
1917(b)(1)(C)(ii) of the Social Security Act (42 U.S.C.
1396p(b)(1)(C)(ii)) (as amended by subsection (a)) are
portable to other States with such a partnership.
(B) Minimum reporting requirements.--Standards for
minimum reporting requirements for issuers of long-term
care insurance policies under such State long-term care
insurance partnerships that shall specify the data and
information that each such issuer shall report to the
State with which it has such a partnership. The
requirements developed in accordance with this
subparagraph shall specify the type and format of the
data and information to be reported and the frequency
with which such reports are to be made.
(2) State reporting requirements.--Nothing in paragraph
(1)(B) shall be construed as prohibiting a State from requiring
an issuer of a long-term care insurance policy sold in the
State (regardless of whether the policy is issued under a State
long-term care insurance partnership under section
1917(b)(1)(C)(ii) of the Social Security Act) to require the
issuer to report information or data to the State that is in
addition to the information or data required under the minimum
reporting requirements developed under that paragraph.
(d) Annual Reports to Congress.--The Secretary of Health and Human
Services shall annually report to Congress on the long-term care
insurance partnerships established in accordance with section
1917(b)(1)(C)(ii) of the Social Security Act (42 U.S.C.
1396p(b)(1)(C)(ii))). Such reports shall include analyses of the extent
to which such partnerships expand or limit access of individuals to
long-term care and the impact of such partnerships on Federal and State
expenditures under the medicare and medicaid programs.
SEC. 104. NATIONAL CLEARINGHOUSE FOR LONG-TERM CARE INFORMATION.
(a) Establishment.--The Secretary of Health and Human Services
shall establish, by grant, contract, or interagency agreement, a
National Clearinghouse for Long-Term Care Information.
(b) Duties.--The National Clearinghouse for Long-Term Care
Information shall--
(1) educate consumers regarding the extent to which Federal
and State health insurance programs provide coverage for long-
term care and options for financing long-term care;
(2) establish mechanisms for assisting consumers with the
decisionmaking process for determining whether to purchase a
long-term care insurance policy or pursue other options for
financing long-term care; and
(3) establish an Internet website that allows consumers to
compare qualified long-term care insurance contracts (as
defined in section 7702B(b) of the Internal Revenue Code of
1986) with respect to price, benefits provided, historical data
on premium increases, and other information that would help a
consumer determine whether such a policy would meet their
needs.
(c) Authorization of Appropriations.--There are authorized to be
appropriated for purposes of carrying out this section, such sums as
may be necessary for fiscal year 2006 and each fiscal year thereafter.
Subtitle B--Amendments to the Internal Revenue Code of 1986
SEC. 121. 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), the
applicable percentage shall be determined in accordance with the
following table:
The
applicable
``For taxable years beginning in calendar year-- percentage
is--
2005, 2006, or 2007........................................ 25
2008....................................................... 35
2009....................................................... 65
2010 or thereafter......................................... 100.
``(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) Long-Term Care Insurance Permitted to Be Offered Under
Cafeteria Plans and Flexible Spending Arrangements.--
(1) Cafeteria plans.--The last sentence of section 125(f)
of such Code (defining qualified benefits) is amended by
inserting before the period at the end ``; except that such
term shall include the payment of premiums for any qualified
long-term care insurance contract (as defined in section 7702B)
to the extent the amount of such payment does not exceed the
eligible long-term care premiums (as defined in section
213(d)(10)) for such contract''.
(2) Flexible spending arrangements.--Section 106 of such
Code (relating to contributions by an employer to accident and
health plans) is amended by striking subsection (c) and
redesignating subsection (d) as subsection (c).
(c) Conforming Amendments.--
(1) Section 62(a) of such Code is amended by inserting
before the last sentence at the end the following new
paragraph:
``(21) Premiums on qualified long-term care insurance
contracts.--The deduction allowed by section 224.''.
(2) Sections 223(b)(4)(B), 223(d)(4)(C), 223(f)(3)(B),
3231(e)(11), 3306(b)(18), 3401(a)(22), 4973(g)(1), and
4973(g)(2)(B)(i) of such Code are each amended by striking
``section 106(d)'' and inserting ``section 106(c)''.
(3) Section 6041 of such Code is amended--
(A) in subsection (f)(1) by striking ``(as defined
in section 106(c)(2))'', and
(B) by adding at the end the following new
subsection:
``(h) Flexible Spending Arrangement Defined.--For purposes of this
section, a flexible spending arrangement is a benefit program which
provides employees with coverage under which--
``(1) specified incurred expenses may be reimbursed
(subject to reimbursement maximums and other reasonable
conditions), and
``(2) the maximum amount of reimbursement which is
reasonably available to a participant for such coverage is less
than 500 percent of the value of such coverage.
In the case of an insured plan, the maximum amount reasonably available
shall be determined on the basis of the underlying coverage.''.
(4) The table of sections for part VII of subchapter B of
chapter 1 of such Code is amended by striking the last item and
inserting the following new items:
``Sec. 224. Premiums on qualified long-term care insurance contracts.
``Sec. 225. Cross reference.''.
(d) Effective Dates.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to taxable years
beginning after December 31, 2005.
(2) Cafeteria plans and flexible spending arrangements.--
The amendments made by subsection (b) shall apply to taxable
years beginning after December 31, 2007.
SEC. 122. 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), as amended by the Energy Tax Incentives Act of 2005,
is amended by inserting after section 25D the following new section:
``SEC. 25E. 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:
The
applicable
``For taxable years beginning in calendar year-- credit
amount is--
2005....................................................... $1,000
2006....................................................... 1,500
2007....................................................... 2,000
2008....................................................... 2,500
2009 or thereafter......................................... 3,000.
``(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 2005, 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 `August 2004' for `August 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.
Notwithstanding the preceding sentence, a certification
shall not be treated as valid unless it is made within
the 39\1/2\ month period ending on such due date (or
such other period as the Secretary prescribes).
``(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 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, without reminding or
cuing assistance, 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(c) for the taxable year.
``(iv) An individual who would be described
in clause (iii) for the taxable year if section
151(c) 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 under subsection (c)(1)(D)
or (d)(1)(C) of section 152.
``(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 adjusted gross
income 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 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 25E(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 25D the following new item:
``Sec. 25E. 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, 2005.
SEC. 123. TREATMENT OF EXCHANGES OF LONG-TERM CARE INSURANCE CONTRACTS.
(a) In General.--Subsection (a) of section 1035 of the Internal
Revenue Code of 1986 (relating to exchanges of insurance policies) is
amended by striking the period at the end of paragraph (3) and
inserting ``; or'' and by adding at the end the following new
paragraph:
``(4) a qualified long-term care insurance contract for
another qualified long-term care insurance contract.''.
(b) Qualified Long-Term Care Insurance Contract.--Subsection (b) of
section 1035 of such Code (relating to definitions) is amended by
adding at the end the following new paragraph:
``(4) Qualified long-term care insurance contract.--The
term `qualified long-term care insurance contract' means--
``(A) any qualified long-term care insurance
contract (as defined in section 7702B), and
``(B) any contract which is treated as such by
section 321(f)(2) of the Health Insurance Portability
and Accountability Act of 1996.''.
(c) Effective Date.--
(1) In general.--The amendments made by this section shall
apply to exchanges after December 31, 1997.
(2) Waiver of limitations.--If the credit or refund of any
overpayment of tax with respect to a taxable year ending before
the date of the enactment of this Act resulting from the
application of section 1035(a)(4) of the Internal Revenue Code
of 1986, as added by this section, is prevented at any time by
the operation of any law or rule of law (including res
judicata), such credit or refund may nevertheless be allowed or
made if the claim therefor is filed before the close of the 1-
year period beginning on the date of the enactment of this Act.
TITLE II--MEDICAID HOME AND COMMUNITY-BASED SERVICES OPTIONAL BENEFIT
SEC. 201. MEDICAID HOME AND COMMUNITY-BASED SERVICES OPTIONAL BENEFIT.
(a) Home and Community-Based Services as an Optional Benefit for
Individuals Eligible for Medical Assistance.--Title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) is amended--
(1) in section 1905(a)--
(A) in paragraph (27), by striking ``and'' at the
end;
(B) by redesignating paragraph (28) as paragraph
(29); and
(C) by inserting after paragraph (27), the
following:
``(28) subject to section 1930A, such home and community-
based services (as defined in subsections (c)(4)(B) and
(d)(5)(C)(i) of section 1915 (not including payment for room
and board but including, in the case of services described in
section 1915(c)(4)(B), any other services requested by a State
and approved by the Secretary under such section)) as the State
shall specify in a State plan amendment; and''; and
(2) by inserting after section 1930, the following:
``home and community-based services
``Sec. 1930A. (a) In General.--A State may provide through a State
plan amendment for the provision of such home and community-based
services under section 1905(a)(28) as the State shall specify for
individuals eligible for medical assistance under the State plan
(without determining that but for the provision of such services the
individuals would require the level of care provided in a hospital or a
nursing facility or intermediate care facility for the mentally
retarded), but only if the State meets the following requirements:
``(1) Needs-based criteria for eligibility for, and receipt
of, home and community-based services.--The State establishes
needs-based criteria for determining an individual's
eligibility under the State plan for medical assistance for
such home and community-based services, and if the individual
is eligible for such services, the specific home and community-
based services that the individual will receive.
``(2) Establishment of more stringent needs-based
eligibility criteria for institutionalized care.--The State
establishes needs-based criteria for determining whether an
individual requires the level of care provided in a hospital, a
nursing facility, or an intermediate care facility for the
mentally retarded under the State plan or under any waiver of
such plan that are more stringent than the needs-based criteria
established under paragraph (1) for determining eligibility for
home and community-based services.
``(3) Projection of number of individuals to be provided
home and community-based services.--The State submits to the
Secretary, in such form and manner, and upon such frequency as
the Secretary shall specify, the projected number of
individuals to be provided home and community-based services.
``(4) Criteria based on individual assessment.--
``(A) In general.--The criteria established by the
State for purposes of paragraphs (1) and (2) requires
an assessment of an individual's support needs and
capabilities, and may take into account the inability
of the individual to perform 1 or more activities of
daily living (as defined in section 7702B(c)(2)(B) of
the Internal Revenue Code of 1986) or the need for
significant assistance to perform such activities, and
such other risk factors as the State determines to be
appropriate.
``(B) Adjustment authority.--The State plan
amendment provides for modification of the criteria
established under paragraph (1) (without having to
obtain prior approval from the Secretary) in the event
that the enrollment of individuals eligible for home
and community-based services exceeds the projected
enrollment submitted for purposes of paragraph (3), but
only if--
``(i) the State provides at least 60 days
notice to the Secretary and the public of the
proposed modification;
``(ii) the State deems an individual
receiving home and community-based services on
the basis of the most recent version of the
criteria in effect prior to the effective date
of the modification to continue to be eligible
for such services after the effective date of
the modification and until such time as the
individual no longer meets the standard for
receipt of such services under such pre-
modified criteria; and
``(iii) after the effective date of such
modification, the State applies the criteria
for determining whether an individual requires
the level of care provided in a hospital, a
nursing facility, or an intermediate care
facility for the mentally retarded under the
State plan or under any waiver of such plan
which applied prior to the application of the
more stringent criteria developed under
paragraph (2).
``(5) Independent evaluation and assessment.--
``(A) Eligibility determination.--The State uses an
independent evaluation for making the determinations
described in paragraphs (1) and (2).
``(B) Assessment.--In the case of an individual who
is determined to be eligible for home and community-
based services, the State uses an independent
assessment, based on the needs of the individual to--
``(i) determine a necessary level of
services and supports to be provided,
consistent with an individual's physical and
mental capacity,
``(ii) prevent the provision of unnecessary
or inappropriate care; and
``(iii) establish an individualized care
plan for the individual in accordance with
paragraph (7).
``(6) Assessment.--The independent assessment required
under paragraph (5)(B) shall include the following:
``(A) An objective evaluation of an individual's
inability of the individual to perform 1 or more
activities of daily living (as defined in section
7702B(c)(2)(B) of the Internal Revenue Code of 1986) or
the need for significant assistance to perform such
activities, and of the individual's ability to engage
in major life activities such as walking, seeing,
hearing, breathing, speaking, working, performing
manual tasks, learning, thinking, concentrating,
interacting with others, sleeping, and any other
appropriate activities.
``(B) A face-to-face evaluation of the individual
by an individual trained in the assessment and
evaluation of individuals whose physical or mental
conditions trigger a potential need for home and
community-based services.
``(C) Where appropriate, consultation with the
individual's family, spouse, guardian, or other
responsible individual.
``(D) Consultation with appropriate treating and
consulting health and support professionals caring for
the individual.
``(E) An examination of the individual's relevant
history, medical records, and care and support needs,
guided by best practices and research on effective
strategies that result in improved health and quality
of life outcomes.
``(F) If the State offers individuals the option to
self-direct the purchase of, or control the receipt of,
home and community-based service, an evaluation of the
ability of the individual or the individual's
representative to self-direct the purchase of, or
control the receipt of, such services if the individual
so elects.
``(7) Individualized care plan.--
``(A) In general.--In the case of an individual who
is determined to be eligible for home and community-
based services, the State uses the independent
assessment required under paragraph (5)(B) to establish
a written individualized care plan for the individual.
``(B) Plan requirements.--The State ensures that
the individualized care plan for an individual--
``(i) is developed--
``(I) in consultation with the
individual, the individual's treating
physician, health care or support
professional, or other appropriate
individuals, as defined by the State,
and, where appropriate the individual's
family, caregiver, or representative;
and
``(II) taking into account the
extent of, and need for, any family or
other supports for the individual;
``(ii) identifies the necessary home and
community-based services to be furnished to the
individual (or, if the individual elects to
self-direct the purchase of, or control the
receipt of, such services, funded for the
individual); and
``(iii) is reviewed at least annually and
as needed when there is a significant change in
the individual's circumstances.
``(C) State option to offer election for self-
directed services.--
``(i) Individual choice.--At the option of
the State, the State may allow an individual or
the individual's representative to elect to
receive self-directed home and community-based
services in a manner which gives them the most
control over such services consistent with the
individual's abilities and the requirements of
clause (ii).
``(ii) Self-directed services.--The term
`self-directed' means, with respect to the home
and community-based services offered under the
State plan amendment, such services for the
individual which are planned and purchased
under the direction and control of such
individual or the individual's authorized
representative, including the amount, duration,
scope, provider, and location of such services,
under the State plan consistent with the
following requirements:
``(I) Assessment.--There is an
assessment of the needs, capabilities,
and preferences of the individual with
respect to such services.
``(II) Service plan.--Based on such
assessment, there is developed jointly
with such individual or the
individual's authorized representative
a plan for such services for such
individual that is approved by the
State and that--
``(aa) specifies those
services which the individual
or the individual's authorized
representative would be
responsible for directing;
``(bb) identifies the
methods by which the individual
or the individual's authorized
representative will select,
manage, and dismiss providers
of such services;
``(cc) specifies the role
of family members and others
whose participation is sought
by the individual or the
individual's authorized
representative with respect to
such services;
``(dd) is developed through
a person-centered process that
is directed by the individual
or the individual's authorized
representative, builds upon the
individual's capacity to engage
in activities that promote
community life and that
respects the individual's
preferences, choices, and
abilities, and involves
families, friends, and
professionals as desired or
required by the individual or
the individual's authorized
representative;
``(ee) includes appropriate
risk management techniques that
recognize the roles and sharing
of responsibilities in
obtaining services in a self-
directed manner and assure the
appropriateness of such plan
based upon the resources and
capabilities of the individual
or the individual's authorized
representative; and
``(ff) may include an
individualized budget which
identifies the dollar value of
the services and supports under
the control and direction of
the individual or the
individual's authorized
representative.
``(III) Budget process.--With
respect to individualized budgets
described in subclause (II)(ff), the
State plan amendment--
``(aa) describes the method
for calculating the dollar
values in such budgets based on
reliable costs and service
utilization;
``(bb) defines a process
for making adjustments in such
dollar values to reflect
changes in individual
assessments and service plans;
and
``(cc) provides a procedure
to evaluate expenditures under
such budgets.
``(8) Quality assurance; conflict of interest standards.--
``(A) Quality assurance.--The State ensures that
the provision of home and community-based services
meets Federal and State guidelines for quality
assurance.
``(B) Conflict of interest standards.--The State
establishes standards for the conduct of the
independent evaluation and the independent assessment
to safeguard against conflicts of interest.
``(9) Redeterminations and appeals.--The State allows for
at least annual redeterminations of eligibility, and appeals in
accordance with the frequency of, and manner in which,
redeterminations and appeals of eligibility are made under the
State plan.
``(10) Presumptive eligibility for assessment.--
``(A) In general.--The State, at its option, elects
to provide for a period of presumptive eligibility for
an individual that is limited to medical assistance for
carrying out the independent evaluation and assessment
under paragraph (5) to determine an individual's
eligibility for home and community-based services, and
if the individual is eligible for such services, the
specific home and community-based services that the
individual will receive.
``(B) Application of existing rules.--In the case
of a State that makes such an election, the State
provides for a period of presumptive eligibility in the
same manner as the State may provide for such a period
under section 1920B (except that subsection (d)(2) of
that section is applied by substituting `section 1903'
for `clause (4) of the first sentence of section
1905(b)').
``(b) Definition of Individual's Representative.--In this section,
the term `individual's representative' means, with respect to an
individual, a parent, a family member, or a guardian of the individual,
an advocate for the individual, or any other individual who is
authorized to represent the individual.
``(c) No Effect On 1915 or 1115 Waivers.--Nothing in this section
shall be construed as effecting the option of a State to offer home and
community-based services under a waiver under subsections (c) or (d) of
section 1915 or under section 1115.''.
(2) Conforming amendment.--Section 1902(a)(10)(C)(iv) of
such Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by
inserting ``or (28)'' after ``(24)''.
(b) State Option To Expand Home and Community-Based Services to
Additional At-Risk Individuals.--
(1) In general.--Section 1930A of the Social Security Act
(42 U.S.C. 1396d(y)) (as added by subsection (a)) is amended--
(A) by redesignating subsection (b) as subsection
(c); and
(B) by inserting after subsection (a) the
following:
``(b) Home and Community-Based Services for At-Risk Individuals.--
``(1) In general.--If a State elects to offer under the
State plan medical assistance for home and community-based
services in accordance with section 1905(a)(28) and subsection
(a), the State may elect, subject to paragraph (3), to offer
such services to an individual described in paragraph (2) who
is determined on the basis of an independent evaluation to meet
the criteria established under subsection (a)(1) for
eligibility for, and receipt of, such services.
``(2) Individual described.--For purposes of paragraph (1),
an individual described in this paragraph is an individual
whose income (as determined under section 1612, but without
regard to subsection (b) thereof) does not exceed such percent
of the supplemental security income benefit rate established by
section 1611(b)(1) as the State may establish (but not to
exceed 300 percent).
``(3) Application of rules for offering home and community-
based services as an optional benefit.--The requirements of
subsection (a) shall apply to the provision of home and
community-based services to eligible individuals under this
subsection.''.
(2) Conforming amendment.--Section 1903(f)(4) of such Act
(42 U.S.C. 1396b(f)(4)) is amended in the matter preceding
subparagraph (A), by inserting ``1930A(b)'' after
``1905(p)(1)''.
(c) Quality of Care Measures.--
(1) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary''), acting
through the Director of the Agency for Healthcare Research and
Quality, shall consult with consumers, health and social
service providers and other professionals knowledgeable about
long-term care services and supports to develop program
performance indicators, client function indicators, and
measures of client satisfaction with respect to home and
community-based services offered under State medicaid programs
(under a waiver approved under section 1115 or 1915 of the
Social Security Act or under section 1930A of such Act (as
added by subsections (a) and (b))).
(2) Best practices.--The Secretary shall--
(A) use the indicators and measures developed under
paragraph (1) to assess such home and community-based
services, the outcomes associated with the receipt of
such services (particularly with respect to the health
and welfare of the recipient of the services), and the
overall system for providing home and community-based
services under the medicaid program under title XIX of
the Social Security Act; and
(B) make publicly available the best practices
identified through such assessment and a comparative
analyses of the system features of each State.
TITLE III--INTEGRATED ACUTE AND LONG-TERM CARE SERVICES FOR DUALLY
ELIGIBLE INDIVIDUALS.
SEC. 301. REMOVAL OF BARRIERS TO INTEGRATED ACUTE AND LONG-TERM CARE
SERVICES FOR DUALLY ELIGIBLE INDIVIDUALS.
(a) Regulations and Legislative Recommendations.--Not later than
January 1, 2007, the Secretary of Health and Human Services, in
consultation with directors of State medicaid programs under title XIX
of the Social Security Act, health care insurers, managed care entities
(as defined in section 1932(a)(1)(B) of the Social Security Act (42
U.S.C. 1396u-2(a)(1)(B)), entities offering Medicare Advantage plans
under part C of title XVIII of such Act (42 U.S.C. 1395w-21 et seq.)
(including specialized MA plans for special needs individuals (as
defined in section 1859(b)(6) of such Act), PACE providers (as defined
in section 1934(a)(3) of the Social Security Act (42 U.S.C. 1396u-
4(a)(3)), and representatives of individuals who are dually eligible
for the medicare and medicaid programs, shall do the following:
(1) Removal of administrative barriers to integrated
care.--Issue regulations removing administrative barriers under
the medicare and medicaid programs that impede the offering of
integrated acute and long-term care services which combine
acute, home and community-based, nursing facility, and mental
health services, and, to the extent consistent with an
enrollee's coverage for such services under part D of title
XVIII of the Social Security Act, coverage for prescribed
drugs, into a single model of care for individuals who are
dually eligible for such programs. Such regulations shall
address conflicting requirements under such programs for
managed care entities (as defined in section 1932(a)(1)(B) of
the Social Security Act (42 U.S.C. 1396u-2(a)(1)(B)), entities
offering Medicare Advantage plans under part C of title XVIII
of such Act (42 U.S.C. 1395w-21 et seq.) (including specialized
MA plans for special needs individuals (as defined in section
1859(b)(6) of such Act), and PACE providers (as defined in
section 1934(a)(3) of the Social Security Act (42 U.S.C. 1396u-
4(a)(3)) with respect to identification cards, marketing
requirements, and such other requirements as the Secretary
shall identify.
(2) Submission of recommendations for removal of statutory
barriers to integrated care.--Submit to Congress
recommendations for removal of such statutory barriers to the
offering of such integrated services to individuals dually
eligible under the medicare and medicaid programs as the
Secretary shall identify.
(b) MEDPAC Comments.--Not later than February 1, 2007, the Medicare
Payment Advisory Commission shall submit to Congress comments on the
recommendations submitted by the Secretary of Health and Human Services
under subsection (a)(2).
TITLE IV--EFFECTIVE DATE
SEC. 401. EFFECTIVE DATE.
(a) In General.--Except as otherwise provided in this Act, this Act
and the amendments made by this Act take effect on October 1, 2005.
(b) Extension of Effective Date for State Law Amendment.--In the
case of a State plan under title XIX of the Social Security Act which
the Secretary of Health and Human Services determines requires State
legislation in order for the plan to meet the additional requirements
imposed by the amendments made by a provision of this Act, the State
plan shall not be regarded as failing to comply with the requirements
of this Act solely on the basis of its failure to meet these additional
requirements before the first day of the first calendar quarter
beginning after the close of the first regular session of the State
legislature that begins after the date of enactment of this Act. For
purposes of the previous sentence, in the case of a State that has a 2-
year legislative session, each year of the session shall be considered
to be a separate regular session of the State legislature.
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