S 1257 IS
111th CONGRESS
1st Session
S. 1257
To amend the Social Security Act to build on the aging network to establish long-term services and supports through single-entry point systems, evidence-based disease prevention and health promotion programs, and enhanced nursing home diversion programs.
IN THE SENATE OF THE UNITED STATES
June 11, 2009
Ms. CANTWELL (for herself and Ms. STABENOW) introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend the Social Security Act to build on the aging network to establish long-term services and supports through single-entry point systems, evidence-based disease prevention and health promotion programs, and enhanced nursing home diversion programs.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘Project 2020: Building on the Promise of Home- and Community-Based Services Act of 2009’.
SEC. 2. LONG-TERM SERVICES AND SUPPORTS.
‘TITLE XXII--LONG-TERM SERVICES AND SUPPORTS
‘SEC. 2201. DEFINITIONS.
‘Except as otherwise provided, the terms used in this title have the meanings given the terms in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).
‘Subtitle A--Single-Entry Point System Program
‘SEC. 2211. STATE SINGLE-ENTRY POINT SYSTEMS.
‘(a) Definitions- In this title:
‘(1) LONG-TERM SERVICES AND SUPPORTS- The term ‘long-term services and supports’ means any service (including a disease prevention and health promotion service, an in-home service, or a case management service), care, or item (including an assistive device) that is--
‘(A) intended to assist individuals in coping with, and, to the extent practicable, compensating for, functional impairment in carrying out activities of daily living;
‘(B) furnished at home, in a community care setting, including a small community care setting (as defined in section 1929(g)(1)) and a large community care setting (as defined in section 1929(h)(1)), or in a long-term care facility; and
‘(C) not furnished to diagnose, treat, or cure a medical disease or condition.
‘(2) SINGLE-ENTRY POINT SYSTEM- The term ‘single-entry point system’ means any coordinated system for providing--
‘(A) comprehensive information to consumers and caregivers on the full range of available public and private long-term services and supports, options, service providers, and resources, including information on the availability of integrated long-term care, including consumer directed care options;
‘(B) personal counseling to assist individuals in assessing their existing or anticipated long-term care needs, and developing and implementing a plan for long-term care designed to meet their specific needs and circumstances; and
‘(C) consumers and caregivers access to the range of publicly supported and privately supported long-term services and supports that are available.
‘(b) Program- The Secretary shall establish and carry out a single-entry point system program. In carrying out the program, the Secretary shall make grants to States, from allotments described in subsection (c), to pay for the Federal share of the cost of establishing State single-entry point systems.
‘(c) Allotments-
‘(1) ALLOTMENTS TO INDIAN TRIBES AND TERRITORIES-
‘(A) RESERVATION- The Secretary shall reserve from the funds made available under subsection (g)--
‘(i) for fiscal year 2010, $1,962,456; and
‘(ii) for each subsequent fiscal year, $1,962,456, increased by the percentage increase in the Consumer Price Index for All Urban Consumers, between October of the fiscal year preceding the subsequent fiscal year and October, 2007.
‘(B) ALLOTMENTS- The Secretary shall use the funds reserved under subparagraph (A) to make allotments to--
‘(i) Indian tribes; and
‘(ii) Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the United States Virgin Islands.
‘(2) ALLOTMENTS TO STATES-
‘(A) IN GENERAL-
‘(i) AMOUNT- The Secretary shall allot to each eligible State for a fiscal year the sum of the fixed amount determined under subparagraph (B), and the allocation determined under subparagraph (C), for the State.
‘(ii) SUBGRANTS TO AREA AGENCIES ON AGING-
‘(I) IN GENERAL- Each State agency receiving an allotment under clause (i) shall use such allotment to make subgrants to area agencies on aging that can demonstrate performance capacity to carry out activities described in this section whether such area agency on aging carries out the activities directly or through contract with an aging network or disability entity. An area agency on agency desiring a subgrant shall establish or designate a collaborative board to ensure meaningful involvement of stakeholders in the development, planning, implementation, and evaluation of a single-entry point system consistent with the following:
‘(aa) The collaborative board shall be composed of--
‘(AA) individuals representing all populations served by the agency’s single-entry point system, including older adults and individuals from diverse backgrounds who have a disability or a chronic condition requiring long-term support;
‘(BB) a representative from the local center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)), and representatives from other organizations that provide services to the individuals served by the system and those who advocate on behalf of such individuals; and
‘(CC) representatives of the government and non-governmental agencies that are affected by the system.
‘(bb) The agency shall work in conjunction with the collaborative board on--
‘(AA) the design and operations of the single-entry point system;
‘(BB) stakeholder input; and
‘(CC) other program and policy development issues related to the single-entry point system.
‘(cc) An advisory board established under the Real Choice Systems Change Program or for an existing single-entry point system may be used to carry out the activities of a collaborative board under this subclause if such advisory board meets the requirements under item (aa).
‘(II) SUBGRANTS TO OTHER ENTITIES- A State agency may make subgrants described in subclause (I) to other qualified aging network or disability entities only if the area agency on aging chooses not to apply for a subgrant or is not able to demonstrate performance capacity to carry out the activities described in this section.
‘(III) SUBGRANTEE RECIPIENT SUBGRANTS- An administrator of a single-entry point system established by a State receiving an allotment under clause (i) shall make any necessary subgrants to key partners involved in developing, planning, or implementing the single-entry point system. Such partners may include centers for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)).
‘(B) FIXED AMOUNTS FOR STATES-
‘(i) RESERVATION- The Secretary shall reserve from the funds made available under subsection (g)--
‘(I) for fiscal year 2010, $15,759,000; and
‘(II) for each subsequent fiscal year, $15,759,000, increased by the percentage increase in the Consumer Price Index for All Urban Consumers, between October of the fiscal year preceding the subsequent fiscal year and October, 2007.
‘(ii) FIXED AMOUNTS- The Secretary shall use the funds reserved under clause (i) to provide equal fixed amounts to the States.
‘(C) ALLOCATION FOR STATES- The Secretary shall allocate to each eligible State for a fiscal year an amount that bears the same relationship to the funds made available under subsection (g) (and not reserved under paragraph (1) or subparagraph (B)) for that fiscal year as the number of persons who are either older individuals or individuals with disabilities in that State bears to the number of such persons or individuals in all the States.
‘(D) DETERMINATION OF NUMBER OF PERSONS-
‘(i) OLDER INDIVIDUALS- The number of older individuals in any State and in all States shall be determined by the Secretary on the basis of the most recent data available from the Bureau of the Census, and other reliable demographic data satisfactory to the Secretary.
‘(ii) INDIVIDUALS WITH DISABILITIES- The number of individuals with disabilities in any State and in all States shall be determined by the Secretary on the basis of the most recent data available from the American Community Survey, and other reliable demographic data satisfactory to the Secretary, on individuals who have a sensory disability, physical disability, mental disability, self-care disability, go-outside-home disability, or employment disability.
‘(3) ELIGIBILITY- In addition to the States determined by the Secretary to be eligible for a grant under this section, a State that receives a Federal grant for an aging and disability resource center is eligible for a grant under this section.
‘(4) DEFINITION- In this subsection, the term ‘State’ shall not include any jurisdiction described in paragraph (1)(B)(ii).
‘(d) Applications-
‘(1) IN GENERAL- To be eligible to receive an initial grant under this section, a State agency shall, after consulting and coordinating with consumers, other stakeholders, centers for independent living in the State, if any, and area agencies on aging in the State, if any, submit an application to the Secretary at such time, in such manner, and containing the following information:
‘(A) Evidence of substantial involvement of stakeholders and agencies in the State that are administering programs that will be the subject of referrals.
‘(B) The applicant’s plan for providing--
‘(i) comprehensive information on the full range of available public and private long-term services and supports options, providers, and resources, including building awareness of the single-entry point system as a resource;
‘(ii) objective, neutral, and personal information, counseling, and assistance to individuals and their caregivers in assessing their existing or anticipated long-term care needs, and developing and implementing a plan for long-term care to meet their needs;
‘(iii) for eligibility screening and referral for services;
‘(iv) for stakeholder input;
‘(v) for a management information system; and
‘(vi) for an evaluation of the effectiveness of the single-entry point system.
‘(C) A specification of the period of the grant request, which shall include not less than 3 consecutive fiscal years in the 5-fiscal-year period beginning with fiscal year 2010.
‘(D) Such other information as the Secretary determines appropriate.
‘(2) APPLICATION FOR CONTINUATION-
‘(A) IN GENERAL- A State that receives an initial grant under this section shall apply, after consulting and coordinating with the area agencies on aging, for a continuation of the initial grant, which includes a description of any significant changes to the information provided in the initial application and such data concerning performance measures related to the requirements in the initial application as the Secretary shall require.
‘(B) EFFECT- The requirement under subparagraph (A) shall be in effect through fiscal year 2020.
‘(e) Use of Funds-
‘(1) IN GENERAL- A State that receives a grant under this section shall use the funds made available through the grant to--
‘(A) establish a State single-entry point system, to enable older individuals and individuals with disabilities and their caregivers to obtain resources concerning long-term services and supports options; and
‘(B) provide information on, access to, and assistance regarding long-term services and supports.
‘(2) SERVICES- In particular, the State single-entry point system shall be the referral source to--
‘(A) provide information about long-term care planning and available long-term services and supports through a variety of media (such as websites, seminars, and pamphlets);
‘(B) provide assistance with making decisions about long-term services and supports and determining the most appropriate services through options counseling, future financial planning, and case management;
‘(C) provide streamlined access to and assistance with applying for federally funded long-term care benefits (including medical assistance under title XIX, Medicare skilled nursing facility services, services under title III of the Older Americans Act of 1965 (42 U.S.C. 3021 et seq.), the services of Aging and Disability Resource Centers), and State-funded and privately funded long-term care benefits, through efforts to shorten and simplify the eligibility processes for older individuals and individuals with disabilities;
‘(D) provide referrals to the State evidence-based disease prevention and health promotion programs under subtitle B;
‘(E) allocate the State funds available under subtitle C and carry out the State enhanced nursing home diversion program under subtitle C; and
‘(F) and provide information about, other services available in the State that may assist an individual to remain in the community, including the Medicare and Medicaid programs, the State health insurance assistance program, the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), and the Low-Income Home Energy Assistance Program under the Low-Income Home Energy Assistance Act of 1981 (42 U.S.C. 8621 et seq.), and such other services, as the State shall include.
‘(3) COLLABORATIVE ARRANGEMENTS-
‘(A) CENTER FOR INDEPENDENT LIVING- Each entity receiving an allotment under subsection (c) shall involve in the planning and implementation of the single-entry point system the local center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)), which provides information, referral, assistance, or services to individuals with disabilities.
‘(B) OTHER ENTITIES- To the extent practicable, the State single-entry point system shall enter into collaborative arrangements with aging and disability programs, service providers, agencies, the direct care work force, and other entities in order to ensure that information about such services may be made available to individuals accessing the State single-entry point system.
‘(f) Federal Share-
‘(1) IN GENERAL- The Federal share of the cost described in subsection (b) shall be 75 percent.
‘(2) NON-FEDERAL SHARE- The State may provide the non-Federal share of the cost in cash or in-kind, fairly evaluated, including plant, equipment, or services. The State may provide the non-Federal share from State, local, or private sources.
‘(g) Funding-
‘(1) IN GENERAL- The Secretary shall use amounts made available under paragraph (2) to make the grants described in subsection (b).
‘(2) FUNDING- There are authorized to be appropriated to carry out this section--
‘(A) $30,900,000 for fiscal year 2010;
‘(B) $38,264,000 for fiscal year 2011;
‘(C) $48,410,000 for fiscal year 2012;
‘(D) $53,560,000 for fiscal year 2013;
‘(E) $63,860,000 for fiscal year 2014;
‘(F) $69,010,000 for fiscal year 2015;
‘(G) $74,160,000 for fiscal year 2016;
‘(H) $79,310,000 for fiscal year 2017;
‘(I) $84,460,000 for fiscal year 2018;
‘(J) $89,610,000 for fiscal year 2019; and
‘(K) $95,790,000 for fiscal year 2020.
‘(3) AVAILABILITY- Funds appropriated under paragraph (2) shall remain available until expended.
‘Subtitle B--Healthy Living Program
Full Text of Legislation