[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4224 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 4224

To establish a pilot program to train public housing residents as home 
health aides and in home-based health services to enable such residents 
 to provide covered home-based health services to residents of public 
  housing and residents of federally-assisted rental housing, who are 
             elderly and disabled, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2009

Ms. Velazquez (for herself, Mr. Frank of Massachusetts, and Ms. Waters) 
 introduced the following bill; which was referred to the Committee on 
                           Financial Services

_______________________________________________________________________

                                 A BILL


 
To establish a pilot program to train public housing residents as home 
health aides and in home-based health services to enable such residents 
 to provide covered home-based health services to residents of public 
  housing and residents of federally-assisted rental housing, who are 
             elderly and disabled, 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 ``Together We Care Act of 2009''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--The Congress finds the following:
            (1) The ``baby boom'' generation will require health care 
        attention that will exceed the current supply of health care 
        providers.
            (2) There is a shortage of training programs specializing 
        in health care and long-term services that focus on home care 
        instead of institutionalized care.
            (3) Although the need for home-based health services 
        transcends all income levels, the availability of such services 
        is more limited for residents of public housing.
            (4) Estimates indicate that there are 44,000,000 caregivers 
        in the United States providing unpaid care to at least one 
        adult, representing 22,900,000 households.
            (5) Of working persons providing unpaid care, 62 percent 
        have had to make adjustments to work schedules or leave 
        employment.
            (6) Many low-income families in the United States are 
        placed in an untenable position of choosing between work and 
        caregiving responsibilities at home.
            (7) Many residents of public housing in the United States 
        are aging and in need of care.
            (8) The Department of Housing and Urban Development 
        estimates the percentage of households assisted by the 
        Department that are elderly households is 35 percent in New 
        York, 33 percent in Boston, 35 percent in Chicago, 24 percent 
        in Cleveland, 40 percent in Los Angeles, and 20 percent in 
        Puerto Rico.
            (9) New service programs are needed to provide home-based 
        health services to residents of public housing and to provide 
        job training and job placement for persons receiving assistance 
        from the Department of Housing and Urban Development needing 
        employment.
            (10) The Department of Housing and Urban Development should 
        establish a home-based health services pilot program to meet 
        the challenges of the increasing number of elderly persons and 
        persons with disabilities in public housing, which would 
        simultaneously create an opportunity to train job seekers in a 
        trade that provides home-based health services.
    (b) Purposes.--The purposes of this Act are--
            (1) to give flexibility to the Department of Housing and 
        Urban Development and other entities to establish training 
        programs in home-based health services for public housing 
        residents; and
            (2) to provide needed home care options to elderly and 
        disabled public housing residents (including elderly and 
        disabled veterans who are public housing residents) and elderly 
        and disabled residents of federally-assisted rental housing to 
        allow them to remain in their homes and their communities.

SEC. 3. PILOT GRANT PROGRAM TO TRAIN PUBLIC HOUSING RESIDENTS TO 
              PROVIDE COVERED HOME-BASED HEALTH SERVICES.

    Section 34 of the United States Housing Act of 1937 (42 U.S.C. 
1437z-6) is amended by adding at the end the following new subsections:
    ``(f) Pilot Grant Program To Train Public Housing Residents To 
Provide Covered Home-Based Health Services.--
            ``(1) Establishment of pilot grant program.--The Secretary, 
        in consultation with the Secretary of Health and Human 
        Services, shall establish a competitive grant program to make 
        grants to eligible entities under paragraph (2) for use for the 
        training of public housing residents as home health aides and 
        as providers of home-based health services (including as 
        personal and home care aides) to enable such residents to 
        provide covered home-based health services to--
                    ``(A) residents of public housing who are elderly 
                or disabled, or both (including elderly and disabled 
                veterans who are residents of public housing); and
                    ``(B) subject to the criteria set forth pursuant to 
                paragraph (3), residents of federally-assisted rental 
                housing who are elderly or disabled, or both.
            ``(2) Eligible entities.--A grant under this subsection may 
        be made only to an entity that--
                    ``(A) is a public housing agency or other unit of 
                State or local government (including an agency of such 
                unit), community health center, home care provider 
                organization, faith-based organization, labor 
                organization, or other organization determined to be 
                qualified by the Secretary; and
                    ``(B) demonstrates to the satisfaction of the 
                Secretary that it has established, or provides such 
                assurances that it will establish, an employment 
                training program to train public housing residents to 
                provide covered home-based health services that 
                complies with regulations that the Secretary shall 
                issue.
            ``(3) Residents of federally-assisted rental housing.--The 
        Secretary may set forth criteria under which an entity 
        receiving funding under this subsection may train public 
        housing residents to provide covered home-based health services 
        to elderly and disabled residents of federally-assisted rental 
        housing.
            ``(4) Application.--To be eligible for a grant under this 
        subsection an eligible entity under paragraph (2) shall submit 
        to the Secretary an application at such time, in such manner, 
        and containing such information as the Secretary shall require.
            ``(5) Competitive grant awards.--
                    ``(A) General criteria for selection.--The 
                Secretary shall establish policies and procedures for 
                reviewing and approving funding for eligible entities 
                through a competitive process taking into 
                consideration--
                            ``(i) with respect to the service area in 
                        which public housing residents trained under an 
                        employment training program described in 
                        paragraph (2)(B) will provide covered home-
                        based health services--
                                    ``(I) the percentage of residents 
                                age 62 and older;
                                    ``(II) the percentage of disabled 
                                residents; and
                                    ``(III) the percentage of 
                                unemployed or underemployed residents;
                            ``(ii) the ability of an eligible entity to 
                        provide training that leads to the provision of 
                        quality care;
                            ``(iii) the record of the quality of care 
                        of an eligible entity; and
                            ``(iv) such other criteria as determined by 
                        the Secretary.
                    ``(B) Geographic consideration.--In awarding 
                grants, the Secretary shall consider a geographic mix 
                of a variety of eligible entities so that the grant 
                program will include at least--
                            ``(i) one employment training program 
                        described in paragraph (2)(B) that primarily 
                        serves an urban population;
                            ``(ii) one employment training program 
                        described in paragraph (2)(B) that primarily 
                        serves a rural population;
                            ``(iii) one employment training program 
                        described in paragraph (2)(B) that primarily 
                        serves an Indian population; and
                            ``(iv) one employment training program 
                        described in paragraph (2)(B) that primarily 
                        serves a population in the Commonwealth of 
                        Puerto Rico, the United States Virgin Islands, 
                        Guam, American Samoa, or the Commonwealth of 
                        the Northern Mariana Islands.
            ``(6) Use of grant funds.--An entity receiving funding 
        under this subsection may use such funds--
                    ``(A) to establish (or maintain) and carry-out an 
                employment training program to train public housing 
                residents to provide covered home-based health care 
                services to elderly and disabled public housing 
                residents and elderly and disabled residents of 
                federally-assisted rental housing;
                    ``(B) for the transportation expenses of public 
                housing residents in training under such an employment 
                training program;
                    ``(C) for the child care expenses of public housing 
                residents in training under such an employment training 
                program;
                    ``(D) for the administrative expenses of carrying 
                out such an employment training program; and
                    ``(E) for any other activity the Secretary 
                determines appropriate.
            ``(7) Report to congress.--Not later than 24 months after 
        the date of the enactment of the Together We Care Act of 2009, 
        the Secretary shall submit to Congress a report on the use and 
        impact of the grant program established by this subsection. The 
        report shall include--
                    ``(A) a review of the effectiveness of the program 
                in--
                            ``(i) providing jobs for public housing 
                        residents;
                            ``(ii) meeting the unmet health and long-
                        term care needs of elderly and disabled 
                        residents of public housing and elderly and 
                        disabled residents of federally-assisted rental 
                        housing; and
                            ``(iii) enabling the provision of quality 
                        care; and
                    ``(B) any recommendations the Secretary determines 
                appropriate regarding the grant program.
            ``(8) Definitions.--As used in this subsection, subsection 
        (g), and subsection (h):
                    ``(A) Home-based health services.--The term `home-
                based health services' means health care and long-term 
                services provided to an individual in a place of 
                residence used as such individual's home and includes--
                            ``(i) home health services described in 
                        section 1861(m) of the Social Security Act (42 
                        U.S.C. 1395x(m));
                            ``(ii) personal care services described in 
                        section 1905(a)(24) of such Act (42 U.S.C. 
                        1396d(a)(24)); and
                            ``(iii) home-based services which may be 
                        covered under a waiver under subsection (c) or 
                        (d) of section 1915 of such Act (42 U.S.C. 
                        1396n).
                    ``(B) Home health aide.--The term `home health 
                aide' has the meaning given the term in section 
                1891(a)(3)(E) of the Social Security Act (42 U.S.C. 
                1395bbb(a)(3)(E)).
                    ``(C) Covered.--The term `covered' means, with 
                respect to home-based health services, such services--
                            ``(i) for which medical assistance is 
                        available under a State plan under title XIX of 
                        the Social Security Act; or
                            ``(ii) for which financial assistance is 
                        available under subsection (g).
                    ``(D) Federally-assisted rental housing.--The term 
                `federally-assisted rental housing' means--
                            ``(i) housing assisted under section 202 of 
                        the Housing Act of 1959 (12 U.S.C. 1701q);
                            ``(ii) housing assisted under section 515 
                        of the Housing Act of 1949 (42 U.S.C. 1485);
                            ``(iii) housing assisted under section 8 of 
                        the United States Housing Act of 1937 (42 
                        U.S.C. 1437f) (including project-based and 
                        tenant-based assistance);
                            ``(iv) housing assisted under the block 
                        grant program under the Native American Housing 
                        Assistance and Self-Determination Act of 1996 
                        (25 U.S.C. 4101 et seq.);
                            ``(v) housing financed by a mortgage 
                        insured under section 221(d)(3) of the National 
                        Housing Act (12 U.S.C. 1715l(d)(3)) or held by 
                        the Secretary, a State, or State agency; and
                            ``(vi) housing assisted under section 811 
                        of the Cranston-Gonzalez National Affordable 
                        Housing Act (42 U.S.C. 8013).
            ``(9) Inapplicability of previous subsections.--Subsections 
        (a) through (e) shall not apply to this subsection, subsection 
        (g), and subsection (h).
            ``(10) Rule of construction.--This subsection and 
        subsection (g) may not be construed as affecting any 
        requirement under State law for training, licensure, or any 
        other certification as a home health aide or as a provider of 
        any home-based health service under this subsection and 
        subsection (g).
            ``(11) Regulations.--Not later than 6 months after the date 
        of enactment of the Together We Care Act of 2009, the Secretary 
        shall issue regulations to carry out this subsection.
            ``(12) Authorization of appropriations.--There are 
        authorized to be appropriated $2,500,000 for each of the fiscal 
        years 2010, 2011, and 2012, for grants under this subsection.
    ``(g) Financial Assistance for Home-Based Health Services in 
Certain Jurisdictions.--
            ``(1) Financial assistance.--The Secretary, in consultation 
        with the Secretary of Health and Human Services, may provide 
        financial assistance under this subsection to entities 
        receiving grant funds under the pilot program established under 
        subsection (f) that provide training for public housing 
        residents as home health aides and as providers of home-based 
        health services and provide (or pay for) such services for use 
        only for their costs in providing (or paying for) such services 
        to--
                    ``(A) residents of public housing who are elderly 
                or disabled, or both (including elderly or disabled 
                veterans who are residents of public housing); or
                    ``(B) at the discretion of the Secretary, residents 
                of federally-assisted rental housing who are elderly or 
                disabled, or both.
            ``(2) Requirements.--
                    ``(A) Location.--Assistance under paragraph (1) may 
                be provided only for services furnished in locations in 
                which medical assistance for home-based health services 
                is not available under a State plan under title XIX of 
                the Social Security Act.
                    ``(B) Trained public housing residents.--Assistance 
                under paragraph (1) may be used only for costs of 
                services described in paragraph (1) that are provided 
                by public housing residents trained by an entity 
                receiving grant funds under the pilot program 
                established under subsection (f).
            ``(3) Eligibility.--To be eligible for financial assistance 
        under this subsection an entity shall--
                    ``(A) provide such assurances as the Secretary 
                shall require that it will use the funds only as 
                provided in paragraphs (1) and (2);
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary requires; and
                    ``(C) comply with such other terms and conditions 
                as the Secretary shall establish to carry out this 
                subsection.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated $2,500,000 for each of the fiscal 
        years 2010, 2011, and 2012, for financial assistance under this 
        subsection.
    ``(h) Impact of Income on Eligibility for Housing Benefits.--For 
any resident of public housing who is trained as a home health aide or 
as a provider of home-based health services pursuant to the program 
under subsection (f), any income received by such resident for 
providing covered home-based health services shall apply towards 
eligibility for benefits under Federal housing programs as follows:
            ``(1) No income received shall apply for the 12 months 
        after the completion of the training of such resident.
            ``(2) 25 percent of income received shall apply for the 
        period that is 12 to 24 months after the completion of the 
        training of such resident.
            ``(3) 50 percent of income received shall apply for the 
        period that is 24 to 36 months after the completion of the 
        training of such resident.
            ``(4) 100 percent of income received shall apply for any 
        period that begins after 36 months after the completion of the 
        training of such resident.''.
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