Established in 1996, The National Alliance for Caregiving is a non-profit coalition of national organizations focusing on issues of family caregiving. Alliance members include grassroots organizations, professional associations, service organizations, disease-specific organizations, a government agency, and corporations.

The Alliance was created to conduct research, do policy analysis, develop national programs, increase public awareness of family caregiving issues, work to strengthen state and local caregiving coalitions, and represent the US caregiving community internationally. Recognizing that family caregivers provide important societal and financial contributions toward maintaining the well-being of those they care for, the Alliance's mission is to be the objective national resource on family caregiving with the goal of improving the quality of life for families and care recipients.

 

 


2010

Federal Legislation


U.S. Healthcare Reform Update
The next two weeks are critical for health reform efforts in Congress. The need to support the nation's 66 million family caregivers and sustain them as the backbone of our chronic and long-term care system is a central issue in the congressional efforts to reform healthcare. Lawmakers need to hear from us now. Your voice and the voice of the caregiving community can make a difference. Below is a paragraph that you can use to send to your members of Congress to let them know that family caregivers are counting on them to finish the job.

To locate your congressmen or senators address, visit: www.congress.org or call the Capitol Switchboard, toll-free, at 1-800-828-0498.

Dear Senator or Representative:
As family caregivers, we urge you to vote yes when you have the chance to cast your final vote on health reform. Congress needs to enact healthcare reform now, with such important components as: Increasing access to services and supports for home and community based care; Ensuring that all health plans cover all prevention services and immunizations; Creating new transition programs for Medicare beneficiaries to better coordinate care among specialists, doctors, nurses, therapists, to reduce the rate of re-admissions to the hospital; and requiring all insurance plans offer dependent health care coverage for children until age 26, as well as banning all pre-existing condition limitations, and prohibiting insurance companies from placing life-time limits or monetary caps on coverage. We urge you to pass healthcare reform now.

Very truly yours,

2009

Federal Legislation


Legislative Update
Below please find highlights of caregiving legislation that has been introduced in the first two months of the 111th Congress. Information on the legislation is presented below in the following categories: Tax, Social Security/Medicare/Medicaid Enhancements, Family Leave Enhancements, Educational Outreach and Respite Care Services, Safety for Seniors/Crimes against the Elderly or Disabled, and Bankruptcy Assistance.

Tax Implications

H.R. 897-Long-Term Care Retirement and Security Act, introduced by Representative Adam Putnam (R-FL) on February 13, 2009. The legislation allows individuals to deduct from their federal income tax, qualified long-term care insurance premiums for the taxpayer, or the taxpayer's spouse and dependents. The measure would also establish an applicable tax credit for eligible family caregivers who are caring for individuals with long-term care needs. The measure also permits long-term care insurance to be included in employee benefit cafeteria plans and flexible spending arrangements, as long as these products meet consumer protections based on the findings of the National Association of Insurance Commissioners' recommendations.

Social Security/Medicare/Medicaid Enhancements

H.R. 847 -- Social Security Caregiver Credit Act of 2007, introduced by Representative Nita Lowey (D-NY) on January 18, 2009. 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 to determine Social Security calculations.

H.R. 1094-Medicare Home Health Flexibility Act of 2009, introduced by Representative John Lewis (D-GA) on February 13, 2009. The legislation gives home health care agencies flexibility to determine who may make an initial assessment visit for an individual who is eligible for home health services under Medicare. The legislation specifies that occupational therapists may make the initial assessment if occupational therapy is included in such a plan.

Family and Medical Leave Enhancements

S. 354-Federal Employees Paid Parental Leave Act of 2009, introduced by Senator Jim Webb (D-VA) on January 29, 2009. The legislation would give 2.7 million federal workers four weeks of paid leave after the birth or adoption of a child, or to care for a sick family member. In addition to giving federal employees four weeks of paid leave, the legislation would allow workers to use any accumulated annual or sick leave to offset the 12 weeks of unpaid leave guaranteed by the Family and Medical Leave Act. Identical legislation was introduced in the House of Representatives, H.R. 626 on January 23 by Representatives Caroline Maloney (D-NY), Frank Wolf (R-VA), Steny Hoyer (D-MD), Danny Davis (D-Il), and Edolphus Towns (D-NY). Similar legislation passed the House last year by a vote of 276-146, but did not pass the Senate.

H.R. 824 - The Family and Medical Leave Enhancement Act of 2009, introduced by Rep. Carolyn Maloney (D-NY) on February 3, 2009. The legislation would broaden the protections of the Family and Medical Leave Act to allow employees in companies with more than 25 employees to take family and medical leave. Current law applies only to companies with 50 or more employees. The legislation would also provide up to 24 hours per year of unpaid Parental Involvement and Family Wellness leave, which would allow parents and grandparents to attend parent-teacher conferences, attend school activities, or take children or grandchildren, or parents to doctor appointments.

Educational Outreach/Care Coordination/Respite Services

H.R. 519 - Elder Caregiver Support and Information Enhancement Act of 2009, introduced by Representative Steve Israel (D-NY) on January 14, 2009. The legislation authorizes additional appropriations for the National Family Caregiver Support Programs (NFCSP) under Title III of the Older Americans Act. Congress provided $153.4 million for the NFCSP in FY 2008. The program has experienced level or only modest increases in funding since its inception in 2001. The measure will double the funding for these programs to $250 million so that these programs can provide caregivers with information, assistance, counseling, respite care services, and caregiver training.

H.R. 211 -- Calling for 2-1-1 Act of 2009, introduced by Representative Anna Eshoo (D-CA) on January 6, 2009. 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.

S. 245-Retooling the Health Care Workforce for an Aging America Act of 2009, introduced by Senator Herb Kohl (D-WI) on January 14, 2009. The legislation is designed to expand, train, and support a workforce that has expertise in caring for the medical needs of an aging population. The bill follows many of the recommendations of the of the National Institute of Medicine's (IOM) report on the workforce shortage in the field of geriatrics and chronic care management. Specifically, the measure requires the Department of Health and Human Services (HHS) to develop an analysis of health care and geriatric workforce needs and outline policy options to retrain and hire geriatric care professionals in a variety of health care fields. The bill also requires the Department of Labor to provide information to dislocated workers and veterans about how they can be trained to work in the health care and aging careers.
The legislation also requires HHS to:

Identical legislation has been introduced in the House, H.R. 468 by Representative Janice Schakowsky (D-IL) on January 13, 2009.

H.R. 307 -- Christopher and Dana Reeves Paralysis Act, introduced by Rep. Tammy Baldwin on January 8, 2009. The legislation is very similar to a measure that passed the House on October 15, 2007 by voice vote. Like last year's bill, the measure 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 identify and remove barriers that contribute to caregiver burnout--isolation and depression.

Safety for seniors and Crimes against Elderly or Disabled

H.R. 973-Elder Serve Act of 2009, introduced by Representative John Yarmouth (D-KY) on February 10, 2009. The legislation will create pilot programs in six communities, authorizing $3 million over three years to establish Emergency Crisis Response Teams (ECRTs) to coordinate local law enforcement, short-term housing placement, bereavement services, adult protective services, legal advocacy services, job placement assistance and health care to who are victims of elder abuse. Sponsors of the legislation have used the Louisville, Kentucky's ElderService program as a model to protect seniors from physical or psychological abuse or neglect.

H.R. 632-National Silver Alert Act of 2009, introduced by Representative Lloyd Doggett on January 22, 2009. The measure passed the House of Representatives on February 3, 2009 by voice vote. The legislation directs the Attorney General to establish a national Silver Alert communications network to assist regional and local search efforts for missing seniors in coordination with states, local governments, and law enforcement agencies. The bill will also make training, and educational materials available to state, local governments, and law enforcement agencies throughout the nation.

Bankruptcy Assistance

H.R. 901 - The Medical Bankruptcy Fairness Act of 2009, introduced by Representative Shea-Porter (D-NH) on February 4, 2009. The legislation changes the definitions section of the bankruptcy laws by adding a definition of a "medically distressed debtor." Under the bill, a medically distressed debtor is a debtor, or a dependent of the debtor, who had in excess of 25 percent of the household income, or $10,000 of medical debt (which was not covered by insurance) in a 12 month period in the last three years, or lives in a household with a person who was out of work for four weeks in the last 12 months. In addition, the bill allows the medical debtor to keep $250,000 in value of their residence, and protects a family caregiver from having this case dismissed, or referred to Chapter 11 or Chapter 13 of the bankruptcy courts.

2008

Federal Legislation

The 110th Congress recessed on October 3, 2008 rather than adjourn. Members may be called back for a special "lame-duck" session subject to the call of the Speaker or Majority Leader in November. To date, 40 pieces of legislation have been introduced in Congress related to family caregiving. Below you will find highlights of legislation that has been introduced at the end of the 110th Congress.

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

 

Tax Implications



S. 2743 - The Financial Security Accounts for Individuals with Disabilities Act of 2008, introduced by Senator Robert Casey (D-PA) and Senator Orin Hatch (R-UT) on March 12, 2008. The bill allows individuals and their families to create tax-exempt savings accounts similar to Individual Retirement Accounts (IRAs) and 529 college savings accounts for the added expenses families will incur to care for a loved living with a disability. The tax-exempt savings could be used for education, medical and dental care, community support services, employment training and support, moving and assistive technology, housing and transportation. Contributions to these accounts are capped at $500,000. Under the proposal, the principle in the account would accrue tax-free during the life of the beneficiary. When distributions are made for qualified expenses, the distributions are excludable from the gross income of the beneficiary. In the House, H.R. 2370 has been introduced by Rep. Andrew Crenshaw (R-FL).

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, housing, and transportation needs.

H.R. 5655-Expanding the Dependent Care Tax Credit, introduced by Rep. Anthony Weiner (D-NY) on April 28, 2008. The bill would increase the dollar limitations on employment-related expenses that qualify for dependent care services. It also repeals the requirement that the dependent care receiver lives with the caregiver, making retirees eligible for the credit, and making the credit refundable.

S. 2267--Americans Giving Care To Elders (AGE) Act of 2007, introduced by Senators Any Klobuchar on October 31, 2007. The bill allows caregivers to receive a tax credit for up to $6,000 for qualified eldercare expenses incurred for their parents (or ancestors of such parents). The bill would also provide $12 million over four years for the establishment of a National Resource Center on Family Caregiving, which would identify and develop "best practices" information for services and programs to aid family caregivers. The bill also establishes a website for family caregivers on programs and services nationwide.

S. 614 --Middle Class Opportunity Act, introduced by Senator Charles Schumer (D-NY) on February 15, 2007. The legislation would double the child care tax credit to taxpayers that incur expenses for their parents or grandparents who do not live with them. Currently a caregiver's mother or father must live with them in order to claim the credit.

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 15, 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 (D-MD), 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 December 1, 2007. The legislation provides a tax credit starting at $2,500 in 2008, with a reduction of $100 for every $1,000 the taxpayer earns over $75,000 if they care for a family member's long-term care needs. The credit would increase to $2,750 in 2009 and $3,000 in 2010. The bill would increase funding for the National Family Caregiver Support Programs to $250 million in FY 2008 (up from $156 million in FY 2007). In addition, the bill also provides a tax deduction for the purchase of qualified long-term care insurance premiums.

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.

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Social Security/Medicare/Medicaid Enhancements



S. 321--Fostering Independence Through Technology Act, introduced by Senator Amy Klobuchar (D-MN) on January 17, 2008. The bill directs Health and Human Services (HHS) to conduct pilot projects under Medicare to provide incentives to home health agencies to utilize home monitoring and communications technology.

H.R. 2244 -- Geriatric Assessments of Chronic Care Coordination Services, introduced by Rep. Gene Green (D-TX) on May 9, 2008. The bill directs the Medicare program to conduct outreach activities to Medicare recipients to ensure that providers assess and evaluate chronic health conditions and provide a plan of continual care to manage and monitor health conditions for patients, and provide education services family caregivers. The bill further outlines additional services that should be discussed including hospice care, advanced directives, and information about community services that can be of assistance to patients and family caregivers. The measure directs the Department of Health and Human Services to conduct a study to determine if better chronic care case management can reduce health care costs. Similar legislation has been introduced in the Senate, S. 1340, by Senator Blanche Lincoln (D-AK).

S. 932 - Medicare Patient Access to Physical Therapists Act of 2007, introduced by Senator Blanche Lincoln on March 20, 2007. The legislation allows qualified physical therapists to provide services covered under Medicare for beneficiaries without the requirement of a physician's referral. The measure also separates outpatient speech-language pathology services from outpatient physical therapy services. House companion legislation, H.R 1552, has been introduced by Rep. Earl Pomeroy (D-ND) on March 15, 2007.

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 before disabled individuals become eligible for benefits under the Social Security Act (SSA) title XVIII (Medicare). The bill also eliminates the waiting period for individuals with life-threatening conditions to become eligible for these benefits. Identical legislation was introduced in the Senate, S. 2102, 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. Results

H.R. 4218 -- Medicare Diabetes Self-Management Training Act of 2007, introduced by Rep. Diana DeGette (D-CO) on November 15, 2007. 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.

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 devices would include: 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. Identical legislation was introduced in the Senate, S. 2235, by Senator Barbara Boxer (D-CA) on October 25, 2007.

H.R. 4541 -- the Medicare Part D Long-Term Care Patient Protection Act of 2007, introduced by Rep. Geoff Davis (D-KY) on December 13, 2007. The legislation is designed to provide additional flexibility to ensure that long-term care facilities have access to prescription drug plans in order to meet the unique needs of long-term care residents.

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



S. 3327 -- Empowered at Home Act of 2008, introduced by Senator John Kerry (D-MA) on July 28, 2008. As introduced, the bill is designed to increase access to home and community-based care (HCBC) services by giving states new incentives and resources to make additional services available. The measure has four basic parts. First, it expands the Medicaid HCBS State Plan Amendment Option by giving states more flexibility in determining eligibility for which services they can offer under the program. In return for greater flexibility, the bill does not allow states to cap enrollment and it requires that states provide these services throughout the entire state. Secondly, the bill ensures that the same spousal impoverishment protections offered for new nursing home beneficiaries will be in place for those opting home and community-based care services. In addition, low-income recipients of home and community based services will be able to keep more of their assets when they become eligible for Medicaid. Sponsors argue the intent of this provision is to provide greater incentives for recipients to stay-in-the home with greater supports for as long as possible. Thirdly, the bill addresses the financial needs of spouses and family members caring for a loved one by promoting tax deductions for the purchase of private tax-qualified long-term care insurance products. Finally, the bill seeks to improve the overall quality of home and community based services available by providing grants to states to invest in organizations and systems that can help to ensure a sufficient supply of high quality workers.

H.R. 1161 -- Social Security Caregiver Credit Act of 2007, introduced by Representative Nita Lowey (D-NY), introduced 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) 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 programs to provide mental health treatment and services to all at-risk children. 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. Similar 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), introduced 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.

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End of Life Issues



S. 464 -- Advance Planning and Compassionate Care Act of 2007, introduced by Senator John D. Rockefeller 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



S. 2708 -- Caring for an Aging America Act, introduced by Senator Barbara Boxer (D-CA) on March 5, 2008. The measure is designed to create incentives to attract physicians, nurses, physician assistants, psychologists, social workers, and clinical nurse specialists to work in the field of geriatric medicine. The bill would create a Geriatric and Gerontology Loan Repayment program under the Public Health Service Act, and provides grants for nursing education for geriatric care. The bill also would establish a Health and Long-Term Care Workforce Panel to review trends and assess needs for aging population.

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. 6029 - Family Fairness Act of 2008, introduced by Rep. Tammy Baldwin (D-WI) on June 13, 2008. The measure expands the Family and Medical Leave Act by eliminating the requirement that the employee must serve at least 1,250 hours of work during a 12-month period. The bill specifies that an employee is eligible for coverage under the act if the employee has been employed for at least 12 months.

H.R. 2392 -- Family and Workplace Balancing Act of 2007, introduced by Rep. Lynn Woolsey (D-CA) on May 17, 2007. The bill directs the Department of Labor to make five-year grants to states and local governments to help pay for projects that provide wage replacement for eligible workers who need time off for family caregiving responsibilities. The bill also expands the Family and Medical Leave law to workers whose employers have 15 or fewer employees. The measure also requires the Department of Health and Human Services (HHS) to make additional funds available to expand child care programs, including universal pre-kindergarten program for all children ages 3 to 5. It also expands the free school breakfast program to all children regardless of family income.

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.

S. 1681 -- Family Leave Insurance Act of 2007, introduced by Senator Chris Dodd (D-CT) on July 21, 2007. The legislation will create a Family and Medical Leave Insurance Program. The program would provide up to 8 weeks of paid leave to workers needing time off due to 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 - Family and Medical Leave Expansion Act, introduced by Rep. Carolyn Maloney (D-NY) on March 7, 2007. The measure directs the Department of Labor to make five-year grants for programs that provide wage replacement for eligible individuals who must respond to caregiving needs resulting from the birth or adoption of a child, or other family caregiving needs. The bill also expands the family and medical leave benefits to employees who work for companies with 25 or more employees (current law applies to 50). For federal workers, the bill permits the Office of Personnel Management (OPM) to conduct a grant program to provide six weeks of paid leave annually. Lastly, the bill allows employees covered under the Family and Medical Leave Act to take time off to attend a variety of academic and extracurricular activities for their children or grandchildren.

H.R. 2792 -- Family and Medical Leave Inclusion Act, introduced by Rep. Carolyn Maloney (D-NY) on June 20, 2007. 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. The legislation passed the House on June 19, 2008 by a vote of 278-144, but has not cleared the Senate. As passed, 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 on January 4, 2007 by Rep. Anna Eshoo.

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. 1727 -- 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 identify and remove barriers that contribute to caregiver burnout--isolation and depression. In the House, 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, 2007. The measure authorizes grants for treatment and support services for Alzheimer's patients and provides respite care services and assistance for family caregivers.

S. 898 -- Alzheimer's Breakthrough Act of 2007, introduced by Senator Barbara Mikulski on March 15, 2007. The measure was reported out of the Senate Committee on Health, Education, Labor and Pensions (HELP) on August 3. The measure has been placed on the Senate Calendar for consideration. For caregivers the bill directs HHS to award a cooperative grant to a nonprofit organization to establish and operate an Alzheimer's Call center to provide expert advice, care consultation, information, and referrals nationwide at the national and local level. Companion legislation has been introduced in the House of Representatives, H.R. 1560, was introduced on March 19, 2007 by Reps. Ed Markey (D-MA) and Rep. Chris Smith (R-NJ).

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Safety for Seniors and Crimes Against Elderly or Disabled



S. 845-- Safety of Seniors Act of 2007, introduced by Senator Michael Enzi and Senator Ted Kennedy on March 12, 2007. The bill was signed into law by President Bush on April 23, 2008 (P.L. 110-202). PL 110-202 directs the Department of Health and Humana Services (HHS) to oversee and support a national public education campaign to prevent older Americans at risk of falling. The bill authorizes states to create demonstration programs to identify high-risk populations; evaluate residential facilities; conduct screening for older Americans; coordinate services with health care and social service providers.

H.R. 1476 -- Senior Safety and Dignity Act of 2007, introduced by Representative Ginny Brown Waite (D-FL) on March 12, 2007. The bill expands the nursing home patient's bill of rights the right to receive care from a creditable caregiver. The bill requires skilled nursing facility (SNF) owners to conduct background checks on applicants and prohibits hiring abusive workers or workers convicted of a relevant crime. The measure also establishes civil penalties for violations. H.R. 1476 also directs the HHS to establish a national criminal background registry.

S. 1070 -- Elder Justice Act of 2007, introduced by Senator Orin Hatch (R-UT) on March 29, 2007. The bill was reported favorably out of the Senate Finance Committee on September 8, 2008. As reported, 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. Rohm Emanuel on March 29, 2007.

H.R. 3078 -- Long-Term Care Patient Protection Act, introduced by Rep. Tim Mahoney (D-FL) on July 18, 2007. The measure directs state Medicaid programs to require screening, including national criminal history background checks for anyone who has direct patient access to patients of nursing facilities and other long-term care facilities.

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.

S. 3406 - Americans With Disabilities Act Amendments of 2008, was introduced by Senator Tom Harkin on July 31, 2008, and signed into law on September 25, 2008 by President Bush (Public Law 110-325). As signed into law, the measure reflects bipartisan compromise in an effort to make it easier for people with disabilities to qualify for protections under the Americans with Disabilities Act (ADA). The final version of the bill is similar to the House-bill, H.R. 3195 introduced by Representative Steny Hoyer. Overall, the measure would overturn several court decisions to ensure that people with disabilities not lose their coverage under the ADA simply because their condition is treatable with medication or can be addressed with the help of assistive technology. The new amendments lowers the threshold for determining when an impairment constitutes a disability without using new undefined terms. The new measure also directs that the definition of disability be construed in favor of broad coverage. Supporters of the new law cite examples of individuals who were subjected to discrimination on the basis of their disabilities, but were unable to invoke the ADA's protections because they were not considered people with disabilities when the effects of their medication, medical supplies, behavioral adaptations, or other interventions were considered. To review the final provisions, please see the September 11, 2008 Congressional Record, pages, S8344-S8357.

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Veterans Issues



On January 28, 2008, President Bush signed into law H.R. 4986, the "National Defense Authorization Act for FY 2008" (P.L. 110-181). The provisions of interest to family caregivers are similar to provisions contained in an earlier version of the National Defense Authorization Act for 2008 (H.R. 1585), which was passed by Congress and later vetoed by the President Bush because of language in the bill that would allow plaintiffs in lawsuits against Iraq's former regime to freeze assets needed for the current Iraqi government. When H.R. 1585 was vetoed, the offending language was removed, and the new bill, H.R. 4986 became law.

P.L. 110-181 contains a number of provisions aimed to augment services, and provide additional protections for wounded veterans, their families and caregivers. It also contains a requirement for the Department of Defense (DOD) in consultation with the Social Security Administration to develop a comprehensive handbook on benefits and protections available to seriously injured service members. Specifically, section 1401 of the act: " establishes 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; " orders semi-annual inspections of housing facilities for recovering service members; " establishes a comprehensive policy (between the VA and DOD) on the health care and management of members of the armed forces, including the development of fully interoperable electronic health records; " requires new DOD-wide standards for processing disability evaluations to reduce discrepancies between DOD assessments and those conducted by the VA; " creates new DOD-wide standards for processing medical evaluations, better training for those performing the evaluations, and assigning independent medical advisors to assist recovering service members and families; " establishes a comprehensive policy to address traumatic brain injury (TBI), posts-traumatic stress disorder (PTSD), and other mental health conditions, and military eye injuries; " funds a new study on support services needed for families of recovering service members; and " directs the National Academy of Science to report on the physical and mental health needs of those deployed in Iraq and Afghanistan and their families.

P.L. 110-181 also includes provisions of S. 1975, Support for Injured Service Members Act, introduced by Senator Chris Dodd (D-CT) and Senator Hillary Clinton (D-NY). The provisions allow the families of wounded military personnel to take up to 26 weeks of unpaid leave. The legislation follows key recommendations of the Commission on the Care of Wounded Warriors, led by former Senator Bob Dole and former Secretary of Health and Human Services (HHS) Donna Shalala. In addition, section 583 of P.L. 110-181 contains a number of key provisions included in H.R. 1541, legislation entitled, "Coming Together for Guard and Reserve Families" first introduced by Rep. Bruce Brale. The provisions establish a DOD Military Readiness Council to provide and enhance services to DOD families before, during, and post-deployment. In addition, the provisions: " directs the Secretary to provide specified information, programs, activities, training, and other support services for the parents, children, infants, and toddlers of members undergoing deployment; " 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; " 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; and " creates a National Military Family Readiness and Service Reintegration Outreach Pilot Program to provide: (1) marriage counseling; (2) services for children; (3) suicide prevention; (4) substance abuse awareness and treatment; (5) mental health awareness and treatment; (6) financial counseling; (7) anger management counseling; (8) domestic violence awareness and prevention; (9) employment assistance; (10) assistance in living with a member with post-traumatic stress disorder (PTSD) or traumatic brain injury.

S. 2921 -- Caring for Wounded Warriors Act of 2008, introduced by Senator Hillary Clinton (D-NY) on April 28, 2008. The bill directs the VA to create three pilot programs to assess the feasibility and advisability of providing training and certification for family caregivers of veterans and members of the Armed Forces with traumatic brain injury (TBI). Once family caregivers have received their certification, they are eligible for compensation from the VA for the care provided. The measure also creates a pilot program for graduate students enrolled in mental health or rehabilitation-related fields to receive course credit to become respite care workers for family caregivers.

H.R. 3070 -- Disabled Veterans Caregiver Compensation Act, introduced by Rep. Collin Peterson (D-MN) on July 21, 2007. The legislation would require the Veterans Administration to pay disabled veterans $234 a month throughout the time they are in need of regular care and if they are receiving the care from a family member who is depending on the veteran for support.

S. 1649 - Military Family Support Act of 2008, introduced by Senator Russ Feingold (D-WI) on June 19, 2008. The bill establishes two programs to provide additional leave options for persons who have been designated as caregivers for dependents of those deployed for military service. The bill requires the Office of Personnel Management (OPM) to create a program under which federal employees are designated caregivers could use accrued annual or sick leave, leave bank benefits, and other leave available to them under the law to retain their job status. For private sector employees, the Department of Labor (DOL) would create a voluntary program, allowing private sector companies to create similar leave programs for their employees. The bill specifically exempts the provisions of the Family and Medical Leave Act from the types of leave that can be used by designated caregivers. Companion legislation has been introduced in the House, H.R. 6326, by Representative Lynn Woosley on June 19, 2008.

H.R. 3458 - Veterans Affairs Pilot Program on Traumatic Brain Injury Care in Rural Areas, introduced by Representative Shelly Moore Capito (D-WV), introduced 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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