SUB-ACUTE AND LONG-TERM CARE PROGRAM REFORM.

SEC. 701. SUB-ACUTE AND LONG-TERM CARE PROGRAM REFORM. (a) In General.—(1) Chapter 55 of title 10, United States Code, is amended by inserting after section 1074i the following new section: “§ 1074j. Sub-acute care program “(a) Establishment.—The Secretary of Defense shall establish an effective, efficient, and integrated sub-acute care benefits program under this chapter (hereinafter referred to in this section as the ‘program’). Except as otherwise provided in this section, the types of health care authorized under the program shall be the same as those provided under section 1079 of this title. The Secretary, after consultation with the other administering Secretaries, shall promulgate regulations to carry out this section. “(b) Benefits.—(1) The program shall include a uniform skilled nursing facility benefit that shall be provided in the manner and under the conditions described in section 1861 (h) and (i) of the Social Security Act (42 U.S.C. 1395x (h) and (i)), except that the limitation on the number of days of coverage under section 1812 (a) and (b) of such Act (42 U.S.C. 1395d (a) and (b)) shall not be applicable under the program. Skilled nursing facility care for each spell of illness shall continue to be provided for as long as medically necessary and appropriate. “(2) In this subsection: “(A) The term ‘skilled nursing facility’ has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i-3(a)). “(B) The term ‘spell of illness’ has the meaning given such term in section 1861(a) of such Act (42 U.S.C. 1395x(a)). “(3) The program shall include a comprehensive, part-time or intermittent home health care benefit that shall be provided in the manner and under the conditions described in section 1861(m) of the Social Security Act (42 U.S.C. 1395x(m)).”. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1074i the following new item: “1074j. Sub-acute care program.”. (b) Extended Benefits for Disabled Beneficiaries.—Section 1079 of title 10, United States Code, is amended by striking subsections (d), (e), and (f) and inserting the following new subsections: “(d)(1) The Secretary of Defense shall establish a program to provide extended benefits for eligible dependents, which may include the provision of comprehensive health care services, including case management services, to assist in the reduction of the disabling effects of a qualifying condition of an eligible 115 STAT. 1159dependent. Registration shall be required to receive the extended benefits. “(2) The Secretary of Defense, after consultation with the other administering Secretaries, shall promulgate regulations to carry out this subsection. “(3) In this subsection: “(A) The term ‘eligible dependent’ means a dependent of a member of the uniformed services on active duty for a period of more than 30 days, as described in subparagraph (A), (D), or (I) of section 1072(2) of this title, who has a qualifying condition. “(B) The term ‘qualifying condition’ means the condition of a dependent who is moderately or severely mentally retarded, has a serious physical disability, or has an extraordinary physical or psychological condition. “(e) Extended benefits for eligible dependents under subsection (d) may include comprehensive health care services (including services necessary to maintain, or minimize or prevent deterioration of, function of the patient) and case management services with respect to the qualifying condition of such a dependent, and include, to the extent such benefits are not provided under provisions of this chapter other than under this section, the following: “(1) Diagnosis. “(2) Inpatient, outpatient, and comprehensive home health care supplies and services which may include cost effective and medically appropriate services other than part-time or intermittent services (within the meaning of such terms as used in the second sentence of section 1861(m) of the Social Security Act). “(3) Training, rehabilitation, special education, and assistive technology devices. “(4) Institutional care in private nonprofit, public, and State institutions and facilities and, if appropriate, transportation to and from such institutions and facilities. “(5) Custodial care, notwithstanding the prohibition in section 1077(b)(1) of this title. “(6) Respite care for the primary caregiver of the eligible dependent. “(7) Such other services and supplies as determined appropriate by the Secretary, notwithstanding the limitations in subsection (a)(13). “(f)(1) Members shall be required to share in the cost of any benefits provided to their dependents under subsection (d) as follows: “(A) Members in the lowest enlisted pay grade shall be required to pay the first $25 incurred each month, and members in the highest commissioned pay grade shall be required to pay the first $250 incurred each month. The amounts to be paid by members in all other pay grades shall be determined under regulations to be prescribed by the Secretary of Defense in consultation with the administering Secretaries. “(B) A member who has more than one dependent incurring expenses in a given month under a plan covered by subsection (d) shall not be required to pay an amount greater than would be required if the member had only one such dependent. 115 STAT. 1160 “(2) In the case of extended benefits provided under paragraph (3) or (4) of subsection (e) to a dependent of a member of the uniformed services— “(A) the Government’s share of the total cost of providing such benefits in any month shall not exceed $2,500, except for costs that a member is exempt from paying under paragraph (3); and “(B) the member shall pay (in addition to any amount payable under paragraph (1)) the amount, if any, by which the amount of such total cost for the month exceeds the Government’s maximum share under subparagraph (A). “(3) A member of the uniformed services who incurs expenses under paragraph (2) for a month for more than one dependent shall not be required to pay for the month under subparagraph (B) of that paragraph an amount greater than the amount the member would otherwise be required to pay under that subparagraph for the month if the member were incurring expenses under that subparagraph for only one dependent. “(4) To qualify for extended benefits under paragraph (3) or (4) of subsection (e), a dependent of a member of the uniformed services shall be required to use public facilities to the extent such facilities are available and adequate, as determined under joint regulations of the administering Secretaries. “(5) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to carry out this subsection.”. (c) Definitions of Custodial Care and Domiciliary Care.—Section 1072 of title 10, United States Code, is amended by adding at the end the following new paragraphs: “(8) The term ‘custodial care’ means treatment or services, regardless of who recommends such treatment or services or where such treatment or services are provided, that— “(A) can be rendered safely and reasonably by a person who is not medically skilled; or “(B) is or are designed mainly to help the patient with the activities of daily living. “(9) The term ‘domiciliary care’ means care provided to a patient in an institution or homelike environment because— “(A) providing support for the activities of daily living in the home is not available or is unsuitable; or “(B) members of the patient’s family are unwilling to provide the care.”. (d) Continuation of Individual Case Management Services for Certain Eligible Beneficiaries.—(1) Notwithstanding the termination of the Individual Case Management Program by subsection (g), the Secretary of Defense shall, in any case in which the Secretary makes the determination described in paragraph (2), continue to provide payment as if such program were in effect for home health care or custodial care services provided to an eligible beneficiary that would otherwise be excluded from coverage under regulations implementing chapter 55 of title 10, United States Code. (2) The determination referred to in paragraph (1) is a determination that discontinuation of payment for services not otherwise provided under such chapter would result in the provision of services inadequate to meet the needs of the eligible beneficiary and would be unjust to such beneficiary. 115 STAT. 1161 (3) For purposes of this subsection, “eligible beneficiary” means a covered beneficiary (as that term is defined in section 1072 of title 10, United States Code) who, before the effective date of this section, was provided custodial care services under the Individual Case Management Program for which the Secretary provided payment. (e) Report on Initiatives Regarding Long-Term Care.—The Secretary of Defense shall, not later than April 1, 2002, submit to Congress a report on the feasibility and desirability of establishing new initiatives, taking into account chapter 90 of title 5, United States Code, to improve the availability of long-term care for members and retired members of the uniformed services and their families. (f) Reference in Title 10 to Long-Term Care Program in Title 5.—(1) Chapter 55 of title 10, United States Code, is amended by inserting after section 1074j (as added by subsection (a)) the following new section: “§ 1074k. Long-term care insurance “Provisions regarding long-term care insurance for members and certain former members of the uniformed services and their families are set forth in chapter 90 of title 5.”. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1074j (as added by subsection (a)) the following new item: “1074k. Long-term care insurance.”. (g) Conforming Amendments.—(1) The following provisions of law are repealed: (A) Section 703 of the National Defense Authorization Act for Fiscal Year 2000 (Public Law 106–65; 113 Stat. 682; 10 U.S.C. 1077 note). (B) Section 8118 of the Department of Defense Appropriations Act, 2000 (Public Law 106–79; 113 Stat. 1260). (C) Section 8100 of the Department of Defense Appropriations Act, 2001 (Public Law 106–259; 114 Stat. 696). (2) Section 1079 of title 10, United States Code, is amended in subsection (a) by striking paragraph (17).