[Senate Report 109-337]
[From the U.S. Government Publishing Office]
Calendar No. 617
109th Congress Report
SENATE
2d Session 109-337
======================================================================
ELDER JUSTICE ACT
_______
September 19, 2006.--Ordered to be printed
_______
Mr. Grassley, from the Committee on Finance, submitted the following
R E P O R T
[To accompany S. 2010]
The Committee on Finance, to which was referred the bill
(S. 2010) to amend the Social Security Act to enhance the
Social Security of the Nation by ensuring adequate public-
private infrastructure and to resolve to prevent, detect,
treat, intervene in, and prosecute elder abuse, neglect, and
exploitation, and for other purposes, reports favorably thereon
with an amendment in the nature of a substitute and recommends
the bill, as amended, do pass.
I. BACKGROUND
More than a quarter of a century has passed since the first
Congressional hearings on elder abuse declared it to be a
national disgrace. Throughout this period, Congressional action
has remained limited. From a policy perspective, elder justice
means assuring that adequate public-private infrastructure and
resources exist to prevent, detect, treat, understand,
intervene in and, where appropriate, prosecute elder abuse,
neglect, and exploitation. From an individual perspective,
elder justice is the right of every older individual to be free
of abuse, neglect, and exploitation.
There are between 500,000 and 5 million older individuals
who are abused in this country every year. Despite the dearth
of data to quantify precisely the number of seniors subjected
to abuse, experts agree that we have only seen the tip of the
iceberg. In fact, according to the National Elder Abuse
Incidence Study conducted by the National Center on Elder
Abuse, 84 percent of all cases of elder abuse are never
reported. It is clear that abuse and neglect shorten the
victim's life, often triggering a downward spiral, ``tipping
over'' an otherwise productive, self-sufficient older
individual. There are three main types of elder abuse: abuse
and neglect in homes and domestic settings; abuse and neglect
in institutions and other types of residential care; and
financial fraud and exploitation.
Studying the results of efforts to respond to other family
violence issues, such as domestic violence and child abuse, has
resulted in the conclusion that abuse, neglect, and
exploitation require a multi-faceted solution, including public
health, social service, and law enforcement approaches. While
these other types of abuse have been recognized and receive
sizable Federal funding, elder abuse remains under-researched,
under-reported, and under-funded. The Elder Justice Act
provides Federal leadership to those on the front lines who are
fighting elder abuse with scarce resources and fragmented
systems.
Highlights of the Elder Justice Act include the following:
Elevating elder justice issues to national attention. The
bill will establish within the Department of Health and Human
Services programmatic, grant-making, policy and technical
assistance functions relating to elder justice; creation of a
public-private Coordinating Council to coordinate activities of
all relevant Federal agencies, States, communities, and private
and not-for-profit entities; and provide a consistent funding
stream and national coordination for Adult Protective Services
(APS).
Improving the quality, quantity, and accessibility of
information. An elder justice national data repository will be
developed to increase the knowledge base and collect data about
elder abuse, neglect, and exploitation.
Increasing knowledge and supporting promising projects. To
help overcome the lack of research on elder abuse and related
issues, the Elder Justice Act will enhance research, clinical
practice, training, and dissemination of information relating
to these issues. Priorities include jump-starting intervention
research, developing community strategies to make elders safer,
and enhancing multi-disciplinary efforts.
Developing forensic capacity. There is scant data to assist
in the detection of elder abuse, neglect, and exploitation.
Creating new forensic expertise (similar to that in child
abuse) will promote detection and increase expertise. New
programs will train health professionals in both forensic
pathology and geriatrics.
Increasing prosecution. The Elder Justice Act establishes
new penalties for failure to promptly report crimes in
residential care facilities and to provide notice of nursing
home closings.
Training. The Act supports training to combat elder abuse,
neglect, and exploitation both within individual disciplines
and in multi-disciplinary (such as public health-social
service-law enforcement) settings.
Model State Laws and Practices. A study will review State
practices and laws relating to elder justice.
Increasing Security, Collaboration, and Consumer
Information in Long-Term Care. The bill will:
Improve prompt reporting of crimes in long-
term care settings,
Enhance long-term care staffing,
Enhance the long-term care ombudsman
program,
Require a study on establishment of a
national nurse aide registry to enable background
checks on nurse's aids,
Provide information about long-term care for
consumers through a Consumer Clearinghouse,
Require new reporting of crimes in nursing
homes on the official Federal website, and
Require establishment of consumer
information on nursing homes on the official Federal
website.
Evaluations/Accountability. The bill contains provisions to
determine what works and assure funds are properly spent.
LEGISLATIVE HISTORY
After dozens of hearings in various Senate and House
committees from 1979 to the present, the Elder Justice Act, S.
2933, was first introduced by Senator John Breaux (D-LA) and
Senator Orrin G. Hatch (R-UT) on September 12, 2002, and
referred to the Senate Finance Committee. Under the
Chairmanship of Senator Max Baucus (D-MT), the Senate Finance
Committee held a hearing on June 18, 2002, entitled Elder
Justice: Protecting Seniors from Abuse and Neglect. Five
experts on elder abuse testified, including Robert Blancato,
President, National Committee for Prevention of Elder Abuse;
Catherine Hawes, Ph.D., Professor, Department of Health Policy
and Management, School of Rural Public Health, Texas A&M
University; Joanne Otto, M.S.W., Executive Director, National
Association of Adult Protective Services Administrators; Carmel
Dyer, M.D., Associate Professor of Medicine, Baylor College of
Medicine; Randolph Thomas, M.A., Law Enforcement Instructor,
South Carolina Department of Public Safety, Criminal Justice
Academy; and Richard Bonnie, J.D., Chair, Panel to Review Risk
and Prevalence of Elder Abuse and Neglect, Committee on
National Statistics of the National Research Council. Prominent
in the discussion were the findings of the National Research
Council publication entitled Elder Mistreatment: Abuse,
Neglect, and Exploitation in an Aging America. The National
Research Council was directed by Congress to assess the current
state of knowledge in the area of elder mistreatment and to
formulate a set of recommendations for a research agenda in the
field. The National Research Council reported that it was
unable to formulate a research agenda for several reasons,
including unclear and inconsistent definitions; unclear and
inadequate measures; incomplete professional accounts; lack of
population-based data; lack of prospective data; lack of
control group; and lack of systematic evaluation studies. No
legislative action was taken during the 107th Congress.
Senators Breaux and Hatch introduced the Elder Justice Act,
S. 333, again during the 108th Congress on February 10, 2003,
and the bill was referred to the Senate Finance Committee.
On September 28, 2004, under the leadership of Chairman
Charles E. Grassley (R-IA), the Senate Finance Committee
considered the bill in Executive Session and reported it
unanimously. It was placed on the Legislative Calendar, but the
Senate failed to act on the bill.
Senator Orrin G. Hatch and Senator Blanche L. Lincoln (D-
AR) introduced the Elder Justice Act, S. 2010, again during the
109th Congress on November 15, 2005, and the bill was referred
to the Senate Finance Committee. Under the leadership of
Chairman Charles E. Grassley, the Senate Finance Committee
considered the bill in Executive Session on August 4, 2006 and,
for the second time, unanimously reported it as an amendment in
the nature of a substitute.
II. SECTION-BY-SECTION ANALYSIS
Short Title; Table of Contents; Definitions
PRESENT LAW
No provision.
COMMITTEE BILL
The bill sets forth the title of the Act as the Elder
Justice Act and outlines the table of contents. It also
specifies that any term defined in new amendment to title XX of
the Social Security Act has the meaning set forth by the
Committee Bill.
Findings
PRESENT LAW
No provision.
COMMITTEE BILL
The Committee Bill describes the following findings of
Congress:
1. The proportion of the United States population age
60 years or older will drastically increase in the next
30 years as more than 76,000,000 baby boomers approach
retirement and old age.
2. Each year, anywhere between 500,000 and 5,000,000
elders in the United States are abused, neglected, or
exploited.
3. Elder abuse, neglect, and exploitation have no
boundaries and cross all racial, social class, gender,
and geographic lines.
4. Victims of elder abuse, neglect, and exploitation
are not only subject to injury from mistreatment and
neglect, they are also 3.1 times more likely than
elders who were not victims of elder abuse, neglect,
and exploitation to die at an earlier age than
expected.
5. There is a general dearth of data as to the nature
and scope of elder abuse, neglect, and exploitation.
6. Despite the dearth of data in the field, experts
agree that most cases of elder abuse, neglect, and
exploitation are never reported and that abuse,
neglect, and exploitation shorten a victim's life,
often triggering a downward spiral of an otherwise
productive, self-sufficient elder's life. Programs
addressing other difficult issues such as domestic
violence and child abuse and neglect have demonstrated
the need for a multi-faceted law, combining public
health, social service, and law enforcement approaches.
7. For over 20 years, Congress has been presented
with facts and testimony calling for a coordinated
Federal effort to combat elder abuse, neglect, and
exploitation.
8. The Federal Government has been slow to respond to
the needs of victims of elder abuse, neglect, and
exploitation or to undertake prevention efforts.
9. No Federal law has been enacted that adequately
and comprehensively addresses the issues of abuse,
neglect, and exploitation, and there are very limited
resources available to those in the field who directly
deal with the issues.
10. Differences in State laws and practices in the
areas of elder abuse, neglect, and exploitation lead to
significant disparities in prevention, protective and
social services, treatment systems, and law enforcement
and lead to other inequities.
11. The Federal Government has played an important
role in promoting research, training, public safety,
data collection, the identification, development, and
dissemination of promising health care, social, and
protective services, and law enforcement practices
relating to child abuse and neglect, domestic violence,
and violence against women. The Federal Government
should promote similar efforts and protections relating
to elder abuse, neglect, and exploitation.
12. The Federal Government should provide leadership
and assist States and communities in their efforts to
protect elders in the United States by--
(A) promoting coordinated planning among all levels
of government;
(B) generating and sharing knowledge relevant to
protecting elders;
(C) providing leadership to combat the abuse,
neglect, and exploitation of the Nation's elders; and
(D) providing resources to States and communities to
promote elder justice.
13. The problem of elder abuse, neglect, and
exploitation requires a comprehensive approach that--
(A) integrates the work of health, legal, and social
services agencies and organizations;
(B) emphasizes the need for prevention, reporting,
investigation, assessment, treatment, and prosecution
of elder abuse, neglect, and exploitation at all levels
of government;
(C) ensures that sufficient numbers of properly
trained personnel with specialized knowledge are in
place to--
(i) treat, assess, and provide services relating to
elder abuse, neglect, and exploitation; and
(ii) carry out elder protection duties;
(D) is sensitive to ethnic and cultural diversity;
(E) recognizes the role of mental health, disability,
dementia, substance abuse, medication mismanagement,
and family dysfunction problems in increasing and
exacerbating elder abuse, neglect, and exploitation;
and
(F) balances elders' right to self-determination with
society's responsibility to protect elders.
14. The human, social, and economic cost of abuse,
neglect, and exploitation is high and includes
unnecessary expenditures of funds from many public
programs.
15. The failure to coordinate activities relating to,
and comprehensively prevent and treat, elder abuse,
neglect, and exploitation threatens the future and
well-being of millions of elders in the United States.
16. All elements of society in the United States have
a shared responsibility in responding to a national
problem of elder abuse, neglect, and exploitation.
Purposes
PRESENT LAW
No provision.
COMMITTEE BILL
The Committee Bill defines the purposes of the Elder
Justice Act, as follows:
1. To enhance the social security of the Nation by ensuring
adequate public-private infrastructure and resolve to prevent,
detect, treat, understand, and intervene in, and where
appropriate, aid in the prosecution of, elder abuse, neglect,
and exploitation.
2. To bring a comprehensive approach to preventing and
combating elder abuse, neglect, and exploitation, a long
invisible problem that afflicts the most vulnerable among the
aging population of the United States.
3. To raise the issue of elder abuse, neglect, and
exploitation to national attention, and to create the
infrastructure at the Federal, State and local levels to ensure
that individuals and organizations on the front lines, who are
fighting elder abuse, neglect, and exploitation with scarce
resources and fragmented systems, have the resources and
information needed to carry out their fight.
4. To bring a comprehensive multidisciplinary approach to
elder justice.
5. To set in motion research and data collection to fill
gaps in knowledge about elder abuse, neglect, and exploitation.
6. To supplement activities of service providers and
programs, to enhance training, and to leverage scarce resources
efficiently, in order to ensure that elder justice receives the
attention it deserves as the Nation's population ages.
7. To recognize and address the role of mental health,
disability, dementia, substance abuse, medication
mismanagement, and family dysfunction problems in increasing
and exacerbating elder abuse, neglect, and exploitation.
8. To create short- and long-term strategic plans for the
development and coordination of elder justice research,
programs, studies, training, and other efforts nationwide.
9. To promote collaborative efforts and diminish overlap
and gaps in efforts in developing the important field of elder
justice.
10. To honor and respect the right of all persons with
diminished capacity to decision making, autonomy, self-
determination, and dignity of choice.
11. To respect the wishes of individuals with diminished
capacity and their family members in providing supportive
services and care plans intended to protect elders from abuse,
neglect (including self-neglect), and exploitation.
Definitions
PRESENT LAW
No provision.
COMMITTEE BILL
Section 4 adopts the meaning of any term used in Section
2011 of the Social Security Act, unless specifically provided
otherwise in the Committee Bill.
Elder justice
PRESENT LAW
No provision.
COMMITTEE BILL
Section 5 of the Committee Bill would amend the Social
Security Act by adding ``Elder Justice'' to an amended title
XX, entitled ``Block Grants to States for Social Services and
Elder Justice'' and adding a new ``Subtitle 2--Elder Justice''.
Definitions
PRESENT LAW
Under current law, ``abuse,'' ``exploitation,'' ``long term
care facility,'' and ``neglect'' are defined in the ``Older
Americans Act.''
COMMITTEE BILL
For data collection and other purposes of the bill, the
Committee Bill defines the following terms: adult protective
services, caregiver, direct care, elder, elder justice,
eligible entity, exploitation, fiduciary, grant, guardianship,
Indian tribe, law enforcement, long-term care, long-term care
facility, neglect, self-neglect, serious bodily injury,
criminal sexual abuse, social, State, State legal assistance
developer, and State long-term care ombudsman.
Definitions related to some of the purposes of the amended
title XX are defined in other related statutes. Related
statutes are as follows:
PRESENT LAW AND COMMITTEE BILL: DEFINITIONS
------------------------------------------------------------------------
Term Present law Committee Bill
------------------------------------------------------------------------
Abuse........................... Section 102(13) of ``Abuse'' is
the Older defined as the
Americans Act: knowing
``Abuse'' of an infliction of
older person is physical or
defined as the psychological
willful harm or the
infliction of knowing
injury, deprivation of
unreasonable goods or services
confinement, that are
intimidation, or necessary to meet
cruel punishment essential needs
with resulting or to avoid
physical harm, physical or
pain, or mental psychological
anguish, or harm.
deprivation by a
person, including
a caregiver, of
goods or services
that are
necessary to
avoid physical
harm, mental
anguish or mental
illness.
Exploitation.................... Section 102(24) of ``Exploitation''
the Older is defined as the
Americans Act: fraudulent or
``Exploitation'' otherwise
of an older illegal,
person is defined unauthorized, or
as the illegal or improper act or
improper act or process of an
process of an individual,
individual, including a
including a caregiver or
caregiver, using fiduciary, that
the resources of uses the
an older resources of an
individual for elder for
monetary or monetary or
personal benefit, personal benefit,
profit, or gain. profit, or gain,
or that results
in depriving an
elder of rightful
access to, or use
of, benefits,
resources,
belongings, or
assets.
Long-term care facility......... Section 102(32) of ``Long-term care
the Older facility'' is
Americans Act: defined as a
``Long term care residential care
facility'' is provider that
defined as a arranges for, or
skilled nursing directly
facility as provides, long-
defined in term care.
Section 1819(a)
of the Social
Security Act; any
nursing facility
as defined in
Section 1919(a)
of the Social
Security Act; and
for purposes of
the title III and
title VII
provisions for
elder abuse
prevention, a
board and care
facility.
Neglect......................... Section 102(34) of ``Neglect'' is
the Older defined as the
Americans Act: failure of a
``Neglect'' is caregiver or
defined as the fiduciary to
failure to provide the goods
provide for or services that
oneself the goods are necessary to
or services that maintain the
are necessary to health or safety
avoid physical of an elder, or
harm, mental self-neglect.
anguish, or
mental illness;
or the failure of
a caregiver to
provide the goods
or services.
Criminal sexual abuse........... Title XVII of the ``Criminal sexual
Violent Crime abuse'' is
Control and defined as
Enforcement Act: serious bodily
A ``sexually injury that shall
violent offense'' be considered to
is defined as any have occurred if
criminal offense the conduct
that consists of causing the
aggravated sexual injury is conduct
abuse or sexual constituting
abuse (as defined aggravated sexual
by 18 U.S.C. abuse under
Section 2241 and Section 2241, or
2242 or as sexual abuse
defined by State under 18 U.S.C.
law) or an or any similar
offense that has offense under
as its elements State law.
engaging in
physical contact
with another
person with
intent to commit
aggravated sexual
abuse or sexual
abuse.
------------------------------------------------------------------------
General provisions
(a) Protection of privacy
PRESENT LAW
The Health Insurance Portability and Accountability Act of
1996 (HIPAA), Section 264 governs the protection of individual
health privacy.
COMMITTEE BILL
The activities that would be carried out under this Part
must ensure the protection of individual health privacy
consistent with the regulations under Section 264(c) of the
Health Insurance Portability and Accountability Act of 1996
(HIPAA) and any State and local privacy regulations.
(b) Rule of construction
PRESENT LAW
No provision.
COMMITTEE BILL
Includes a provision to accommodate religious beliefs in
health care when determining whether there is abuse for data
collection purposes.
Part A--National Coordination of Elder Justice Activities and Research
Elder Justice Coordinating Council
PRESENT LAW
No provision.
COMMITTEE BILL
The bill would establish an Elder Justice Coordinating
Council in the Office of the Secretary of HHS.
Membership. The Council would be composed of the following
members: the Secretary of HHS (or designee) who will chair the
Council and the Attorney General (or designee). Membership
would also include the head of each Federal department or
agency having administrative responsibility for administering
programs related to elder abuse, neglect, or exploitation.
Members must be officers or employees of the Federal
Government.
Meetings. The Council is to meet at least twice a year.
Duties and Reports. The Council would be required to make
recommendations to the Secretary for the coordination of
activities of the Department of Health and Human Services, the
Department of Justice, and other relevant Federal, State,
local, and private agencies and entities, relating to elder
abuse, neglect, and exploitation and other crimes against
elders. The Council would be required to submit a report to
Congress that describes its activities and challenges and make
recommendations for legislation, model laws, and other actions
deemed appropriate. The report is to be submitted to Congress
within 2 years of enactment of the Elder Justice Act and every
2 years thereafter.
Other Requirements. The Committee Bill also sets forth
requirements for powers of the Council, vacancies in
membership, travel expenses, and detail of Federal Government
employees to the Council.
Advisory Board on Elder Abuse, Neglect, and Exploitation
PRESENT LAW
No provision.
COMMITTEE BILL
The bill would establish the Advisory Board on Elder Abuse,
Neglect and Exploitation.
Solicitation of Nominations, Membership, and Terms. The
Secretary of HHS would be required to publish a notice in the
Federal Register soliciting nominations for Advisory Board
membership. The Board would be composed of 27 members appointed
by the Secretary and must have experience and expertise in
prevention of elder abuse, neglect, and exploitation. Each
member would be appointed for a 3-year term, except for the
first members of the Board whose terms would be staggered.
Duties and Reports. The Board would be required to create a
short and long-term multidisciplinary plan for development of
the field of elder justice.
Within 18 months of the Committee Bill's enactment and
annually thereafter, the Advisory Board would be required to
prepare and submit to the Elder Justice Coordinating Council
and the appropriate committees of Congress, a report containing
information on Federal, State, and local public and private
elder justice activities. The report is also to contain
recommendations on programs, research, services, practice,
enforcement, and coordination among entities that carry out
elder justice and other related activities; modifications
needed in Federal and State laws, research, training, and
national data collection; and on a multidisciplinary strategic
plan to guide the field of elder justice.
Other Requirements. The Committee Bill sets forth
requirements relating to powers of the Board, vacancies,
expired terms, election of officers, travel expenses, and
detail of government employees to the Board.
Research protections
PRESENT LAW
Definition of Legally Authorized Representative. Subpart A
of part 46 of title 45, Code of Federal Regulations, known as
the Common Rule, that governs most federally-funded human
subjects research, currently defines the term ``legally
authorized representative'' as ``an individual or judicial or
other body authorized under applicable law to consent on behalf
of a prospective subject to the subject's participation in the
procedure(s) involved in the research.''
Researcher Guidelines. No guidelines are currently in place
to assist researchers who work in the areas of elder abuse,
neglect, and exploitation with issues relating to human
subjects research.
COMMITTEE BILL
The Bill would define ``legally authorized
representative,'' for purposes of research under the proposed
title XX, to mean, unless otherwise provided by law, the
individual, or judicial or other body authorized under the
applicable law to consent to medical treatment on behalf of
another person.''
It would also require the Secretary, acting through the
Director of the National Institute on Aging (NIA), to
promulgate guidelines to assist researchers working in the
areas of elder abuse, neglect, and exploitation, with issues
relating to human subjects research.
Authorization of appropriations
PRESENT LAW
No provision.
COMMITTEE BILL
To carry out the functions under subtitle A (the Federal
Elder Justice System), the Committee Bill authorizes $6.5
million for FY 2007, and $7 million for each of FYs 2008-2010.
Subpart 2--Elder Abuse, Neglect, and Exploitation Forensic Centers
Establishment and support of Elder Abuse, Neglect, and Exploitation
Forensic Centers
PRESENT LAW
No provision.
COMMITTEE BILL
The Bill would require the Secretary, in consultation with
the Attorney General, to award grants to eligible entities to
establish and operate both stationary and mobile forensic
centers and to develop forensic expertise pertaining to elder
abuse, neglect, and exploitation. With respect to the
stationary forensic centers, the Committee Bill would require
the Secretary to make four grants to higher education
institutions with demonstrated expertise in forensics or
commitment to preventing or treating elder abuse, neglect, or
exploitation; and with respect to mobile forensic centers, the
Committee Bill would require the Secretary to make six grants
to appropriate entities.
Funding would be authorized for the centers to: (1) develop
forensic markers that would determine whether abuse or neglect
occurred and whether a crime was committed, and determine
methodologies for how and when intervention should occur; (2)
develop forensic expertise with respect to elder abuse,
neglect, and exploitation in order to provide relevant
evaluation, intervention, support and advocacy, case review and
tracking; and (3) in coordination with the Attorney General,
use data made available by grant recipients under this section
to develop the capacity of geriatric health care professionals
and law enforcement to collect forensic evidence, including
forensic evidence relating to a potential determination of
elder abuse, neglect, or exploitation. The Committee Bill would
also require the Secretary, in consultation with the Attorney
General, to use data to develop the capacity to collect
forensic evidence.
The Committee Bill would authorize $4 million in funding
for FY 2007, $6 million for FY 2008, and $8 million for each of
FYs 2009-2010.
Part B--Programs To Promote Elder Justice
Enhancement of long-term care
PRESENT LAW
Nursing homes that receive Federal funds are required to
meet certain Federal laws and standards to receive funding.
These laws require nursing aides, who work on a full-time basis
for more than 4 months, to complete a training and/or
competency evaluation program and be competent to provide care.
Nursing homes must also provide regular performance reviews and
in-service education (including training for individuals
providing nursing and nursing-related services to residents
with cognitive impairments) to assure that nursing aides are
competent to perform services. Regulations also require nursing
aides to complete a training program lasting no less than 75
clock hours of training, at least 16 of which must be
supervised practical training, in order to be certified.
A number of States have also used enhanced Medicaid funding
to improve recruitment and retention of nursing aides working
in nursing homes. For these States, some portion of an increase
in State Medicaid payments (and other public funding sources)
to long-term care providers must be (or intended to be) used to
increase wages and or benefits for nursing aides. Typically,
this ``wage pass-though'' legislation has either designated
some specified dollar amount (e.g., $.50 or $1.00) or a certain
percentage of increased State payments to be used for wages and
or benefits.
Nursing Home Compare is a website hosted by the Department
of Health and Human Services that allows consumers to search
for data on certain quality indicators for nursing homes
certified to participate in Medicare and/or Medicaid across the
country. The information reported on this site includes
selected findings of the Survey and Certification surveys
conducted by State Survey agencies during the three most recent
inspections and complaint investigations. Specifically, the
website contains data on the Federal regulatory requirements
that the nursing home failed to meet as reported on form HCFA-
2567. There is currently no requirement that information about
the adjudication of criminal violations be reported on this
website.
COMMITTEE BILL
The Bill would require the Secretary of HHS to carry out
activities that provide incentives for individuals to train
for, seek, and maintain employment providing direct care in
long-term care facilities.
Coordination of Federal Agencies to Train Long-Term Care
Staff. The Secretary of HHS would be required to coordinate
activities with the Secretary of Labor and the Assistant
Secretary of ACF to provide incentives to welfare-to-work and
TANF recipients to train for and seek employment as direct care
providers in long-term care facilities.
Career Ladders, Wage and Benefit Grants. The Secretary of
HHS would be required to award grants to long-term care
facilities to conduct programs that offer direct care employees
continuing training and varying levels of certification. Grants
would also be used to provide for or make arrangements with
employers to pay bonuses, or other increased compensation or
benefits, to employees who obtain certification. To receive
grant funds, long-term care facilities would submit
applications directly to the Secretary.
Management Improvement. The Secretary of HHS would be
required to award grants to long-term care facilities for
training and technical assistance. Eligible recipients could
include administrators, directors of nursing, staff developers,
charge nurses, and others who establish or implement management
practices for direct care employees. Training and technical
assistance would be intended to promote retention and could
include: (1) the establishment of human resource policies
rewarding high performance, including policies that provide for
improved wages and benefits on the basis of job reviews; (2)
the establishment of motivational organizational practices; (3)
the creation of a workplace culture that respects and values
caregivers and their needs; (4) the promotion of a workplace
culture that respects the rights of residents and results in
improvements in their care; and (5) the establishment of other
programs that promote high quality care, such as continuing
education for certified nursing aide employees. Long-term care
facilities would submit applications to the Administrator to
qualify for grant funds. The Secretary would be required to
develop accountability measures to ensure that funded
activities under this title benefit eligible employees and
increase the stability of the long-term care workforce.
Informatics Systems Grant Program. The Secretary is
authorized to make grants to long-term care facilities for the
purpose of assisting such entities in off-setting the costs
related to purchasing, leasing, developing, and implementing
standardized clinical health care informatics systems designed
to improve patient safety and reduce adverse events and health
care complications resulting from medication errors.
Inclusion of Certain Crimes on Nursing Home Compare
Website. The Secretary is required to ensure that information
relating to the number of criminal convictions by nursing
facilities or by an employee of a nursing facility are part of
the information provided for comparison of nursing facilities
on the official Internet website of the Federal Government for
medicare beneficiaries.
Consumer Rights Information Page on Nursing Home Compare
Website. The Secretary shall ensure that the Nursing Home
Compare Medicare website develops and includes a consumer
rights information page that includes documentation on
available nursing facilities, consumer rights, the survey
process, and services available through the State long-term
care ombudsman.
Standards Involving Clinical Data by Long-Term Care
Facilities. The Secretary shall develop and adopt uniform open
electronic standards for transactions involving clinical data
by long-term care facilities.
The Committee bill would authorize $20 million for FY 2007,
$17.5 million for FY 2008, and $15 million for FY 2009 and FY
2010.
Adult protective services functions and grant programs
Adult protective services--Functions
PRESENT LAW
Provisions related to some functions of adult protective
services are found in title XX of the Social Security Act
(Social Services Block Grant) (administered by the
Administration on Children and Families (ACF)) and the Older
Americans Act (administered by AoA), both in DHHS, as follows.
Title XX of the Social Security Act. Title XX provides
funds to States to carry out a wide range of social services on
behalf of various groups. The statute sets out a number of
goals for the use of these funds, including the goal of
``preventing or remedying neglect, abuse, or exploitation of
children and adults unable to protect their own interests. . .
.''
Funds are generally administered by State social services
or human services agencies (for this purpose, sometimes
referred to as adult protective services offices), and/or State
agencies on aging.
No match is required for Federal title XX funds, and
Federal law does not specify a sub-State allocation formula. In
other words, States have complete discretion for the
distribution of funds within their borders. Based on the 2002
Annual Report for the Social Services Block Grant, 34 States
used some portion of title XX funds for adult protective
services, and approximately 425,000 adults received adult
protective services that were funded in whole or in part with
title XX funds. Of all State expenditures under title XX for
2002, 5.8 percent were for protective services for adults.\1\
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\1\A percentage of expenditures differs from a percentage of the
title XX appropriation. Title XX expenditures include spending from
funds transferred from the Temporary Assistance for Needy Families
(TANF) program to title XX.
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Older Americans Act. Title II of the Older Americans Act
requires the Assistant Secretary on Aging in DHHS to establish
a National Center on Elder Abuse. The Center is required to,
among other things, compile, publish and disseminate research
and training materials on prevention of elder abuse, neglect,
and exploitation; maintain a clearinghouse on programs showing
promise in preventing elder abuse, neglect, and exploitation;
conduct research and demonstration projects that identify
causes, prevention, and treatment; and provide technical
assistance to State agencies and other organizations in
planning and improving prevention programs. AoA awards funds to
six organizations that share the funds: the National
Association of State Units on Aging, which administers the
Center, in cooperation with the National Protective Services
Association; the National Committee for the Prevention of Elder
Abuse; the American Bar Association; and the Clearinghouse on
Abuse, Neglect, and Exploitation.
Funding history for the Center is as follows: FY 1998,
$250,000; FY 1999, $200,000; FY 2000, $815,250; FY 2001,
$815,000; FY 2002, $815,000, and FY 2003, $815,000. The 2000
amendments to the Act required that the Center receive at least
the same amount of funds as it received in FY 2000.
Title III of the Older Americans Act authorizes, but does
not require, State agencies on aging to conduct various
activities related to prevention of elder abuse, neglect, and
exploitation. No Federal funds are separately allotted for this
purpose under title III, and States decide how much of their
title III allotments are to be used for prevention activities.
In many States, State agencies on aging administer funds for
adult protective services funded under title XX of the Social
Security Act (described below).
Title VII of the Older Americans Act authorizes a program
of grants to States to carry out activities related to
prevention of elder abuse, neglect, and exploitation. Funds are
administered by State agencies on aging. In FY 2006, the
appropriation level for this program under title VII is $5.2
million.
Section 1128E of the Social Security Act requires the
Secretary to maintain a national health care fraud and abuse
data collection program for the reporting of final adverse
actions (not including settlements in which no findings of
liability have been made), including health care related civil
judgments and criminal convictions of health care
practitioners, providers, and suppliers. The database is
directed by HHS, acting through the office of the Attorney
General, and is named the Healthcare Integrity and Protection
Data Bank (HIPDB).
For the purposes of this database, Medicaid regulation 42
CFR Sec. 455.12 requires that State agencies report the number
of complaints of fraud and abuse made to the agency that
warrant preliminary investigation. For each case, reports
should include the provider's name and number; the source of
the complaint; the type of provider; the nature of the
complaint; the approximate range of dollars involved; and the
legal and administrative disposition of the case, including
actions taken by law enforcement officials to whom the case has
been referred. Section 1128E requires the Secretary to include
procedures assuring that the privacy of individuals receiving
health care services is appropriately protected.
The Secretary makes available the information in the
database to government agencies and health plans and, upon
request, to health care providers, suppliers, and practitioners
who wish to self-query. The Secretary may establish or approve
fees sufficient to recover the full costs of the databases'
operation.
According to Section 1128E(g)(1)(A) of the Social Security
Act, a final adverse action includes: (1) civil judgments
related to the delivery of a health care item or service that
are against a health care provider or practitioner in Federal
or State court; (2) Federal or State criminal convictions
related to the delivery of health care; (3) certain actions by
Federal or State agencies responsible for the licensing and
certification of providers and licensed practitioners; (4)
prohibition against participating in Federal or State health
care programs; or (5) any other adjudicated actions or
decisions established by the Secretary under regulation.
Medicaid regulation 42 CFR Sec. 483.374 also requires
facilities to report each serious occurrence to both the State
Medicaid agency and, unless prohibited by State law, the State-
designated protection and advocacy system.
COMMITTEE BILL
The Bill would establish certain functions with respect to
Adult Protective Services (APS) to be administered by the
Secretary.
Adult Protective Services--Functions. Functions include
providing funding and support to State and local adult
protective services offices that investigate reports of abuse,
neglect and exploitation of elders and vulnerable adults;
collecting and disseminating information on abuse in
coordination with the Department of Justice; developing and
disseminating information on best practices; conducting
research and providing technical assistance to States that
provide or fund protective services; and reporting crimes on
the Nursing Home Compare website.
To carry out these functions, the Committee Bill authorizes
$3 million for FY 2007 and $4 million for each of FYs 2008-
2010.
Adult protective service grant program (State formula grants)
PRESENT LAW
No provision in current law for State formula grants that
are solely and specifically targeted at providing adult
protective services and carrying out projects to employ workers
having caseloads of elders alone.
Some other legislation is related to adult protective
services, as follows.
Title XX of the Social Security Act. Title XX provides
funds to States to carry out a wide range of social services on
behalf of various groups. The statute sets out a number of
goals for the use of these funds, including the goal of
``preventing or remedying neglect, abuse, or exploitation of
children and adults unable to protect their own interests....''
Funds are generally administered by State social services or
human services agencies (for this purpose, sometimes referred
to as adult protective services offices), and/or State agencies
on aging.
Title III of the Older Americans Act authorizes, but does
not require, State agencies on aging to conduct various
activities related to prevention of elder abuse, neglect, and
exploitation, which may include adult protective services. No
Federal funds are separately appropriated for this purpose
under title III, and States decide how much of their title III
allotments are to be used for these activities. In many States,
State agencies on aging administer funds for adult protective
services funded under title XX of the Social Security Act
(described below).
Title VII of the Older Americans Act authorizes a program
of grants to States to carry out activities related to
prevention of elder abuse, neglect, and exploitation. Funds are
administered by State agencies on aging. In FY 2006, the
appropriation level for this program under title VII is $5.2
million.
COMMITTEE BILL
The Bill provides for grants to improve Adult Protective
Services.
Grants to Improve Worker Caseloads for Adult Protective
Services. The Secretary would be required to award annual
grants to enhance adult protective service programs provided by
States and local governments.
Formula for Distribution of Funds. Distribution of funds to
States would be based on a formula that takes into account the
number of elders (people age 60 or older) residing in a State
relative to the total U.S. population of elders. States would
receive no less than 0.75 percent of the grant program's annual
appropriation. The District of Columbia, Puerto Rico, the U.S.
Virgin Islands, Guam, and American Samoa would receive no less
than 0.1 percent of the annual appropriation. In order to
comply with these minimum amount requirements, the Secretary is
required to make pro rata reductions in amounts to be allotted.
Use of Funds. Funds may be used only by States and local
governments to provide adult protective services. States
receiving funds would be required to provide these funds to the
agency or unit of State government having legal responsibility
for providing adult protective services in the State. Each
State would be required to use these funds to supplement and
not supplant other Federal, State, and local public funds
expended to provide adult protective services.
Reports. Each State would be required to submit a report to
the Secretary on the number of elders served by the grants. The
Secretary would be required to submit to the appropriate
congressional committees a report compiling, summarizing, and
analyzing the State reports.
The Committee Bill would authorize $100 million for each of
FYs 2007-2010.
State adult protective service grants (Demonstration program)
PRESENT LAW
No provision in current law specifically authorizes a
dedicated amount of funds for State adult protective service
demonstration programs. However, the Older American Act
authorizes a related demonstration program (as follows), but no
specific authorization is specified by law.
Section 413 of the Older Americans Act, Older Individuals'
Protection from Violence Projects, requires the Assistant
Secretary to award funds to States' area agencies on aging, and
nonprofit organizations, or tribal organizations, to carry out
a wide range of projects related to protection of older persons
from violence. Funds are to be used to: support local
communities to coordinate activities regarding intervention in
and prevention of abuse, neglect, and exploitation; develop
outreach to assist victims; expand access to family violence
and sexual assault programs (including shelters, rape crisis
centers, and support groups) as well as mental health services,
safety planning and other services; and promote research on
legal organization and training impediments to providing
services through shelters and other programs.
COMMITTEE BILL
The Bill would require the Secretary to establish grants to
States for adult protective service demonstration programs.
Funds may be used by State and local units of government to
conduct demonstration programs that test: training modules
developed for the purpose of detecting or preventing elder
abuse; methods to detect or prevent financial exploitation and
elder abuse; whether training on elder abuse forensics enhances
the detection of abuse by employees of State or local
government; and other related matters. States would be required
to submit applications to the Secretary.
Each State receiving funds would be required to submit a
report on the demonstration to the Secretary. The Secretary
would be required to submit to the appropriate congressional
committees a report compiling, summarizing, and analyzing the
State reports, as well making recommendations for appropriate
legislative or administrative action.
The Committee Bill would authorize $25 million for each of
FYs 2007-2010.
Long-Term Care Ombudsman program grants and training
PRESENT LAW
Title II of the Older Americans Act requires the Assistant
Secretary on Aging to establish the National Ombudsman Resource
Center under the Director of the Long-Term Care Ombudsman
program. The Center is required to, through grants and
contracts, conduct research and provide training, technical
assistance, and information to State long-term care ombudsmen;
and to assist State long-term care ombudsmen in the
implementation of the State long-term care ombudsman program.
Funds awarded to the Center are not separately authorized, but
are not to be less than the amount made available to the Center
for FY 2000. Funds for the Center are awarded through title IV
of the Older Americans Act (Research, Training, and
Demonstration Projects and Programs). The State long-term care
ombudsman program is authorized by title VII of the Act
(Allotments for Vulnerable Elder Rights Protection Activities).
COMMITTEE BILL
The Committee Bill requires the Secretary to provide grants
to improve the capacity of ombudsman programs to respond to and
resolve complaints about abuse and neglect; conduct pilot
programs; provide support for the resource center; and improve
training. This provision is authorized at $5 million for FY
2007, $7.5 million for FY 2008, and $10 million for FY 2009 and
FY 2010.
The Secretary shall establish programs to provide and
improve ombudsman training with respect to elder abuse, neglect
and exploitation for national organizations and State long-term
care ombudsman programs. These programs are authorized at $10
million for each of the fiscal years FY 2007 through FY 2010.
Part C--Collection of Data, Dissemination of Information and Studies
Collection of uniform national data on elder abuse, neglect and
exploitation
PRESENT LAW
No provision that establishes an ongoing, uniform national
data collection process or provides grants to States to assist
with data collection.
A related law, the Family Violence Prevention and Services
Act of 1992 (P.L. 102-295), required HHS to conduct a study of
the national incidence of abuse, neglect, and exploitation of
elderly persons. This study, referred to as ``the National
Elder Abuse Incidence Study,'' used a nationally-representative
sample of 20 counties in 15 States and combined local Adult
Protective Services (APS) reports with reports from other
community service agencies to estimate the number of new elder
abuse and neglect cases over a given period. The final report
for this study was released by HHS in 1998.
In addition to the study described above, the Federal
Government has periodically surveyed State APS units over the
last 20 years on the prevalence of elder abuse, neglect, and
exploitation. In these surveys, there was significant variation
among the States in the definitions used and the
comprehensiveness of data collected. This variation has created
challenges in establishing a national data set and identifying
trends in abuse, neglect, and exploitation.
COMMITTEE BILL
The Bill would establish as the purpose of the section the
improvement, streamlining, and promotion of uniform collection,
maintenance, and dissemination of national data regarding elder
abuse, neglect, and exploitation. The activities of the
Secretary would be carried out in three phases.
The Secretary would be required to develop, under Phase I,
a method for collecting national data regarding elder abuse,
neglect, and exploitation and uniform national data reporting
forms adapted to each relevant entity or discipline (e.g.,
health, public safety, social and protective services, and law
enforcement). The Secretary would be required to consult with
the Attorney General to develop this method for national data
collection. The national data reporting forms must include the
definitions of title XX for determining whether an event will
be reportable. Finally, the activities that would be carried
out under this section must ensure the protection of individual
health privacy consistent with the regulations under Section
264 of the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) and any State and local privacy regulations.
Phase I must occur no later than 1 year after the date of
enactment.
Phase II would require the Secretary to ensure that the
national data reporting forms and data collection methods
(developed under Phase I) would be pilot tested in six States
selected by the Secretary. After pilot testing the data
collection efforts, the Secretary must review the findings,
consult with the Attorney General and other relevant experts,
and adjust the national data reporting forms and data
collection methods as necessary. Phase II must occur no later
than 1 year following the completion of activities under Phase
I.
Phase III would require the Secretary to submit the
national data reporting forms and instructions to: (1) the
heads of the relevant Federal entities as may be appropriate,
and (2) the Governor's office of each State for collection from
all relevant State entities of data including health care,
social services, and law enforcement data.
In Phase III, the Secretary would be authorized to award
grants to States to improve data collection activities relating
to elder abuse, neglect, and exploitation. Each State that
wants to apply for a grant must submit an application to the
Administrator following the prescribed requirements. Each State
receiving a grant in a fiscal year would be required to submit
data for the calendar year that begins during that year using
the national data forms.
The amount of each grant to a State must be distributed
using the following method: For the first fiscal year in which
a State receives grant funds, the Secretary would be required
to initially distribute 50 percent of those funds. The
remaining funds are to be distributed at the end of the
calendar year that begins during that fiscal year if the
Secretary determines that the State has properly reported data
required under this section for the calendar year. For
subsequent years, the Secretary would be required to distribute
grant funds to a State for a fiscal year if the State properly
reported required data for the calendar year that ends during
that fiscal year. The reports submitted by States must indicate
the State and year in which the event occurred and identify the
total number of events that occurred in each State during the
year and the type of event.
The Secretary would be required to submit a report no later
than 1 year after the enactment date regarding the activities
required by this section to Congress, including the Senate
Committee on Finance and the House Committee on Ways and Means,
and the House Committee on Energy and Commerce.
To carry out the activities of this section, the Committee
Bill would authorize $10 million for FY 2007, $30 million for
FY 2008, and $100 million for each of FYs 2009 and 2010.
Long-term care consumer clearinghouse
PRESENT LAW
No provision requiring establishment of a long-term care
consumer clearinghouse.
In related activities, DHHS has funded some States to
establish State-based consumer-friendly access to information
about long-term care services. In FY 2003 through FY 2006, the
Centers for Medicare and Medicaid Services (CMS) and AoA
awarded approximately $18 million in grants to States for the
purpose of assisting States in their efforts to create a
single, coordinated system of information and access for all
persons seeking long-term care to minimize confusion, enhance
individual choice, and support informed decision-making. A
total of 24 States have received grants for this purpose. Some
of the common activities under this grant program include
information and referral, outreach, counseling about public
benefits and long-term care options, and case management.
States' methods for implementing the grant may vary; some
States have established an actual physical location, and other
States have established a State-wide clearinghouse through a
toll-free number or a web-based information site.
In addition, CMS has made available to the public, via its
website, a comparison of Medicare and Medicaid-certified
nursing homes and home health agencies. The information
provides detailed facility and agency information and
characteristics, and contains several measures of quality
(e.g., improvement in mobility). This website does not cover
assisted living facilities, group homes and other residential
facilities that are not nursing facilities; nor does it cover
non-medical, non-certified, home- and community-based long-term
care services.
COMMITTEE BILL
The Bill would require the Secretary to establish a long-
term care consumer clearinghouse which must provide
comprehensive detailed information, in a consumer-friendly
form, to consumers about choices relating to long-term care
providers.
The clearinghouse is to include information about obtaining
the services of, and employing, caregivers; options for
residential long-term care (e.g., the type of care provided by
nursing facilities, and the type of care provided by group
homes and other residential facilities); benefits available
through the Federal health care programs; and links to Federal
and State websites that describe the care available through
specific long-term care facilities including information about
the satisfaction of those residents and their families with the
care provided. The clearinghouse must also provide information
(from States and other sources) on long-term care providers,
including assisted living facilities, board and care
facilities, congregate care facilities, home health care
providers, and other long-term care providers.
To carry out the activities of this section, the Committee
Bill would authorize $2 million for FY 2007, $3 million for FY
2008, and $4 million for each of FYs 2009 and 2010.
Consumer information about the continuum of residential long-term care
facilities
PRESENT LAW
No provision.
COMMITTEE BILL
The Bill would require the Secretary, in consultation with
the Attorney General, to conduct a study on consumer concerns
relating to residential long-term care facilities other than
nursing facilities. The study may be carried out either
directly or through a grant. The organization conducting the
study must develop definitions for classes of residential long-
term care facilities and collect information on the following
features of these facilities: prices, level of services,
oversight and enforcement provisions, and admission and
discharge criteria.
The Secretary would be required to prepare a report
containing the results of the study and submit the report to
the appropriate committees.
To carry out the study, the Committee Bill would authorize
$3 million for each of FYs 2007-2010.
Evaluations of elder justice programs
PRESENT LAW
No provision.
COMMITTEE BILL
The Bill would require the Secretary of HHS to reserve a
portion of the funds appropriated in each program under title
XX to be used to provide assistance to eligible entities to
conduct validated evaluations of the effectiveness of the
activities funded under each program under title XX. To be
eligible to receive these funds, an eligible entity must submit
an application to the Secretary following the timing and
requirements prescribed by the Secretary, including a proposal
for the evaluation.
Entities would be required to submit to the Secretary and
appropriate congressional committees a report containing the
results of the evaluation together with any recommendations
deemed appropriate. The report would be due by the date
specified by the Secretary.
Report
PRESENT LAW
Currently, no provision exists concerning Federal agency
coordination to encourage the employment of welfare recipients
or recipients of Temporary Assistance to Needy Families (TANF)
in long-term care facilities.
COMMITTEE BILL
The Committee Bill requires, not later than October 1,
2011, a report from the Secretary to the Elder Justice
Coordinating Council and appropriate committees, summarizing:
(1) State reports submitted under section 2042; (2) results of
the study under section 2053; (3) recommendations for
legislative or administrative action; and (4) a requirement for
State plans under the program for Temporary Assistance for
Needy Families.
Amendments to Part A, Title XI of the Social Security Act--Long-term
care facilities
PRESENT LAW
No Federal provisions for mandatory reporting of crimes in
federally funded long-term care facilities. There are some
Federal laws and regulations under Medicare and Medicaid in the
event that a facility participating in either of those programs
closes.
Reporting. Based on a 2000 survey of State Adult Protective
Services systems, all States had elder/adult abuse reporting
laws. State laws varied in who was a mandated reporter and who
was encouraged to report incidents of elder/adult abuse. Many
States and territories named health care professionals, such as
nurses, physicians and nursing aides, as mandated reporters of
elder/adult abuse. Five States did not list anyone as a
mandated reporter.
Eleven States reported that there were no statutory
consequences for failure of mandated reporters to report abuse;
the remaining States and the District of Columbia and Guam had
a specified consequence. The most common consequence for
failing to report was a misdemeanor with a possible fine and/or
jail sentence. State law also varied with regard to specifying
a time frame within which reporters were required to report
suspicion of abuse. Nineteen States had no time frame. Of those
that specified a time frame, the requirements varied from
immediately to more than 4 days.
Notification of Facility Closure. If a long-term care
facility that receives Federal funds through participation in
Medicare or Medicaid closes, current Federal laws and
regulations provide some guidance on the parties that need to
be notified and the process for relocating residents. If a
facility wants to terminate its status as a Medicare provider
(for example, due to facility closure), the facility must
notify both CMS and the public no later than 15 days in advance
of the proposed termination date. If a facility wants to
terminate its status as a Medicaid provider, Federal
regulations do not specify a timeframe for notifying Federal or
State agencies; however, the facility is required to notify
Medicaid residents at least 30 days before transferring or
discharging him or her. Facility closure is one circumstance in
which a resident would need to be transferred.
The State Medicaid agency has the primary responsibility
for relocating Medicaid patients and for ensuring their safe
and orderly transfer from a facility that no longer
participates in Medicaid to a participating facility that meets
acceptable standards. CMS has provided guidance to States
concerning relocating patients. Each State is expected to have
a plan that describes the relocation of patients. Additionally,
the notice to residents is to include information as to how to
contact the ombudsman established by the Older Americans Act.
COMMITTEE BILL
Reporting of Crimes in Federally Funded Facilities. The
Committee Bill would require reporting to law enforcement of
crimes occurring in federally funded long-term care facilities
that receive at least $10,000 in Federal funds during the
preceding year. The owner or operator of these facilities would
be required to annually notify each individual who is an owner,
operator, employee, manager, agent, or contractor of a long-
term care facility that they are required to report any
reasonable suspicion of a crime against any person who is a
resident of or receiving care from the facility. These
individuals are referred to in this section as ``covered
individuals.'' Suspected crimes must be reported to the
Secretary and one or more law enforcement entities for the
political subdivision in which the facility is located.
Timing of Reporting. If the events that cause the suspicion
of a crime result in serious bodily injury, the covered
individual must report the suspicion immediately, but not later
than 2 hours after forming the suspicion. If the events that
cause the suspicion do not result in serious bodily injury, the
individual must report the suspicion not later than 24 hours
after forming the suspicion.
Penalties for Non-Reporting. If a covered individual does
not report suspicion of a crime within the timeframe described
above, the individual will be subject to a civil money penalty
of up to $200,000, or the Secretary shall classify the
individual as an ``excluded individual'' (i.e., any employer of
the individual is unable to receive Federal funds) for a period
of not more than 3 years. If a covered individual does not
report suspicion of a crime within the timeframe described
above and this violation exacerbates the harm to the victim, or
results in harm to another person, the individual will be
subject to a civil money penalty of up to $300,000, and the
Secretary shall classify the individual as an ``excluded
individual'' (i.e., any employer of the individual is unable to
receive Federal funds) for a period of not more than 3 years.
If an individual is classified as an ``excluded
individual,'' any entity that employs that individual will not
be eligible to receive Federal funds. The Secretary may take
into account the financial burden on providers with underserved
populations in determining any penalty to be imposed under this
section. Underserved populations are defined as the population
of an area designated by the Secretary as an area or population
group with a shortage of elder justice programs. These may
include those that are geographically isolated, racial and
ethnic minority populations, and populations underserved
because of special needs (such as language barriers,
disabilities, alien status, or age).
Additional Penalties for Retaliation. A long-term care
facility may not retaliate against an employee for making a
report, causing a report to be made, or for taking steps to
make a report. Retaliation includes discharge, demotion,
suspension, threats, harassment, denial of a promotion or other
employment-related benefit, or any other manner of
discrimination against an employee in the terms and conditions
of employment because of lawful acts done by the employee.
Long-term care facilities may also not retaliate against a
nurse by filing a complaint or report with the appropriate
State professional disciplinary agency because of lawful acts
done by the nurse.
If a long-term care facility does retaliate, it shall be
subject to a civil money penalty of up to $200,000 or the
Secretary may exclude it from participation in any Federal
health care program for a period of 2 years.
Notice to Employees. Each long-term care facility must post
conspicuously, in an appropriate location, a sign specifying
rights of employees under this section. The sign shall include
a statement that an employee may file a complaint against a
long-term care facility that violates the provisions of this
section with the Secretary. The notice must also contain
information as to how to file a complaint.
Notification of Public Agencies and Safety of Residents in
the Event of Facility Closure. In addition, if a long-term care
facility (that received at least $10,000 in Federal funds
during the previous year) is going to close, the owner or
operator of the facility must submit to the Secretary and the
appropriate State regulatory agency written notification of an
impending closure within 60 days prior to the closure date. In
the notice, the owner or operator must include a plan for
transfer and adequate relocation of residents, including
assurances that residents will be moved to the most appropriate
facility in terms of quality, services, and location. Within 10
days after the facility closes, the owner or operator of the
facility must submit to the Secretary, and the appropriate
State agency, information on where the residents were
transferred to and when.
Anyone who owns a skilled nursing facility that fails to
comply with the notification of closure and reporting
requirements shall be subject to a civil monetary penalty of up
to $1,000,000, exclusion from participation in the programs
under the Social Security Act, and any other civil monetary
penalties and assessments.
A civil monetary penalty or assessment will be imposed in
the same manner as a civil monetary penalty, assessment or
exclusion under Section 1128A of the Social Security Act.
Amendments to Part A, Title XI of the Social Security Act--National
nursing aide registry study and report
PRESENT LAW
Section 1819(b)(5)(F) (Medicare law) and 1919(b)(5)(F)
(Medicaid law) of the Social Security Act define nursing aides
as individuals providing nursing or nursing-related services to
residents in nursing facilities as well as registered
dieticians or persons who volunteer to provide such services
without monetary compensation. Nursing aides do not include
physicians; physician assistants; nurse practitioners;
physical, speech, or occupational therapists; physical or
occupational therapy assistants; registered professional
nurses; licensed practical nurses; or licensed certified social
workers. For Medicare-certified facilities, nursing aides also
exclude registered respiratory therapists or certified
respiratory therapy technicians.
No present law exists concerning a nursing aide registry
study.
COMMITTEE BILL
The Secretary shall conduct a study on establishing a
national nursing aide registry that shall include an evaluation
of who should be included in the registry; how the registry
would comply with Federal and State privacy laws and
regulations; how data would be collected for the registry; what
entities and individuals would have access to the data
collected; how the registry would provide appropriate
information regarding violations of Federal and State law by
individuals included in the registry; how the functions of the
registry would be coordinated with the pilot program for
national and State background checks on direct care patient
access employees of long-term care facilities; and how the
information in State nursing aide registries would be
maintained in a national registry.
After receiving the report submitted to Secretary, the
Committee on Ways and Means and the Committee on Energy and
Commerce of the House of Representatives and the Committee on
Finance of the Senate shall, as they deem appropriate, take
action based on the recommendations contained in the report.
Not later than 18 months after the date of enactment of
this Act, the Secretary shall submit a report to the Elder
Justice Coordinating Council, the Committee on Ways and Means
and the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate
containing the findings and recommendations of the study.
Funding for the study shall not exceed $500,000.
III. REGULATORY IMPACT AND OTHER MATTERS
A. Regulatory Impact
Pursuant to paragraph 11(b) of rule XXVI of the Standing
Rules of the Senate, the Committee makes the following
statement concerning the regulatory impact that might be
incurred in carrying out the provisions of the bill as amended.
Impact on individuals and businesses
The provisions of the bill are not expected to impose
additional administrative requirements or regulatory burdens on
individuals or businesses.
B. Unfunded Mandates Statement
Impact on personal privacy and paperwork
The provisions of the bill do not reduce personal privacy.
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (P.L. 104-4).
The Committee has determined that the provisions of the
bill contain no Federal private sector mandates.
The Committee has determined that the provisions of the
bill do not impose a Federal intergovernmental mandate on
State, local, or tribal governments.
IV. COST ESTIMATE
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 8, 2006.
Hon. Charles E. Grassley,
Chairman, Committee on Finance,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 2010, the Elder
Justice Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Christina
Hawley Anthony.
Sincerely,
Donald B. Marron,
Acting Director.
Enclosure.
S. 2010--Elder Justice Act
Summary: S. 2010 would amend Title XX of the Social
Security Act by creating a new subtitle dealing with elder
justice issues. The bill would authorize appropriations
totaling $974 million over the 2007-2011 period for grants and
other activities authorized in the new subtitle. Assuming
appropriation of the authorized amounts, CBO estimates the bill
would result in additional outlays of $32 million in 2007 and
$894 million over the 2007-2011 period. Enacting the bill would
not affect direct spending. CBO estimates that the civil
monetary penalties authorized by the bill would have a
negligible effect on revenues.
S. 2010 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
The bill would benefit state, local, and tribal governments and
any costs they incur would result from complying with
conditions of federal assistance.
Estimated cost to the Federal Government: The estimated
budgetary impact of is shown in the following table. The costs
of this legislation fall within budget function 500 (education,
employment, training, and social services).
Basis of estimate: The bill would amend Title XX of the
Social Security Act to create a new subtitle for ``Elder
Justice'' that would authorize programs aimed at providing
legal protection and services to older individuals. S. 2010
would authorize discretionary appropriations totaling $189
million in 2007 and $974 million over the 2007-2011 period for
administrative activities and grants. Assuming appropriation of
the authorized amounts, CBO estimates that enacting the bill
would increase outlays by $32 million in 2007 and by $894
million from 2007 to 2011. For this estimate, CBO assumes the
bill will be enacted early in fiscal year 2007, that the
authorized amounts are appropriated for each year, and that
outlays will follow historical spending patterns of similar
programs.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------
2007 2008 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Part A: National Coordination of Elder Justice Activities and Research
Coordination of Elder Justice Activities:
Authorization Level....................................... 7 7 7 7 0
Estimated Outlays......................................... 4 7 7 7 3
Forensic Centers:
Authorization Level....................................... 4 6 8 8 0
Estimated Outlays......................................... 2 5 7 8 4
Part B: Programs to Promote Elder Justice
Grants and Incentives for Long-Term Care:
Authorization Level....................................... 20 18 15 15 0
Estimated Outlays......................................... 2 12 16 16 14
Secretarial Responsibilities:
Authorization Level....................................... 3 4 4 4 0
Estimated Outlays......................................... 2 4 4 4 1
Adult Protective Services Grant Programs:
Authorization Level....................................... 100 100 100 100 0
Estimated Outlays......................................... 10 60 90 100 90
Adult Protective Services Demonstrations:
Authorization Level....................................... 25 25 25 25 0
Estimated Outlays......................................... 3 15 23 25 23
Long-Term Care Ombudsman Grants:
Authorization Level....................................... 5 8 10 10 0
Estimated Outlays......................................... 1 3 6 9 9
Ombudsman Training:
Authorization Level....................................... 10 10 10 10 0
Estimated Outlays......................................... 1 6 9 10 9
Part C: Collection of Data, Dissemination of Information, and Studies
Data Collection:
Authorization Level....................................... 10 30 100 100 0
Estimated Outlays......................................... 5 20 65 100 50
Long-Term Care Clearinghouse:
Authorization Level....................................... 2 3 4 4 0
Estimated Outlays......................................... 1 3 4 4 2
Consumer Information on Residential Long-Term Care:
Authorization Level....................................... 3 3 3 3 0
Estimated Outlays......................................... 2 3 3 3 2
National Nurses Aid Registry:
Authorization Level....................................... 1 0 0 0 0
Estimated Outlays......................................... * * * 0 0
Total Spending Under S. 2010:
Authorization Level................................... 189 213 286 286 0
Estimated Outlays..................................... 32 137 234 286 205
----------------------------------------------------------------------------------------------------------------
NOTE: * = less than $500,000.
Spending subject to appropriation
Part A: National Coordination of Elder Justice Activities
and Research. Part A of the new subtitle would establish an
Elder Justice Coordinating Council and an advisory board on
Elder Abuse, Neglect, and Exploitation. The bill would
authorize the appropriation of $6.5 million for fiscal year
2007 and $7 million annually for fiscal years 2008 through 2010
for those activities.
In addition, Part A would establish stationary and mobile
centers for the provision of forensic services relating to
elder abuse, neglect, and exploitation. For example, such
centers would establish indicators of crimes related to elder
abuse as well as methodologies for determining whether and how
various service providers should intervene if such abuse is
indicated. The bill would authorize appropriations of $4
million for fiscal year 2007, $6 million for fiscal year 2008,
and $8 million for each of fiscal years 2009 and 2010 to
establish those centers.
Part B: Programs to Promote Elder Justice. Part B would
provide grants and incentives to long-term care facilities that
would improve management practices, and encourage training,
recruitment, and retention of employees. In addition, part B
would authorize grants to long-term care facilities to improve
and upgrade computer software and hardware that would improve
patient safety and reduce health care complications resulting
from mediation errors. The bill would authorize appropriations
of $20 million for fiscal year 2007, $18 million for fiscal
year 2008, and $15 million for each of fiscal years 2009 and
2010 for those purposes.
Part B also would authorize funding for state and local
adult protective service offices that would investigate reports
of the abuse, neglect, and exploitation of elders, and would
require the Department of Health and Human Services (HHS) to
collect and disseminate data related to elder abuse. The bill
would authorize appropriations of $3 million for fiscal year
2007 and $4 million for each of fiscal years 2008 through 2010
for the administrative responsibilities of HHS, and $100
million for each of fiscal years 2007 through 2010 for grants
to states. In addition, the bill would authorize demonstration
programs for states and local governments to test methods aimed
at detecting and preventing elder abuse. Those demonstration
programs would be authorized at $25 million per year for the
2007-2010 period.
The bill would authorize grants to support the existing
long-term care ombudsman program by improving the capacity of
state programs to respond to and resolve complaints about abuse
and neglect, conducting pilot programs with state or local
offices and providing support for those programs through a
national resource center. Those grants would be authorized at
$5 million for fiscal year 2007, $7.5 million for fiscal year
2008, and $10 million for each of fiscal years 2009 and 2010.
Finally, Part B would authorize appropriations of $10
million in each of fiscal years 2007 through 2010 for ombudsman
training programs.
Part C: Collection of Data, Dissemination of Information,
and Studies. The bill would establish standards for the
collection, maintenance and dissemination of data relating to
elder abuse, neglect, and exploitation under Part C of the new
subtitle. In the first year after enactment of the bill, HHS
would develop methods for collecting national data relating to
elder abuse, neglect, and exploitation. In the following year,
the data reporting forms and collection methods would be tested
in six states, and adjusted as necessary, before being
distributed nationally. The bill would authorize HHS to provide
grants to states to improve their data collection activities
relating to elder abuse, neglect, and exploitation. For those
data collection activities, S. 2010 would authorize
appropriations of $10 million for fiscal year 2007, $30 million
for fiscal year 2008, and $100 million for each of fiscal years
2009 and 2010.
In addition, the bill would establish a consumer
clearinghouse on long-term care that would provide information
about choices relating to long-term care. For that purpose, the
bill would authorize appropriations of $2 million for fiscal
year 2007, $3 million for fiscal year 2008, and $4 million for
each of fiscal years 2009 and 2010.
The bill also would authorize a study on consumer concerns
relating to residential long-term care facilities (other than
nursing facilities). funding for that study would be authorized
at $3 million for each of fiscal years 2007 through 2010.
Finally, the bill would authorize a national nurses aide
registry, but funding for the registry could not exceed
$500,000.
Revenues
S. 2010 could affect revenues through the creation of
several new civil penalties for violations relating to non-
reporting of crimes against residents in long-term care
facilities. Collections of such penalties are recorded as
revenues and deposited in the Treasury; however, CBO expects
that any increase in revenues related to those penalties would
be negligible.
Intergovernmental and private-sector impact: S. 2010
contains no intergovernmental or private-sector mandates as
defined in UMRA. The bill would authorize grants to state,
local, and tribal governments for prevention and intervention
programs, training, and multidisiplinary and collaborative
programs tied to elder abuse, neglect, and exploitations. The
costs of any requirements tied to these grants would be
incurred voluntarily.
Estimate prepared by: Federal Costs: Christina Hawley
Anthony; Impact on state, local, and tribal governments: Lisa
Ramirez-Branum; Impact on the private sector: Paige Shevlin.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
V. VOTES OF THE COMMITTEE
In compliance with paragraph 7(b) of rule XXVI of the
Standing Rules of the Senate, the following statements are made
concerning the votes taken on the Committee's consideration of
the bill.
On August 3, 2006, the bill, as modified, was ordered
favorably reported by roll call vote--20 ayes, 0 nays.
VI. CHANGES IN EXISTING LAW
In compliance with paragraph 12 of Rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE IV--GRANTS TO STATES FOR AID AND SERVICES TO NEEDY FAMILIES WITH
CHILDREN AND FOR CHILD-WELFARE SERVICES
PART A--BLOCK GRANTS TO STATES FOR TEMPORARY ASSISTANCE FOR NEEDY
FAMILIES
* * * * * * *
ELIGIBLE STATES; STATE PLAN
Sec. 402. (a) In General.--As used in this part, the term
``eligible State'' means, with respect to a fiscal year, a
State that, during the 27-month period ending with the close of
the 1st quarter of the fiscal year, has submitted to the
Secretary a plan that the Secretary has found includes the
following:
(1) Outline of family assistance program.--
(A) General provisions.--A written document
that outlines how the State intends to do the
following:
(i) Conduct a program, designed to
serve all political subdivisions in the
State (not necessarily in a uniform
manner), that provides assistance to
needy families with (or expecting)
children and provides parents with job
preparation, work and support services
to enable them to leave the program and
become self-sufficient.
* * * * * * *
(vii) Coordinate the program with
activities carried out by the Secretary
under section 2041(a) in order to
facilitate such activities and provide
incentives for individuals to train
for, seek, and maintain employment
providing direct care in a long-term
care facility (as such terms are
defined in section 2011).
* * * * * * *
USE OF GRANTS
Sec. 404. (a) General Rules.--Subject to this part, a
State to which a grant is made under section 403 may use the
grant--
* * * * * * *
(d) Authority To Use Portion of Grant for Other Purposes.--
(1) In general.--Subject to paragraph (2), a State
may use not more than 30 percent of the amount of any
grant made to the State under section 403(a) for a
fiscal year to carry out a State program pursuant to
any or all of the following provisions of law:
(A) Subtitle 1 of title XX of this Act.
(B) The Child Care and Development Block
Grant Act of 1990.
(2) Limitation on amount transferable to subtitle 1
of title xx programs.--
(A) In general.--A State may use not more
than the applicable percent of the amount of
any grant made to the State under section
403(a) for a fiscal year to carry out State
programs pursuant to subtitle 1 of title XX.
(B) Applicable percent.--For purposes of
subparagraph (A), the applicable percent is
4.25 percent in the case of fiscal year 2001
and each succeeding fiscal year.
(3) Applicable rules.--
(A) In general.--Except as provided in
subparagraph (B) of this paragraph, any amount
paid to a State under this part that is used to
carry out a State program pursuant to a
provision of law specified in paragraph (1)
shall not be subject to the requirements of
this part, but shall be subject to the
requirements that apply to Federal funds
provided directly under the provision of law to
carry out the program, and the expenditure of
any amount so used shall not be considered to
be an expenditure under this part.
(B) Exception relating to subtitle 1 of
title xx programs.--All amounts paid to a State
under this part that are used to carry out
State programs pursuant to subtitle 1 of title
XX shall be used only for programs and services
to children or their families whose income is
less than 200 percent of the income official
poverty line (as defined by the Office of
Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable
to a family of the size involved.
* * * * * * *
PART B--CHILD AND FAMILY SERVICES
Subpart 1--Child Welfare Services
APPROPRIATION
Sec. 420. (a) * * *
* * * * * * *
STATE PLANS FOR CHILD WELFARE SERVICES
Sec. 422. (a) In order to be eligible for payment under
this subpart, a State must have a plan for child welfare
services which has been developed jointly by the Secretary and
the State agency designated pursuant to subsection (b)(1), and
which meets the requirements of subsection (b).
(b) Each plan for child welfare services under this subpart
shall--
(1) provide that (A) the individual or agency that
administers or supervises the administration of the
State's services program under subtitle 1 of title XX
will administer or supervise the administration of the
plan (except as otherwise provided in section 103(d) of
the Adoption Assistance and Child Welfare Act of 1980),
and (B) to the extent that child welfare services are
furnished by the staff of the State agency or local
agency administering the plan, a single organizational
unit in such State or local agency, as the case may be,
will be responsible for furnishing such child welfare
services;
(2) provide for coordination between the services
provided for children under the plan and the services
and assistance provided under subtitle 1 of title XX,
under the State program funded under part A, under the
State plan approved under subpart 2 of this part, under
the State plan approved under the State plan approved
under part E, and under other State programs having a
relationship to the program under this subpart, with a
view to provision of welfare and related services which
will best promote the welfare of such children and
their families;
(3) provide that the standards and requirements
imposed with respect to child day care under subtitle 1
of title XX shall apply with respect to day care
services under this subpart, except insofar as
eligibility for such services is involved;
* * * * * * *
PART E--FEDERAL PAYMENTS FOR FOSTER CARE AND ADOPTION ASSISTANCE
* * * * * * *
STATE PLAN FOR FOSTER CARE AND ADOPTION ASSISTANCE
Sec. 471. (a) In order for a State to be eligible for
payments under this part, it shall have a plan approved by the
Secretary which--
(1) provides for foster care maintenance payments in
accordance with section 472 and for adoption assistance
in accordance with section 473;
(2) provides that the State agency responsible for
administering the program authorized by subpart 1 of
part B of this title shall administer, or supervise the
administration of, the program authorized by this part;
(3) provides that the plan shall be in effect in all
political subdivisions of the State, and, if
administered by them, be mandatory upon them;
(4) provides that the State shall assure that the
programs at the local level assisted under this part
will be coordinated with the programs at the State or
local level assisted under parts A and B of this title,
under subtitle 1 of title XX of this Act, and under any
other appropriate provision of Federal law;
* * * * * * *
FOSTER CARE MAINTENANCE PAYMENTS PROGRAM
Sec. 472. (a) Each State with a plan approved under this
part shall make foster care maintenance payments (as defined in
section 475(4)) under this part with respect to a child who
would have met the requirements of section 406(a) or of section
407 (as such sections were in effect on July 16, 1996) but for
his removal from the home of a relative (specified in section
406(a) (as so in effect)), if--
* * * * * * *
(h)(1) For purposes of titles XIX, any child with
respect to whom foster care maintenance payments are
made under this section is deemed to be a dependent
child as defined in section 406 (as in effect as of
July 16, 1996) and deemed to be a recipient of aid to
families with dependent children under part A of this
title (as so in effect). For purposes of subtitle 1 of
title XX, any child with respect to whom foster care
maintenance payments are made under this section is
deemed to be a minor child in a needy family under a
State program funded under part A of this title and is
deemed to be a recipient of assistance under such part.
* * * * * * *
ADOPTION ASSISTANCE PROGRAM
Sec. 473. (a)(1)(A) Each State having a plan approved
under this part shall enter into adoption assistance agreements
(as defined in section 475(3)) with the adoptive parents of
children with special needs.
* * * * * * *
(b)(1) For purposes of title XIX, any child who is
described in paragraph (3) is deemed to be a dependent child as
defined in section 406 (as in effect as of July 16, 1996) and
deemed to be a recipient of aid to families with dependent
children under part A of this title (as so in effect) in the
State where such child resides.
(2) For purposes of subtitle 1 of title XX, any child
who is described in paragraph (3) is deemed to be a
minor child in a needy family under a State program
funded under part A of this title and deemed to be a
recipient of assistance under such part.
* * * * * * *
TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE
SIMPLIFICATION
PART A--GENERAL PROVISIONS
DEFINITIONS
Sec. 1101. (a) When used in this Act--
(1) The term ``State'', except where otherwise
provided, includes the District of Columbia and the
Commonwealth of Puerto Rico, and when used in titles
IV, V, VII, XI, XIX, and XXI includes the Virgin
Islands and Guam. Such term when used in titles III,
IX, and XII also includes the Virgin Islands. Such term
when used in title V and in part B of this title also
includes American Samoa, the Northern Mariana Islands,
and the Trust Territory of the Pacific Islands. Such
term when used in titles XIX and XXI also includes the
Northern Mariana Islands and American Samoa. In the
case of Puerto Rico, the Virgin Islands, and Guam,
titles I, X, and XIV, and title XVI (as in effect
without regard to the amendment made by section 301 of
the Social Security Amendments of 1972) shall continue
to apply, and the term ``State'' when used in such
titles (but not in title XVI as in effect pursuant to
such amendment after December 31, 1973) includes Puerto
Rico, the Virgin Islands, and Guam. Such term when used
in title XX also includes the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands. Such
term when used in title IV also includes American
Samoa.
* * * * * * *
EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN
MEDICARE AND STATE HEALTH CARE PROGRAMS
Sec. 1128. (a) Mandatory Exclusion.--The Secretary shall
exclude the following individuals and entities from
participation in any Federal health care program (as defined in
section 1128B(f)):
* * * * * * *
(h) Definition of State Health Care Program.--For purposes
of this section and sections 1128A and 1128B, the term ``State
health care program'' means--
(1) a State plan approved under title XIX,
(2) any program receiving funds under title V or from
an allotment to a State under such title,
(3) any program receiving funds under subtitle 1 of
title XX or from an allotment to a State under [such
title] such subtitle, or
(4) a State child health plan approved under title
XXI.
* * * * * * *
CIVIL MONETARY PENALTIES
Sec. 1128A. (a) Any person (including an organization,
agency, or other entity, but excluding a beneficiary, as
defined in subsection (i)(5)) that--
* * * * * * *
(i) For the purposes of this section:
(1) The term ``State agency'' means the agency
established or designated to administer or supervise
the administration of the State plan under title XIX of
this Act or designated to administer the State's
program under title V or subtitle 1 of title XX of this
Act.
* * * * * * *
STATE GRANTS FOR WORK INCENTIVES ASSISTANCE TO DISABLED BENEFICIARIES
Sec. 1150. * * *
* * * * * * *
REPORTING TO LAW ENFORCEMENT OF CRIMES OCCURRING IN FEDERALLY FUNDED
LONG-TERM CARE FACILITIES
Sec. 1150A. (a) Determination and Notification.--
(1) Determination.--The owner or operator of each
long-term care facility that receives Federal funds
under this Act shall annually determine whether the
facility received at least $10,000 in such Federal
funds during the preceding year.
(2) Notification.--If the owner or operator
determines under paragraph (1) that the facility
received at least $10,000 in such Federal funds during
the preceding year, such owner or operator shall
annually notify each covered individual (as defined in
paragraph (3)) of that individual's obligation to
comply with the reporting requirements described in
subsection (b).
(3) Covered individual defined.--In this section, the
term ``covered individual'' means each individual who
is an owner, operator, employee, manager, agent, or
contractor of a long-term care facility that is the
subject of a determination described in paragraph (1).
(b) Reporting Requirements.--
(1) In general.--Each covered individual shall report
to the Secretary and 1 or more law enforcement entities
for the political subdivision in which the facility is
located any reasonable suspicion of a crime (as defined
by the law of the applicable political subdivision)
against any individual who is a resident of, or is
receiving care from, the facility.
(2) Timing.--If the events that cause the suspicion--
(A) result in serious bodily injury, the
individual shall report the suspicion
immediately, but not later than 2 hours after
forming the suspicion; and
(B) do not result in serious bodily injury,
the individual shall report the suspicion not
later than 24 hours after forming the
suspicion.
(c) Penalties.--
(1) In general.--If a covered individual violates
subsection (b)--
(A) the covered individual shall be subject
to a civil money penalty of not more than
$200,000; or
(B) the Secretary shall classify the covered
individual as an excluded individual, for a
period of not more than 3 years.
(2) Increased harm.--If a covered individual violates
subsection (b) and the violation exacerbates the harm
to the victim of the crime or results in harm to
another individual--
(A) the covered individual shall be subject
to a civil money penalty of not more than
$300,000; and
(B) the Secretary shall classify the covered
individual as an excluded individual, for a
period of not more than 3 years.
(3) Excluded individual.--During any period for which
a covered individual is classified as an excluded
individual under paragraph (1)(B) or (2)(B), a long-
term care facility that employs such individual shall
be ineligible to receive Federal funds under this Act.
(4) Extenuating circumstances.--
(A) In general.--The Secretary may take into
account the financial burden on providers with
underserved populations in determining any
penalty to be imposed under this subsection.
(B) Underserved population defined.--In this
paragraph, the term ``underserved population''
means the population of an area designated by
the Secretary as an area with a shortage of
elder justice programs or a population group
designated by the Secretary as having a
shortage of such programs. Such areas or groups
designated by the Secretary may include--
(i) areas or groups that are
geographically isolated (such as
isolated in a rural area);
(ii) racial and ethnic minority
populations; and
(iii) populations underserved because
of special needs (such as language
barriers, disabilities, alien status,
or age).
(d) Additional Penalties for Retaliation.--
(1) In general.--A long-term care facility may not--
(A) discharge, demote, suspend, threaten,
harass, or deny a promotion or other
employment-related benefit to an employee, or
in any other manner discriminate against an
employee in the terms and conditions of
employment because of lawful acts done by the
employee; or
(B) file a complaint or a report against a
nurse or other employee with the appropriate
State professional disciplinary agency because
of lawful acts done by the nurse or employee,
for making a report, causing a report to be made, or
for taking steps in furtherance of making a report
pursuant to subsection (b)(1).
(2) Penalties for retaliation.--If a long-term care
facility violates subparagraph (A) or (B) of paragraph
(1) the facility shall be subject to a civil money
penalty of not more than $200,000 or the Secretary may
classify the entity as an excluded entity for a period
of 2 years pursuant to section 1128(b), or both.
(3) Requirement to post notice.--Each long-term care
facility shall post conspicuously in an appropriate
location a sign (in a form specified by the Secretary)
specifying the rights of employees under this section.
Such sign shall include a statement that an employee
may file a complaint with the Secretary against a long-
term care facility that violates the provisions of this
subsection and information with respect to the manner
of filing such a complaint.
(e) Procedure.--The provisions of section 1128A (other than
subsections (a) and (b) and the second sentence of subsection
(f)) shall apply to a civil money penalty under this section in
the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).
(f) Definitions.--In this section, the terms ``elder
justice'', ``long-term care facility'', and ``law enforcement''
have the meanings given those terms in section 2011.
ENSURING SAFETY OF RESIDENTS WHEN FEDERALLY FUNDED LONG-TERM CARE
FACILITIES CLOSE
Sec. 1150B. (a) Notification of Facility Closure.--If the
owner or operator determines under section 1150A(a)(1) that a
long-term care facility received at least $10,000 in Federal
funds under this Act during the preceding year, the owner or
operator of the facility shall--
(1) submit to the Secretary and the appropriate State
regulatory agency written notification of an impending
closure not later than the date that is 60 days prior
to the date of such closure;
(2) include in the notice a plan for the transfer and
adequate relocation of the residents of the facility
prior to closure, including assurances that the
residents will be transferred to the most appropriate
facility in terms of quality, services, and location;
and
(3) not later than 10 days after the facility
closure, submit to the Secretary and the appropriate
State agency information identifying where residents of
the closed facility were transferred and on what date.
(b) Sanctions.--Any person owning or operating a long-term
care facility that fails to comply with the requirements of
subsection (a) shall be subject to--
(1) a civil monetary penalty of up to $1,000,000;
(2) exclusion from participation in the programs
under this Act (in accordance with the procedures of
section 1128); and
(3) any other applicable civil monetary penalties and
assessments.
(c) Procedure.--The provisions of section 1128A (other than
subsections (a) and (b) and the second sentence of subsection
(f)) shall apply to a civil money penalty or assessment under
this section in the same manner as such provisions apply to a
penalty or proceeding under section 1128A(a).
(d) Definition.--In this section, the term ``long-term care
facility'' has the meaning given that term in section 2011.
* * * * * * *
TITLE XX--BLOCK GRANTS TO STATES FOR SOCIAL SERVICES AND ELDER JUSTICE
Subtitle 1--Block Grants to States for Social Services
PURPOSES OF [TITLE] SUBTITLE; AUTHORIZATION OF APPROPRIATIONS
Sec. 2001. For the purposes of consolidating Federal
assistance to States for social services into a single grant,
increasing State flexibility in using social service grants,
and encouraging each State, as far as practicable under the
conditions in that State, to furnish services directed at the
goals of--
(1) achieving or maintaining economic self-support to
prevent, reduce, or eliminate dependency;
(2) achieving or maintaining self-sufficiency,
including reduction or prevention of dependency;
(3) preventing or remedying neglect, abuse, or
exploitation of children and adults unable to protect
their own interests, or preserving, rehabilitating or
reuniting families;
(4) preventing or reducing inappropriate
institutional care by providing for community-based
care, home-based care, or other forms of less intensive
care; and
(5) securing referral or admission for institutional
care when other forms of care are not appropriate, or
providing services to individuals in institutions,
there are authorized to be appropriated for each fiscal year
such sums as may be necessary to carry out the purposes of
[this title] this subtitle.
PAYMENTS TO STATES
Sec. 2002. (a)(1) Each State shall be entitled to payment
under [this title] this subtitle for each fiscal year in an
amount equal to its allotment for such fiscal year, to be used
by such State for services directed at the goals set forth in
section 2001, subject to the requirements of [this title] this
subtitle.
(2) For purposes of paragraph (1)--
(A) services which are directed at the goals
set forth in section 2001 include, but are not
limited to, child care services, protective
services for children and adults, services for
children and adults in foster care, services
related to the management and maintenance of
the home, day care services for adults,
transportation services, family planning
services, training and related services,
employment services, information, referral, and
counseling services, the preparation and
delivery of meals, health support services and
appropriate combinations of services designed
to meet the special needs of children, the
aged, the mentally retarded, the blind, the
emotionally disturbed, the physically
handicapped, and alcoholics and drug addicts;
and
(B) expenditures for such services may
include expenditures for--
(i) administration (including
planning and evaluation);
(ii) personnel training and
retraining directly related to the
provision of those services (including
both short- and long-term training at
educational institutions through grants
to such institutions or by direct
financial assistance to students
enrolled in such institutions); and
(iii) conferences or workshops, and
training or retraining through grants
to nonprofit organizations within the
meaning of section 501(c)(3) of the
Internal Revenue Code of 1954 or to
individuals with social services
expertise, or through financial
assistance to individuals participating
in such conferences, workshops, and
training or retraining (and this clause
shall apply with respect to all persons
involved in the delivery of such
services).
(b) The Secretary shall make payments in accordance with
section 6503 of title 31, United States Code, to each State
from its allotment for use under [this title] this subtitle.
(c) Payments to a State from its allotment for any fiscal
year must be expended by the State in such fiscal year or in
the succeeding fiscal year.
(d) A State may transfer up to 10 percent of its allotment
under section 2003 for any fiscal year for its use for that
year under other provisions of Federal law providing block
grants for support of health services, health promotion and
disease prevention activities, or low-income home energy
assistance (or any combination of those activities). Amounts
allotted to a State under any provisions of Federal law
referred to in the preceding sentence and transferred by a
State for use in carrying out the purposes of [this title] this
subtitle shall be treated as if they were paid to the State
under [this title] this subtitle but shall not affect the
computation of the State's allotment under [this title] this
subtitle. The State shall inform the Secretary of any such
transfer of funds.
(e) A State may use a portion of the amounts described in
subsection (a) for the purpose of purchasing technical
assistance from public or private entities if the State
determines that such assistance is required in developing,
implementing, or administering programs funded under [this
title] this subtitle.
(f) A State may use funds provided under [this title] this
subtitle to provide vouchers, for services directed at the
goals set forth in section 2001, to families, including--
(1) families who have become ineligible for
assistance under a State program funded under part A of
title IV by reason of a durational limit on the
provision of such assistance; and
(2) families denied cash assistance under the State
program funded under part A of title IV for a child who
is born to a member of the family who is--
(A) a recipient of assistance under the
program; or
(B) a person who received such assistance at
any time during the 10-month period ending with
the birth of the child.
ALLOTMENTS
Sec. 2003. (a) The allotment for any fiscal year to each
of the jurisdictions of Puerto Rico, Guam, the Virgin Islands,
and the Northern Mariana Islands shall be an amount which bears
the same ratio to the amount specified in subsection (c) as the
amount which was specified for allocation to the particular
jurisdiction involved for the fiscal year 1981 under section
2002(a)(2)(C) of this Act (as in effect prior to the enactment
of this section) bore to $2,900,000,000. The allotment for
fiscal year 1989 and each succeeding fiscal year to American
Samoa shall be an amount which bears the same ratio to the
amount allotted to the Northern Mariana Islands for that fiscal
year as the population of American Samoa bears to the
population of the Northern Mariana Islands determined on the
basis of the most recent data available at the time such
allotment is determined.
* * * * * * *
STATE ADMINISTRATION
Sec. 2004. Prior to expenditure by a State of payments
made to it under section 2002 for any fiscal year, the State
shall report on the intended use of the payments the State is
to receive under [this title] this subtitle, including
information on the types of activities to be supported and the
categories or characteristics of individuals to be served. The
report shall be transmitted to the Secretary and made public
within the State in such manner as to facilitate comment by any
person (including any Federal or other public agency) during
development of the report and after its completion. The report
shall be revised throughout the year as may be necessary to
reflect substantial changes in the activities assisted under
[this title] this subtitle, and any revision shall be subject
to the requirements of the previous sentence.
LIMITATIONS ON USE OF GRANTS
Sec. 2005. (a) Except as provided in subsection (b),
grants made under [this title] this subtitle may not be used by
the State, or by any other person with which the State makes
arrangements to carry out the purposes of [this title] this
subtitle--
(1) for the purchase or improvement of land, or the
purchase, construction, or permanent improvement (other
than minor remodeling) of any building or other
facility;
(2) for the provision of cash payments for costs of
subsistence or for the provision of room and board
(other than costs of subsistence during rehabilitation,
room and board provided for a short term as an integral
but subordinate part of a social service, or temporary
emergency shelter provided as a protective service);
(3) for payment of the wages of any individual as a
social service (other than payment of the wages of
welfare recipients employed in the provision of child
day care services);
(4) for the provision of medical care (other than
family planning services, rehabilitation services, or
initial detoxification of an alcoholic or drug
dependent individual) unless it is an integral but
subordinate part of a social service for which grants
may be used under [this title] this subtitle;
(5) for social services (except services to an
alcoholic or drug dependent individual or
rehabilitation services) provided in and by employees
of any hospital, skilled nursing facility, intermediate
care facility, or prison, to any individual living in
such institution;
(6) for the provision of any educational service
which the State makes generally available to its
residents without cost and without regard to their
income;
(7) for any child day care services unless such
services meet applicable standards of State and local
law;
(8) for the provision of cash payments as a service
(except as otherwise provided in this section);
(9) for payment for any item or service (other than
an emergency item or service) furnished--
(A) by an individual or entity during the
period when such individual or entity is
excluded under [this title] this subtitle or
title V, XVIII, or XIX pursuant to section
1128, 1128A, 1156, or 1842(j)(2), or
(B) at the medical direction or on the
prescription of a physician during the period
when the physician is excluded under [this
title] this subtitle or title V, XVIII, or XIX
pursuant to section 1128, 1128A, 1156, or
1842(j)(2) and when the person furnishing such
item or service knew or had reason to know of
the exclusion (after a reasonable time period
after reasonable notice has been furnished to
the person); or
(10) in a manner inconsistent with the Assisted
Suicide Funding Restriction Act of 1997.
(b) The Secretary may waive the limitation contained in
subsection (a)(1) and (4) upon the State's request for such a
waiver if he finds that the request describes extraordinary
circumstances to justify the waiver and that permitting the
waiver will contribute to the State's ability to carry out the
purposes of [this title] this subtitle.
REPORTS AND AUDITS
Sec. 2006. (a) Each State shall prepare reports on its
activities carried out with funds made available (or
transferred for use) under [this title] this subtitle. Reports
shall be prepared annually, covering the most recently
completed fiscal year, and shall be in such form and contain
such information (including but not limited to the information
specified in subsection (c)) as the State finds necessary to
provide an accurate description of such activities, to secure a
complete record of the purposes for which funds were spent, and
to determine the extent to which funds were spent in a manner
consistent with the reports required by section 2004. The State
shall make copies of the reports required by this section
available for public inspection within the State and shall
transmit a copy to the Secretary. Copies shall also be
provided, upon request, to any interested public agency, and
each such agency may provide its views on these reports to the
Congress.
(b) Each State shall, not less often than every two years,
audit its expenditures from amounts received (or transferred
for use) under [this title] this subtitle. Such State audits
shall be conducted by an entity independent of any agency
administering activities funded under [this title] this
subtitle, in accordance with generally accepted auditing
principles. Within 30 days following the completion of each
audit, the State shall submit a copy of that audit to the
legislature of the State and to the Secretary. Each State shall
repay to the United States amounts ultimately found not to have
been expended in accordance with [this title] this subtitle, or
the Secretary may offset such amounts against any other amount
to which the State is or may become entitled under [this title]
this subtitle.
(c) Each report prepared and transmitted by a State under
subsection (a) shall set forth (with respect to the fiscal year
covered by the report)--
(1) the number of individuals who received services
paid for in whole or in part with funds made available
under [this title] this subtitle, showing separately
the number of children and the number of adults who
received such services, and broken down in each case to
reflect the types of services and circumstances
involved;
* * * * * * *
ADDITIONAL GRANTS
Sec. 2007. (a) Entitlement.-- * * *
* * * * * * *
(f) Definitions.--As Used In This Section:
(1) Qualified empowerment zone.-- * * *
* * * * * * *
(6) Urban area.--The term ``urban area'' has the
meaning given such term in section 1393(a)(3) of the
Internal Revenue Code of 1986.
* * * * * * *
Subtitle 2--Elder Justice
SEC. 2011. DEFINITIONS.
In this subtitle:
(1) Abuse.--The term ``abuse'' means the knowing
infliction of physical or psychological harm or the
knowing deprivation of goods or services that are
necessary to meet essential needs or to avoid physical
or psychological harm.
(2) Adult protective services.--The term ``adult
protective services'' means such services provided to
adults as the Secretary may specify and includes
services such as--
(A) disseminating reports of adult abuse,
neglect, or exploitation;
(B) investigating the reports described in
subparagraph (A);
(C) case planning, monitoring, evaluation,
and other case work and services; and
(D) providing, arranging for, or facilitating
the provision of medical, social service,
economic, legal, housing, law enforcement, or
other protective, emergency, or support
services.
(3) Caregiver.--The term ``caregiver'' means an
individual who has the responsibility for the care of
an elder, either voluntarily, by contract, by receipt
of payment for care, or as a result of the operation of
law, and means a family member or other individual who
provides (on behalf of such individual or of a public
or private agency, organization, or institution)
compensated or uncompensated care to an elder who needs
supportive services in any setting.
(4) Direct care.--The term ``direct care'' means care
by an employee or contractor who provides assistance or
long-term care services to a recipient.
(5) Elder.--The term ``elder'' means an individual
age 60 or older.
(6) Elder justice.--The term ``elder justice''
means--
(A) from a societal perspective, efforts to--
(i) prevent, detect, treat, intervene
in, and prosecute elder abuse, neglect,
and exploitation; and
(ii) protect elders with diminished
capacity while maximizing their
autonomy; and
(B) from an individual perspective, the
recognition of an elder's rights, including the
right to be free of abuse, neglect, and
exploitation.
(7) Eligible entity.--The term ``eligible entity''
means a State or local government agency, Indian tribe
or tribal organization, or any other public or private
entity that is engaged in and has expertise in issues
relating to elder justice or in a field necessary to
promote elder justice efforts.
(8) Exploitation.--The term ``exploitation'' means
the fraudulent or otherwise illegal, unauthorized, or
improper act or process of an individual, including a
caregiver or fiduciary, that uses the resources of an
elder for monetary or personal benefit, profit, or
gain, or that results in depriving an elder of rightful
access to, or use of, benefits, resources, belongings,
or assets.
(9) Fiduciary.--The term ``fiduciary''--
(A) means a person or entity with the legal
responsibility--
(i) to make decisions on behalf of
and for the benefit of another person;
and
(ii) to act in good faith and with
fairness; and
(B) includes a trustee, a guardian, a
conservator, an executor, an agent under a
financial power of attorney or health care
power of attorney, or a representative payee.
(10) Grant.--The term ``grant'' includes a contract,
cooperative agreement, or other mechanism for providing
financial assistance.
(11) Guardianship.--The term ``guardianship'' means--
(A) the process by which a State court
determines that an adult individual lacks
capacity to make decisions about self-care and
property, and appoints another individual or
entity known as a guardian, as a conservator,
or by a similar term, as a surrogate
decisionmaker;
(B) the manner in which the court-appointed
surrogate decisionmaker carries out duties to
the individual and the court; or
(C) the manner in which the court exercises
oversight of the surrogate decisionmaker.
(12) Indian tribe.--
(A) In general.--The term ``Indian tribe''
has the meaning given such term in section 4 of
the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b).
(B) Inclusion of pueblo and rancheria.--The
term ``Indian tribe'' includes any Pueblo or
Rancheria.
(13) Law enforcement.--The term ``law enforcement''
means the full range of potential responders to elder
abuse, neglect, and exploitation including--
(A) police, sheriffs, detectives, public
safety officers, and corrections personnel;
(B) prosecutors;
(C) medical examiners;
(D) investigators; and
(E) coroners.
(14) Long-term care.--
(A) In general.--The term ``long-term care''
means supportive and health services specified
by the Secretary for individuals who need
assistance because the individuals have a loss
of capacity for self-care due to illness,
disability, or vulnerability.
(B) Loss of capacity for self-care.--For
purposes of subparagraph (A), the term ``loss
of capacity for self-care'' means an inability
to engage in 1 or more activities of daily
living, including eating, dressing, bathing,
and management of one's financial affairs.
(15) Long-term care facility.--The term ``long-term
care facility'' means a residential care provider that
arranges for, or directly provides, long-term care.
(16) Neglect.--The term ``neglect'' means--
(A) the failure of a caregiver or fiduciary
to provide the goods or services that are
necessary to maintain the health or safety of
an elder; or
(B) self-neglect.
(17) Nursing facility.--
(A) In general.--The term ``nursing
facility'' has the meaning given such term
under section 1919(a).
(B) Inclusion of skilled nursing facility.--
The term ``nursing facility'' includes a
skilled nursing facility (as defined in section
1819(a)).
(18) Self-neglect.--The term ``self-neglect'' means
an adult's inability, due to physical or mental
impairment or diminished capacity, to perform essential
self-care tasks including--
(A) obtaining essential food, clothing,
shelter, and medical care;
(B) obtaining goods and services necessary to
maintain physical health, mental health, or
general safety; or
(C) managing one's own financial affairs.
(19) Serious bodily injury.--
(A) In general.--The term ``serious bodily
injury'' means an injury--
(i) involving extreme physical pain;
(ii) involving substantial risk of
death;
(iii) involving protracted loss or
impairment of the function of a bodily
member, organ, or mental faculty; or
(iv) requiring medical intervention
such as surgery, hospitalization, or
physical rehabilitation.
(B) Criminal sexual abuse.--Serious bodily
injury shall be considered to have occurred if
the conduct causing the injury is conduct
described in section 2241 (relating to
aggravated sexual abuse) or 2242 (relating to
sexual abuse) of title 18, United States Code,
or any similar offense under State law.
(20) Social.--The term ``social'', when used with
respect to a service, includes adult protective
services.
(21) State legal assistance developer.--The term
``State legal assistance developer'' means an
individual described in section 731 of the Older
Americans Act of 1965.
(22) State long-term care ombudsman.--The term
``State Long-Term Care Ombudsman'' means the State
Long-Term Care Ombudsman described in section 712(a)(2)
of the Older Americans Act of 1965.
SEC. 2012. GENERAL PROVISIONS.
(a) Protection of Privacy.--In pursuing activities under this
subtitle, the Secretary shall ensure the protection of
individual health privacy consistent with the regulations
promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 and applicable State
and local privacy regulations.
(b) Rule of Construction.--Nothing in this subtitle shall be
construed to interfere with or abridge an elder's right to
practice his or her religion through reliance on prayer alone
for healing when this choice--
(1) is contemporaneously expressed, either orally or
in writing, with respect to a specific illness or
injury which the elder has at the time of the decision
by an elder who is competent at the time of the
decision;
(2) is previously set forth in a living will, health
care proxy, or other advance directive document that is
validly executed and applied under State law; or
(3) may be unambiguously deduced from the elder's
life history.
PART A--NATIONAL COORDINATION OF ELDER JUSTICE ACTIVITIES AND RESEARCH
Subpart 1--Elder Justice Coordinating Council and Advisory Board on
Elder Abuse, Neglect, and Exploitation
SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL.
(a) Establishment.--There is established within the Office
of the Secretary an Elder Justice Coordinating Council (in this
section referred to as the ``Council'').
(b) Membership.--
(1) In general.--The Council shall be composed of the
following members:
(A) The Secretary (or the Secretary's
designee).
(B) The Attorney General (or the Attorney
General's designee).
(C) The head of each Federal department or
agency or other governmental entity identified
by the Chair referred to in subsection (d) as
having responsibilities, or administering
programs, relating to elder abuse, neglect, and
exploitation.
(2) Requirement.--Each member of the Council shall be
an officer or employee of the Federal Government.
(c) Vacancies.--Any vacancy in the Council shall not affect
its powers, but shall be filled in the same manner as the
original appointment was made.
(d) Chair.--The member described in subsection (b)(1)(A)
shall be Chair of the Council.
(e) Meetings.--The Council shall meet at least 2 times per
year, as determined by the Chair.
(f) Duties.--
(1) In general.--The Council shall make
recommendations to the Secretary for the coordination
of activities of the Department of Health and Human
Services, the Department of Justice, and other relevant
Federal, State, local, and private agencies and
entities, relating to elder abuse, neglect, and
exploitation and other crimes against elders.
(2) Report.--Not later than the date that is 2 years
after the date of enactment of the Elder Justice Act
and every 2 years thereafter, the Council shall submit
to the Committee on Finance of the Senate and the
Committee on Ways and Means and the Committee on Energy
and Commerce of the House of Representatives a report
that--
(A) describes the activities and
accomplishments of, and challenges faced by--
(i) the Council; and
(ii) the entities represented on the
Council; and
(B) makes such recommendations for
legislation, model laws, or other action as the
Council determines to be appropriate.
(g) Powers of the Council.--
(1) Information from federal agencies.--Subject to
the requirements of section 2012(a), the Council may
secure directly from any Federal department or agency
such information as the Council considers necessary to
carry out this section. Upon request of the Chair of
the Council, the head of such department or agency
shall furnish such information to the Council.
(2) Postal services.--The Council may use the United
States mails in the same manner and under the same
conditions as other departments and agencies of the
Federal Government.
(h) Travel Expenses.--The members of the Council shall not
receive compensation for the performance of services for the
Council. The members shall be allowed travel expenses,
including per diem in lieu of subsistence, at rates authorized
for employees of agencies under subchapter I of chapter 57 of
title 5, United States Code, while away from their homes or
regular places of business in the performance of services for
the Council. Notwithstanding section 1342 of title 31, United
States Code, the Secretary may accept the voluntary and
uncompensated services of the members of the Council.
(i) Detail of Government Employees.--Any Federal Government
employee may be detailed to the Council without reimbursement,
and such detail shall be without interruption or loss of civil
service status or privilege.
(j) Status as Permanent Council.--Section 14 of the Federal
Advisory Committee Act (5 U.S.C. App.) shall not apply to the
Council.
SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, AND EXPLOITATION.
(a) Establishment.--There is established a board to be known
as the ``Advisory Board on Elder Abuse, Neglect, and
Exploitation'' (in this section referred to as the ``Advisory
Board'') to create short- and long-term multidisciplinary
strategic plans for the development of the field of elder
justice and to make recommendations to the Elder Justice
Coordinating Council established under section 2021.
(b) Composition.--The Advisory Board shall be composed of 27
members appointed by the Secretary from among members of the
general public who are individuals with experience and
expertise in elder abuse, neglect, and exploitation prevention,
detection, treatment, intervention, or prosecution.
(c) Solicitation of Nominations.--The Secretary shall publish
a notice in the Federal Register soliciting nominations for the
appointment of members of the Advisory Board under subsection
(b).
(d) Terms.--
(1) In general.--Each member of the Advisory Board
shall be appointed for a term of 3 years, except that,
of the members first appointed--
(A) 9 shall be appointed for a term of 3
years;
(B) 9 shall be appointed for a term of 2
years; and
(C) 9 shall be appointed for a term of 1
year.
(2) Vacancies.--
(A) In general.--Any vacancy in the Advisory
Board shall not affect its powers, but shall be
filled in the same manner as the original
appointment was made.
(B) Filling unexpired term.--An individual
chosen to fill a vacancy shall be appointed for
the unexpired term of the member replaced.
(3) Expiration of terms.--The term of any member
shall not expire before the date on which the member's
successor takes office.
(e) Election of Officers.--The Advisory Board shall elect a
Chair and Vice Chair from among its members. The Advisory Board
shall elect its initial Chair and Vice Chair at its initial
meeting.
(f) Duties.--
(1) Enhance communication on promoting quality of,
and preventing abuse and neglect in, long-term care.--
The Advisory Board shall develop collaborative and
innovative approaches to improve the quality of,
including preventing abuse and neglect in, long-term
care.
(2) Collaborative efforts to develop consensus around
the management of certain quality-related factors.--
(A) In general.--The Advisory Board shall
establish multidisciplinary panels to address,
and develop consensus on, subjects relating to
improving the quality of long-term care. At
least 1 such panel shall address, and develop
consensus on, methods for managing resident-to-
resident abuse in long-term care.
(B) Activities conducted.--The
multidisciplinary panels established under
subparagraph (A) shall examine relevant
research and data, identify best practices with
respect to the subject of the panel, determine
the best way to carry out those best practices
in a practical and feasible manner, and
determine an effective manner of distributing
information on such subject.
(3) Report.--Not later than the date that is 18
months after the date of enactment of the Elder Justice
Act, and annually thereafter, the Advisory Board shall
prepare and submit to the Elder Justice Coordinating
Council, the Committee on Finance of the Senate, and
the Committee on Ways and Means and the Committee on
Energy and Commerce of the House of Representatives a
report containing--
(A) information on the status of Federal,
State, and local public and private elder
justice activities;
(B) recommendations (including recommended
priorities) regarding--
(i) elder justice programs, research,
training, services, practice,
enforcement, and coordination;
(ii) coordination between entities
pursuing elder justice efforts and
those involved in related areas that
may inform or overlap with elder
justice efforts, such as activities to
combat violence against women and child
abuse and neglect; and
(iii) activities relating to adult
fiduciary systems, including
guardianship and other fiduciary
arrangements;
(C) recommendations for specific
modifications needed in Federal and State laws
(including regulations) or for programs,
research, and training to enhance prevention,
detection, and treatment (including diagnosis)
of, intervention in (including investigation
of), and prosecution of elder abuse, neglect,
and exploitation;
(D) recommendations on methods for the most
effective coordinated national data collection
with respect to elder justice, and elder abuse,
neglect, and exploitation; and
(E) recommendations for a multidisciplinary
strategic plan to guide the effective and
efficient development of the field of elder
justice.
(g) Powers of the Advisory Board.--
(1) Information from federal agencies.--Subject to
the requirements of section 2012(a), the Advisory Board
may secure directly from any Federal department or
agency such information as the Advisory Board considers
necessary to carry out this section. Upon request of
the Chair of the Advisory Board, the head of such
department or agency shall furnish such information to
the Advisory Board.
(2) Sharing of data and reports.--The Advisory Board
may request from any entity pursuing elder justice
activities under the Elder Justice Act or an amendment
made by that Act, any data, reports, or recommendations
generated in connection with such activities.
(3) Postal services.--The Advisory Board may use the
United States mails in the same manner and under the
same conditions as other departments and agencies of
the Federal Government.
(h) Travel Expenses.--The members of the Advisory Board shall
not receive compensation for the performance of services for
the Advisory Board. The members shall be allowed travel
expenses for up to 4 meetings per year, including per diem in
lieu of subsistence, at rates authorized for employees of
agencies under subchapter I of chapter 57 of title 5, United
States Code, while away from their homes or regular places of
business in the performance of services for the Advisory Board.
Notwithstanding section 1342 of title 31, United States Code,
the Secretary may accept the voluntary and uncompensated
services of the members of the Advisory Board.
(i) Detail of Government Employees.--Any Federal Government
employee may be detailed to the Advisory Board without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
(j) Status as Permanent Advisory Committee.--Section 14 of
the Federal Advisory Committee Act (5 U.S.C. App.) shall not
apply to the advisory board.
SEC. 2023. RESEARCH PROTECTIONS.
(a) Guidelines.--The Secretary shall promulgate guidelines to
assist researchers working in the area of elder abuse, neglect,
and exploitation, with issues relating to human subject
protections.
(b) Definition of Legally Authorized Representative for
Application of Regulations.--For purposes of the application of
subpart A of part 46 of title 45, Code of Federal Regulations,
to research conducted under this subpart, the term ``legally
authorized representative'' means, unless otherwise provided by
law, the individual or judicial or other body authorized under
the applicable law to consent to medical treatment on behalf of
another person.
SEC. 2024. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated to carry out this
subpart--
(1) for fiscal year 2007, $6,500,000; and
(2) for each of fiscal years 2008 through 2010,
$7,000,000.
Subpart 2--Elder Abuse, Neglect, and Exploitation Forensic Centers
SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER ABUSE, NEGLECT, AND
EXPLOITATION FORENSIC CENTERS.
(a) In General.--The Secretary, in consultation with the
Attorney General, shall make grants to eligible entities to
establish and operate stationary and mobile forensic centers,
to develop forensic expertise regarding, and provide services
relating to, elder abuse, neglect, and exploitation.
(b) Stationary Forensic Centers.--The Secretary shall make 4
of the grants described in subsection (a) to institutions of
higher education with demonstrated expertise in forensics or
commitment to preventing or treating elder abuse, neglect, or
exploitation, to establish and operate stationary forensic
centers.
(c) Mobile Centers.--The Secretary shall make 6 of the grants
described in subsection (a) to appropriate entities to
establish and operate mobile forensic centers.
(d) Authorized Activities.--
(1) Development of forensic markers and
methodologies.--An eligible entity that receives a
grant under this section shall use funds made available
through the grant to assist in determining whether
abuse, neglect, or exploitation occurred and whether a
crime was committed and to conduct research to describe
and disseminate information on--
(A) forensic markers that indicate a case in
which elder abuse, neglect, or exploitation may
have occurred; and
(B) methodologies for determining, in such a
case, when and how health care, emergency
service, social and protective services, and
legal service providers should intervene and
when the providers should report the case to
law enforcement authorities.
(2) Development of forensic expertise.--An eligible
entity that receives a grant under this section shall
use funds made available through the grant to develop
forensic expertise regarding elder abuse, neglect, and
exploitation in order to provide medical and forensic
evaluation, therapeutic intervention, victim support
and advocacy, case review, and case tracking.
(3) Collection of evidence.--The Secretary, in
coordination with the Attorney General, shall use data
made available by grant recipients under this section
to develop the capacity of geriatric health care
professionals and law enforcement to collect forensic
evidence, including collecting forensic evidence
relating to a potential determination of elder abuse,
neglect, or exploitation.
(e) Application.--To be eligible to receive a grant under
this section, an entity shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section--
(1) for fiscal year 2007, $4,000,000;
(2) for fiscal year 2008, $6,000,000; and
(3) for each of fiscal years 2009 and 2010,
$8,000,000.
PART B--PROGRAMS TO PROMOTE ELDER JUSTICE
SEC. 2041. ENHANCEMENT OF LONG-TERM CARE.
(a) Grants and Incentives for Long-Term Care Staffing.--
(1) In general.--The Secretary shall carry out
activities, including activities described in
paragraphs (2) and (3), to provide incentives for
individuals to train for, seek, and maintain employment
providing direct care in a long-term care facility.
(2) Specific programs to enhance training,
recruitment, and retention of staff.--
(A) Coordination with other programs to
recruit and train long-term care staff.--The
Secretary shall coordinate activities under
this subsection with the Secretary of Labor and
the Assistant Secretary for the Administration
for Children and Families in order to provide
incentives to participants in programs carried
out under part A of title IV to train for and
seek employment providing direct care in a
long-term care facility.
(B) Career ladders and wage or benefit
increases to increase staffing in long-term
care facilities.--
(i) In general.--The Secretary shall
make grants to long-term care
facilities to carry out programs
through which the facilities--
(I) offer, to employees who
provide direct care to
residents of a long-term care
facility, continuing training
and varying levels of
certification, based on
observed clinical care
practices and the amount of
time the employees spend
providing direct care; and
(II) provide, or make
arrangements to provide,
bonuses or other increased
compensation or benefits to
employees who achieve
certification under such a
program.
(ii) Application.--To be eligible to
receive a grant under this
subparagraph, a long-term care facility
shall submit an application to the
Secretary at such time, in such manner,
and containing such information as the
Secretary may require (which may
include evidence of consultation with
the State in which the long-term care
facility is located with respect to
carrying out activities funded under
the grant).
(iii) Authority to limit number of
applicants.--Nothing in this
subparagraph shall be construed as
prohibiting the Secretary from limiting
the number of applicants for a grant
under this subparagraph.
(3) Specific programs to improve management
practices.--
(A) In general.--The Secretary shall make
grants to long-term care facilities to enable
the facilities to provide training and
technical assistance to eligible employees.
(B) Authorized activities.--A long-term care
facility that receives a grant under
subparagraph (A) shall use funds made available
through the grant to provide training and
technical assistance to eligible employees
regarding management practices using methods
that are demonstrated to promote retention of
individuals who provide direct care to
residents of the long-term care facility, such
as--
(i) the establishment of standard
human resource policies that reward
high performance, including policies
that provide for improved wages and
benefits on the basis of job reviews;
(ii) the establishment of
motivational and thoughtful work
organization practices;
(iii) the creation of a workplace
culture that respects and values
caregivers and their needs;
(iv) the promotion of a workplace
culture that respects the rights of
residents of a long-term care facility
and results in improved care for the
residents; and
(v) the establishment of other
programs that promote the provision of
high quality care, such as a continuing
education program that provides
additional hours of training, including
on-the-job training, for employees who
are certified nurse aides.
(C) Application.--To be eligible to receive a
grant under this paragraph, a long-term care
facility shall submit an application to the
Secretary at such time, in such manner, and
containing such information as the Secretary
may require (which may include evidence of
consultation with the State in which the long-
term care facility is located with respect to
carrying out activities funded under the
grant).
(D) Authority to limit number of
applicants.--Nothing in this paragraph shall be
construed as prohibiting the Secretary from
limiting the number of applicants for a grant
under this paragraph.
(E) Eligible employee defined.--In this
paragraph, the term ``eligible employee'' means
an individual who establishes or implements
management practices applicable with respect to
individuals who provide direct care to
residents of a long-term care facility and
includes administrators, directors of nursing,
staff developers, and charge nurses.
(4) Accountability measures.--The Secretary shall
develop accountability measures to ensure that the
activities conducted using funds made available under
this subsection benefit eligible employees and increase
the stability of the long-term care workforce.
(b) Informatics Systems Grant Program.--
(1) Grants authorized.--The Secretary is authorized
to make grants to long-term care facilities for the
purpose of assisting such entities in offsetting the
costs related to purchasing, leasing, developing, and
implementing standardized clinical health care
informatics systems designed to improve patient safety
and reduce adverse events and health care complications
resulting from medication errors.
(2) Use of grant funds.--Funds provided under grants
under this subsection may be used for any of the
following:
(A) Purchasing, leasing, and installing
computer software and hardware, including
handheld computer technologies.
(B) Making improvements to existing computer
software and hardware.
(C) Making upgrades and other improvements to
existing computer software and hardware to
enable e-prescribing.
(D) Providing education and training to
eligible long-term care facility staff on the
use of technology to implement the electronic
transmission of prescription and patient
information.
(3) Application.--To be eligible to receive a grant
under this subsection, a long-term care facility shall
submit an application to the Secretary at such time, in
such manner, and containing such information as the
Secretary may require (which may include evidence of
consultation with the State in which the long-term care
facility is located with respect to carrying out
activities funded under the grant).
(4) Authority to limit number of applicants.--Nothing
in this subsection shall be construed as prohibiting
the Secretary from limiting the number of applicants
for a grant under this subsection.
(5) Accountability measures.--The Secretary shall
develop accountability measures to ensure that the
activities conducted using funds made available under
this subsection help improve patient safety and reduce
adverse events and health care complications resulting
from medication errors.
(c) Inclusion of Adjudicated Crimes on Nursing Home Compare
Website.--Not later than 1 year after the date of enactment of
the Elder Justice Act, the Secretary shall ensure that the
Department of Health and Human Services includes, as part of
the information provided for comparison of nursing facilities
on the official Internet website of the Federal Government for
Medicare beneficiaries (commonly referred to as the ``Nursing
Home Compare'' Medicare website), the number of adjudicated
instances of criminal violations by a nursing facility or
crimes committed by an employee of a nursing facility--
(1) that were committed inside of the facility; and
(2) with respect to such instances of violations or
crimes committed outside of the facility, that were the
violations or crimes of elder abuse, neglect, and
exploitation, criminal sexual abuse of an elder, or
other violations or crimes that resulted in the serious
bodily injury of an elder.
(d) Development of Consumer Rights Information Page on
Nursing Home Compare Website.--Not later than 1 year after the
date of enactment of the Elder Justice Act, the Secretary shall
ensure that the Department of Health and Human Services, as
part of the information provided for comparison of nursing
facilities on the Nursing Home Compare Medicare website
develops and includes a consumer rights information page that
contains links to descriptions of, and information with respect
to, the following:
(1) The documentation on nursing facilities that is
available to the public.
(2) General information and tips on choosing a
nursing facility that meets the needs of the
individual.
(3) General information on consumer rights with
respect to nursing facilities.
(4) The nursing facility survey process (on a
national and State-specific basis).
(5) On a State-specific basis, the services available
through the State long-term care ombudsman for such
State.
(e) Development and Adoption of Standards for Transactions
Involving Clinical Data by Long-Term Care Facilities.--
(1) Standards.--The Secretary shall develop and adopt
uniform open electronic standards for transactions
involving clinical data by long-term care facilities.
Such standards shall include messaging and nomenclature
standards.
(2) Compatibility with other standards.--The
standards developed and adopted under paragraph (1)
shall be compatible with standards established under
part C of title XI, standards established under
subsections (b)(2)(B)(i) and (e)(4) of section 1860D-4,
and with general health information technology
standards.
(3) Electronic submission of data to the secretary.--
(A) In general.--Not later than 10 years
after the date of enactment of the Elder
Justice Act, the Secretary shall have
procedures in place to accept the optional
electronic submission of clinical data by long-
term care facilities pursuant to the standards
developed and adopted under paragraph (1).
(B) Rule of construction.--Nothing in this
subsection shall be construed to require a
long-term care facility to submit clinical data
electronically to the Secretary.
(f) Regulations.--The Secretary shall promulgate regulations
to carry out subsections (c), (d), and (e) of this section.
Such regulations shall require a State, as a condition of the
receipt of funds under this part, to conduct such data
collection and reporting as the Secretary determines are
necessary to satisfy the requirements of such subsections.
(g) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section--
(1) for fiscal year 2007, $20,000,000;
(2) for fiscal year 2008, $17,500,000; and
(3) for each of fiscal years 2009 and 2010,
$15,000,000.
SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND GRANT PROGRAMS.
(a) Secretarial Responsibilities.--
(1) In general.--The Secretary shall ensure that the
Department of Health and Human Services--
(A) provides funding authorized by this part
to State and local adult protective services
offices that investigate reports of the abuse,
neglect, and exploitation of elders;
(B) collects and disseminates data annually
relating to the abuse, exploitation, and
neglect of elders in coordination with the
Department of Justice;
(C) develops and disseminates information on
best practices regarding, and provides training
on, carrying out adult protective services;
(D) conducts research related to the
provision of adult protective services; and
(E) provides technical assistance to States
and other entities that provide or fund the
provision of adult protective services,
including through grants made under subsections
(b) and (c).
(2) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, $3,000,000 for fiscal year 2007 and
$4,000,000 for each of fiscal years 2008 through 2010.
(b) Grants to Enhance the Provision of Adult Protective
Services.--
(1) Establishment.--There is established an adult
protective services grant program under which the
Secretary shall annually award grants to States in the
amounts calculated under paragraph (2) for the purposes
of enhancing adult protective services provided by
States and local units of government.
(2) Amount of payment.--
(A) In general.--Subject to the availability
of appropriations and subparagraphs (B) and
(C), the amount paid to a State for a fiscal
year under the program under this subsection
shall equal the amount appropriated for that
year to carry out this subsection multiplied by
the percentage of the total number of elders
who reside in the United States who reside in
that State.
(B) Guaranteed minimum payment amount.--
(i) 50 states.--Subject to clause
(ii), if the amount determined under
subparagraph (A) for a State for a
fiscal year is less than 0.75 percent
of the amount appropriated for such
year, the Secretary shall increase such
determined amount so that the total
amount paid under this subsection to
the State for the year is equal to 0.75
percent of the amount so appropriated.
(ii) Territories.--In the case of a
State other than 1 of the 50 States,
clause (i) shall be applied as if each
reference to ``0.75'' were a reference
to ``0.1''.
(C) Pro rata reductions.--The Secretary shall
make such pro rata reductions to the amounts
described in subparagraph (A) as are necessary
to comply with the requirements of subparagraph
(B).
(3) Authorized activities.--
(A) Adult protective services.--Funds made
available pursuant to this subsection may only
be used by States and local units of government
to provide adult protective services and may
not be used for any other purpose.
(B) Use by agency.--Each State receiving
funds pursuant to this subsection shall provide
such funds to the agency or unit of State
government having legal responsibility for
providing adult protective services within the
State.
(C) Supplement not supplant.--Each State or
local unit of government shall use funds made
available pursuant to this subsection to
supplement and not supplant other Federal,
State, and local public funds expended to
provide adult protective services in the State.
(4) State reports.--Each State receiving funds under
this subsection shall submit to the Secretary, at such
time and in such manner as the Secretary may require, a
report on the number of elders served by the grants
awarded under this subsection.
(5) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, $100,000,000 for each of fiscal years 2007
through 2010.
(c) State Demonstration Programs.--
(1) Establishment.--The Secretary shall award grants
to States for the purposes of conducting demonstration
programs in accordance with paragraph (2).
(2) Demonstration programs.--Funds made available
pursuant to this subsection may be used by States and
local units of government to conduct demonstration
programs that test--
(A) training modules developed for the
purpose of detecting or preventing elder abuse;
(B) methods to detect or prevent financial
exploitation of elders;
(C) methods to detect elder abuse;
(D) whether training on elder abuse forensics
enhances the detection of elder abuse by
employees of the State or local unit of
government; or
(E) other matters relating to the detection
or prevention of elder abuse.
(3) Application.--To be eligible to receive a grant
under this subsection, a State shall submit an
application to the Secretary at such time, in such
manner, and containing such information as the
Secretary may require.
(4) State reports.--Each State that receives funds
under this subsection shall submit a report to the
Secretary at such time, in such manner, and containing
such information as the Secretary may require on the
results of the demonstration program conducted by the
State using funds made available under this subsection.
(5) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, $25,000,000 for each of fiscal years 2007
through 2010.
SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM GRANTS AND TRAINING.
(a) Grants to Support the Long-Term Care Ombudsman Program.--
(1) In general.--The Secretary shall make grants to
eligible entities with relevant expertise and
experience in abuse and neglect in long-term care
facilities or long-term care ombudsman programs and
responsibilities, for the purpose of--
(A) improving the capacity of State long-term
care ombudsman programs to respond to and
resolve complaints about abuse and neglect;
(B) conducting pilot programs with State
long-term care ombudsman offices or local
ombudsman entities; and
(C) providing support for such State long-
term care ombudsman programs and such pilot
programs (such as through the establishment of
a national long-term care ombudsman resource
center).
(2) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection--
(A) for fiscal year 2007, $5,000,000;
(B) for fiscal year 2008, $7,500,000; and
(C) for each of fiscal years 2009 and 2010,
$10,000,000.
(b) Ombudsman Training Programs.--
(1) In general.--The Secretary shall establish
programs to provide and improve ombudsman training with
respect to elder abuse, neglect, and exploitation for
national organizations and State long-term care
ombudsman programs.
(2) Authorization of appropriations.--There are
authorized to be appropriated to carry out this
subsection, for each of fiscal years 2007 through 2010,
$10,000,000.
PART C--COLLECTION OF DATA, DISSEMINATION OF INFORMATION, AND STUDIES
SEC. 2051. COLLECTION OF UNIFORM NATIONAL DATA ON ELDER ABUSE, NEGLECT,
AND EXPLOITATION.
(a) Purpose.--The purpose of this section is to improve,
streamline, and promote uniform collection, maintenance, and
dissemination of national data relating to the various types of
elder abuse, neglect, and exploitation.
(b) Phase I--Development.--
(1) In general.--Not later than the date that is 1
year after the date of enactment of the Elder Justice
Act, the Secretary, after consultation with the
Attorney General, shall develop--
(A) a method for collecting national data
regarding elder abuse, neglect, and
exploitation; and
(B) uniform national data reporting forms
adapted to each relevant entity or discipline
(such as health, public safety, social and
protective services, and law enforcement)
reflecting--
(i) the distinct manner in which each
entity or discipline receives and
maintains information; and
(ii) the sequence and history of
reports to, or involvement of,
different entities or disciplines,
independently, or the sequence and
history of reports from 1 entity or
discipline to another over time.
(2) Forms.--Subject to the requirements of section
2012(a), the national data reporting forms described in
paragraph (1)(B) shall incorporate the definitions of
this subtitle for use in determining whether an event
is reportable.
(c) Phase II--Pilot Tests.--
(1) In general.--Not later than the date that is 1
year after the date on which the activities described
in subsection (b)(1) are completed, the Secretary shall
ensure that the national data reporting forms and data
collection methods developed in accordance with such
subsection are pilot tested in 6 States selected by the
Secretary.
(2) Adjustments to the form and methods.--The
Secretary, after considering the results of the pilot
testing described in paragraph (1) and consultation
with the Attorney General, shall adjust the national
data reporting forms and data collection methods as
necessary.
(d) Phase III--National Distribution.--
(1) Distribution of national data reporting forms.--
After completion of the adjustment to the national data
reporting forms under subsection (c)(2), the Secretary
shall submit the national data reporting forms along
with instructions to--
(A) the heads of the relevant Federal
entities as may be appropriate; and
(B) the appropriate office of each State for
collection from all relevant State entities of
data, including health care, social services,
and law enforcement data.
(2) Data collection grants.--
(A) Authorization.--The Secretary is
authorized to award grants to States to improve
data collection activities relating to elder
abuse, neglect, and exploitation.
(B) Application.--To be eligible to receive a
grant under this paragraph, a State shall
submit an application to the Secretary at such
time, in such manner, and containing such
information as the Secretary may require.
(C) Requirements.--Each State receiving a
grant under this paragraph for a fiscal year
shall report data for the calendar year that
begins during that fiscal year, using the
national data reporting forms described in
paragraph (1).
(D) Funding.--
(i) First year.--For the first fiscal
year for which a State receives grant
funds under this paragraph, the
Secretary shall initially distribute 50
percent of such funds to the State. The
Secretary shall distribute the
remaining funds to the State at the end
of the calendar year that begins during
that fiscal year, if the Secretary
determines that the State has properly
reported data required under this
paragraph for the calendar year.
(ii) Subsequent years.--Except as
provided in clause (i), the Secretary
shall distribute grant funds to a State
under this paragraph for a fiscal year
if the Secretary determines that the
State properly reported data required
under this paragraph for the calendar
year that ends during that fiscal year.
(E) Required information.--Each report
submitted under this paragraph shall--
(i) indicate the State and year in
which each event occurred; and
(ii) identify the total number of
events that occurred in each State
during the year and the type of each
event.
(e) Report.--Not later than 1 year after the date of
enactment of the Elder Justice Act and annually thereafter, the
Secretary shall prepare and submit to the Committee on Finance
of the Senate and the Committee on Ways and Means and the
Committee on Energy and Commerce of the House of
Representatives a report regarding activities conducted under
this section.
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section--
(1) for fiscal year 2007, $10,000,000;
(2) for fiscal year 2008, $30,000,000; and
(3) for each of fiscal years 2009 and 2010,
$100,000,000.
SEC. 2052. LONG-TERM CARE CONSUMER CLEARINGHOUSE.
(a) Establishment.--The Secretary shall establish a long-term
care consumer clearinghouse.
(b) Information.--The clearinghouse shall provide
comprehensive detailed information, in a consumer-friendly
form, to consumers about choices relating to long-term care
providers, such as information about--
(1) obtaining the services of, and employing,
caregivers who provide long-term care at an
individual's home; and
(2) options for residential long-term care, such as--
(A)(i) the type of care provided by nursing
facilities; and
(ii) the type of care provided by group homes
and other residential long-term care facilities
that are not nursing facilities;
(B) the benefits related to long-term care
that are available through the programs carried
out under titles XVIII and XIX; and
(C) links to Federal and State Internet
websites that describe the care available
through specific long-term care facilities,
including data on the satisfaction level of
residents of, and families of residents of, the
facilities.
(c) Providers.--In providing information on long-term care
providers under this section, the clearinghouse shall provide
information (from States and other sources) on assisted living
facilities, board and care facilities, congregate care
facilities, home health care providers, and other long-term
care providers.
(d) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section--
(1) for fiscal year 2007, $2,000,000;
(2) for fiscal year 2008, $3,000,000; and
(3) for each of fiscal years 2009 and 2010,
$4,000,000.
SEC. 2053. CONSUMER INFORMATION ABOUT THE CONTINUUM OF RESIDENTIAL
LONG-TERM CARE FACILITIES.
(a) Study.--
(1) In general.--The Secretary, after consultation
with the Attorney General, shall, directly or through a
grant, conduct a study on consumer concerns relating to
residential long-term care facilities, other than
nursing facilities.
(2) Specific topics.--The entity conducting the study
shall--
(A) develop definitions for classes of the
residential long-term care facilities described
in paragraph (1); and
(B) collect information on the prices of,
level of services provided by, oversight and
enforcement provisions of, and admission and
discharge criteria of, the facilities.
(b) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section, for each of fiscal
years 2007 through 2010, $3,000,000.
SEC. 2054. PROVISION OF INFORMATION REGARDING, AND EVALUATIONS OF,
ELDER JUSTICE PROGRAMS.
(a) Provision of Information.--To be eligible to receive a
grant under this part, an applicant shall agree--
(1) except as provided in paragraph (2), to provide
the eligible entity conducting an evaluation under
subsection (b) of the activities funded through the
grant with such information as the eligible entity may
require in order to conduct such evaluation; or
(2) in the case of an applicant for a grant under
section 2041(b), to provide the Secretary with such
information as the Secretary may require to conduct an
evaluation or audit under subsection (c).
(b) Use of Eligible Entities To Conduct Evaluations.--
(1) Evaluations required.--Except as provided in
paragraph (2), the Secretary shall--
(A) reserve a portion (not less than 2
percent) of the funds appropriated with respect
to each program carried out under this part;
and
(B) use the funds reserved under subparagraph
(A) to provide assistance to eligible entities
to conduct evaluations of the activities funded
under each program carried out under this part.
(2) Informatics systems grant program not included.--
The provisions of this subsection shall not apply to
the informatics systems grant program under section
2041(b).
(3) Authorized activities.--A recipient of assistance
described in paragraph (1)(B) shall use the funds made
available through the assistance to conduct a validated
evaluation of the effectiveness of the activities
funded under a program carried out under this part.
(4) Applications.--To be eligible to receive
assistance under paragraph (1)(B), an entity shall
submit an application to the Secretary at such time, in
such manner, and containing such information as the
Secretary may require, including a proposal for the
evaluation.
(5) Reports.--Not later than a date specified by the
Secretary, an eligible entity receiving assistance
under paragraph (1)(B) shall submit to the Secretary,
the Committee on Ways and Means and the Committee on
Energy and Commerce of the House of Representatives,
and the Committee on Finance of the Senate a report
containing the results of the evaluation conducted
using such assistance together with such
recommendations as the entity determines to be
appropriate.
(c) Evaluations and Audits of Informatics Systems Grant
Program by the Secretary.--
(1) Evaluations.--The Secretary shall conduct an
evaluation of the activities funded under the
informatics systems grant program under section
2041(b). Such evaluation shall include an evaluation of
whether the funding provided under the grant is
expended only for the purposes for which it is made.
(2) Audits.--The Secretary shall conduct appropriate
audits of grants made under section 2041(b).
SEC. 2055. REPORT.
Not later than October 1, 2011, the Secretary shall submit to
the Elder Justice Coordinating Council, the Committee on
Finance of the Senate, and the Committee on Ways and Means and
the Committee on Energy and Commerce of the House of
Representatives a report--
(1) compiling, summarizing, and analyzing the
information contained in the State reports submitted
under subsections (b)(4) and (c)(4) of section 2042;
and
(2) containing--
(A) the results of the study conducted under
section 2053; and
(B) such recommendations for legislative or
administrative action as the Secretary
determines to be appropriate.''
* * * * * * *