[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1198 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1198
To reauthorize funding for programs to prevent and investigate elder
abuse, neglect, and exploitation, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 19, 2023
Mr. Wyden (for himself and Mr. Casey) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To reauthorize funding for programs to prevent and investigate elder
abuse, neglect, and exploitation, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Elder Justice Reauthorization and
Modernization Act of 2023''.
SEC. 2. REAUTHORIZATION OF FUNDING FOR PROGRAMS TO PREVENT AND
INVESTIGATE ELDER ABUSE, NEGLECT, AND EXPLOITATION.
(a) Nursing Home Worker Training Grants.--Section 2041 of the
Social Security Act (42 U.S.C. 1397m) is amended to read as follows:
``SEC. 2041. NURSING HOME WORKER TRAINING GRANTS.
``(a) In General.--
``(1) State entitlement.--
``(A) In general.--Each State shall be entitled to
receive from the Secretary for each fiscal year
specified in subsection (e)(1) a grant in an amount
equal to the amount allotted to the State under
subparagraph (B).
``(B) State allotments.--
``(i) In general.--Subject to clauses (ii)
and (iii), the amount allotted to a State under
this subparagraph for a fiscal year shall be--
``(I) the number of State residents
who have attained 65 years of age or
have a disability (as defined in
section 216(i)(1)), as determined by
the Secretary using the most recent
version of the American Community
Survey published by the Bureau of the
Census (or a successor data set);
divided by
``(II) the total number of such
residents of all States.
``(ii) Limitation.--The amount allotted to
a State under this subparagraph for a fiscal
year shall be not less than 0.25 percent of the
available amount for the fiscal year.
``(iii) Adjustment of state allotments.--
Subject to clause (ii), the Secretary shall
proportionately increase or decrease the
amounts allotted under this subparagraph for a
fiscal year as necessary to ensure that the
available amount for the fiscal year is
allotted among the States.
``(iv) Redeterminations.--
``(I) Frequency.--The Secretary
shall make the determination referred
to in clause (i)(I) every 5 years.
``(II) Limitation.--Subject to
clause (ii), the amount allotted to a
State under this subparagraph, on the
basis of such a determination, for a
fiscal year after fiscal year 2028
shall be--
``(aa) not less than 90
percent of the amount of the
grant made to the State under
this subparagraph for the then
preceding fiscal year; and
``(bb) not more than 110
percent of the amount referred
to in item (aa).
``(2) Grants to indian tribes and tribal organizations.--
``(A) In general.--The Secretary, in consultation
with the Secretary of the Interior, shall make grants
in accordance with this section to Indian tribes and
tribal organizations who operate at least 1 eligible
setting.
``(B) Grant formula.--The Secretary, in
consultation with the Secretary of the Interior, shall
devise a formula for distributing among Indian tribes
and tribal organizations the amount required to be
reserved by subsection (e)(1) for each fiscal year.
``(3) Sub-grants.--A State, Indian tribe, or tribal
organization to which an amount is paid under this section may
use the amount to make sub-grants to local organizations,
including community organizations, local non-profits, elder
rights and justice groups, and workforce development boards for
any purpose described in paragraph (1) or (2) of subsection
(b).
``(b) Use of Funds.--
``(1) Required uses.--A State to which an amount is paid
under this section shall use the amount to--
``(A) provide wage subsidies to eligible
individuals;
``(B) provide tuition assistance to, and directly
pay the cost of applicable licensing exam fees for,
eligible individuals for a degree or certification in a
field relevant to their position referred to in
subsection (f)(1)(A);
``(C) provide, subsidize, or facilitate access to
child care for eligible individuals, including help
with referrals, co-pays, or other direct assistance as
needed; and
``(D) provide assistance where necessary with
obtaining appropriate transportation, including public
transportation if available, or gas money or transit
vouchers for ride share, taxis, and similar types of
transportation if public transportation is unavailable
or impractical based on work hours or location.
``(2) Authorized uses.--A State to which an amount is paid
under this section may use the amount to--
``(A) establish a reserve fund for financial
assistance to eligible individuals in emergency
situations;
``(B) provide in-kind resource donations, such as
interview clothing and conference attendance fees;
``(C) provide assistance with programs and
activities, including legal assistance, deemed
necessary to address arrest or conviction records that
are an employment barrier;
``(D) support employers operating an eligible
setting in the State in providing employees with not
less than 2 weeks of paid leave per year; or
``(E) provide other support services the Secretary
deems necessary to allow for successful recruitment and
retention of workers.
``(3) Provision of funds only for the benefit of eligible
individuals in eligible settings.--A State to which an amount
is paid under this section may provide the amount to only an
eligible individual or a partner organization serving an
eligible individual.
``(4) Nonsupplantation.--A State to which an amount is paid
under this section shall not use the amount to supplant the
expenditure of any State funds for recruiting, supporting, or
retaining employees in an eligible setting.
``(5) Obligation deadline.--A State, Indian tribe, or
tribal organization shall remit to the Secretary for
reallotment under this section any amount paid under this
section for a fiscal year that is not obligated within 2 years
after the end of the fiscal year.
``(c) Administration.--A State to which a grant is made under this
section shall reserve not more than 10 percent of the grant to--
``(1) administer subgrants in accordance with this section;
``(2) provide technical assistance and support for applying
for and accessing such a subgrant opportunity;
``(3) publicize the availability of the subgrants;
``(4) carry out activities to increase the supply of
eligible individuals; and
``(5) provide technical assistance to help subgrantees find
and train individuals to provide the services for which such
individuals are contracted.
``(d) Reports.--
``(1) State reports.--Not less frequently than annually,
each State to which a grant has been made under this section
shall transmit to the Secretary a written report describing the
activities undertaken by the State pursuant to this section
during the period covered by the report, which shall include a
specification of--
``(A) the total amount expended in the State for
each type of use described in paragraph (1) or (2) of
subsection (b);
``(B) the total number of non-State organizations
in the State to which grant funds were provided, and
the amount so provided to each such organization;
``(C) the change in the number of individuals
working in each job category described in subsection
(f)(1)(A) in an eligible setting in the State due to
programs or services funded with grants under this
section;
``(D) the average duration of employment for each
such job category for individuals receiving, or who
previously received, services or supports from a grant
under this section;
``(E) wages of workers in each job category
described in subsection (f)(1)(A) in an eligible
setting in the State with support from grants under
this section, as compared to all other workers in the
same eligible setting in the State;
``(F) the average amount of paid time off to which
a worker in each job category described in subsection
(f)(1)(A) in an eligible setting in the State is
entitled by their contract among workers with support
from a grant under this section, as compared to all
workers in eligible settings in the State; and
``(G) such other data elements as the Secretary
deems relevant.
``(2) Report to congress.--Not later than 3 years after the
date of the enactment of this section, and every 4 years
thereafter, the Secretary shall submit to Congress a written
report outlining how the States have used the grants made under
this section during the period covered by the report, which
shall include--
``(A) the total amount expended in each State for
each type of use described in paragraph (1) or (2) of
subsection (b);
``(B) the total number of non-State organizations
in each State to which grant funds were provided, and
the amount so provided to each such organization;
``(C) an analysis of the data provided in the State
reports; and
``(D) such other data elements as the Secretary
deems relevant.
``(e) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the Secretary
$400,000,000 for each of fiscal years 2024 through 2027 to carry out
this section, of which 2 percent shall be reserved for grants to Indian
tribes and tribal organizations.
``(f) Definitions.--In this section:
``(1) Available amount.--The term `available amount' means,
with respect to a fiscal year, the amount specified in
subsection (e) that remains after the reservation required by
such subsection for the fiscal year, plus all amounts remitted
to the Secretary under subsection (b)(5) that have not been
reallotted under subsection (a)(1)(B)(iii).
``(2) Eligible individual.--The term `eligible individual'
means an individual who--
``(A)(i) is a qualified home health aide, as
defined in section 484.80(a) of title 42, Code of
Federal Regulations;
``(ii) is a nurse aide approved by the State as
meeting the requirements of sections 483.150 through
483.154 of such title, and is listed in good standing
on the State nurse aide registry;
``(iii) is a personal care aide approved by the
State, and furnishes personal care services, as defined
in section 440.167 of such title;
``(iv) is a qualified hospice aide, as defined in
section 418.76 of such title;
``(v) is a licensed practical nurse or a licensed
or certified social worker; or
``(vi) is receiving training to be certified or
licensed as such an aide, nurse, or social worker; and
``(B) provides (or, in the case of a trainee,
intends to provide) services as such an aide, nurse, or
social worker in an eligible setting.
``(3) Eligible setting.--The term `eligible setting'
means--
``(A) a skilled nursing facility, as defined in
section 1819;
``(B) a nursing facility, as defined in section
1919;
``(C) a home health agency, as defined in section
1891;
``(D) a facility approved to deliver home or
community-based services authorized under State options
described in subsection (c) or (i) of section 1915 or,
as relevant, demonstration projects authorized under
section 1115;
``(E) a hospice, as defined in section 1814; or
``(F) a tribal assisted living facility.
``(4) Tribal organization.--The term `tribal organization'
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act.''.
(b) Adult Protective Services Functions and Grant Programs.--
(1) Direct funding; state entitlement.--Section 2042 of the
Social Security Act (42 U.S.C. 1397m-1) is amended--
(A) in subsection (a), by striking paragraph (2)
and inserting the following:
``(2) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$8,000,000 for each of fiscal years 2024 through 2027 to carry
out this section.'';
(B) in subsection (b)--
(i) in paragraph (2)(A), by striking ``the
availability of appropriations and''; and
(ii) by striking paragraph (5) and
inserting the following:
``(5) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$400,000,000 for each of fiscal years 2024 through 2027 to
carry out this section.''; and
(C) in subsection (c), by striking paragraph (6)
and inserting the following:
``(6) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$75,000,000 for each of fiscal years 2024 through 2027 to carry
out this section.''.
(2) State entitlement; grants to indian tribes and tribal
organizations.--Section 2042 of such Act (42 U.S.C. 1397m-1),
as amended by paragraph (1), is amended--
(A) in subsection (a)(1)(A), by striking ``State
and local'' and inserting ``State, local, and tribal'';
(B) in subsection (b)--
(i) in paragraph (1), by striking ``the
Secretary shall annually award grants to States
in the amounts calculated under paragraph (2)''
and inserting ``each State shall be entitled to
annually receive from the Secretary in the
amounts calculated under paragraph (2), and the
Secretary may annually award to each Indian
tribe and tribal organization in accordance
with paragraph (3), grants'';
(ii) in paragraph (2)--
(I) in the paragraph heading, by
inserting ``for a state'' after
``payment'';
(II) in subparagraph (A), by
inserting ``that remains after the
reservation under paragraph (3)(B)''
before ``multiplied''; and
(III) in subparagraph (B)(i)--
(aa) by inserting ``that so
remains'' after ``such year'';
and
(bb) by striking ``amount
so appropriated'' and inserting
``remaining amount''; and
(iii) by redesignating paragraphs (3)
through (5) as paragraphs (4) through (6),
respectively, and inserting after paragraph (2)
the following:
``(3) Amount of payment to indian tribe or tribal
organization.--
``(A) In general.--The Secretary, in consultation
with Indian tribes and tribal organizations, shall
determine the amount of any grant to be made to each
Indian tribe and tribal organization from the amount
reserved under subparagraph (B). Paragraphs (4) and (5)
shall apply to grantees under this paragraph in the
same manner in which such paragraphs apply to States.
``(B) Reservation of funds.--The Secretary shall
reserve 2 percent of the amount made available by
subsection (b)(6) for each fiscal year for grants under
this paragraph.'';
(C) in subsection (c)--
(i) in paragraph (1), by striking ``to
States'' and inserting ``to States, Indian
tribes, and tribal organizations'';
(ii) in paragraph (2)--
(I) in the matter preceding
subparagraph (A), by inserting ``and
Indian tribes and tribal
organizations'' after ``government'';
and
(II) in subparagraph (D), by
inserting ``or Indian tribe or tribal
organization, as the case may be''
after ``government'';
(iii) in paragraph (4), by inserting ``or
Indian tribe or tribal organization'' after ``a
State'' the first place it appears; and
(iv) in paragraph (5)--
(I) by inserting ``or Indian tribe
or tribal organization'' after ``Each
State''; and
(II) by inserting ``or Indian tribe
or tribal organization, as the case may
be'' after ``the State''; and
(D) by adding at the end the following:
``(d) Definition of Tribal Organization.--In this section, the term
`tribal organization' has the meaning given the term in section 4 of
the Indian Self-Determination and Education Assistance Act.''.
(c) Long-Term Care Ombudsman Program Grants and Training.--Section
2043 of the Social Security Act (42 U.S.C. 1397m-2) is amended--
(1) in subsection (a), by striking paragraph (2) and
inserting the following:
``(2) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
to carry out this subsection--
``(A) $22,500,000 for fiscal year 2024; and
``(B) $30,000,000 for each of fiscal years 2025 and
2026.''; and
(2) in subsection (b), by striking paragraph (2) and
inserting the following:
``(2) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$30,000,000 for each of fiscal years 2024 through 2027 to carry
out this subsection.''.
(d) Incentives for Developing and Sustaining Structural Competency
in Providing Health and Human Services.--
(1) In general.--Part II of subtitle B of title XX of the
Social Security Act (42 U.S.C. 397m-5) is amended by adding at
the end the following:
``SEC. 2047. INCENTIVES FOR DEVELOPING AND SUSTAINING STRUCTURAL
COMPETENCY IN PROVIDING HEALTH AND HUMAN SERVICES.
``(a) Grants to States To Support Linkages to Legal Services and
Medical Legal Partnerships.--
``(1) In general.--Not later than 2 years after the date of
the enactment of this section, the Secretary shall establish
and administer a program of grants to States to support the
development or adoption of approaches to maintain or improve
linkages between health services, human services, and legal
services for older adults and adults with disabilities,
including through the following:
``(A) Medical-legal partnerships.--The
establishment and support of medical-legal
partnerships, the incorporation of the partnerships in
the elder justice framework and health and human
services safety net, and the implementation and
operation of such a partnership by an eligible
grantee--
``(i) at the option of a State, in
conjunction with an area agency on aging;
``(ii) in a solo provider practice in a
health professional shortage area (as defined
in section 332(a) of the Public Health Service
Act), a medically underserved community (as
defined in section 399B of such Act), or a
rural area (as defined in section 330J(e) of
such Act);
``(iii) in a minority-serving institution
(defined for purposes of this section as an
eligible institution described in section
371(a) of the Higher Education Act of 1965)
with health, law, and social services
professional programs;
``(iv) in an entity receiving funding
section 330 of the Public Health Service Act or
a look-alike, as described in section
1905(l)(2)(B); or
``(v) in certain hospitals that are
critical access hospitals (as defined in
section 1861(mm)(1)), medicare-dependent, small
rural hospitals (as defined in subsection
(d)(5)(G)(iv)), sole community hospitals (as
defined in section 1886(d)(5)(D)(iii)), rural
emergency hospitals (as defined in section
1861(kkk)), or hospitals that receive
disproportionate share hospital payments under
section 1886(d)(5)(F) or section 1923.
``(B) Legal hotlines development or expansion.--The
provision of incentives to develop, enhance, and
integrate platforms, such as legal assistance hotlines,
that help to facilitate the identification of older
adults and adults with disabilities who could benefit
from linkages to available legal services such as those
described in subparagraph (A).
``(2) State reports.--Each State to which a grant is made
under this subsection shall submit to the Secretary biannual
reports on the activities carried out by the State pursuant to
this subsection, which shall include assessments of the
effectiveness of the activities with respect to--
``(A) the number of unique individuals identified
through the mechanism outlined in paragraph (1)(B) who
are referred to services described in paragraph (1)(A),
and the average time period associated with resolving
issues;
``(B) the success rate for referrals to community-
based resources; and
``(C) other factors determined relevant by the
Secretary.
``(3) Report to congress.--Not less than once every 2
years, the Secretary shall submit to Congress a report that
analyzes the data provided by the State reports and the extent
to which grantees are establishing linkages to medical-legal
partnerships and other legal services for older adults and
adults with disabilities.
``(4) Report to congress.--Not less that once every 4
years, the Secretary shall submit to Congress a written report
on the activities conducted under this subsection.
``(5) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$125,000,000 for each of fiscal years 2024 through 2027 to
carry out this subsection.
``(6) Supplement not supplant.--Support provided to area
agencies on aging, State units on aging, eligible entities, or
other community-based organizations pursuant to this subsection
shall be used to supplement and not supplant any other Federal,
State, or local funds expended to provide the same or
comparable services described in this subsection.
``(b) Grants and Training To Support Area Agencies on Aging or
Other Community-Based Organizations To Address Social Isolation Among
Older Adults and Adults With Disabilities.--
``(1) Grants.--The Secretary shall make grants to eligible
area agencies on aging or other community-based organizations
for the purpose of--
``(A) conducting outreach to individuals at risk
for, or already experiencing, social isolation or
loneliness, through established screening tools or
other methods identified by the Secretary;
``(B) developing community-based interventions for
the purposes of mitigating loneliness or social
isolation (including evidence-based programs, as
defined by the Secretary, developed with multi-
stakeholder input for the purposes of promoting social
connection, mitigating social isolation or loneliness,
or preventing social isolation or loneliness) among at-
risk individuals;
``(C) connecting at-risk individuals with community
social and clinical supports; and
``(D) evaluating the effect of programs developed
and implemented under subparagraphs (B) and (C).
``(2) Training.--
``(A) In general.--The Secretary shall establish
programs to provide and improve training for area
agencies on aging or community-based organizations with
respect to addressing and preventing social isolation
and loneliness among older adults and adults with
disabilities.
``(B) Prioritization authority.--For purposes of
connecting at-risk individuals with existing community
social and clinical supports, the Secretary may, in
carrying out subparagraph (A), prioritize models that
incorporate training and service delivery in
coordination with medical-legal partnerships.
``(3) Evaluation.--Not later than 3 years after the date of
the enactment of this section and every 3 years thereafter, the
Secretary shall submit to Congress a written report that
assesses the extent to which the programs established under
this subsection address social isolation and loneliness among
older adults and adults with disabilities.
``(4) Appropriation.--Out of any money in the Treasury not
otherwise appropriated, there are appropriated to the Secretary
$62,500,000 for each of fiscal years 2024 through 2027 to carry
out this subsection.
``(5) Coordination.--The Secretary shall coordinate with
resource centers, grant programs, or other funding mechanisms
established under section 411(a)(18) of the Older Americans Act
(42 U.S.C. 3032(a)(18)), section 417(a)(1) of such Act (42
U.S.C. 3032F(a)(1)), or other programs as determined by the
Secretary.
``(c) Definitions.--In this section:
``(1) Area agency on aging.--The term `area agency on
aging' means an area agency on aging designated under section
305 of the Older Americans Act of 1965 (42 U.S.C. 3025).
``(2) Community-based organization.--The term `community-
based organization' includes, except as otherwise provided by
the Secretary, a nonprofit community-based organization, a
consortium of nonprofit community-based organizations, a
national nonprofit organization acting as an intermediary for a
community-based organization, or a community-based organization
that has a fiscal sponsor that allows the organization to
function as an organization described in section 501(c)(3) of
the Internal Revenue Code of 1986 and exempt from taxation
under section 501(a) of such Code.
``(3) Loneliness.--The term `loneliness' means subjectively
feeling alone, or the discrepancy between one's desired level
of social connection and one's actual level of social
connection.
``(4) Social connection.--The term `social connection'
means the variety of ways one can connect with others socially,
through physical, behavioral, social-cognitive, and emotional
channels.
``(5) Social isolation.--The term `social isolation' means
objectively being alone, or having few relationships or
infrequent social contact.''.
(2) Clarification that medical-legal partnerships are
authorized adult protective services activities.--Section 2011
of such Act (42 U.S.C. 1397j) is amended--
(A) in paragraph (2)(D), by inserting ``, including
through a medical-legal partnership'' before the
period; and
(B) by redesignating paragraphs (16) through (22)
as paragraphs (17) through (23), respectively, and
inserting after paragraph (15) the following:
``(16) Medical-legal partnership.--The term `medical-legal
partnership' means an arrangement in a health care or human
services setting that integrates lawyers and social workers to
address the needs of an individual patient related to social
determinants of health, and to help clinicians, case managers,
and social workers address structural problems at the root of
many health inequities, including a multidisciplinary team
integrated into such a setting to address such needs and to
establish and maintain structural competence among clinicians,
case managers, and social workers to best address structural
problems at the root of many health inequities.''.
(e) Technical Amendment.--Section 2011(12)(A) of the Social
Security Act (42 U.S.C. 1397j(12)(A)) is amended by striking ``450b''
and inserting ``5304''.
SEC. 3. ASSESSMENT REPORTS.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, and not less frequently than once every 2 years
thereafter, the Secretary of Health and Human Services shall submit a
report to the Committee on Ways and Means of the House of
Representatives and the Committee on Finance and the Special Committee
on Aging of the Senate on the programs, coordinating bodies,
registries, and activities established or authorized under subtitle B
of title XX of the Social Security Act (42 U.S.C. 1397l et seq.), as
amended by sections 2 and 3, section 1150B of such Act (42 U.S.C.
1320b-25, or paragraphs (1) and (2) of section 6703(b) of the Patient
Protection and Affordable Care Act (42 U.S.C. 1395i-3a(b)). Each such
report shall assess the extent to which such programs, coordinating
bodies, registries, and activities have improved access to, and the
quality of, resources available to older adults, adults with
disabilities, and their caregivers to ultimately prevent, detect, and
treat abuse, neglect, and exploitation, and shall include, as
appropriate, recommendations to Congress on funding levels and policy
changes to help these programs, coordinating bodies, registries, and
activities better prevent, detect, and treat abuse, neglect, and
exploitation of older adults and adults with disabilities.
(b) Appropriation.--Out of any money in the Treasury not otherwise
appropriated, there are appropriated to the Secretary of Health and
Human Services $5,000,000 for each of fiscal years 2024 through 2027 to
carry out this section.
<all>