TITLE VIII--CLASS ACT <<NOTE: Community Living Assistance Services and 
Supports Act. 42 USC 201 note.>> 

SEC. 8001. SHORT TITLE OF TITLE.

    This title may be cited as the ``Community Living Assistance 
Services and Supports Act'' or the ``CLASS Act''.

SEC. 8002. ESTABLISHMENT OF NATIONAL VOLUNTARY INSURANCE PROGRAM FOR 
            PURCHASING COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORT.

    (a) Establishment of CLASS Program.--
            (1) In general.--The Public Health Service Act (42 U.S.C. 
        201 et seq.), as amended by section 4302(a), is amended by 
        adding at the end the following:

    ``TITLE XXXII--COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

``SEC. 3201. <<NOTE: 42 USC 300ll.>>  PURPOSE.

    ``The purpose of this title is to establish a national voluntary 
insurance program for purchasing community living assistance services 
and supports in order to--
            ``(1) provide individuals with functional limitations with 
        tools that will allow them to maintain their personal and 
        financial independence and live in the community through a new 
        financing strategy for community living assistance services and 
        supports;
            ``(2) establish an infrastructure that will help address the 
        Nation's community living assistance services and supports 
        needs;
            ``(3) alleviate burdens on family caregivers; and
            ``(4) address institutional bias by providing a financing 
        mechanism that supports personal choice and independence to live 
        in the community.

``SEC. 3202. <<NOTE: 42 USC 300ll-1.>>  DEFINITIONS.

    ``In this title:
            ``(1) Active enrollee.--The term `active enrollee' means an 
        individual who is enrolled in the CLASS program in accordance 
        with section 3204 and who has paid any premiums due to maintain 
        such enrollment.
            ``(2) Actively employed.--The term `actively employed' means 
        an individual who--
                    ``(A) is reporting for work at the individual's 
                usual place of employment or at another location to 
                which the

[[Page 124 STAT. 829]]

                individual is required to travel because of the 
                individual's employment (or in the case of an individual 
                who is a member of the uniformed services, is on active 
                duty and is physically able to perform the duties of the 
                individual's position); and
                    ``(B) is able to perform all the usual and customary 
                duties of the individual's employment on the 
                individual's regular work schedule.
            ``(3) Activities of daily living.--The term `activities of 
        daily living' means each of the following activities specified 
        in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986:
                    ``(A) Eating.
                    ``(B) Toileting.
                    ``(C) Transferring.
                    ``(D) Bathing.
                    ``(E) Dressing.
                    ``(F) Continence.
            ``(4) CLASS program.--The term `CLASS program' means the 
        program established under this title.
            ``(5) Eligibility assessment system.--The term `Eligibility 
        Assessment System' means the entity established by the Secretary 
        under section 3205(a)(2) to make functional eligibility 
        determinations for the CLASS program.
            ``(6) Eligible beneficiary.--
                    ``(A) In general.--The term `eligible beneficiary' 
                means any individual who is an active enrollee in the 
                CLASS program and, as of the date described in 
                subparagraph (B)--
                          ``(i) has paid premiums for enrollment in such 
                      program for at least 60 months;
                          ``(ii) has earned, with respect to at least 3 
                      calendar years that occur during the first 60 
                      months for which the individual has paid premiums 
                      for enrollment in the program, at least an amount 
                      equal to the amount of wages and self-employment 
                      income which an individual must have in order to 
                      be credited with a quarter of coverage under 
                      section 213(d) of the Social Security Act for the 
                      year; and
                          ``(iii) has paid premiums for enrollment in 
                      such program for at least 24 consecutive months, 
                      if a lapse in premium payments of more than 3 
                      months has occurred during the period that begins 
                      on the date of the individual's enrollment and 
                      ends on the date of such determination.
                    ``(B) Date described.--For purposes of subparagraph 
                (A), the date described in this subparagraph is the date 
                on which the individual is determined to have a 
                functional limitation described in section 3203(a)(1)(C) 
                that is expected to last for a continuous period of more 
                than 90 days.
                    ``(C) Regulations.--The Secretary shall promulgate 
                regulations specifying exceptions to the minimum 
                earnings requirements under subparagraph (A)(ii) for 
                purposes of being considered an eligible beneficiary for 
                certain populations.
            ``(7) Hospital; nursing facility; intermediate care facility 
        for the mentally retarded; institution for

[[Page 124 STAT. 830]]

        mental diseases.--The terms `hospital', `nursing facility', 
        `intermediate care facility for the mentally retarded', and 
        `institution for mental diseases' have the meanings given such 
        terms for purposes of Medicaid.
            ``(8) CLASS independence advisory council.--The term `CLASS 
        Independence Advisory Council' or `Council' means the Advisory 
        Council established under section 3207 to advise the Secretary.
            ``(9) CLASS independence benefit plan.--The term `CLASS 
        Independence Benefit Plan' means the benefit plan developed and 
        designated by the Secretary in accordance with section 3203.
            ``(10) CLASS independence fund.--The term `CLASS 
        Independence Fund' or `Fund' means the fund established under 
        section 3206.
            ``(11) Medicaid.--The term `Medicaid' means the program 
        established under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            ``(12) Poverty line.--The term `poverty line' has the 
        meaning given that term in section 2110(c)(5) of the Social 
        Security Act (42 U.S.C. 1397jj(c)(5)).
            ``(13) Protection and advocacy system.--The term `Protection 
        and Advocacy System' means the system for each State established 
        under section 143 of the Developmental Disabilities Assistance 
        and Bill of Rights Act of 2000 (42 U.S.C. 15043).

``SEC. 3203. <<NOTE: 42 USC 300ll-2.>>  CLASS INDEPENDENCE BENEFIT PLAN.

    ``(a) Process for Development.--
            ``(1) In general.--The Secretary, in consultation with 
        appropriate actuaries and other experts, shall develop at least 
        3 actuarially sound benefit plans as alternatives for 
        consideration for designation by the Secretary as the CLASS 
        Independence Benefit Plan under which eligible beneficiaries 
        shall receive benefits under this title. Each of the plan 
        alternatives developed shall be designed to provide eligible 
        beneficiaries with the benefits described in section 3205 
        consistent with the following requirements:
                    ``(A) Premiums.--
                          ``(i) In general.--Beginning with the first 
                      year of the CLASS program, and for each year 
                      thereafter, subject to clauses (ii) and (iii), the 
                      Secretary shall establish all premiums to be paid 
                      by enrollees for the year based on an actuarial 
                      analysis of the 75-year costs of the program that 
                      ensures solvency throughout such 75-year period.
                          ``(ii) Nominal premium for poorest individuals 
                      and full-time students.--
                                    ``(I) In general.--The monthly 
                                premium for enrollment in the CLASS 
                                program shall not exceed the applicable 
                                dollar amount per month determined under 
                                subclause (II) for--
                                            ``(aa) any individual whose 
                                        income does not exceed the 
                                        poverty line; and
                                            ``(bb) any individual who 
                                        has not attained age 22, and is 
                                        actively employed during any

[[Page 124 STAT. 831]]

                                        period in which the individual 
                                        is a full-time student (as 
                                        determined by the Secretary).
                                    ``(II) Applicable dollar amount.--
                                The applicable dollar amount described 
                                in this subclause is the amount equal to 
                                $5, increased by the percentage increase 
                                in the consumer price index for all 
                                urban consumers (U.S. city average) for 
                                each year occurring after 2009 and 
                                before such year.
                          ``(iii) Class independence fund reserves.--At 
                      such time as the CLASS program has been in 
                      operation for 10 years, the Secretary shall 
                      establish all premiums to be paid by enrollees for 
                      the year based on an actuarial analysis that 
                      accumulated reserves in the CLASS Independence 
                      Fund would not decrease in that year. At such 
                      time <<NOTE: Determination.>>  as the Secretary 
                      determines the CLASS program demonstrates a 
                      sustained ability to finance expected yearly 
                      expenses with expected yearly premiums and 
                      interest credited to the CLASS Independence Fund, 
                      the Secretary may decrease the required amount of 
                      CLASS Independence Fund reserves.
                    ``(B) Vesting period.--A 5-year vesting period for 
                eligibility for benefits.
                    ``(C) Benefit triggers.--A benefit trigger for 
                provision of benefits that requires a determination that 
                an individual has a functional limitation, as certified 
                by a licensed health care practitioner, described in any 
                of the following clauses that is expected to last for a 
                continuous period of more than 90 days:
                          ``(i) The individual is determined to be 
                      unable to perform at least the minimum number 
                      (which may be 2 or 3) of activities of daily 
                      living as are required under the plan for the 
                      provision of benefits without substantial 
                      assistance (as defined by the Secretary) from 
                      another individual.
                          ``(ii) The individual requires substantial 
                      supervision to protect the individual from threats 
                      to health and safety due to substantial cognitive 
                      impairment.
                          ``(iii) <<NOTE: Regulations.>>  The individual 
                      has a level of functional limitation similar (as 
                      determined under regulations prescribed by the 
                      Secretary) to the level of functional limitation 
                      described in clause (i) or (ii).
                    ``(D) Cash benefit.--Payment of a cash benefit that 
                satisfies the following requirements:
                          ``(i) Minimum required amount.--The benefit 
                      amount provides an eligible beneficiary with not 
                      less than an average of $50 per day (as determined 
                      based on the reasonably expected distribution of 
                      beneficiaries receiving benefits at various 
                      benefit levels).
                          ``(ii) Amount scaled to functional ability.--
                      The benefit amount is varied based on a scale of 
                      functional ability, with not less than 2, and not 
                      more than 6, benefit level amounts.
                          ``(iii) Daily or weekly.--The benefit is paid 
                      on a daily or weekly basis.
                          ``(iv) No lifetime or aggregate limit.--The 
                      benefit is not subject to any lifetime or 
                      aggregate limit.

[[Page 124 STAT. 832]]

                    ``(E) Coordination with supplemental coverage 
                obtained through the exchange.--The benefits allow for 
                coordination with any supplemental coverage purchased 
                through an Exchange established under section 1311 of 
                the Patient Protection and Affordable Care Act.
            ``(2) Review and recommendation by the class independence 
        advisory council.--The CLASS Independence Advisory Council 
        shall--
                    ``(A) evaluate the alternative benefit plans 
                developed under paragraph (1); and
                    ``(B) recommend for designation as the CLASS 
                Independence Benefit Plan for offering to the public the 
                plan that the Council determines best balances price and 
                benefits to meet enrollees' needs in an actuarially 
                sound manner, while optimizing the probability of the 
                long-term sustainability of the CLASS program.
            ``(3) Designation by the secretary.--Not 
        later <<NOTE: Deadline.>>  than October 1, 2012, the Secretary, 
        taking into consideration the recommendation of the CLASS 
        Independence Advisory Council under paragraph (2)(B), shall 
        designate a benefit plan as the CLASS Independence Benefit 
        Plan. <<NOTE: Publication. Regulations. Public information.>>  
        The Secretary shall publish such designation, along with details 
        of the plan and the reasons for the selection by the Secretary, 
        in a final rule that allows for a period of public comment.

    ``(b) Additional Premium Requirements.--
            ``(1) Adjustment of premiums.--
                    ``(A) In general.--Except as provided in 
                subparagraphs (B), (C), (D), and (E), the amount of the 
                monthly premium determined for an individual upon such 
                individual's enrollment in the CLASS program shall 
                remain the same for as long as the individual is an 
                active enrollee in the program.
                    ``(B) Recalculated premium if required for program 
                solvency.--
                          ``(i) <<NOTE: Determination.>>  In general.--
                      Subject to clause (ii), if the Secretary 
                      determines, based on the most recent report of the 
                      Board of Trustees of the CLASS Independence Fund, 
                      the advice of the CLASS Independence Advisory 
                      Council, and the annual report of the Inspector 
                      General of the Department of Health and Human 
                      Services, and waste, fraud, and abuse, or such 
                      other information as the Secretary determines 
                      appropriate, that the monthly premiums and income 
                      to the CLASS Independence Fund for a year are 
                      projected to be insufficient with respect to the 
                      20-year period that begins with that year, the 
                      Secretary shall adjust the monthly premiums for 
                      individuals enrolled in the CLASS program as 
                      necessary (but maintaining a nominal premium for 
                      enrollees whose income is below the poverty line 
                      or who are full-time students actively employed).
                          ``(ii) Exemption from increase.--Any increase 
                      in a monthly premium imposed as result of a 
                      determination described in clause (i) shall not 
                      apply with respect to the monthly premium of any 
                      active enrollee who--
                                    ``(I) has attained age 65;

[[Page 124 STAT. 833]]

                                    ``(II) has paid premiums for 
                                enrollment in the program for at least 
                                20 years; and
                                    ``(III) is not actively employed.
                    ``(C) Recalculated premium if reenrollment after 
                more than a 3-month lapse.--
                          ``(i) In general.--The reenrollment of an 
                      individual after a 90-day period during which the 
                      individual failed to pay the monthly premium 
                      required to maintain the individual's enrollment 
                      in the CLASS program shall be treated as an 
                      initial enrollment for purposes of age-adjusting 
                      the premium for enrollment in the program.
                          ``(ii) Credit for prior months if reenrolled 
                      within 5 years.--An individual who reenrolls in 
                      the CLASS program after such a 90-day period and 
                      before the end of the 5-year period that begins 
                      with the first month for which the individual 
                      failed to pay the monthly premium required to 
                      maintain the individual's enrollment in the 
                      program shall be--
                                    ``(I) credited with any months of 
                                paid premiums that accrued prior to the 
                                individual's lapse in enrollment; and
                                    ``(II) notwithstanding the total 
                                amount of any such credited months, 
                                required to satisfy section 
                                3202(6)(A)(ii) before being eligible to 
                                receive benefits.
                    ``(D) No longer status as a full-time student.--An 
                individual subject to a nominal premium on the basis of 
                being described in subsection (a)(1)(A)(ii)(I)(bb) who 
                ceases to be described in that subsection, beginning 
                with the first month following the month in which the 
                individual ceases to be so described, shall be subject 
                to the same monthly premium as the monthly premium that 
                applies to an individual of the same age who first 
                enrolls in the program under the most similar 
                circumstances as the individual (such as the first year 
                of eligibility for enrollment in the program or in a 
                subsequent year).
                    ``(E) Penalty for reenollment after 5-year lapse.--
                In the case of an individual who reenrolls in the CLASS 
                program after the end of the 5-year period described in 
                subparagraph (C)(ii), the monthly premium required for 
                the individual shall be the age-adjusted premium that 
                would be applicable to an initially enrolling individual 
                who is the same age as the reenrolling individual, 
                increased by the greater of--
                          ``(i) an amount that the Secretary determines 
                      is actuarially sound for each month that occurs 
                      during the period that begins with the first month 
                      for which the individual failed to pay the monthly 
                      premium required to maintain the individual's 
                      enrollment in the CLASS program and ends with the 
                      month preceding the month in which the reenollment 
                      is effective; or
                          ``(ii) 1 percent of the applicable age-
                      adjusted premium for each such month occurring in 
                      such period.
            ``(2) Administrative expenses.--In determining the monthly 
        premiums for the CLASS program the Secretary may

[[Page 124 STAT. 834]]

        factor in costs for administering the program, not to exceed for 
        any year in which the program is in effect under this title, an 
        amount equal to 3 percent of all premiums paid during the year.
            ``(3) No underwriting requirements.--No underwriting (other 
        than on the basis of age in accordance with subparagraphs (D) 
        and (E) of paragraph (1)) shall be used to--
                    ``(A) determine the monthly premium for enrollment 
                in the CLASS program; or
                    ``(B) prevent an individual from enrolling in the 
                program.

    ``(c) <<NOTE: Procedures.>>  Self-attestation and Verification of 
Income.--The Secretary shall establish procedures to--
            ``(1) permit an individual who is eligible for the nominal 
        premium required under subsection (a)(1)(A)(ii), as part of 
        their automatic enrollment in the CLASS program, to self-attest 
        that their income does not exceed the poverty line or that their 
        status as a full-time student who is actively employed;
            ``(2) verify, using procedures similar to the procedures 
        used by the Commissioner of Social Security under section 
        1631(e)(1)(B)(ii) of the Social Security Act and consistent with 
        the requirements applicable to the conveyance of data and 
        information under section 1942 of such Act, the validity of such 
        self-attestation; and
            ``(3) require an individual to confirm, on at least an 
        annual basis, that their income does not exceed the poverty line 
        or that they continue to maintain such status.

``SEC. 3204. <<NOTE: 42 USC 300ll-3.>>  ENROLLMENT AND DISENROLLMENT 
            REQUIREMENTS.

    ``(a) <<NOTE: Procedures.>>  Automatic Enrollment.--
            ``(1) In general.--Subject to paragraph (2), the Secretary, 
        in coordination with the Secretary of the Treasury, shall 
        establish procedures under which each individual described in 
        subsection (c) may be automatically enrolled in the CLASS 
        program by an employer of such individual in the same manner as 
        an employer may elect to automatically enroll employees in a 
        plan under section 401(k), 403(b), or 457 of the Internal 
        Revenue Code of 1986.
            ``(2) Alternative enrollment procedures.--The procedures 
        established under paragraph (1) shall provide for an alternative 
        enrollment process for an individual described in subsection (c) 
        in the case of such an individual--
                    ``(A) who is self-employed;
                    ``(B) who has more than 1 employer; or
                    ``(C) whose employer does not elect to participate 
                in the automatic enrollment process established by the 
                Secretary.
            ``(3) Administration.--
                    ``(A) <<NOTE: Regulations.>>  In general.--The 
                Secretary and the Secretary of the Treasury shall, by 
                regulation, establish procedures to ensure that an 
                individual is not automatically enrolled in the CLASS 
                program by more than 1 employer.
                    ``(B) Form.--Enrollment in the CLASS program shall 
                be made in such manner as the Secretary may prescribe in 
                order to ensure ease of administration.

    ``(b) Election to Opt-Out.--An individual described in subsection 
(c) may elect to waive enrollment in the CLASS program

[[Page 124 STAT. 835]]

at any time in such form and manner as the Secretary and the Secretary 
of the Treasury shall prescribe.
    ``(c) Individual Described.--For purposes of enrolling in the CLASS 
program, an individual described in this paragraph is an individual--
            ``(1) who has attained age 18;
            ``(2) who--
                    ``(A) receives wages on which there is imposed a tax 
                under section 3201(a) of the Internal Revenue Code of 
                1986; or
                    ``(B) derives self-employment income on which there 
                is imposed a tax under section 1401(a) of the Internal 
                Revenue Code of 1986;
            ``(3) who is actively employed; and
            ``(4) who is not--
                    ``(A) a patient in a hospital or nursing facility, 
                an intermediate care facility for the mentally retarded, 
                or an institution for mental diseases and receiving 
                medical assistance under Medicaid; or
                    ``(B) confined in a jail, prison, other penal 
                institution or correctional facility, or by court order 
                pursuant to conviction of a criminal offense or in 
                connection with a verdict or finding described in 
                section 202(x)(1)(A)(ii) of the Social Security Act (42 
                U.S.C. 402(x)(1)(A)(ii)).

    ``(d) Rule of Construction.--Nothing in this title shall be 
construed as requiring an active enrollee to continue to satisfy 
subparagraph (B) or (C) of subsection (c)(1) in order to maintain 
enrollment in the CLASS program.
    ``(e) Payment.--
            ``(1) Payroll deduction.--An amount equal to the monthly 
        premium for the enrollment in the CLASS program of an individual 
        shall be deducted from the wages or self-employment income of 
        such individual in accordance with such procedures as the 
        Secretary, in coordination with the Secretary of the Treasury, 
        shall establish for employers who elect to deduct and withhold 
        such premiums on behalf of enrolled employees.
            ``(2) Alternative payment mechanism.--The Secretary, in 
        coordination with the Secretary of the Treasury, shall establish 
        alternative procedures for the payment of monthly premiums by an 
        individual enrolled in the CLASS program--
                    ``(A) who does not have an employer who elects to 
                deduct and withhold premiums in accordance with 
                subparagraph (A); or
                    ``(B) who does not earn wages or derive self-
                employment income.

    ``(f) Transfer of Premiums Collected.--
            ``(1) In general.--During each calendar year the Secretary 
        of the Treasury shall deposit into the CLASS Independence Fund a 
        total amount equal, in the aggregate, to 100 percent of the 
        premiums collected during that year.
            ``(2) Transfers based on estimates.--The amount deposited 
        pursuant to paragraph (1) shall be transferred in at least 
        monthly payments to the CLASS Independence Fund on the basis of 
        estimates by the Secretary and certified to the Secretary of the 
        Treasury of the amounts collected in accordance with 
        subparagraphs (A) and (B) of paragraph (5). Proper adjustments 
        shall be made in amounts subsequently transferred to

[[Page 124 STAT. 836]]

        the Fund to the extent prior estimates were in excess of, or 
        were less than, actual amounts collected.

    ``(g) Other Enrollment and Disenrollment Opportunities.--The 
Secretary, <<NOTE: Procedures.>>  in coordination with the Secretary of 
the Treasury, shall establish procedures under which--
            ``(1) an individual who, in the year of the individual's 
        initial eligibility to enroll in the CLASS program, has elected 
        to waive enrollment in the program, is eligible to elect to 
        enroll in the program, in such form and manner as the 
        Secretaries shall establish, only during an open enrollment 
        period established by the Secretaries that is specific to the 
        individual and that may not occur more frequently than 
        biennially after the date on which the individual first elected 
        to waive enrollment in the program; and
            ``(2) an individual shall only be permitted to disenroll 
        from the program (other than for nonpayment of premiums) during 
        an annual disenrollment period established by the Secretaries 
        and in such form and manner as the Secretaries shall establish.

``SEC. 3205. <<NOTE: 42 USC 300ll-4.>>  BENEFITS.

    ``(a) Determination of Eligibility.--
            ``(1) Application for receipt of benefits.--The Secretary 
        shall establish procedures under which an active enrollee shall 
        apply for receipt of benefits under the CLASS Independence 
        Benefit Plan.
            ``(2) Eligibility assessments.--
                    ``(A) In general.--Not 
                later <<NOTE: Deadline. Contracts.>>  than January 1, 
                2012, the Secretary shall--
                          ``(i) establish an Eligibility Assessment 
                      System (other than a service with which the 
                      Commissioner of Social Security has entered into 
                      an agreement, with respect to any State, to make 
                      disability determinations for purposes of title II 
                      or XVI of the Social Security Act) to provide for 
                      eligibility assessments of active enrollees who 
                      apply for receipt of benefits;
                          ``(ii) enter into an agreement with the 
                      Protection and Advocacy System for each State to 
                      provide advocacy services in accordance with 
                      subsection (d); and
                          ``(iii) enter into an agreement with public 
                      and private entities to provide advice and 
                      assistance counseling in accordance with 
                      subsection (e).
                    ``(B) Regulations.--The Secretary shall promulgate 
                regulations to develop an expedited nationally equitable 
                eligibility determination process, as certified by a 
                licensed health care practitioner, an appeals process, 
                and a redetermination process, as certified by a 
                licensed health care practitioner, including whether an 
                active enrollee is eligible for a cash benefit under the 
                program and if so, the amount of the cash benefit (in 
                accordance the sliding scale established under the 
                plan).
                    ``(C) Presumptive eligibility for certain 
                institutionalized enrollees planning to discharge.--An 
                active enrollee shall be deemed presumptively eligible 
                if the enrollee--
                          ``(i) has applied for, and attests is eligible 
                      for, the maximum cash benefit available under the 
                      sliding

[[Page 124 STAT. 837]]

                      scale established under the CLASS Independence 
                      Benefit Plan;
                          ``(ii) is a patient in a hospital (but only if 
                      the hospitalization is for long-term care), 
                      nursing facility, intermediate care facility for 
                      the mentally retarded, or an institution for 
                      mental diseases; and
                          ``(iii) <<NOTE: Deadline.>>  is in the process 
                      of, or about to begin the process of, planning to 
                      discharge from the hospital, facility, or 
                      institution, or within 60 days from the date of 
                      discharge from the hospital, facility, or 
                      institution.
                    ``(D) Appeals.--The Secretary <<NOTE: Procedures.>>  
                shall establish procedures under which an applicant for 
                benefits under the CLASS Independence Benefit Plan shall 
                be guaranteed the right to appeal an adverse 
                determination.

    ``(b) Benefits.--An eligible beneficiary shall receive the following 
benefits under the CLASS Independence Benefit Plan:
            ``(1) Cash benefit.--A cash benefit established by the 
        Secretary in accordance with the requirements of section 
        3203(a)(1)(D) that--
                    ``(A) the first year in which beneficiaries receive 
                the benefits under the plan, is not less than the 
                average dollar amount specified in clause (i) of such 
                section; and
                    ``(B) for any subsequent year, is not less than the 
                average per day dollar limit applicable under this 
                subparagraph for the preceding year, increased by the 
                percentage increase in the consumer price index for all 
                urban consumers (U.S. city average) over the previous 
                year.
            ``(2) Advocacy services.--Advocacy services in accordance 
        with subsection (d).
            ``(3) Advice and assistance counseling.--Advice and 
        assistance counseling in accordance with subsection (e).
            ``(4) Administrative expenses.--Advocacy services and advise 
        and assistance counseling services under paragraphs (2) and (3) 
        of this subsection shall be included as administrative expenses 
        under section 3203(b)(3).

    ``(c) Payment of Benefits.--
            ``(1) Life independence account.--
                    ``(A) In general.--The 
                Secretary <<NOTE: Procedures.>>  shall establish 
                procedures for administering the provision of benefits 
                to eligible beneficiaries under the CLASS Independence 
                Benefit Plan, including the payment of the cash benefit 
                for the beneficiary into a Life Independence Account 
                established by the Secretary on behalf of each eligible 
                beneficiary.
                    ``(B) Use of cash benefits.--Cash benefits paid into 
                a Life Independence Account of an eligible beneficiary 
                shall be used to purchase nonmedical services and 
                supports that the beneficiary needs to maintain his or 
                her independence at home or in another residential 
                setting of their choice in the community, including (but 
                not limited to) home modifications, assistive 
                technology, accessible transportation, homemaker 
                services, respite care, personal assistance services, 
                home care aides, and nursing support. Nothing in the 
                preceding sentence shall prevent an eligible beneficiary 
                from using cash benefits paid into a Life Independence 
                Account for obtaining assistance with decision making 
                concerning medical care, including the right to accept 
                or refuse medical or surgical treatment and the

[[Page 124 STAT. 838]]

                right to formulate advance directives or other written 
                instructions recognized under State law, such as a 
                living will or durable power of attorney for health 
                care, in the case that an injury or illness causes the 
                individual to be unable to make health care decisions.
                    ``(C) <<NOTE: Procedures.>>  Electronic management 
                of funds.--The Secretary shall establish procedures 
                for--
                          ``(i) crediting an account established on 
                      behalf of a beneficiary with the beneficiary's 
                      cash daily benefit;
                          ``(ii) allowing the beneficiary to access such 
                      account through debit cards; and
                          ``(iii) accounting for withdrawals by the 
                      beneficiary from such account.
                    ``(D) Primary payor rules for beneficiaries who are 
                enrolled in medicaid.--In the case of an eligible 
                beneficiary who is enrolled in Medicaid, the following 
                payment rules shall apply:
                          ``(i) Institutionalized beneficiary.--If the 
                      beneficiary is a patient in a hospital, nursing 
                      facility, intermediate care facility for the 
                      mentally retarded, or an institution for mental 
                      diseases, the beneficiary shall retain an amount 
                      equal to 5 percent of the beneficiary's daily or 
                      weekly cash benefit (as applicable) (which shall 
                      be in addition to the amount of the beneficiary's 
                      personal needs allowance provided under Medicaid), 
                      and the remainder of such benefit shall be applied 
                      toward the facility's cost of providing the 
                      beneficiary's care, and Medicaid shall provide 
                      secondary coverage for such care.
                          ``(ii) Beneficiaries receiving home and 
                      community-based services.--
                                    ``(I) 50 percent of benefit retained 
                                by beneficiary.--Subject to subclause 
                                (II), if a beneficiary is receiving 
                                medical assistance under Medicaid for 
                                home and community based services, the 
                                beneficiary shall retain an amount equal 
                                to 50 percent of the beneficiary's daily 
                                or weekly cash benefit (as applicable), 
                                and the remainder of the daily or weekly 
                                cash benefit shall be applied toward the 
                                cost to the State of providing such 
                                assistance (and shall not be used to 
                                claim Federal matching funds under 
                                Medicaid), and Medicaid shall provide 
                                secondary coverage for the remainder of 
                                any costs incurred in providing such 
                                assistance.
                                    ``(II) Requirement for state 
                                offset.--A State shall be paid the 
                                remainder of a beneficiary's daily or 
                                weekly cash benefit under subclause (I) 
                                only if the State home and community-
                                based waiver under section 1115 of the 
                                Social Security Act (42 U.S.C. 1315) or 
                                subsection (c) or (d) of section 1915 of 
                                such Act (42 U.S.C. 1396n), or the State 
                                plan amendment under subsection (i) of 
                                such section does not include a waiver 
                                of the requirements of section 
                                1902(a)(1) of the Social Security Act 
                                (relating to statewideness) or of 
                                section 1902(a)(10)(B) of such Act 
                                (relating to comparability) and the 
                                State offers at a minimum

[[Page 124 STAT. 839]]

                                case management services, personal care 
                                services, habilitation services, and 
                                respite care under such a waiver or 
                                State plan amendment.
                                    ``(III) Definition of home and 
                                community-based services.--In this 
                                clause, the term `home and community-
                                based services' means any services which 
                                may be offered under a home and 
                                community-based waiver authorized for a 
                                State under section 1115 of the Social 
                                Security Act (42 U.S.C. 1315) or 
                                subsection (c) or (d) of section 1915 of 
                                such Act (42 U.S.C. 1396n) or under a 
                                State plan amendment under subsection 
                                (i) of such section.
                          ``(iii) Beneficiaries enrolled in programs of 
                      all-inclusive care for the elderly (pace).--
                                    ``(I) In general.--Subject to 
                                subclause (II), if a beneficiary is 
                                receiving medical assistance under 
                                Medicaid for PACE program services under 
                                section 1934 of the Social Security Act 
                                (42 U.S.C. 1396u-4), the beneficiary 
                                shall retain an amount equal to 50 
                                percent of the beneficiary's daily or 
                                weekly cash benefit (as applicable), and 
                                the remainder of the daily or weekly 
                                cash benefit shall be applied toward the 
                                cost to the State of providing such 
                                assistance (and shall not be used to 
                                claim Federal matching funds under 
                                Medicaid), and Medicaid shall provide 
                                secondary coverage for the remainder of 
                                any costs incurred in providing such 
                                assistance.
                                    ``(II) Institutionalized recipients 
                                of pace program services.--If a 
                                beneficiary receiving assistance under 
                                Medicaid for PACE program services is a 
                                patient in a hospital, nursing facility, 
                                intermediate care facility for the 
                                mentally retarded, or an institution for 
                                mental diseases, the beneficiary shall 
                                be treated as in institutionalized 
                                beneficiary under clause (i).
            ``(2) Authorized representatives.--
                    ``(A) In general.--The 
                Secretary <<NOTE: Procedures.>>  shall establish 
                procedures to allow access to a beneficiary's cash 
                benefits by an authorized representative of the eligible 
                beneficiary on whose behalf such benefits are paid.
                    ``(B) Quality assurance and protection against fraud 
                and abuse.--The procedures established under 
                subparagraph (A) shall ensure that authorized 
                representatives of eligible beneficiaries comply with 
                standards of conduct established by the Secretary, 
                including standards requiring that such representatives 
                provide quality services on behalf of such 
                beneficiaries, do not have conflicts of interest, and do 
                not misuse benefits paid on behalf of such beneficiaries 
                or otherwise engage in fraud or abuse.
            ``(3) Commencement of benefits.--Benefits shall be paid to, 
        or on behalf of, an eligible beneficiary beginning with the 
        first month in which an application for such benefits is 
        approved.
            ``(4) Rollover option for lump-sum payment.--An eligible 
        beneficiary may elect to--

[[Page 124 STAT. 840]]

                    ``(A) defer payment of their daily or weekly benefit 
                and to rollover any such deferred benefits from month-
                to-month, but not from year-to-year; and
                    ``(B) receive a lump-sum payment of such deferred 
                benefits in an amount that may not exceed the lesser 
                of--
                          ``(i) the total amount of the accrued deferred 
                      benefits; or
                          ``(ii) the applicable annual benefit.
            ``(5) Period for determination of annual benefits.--
                    ``(A) In general.--The applicable period for 
                determining with respect to an eligible beneficiary the 
                applicable annual benefit and the amount of any accrued 
                deferred benefits is the 12-month period that commences 
                with the first month in which the beneficiary began to 
                receive such benefits, and each 12-month period 
                thereafter.
                    ``(B) Inclusion of increased benefits.--The 
                Secretary shall establish procedures under which cash 
                benefits paid to an eligible beneficiary that increase 
                or decrease as a result of a change in the functional 
                status of the beneficiary before the end of a 12-month 
                benefit period shall be included in the determination of 
                the applicable annual benefit paid to the eligible 
                beneficiary.
                    ``(C) Recoupment of unpaid, accrued benefits.--
                          ``(i) In general.--The Secretary, in 
                      coordination with the Secretary of the Treasury, 
                      shall recoup any accrued benefits in the event 
                      of--
                                    ``(I) the death of a beneficiary; or
                                    ``(II) the failure of a beneficiary 
                                to elect under paragraph (4)(B) to 
                                receive such benefits as a lump-sum 
                                payment before the end of the 12-month 
                                period in which such benefits accrued.
                          ``(ii) Payment into class independence fund.--
                      Any benefits recouped in accordance with clause 
                      (i) shall be paid into the CLASS Independence Fund 
                      and used in accordance with section 3206.
            ``(6) Requirement to recertify eligibility for receipt of 
        benefits.--An eligible beneficiary shall periodically, as 
        determined by the Secretary--
                    ``(A) recertify by submission of medical evidence 
                the beneficiary's continued eligibility for receipt of 
                benefits; and
                    ``(B) submit records of expenditures attributable to 
                the aggregate cash benefit received by the beneficiary 
                during the preceding year.
            ``(7) Supplement, not supplant other health care benefits.--
        Subject to the Medicaid payment rules under paragraph (1)(D), 
        benefits received by an eligible beneficiary shall supplement, 
        but not supplant, other health care benefits for which the 
        beneficiary is eligible under Medicaid or any other Federally 
        funded program that provides health care benefits or assistance.

    ``(d) <<NOTE: Contracts.>>  Advocacy Services.--An agreement entered 
into under subsection (a)(2)(A)(ii) shall require the Protection and 
Advocacy System for the State to--
            ``(1) assign, as needed, an advocacy counselor to each 
        eligible beneficiary that is covered by such agreement and who 
        shall provide an eligible beneficiary with--

[[Page 124 STAT. 841]]

                    ``(A) information regarding how to access the 
                appeals process established for the program;
                    ``(B) assistance with respect to the annual 
                recertification and notification required under 
                subsection (c)(6); and
                    ``(C) <<NOTE: Regulations.>>  such other assistance 
                with obtaining services as the Secretary, by regulation, 
                shall require; and
            ``(2) ensure that the System and such counselors comply with 
        the requirements of subsection (h).

    ``(e) <<NOTE: Contracts.>>  Advice and Assistance Counseling.--An 
agreement entered into under subsection (a)(2)(A)(iii) shall require the 
entity to assign, as requested by an eligible beneficiary that is 
covered by such agreement, an advice and assistance counselor who shall 
provide an eligible beneficiary with information regarding--
            ``(1) accessing and coordinating long-term services and 
        supports in the most integrated setting;
            ``(2) possible eligibility for other benefits and services;
            ``(3) development of a service and support plan;
            ``(4) information about programs established under the 
        Assistive Technology Act of 1998 and the services offered under 
        such programs;
            ``(5) available assistance with decision making concerning 
        medical care, including the right to accept or refuse medical or 
        surgical treatment and the right to formulate advance directives 
        or other written instructions recognized under State law, such 
        as a living will or durable power of attorney for health care, 
        in the case that an injury or illness causes the individual to 
        be unable to make health care decisions; and
            ``(6) such other services as the Secretary, by regulation, 
        may require.

    ``(f) No Effect on Eligibility for Other Benefits.--Benefits paid to 
an eligible beneficiary under the CLASS program shall be disregarded for 
purposes of determining or continuing the beneficiary's eligibility for 
receipt of benefits under any other Federal, State, or locally funded 
assistance program, including benefits paid under titles II, XVI, XVIII, 
XIX, or XXI of the Social Security Act (42 U.S.C. 401 et seq., 1381 et 
seq., 1395 et seq., 1396 et seq., 1397aa et seq.), under the laws 
administered by the Secretary of Veterans Affairs, under low-income 
housing assistance programs, or under the supplemental nutrition 
assistance program established under the Food and Nutrition Act of 2008 
(7 U.S.C. 2011 et seq.).
    ``(g) Rule of Construction.--Nothing in this title shall be 
construed as prohibiting benefits paid under the CLASS Independence 
Benefit Plan from being used to compensate a family caregiver for 
providing community living assistance services and supports to an 
eligible beneficiary.
    ``(h) <<NOTE: Procedures.>>  Protection Against Conflict of 
Interests.--The Secretary shall establish procedures to ensure that the 
Eligibility Assessment System, the Protection and Advocacy System for a 
State, advocacy counselors for eligible beneficiaries, and any other 
entities that provide services to active enrollees and eligible 
beneficiaries under the CLASS program comply with the following:
            ``(1) If the entity provides counseling or planning 
        services, such services are provided in a manner that fosters 
        the best interests of the active enrollee or beneficiary.

[[Page 124 STAT. 842]]

            ``(2) The entity has established operating procedures that 
        are designed to avoid or minimize conflicts of interest between 
        the entity and an active enrollee or beneficiary.
            ``(3) The entity provides information about all services and 
        options available to the active enrollee or beneficiary, to the 
        best of its knowledge, including services available through 
        other entities or providers.
            ``(4) The entity assists the active enrollee or beneficiary 
        to access desired services, regardless of the provider.
            ``(5) The entity reports the number of active enrollees and 
        beneficiaries provided with assistance by age, disability, and 
        whether such enrollees and beneficiaries received services from 
        the entity or another entity.
            ``(6) If the entity provides counseling or planning 
        services, the entity ensures that an active enrollee or 
        beneficiary is informed of any financial interest that the 
        entity has in a service provider.
            ``(7) The entity provides an active enrollee or beneficiary 
        with a list of available service providers that can meet the 
        needs of the active enrollee or beneficiary.

``SEC. 3206. <<NOTE: 42 USC 300ll-5.>>  CLASS INDEPENDENCE FUND.

    ``(a) Establishment of CLASS Independence Fund.--There is 
established in the Treasury of the United States a trust fund to be 
known as the `CLASS Independence Fund'. The Secretary of the Treasury 
shall serve as Managing Trustee of such Fund. The Fund shall consist of 
all amounts derived from payments into the Fund under sections 3204(f) 
and 3205(c)(5)(C)(ii), and remaining after investment of such amounts 
under subsection (b), including additional amounts derived as income 
from such investments. The amounts held in the Fund are appropriated and 
shall remain available without fiscal year limitation--
            ``(1) to be held for investment on behalf of individuals 
        enrolled in the CLASS program;
            ``(2) to pay the administrative expenses related to the Fund 
        and to investment under subsection (b); and
            ``(3) to pay cash benefits to eligible beneficiaries under 
        the CLASS Independence Benefit Plan.

    ``(b) Investment of Fund Balance.--The Secretary of the Treasury 
shall invest and manage the CLASS Independence Fund in the same manner, 
and to the same extent, as the Federal Supplementary Medical Insurance 
Trust Fund may be invested and managed under subsections (c), (d), and 
(e) of section 1841(d) of the Social Security Act (42 U.S.C. 1395t).
    ``(c) Board of Trustees.--
            ``(1) <<NOTE: Establishment.>>  In general.--With respect to 
        the CLASS Independence Fund, there is hereby created a body to 
        be known as the Board of Trustees of the CLASS Independence Fund 
        (hereinafter in this section referred to as the `Board of 
        Trustees') composed of the Secretary of the Treasury, the 
        Secretary of Labor, and the Secretary of Health and Human 
        Services, all ex officio, and of two members of the public (both 
        of whom may not be from the same political party), who shall be 
        nominated by the President for a term of 4 years and subject to 
        confirmation by the Senate. A member of the Board of Trustees 
        serving as a member of the public and nominated and confirmed to 
        fill a vacancy occurring during a term shall

[[Page 124 STAT. 843]]

        be nominated and confirmed only for the remainder of such term. 
        An individual nominated and confirmed as a member of the public 
        may serve in such position after the expiration of such member's 
        term until the earlier of the time at which the member's 
        successor takes office or the time at which a report of the 
        Board is first issued under paragraph (2) after the expiration 
        of the member's term. The Secretary of the Treasury shall be the 
        Managing Trustee of the Board of Trustees. The Board of Trustees 
        shall meet not less frequently than once each calendar year. A 
        person serving on the Board of Trustees shall not be considered 
        to be a fiduciary and shall not be personally liable for actions 
        taken in such capacity with respect to the Trust Fund.
            ``(2) Duties.--
                    ``(A) In general.--It shall be the duty of the Board 
                of Trustees to do the following:
                          ``(i) Hold the CLASS Independence Fund.
                          ``(ii) <<NOTE: Reports. Deadline.>>  Report to 
                      the Congress not later than the first day of April 
                      of each year on the operation and status of the 
                      CLASS Independence Fund during the preceding 
                      fiscal year and on its expected operation and 
                      status during the current fiscal year and the next 
                      2 fiscal years.
                          ``(iii) <<NOTE: Reports.>>  Report immediately 
                      to the Congress whenever the Board is of the 
                      opinion that the amount of the CLASS Independence 
                      Fund is not actuarially sound in regards to the 
                      projection under section 3203(b)(1)(B)(i).
                          ``(iv) Review the general policies followed in 
                      managing the CLASS Independence Fund, and 
                      recommend changes in such policies, including 
                      necessary changes in the provisions of law which 
                      govern the way in which the CLASS Independence 
                      Fund is to be managed.
                    ``(B) Report.--The report provided for in 
                subparagraph (A)(ii) shall--
                          ``(i) include--
                                    ``(I) a statement of the assets of, 
                                and the disbursements made from, the 
                                CLASS Independence Fund during the 
                                preceding fiscal year;
                                    ``(II) an estimate of the expected 
                                income to, and disbursements to be made 
                                from, the CLASS Independence Fund during 
                                the current fiscal year and each of the 
                                next 2 fiscal years;
                                    ``(III) a statement of the actuarial 
                                status of the CLASS Independence Fund 
                                for the current fiscal year, each of the 
                                next 2 fiscal years, and as projected 
                                over the 75-year period beginning with 
                                the current fiscal year; and
                                    ``(IV) an actuarial opinion by the 
                                Chief Actuary of the Centers for 
                                Medicare & Medicaid Services certifying 
                                that the techniques and methodologies 
                                used are generally accepted within the 
                                actuarial profession and that the 
                                assumptions and cost estimates used are 
                                reasonable; and
                          ``(ii) <<NOTE: Publication.>>  be printed as a 
                      House document of the session of the Congress to 
                      which the report is made.

[[Page 124 STAT. 844]]

                    ``(C) <<NOTE: Determination.>>  Recommendations.--If 
                the Board of Trustees determines that enrollment trends 
                and expected future benefit claims on the CLASS 
                Independence Fund are not actuarially sound in regards 
                to the projection under section 3203(b)(1)(B)(i) and are 
                unlikely to be resolved with reasonable premium 
                increases or through other means, the Board of Trustees 
                shall include in the report provided for in subparagraph 
                (A)(ii) recommendations for such legislative action as 
                the Board of Trustees determine to be appropriate, 
                including whether to adjust monthly premiums or impose a 
                temporary moratorium on new enrollments.

``SEC. 3207. <<NOTE: 42 USC 300ll-6.>>  CLASS INDEPENDENCE ADVISORY 
            COUNCIL.

    ``(a) Establishment.--There is hereby created an Advisory Committee 
to be known as the `CLASS Independence Advisory Council'.
    ``(b) Membership.--
            ``(1) In general.--The CLASS Independence Advisory Council 
        shall be composed of not more than 15 individuals, not otherwise 
        in the employ of the United States--
                    ``(A) <<NOTE: Appointment. President.>>  who shall 
                be appointed by the President without regard to the 
                civil service laws and regulations; and
                    ``(B) a majority of whom shall be representatives of 
                individuals who participate or are likely to participate 
                in the CLASS program, and shall include representatives 
                of older and younger workers, individuals with 
                disabilities, family caregivers of individuals who 
                require services and supports to maintain their 
                independence at home or in another residential setting 
                of their choice in the community, individuals with 
                expertise in long-term care or disability insurance, 
                actuarial science, economics, and other relevant 
                disciplines, as determined by the Secretary.
            ``(2) Terms.--
                    ``(A) In general.--The members of the CLASS 
                Independence Advisory Council shall serve overlapping 
                terms of 3 years (unless appointed to fill a vacancy 
                occurring prior to the expiration of a term, in which 
                case the individual shall serve for the remainder of the 
                term).
                    ``(B) Limitation.--A member shall not be eligible to 
                serve for more than 2 consecutive terms.
            ``(3) <<NOTE: President. Appointment.>>  Chair.--The 
        President shall, from time to time, appoint one of the members 
        of the CLASS Independence Advisory Council to serve as the 
        Chair.

    ``(c) Duties.--The CLASS Independence Advisory Council shall advise 
the Secretary on matters of general policy in the administration of the 
CLASS program established under this title and in the formulation of 
regulations under this title including with respect to--
            ``(1) the development of the CLASS Independence Benefit Plan 
        under section 3203;
            ``(2) the determination of monthly premiums under such plan; 
        and
            ``(3) the financial solvency of the program.

    ``(d) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.), other than section 14 of that Act, shall apply to the 
CLASS Independence Advisory Council.
    ``(e) Authorization of Appropriations.--

[[Page 124 STAT. 845]]

            ``(1) In general.--There are authorized to be appropriated 
        to the CLASS Independence Advisory Council to carry out its 
        duties under this section, such sums as may be necessary for 
        fiscal year 2011 and for each fiscal year thereafter.
            ``(2) Availability.--Any sums appropriated under the 
        authorization contained in this section shall remain available, 
        without fiscal year limitation, until expended.

``SEC. 3208. <<NOTE: 42 USC 300ll-7.>>  SOLVENCY AND FISCAL 
            INDEPENDENCE; REGULATIONS; ANNUAL REPORT.

    ``(a) <<NOTE: Consultation.>>  Solvency.--The Secretary shall 
regularly consult with the Board of Trustees of the CLASS Independence 
Fund and the CLASS Independence Advisory Council, for purposes of 
ensuring that enrollees premiums are adequate to ensure the financial 
solvency of the CLASS program, both with respect to fiscal years 
occurring in the near-term and fiscal years occurring over 20- and 75-
year periods, taking into account the projections required for such 
periods under subsections (a)(1)(A)(i) and (b)(1)(B)(i) of section 3202.

    ``(b) No Taxpayer Funds Used To Pay Benefits.--No taxpayer funds 
shall be used for payment of benefits under a CLASS Independent Benefit 
Plan. <<NOTE: Definitions.>>  For purposes of this subsection, the term 
`taxpayer funds' means any Federal funds from a source other than 
premiums deposited by CLASS program participants in the CLASS 
Independence Fund and any associated interest earnings.

    ``(c) Regulations.--The Secretary shall promulgate such regulations 
as are necessary to carry out the CLASS program in accordance with this 
title. Such regulations shall include provisions to prevent fraud and 
abuse under the program.
    ``(d) <<NOTE: Effective date.>>  Annual Report.--Beginning January 
1, 2014, the Secretary shall submit an annual report to Congress on the 
CLASS program. Each report shall include the following:
            ``(1) The total number of enrollees in the program.
            ``(2) The total number of eligible beneficiaries during the 
        fiscal year.
            ``(3) The total amount of cash benefits provided during the 
        fiscal year.
            ``(4) A description of instances of fraud or abuse 
        identified during the fiscal year.
            ``(5) Recommendations for such administrative or legislative 
        action as the Secretary determines is necessary to improve the 
        program, ensure the solvency of the program, or to prevent the 
        occurrence of fraud or abuse.

``SEC. 3209. <<NOTE: 42 USC 300ll-8.>>  INSPECTOR GENERAL'S REPORT.

    ``The Inspector General of the Department of Health and Human 
Services shall submit an annual report to the Secretary and Congress 
relating to the overall progress of the CLASS program and of the 
existence of waste, fraud, and abuse in the CLASS program. Each such 
report shall include findings in the following areas:
            ``(1) The eligibility determination process.
            ``(2) The provision of cash benefits.
            ``(3) Quality assurance and protection against waste, fraud, 
        and abuse.
            ``(4) Recouping of unpaid and accrued benefits.

[[Page 124 STAT. 846]]

``SEC. 3210. <<NOTE: 42 USC 300ll-9.>>  TAX TREATMENT OF PROGRAM.

    ``The CLASS program shall be treated for purposes of the Internal 
Revenue Code of 1986 in the same manner as a qualified long-term care 
insurance contract for qualified long-term care services.''.
            (2) Conforming amendments to medicaid.--Section 1902(a) of 
        the Social Security Act (42 U.S.C. 1396a(a)), as amended by 
        section 6505, is amended by inserting after paragraph (80) the 
        following:
            ``(81) <<NOTE: Regulations.>>  provide that the State will 
        comply with such regulations regarding the application of 
        primary and secondary payor rules with respect to individuals 
        who are eligible for medical assistance under this title and are 
        eligible beneficiaries under the CLASS program established under 
        title XXXII of the Public Health Service Act as the Secretary 
        shall establish; and''.

    (b) Assurance of Adequate Infrastructure for the Provision of 
Personal Care Attendant Workers.--Section 1902(a) of the Social Security 
Act (42 U.S.C. 1396a(a)), as amended by subsection (a)(2), is amended by 
inserting after paragraph (81) the following:
            ``(82) <<NOTE: Deadline.>>  provide that, not later than 2 
        years after the date of enactment of the Community Living 
        Assistance Services and Supports Act, each State shall--
                    ``(A) assess the extent to which entities such as 
                providers of home care, home health services, home and 
                community service providers, public authorities created 
                to provide personal care services to individuals 
                eligible for medical assistance under the State plan, 
                and nonprofit organizations, are serving or have the 
                capacity to serve as fiscal agents for, employers of, 
                and providers of employment-related benefits for, 
                personal care attendant workers who provide personal 
                care services to individuals receiving benefits under 
                the CLASS program established under title XXXII of the 
                Public Health Service Act, including in rural and 
                underserved areas;
                    ``(B) <<NOTE: Designation.>>  designate or create 
                such entities to serve as fiscal agents for, employers 
                of, and providers of employment-related benefits for, 
                such workers to ensure an adequate supply of the workers 
                for individuals receiving benefits under the CLASS 
                program, including in rural and underserved areas; and
                    ``(C) ensure that the designation or creation of 
                such entities will not negatively alter or impede 
                existing programs, models, methods, or administration of 
                service delivery that provide for consumer controlled or 
                self-directed home and community services and further 
                ensure that such entities will not impede the ability of 
                individuals to direct and control their home and 
                community services, including the ability to select, 
                manage, dismiss, co-employ, or employ such workers or 
                inhibit such individuals from relying on family members 
                for the provision of personal care services.''.

    (c) <<NOTE: 42 USC 300ll note.>>  Personal Care Attendants Workforce 
Advisory Panel.--
            (1) <<NOTE: Deadline.>>  Establishment.--Not later than 90 
        days after the date of enactment of this Act, the Secretary of 
        Health and Human Services shall establish a Personal Care 
        Attendants Workforce

[[Page 124 STAT. 847]]

        Advisory Panel for the purpose of examining and advising the 
        Secretary and Congress on workforce issues related to personal 
        care attendant workers, including with respect to the adequacy 
        of the number of such workers, the salaries, wages, and benefits 
        of such workers, and access to the services provided by such 
        workers.
            (2) Membership.--In appointing members to the Personal Care 
        Attendants Workforce Advisory Panel, the Secretary shall ensure 
        that such members include the following:
                    (A) Individuals with disabilities of all ages.
                    (B) Senior individuals.
                    (C) Representatives of individuals with 
                disabilities.
                    (D) Representatives of senior individuals.
                    (E) Representatives of workforce and labor 
                organizations.
                    (F) Representatives of home and community-based 
                service providers.
                    (G) Representatives of assisted living providers.

    (d) Inclusion of Information on Supplemental Coverage in the 
National Clearinghouse for Long-term Care Information; Extension of 
Funding.--Section 6021(d) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396p note) is amended--
            (1) in paragraph (2)(A)--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                          ``(iv) include information regarding the CLASS 
                      program established under title XXXII of the 
                      Public Health Service Act and coverage available 
                      for purchase through a Exchange established under 
                      section 1311 of the Patient Protection and 
                      Affordable Care Act that is supplemental coverage 
                      to the benefits provided under a CLASS 
                      Independence Benefit Plan under that program, and 
                      information regarding how benefits provided under 
                      a CLASS Independence Benefit Plan differ from 
                      disability insurance benefits.''; and
            (2) in paragraph (3), by striking ``2010'' and inserting 
        ``2015''.

    (e) <<NOTE: 42 USC 300ll note.>>  Effective Date.--The amendments 
made by subsections (a), (b), and (d) take effect on January 1, 2011.

    (f) <<NOTE: 42 USC 300ll note.>>  Rule of Construction.--Nothing in 
this title or the amendments made by this title are intended to replace 
or displace public or private disability insurance benefits, including 
such benefits that are for income replacement.