[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2620 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 2620

  To amend the Older Americans Act of 1965 to authorize the Assistant 
Secretary for Aging to provide allotments to eligible States to provide 
older individuals with financial assistance to select a flexible range 
   of home and community-based long-term care services or supplies, 
    provided in a manner that respects the individuals' choices and 
                              preferences.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 7, 2006

 Mrs. Clinton introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To amend the Older Americans Act of 1965 to authorize the Assistant 
Secretary for Aging to provide allotments to eligible States to provide 
older individuals with financial assistance to select a flexible range 
   of home and community-based long-term care services or supplies, 
    provided in a manner that respects the individuals' choices and 
                              preferences.

    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 ``Community-Based Choices for Older 
Americans Act of 2006''.

SEC. 2. PURPOSE.

    The purpose of this Act is to provide grants to States in order to 
achieve the following:
            (1) To enable eligible individuals to make informed choices 
        about the long-term care services and supplies that best meet 
        their needs and preferences.
            (2) To provide financial assistance to older individuals to 
        purchase a flexible range of long-term care services or 
        supplies in a manner that respects the individuals' cultural, 
        ethnic, and lifestyle preferences in the least restrictive 
        settings possible.
            (3) To make the purchase of long-term care services and 
        supplies delivered in a home or community-based setting, such 
        as a naturally occurring retirement community, more affordable 
        for individuals with financial need.
            (4) To help families continue to care for their older 
        relatives with long-term care needs, including older 
        individuals with physical and cognitive impairments, and to 
        help reduce the number of older individuals who are forced to 
        impoverish themselves in order to pay for the long-term care 
        services and supplies they need.
            (5) To help relieve financial pressure on the medicaid 
        program by delaying or preventing older individuals from 
        spending down their income and assets to medicaid eligibility 
        thresholds.
            (6) To concentrate the resources made available under this 
        Act to those individuals with the greatest economic need for 
        long-term care services and supplies.

SEC. 3. ESTABLISHMENT OF THE NATIONAL LONG-TERM CARE CHOICE PROGRAM.

    The Older Americans Act of 1965 (42 U.S.C. 3001 et seq.) is amended 
by adding at the end the following:

          ``TITLE VIII--NATIONAL LONG-TERM CARE CHOICE PROGRAM

``SEC. 801. DEFINITIONS.

    ``In this title:
            ``(1) Caregiver.--The term `caregiver' means an adult 
        family member, or another individual, who is a paid or unpaid 
        provider of home or community-based care to an eligible 
        individual.
            ``(2) Consumer choice.--The term `consumer choice' means 
        the opportunity for an eligible individual--
                    ``(A) to have greater control over the covered 
                long-term care services and supplies the individual 
                receives; and
                    ``(B) to elect--
                            ``(i) to receive a payment under this title 
                        through a fiscal intermediary as described in 
                        section 806(b)(2)(B) for the purpose of 
                        purchasing covered long-term care services or 
                        supplies; or
                            ``(ii) to receive such services or supplies 
                        from a provider paid by the State involved (or 
                        its designee) as described in section 
                        806(b)(2)(A).
            ``(3) Covered long-term care services or supplies.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `covered long-term care services or supplies' 
                means any of the following services or supplies, but 
                only if, with respect to an eligible individual, such 
                services or supplies are not available or not eligible 
                for payment by any entity carrying out a program 
                described in section 804(b)(8) or a similar third 
                party:
                            ``(i) Adult day services (including health 
                        and social day care services).
                            ``(ii) Bill paying.
                            ``(iii) Care-related supplies and 
                        equipment.
                            ``(iv) Companion services.
                            ``(v) Congregate meals.
                            ``(vi) Environmental modifications.
                            ``(vii) Fiscal intermediary services.
                            ``(viii) Home-delivered meals.
                            ``(ix) Home health services.
                            ``(x) Homemaker services (including chore 
                        services).
                            ``(xi) Mental and behavioral health 
                        services.
                            ``(xii) Nutritional counseling.
                            ``(xiii) Personal care services.
                            ``(xiv) Personal emergency response 
                        systems.
                            ``(xv) Respite care.
                            ``(xvi) Telemedicine devices.
                            ``(xvii) Transition services for 
                        individuals who have a plan that meets such 
                        requirements as a State shall establish, to 
                        relocate from a nursing home to a home or 
                        community-based setting within 60 days.
                            ``(xviii) Transportation.
                            ``(xix) Any service or supply that a State 
                        describes in its State plan and is approved by 
                        the Assistant Secretary.
                            ``(xx) Any service or supply that is 
                        requested by an eligible individual (in 
                        coordination with the individual's service 
                        coordinator) and that is approved by the State.
                    ``(B) Exclusions.--
                            ``(i) Service coordination.--Such term does 
                        not include a service directly provided by the 
                        service coordinator for an eligible individual 
                        as part of service coordination under this 
                        title.
                            ``(ii) Services for nursing home 
                        residents.--Such term does not include any 
                        service for a resident of a nursing home, 
                        except a service described in subparagraph 
                        (A)(xvii).
            ``(4) Eligible individual.--The term `eligible individual' 
        means an individual--
                    ``(A) who is age 60 or older;
                    ``(B) who is not eligible for medical assistance 
                under the medicaid program established under title XIX 
                of the Social Security (42 U.S.C. 1396 et seq.);
                    ``(C) who meets such income eligibility and total 
                asset criteria as a State may establish;
                    ``(D) who--
                            ``(i)(I) is unable to perform (without 
                        substantial assistance from another individual) 
                        at least 2 activities of daily living (such as 
                        eating, toileting, transferring, bathing, 
                        dressing, and continence); or
                            ``(II) at the option of the State, is 
                        unable to perform at least 3 such activities 
                        without such assistance;
                            ``(ii) has a level of disability similar 
                        (as determined by the State) to the level of 
                        disability described in clause (i); or
                            ``(iii) requires substantial supervision 
                        due to cognitive or mental impairment; and
                    ``(E) who satisfies such other eligibility criteria 
                as the State may establish in accordance with such 
                guidance as the Assistant Secretary may provide.
            ``(5) Eligible state.--The term `eligible State' means a 
        State with an approved State plan under section 804.
            ``(6) Fiscal intermediary.--The term `fiscal intermediary' 
        means an entity that--
                    ``(A) assists individuals who choose to employ 
                providers of covered long-term care services or 
                supplies directly, to--
                            ``(i) carry out employer-related 
                        responsibilities, as designated by a State with 
                        the approval of the Assistant Secretary;
                            ``(ii) assure compliance with Federal, 
                        State, and local law; and
                            ``(iii) assure compliance with other 
                        requirements designated by the State; and
                    ``(B) receives and disburses, as described in 
                section 806(b)(2)(B), payments described in section 
                806(b).
            ``(7) Fiscal intermediary service.--The term `fiscal 
        intermediary service' means a service to enable an eligible 
        individual to carry out a responsibility described in 
        subparagraph (A)(i) or (B) of paragraph (6) or assure 
        compliance with Federal, State, or local law, or another 
        requirement designated by the State.
            ``(8) Long-term care.--The term `long-term care' means a 
        wide range of supportive social, health, and mental health 
        services for individuals who do not have the capacity for self-
        care due to illness or frailty.
            ``(9) Naturally occurring retirement community.--The term 
        `naturally occurring retirement community' means a residential 
        area (such as an apartment building, housing complex or 
        development, or neighborhood) not originally built for older 
        individuals but in which a substantial number of individuals 
        have aged in place and become older individuals.
            ``(10) Nursing home.--The term `nursing home' means--
                    ``(A) a nursing facility, as defined in section 
                1919(a) of the Social Security Act (42 U.S.C. 
                1396r(a));
                    ``(B) a skilled nursing facility, as defined in 
                section 1819(a) of such Act (42 U.S.C. 1395i-3(a)); and
                    ``(C) a residential care facility that directly 
                provides care or services described in paragraph (1) of 
                section 1919(a) of the Social Security Act (42 U.S.C. 
                1396r(a)) but does not receive payment for such care or 
                services under the medicare or medicaid programs 
                established under titles XVIII and XIX, respectively, 
                of the Social Security Act (42 U.S.C. 1395 et seq., 
                1396 et seq.).
            ``(11) Qualified provider.--The term `qualified provider' 
        means a provider of covered long-term care services or supplies 
        who meets such licensing, quality, and other standards as the 
        State may establish.
            ``(12) Representative.--The term `representative' means a 
        person appointed by the eligible individual, or legally acting 
        on the individual's behalf, to represent or advise the 
        individual in financial or service coordination matters.
            ``(13) Service coordination.--The term `service 
        coordination' means a service that--
                    ``(A) is provided to an eligible individual, at the 
                direction of the eligible individual or a 
                representative of the eligible individual (as 
                appropriate); and
                    ``(B) consists of facilitating consumer choice or 
                carrying out--
                            ``(i) a function described in section 805; 
                        or
                            ``(ii) a function described in section 
                        804(9), as determined appropriate by the State 
                        involved.
            ``(14) Service coordinator.--The term `service coordinator' 
        means an individual who--
                    ``(A) provides service coordination for an eligible 
                individual; and
                    ``(B) is trained or experienced in the skills that 
                are required to facilitate consumer choice and carry 
                out the functions described in paragraph (13)(B).
            ``(15) State.--The term `State' means each of the 50 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, Guam, the United States Virgin Islands, American Samoa, 
        and the Commonwealth of the Northern Mariana Islands.

``SEC. 802. ALLOTMENTS TO ELIGIBLE STATES.

    ``(a) Allotments.--
            ``(1) In general.--The Assistant Secretary shall make an 
        allotment to each eligible State for a fiscal year, to enable 
        the State to carry out a program that pays for the Federal 
        share of the cost of providing covered long-term care services 
        and supplies for eligible individuals under this title. The 
        Assistant Secretary shall make the allotment in an amount 
        determined under section 803.
            ``(2) Limitations.--From an allotment made under paragraph 
        (1) for a program carried out in a State under this title for a 
        fiscal year, not more than 15 percent may be used to pay for 
        administrative costs (other than service coordination) of the 
        program.
    ``(b) Federal Share.--From that allotment for that fiscal year--
            ``(1) funds from the allotment shall be available to such 
        State for paying a Federal share equal to such percentage as 
        the State determines to be appropriate, but not more than 75 
        percent, of the cost of administration of the program carried 
        out in the State under this title; and
            ``(2) the remainder of such allotment shall be available to 
        such State only for paying a Federal share equal to such 
        percentage as the State determines to be appropriate, but not 
        more than 85 percent, of the cost of providing covered long-
        term care services and supplies through the program.
    ``(c) Supplement, Not Supplant.--Allotments made to a State under 
this section shall supplement and not supplant other Federal or State 
payments that are made for the provision of long-term care services or 
supports under--
            ``(1) the medicaid program carried out under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.);
            ``(2) a program funded under title XX of such Act (42 
        U.S.C. 1397 et seq.);
            ``(3) a program funded under title III of this Act; or
            ``(4) any other Federal or State program.

``SEC. 803. ALLOTMENTS.

    ``(a) Allotments.--
            ``(1) In general.--Subject to subsection (b), from sums 
        appropriated for a fiscal year to carry out this title, the 
        Assistant Secretary shall allot to each eligible State an 
        amount that bears the same relationship to such sums as the 
        number of individuals who are age 60 or older and whose income 
        does not exceed 100 percent of the poverty line who reside in 
        the State bears to the total number of such individuals who 
        reside in all States.
            ``(2) Data.--For purposes of paragraph (1), the number of 
        individuals described in that paragraph shall be determined on 
        the basis of the most recent available data from the Bureau of 
        the Census.
            ``(3) Definition.--In paragraph (1), the term `State' does 
        not include a State specified in subsection (b).
    ``(b) Allotments to Territories.--Of the sums appropriated for a 
fiscal year to carry out this title, the Assistant Secretary shall 
allot an amount equal to 0.25 percent of such sums among the following 
commonwealths and territories according to the percentage specified for 
each such commonwealth or territory:
            ``(1) The Commonwealth of Puerto Rico, 91.6 percent.
            ``(2) Guam, 3.5 percent.
            ``(3) The United States Virgin Islands, 2.6 percent.
            ``(4) American Samoa, 1.2 percent.
            ``(5) The Commonwealth of the Northern Mariana Islands, 1.1 
        percent.
    ``(c) Availability of Amounts Allotted.--
            ``(1) In general.--Except as provided in paragraph (2), an 
        amount allotted to an eligible State for a fiscal year shall 
        remain available for expenditure by the State for the 2 
        succeeding fiscal years.
            ``(2) Availability of redistributed amounts.--An amount 
        redistributed to an eligible State under subsection (d) in a 
        fiscal year shall be available for expenditure by the State for 
        the succeeding fiscal year.
    ``(d) Redistribution of Unspent Funds.--An amount that is not 
expended by an eligible State during the period in which such amount is 
available under subsection (c) shall be redistributed by the Assistant 
Secretary according to a formula determined by the Assistant Secretary 
that takes into account the extent to which an eligible State has 
exhausted, or is likely to exhaust, its allotment for that fiscal year.

``SEC. 804. STATE PLANS.

    ``(a) In General.--In order to receive an allotment made under 
section 802 for an eligible State for a fiscal year, the State shall 
submit to the Assistant Secretary for approval a State plan that 
includes the information and assurances described in subsection (b).
    ``(b) Contents.--
            ``(1) Eligibility.--The plan shall include descriptions of 
        the eligibility criteria and methodologies that the State will 
        apply, consistent with section 801(4), to determine whether an 
        individual is an eligible individual for the program carried 
        out in the State under this title.
            ``(2) Priority for eligible individuals with greatest 
        economic need.--The plan shall include an assurance that, in 
        establishing and applying the eligibility criteria and 
        methodologies described in paragraph (1), the State will give 
        priority to providing assistance to those eligible individuals 
        who have the greatest economic need, as defined by the State.
            ``(3) Needs and preferences of eligible individuals.--The 
        plan shall include a description of how the State will ensure 
        that the needs and preferences of an eligible individual are 
        addressed in all aspects of the program.
            ``(4) Payments for services.--The plan shall include an 
        assurance that the State will make payments, at the election of 
        an eligible individual, in accordance with section 806(b)(2), 
        and will provide a fiscal intermediary for each eligible 
        individual electing to receive a payment as described in 
        section 806(b)(2)(B).
            ``(5) Services and supplies.--The plan shall describe the 
        services and supplies that the State will make available to an 
        eligible individual, consistent with the definition of covered 
        long-term services or supplies specified in section 801(3).
            ``(6) Cost-sharing.--The plan shall include a description 
        of the methodologies to be used--
                    ``(A) to calculate the ability of an eligible 
                individual to pay for covered long-term care services 
                or supplies without assistance under the program 
                carried out under this title;
                    ``(B) based on the calculation of ability to pay, 
                to determine the amount of cost-sharing that the 
                eligible individual will be responsible for under the 
                program, set on a sliding scale based on income;
                    ``(C) to collect cost-sharing amounts, both in 
                cases in which the State makes payments directly to a 
                qualified provider as described in section 
                806(b)(2)(A), and in cases in which the State makes 
                payments to a fiscal intermediary on behalf of an 
                eligible individual, as described in section 
                806(b)(2)(B); and
                    ``(D) to track expenditures by eligible individuals 
                for the purchase of covered long-term care services or 
                supplies.
            ``(7) Cost-sharing requirements for providers.--The plan 
        shall provide an assurance that the State will require each 
        provider involved in the program carried out in the State under 
        this title--
                    ``(A) to protect the privacy and confidentiality of 
                each eligible individual with respect to the income, 
                and any cost-sharing amount determined under paragraph 
                (6), of an eligible individual;
                    ``(B) to establish appropriate procedures to 
                account for cost-sharing amounts; and
                    ``(C) to widely distribute State-created written 
                materials in languages reflecting the reading abilities 
                of eligible individuals that describe the criteria for 
                cost-sharing, and the State's sliding scale described 
                in paragraph (6)(B).
            ``(8) Coordination with other programs.--The plan shall 
        include a description of the methods by which the State will, 
        as appropriate, refer individuals who apply for assistance 
        under a program carried out under this title for eligibility 
        determinations under--
                    ``(A) the State medicaid program carried out under 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.);
                    ``(B) the medicare program carried out under title 
                XVIII of such Act (42 U.S.C. 1395 et seq.);
                    ``(C) a program funded under title XX of such Act 
                (42 U.S.C. 1397 et seq.);
                    ``(D) other programs funded under this Act; and
                    ``(E) other Federal or State programs that provide 
                long-term care.
            ``(9) Entities and procedures.--The plan shall include a 
        description of the entities and procedures that the State will 
        use to carry out the following functions:
                    ``(A) Establishing eligibility for the program 
                carried out under this title.
                    ``(B) Assessing the need of an eligible individual 
                for covered long-term care services or supplies.
                    ``(C) Determining the amount of payments described 
                in section 806(b) to be made for the eligible 
                individual under the program.
                    ``(D) Evaluating the cost-sharing by the eligible 
                individual under the program.
                    ``(E) In the case of an eligible individual who 
                elects to receive payments as described in section 
                806(b)(2)(B), helping the eligible individual or the 
                eligible individual's representative (as appropriate) 
                identify, retain, and negotiate and terminate 
                agreements with, qualified providers of covered long-
                term services or supplies.
                    ``(F) Monitoring payments made for an eligible 
                individual to ensure that--
                            ``(i) the cost-sharing amounts that the 
                        eligible individual is responsible for under 
                        the State plan are paid;
                            ``(ii) the payments made by the State for 
                        the eligible individual--
                                    ``(I) are made in a timely fashion; 
                                and
                                    ``(II) do not exceed the annual 
                                assistance amount established for the 
                                eligible individual under section 
                                806(a); and
                            ``(iii) when appropriate, the payments are 
                        made by the State in an expedited manner to 
                        account for health status changes of an 
                        eligible individual that require rapid 
                        responses.
                    ``(G) Establishing a quality assurance system that 
                assesses the covered long-term services or supplies 
                provided for the eligible individual to ensure that the 
                qualified provider of such services or supplies meets 
                such licensing, quality, or other standards as the 
                State may establish in accordance with paragraph (11).
                    ``(H) Providing information to eligible individuals 
                about average market rates for covered long-term care 
                services or supplies.
                    ``(I) Administering payments in a timely fashion 
                and in accordance with a written care plan described in 
                section 805(1) for an eligible individual (that takes 
                into account payment rates established by the eligible 
                individual or a representative of the eligible 
                individual (as appropriate)), including the methods 
                for--
                            ``(i) making payments directly to a 
                        qualified provider as described in section 
                        806(b)(2)(A);
                            ``(ii) making payments to a fiscal 
                        intermediary on behalf of an eligible 
                        individual, as described in section 
                        806(b)(2)(B), for the purchase of such services 
                        or supplies; and
                            ``(iii) making payments (when appropriate) 
                        in an expedited manner to account for health 
                        status changes of the eligible individual that 
                        require rapid responses.
                    ``(J) Carrying out such other activities as the 
                eligible State determines are appropriate with respect 
                to the eligible individual or the program carried out 
                under this title.
            ``(10) Service coordinators.--The plan shall include a 
        description of how the State will--
                    ``(A) provide a service coordinator (directly or by 
                contract) for each eligible individual receiving 
                assistance under the program carried out under this 
                title; and
                    ``(B) ensure that the service coordinator carries 
                out the responsibilities described in section 805, 
                including any responsibilities assigned by the State 
                under section 805(5).
            ``(11) Qualified providers.--The plan shall include a 
        description of any licensing, quality, or other standards for 
        qualified providers (including both providers paid directly by 
        the State as described in section 806(b)(2)(A) or through 
        payments made to a fiscal intermediary on behalf of an eligible 
        individual, as described in section 806(b)(2)(B).
            ``(12) Quality assurance.--The plan shall include a 
        description of the procedures to be used to ensure the quality 
        and appropriateness of the covered long-term care services or 
        supplies provided to an eligible individual and the program 
        carried out under this title, which shall include--
                    ``(A) a quality assessment and improvement strategy 
                that establishes--
                            ``(i) standards that provide for access to 
                        covered long-term care services or supplies 
                        within reasonable time frames and that are 
                        designed to ensure the continuity and adequacy 
                        of such services or supplies; and
                            ``(ii) procedures for monitoring and 
                        evaluating the quality and appropriateness of 
                        the covered long-term care services or supplies 
                        provided to eligible individuals under the 
                        program carried out under this title; and
                    ``(B) a mechanism for obtaining feedback from 
                eligible individuals and others regarding their 
                experiences with, and recommendations for improvement 
                of, the program carried out under this title.
            ``(13) Outreach.--The plan shall include a description of 
        the procedures by which the State will conduct outreach for 
        enrollment (including outreach to persons residing in naturally 
        occurring retirement communities) in the program carried out 
        under this title.
            ``(14) Indians.--The plan shall include a description of 
        the procedures by which the State will ensure the provision of 
        assistance under the program carried out under this title to 
        eligible individuals who are Indians (as defined in section 
        4(c) of the Indian Health Care Improvement Act (25 U.S.C. 
        1603(c))) or Native Hawaiians, as defined in section 625.
            ``(15) Data collection.--The plan shall include an 
        assurance that the State will annually collect and report to 
        the Assistant Secretary such data and information related to 
        the program carried out under this title as the Assistant 
        Secretary may require, including the information required under 
        section 807(a)(1)(B).

``SEC. 805. RESPONSIBILITIES OF SERVICE COORDINATORS.

    ``Each eligible State shall ensure that the service coordinator for 
an eligible individual receiving assistance under the program carried 
out under this title, at a minimum, carries out the following 
responsibilities:
            ``(1)(A) Assisting an eligible individual and the eligible 
        individual's representative (as appropriate) with the 
        development of a written care plan for the eligible individual 
        that--
                    ``(i) specifies the covered long-term care services 
                or supplies that best meet the needs and preferences of 
                the eligible individual; and
                    ``(ii) takes into account the ability of caregivers 
                to provide adequate and safe care.
            ``(B) Assuring that the care plan is coordinated with other 
        care plans that may be developed for the eligible individual 
        under other Federal or State programs (including care plans 
        applicable to naturally occurring retirement communities).
            ``(2) Reassessing and, as appropriate, assisting with 
        revising the care plan for the eligible individual--
                    ``(A) not less than annually; and
                    ``(B) whenever there is a change of health status 
                or other event that requires a reassessment of the care 
                plan.
            ``(3) Educating--
                    ``(A) an eligible individual who elects to receive 
                payments as described in section 806(b)(2)(B) about 
                available qualified providers of covered long-term care 
                services or supplies; and
                    ``(B) an eligible individual about specific covered 
                long-term care services or supplies.
            ``(4) Recommending, as appropriate, methods for community 
        integration for an eligible individual who resides in a nursing 
        home and who is relocating to a home or community-based 
        setting.
            ``(5) Carrying out any other responsibilities assigned to 
        the service coordinator by the State.

``SEC. 806. PAYMENTS FOR COVERED LONG-TERM CARE SERVICES OR SUPPLIES.

    ``(a) Annual Assistance Amount.--
            ``(1) In general.--Subject to paragraph (2), an eligible 
        State shall establish an annual assistance amount for each 
        eligible individual enrolled in the program carried out under 
        this title based on an assessment of the eligible individual.
            ``(2) Cost-sharing amount.--The State shall subtract from 
        the annual assistance amount the individual's cost-sharing 
        amount determined under section 804(b)(6) to obtain the amount 
        of the payments described in subsection (b).
            ``(3) Limitation.--The annual assistance amount made for an 
        eligible individual under a program carried out under this 
        title may not exceed--
                    ``(A) in the case of fiscal year 2007, $8,000; and
                    ``(B) in the case of any subsequent fiscal year, 
                the amount described in this paragraph for the 
                preceding fiscal year increased by the percentage 
                increase in the Consumer Price Index for all urban 
                consumers (all items: U.S. city average) for the 
                preceding fiscal year.
    ``(b) Payments.--
            ``(1) Written care plans.--Under a program carried out 
        under this title, an eligible State (or its designee) shall 
        make payments for the provision or purchase of covered long-
        term care services or supplies for eligible individuals in 
        accordance with the written care plans established for such 
        individuals.
            ``(2) Elections.--At the election of an eligible 
        individual, the payments shall be made by the State (or its 
        designee)--
                    ``(A) directly to a qualified provider of covered 
                long-term care services or supplies; or
                    ``(B) to a fiscal intermediary on behalf of the 
                eligible individual, to enable the fiscal intermediary 
                to disburse the payments for the purchase of such 
                services or supplies--
                            ``(i) in advance to the provider or the 
                        eligible individual; or
                            ``(ii) as reimbursement for the eligible 
                        individual.
    ``(c) Limitations.--In making payments under this section, a State 
shall ensure that not more than 10 percent of the funds made available 
to the State under section 802(a) shall be used to pay for service 
coordination.
    ``(d) Exclusion From Income.--Payments made for an eligible 
individual under this section for a program carried out under this 
title shall not be--
            ``(1) included in the gross income of the eligible 
        individual for purposes of the Internal Revenue Code of 1986; 
        or
            ``(2) treated as income, assets, or benefits, or otherwise 
        be taken into account, for purposes of determining the 
        individual's eligibility for, the amount of benefits under, or 
        the amount of cost-sharing required by, any other Federal or 
        State program.

``SEC. 807. ANNUAL REPORTS.

    ``(a) State Reports.--
            ``(1) In general.--Each eligible State shall--
                    ``(A) evaluate the establishment and operation of 
                the State plan under this title in each fiscal year for 
                which the State receives allotments under section 802; 
                and
                    ``(B) prepare and submit to the Assistant 
                Secretary, not later than January 1 of the succeeding 
                fiscal year, a report that includes the following:
                            ``(i) The number of total unduplicated 
                        eligible individuals and the amount of 
                        expenditures made for the individuals, analyzed 
                        by type of payment specified in subparagraph 
                        (A) or (B) of section 806(b)(2) in the program 
                        carried out under this title in the State.
                            ``(ii) The number of eligible individuals 
                        in the program that received each of the 
                        categories of covered long-term care services 
                        or supplies described in clauses (i) through 
                        (xx) of section 801(3)(A), analyzed, for each 
                        category by type of payment specified in 
                        subparagraph (A) or (B) of section 806(b)(2).
                            ``(iii) The total amount of cost-sharing 
                        amounts that the State received from eligible 
                        individuals in the program.
                            ``(iv) Information on the age and income of 
                        the eligible individuals.
            ``(2) Format.--The Assistant Secretary shall provide 
        guidance to eligible States regarding the format for the 
        information included in the report required under paragraph (1) 
        in such manner as to allow for comparison of the information 
        provided across such States.
            ``(3) Public availability.--The Assistant Secretary shall 
        make the State reports submitted under paragraph (1) available 
        to the public.
    ``(b) Reports by Fiscal Intermediaries and Qualified Providers.--
The State shall require fiscal intermediaries and qualified providers 
participating in the program carried out in the State under this title 
to prepare and submit to the State, not less often than twice a year, 
reports containing such information as is necessary for the State to 
meet the reporting requirements described in subsection (a) and as is 
necessary for the administration of the program.
    ``(c) Report to Congress.--At the end of each fiscal year, the 
Assistant Secretary shall prepare and submit to the Committee on 
Education and the Workforce of the House of Representatives and the 
Committee of Health, Education, Labor, and Pensions of the Senate a 
report that contains a summary of the data submitted under subsection 
(a)(1)(B) and a description of any implementations issues with the 
programs carried out under this title.

``SEC. 808. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to the Secretary to carry 
out this title, such sums as may be necessary for each of fiscal years 
2007 through 2012.''.
                                 <all>