,i #aaith ,,congress #ast ,session ,h4 ,r4 #bjhb ,,in ,,the ,,house ,,of ,,representatives ,march #aa1 #bjbe,mr4 ,suozzi 7for himself and ,mr4 ,moolenaar7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means ,a ,,bill ,to amend title ,,ii of the ,social ,security ,act to provide for long-term care insurance benefits1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,well-,being ,insurance for ,seniors to be at ,home ,act or the ,,wish ,act4 #b4 ,findings2 purpose 7a7 ,findings ,congress finds the following3 7#a7 ,more than half of ,americans entering old age today will have a long-term services and supports 7in this section referred to as ,,ltss7 need1 averaging #bih1jjj costs per person for about #b years of serious self-care disability1 and more than half will be out-of-pocket1 according to the ,u4,s4 ,department of ,health and ,human ,services 7in this section referred to as ,,hhs74 7#b7 ,the population age #he or older 7which is a proxy for the number of elders needing ,,ltss7 will double between #bjbb and #bjce1 and nearly triple by #bjej4 ,this aging will outpace the number of working-age people1 including family members1 who can help seniors financially or with unpaid care4 7#c7 ,research has shown that most ,u4,s4 seniors could only afford less than a year of nursing home care1 assisted living care1 or extensive home care using their financial resources4 ,some can get by using unpaid 7family7 care1 but most rely on a combination of paid and unpaid care4 7#d7 ,more than #a in #e middle-income seniors will end up impoverished1 ,medicaid eligible1 and mostly using ,medicaid to cover their ,,ltss costs4 7#e7 ,millions of older ,americans--#a in #e--will need ,,ltss for more than #e years1 with a price tag that would impoverish nearly all ,american households if they faced that need4 ,,hhs projections show that older adults who need ,,ltss for more than #e years incur nearly half of all ,,ltss expenses and #fj percent of ,medicaid's ,,ltss spending4 7#f7 ,only #a in #aj ,american adults 7#aa percent7 have any private coverage for ,,ltss expenses1 leaving almost all middle-class ,american families to exhaust their nest-eggs and become impoverished before qualifying for ,medicaid4 7#g7 ,the ,nation urgently needs to create methods for ordinary ,americans to be able to take responsibility to plan for the risk of a substantial period of disability during retirement years4 7#h7 ,given that ,americans move and work across ,state lines so frequently1 ,state-based ,,ltss plans encounter difficult administrative issues4 ,therefore1 a solution to address ,,ltss needs for seniors must be anchored in a ,federal insurance plan4 ,additionally1 since the time just after onset of disability is more predictable and manageable1 a ,federal insurance plan should cover the risk of especially long periods of long-term care1 leaving the early period of need to personal responsibility4 7#i7 ,those methods must also responsibly support the workforce providing supports and services4 7b7 ,purpose ,the purpose of this ,act is to enable most ,americans to make plans that protect themselves and their families1 to enable disabled older adults to support themselves in their communities during periods of serious disability1 to support the workforce providing direct services to elders living with disabilities1 and to reduce what is now necessary reliance on ,medicaid4 #c4 ,long-term care insurance benefits 7a7 ,in general ,title ,,ii of the ,social ,security ,act 7#db ,u4,s4,c4 #dja et seq47 is amended by adding at the end the following3 #bce4 ,long-term care insurance benefits 7a7 ,in general ,every individual who-- 7#a7 has attained retirement age 7as defined in section #baf7l77#a772 7#b7 has filed an application for long-term care insurance benefits2 7#c7 is insured for long-term care insurance benefits 7as determined under subsection 7c77 at the time such individual's application is filed2 and 7#d7 has a continual serious functional disability 7as defined in subsection 7d77 and1 at the time such individual's application is filed1 has had such disability for a substantial period of time 7as determined under subsection 7e771 shall be entitled to a long-term care insurance benefit for each month beginning with the #ast month in which the individual meets the criteria specified in paragraphs 7#a7 through 7#d71 and ending with the earlier of the month in which the individual dies or the #ast month in which the individual no longer has a continual serious functional disability 7as so defined74 7b7 ,benefit amount ,such individual's long-term care insurance benefit for each month shall be an amount equal to the product of-- 7#a7 an estimate1 to be determined by the ,secretary of ,health and ,human ,services in consultation with the ,department of ,labor1 of the median cost of #f hours per day of paid personal assistance in the ,united ,states1 indexed to wages in the long-term care sector1 multiplied by 7#b7 the ratio 7not greater than #a7 of the number of quarters of coverage the individual has during the applicable base period 7as defined in subsection 7c77#b77 to #dj4 7c7 ,definition of insured status 7#a7 ,in general ,for purposes of subsection 7a71 an individual shall be insured for long-term care insurance benefits in any month if the individual has #f quarters of coverage during the applicable base period4 7#b7 ,applicable base period ,for purposes of this subsection1 the term applicable base period means the period that begins with the #ast quarter of #bjbf4 7d7 ,definition of continual serious functional disability ,for purposes of subsection 7a71 an individual shall be considered to have a continual serious functional disability if the person is a chronically ill individual 7as determined under section #ggjb;,b7c77#b7 of the ,internal ,revenue ,code of #aihf7 and is expected to remain a chronically ill individual 7as so determined7 for at least #a year or until the individual's death4 7e7 ,definition of substantial period 7#a7 ,in general ,for purposes of subsection 7a71 a substantial period of time means-- 7,a7 in the case of an individual who1 at the time described in paragraph 7#c71 has average indexed monthly earnings for long-term care equal to or less than the dollar amount representing the #djth percentile in the table established under subsection 7f7 for such calendar year1 #ab months2 and 7,b7 in the case of an individual who1 at such time1 has average indexed monthly earnings for long-term care greater than such dollar amount1 #ab months plus #a additional month for each #a4be percentile interval above the #djth percentile for which the individual's average indexed monthly earnings for long-term care would attain 7as specified in such table74 7#b7 ,table of earnings 7,a7 ,in general ,the ,commissioner of ,social ,security shall establish a table1 for each calendar year beginning with calendar year #bjbf1 setting forth-- 7i7 the dollar amount representing the #djth percentile among the average indexed monthly earnings for long-term care 7as determined under subparagraph 7,b77 of each individual who has attained age #fb and whose primary insurance amount is first computed during such calendar year 7or1 for calendar year #bjcf1 during any previous calendar year72 and 7ii7 the dollar amounts representing percentiles over #dj 7increasing linearly from #dj in intervals of #a4be7 among the average indexed monthly earnings for long-term care 7as so determined7 of each such individual4 7,b7 ,determination of average indexed monthly earnings for long-term care ,for purposes of this subsection1 the average indexed monthly earnings for long-term care of an individual shall be determined under section #bae7;b7 7as in effect on the date of enactment of this ,act7 as if such section were amended-- 7i7 in paragraph 7#b77;,a71 by striking reduced-- and all that follows through the end and inserting reduced by the number of benefit computation years for which no wages were paid in and no self-employment income credited42 and 7ii7 in paragraph 7#b77;,b77ii71 by striking #aiej and inserting #bjbe4 7#c7 ,time of calculation ,the time described in this paragraph is-- 7,a7 in the case of an individual who has #dj quarters of coverage during the applicable base period 7as defined in subsection 7c77#b77 prior to becoming entitled to old-age insurance benefits1 the time at which the individual's primary insurance amount was first computed with respect to the individual's application for such benefits2 and 7,b7 in the case of any other individual1 the time at which the individual files an application for long-term care insurance benefits under this section4 7f7 ,provision of information relating to obtaining long-,term care ,the ,commissioner of ,social ,security shall provide to each individual entitled to a long-term care insurance benefit under this section1 as soon as practicable following the first day of the first month of such entitlement1 information describing the steps the individual may take to obtain long-term care1 including an explanation of the services 7including care planning1 care management1 and administrative services for hired care providers1 by referral or in-house1 for a fee7 provided by1 and the appropriate contact information for1 the ,aging and ,disability ,resource ,centers described in section #bjb7;b77#h7 of the ,older ,americans ,act of #aife and the area agencies on aging 7as defined in section #ajb7f7 of such ,act74 7g7 ,provision of beneficiary information by any person ,any person may submit applicable information with respect to an individual's application for long-term care insurance benefits1 an annual statement described under subsection 7i77#b71 or any other information required to be submitted by the individual under this title1 including1 as applicable1 the individual's representative1 or any family member or other appropriate person4 7h7 ,treatment of long-,term care insurance benefit payments ,a long-term care insurance benefit payment shall not be regarded as income and shall not be regarded as a resource for any month1 for purposes of determining the eligibility of the recipient 7or the recipient's spouse or family7 for benefits or assistance under any ,federal program or under any ,state or local program financed in whole or in part with ,federal funds4 7i7 ,additional requirements 7#a7 ,relating to wages and withholding rules ,an individual entitled to a long-term care insurance benefit for a month during a calendar year shall1 in any case in which such individual hires an employee who is not a family member to provide paid personal care to the individual during such month1 comply with all applicable ,state and ,federal laws relating to-- 7,a7 the payment of a minimum wage2 and 7,b7 the withholding of payroll taxes and other employment-related taxes4 7#b7 ,annual statement ,an individual entitled to a long-term care insurance benefit for a month during a calendar year shall submit a statement to the ,commissioner of ,social ,security at least once during such calendar year1 as directed by the ,commissioner-- 7,a7 affirming that the individual-- 7i7 continues to have a continual serious functional disability 7as defined in subsection 7d772 and 7ii7 is in compliance with the laws described in paragraph 7#a72 and 7,b7 specifying the country of residence of the individual4 7#c7 ,nonpayment of benefits in certain cases ,no long-term care insurance benefit shall be payable to an individual for any month-- 7,a7 with respect to which the individual fails to satisfy any of the requirements described in the preceding paragraphs of this subsection2 or 7,b7 beginning after the fifth consecutive year with respect to which the individual has reported1 in the annual statement required under paragraph 7#b71 a country of residence other than the ,united ,states 7including any territory of the ,united ,states74 4 7b7 ,estimates of benefits ,section #aadc7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ac7 is amended-- 7#a7 in subparagraph 7,d71 by striking and at the end2 7#b7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7,f7 an estimate of the potential long-term care insurance benefits payable to the individual4 4 #d4 ,establishment of ,federal ,long-,term ,care ,insurance ,trust ,fund 7a7 ,in general ,there is hereby created on the books of the ,treasury of the ,united ,states a trust fund to be known as the ,federal ,long-,term ,care ,insurance ,trust ,fund4 ,the ,federal ,long-,term ,care ,insurance ,trust ,fund shall consist of such gifts and bequests as may be made as provided in section #bja7;i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dja7;i77#a77 and such amounts as may be appropriated to1 or deposited in1 the ,federal ,long-,term ,care ,insurance ,trust ,fund as provided in this section4 7b7 ,appropriation ,there is appropriated to the ,federal ,long-,term ,care ,insurance ,trust ,fund out of moneys in the ,treasury not otherwise appropriated-- 7#a7 for each of fiscal years #bjbf1 #bjbg1 and #bjbh1 #ab1jjj1jjj for the initial establishment of the ,long-,term ,care ,insurance program and payment of benefits during such fiscal years2 and 7#b7 #ej1jjj1jjj for public education relating to the ,long-,term ,care ,insurance program as described in section #f7;a74 7c7 ,management of ,trust ,fund ,the provisions of subsections 7c71 7d71 7e71 7f71 7i71 and 7m7 of section #bja of the ,social ,security ,act 7#db ,u4,s4,c4 #dja7 shall apply with respect to the ,federal ,long-,term ,care ,insurance ,trust ,fund in the same manner as such provisions apply to the ,federal ,old-,age and ,survivors ,insurance ,trust ,fund and the ,disability ,insurance ,trust ,fund1 except that the ,managing ,trustee 7within the meaning of subsection 7d7 of such section7 may invest such portion of the ,federal ,long-,term ,care ,insurance ,trust ,fund as the ,managing ,trustee considers appropriate in conservative market securities4 7d7 ,administration ,there are authorized to be made available for expenditure1 out of the ,federal ,long-,term ,care ,insurance ,trust ,fund1 such sums as may be necessary to pay the costs of the administration of section #c1 including start-up costs1 technical assistance1 outreach1 education1 evaluation1 and reporting4 7e7 ,report ,not later than #e years after the date of enactment of this ,act and every #e years thereafter1 the ,board of ,trustees 7as defined for purposes of title ,,ii of the ,social ,security ,act7 shall submit a report to ,congress evaluating the impact of long-term care insurance benefits under section #bce of such ,act and making recommendations relating to potential geographical adjustments of the amount of such benefits4 7f7 ,allowing gifts ,to be made to the ,federal ,long-,term ,care ,insurance ,trust ,fund ,section #bja7;i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dja7;i77#a77 is amended-- 7#a7 by striking 1 or the ,federal and inserting 1 the ,federal2 and 7#b7 by inserting after in such ,trust ,fund7 the following3 1 or the ,federal ,long-,term ,care ,insurance ,trust ,fund established under the ,well-,being ,insurance for ,seniors to be at ,home ,act4 #e4 ,education and outreach 7a7 ,public education plan 7#a7 ,in general ,not later than #ij days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,commissioner of ,social ,security1 shall publish in the ,federal ,register a #aj-year plan to educate the public about the likelihood of needing long-term care1 the nature of the experience of long-term care in various situations1 the costs of long-term care1 the availability of long-term care insurance benefits1 and the importance of planning and considering private insurance coverage alongside family support and savings 7especially during the first years of a serious disability74 ,such plan shall be modified as necessary based on research on the effectiveness of various strategies and modifications with experience4 7#b7 ,funding ,there are appropriated1 out of the ,federal ,long-,term ,care ,insurance ,trust ,fund1 to the ,secretary of ,health and ,human ,services #ej1jjj1jjj to carry out paragraph 7#a74 7b7 ,individual notices 7#a7 ,in general ,beginning #a year after the date of enactment of this ,act and in accordance with paragraph 7#b71 the ,commissioner of ,social ,security shall provide to each eligible individual a notice that specifies-- 7,a7 7i7 the average indexed monthly earnings for long-term care that would be calculated for the individual under paragraph 7#b77;,b7 of section #bce7;e7 of the ,social ,security ,act if such average indexed monthly earnings for long-term care were calculated in the month before the month such notice is provided2 and 7ii7 for purposes of applying such section to the individual1 the percentile in which such average indexed monthly earnings for long-term care of the individual would fall among the average indexed monthly earnings for long-term care 7as determined under such paragraph 7#b77;,b77 of each individual whose average indexed monthly earnings for long-term care are calculated in such month2 7,b7 the number of quarters of coverage the individual has in the month before the month such notice is provided for purposes of attaining insured status for long-term care insurance benefits under such ,act2 and 7,c7 in any case in which the individual has a continual serious functional disability 7as defined in section #bce7;d7 of such ,act71 the date on which such disability began4 7#b7 ,timing ,a notice described in paragraph 7#a7 shall be provided-- 7,a7 by mail-- 7i7 to each eligible individual not later than #edj days of the date of enactment of this ,act2 and 7ii7 to each eligible individual in the month the individual attains age #de1 age #ee1 age #fe1 and retirement age 7as defined in section #baf7l7 of such ,act72 and 7,b7 for each eligible individual who has attained age #ce1 by making such notice available on the individual's account on the website of the ,social ,security ,administration1 to be updated annually4 7#c7 ,eligible individual ,in this subsection1 the term eligible individual means an individual-- 7,a7 who has a social security account number2 and 7,b7 7i7 who has wages or net earnings from self-employment2 or 7ii7 with respect to whom the ,commissioner has information that the pattern of wages or self-employment income indicate a likelihood of noncovered employment4 #f4 ,,gao ,report on ,performance of the ,,wish ,program ,not later than #e years after the date of enactment of this ,act and every #c years thereafter1 the ,comptroller ,general shall submit a report to ,congress including-- 7#a7 a description of the likelihood of manipulation of eligibility criteria by beneficiaries or beneficiary advisors and recommendations as to the merits of possible remedies2 7#b7 a description of the likelihood of financial exploitation or elder mistreatment by others on whom a beneficiary is dependent or otherwise connected and recommendations as to the merits of possible remedies1 including the merits of imposing a financial management service or fiscal intermediary as has often been implemented by states in ,medicaid's ,cash and ,counseling program2 and 7#c7 a description of the marketplace and consumer understanding of long-term insurance offerings and recommendations as to the merits of possible remedies1 including the merits of standardizing insurance offerings to improve consumer understanding4 #g4 ,report on remaining long-term supports and services needs ,not later than #c years after the date of enactment of this ,act and every #c years thereafter1 the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,administration on ,community ,living and in consultation with the ,commissioner of ,social ,security1 shall submit a plan to ,congress that includes-- 7#a7 estimates of the long-term services and supports needed by individuals who are not eligible for benefits under section #bce of the ,social ,security ,act1 including individuals disabled in childhood1 individuals living with disabilities before retirement age1 and individuals who are not insured for benefits under such section2 and 7#b7 proposed strategies and costs of mitigating unmet needs for such individuals4