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Title II — Improving grants for State and community programs on aging

S. 3057 · 116th Congress · Dec 16, 2019 · Lineage

II Improving grants for State and community programs on aging

Sec. 201 Determinants of health

Section 301(a)(1) (42 U.S.C. 3021(a)(1)) is amended—
(1)
in subparagraph (C), by striking “and” at the end;
(2)
in subparagraph (D), by striking the period at the end and inserting “; and”; and
(3)
by adding at the end the following:

“(E) measure impacts related to determinants of health of older individuals.”

Sec. 202 Younger onset Alzheimer’s disease

The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is amended—
(1)
in section 302(3) (42 U.S.C. 3022(3)), by inserting “of any age” after “an individual”; and
(2)
in section 711(6) (42 U.S.C. 3058f(6)), by inserting “of any age” after “individual”.

Sec. 203 Reauthorization

(a)
Grants for State and community programs on aging— Subsections (a) through (e) of section 303 (42 U.S.C. 3023) are amended to read as follows:

“(a)

“(1) There are authorized to be appropriated to carry out part B (relating to supportive services) $413,011,586 for fiscal year 2020, $437,792,281 for fiscal year 2021, $464,059,818 for fiscal year 2022, $491,903,407 for fiscal year 2023, $521,417,612 for fiscal year 2024, $552,702,669 for fiscal year 2025, and $585,864,829 for fiscal year 2026.

“(2) Funds appropriated under paragraph (1) shall be available to carry out section 712.

“(b)

“(1) There are authorized to be appropriated to carry out subpart 1 of part C (relating to congregate nutrition services) $531,279,663 for fiscal year 2020, $563,156,443 for fiscal year 2021, $596,945,830 for fiscal year 2022, $632,762,580 for fiscal year 2023, $670,728,334 for fiscal year 2024, $710,972,034 for fiscal year 2025, and $753,630,356 for fiscal year 2026.

“(2) There are authorized to be appropriated to carry out subpart 2 of part C (relating to home delivered nutrition services) $269,577,167 for fiscal year 2020, $285,751,797 for fiscal year 2021, $302,896,905 for fiscal year 2022, $321,070,719 for fiscal year 2023, $340,334,963 for fiscal year 2024, $360,755,061 for fiscal year 2025, and $382,400,364 for fiscal year 2026.

“(c) Grants made under part B, and subparts 1 and 2 of part C, of this title may be used for paying part of the cost of—

“(1) the administration of area plans by area agencies on aging designated under section 305(a)(2)(A), including the preparation of area plans on aging consistent with section 306 and the evaluation of activities carried out under such plans; and

“(2) the development of comprehensive and coordinated systems for supportive services, and congregate and home delivered nutrition services under subparts 1 and 2 of part C, the development and operation of multipurpose senior centers, and the delivery of legal assistance.

“(d) There are authorized to be appropriated to carry out part D (relating to disease prevention and health promotion services) $26,650,753 for fiscal year 2020, $28,249,798 for fiscal year 2021, $29,944,786 for fiscal year 2022, $31,741,473 for fiscal year 2023, $33,645,961 for fiscal year 2024, $35,664,718 for fiscal year 2025, and $37,804,601 for fiscal year 2026.

“(e) There are authorized to be appropriated to carry out part E (relating to family caregiver support) $194,331,264 for fiscal year 2020, $205,991,140 for fiscal year 2021, $218,350,609 for fiscal year 2022, $231,451,645 for fiscal year 2023, $245,338,744 for fiscal year 2024, $260,059,069 for fiscal year 2025, and $275,662,613 for fiscal year 2026.”

(b)
Nutrition services incentive program— Section 311(e) of the Older Americans Act of 1965 (42 U.S.C. 3030a(e)) is amended to read as follows:

“(e) There are authorized to be appropriated to carry out this section (other than subsection (c)(1)) $171,682,200 for fiscal year 2020, $181,983,132 for fiscal year 2021, $192,902,120 for fiscal year 2022, $204,476,247 for fiscal year 2023, $216,744,822 for fiscal year 2024, $229,749,511 for fiscal year 2025, and $243,534,482 for fiscal year 2026.”

Sec. 204 Hold harmless formula

(a)
In general— Section 304(a)(3)(D) (42 U.S.C. 3024(a)(3)(D)) is amended to read as follows:

“(D)

“(i) In this subparagraph and paragraph (5)—

“(I) the term allot means allot under this subsection from a sum appropriated under section 303(a) or 303(b)(1), as the case may be; and

“(II) the term covered fiscal year means any of fiscal years 2020 through 2029.

“(ii) If the sum appropriated under section 303(a) or 303(b)(1) for a particular covered fiscal year is less than or equal to the sum appropriated under section 303(a) or 303(b)(1), respectively, for fiscal year 2019, amounts shall be allotted to States from the sum appropriated for the particular year in accordance with paragraphs (1) and (2), and subparagraphs (A) through (C) as applicable, but no State shall be allotted an amount that is less than—

“(I) for fiscal year 2020, 99.75 percent of the corresponding sum appropriated for fiscal year 2019;

“(II) for fiscal year 2021, 99.50 percent of that sum;

“(III) for fiscal year 2022, 99.25 percent of that sum;

“(IV) for fiscal year 2023, 99.00 percent of that sum;

“(V) for fiscal year 2024, 98.75 percent of that sum;

“(VI) for fiscal year 2025, 98.50 percent of that sum;

“(VII) for fiscal year 2026, 98.25 percent of that sum;

“(VIII) for fiscal year 2027, 98.00 percent of that sum;

“(IX) for fiscal year 2028, 97.75 percent of that sum; and

“(X) for fiscal year 2029, 97.50 percent of that sum.

“(iii) If the sum appropriated under section 303(a) or 303(b)(1) for a particular covered fiscal year is greater than the sum appropriated under section 303(a) or 303(b)(1), respectively, for fiscal year 2019, the allotments to States from the sum appropriated for the particular year shall be calculated as follows:

“(I) From the portion equal to the corresponding sum appropriated for fiscal year 2019, amounts shall be allotted in accordance with paragraphs (1) and (2), and subparagraphs (A) through (C) as applicable, but no State shall be allotted an amount that is less than the percentage specified in clause (ii), for that particular year, of the corresponding sum appropriated for fiscal year 2019.

“(II) From the remainder, amounts shall be allotted in accordance with paragraph (1), subparagraphs (A) through (C) as applicable, and paragraph (2) to the extent needed to meet the requirements of those subparagraphs.”

(b)
Repeal— Section 304(a)(3)(D) (42 U.S.C. 3024(a)(3)(D) is repealed, effective October 1, 2029.

Sec. 205 Outreach efforts

Section 306(a)(4)(B)(i)(VII) (42 U.S.C. 3026(a)(4)(B)(i)(VII)) is amended by inserting “, specifically including survivors of the Holocaust” after “placement”.

Sec. 206 Maintenance of effort for State Long-Term Care Ombudsman program

(a)
Area agency on aging— Section 306(a)(9) (42 U.S.C. 3026(a)(9)) is amended by striking “Act and expended by the agency in fiscal year 2000” and inserting “Act and expended by the agency in fiscal year 2019”.
(b)
State agency— Section 307(a)(9) (42 U.S.C. 3027(a)(9)) is amended by striking “not less than” and all that follows and inserting “not less than the total amount expended by the State agency with funds received under this title and title VII for fiscal year 2019.”.

Sec. 207 Coordination with resource centers

(a)
Area plans— Section 306(a) (42 U.S.C. 3026(a)) is amended—
(1)
in paragraph (16), by striking “and” at the end;
(2)
in paragraph (17), by striking the period at the end and inserting a semicolon; and
(3)
by adding at the end the following:

“(18) provide assurances that the area agency on aging will collect data to determine—

“(A) the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019; and

“(B) the effectiveness of the programs, policies, and services provided by such area agency on aging in assisting such individuals; and

“(19) provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on those individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019.”

(b)
State plans— Section 307(a) (42 U.S.C. 3027(a)) is amended by adding at the end the following:

“(31) The plan shall contain an assurance that the State shall prepare and submit to the Assistant Secretary annual reports that describe—

“(A) data collected to determine the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019;

“(B) data collected to determine the effectiveness of the programs, policies, and services provided by area agencies on aging in assisting such individuals; and

“(C) outreach efforts and other activities carried out to satisfy the assurances described in paragraphs (18) and (19) of section 306(a).”

Sec. 208 Senior legal hotlines

Not later than 4 years after the date of enactment of this Act, the Assistant Secretary shall prepare and submit to Congress a report containing—
(1)
information on which States or localities operate senior legal hotlines;
(2)
information on how such hotlines operated by States or localities are funded;
(3)
information of the usefulness of senior legal hotlines in the coordination and provision of legal assistance; and
(4)
recommendations on additional actions that should be taken related to senior legal hotlines.

Sec. 209 Increase in limit on use of allotted funds for State administrative costs

Section 308(b)(2)(A) (42 U.S.C. 3028(b)(2)(A)) is amended by striking “$500,000” and inserting “$750,000”.

Sec. 210 Improvements to nutrition programs

Section 308(b)(4) (42 U.S.C. 3028(b)(4)) is amended by adding at the end the following:

“(D) The State, in consultation with area agencies on aging, shall ensure the process used by the State in transferring funds under this paragraph (including requirements relating to the authority and timing of such transfers) is simplified and clarified to reduce administrative barriers and direct limited resources to the greatest nutrition service needs at the community level. Such process shall be modified to attempt to lessen the administrative barriers of such transfers, and help direct limited resources to where they are needed the most as the unmet need for nutrition services grows.”

Sec. 211 Review of reports

Section 308(b) (42 U.S.C. 3028(b)) is amended by adding at the end the following:

“(8) The Assistant Secretary shall review the reports submitted under section 307(a)(31) and include aggregate data in the report required by section 207(a), including data on—

“(A) the effectiveness of the programs, policies, and services provided by area agencies on aging in assisting older individuals whose needs are the focus of all centers funded under title IV in fiscal year 2019; and

“(B) outreach efforts and other activities carried out to satisfy the assurances described in paragraphs (18) and (19) of section 306(a), to identify such older individuals and their service needs.”

Sec. 212 Other practices

(a)
Evaluation— Section 315(d) (42 U.S.C. 3030c–2(d)) is amended by inserting “, by State,” after “a comprehensive evaluation”.
(b)
GAO study— Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall conduct a study and issue a report that includes—
(1)
information—
(A)
about, and a list of, contracts (implemented by States or area agencies on aging) with health care organizations, and State-implemented cost-sharing policies by area agencies on aging, waiver use and waiver use policies, and voluntary contribution policies, by State, under title III of the Older Americans Act of 1965 (42 U.S.C. 3021 et seq.); and
(B)
about any negative impacts on low-income individuals resulting from the policies and uses described in subparagraph (A), and annual evaluation methods and corrective action that the Assistant Secretary is taking to rectify such an impact;
(2)
information about the policies described in subparagraph (A), such as payment rates (including sliding scales based solely on individual income and the cost of delivering services and whether low-income individuals or other populations are excluded from cost sharing or whether specific demographic groups are targeted with cost sharing), procedures to account for cost-sharing payments, written or other educational materials to inform recipients about cost sharing and voluntary contributions in a way that protects access to services, and the extent to which stakeholders' views are solicited regarding cost-sharing policies;
(3)
information on the number of older individuals paying for services under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.);
(4)
policies that ensure that—
(A)
low-income individuals are not burdened by cost-sharing policies; and
(B)
cost-sharing policies do not result in the denial of services due to the individual’s income or the individual’s failure to make a cost-sharing payment; and
(5)
recommendations to Congress and various stakeholders about ways to clarify or improve cost sharing or voluntary contribution policies and implementation.

Sec. 213 Culturally appropriate, medically tailored meals

Section 339(2)(A)(iii) (42 U.S.C. 3030g–21(2)(A)(iii)) is amended by inserting “, including meals adjusted for cultural considerations and preferences and medically tailored meals” before the comma at the end.

Sec. 214 Nutrition services study

Subpart 3 of part C of title III (42 U.S.C. 3030g–21 et seq.) is amended by adding at the end the following:

“339B. Nutrition services impact study

“(a) Study

“(1) In general—The Assistant Secretary shall perform a study to assess how to measure and evaluate the discrepancy between available services and the demand for such services in the home delivered nutrition services program and the congregate nutrition services program under this part, which shall include assessing various methods (such as those that States use) to measure and evaluate the discrepancy (such as measurement through the length of waitlists).

“(2) Contents—In performing the study, the Assistant Secretary shall—

“(A) consider means of obtaining information in rural and underserved communities; and

“(B) consider using existing tools (existing as of the date the Assistant Secretary begins the study) such as the tools developed through the Performance Outcome Measurement Project.

“(3) Analysis—The Assistant Secretary shall analyze and determine which methods are the least burdensome and most effective for measuring and evaluating the discrepancy described in paragraph (1).

“(b) Recommendations

“(1) Preparation—Not later than 3 years after the date of enactment of this Act, the Assistant Secretary shall prepare recommendations—

“(A) on how to measure and evaluate, with the least burden and the most effectiveness, the discrepancy described in subsection (a)(1) (such as measurement through the length of waitlists); and

“(B) about whether studies similar to the study described in subsection (a) should be carried out for programs carried out under this Act, other than this part.

“(2) Issuance—The Assistant Secretary shall issue the recommendations, and make the recommendations available as a notification pursuant to section 202(a)(34) and to the committees of the Senate and of the House of Representatives with jurisdiction over this Act, and the Special Committee on Aging of the Senate.”

Sec. 215 National Family Caregiver Support program

(a)
Definitions for National Family Caregiver Support program— Section 372(a) (42 U.S.C. 3030s(a)) is amended—
(1)
by redesignating paragraphs (1) through (3) as paragraphs (2) through (4), respectively; and
(2)
by inserting before paragraph (2), as so redesignated, the following:

“(1) Caregiver assessment—The term caregiver assessment means a defined process of gathering information to identify the specific needs, barriers to support services, and existing supports of a family caregiver or older relative caregiver, as identified by the caregiver involved, to appropriately target recommendations for support services described in section 373(b). Such assessment shall be administered through direct contact with the caregiver, which may include contact through a home visit, the Internet, telephone or teleconference, or in-person interaction.”

(b)
General authority— Section 373 (42 U.S.C. 3030s–1) is amended—
(1)
in subsection (b), in the matter preceding paragraph (1), by inserting “which may be informed through the use of caregiver assessments,” after “provided,”;
(2)
in subsection (e)(3), in the first sentence, by inserting “, including caregiver assessments used in the State,” after “mechanisms”;
(3)
by redesignating subsections (e) through (g) as subsections (f) through (h), respectively;
(4)
by inserting after subsection (d) the following:

“(e) Best practices—Not later than 1 year after the date of enactment of the Modernization of the Older Americans Act Amendments and every 5 years thereafter, the Assistant Secretary shall—

“(1) identify best practices relating to the programs carried out under this section and section 631, regarding—

“(A) the use of procedures and tools to monitor and evaluate the performance of the programs carried out under such sections;

“(B) the use of evidence-based caregiver support services; and

“(C) any other issue determined relevant by the Assistant Secretary; and

“(2) make available, including on the website of the Administration and pursuant to section 202(a)(34), best practices described in paragraph (1), to carry out the programs under this section and section 631.”

(5)
by adding at the end the following:

“(i) Activities of national significance—The Assistant Secretary may award funds authorized under this section to States, public agencies, private nonprofit agencies, institutions of higher education, and organizations, including tribal organizations, for conducting activities of national significance that—

“(1) promote quality and continuous improvement in the support provided to family caregivers and older relative caregivers through programs carried out under this section and section 631; and

“(2) include, with respect to such programs, program evaluation, training, technical assistance, and research.

“(j) Technical assistance for caregiver assessments—Not later than 1 year after the date of enactment of the Modernization of the Older Americans Act Amendments, the Assistant Secretary, in consultation with stakeholders with appropriate expertise and, as appropriate, informed by the strategy developed under the RAISE Family Caregivers Act (42 U.S.C. 3030s note), shall provide technical assistance to promote and implement the use of caregiver assessments. Such technical assistance may include sharing available tools or templates, comprehensive assessment protocols, and best practices concerning—

“(1) conducting caregiver assessments (including reassessments) as needed;

“(2) implementing such assessments that are consistent across a planning and service area, as appropriate; and

“(3) implementing caregiver support service plans, including conducting referrals to and coordination of activities with relevant State services.”

(c)
Report on caregiver assessments—
(1)
In general— Not later than 3 years after the date of enactment of this Act, the Assistant Secretary shall issue a report on the use of caregiver assessments by area agencies on aging, entities contracting with such agencies, and tribal organizations. Such report shall include—
(A)
an analysis of the current use of caregiver assessments, as of the date of the report;
(B)
an analysis of the potential impact of caregiver assessments on—
(i)
family caregivers and older relative caregivers; and
(ii)
the older individuals to whom the caregivers described in clause (i) provide care;
(C)
an analysis of the potential impact of using caregiver assessments on the aging network;
(D)
an analysis of how caregiver assessments are being used to identify the specific needs, barriers to support services, and existing supports of family caregivers and older relative caregivers, with particular consideration to supporting—
(i)
a caregiver specified in this subparagraph who is caring for individuals with disabilities, or, if appropriate, with a serious illness; and
(ii)
caregivers with disabilities;
(E)
recommendations for furthering the use of caregiver assessments, as appropriate, including in rural or underserved areas; and
(F)
recommendations for assisting State agencies and area agencies on aging, particularly in rural or underserved areas, in implementing the use of caregiver assessments.
(2)
Submission— Not later than 6 months after the issuance of the report specified in paragraph (1), the Assistant Secretary shall submit the report to the committees of the Senate and the House of Representatives with jurisdiction over this Act, and the Special Committee on Aging of the Senate.
(3)
Definitions— In this subsection—
(A)
the terms caregiver assessment and older relative caregiver have the meanings given such terms in section 372(a) of the Older Americans Act of 1965 (42 U.S.C. 3030s(a));
(B)
the term family caregiver has the meaning given the term in section 302 of such Act (42 U.S.C. 3022); and
(C)
the terms State agency and tribal organization have the meanings given the terms in section 102 of such Act (42 U.S.C. 3002).
(d)
Conforming amendment— Section 631(b) of such Act (42 U.S.C. 3057k–11(b)) is amended by striking “(c), (d), and (e)” and inserting “(c), (d), and (f)”.

Sec. 216 National Family Caregiver Support program cap

(a)
Federal share— Subsection (h)(2), as redesignated by section 215(b)(3) of this Act, of section 373 (42 U.S.C. 3030s–1) is amended by striking subparagraph (C).
(b)
Monitoring the impact of the elimination of the cap on funds for older relative caregivers—
(1)
Report— Not later than 18 months after the date of enactment of this Act, and annually thereafter, the Assistant Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Education and Labor of the House of Representatives a report on the impact of the amendment made by subsection (a) to eliminate the limitation on funds that States may allocate to provide support services to older relative caregivers in the National Family Caregiver Support Program established under part E of title III of the Older Americans Act of 1965 (42 U.S.C. 3030s et seq.). Each such report shall also be made available to the public.
(2)
Contents— For purposes of reports required by paragraph (1), each State that receives an allotment under such National Family Caregiver Support Program for fiscal year 2020 or a subsequent fiscal year shall report to the Assistant Secretary for the fiscal year involved the amount of funds of the total Federal and non-Federal shares described in section 373(h)(2) of the Older Americans Act of 1965 (42 U.S.C. 3030s–1(h)(2)) used by the State to provide support services for older relative caregivers and the amount of such funds so used for family caregivers.