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Federal Legislation

Over 40 pieces of legislation have been introduced in Congress related to family caregiving. Below you will find highlights of some of the most relevant legislation that has been introduced at the end of the first session of the 110th Congress.

Information on the bills is presented below in the following categories:

Tax Implications

Tax-Relief for Caregivers, Long-Term Care Tax Initiatives:

H.R.1911 - Tax Relief for Working Caregivers Act of 2007, introduced by Rep. Joe Donnelly (D-IN) on April 18, 2007. The bill expands the dependent care tax credit (DCTC) to allow more families to receive tax relief for child and elder care expenses. H.R. 1911 extends the DCTC to cover 35 percent of qualified expenses for families earning up to $75,000, with the credit phasing down to 20 percent for families making $100,000 or more. The bill also allows families to claim the DCTC on qualified care expenses paid on behalf of aging parents who do not live with the family.

H.R.1807 - Alzheimer’s Family Assistance Act of 2007, introduced by Rep. Eddie Bernice Johnson (D-TX) on March 29, 2007. The bill allows a phased-in tax credit ($1,000 in 2007 increasing by $500 each year until allowing $3,000 in 2011) for family caregivers of spouses and dependents who have long-term care needs. The bill also allows a tax deduction for long-term care insurance premiums, and applies certain consumer protection standards to long-term care consumer contracts. Companion legislation has been introduced by Senator Barbara Mikulski, S. 897.

S. 897 - The Alzheimer’s Family Assistance Act of 2007 (also referred to as Family Assistance Act of 2007), introduced by Senator Barbara Mikulski (D-MD) on March 15, 2007. The bill provides for a $3,000 tax credit for family members caring for an individual with a cognitive impairment, or chronic long-term care health condition that prevents them from performing three activities of daily living without substantial assistance. The bill also includes tax deductions for individuals who purchase qualified long-term care insurance.

S. 2121 - Caregiver Assistance and Relief Effort Act of 2007, introduced by Senator Robert Menendez (D-NJ) on October 1, 2007. The legislation increases funding for the National Family Caregiver Support Programs, including caregiving support programs for Native Americans, and allows caregivers a tax credit for family members with long-term care needs. The bill also authorizes a tax deduction for long-term care insurance premiums, and applies additional consumer protections to long-term care insurance contracts.

S. 1758 - Community Living Assistance and Services and Supports Act, “CLASS ACT”, introduced by Senator Ted Kennedy (D-MA) on July 11, 2007. The bill is designed to help individuals with functional impairments and their families pay for services and supports that they need to maximize their independence and ability to gain employment, improve education, and contribute to their community. To pay for the program, the bill establishes a voluntary premium assessment of $30 a month that would be collected through payroll deductions. Under the program, the legislation will create a national, voluntary disability insurance program (CLASS program) under which all employees are automatically enrolled, but are allowed to waive enrollment. The bill establishes monthly payroll deductions. Premiums initially are set at $30 a month, and an individual who pays into the program will receive $50 to $100 a day, based on their ability to carry out daily activities. House companion legislation has been introduced, H.R. 3100, by Rep. Frank Pallone (D-NJ) on July 11, 2007.

H.R.2370 - Financial Security Accounts for Individuals with Disabilities Act of 2007, introduced by Rep. Ander Crenshaw (R-FL) on May 17, 2007. The measure permits families of people with physical, cognitive, or developmental disabilities to create savings accounts that accrue tax-free interest during the life of the beneficiary. The bill permits these funds to be used for a variety of purposes, including, medical care, community based-support services, education, employment training, support and assistive technology, or housing and transportation needs. To date, the bill has 67 cosponsors.

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Social Security/Medicare/Medicaid Enhancements



H.R. 154 — Ending the Medicare Disability Waiting Period Act of 2007, introduced by Rep. Gene Green (D-TX) on January 4, 2007. The legislation phases out the 24-month waiting period for disabled individuals to become eligible for benefits under the Social Security Act (SSA) title XVIII (Medicare); and eliminate the waiting period for individuals with life-threatening conditions to become eligible for these benefits. In the Senate, S. 2102 was introduced on September 26, 2007 by Senator Jeff Bingaman (D-NM).

H.R.1588 – Seniors Mental Health Access Improvement Act of 2007, introduced by Rep. Barbara Cubin (D-WV) on March 20, 2007. The bill expands Medicare coverage to include marriage and family therapist services and mental health counselor services. The bill specifies that additional efforts should be included to target rural areas and hospice programs.

H.R.4218 – Medicare Diabetes Self-Management Training Act of 2007, introduced by Rep. Diana DeGette (D-CO) on November 15, 200. The legislation recognizes the role of diabetes educators to 21 million Americans who have diabetes in the US today, and authorizes Medicare to utilize the services of certified diabetes educators to work with Medicare beneficiaries and their families for outpatient diabetes self-management training.

H.R.1809 – Medicare Independent Living Act of 2007, introduced by Rep. James Langevin (D-RI) on March 29, 2007. The bill eliminates the in-home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs, and deems them to be durable medical equipment.

S. 631 – Remote Monitoring Access Act of 2007, introduced by Senator Norm Coleman (D-MN) on February 15, 2007. The bill eliminates payment barriers so that Medicare will cover expenses associated with collecting, analyzing, and transmitting clinical health information to a health care providers by remote technologies in order to better manage chronic disease management for patients. The bill identifies four areas in which remote management technologies are emerging – congestive heart failure, diabetes, cardiac arrhythmia and sleep apnea. In the House companion legislation, H.R. 648, has been introduced by Representative Stephanie Tubbs Jones on January 1, 2007 and has 168 cosponsors.

H.R. 2231 — The Medicare Access to Complex Rehabilitation and Assistive Technology Act, introduced by Representative Thomas Allen (D-ME) on May 9, 2007. The legislation exempts complex rehab and assistive technology from the national competitive bidding program that was passed in the Medicare Modernization Act (MMA). The bill would define complex rehabilitation products and assistive technology products as medically necessary adaptive devices such as: seating, positioning and mobility devices and speech generating devices that are evaluated, fitted, configured, adjusted or programmed to meet the specific and unique needs of an individual. The Senate companion legislation, S.2235 was introduced on October 25, 2007 by Senator Barbara Boxer (D-CA).

H.R. 3865 – Medicare Home Health Care Access Protection Act, introduced by Rep. Jim McGovern (D-MA) on October 10, 2007. The bill would prevent an 11.75 percent reduction for CMS in the Medicare home health payment rates over the next four years. According to the Congressman’s office, home health as a share of Medicare spending has dropped from 8.7 percent in 1997 to 3.2 percent in FY 2006, and is projected to decline to 2.6 percent in 2015. Similar legislation was introduced in the Senate by Senator Susan Collins (R-ME), S. 2181.

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Social Security and Medicaid Expansions



H.R.1161 – Social Security Caregiver Credit Act of 2007, introduced by Representative Nita Lowey (D-NY) on February 16, 2007. The legislation allows workers who work a part-time job, or take time off from their jobs to care for a family member, to continue to earn Social Security coverage by substituting one-half of the average national annual wages earned in their lifetime as income to determine Social Security calculations.

H.R.2188 – Kinship Caregiver Support Act, introduced by Rep. Danny Davis (D-IL) on May 7, 2007. The bill directs the Department of Health and Human Services (HHS) to make grants to pay for the federal share of the costs of establishing kinship navigator programs. The measure expands the definition of family support services to include assisting kinship caregivers or guardians in locating and accessing needed services. The bill also authorizes the use of foster care independence program funds to provide independent living services and education and training vouchers for children who exit foster care to kinship guardianship or adoption after the age of 14. The Senate companion bill S. 661 was introduced on February 22, 2007 by Senator Clinton.

S. 661 – Kinship Caregiver Support Act, introduced by Senator Clinton (D-NY) et al. on February 16, 2007. The measure is designed to assist grandparents, or other relatives who are caring for children, navigate and access existing programs and services for themselves and the children they are raising. States are authorized to establish “Kinship Navigator Programs” designed to help caregivers with a comprehensive understanding of the various types of services that are available and how to access them. Services may include support groups, respite care programs, early childhood education programs, early intervention educational assessments, family support services, mental health services, legal services, child support, youth services, human services, income-based financial support, nutrition programs, housing assistance, and child care.

H.R.687 – Keeping Families Together Act of 2007, introduced by Rep. Jim Ramstad (R-MN) on January 24, 2007. The bill directs the Secretary of Health and Human Services (HHS), acting through the Administrator of the Substance Abuse and Mental Health Services Administration, to award competitive matching grants to states to establish systems of care to provide mental health treatment and services to all children who are in the custody of the state, or at-risk of entering into the custody of the state for the purpose of receiving mental health services. Companion legislation has been introduced in the Senate, S. 382 by Senator Susan Collins (R-ME).

S. 799 — The Community Choice Act, introduced by Senator Harkin on March 7, 2007. The legislation provides individuals with disabilities and older Americans with equal access to community-based attendant services and supports. The measure also includes a demonstration grant to enhance coordinated care for individuals eligible for both Medicare and Medicaid services. Companion legislation has been introduced in the House, H.R. 1621, by Rep. Danny Davis (D-IL) on March 22, 2007.

H.R.1621 – Community Choice Act of 2007, introduced by Rep. Danny Davis (D-IL) on March 22, 2007. The legislation is designed to reform the state Medicaid programs to provide services in various settings that are most appropriate to an individual’s needs, particularly to ensure equal access to community-based attendant services and supports. The bill also provides financial assistance to states as they reform their long-term care systems to provide comprehensive statewide long-term services and supports. The bill is designed to assist states in addressing the decision of the Supreme Court in Olmstead V. LC, (527 U.S. 581 (1999)) and implementing the integration mandate of the Americans with Disabilities Act. The bill also creates a consumer task force to assist states in developing their new programs. To date, there are 51 cosponsors.

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End of Life Issue



S. 464 — Advance Planning and Compassionate Care Act of 2007, introduced by Senator John D. Rockefeller (D-WV) on January 31, 2007. The legislation directs the Department of Health and Human Services (HHS) to develop and report to Congress on outcome standards and measures to evaluate the performance of health care programs and projects that provide end-of-life care to individuals. The bill would establish a national uniform policy on advanced directives. The bill would also direct HHS to operate a clearinghouse and a 24-hour toll-free telephone hotline to provide consumer information about advance directives, end-of-life decision making, and hospice care services.

S. 465 — Advance Directives Improvement and Education Act of 2007, introduced by Senator Bill Nelson (D-FL) on January 31, 2007. The legislation authorizes Medicare to cover expenses incurred for end-of-life planning and consultations as part of the initial preventive physical examination. The measure also directs the Department of Health and Human Services (HHS) to conduct a national education campaign to raise public awareness of the importance of planning for care near the end-of- life; and provide for a national, toll-free information clearinghouse.

S. 466 — Medicare End-of-Life Care Planning Act of 2007, introduced by Senator John Rockefeller (D-WV) on January 31, 2007. The legislation authorizes Medicare to cover an “end-of-life” planning consultation, excluding discussion of advance directives, as part of an initial preventive physical examination.

H.R.1668 – Proportionate Final Benefit Act of 2007, introduced by Rep. Lincoln Davis (D-TN) on March 23, 2007. The bill authorizes payment of Old Age and Disability Income benefit to continue through the month of the beneficiary’s death (without affecting any other person's entitlement to benefits for that month). The payment would be proportionate to the number of days preceding the death of the beneficiary.

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Upgrading Payment Systems for Medicare Providers



H.R. 4082 – The Long-Term Care Quality and Modernization Act, introduced by Rep. Earl Pomeroy on November 16, 2007. The bill is designed to promote further investment to upgrade aging skilled nursing facilities, modernize Medicare and Medicaid payment system and encourage a stable, well-trained long term care workforce. The legislation: (1) creates a Long-Term Care Quality Advisory Commission tasked to develop a national plan to improve long-term care quality; (2) directs the commission to review rules and regulations to improve the training and education of long term care providers; (3) protects access to outpatient therapy services, such as, physical therapy, speech therapy, and occupational therapy; (4) directs the commission to study ways to improve the payment system for Medicare for long-term care services and providers. The bill also modernizes many of Medicare’s rules dealing with patient coverage for new technologies for treating cancer and diabetes. The bill also establishes incentives to modernize aging skilled nursing facilities.

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Family and Medical Leave Enhancements



H.R. 3391 – Military Family and Medical Leave Act, introduced by Rep. Darrell Issa (D-CA) on August 3, 2007. Provisions of this legislation were incorporated into H.R. 1585, the conference report to the Department of Defense (DOD) Authorization Bill. The bill would expand the Family and Medical Leave Act (FMLA) to entitle an eligible employee up to 26 workweeks of leave during a 12-month period to care for a covered service member who is the employee’s spouse, son, daughter, or parent. The bill’s provisions extend to members of the U.S. Armed Forces, including National Guard and Reserve members. Two other companion measures were introduced in the Senate. S. 1975, the Support for Injured Service Members Act of 2007, introduced by Senator Chris Dodd (D-CT) and Senator Hillary Clinton.The DOD authorization conference report has been sent to the President for his signature. On December 28, the Administration indicated that the President was withholding his approval of the bill due other DOD provisions contained in the conference report. It is anticipated that the concerns will be resolved and that the bill will be signed into law towards the end of January.

H.R. 2808 – Living Organ Donor Job Security Act, introduced by Rep. Ruben Hinojosa (D-TX) on June 21, 2007. The bill expands the Family and Medical Leave Act (FMLA) of 1993 to clarify that employees covered by FMLA may also use leave to provide a living organ donation.

H.R. 2392 – Family and Workplace Balancing Act of 2007, introduced by Rep. Lynn Woolsey (D-CA) on May 17, 2007. The bill directs Labor to make five-year grants to states and local governments for paid family and medical leave. The measure also requires the Department of Health and Human Services (HHS) to make additional funds available to expand child care activities for children under the age of three, and to expand quality programs for early childhood education.

S. 1681 – Family Leave Insurance Act of 2007, introduced by Senator Chris Dodd (D-CT) on July 21, 2007. The legislation will provide paid leave to workers for the birth or adoption of a child, to care for a child, spouse or parent with a serious illness or to care for their own serious illness.

S. 910 – Healthy Families Act, introduced by Senator Kennedy on March 15, 2007. The bill requires business with more than 15 employees to provide for paid sick leave of up to seven days to ensure that workers can attend to their own health care needs and the needs of their family members. In the House, companion legislation has been introduced by Representative Rosa DeLauro (D-CT), H.R. 1542, on March 15, 2007.

H.R. 1369 — Expanded Medical and Family Leave Act, introduced by Rep. Carolyn Maloney (D-NY) on March 7, 2007. The measure allows employees to take additional leave to participate in, or attend their children’s and grandchildren’s educational and extracurricular activities. The bill also clarifies that leave may be taken for routine family medical needs, and to assist elderly relatives. The bill expands coverage to employers with 25 or more employees (current law requirements are for 50 or more employees).

H.R. 2792 — Family and Medical Leave Inclusion Act, introduced by Rep. Carolyn Maloney (D-NY) on June 20, 2007; referred to the House Education & Labor Committee. The measure amends the Family and Medical Leave Act (FMLA) to permit leave to care for a domestic partner, single-sex spouse, parent-in-law, adult child, sibling or grandparent if that person has a serious health condition.

H.R.3799 – Federal Employees Paid Parental Leave Act of 2006, introduced by Rep. Carolyn Maloney (D-NY) on November 10, 2007; referred to the Education & Labor Committee, and House Oversight & Government Reform. The bill allows federal employees to obtain eight weeks of paid leave for any of the 12 weeks of unpaid leave under the Family and Medical Leave Act (FMLA) for: (1) the birth of a child; (2) placement of a child with the employee for either adoption or foster care; (3) care of a seriously ill family member; or (4) an employee’s own serious health condition.

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Educational Outreach/Care Coordination/Respite Services



S. 211 — Calling for 2-1-1 Act of 2007, introduced by Senator Hillary Clinton (D-NY) on January 9, 2007. The bill directs the Department of Health and Human Services (HHS) to award a grant to each state to carry out state-wide 2-1-1 telephone service for information and referral on human services. Grants made to human service organizations will require them to conduct and establish an exhaustive database of services available at the state, federal, and local levels. In the House, H.R. 211 was introduced by Rep. Anna Eshoo on January 4, 2007.

S. 586 — Community Health Workers Act of 2007, introduced by Senator Jeff Bingaman (D-NM) on February 14, 2007. The measure authorizes HHS to award grants to promote positive health behaviors for women and children in target populations, especially for racial and ethnic minority women and children in medically underserved areas. House companion bill, H.R. 1968 was introduced by Rep. Solis Hilda on April 19, 2007.

S. 908 – Consortium on the Impact of Technology in Aging Health Service Act of 2007, introduced by Senator Norm Coleman (D-MN) on March 15, 2007. The bill establishes a consortium to study the potential use of technology to assist older adults and their caregivers. The legislation specifies that the consortium should identify developments in current aging services technologies that may result in increased efficiency and cost savings to the healthcare system. Technologies under review should promote the independence of seniors and individuals with disabilities, facilitate early disease detection, and delay the physical, cognitive, social, and emotional decline resulting from disease and the aging process. The bill also directs the consortium to identify ways to provide greater support to community- and facility-based caregivers and minimize caregiver burnout.

S. 937 – Expanding the Promise for Individuals with Autism Act of 2007, introduced by Senator Hillary Clinton (D-NY) on March 20, 2007. The bill directs the Department of Health and Human Services (HHS) to establish a Treatments, Interventions, and Services Task Force to develop a comprehensive methodology and identify the types of services necessary to assist individuals with autism and their families. The House companion bill, H.R. 1881, was introduced by Rep. Michael Doyle (D-PA) on April 17, 2007.

S. 982 – Positive Aging Act of 2007 introduced by Senator Hillary Clinton on March 23, 2007. The legislation provides for the integration of mental health services and mental health treatments for geriatric individuals. The bill creates community-based mental health outreach teams to work with outpatient programs, private, nonprofit hospitals, senior centers, adult day care programs, and assisted living facilities. In the House, Representative Patrick Kennedy (D-RI) introduced, H.R. 1669, companion legislation on March 26, 2007.

S. 633 — Working Together for Rural Mental Health and Wellness to Children and, Seniors Act, introduced by Senator Norm Coleman on February 15, 2007. The legislation directs the Department of Health and Human Services (HHS) to provide grants for assistance to rural hospitals, schools, and communities to establish and secure progressive and innovative services to access mental health services, including telecommuting services and mobile van access for rural areas.

H.R. 17276 - Christopher and Dana Reeves Paralysis Act, introduced by Rep. Tammy Baldwin on March 28, 2007. The legislation passed the House on October 15, 2007 by a voice vote after it was reported from the House Energy & Commerce Committee (Report 110-378). As passed by the House, the legislation directs the National Institute of Health (NIH) to expand, coordinate and improve NIH activities on paralysis research. Title III provisions include educational funding and outreach services for caregivers and to remove barriers that contribute to caregiver burnout, isolation and depression. Congressman Gus Bilirakis (R-FL) has introduced similar legislation, H.R. 446.

H.R. 1032 — Alzheimer’s Treatment and Caregiver Support Act, introduced by Rep. Maxine Walters (D-CA) on February 13, 2006. The measure authorizes grants for treatment and support services for Alzheimer’s patients and provides respite care services and assistance for family caregivers.

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Safety for Seniors and Crimes Against Elderly or Disabled



H.R. 1070 – Elder Justice Act of 2007, introduced by Senator Orin Hatch (R-UT) on March 29, 2007. The bill establishes a Justice Coordinating Council to make recommendations to the Department of Health and Human Services (HHS) on the coordination of activities of the Federal, State, local and private agencies and entities relating to elder abuse, neglect and exploitation. It also provides a first time direct funding stream separate from the Social Services Block Grant for adult protective services. In addition, the Elder Justice Act creates an advisory board to create a short and long-term multidisciplinary strategic plan for the developing field of elder justice. The bill also authorizes $10 million for national organizations or states to train long-term care ombudsman representatives. The House companion bill, H.R. 1783, Elder Justice Act of 2007, was introduced by Rep. Rahm Emanuel on March 29, 2007 and has 82 cosponsors.

H.R.2105 – Elder Abuse Prevention Act, introduced by Rep. Ben Chandler (R-KY) on May 2, 2007. The bill requires a state that is receiving funds for certain law enforcement assistance programs under the Omnibus Crime Control and Safe Streets Act of 1968 to adopt laws and policies that prohibit parole for: (1) any individual who is convicted of a criminal sexual offense against a victim who is elderly; or (2) a sexually violent predator. The bill grants states three years to implement such laws and policies.

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Veterans Issues



On December 28, President Bush announced he was withholding support of H.R. 1585, the FY 2008 National Defense Authorization Act because of other provisions in the measure. It is anticipated that the conflict will be resolved and the President will sign the legislation towards the end of January. H.R. 1585 includes the Wounded Warrior Act, which takes major steps to address problems confronted by wounded service members and their families. Specifically, the conference report would:
  • create the Wounded Warrior Resource Center to serve as a single point of contact for service members, their families, and primary caregivers to report issues with facilities, obtain health care, and receive benefits information;
  • require the Secretary of Defense and the Secretary of Veterans Affairs to jointly develop a comprehensive policy on the health care and management of members of the armed forces, including the development of fully interoperable electronic health records;
  • mandate the establishment of new DOD-wide standards for processing disability evaluations to reduce discrepancies between the Department of Defense assessments and those conducted by the Department of Veterans Affairs;
  • mandate the establishment of new DOD-wide standards for processing medical evaluations, training and qualifying those performing the evaluations, and assigning independent medical advisors to assist recovering service members and families;
  • require a comprehensive policy to address traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), other mental health conditions, and military eye injuries; and
  • require the Secretary of Defense to conduct a study of the support services provided to families of recovering service members and to contract with the National Academy of Sciences to study the physical and mental health needs of those deployed in Iraq or Afghanistan and their families.
In addition, H.R. 1585 includes, S. 1975 -- The Support for Injured Service members Act, introduced by Senator Chris Dodd and Senator Hillary Rodham Clinton (D-NY). The Dodd-Clinton legislation extends the benefits provided under the Family and Medical Leave Act (FMLA) by allowing the families of wounded military personnel to take up to six months of unpaid leave. The legislation will implement a key recommendation of the Commission on the Care for Wounded Warriors, led by former Senator Bob Dole and former Secretary of Health and Human Services Donna Shalala. Similar legislation was introduced by Senator Russ Feingold, Congressman Darrell Issa, and Congressman Cero Rodriguez (D-TX).

H.R. 1541 – Coming Together for Guard and Reserve Families Act, introduced by Rep. Bruce Braley (D-IA) introduced by March 15, 2007. The bill directs the Department of Defense (DOD) to enhance and improve DOD programs to provide family support. Key provisions of the legislation were incorporated into H.R. 1585, the DOD Authorization conference report. Specifically that conference report:
  • establishes the DOD Military Family Readiness Council to provide enhance services to DOD military families before, during, and post-deployment;
  • directs the Secretary to provide specified information, programs and activities, training, and other support services for the parents, children, infants, and toddlers of members undergoing deployments;
  • requires DOD to study and report to Congress on the feasibility and advisability of establishing a pilot program on family-to-family support for families of deployed members of the active and reserve components; and
  • directs the Secretary to carry out a pilot program for a comprehensive soldier and family preparedness and reintegration outreach programs for members and their families.


H.R. 3458 – Veterans Affairs Pilot Program on Traumatic Brain Injury Care in Rural Areas, introduced by Representative Shelly Moore Capito (D-WV) on August 4, 2007. Key provisions of this legislation were incorporated in H.R. 1585, the Department of Defense (DOD) reauthorization bill. The bill directs the VA to carry out a five-year pilot program, in five rural states, under which the Secretary trains and then assigns a specific VA case manager to each veteran diagnosed with traumatic brain injury who is receiving care in a VA facility in that state.

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