[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1257 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1257

   To amend the Social Security Act to build on the aging network to 
 establish long-term services and supports through single-entry point 
    systems, evidence-based disease prevention and health promotion 
        programs, and enhanced nursing home diversion programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 11, 2009

 Ms. Cantwell (for herself and Ms. Stabenow) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend the Social Security Act to build on the aging network to 
 establish long-term services and supports through single-entry point 
    systems, evidence-based disease prevention and health promotion 
        programs, and enhanced nursing home diversion programs.

    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 ``Project 2020: Building on the 
Promise of Home- and Community-Based Services Act of 2009''.

SEC. 2. LONG-TERM SERVICES AND SUPPORTS.

    The Social Security Act (42 U.S.C. 301 et seq.) is amended by 
adding at the end the following:

             ``TITLE XXII--LONG-TERM SERVICES AND SUPPORTS

``SEC. 2201. DEFINITIONS.

    ``Except as otherwise provided, the terms used in this title have 
the meanings given the terms in section 102 of the Older Americans Act 
of 1965 (42 U.S.C. 3002).

            ``Subtitle A--Single-Entry Point System Program

``SEC. 2211. STATE SINGLE-ENTRY POINT SYSTEMS.

    ``(a) Definitions.--In this title:
            ``(1) Long-term services and supports.--The term `long-term 
        services and supports' means any service (including a disease 
        prevention and health promotion service, an in-home service, or 
        a case management service), care, or item (including an 
        assistive device) that is--
                    ``(A) intended to assist individuals in coping 
                with, and, to the extent practicable, compensating for, 
                functional impairment in carrying out activities of 
                daily living;
                    ``(B) furnished at home, in a community care 
                setting, including a small community care setting (as 
                defined in section 1929(g)(1)) and a large community 
                care setting (as defined in section 1929(h)(1)), or in 
                a long-term care facility; and
                    ``(C) not furnished to diagnose, treat, or cure a 
                medical disease or condition.
            ``(2) Single-entry point system.--The term `single-entry 
        point system' means any coordinated system for providing--
                    ``(A) comprehensive information to consumers and 
                caregivers on the full range of available public and 
                private long-term services and supports, options, 
                service providers, and resources, including information 
                on the availability of integrated long-term care, 
                including consumer directed care options;
                    ``(B) personal counseling to assist individuals in 
                assessing their existing or anticipated long-term care 
                needs, and developing and implementing a plan for long-
                term care designed to meet their specific needs and 
                circumstances; and
                    ``(C) consumers and caregivers access to the range 
                of publicly supported and privately supported long-term 
                services and supports that are available.
    ``(b) Program.--The Secretary shall establish and carry out a 
single-entry point system program. In carrying out the program, the 
Secretary shall make grants to States, from allotments described in 
subsection (c), to pay for the Federal share of the cost of 
establishing State single-entry point systems.
    ``(c) Allotments.--
            ``(1) Allotments to indian tribes and territories.--
                    ``(A) Reservation.--The Secretary shall reserve 
                from the funds made available under subsection (g)--
                            ``(i) for fiscal year 2010, $1,962,456; and
                            ``(ii) for each subsequent fiscal year, 
                        $1,962,456, increased by the percentage 
                        increase in the Consumer Price Index for All 
                        Urban Consumers, between October of the fiscal 
                        year preceding the subsequent fiscal year and 
                        October, 2007.
                    ``(B) Allotments.--The Secretary shall use the 
                funds reserved under subparagraph (A) to make 
                allotments to--
                            ``(i) Indian tribes; and
                            ``(ii) Guam, American Samoa, the 
                        Commonwealth of the Northern Mariana Islands, 
                        the Commonwealth of Puerto Rico, and the United 
                        States Virgin Islands.
            ``(2) Allotments to states.--
                    ``(A) In general.--
                            ``(i) Amount.--The Secretary shall allot to 
                        each eligible State for a fiscal year the sum 
                        of the fixed amount determined under 
                        subparagraph (B), and the allocation determined 
                        under subparagraph (C), for the State.
                            ``(ii) Subgrants to area agencies on 
                        aging.--
                                    ``(I) In general.--Each State 
                                agency receiving an allotment under 
                                clause (i) shall use such allotment to 
                                make subgrants to area agencies on 
                                aging that can demonstrate performance 
                                capacity to carry out activities 
                                described in this section whether such 
                                area agency on aging carries out the 
                                activities directly or through contract 
                                with an aging network or disability 
                                entity. An area agency on agency 
                                desiring a subgrant shall establish or 
                                designate a collaborative board to 
                                ensure meaningful involvement of 
                                stakeholders in the development, 
                                planning, implementation, and 
                                evaluation of a single-entry point 
                                system consistent with the following:
                                            ``(aa) The collaborative 
                                        board shall be composed of--

                                                    ``(AA) individuals 
                                                representing all 
                                                populations served by 
                                                the agency's single-
                                                entry point system, 
                                                including older adults 
                                                and individuals from 
                                                diverse backgrounds who 
                                                have a disability or a 
                                                chronic condition 
                                                requiring long-term 
                                                support;

                                                    ``(BB) a 
                                                representative from the 
                                                local center for 
                                                independent living (as 
                                                defined in section 702 
                                                of the Rehabilitation 
                                                Act of 1973 (29 U.S.C. 
                                                796a)), and 
                                                representatives from 
                                                other organizations 
                                                that provide services 
                                                to the individuals 
                                                served by the system 
                                                and those who advocate 
                                                on behalf of such 
                                                individuals; and

                                                    ``(CC) 
                                                representatives of the 
                                                government and non-
                                                governmental agencies 
                                                that are affected by 
                                                the system.

                                            ``(bb) The agency shall 
                                        work in conjunction with the 
                                        collaborative board on--

                                                    ``(AA) the design 
                                                and operations of the 
                                                single-entry point 
                                                system;

                                                    ``(BB) stakeholder 
                                                input; and

                                                    ``(CC) other 
                                                program and policy 
                                                development issues 
                                                related to the single-
                                                entry point system.

                                            ``(cc) An advisory board 
                                        established under the Real 
                                        Choice Systems Change Program 
                                        or for an existing single-entry 
                                        point system may be used to 
                                        carry out the activities of a 
                                        collaborative board under this 
                                        subclause if such advisory 
                                        board meets the requirements 
                                        under item (aa).
                                    ``(II) Subgrants to other 
                                entities.--A State agency may make 
                                subgrants described in subclause (I) to 
                                other qualified aging network or 
                                disability entities only if the area 
                                agency on aging chooses not to apply 
                                for a subgrant or is not able to 
                                demonstrate performance capacity to 
                                carry out the activities described in 
                                this section.
                                    ``(III) Subgrantee recipient 
                                subgrants.--An administrator of a 
                                single-entry point system established 
                                by a State receiving an allotment under 
                                clause (i) shall make any necessary 
                                subgrants to key partners involved in 
                                developing, planning, or implementing 
                                the single-entry point system. Such 
                                partners may include centers for 
                                independent living (as defined in 
                                section 702 of the Rehabilitation Act 
                                of 1973 (29 U.S.C. 796a)).
                    ``(B) Fixed amounts for states.--
                            ``(i) Reservation.--The Secretary shall 
                        reserve from the funds made available under 
                        subsection (g)--
                                    ``(I) for fiscal year 2010, 
                                $15,759,000; and
                                    ``(II) for each subsequent fiscal 
                                year, $15,759,000, increased by the 
                                percentage increase in the Consumer 
                                Price Index for All Urban Consumers, 
                                between October of the fiscal year 
                                preceding the subsequent fiscal year 
                                and October, 2007.
                            ``(ii) Fixed amounts.--The Secretary shall 
                        use the funds reserved under clause (i) to 
                        provide equal fixed amounts to the States.
                    ``(C) Allocation for states.--The Secretary shall 
                allocate to each eligible State for a fiscal year an 
                amount that bears the same relationship to the funds 
                made available under subsection (g) (and not reserved 
                under paragraph (1) or subparagraph (B)) for that 
                fiscal year as the number of persons who are either 
                older individuals or individuals with disabilities in 
                that State bears to the number of such persons or 
                individuals in all the States.
                    ``(D) Determination of number of persons.--
                            ``(i) Older individuals.--The number of 
                        older individuals in any State and in all 
                        States shall be determined by the Secretary on 
                        the basis of the most recent data available 
                        from the Bureau of the Census, and other 
                        reliable demographic data satisfactory to the 
                        Secretary.
                            ``(ii) Individuals with disabilities.--The 
                        number of individuals with disabilities in any 
                        State and in all States shall be determined by 
                        the Secretary on the basis of the most recent 
                        data available from the American Community 
                        Survey, and other reliable demographic data 
                        satisfactory to the Secretary, on individuals 
                        who have a sensory disability, physical 
                        disability, mental disability, self-care 
                        disability, go-outside-home disability, or 
                        employment disability.
            ``(3) Eligibility.--In addition to the States determined by 
        the Secretary to be eligible for a grant under this section, a 
        State that receives a Federal grant for an aging and disability 
        resource center is eligible for a grant under this section.
            ``(4) Definition.--In this subsection, the term `State' 
        shall not include any jurisdiction described in paragraph 
        (1)(B)(ii).
    ``(d) Applications.--
            ``(1) In general.--To be eligible to receive an initial 
        grant under this section, a State agency shall, after 
        consulting and coordinating with consumers, other stakeholders, 
        centers for independent living in the State, if any, and area 
        agencies on aging in the State, if any, submit an application 
        to the Secretary at such time, in such manner, and containing 
        the following information:
                    ``(A) Evidence of substantial involvement of 
                stakeholders and agencies in the State that are 
                administering programs that will be the subject of 
                referrals.
                    ``(B) The applicant's plan for providing--
                            ``(i) comprehensive information on the full 
                        range of available public and private long-term 
                        services and supports options, providers, and 
                        resources, including building awareness of the 
                        single-entry point system as a resource;
                            ``(ii) objective, neutral, and personal 
                        information, counseling, and assistance to 
                        individuals and their caregivers in assessing 
                        their existing or anticipated long-term care 
                        needs, and developing and implementing a plan 
                        for long-term care to meet their needs;
                            ``(iii) for eligibility screening and 
                        referral for services;
                            ``(iv) for stakeholder input;
                            ``(v) for a management information system; 
                        and
                            ``(vi) for an evaluation of the 
                        effectiveness of the single-entry point system.
                    ``(C) A specification of the period of the grant 
                request, which shall include not less than 3 
                consecutive fiscal years in the 5-fiscal-year period 
                beginning with fiscal year 2010.
                    ``(D) Such other information as the Secretary 
                determines appropriate.
            ``(2) Application for continuation.--
                    ``(A) In general.--A State that receives an initial 
                grant under this section shall apply, after consulting 
                and coordinating with the area agencies on aging, for a 
                continuation of the initial grant, which includes a 
                description of any significant changes to the 
                information provided in the initial application and 
                such data concerning performance measures related to 
                the requirements in the initial application as the 
                Secretary shall require.
                    ``(B) Effect.--The requirement under subparagraph 
                (A) shall be in effect through fiscal year 2020.
    ``(e) Use of Funds.--
            ``(1) In general.--A State that receives a grant under this 
        section shall use the funds made available through the grant 
        to--
                    ``(A) establish a State single-entry point system, 
                to enable older individuals and individuals with 
                disabilities and their caregivers to obtain resources 
                concerning long-term services and supports options; and
                    ``(B) provide information on, access to, and 
                assistance regarding long-term services and supports.
            ``(2) Services.--In particular, the State single-entry 
        point system shall be the referral source to--
                    ``(A) provide information about long-term care 
                planning and available long-term services and supports 
                through a variety of media (such as websites, seminars, 
                and pamphlets);
                    ``(B) provide assistance with making decisions 
                about long-term services and supports and determining 
                the most appropriate services through options 
                counseling, future financial planning, and case 
                management;
                    ``(C) provide streamlined access to and assistance 
                with applying for federally funded long-term care 
                benefits (including medical assistance under title XIX, 
                Medicare skilled nursing facility services, services 
                under title III of the Older Americans Act of 1965 (42 
                U.S.C. 3021 et seq.), the services of Aging and 
                Disability Resource Centers), and State-funded and 
                privately funded long-term care benefits, through 
                efforts to shorten and simplify the eligibility 
                processes for older individuals and individuals with 
                disabilities;
                    ``(D) provide referrals to the State evidence-based 
                disease prevention and health promotion programs under 
                subtitle B;
                    ``(E) allocate the State funds available under 
                subtitle C and carry out the State enhanced nursing 
                home diversion program under subtitle C; and
                    ``(F) and provide information about, other services 
                available in the State that may assist an individual to 
                remain in the community, including the Medicare and 
                Medicaid programs, the State health insurance 
                assistance program, the supplemental nutrition 
                assistance program established under the Food and 
                Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), and the 
                Low-Income Home Energy Assistance Program under the 
                Low-Income Home Energy Assistance Act of 1981 (42 
                U.S.C. 8621 et seq.), and such other services, as the 
                State shall include.
            ``(3) Collaborative arrangements.--
                    ``(A) Center for independent living.--Each entity 
                receiving an allotment under subsection (c) shall 
                involve in the planning and implementation of the 
                single-entry point system the local center for 
                independent living (as defined in section 702 of the 
                Rehabilitation Act of 1973 (29 U.S.C. 796a)), which 
                provides information, referral, assistance, or services 
                to individuals with disabilities.
                    ``(B) Other entities.--To the extent practicable, 
                the State single-entry point system shall enter into 
                collaborative arrangements with aging and disability 
                programs, service providers, agencies, the direct care 
                work force, and other entities in order to ensure that 
                information about such services may be made available 
                to individuals accessing the State single-entry point 
                system.
    ``(f) Federal Share.--
            ``(1) In general.--The Federal share of the cost described 
        in subsection (b) shall be 75 percent.
            ``(2) Non-federal share.--The State may provide the non-
        Federal share of the cost in cash or in-kind, fairly evaluated, 
        including plant, equipment, or services. The State may provide 
        the non-Federal share from State, local, or private sources.
    ``(g) Funding.--
            ``(1) In general.--The Secretary shall use amounts made 
        available under paragraph (2) to make the grants described in 
        subsection (b).
            ``(2) Funding.--There are authorized to be appropriated to 
        carry out this section--
                    ``(A) $30,900,000 for fiscal year 2010;
                    ``(B) $38,264,000 for fiscal year 2011;
                    ``(C) $48,410,000 for fiscal year 2012;
                    ``(D) $53,560,000 for fiscal year 2013;
                    ``(E) $63,860,000 for fiscal year 2014;
                    ``(F) $69,010,000 for fiscal year 2015;
                    ``(G) $74,160,000 for fiscal year 2016;
                    ``(H) $79,310,000 for fiscal year 2017;
                    ``(I) $84,460,000 for fiscal year 2018;
                    ``(J) $89,610,000 for fiscal year 2019; and
                    ``(K) $95,790,000 for fiscal year 2020.
            ``(3) Availability.--Funds appropriated under paragraph (2) 
        shall remain available until expended.

                  ``Subtitle B--Healthy Living Program

``SEC. 2221. EVIDENCE-BASED DISEASE PREVENTION AND HEALTH PROMOTION 
              PROGRAMS.

    ``(a) Program.--The Secretary shall establish and carry out a 
healthy living program. In carrying out the program, the Secretary 
shall make grants to State agencies, from allotments described in 
subsection (b), to pay for the Federal share of the cost of carrying 
out evidence-based disease prevention and health promotion programs.
    ``(b) Allotments.--
            ``(1) Allotments to indian tribes and territories.--
                    ``(A) Reservation.--The Secretary shall reserve 
                from the funds made available under subsection (g)--
                            ``(i) for fiscal year 2010, $1,500,952; and
                            ``(ii) for each subsequent fiscal year, 
                        $1,500,952, increased by the percentage 
                        increase in the Consumer Price Index for All 
                        Urban Consumers, between October of the fiscal 
                        year preceding the subsequent fiscal year and 
                        October, 2007.
                    ``(B) Allotments.--The Secretary shall use the 
                reserved funds under subparagraph (A) to make 
                allotments to--
                            ``(i) Indian tribes; and
                            ``(ii) Guam, American Samoa, the 
                        Commonwealth of the Northern Mariana Islands, 
                        the Commonwealth of Puerto Rico, and the United 
                        States Virgin Islands.
            ``(2) In general.--
                    ``(A) Amounts.--
                            ``(i) In general.--Except as provided in 
                        paragraph (3), the Secretary shall allot to 
                        each eligible State for a fiscal year an amount 
                        that bears the same relationship to the funds 
                        made available under this section and not 
                        reserved under paragraph (1) for that fiscal 
                        year as the number of older individuals in the 
                        State bears to the number of older individuals 
                        in all the States.
                            ``(ii) Older individuals.--The number of 
                        older individuals in any State and in all 
                        States shall be determined by the Secretary on 
                        the basis of the most recent data available 
                        from the Bureau of the Census, and other 
                        reliable demographic data satisfactory to the 
                        Secretary.
                    ``(B) Subgrants.--
                            ``(i) In general.--Each State agency that 
                        receives an amount under subparagraph (A) shall 
                        award subgrants to area agencies on aging that 
                        can demonstrate performance capacity to carry 
                        out activities under this section whether such 
                        area agency on aging carries out the activities 
                        directly or through contract with an aging 
                        network entity.
                            ``(ii) Subgrants to other entities.--A 
                        State agency may make subgrants described in 
                        clause (i) to other qualified aging network 
                        entities only if the area agency on aging 
                        chooses not to apply for a subgrant or is not 
                        able to demonstrate performance capacity to 
                        carry out the activities described in this 
                        section.
            ``(3) Minimum allotment.--No State shall receive an 
        allotment under this section for a fiscal year that is less 
        than 0.5 percent of the funds made available to carry out this 
        section for that fiscal year and not reserved under paragraph 
        (1).
            ``(4) Eligibility.--In addition to the States determined by 
        the Secretary to be eligible for a grant under this section, a 
        State that receives a Federal grant for evidence-based disease 
        prevention is eligible for a grant under this section.
    ``(c) Applications.--To be eligible to receive a grant under this 
section, a State agency shall, after consulting and coordinating with 
consumers, other stakeholders, and area agencies on aging in the State, 
if any, submit an application to the Secretary at such time, in such 
manner, and containing the following information:
            ``(1) A description of the evidence-based disease 
        prevention and health promotion program.
            ``(2) Sufficient information to demonstrate that the 
        infrastructure exists to support the program.
            ``(3) A specification of the period of the grant request, 
        which shall include not less than 3 consecutive fiscal years in 
        the 5-fiscal-year period beginning with fiscal year 2010.
            ``(4) Such other information as the Secretary determines 
        appropriate.
    ``(d) Application for Continuation.--
            ``(1) In general.--A State that receives an initial grant 
        under this section shall apply, after consulting and 
        coordinating with the area agencies on aging, for a 
        continuation of the initial grant, which application shall 
        include--
                    ``(A) a description of any significant changes to 
                the information provided in the initial application; 
                and
                    ``(B) such data concerning performance measures 
                related to the requirements in the initial application 
                as the Secretary shall require.
            ``(2) Effect.--The requirement under paragraph (1) shall be 
        in effect through fiscal year 2020.
    ``(e) Use of Funds.--A State that receives a grant under this 
section shall use the funds made available through the grant to carry 
out--
            ``(1) an evidence-based chronic disease self-management 
        program;
            ``(2) an evidence-based falls prevention program; or
            ``(3) another evidence-based disease prevention and health 
        promotion program.
    ``(f) Federal Share.--
            ``(1) In general.--The Federal share of the cost described 
        in subsection (a) shall be 85 percent.
            ``(2) Non-federal share.--The State may provide the non-
        Federal share of the cost in cash or in-kind, fairly evaluated, 
        including plant, equipment, or services. The State may provide 
        the non-Federal share from State, local, or private sources.
    ``(g) Funding.--
            ``(1) In general.--The Secretary shall use amounts made 
        available under paragraph (2) to make the grants described in 
        subsection (a).
            ``(2) Funding.--There are authorized to be appropriated to 
        carry out this section--
                    ``(A) $36,050,000 for fiscal year 2010;
                    ``(B) $41,200,000 for fiscal year 2011;
                    ``(C) $56,650,000 for fiscal year 2012;
                    ``(D) $77,250,000 for fiscal year 2013;
                    ``(E) $92,700,000 for fiscal year 2014;
                    ``(F) $103,000,000 for fiscal year 2015;
                    ``(G) $118,450,000 for fiscal year 2016;
                    ``(H) $133,900,000 for fiscal year 2017;
                    ``(I) $149,350,000 for fiscal year 2018;
                    ``(J) $157,590,000 for fiscal year 2019; and
                    ``(K) $173,040,000 for fiscal year 2020.
            ``(3) Availability.--Funds appropriated under paragraph (2) 
        shall remain available until expended.

                    ``Subtitle C--Diversion Programs

``SEC. 2231. ENHANCED NURSING HOME DIVERSION PROGRAMS.

    ``(a) Definition.--In this section:
            ``(1) Low-income senior.--The term `low-income senior' 
        means an individual who--
                    ``(A) is age 75 or older; and
                    ``(B) is from a household with a household income 
                that is not less than 150 percent, and not more than 
                300 percent, of the poverty line.
            ``(2) Nursing home.--The term `nursing home' means--
                    ``(A) a skilled nursing facility, as defined in 
                section 1819(a); or
                    ``(B) a nursing facility, as defined in section 
                1919(a).
    ``(b) Program.--
            ``(1) In general.--The Secretary shall establish and carry 
        out a diversion program. In carrying out the program, the 
        Secretary shall make grants to States, from allotments 
        described in subsection (c), to pay for the Federal share of 
        the cost of carrying out enhanced nursing home diversion 
        programs.
            ``(2) Cohorts.--The Secretary shall make the grants to--
                    ``(A) a first year cohort consisting of one third 
                of the States, for fiscal year 2010;
                    ``(B) a second year cohort consisting of the cohort 
                described in subparagraph (A) and an additional one 
                third of the States, for fiscal year 2011; and
                    ``(C) a third year cohort consisting of all the 
                eligible States, for fiscal year 2012 and each 
                subsequent fiscal year.
            ``(3) Readiness.--In determining whether to include an 
        eligible State in the first year, second year, or third year 
        and subsequent year cohort, the Secretary shall consider the 
        readiness of the State to carry out an enhanced nursing home 
        diversion program under this section. Readiness shall be 
        determined based on a consideration of the following factors:
                    ``(A) Availability of a comprehensive array of 
                home- and community-based services.
                    ``(B) Sufficient home- and community-based services 
                provider capacity.
                    ``(C) Availability of housing.
                    ``(D) Availability of supports for consumer-
                directed services, including whether a fiscal 
                intermediary is in place.
                    ``(E) Ability to perform timely eligibility 
                determinations and assessment for services.
                    ``(F) Existence of a quality assessment and 
                improvement program for home- and community-based 
                services.
                    ``(G) Such other factors as the Secretary 
                determines appropriate.
    ``(c) Allotments.--
            ``(1) In general.--
                    ``(A) Amount.--The Secretary shall allot to an 
                eligible State (within the applicable cohort) for a 
                fiscal year an amount that bears the same relationship 
                to the funds made available under subsection (i) for 
                that fiscal year as the number of low-income seniors in 
                the State bears to the number of low-income seniors 
                within States in the applicable cohort for that fiscal 
                year.
                    ``(B) Low-income seniors.--The number of low-income 
                seniors in any State and in all States shall be 
                determined by the Secretary on the basis of the most 
                recent data available from the American Community 
                Survey, and other reliable demographic data 
                satisfactory to the Secretary.
            ``(2) Eligibility.--In addition to the States determined by 
        the Secretary to be eligible for a grant under this section, a 
        State that receives a Federal grant for a nursing home 
        diversion is eligible for a grant under this section.
    ``(d) Applications.--To be eligible to receive a grant under this 
section, a State agency shall, after consulting and coordinating with 
consumers, other stakeholders, and area agencies on aging in the State, 
if any, submit an application to the Secretary at such time, in such 
manner, and containing such information as the Secretary may require, 
including a specification of the period of the grant request, which 
shall include not less than 3 consecutive fiscal years in the 5-fiscal-
year period beginning with the fiscal year prior to the year of 
application.
    ``(e) Application for Continuation.--
            ``(1) In general.--A State that receives an initial grant 
        under this section shall apply, after consulting and 
        coordinating with the area agencies on aging, for a 
        continuation of the initial grant, which application shall 
        include--
                    ``(A) a description of any significant changes to 
                the information provided in the initial application; 
                and
                    ``(B) such data concerning performance measures 
                related to the requirements in the initial application 
                as the Secretary shall require.
            ``(2) Effect.--The requirement under paragraph (1) shall be 
        in effect through fiscal year 2020.
    ``(f) Use of Funds.--
            ``(1) In general.--A State that receives a grant under this 
        section shall carry out the following:
                    ``(A) Use the funds made available through the 
                grant to carry out an enhanced nursing home diversion 
                program that enables eligible individuals to avoid 
                admission into nursing homes by enabling the 
                individuals to obtain alternative long-term services 
                and supports and remain in their communities.
                    ``(B) Award subgrants to area agencies on aging 
                that can demonstrate performance capacity to carry out 
                activities under this section whether such area agency 
                on aging carries out the activities directly or through 
                contract with an aging network entity. A State may make 
                subgrants to other qualified aging network entities 
                only if the area agency on aging chooses not to apply 
                for a subgrant or is not able to demonstrate 
                performance capacity to carry out the activities 
                described in this section.
            ``(2) Case management.--
                    ``(A) In general.--The State, through the State 
                single-entry point system established under subtitle A, 
                shall provide for case management services to the 
                eligible individuals.
                    ``(B) Use of existing services.--In carrying out 
                subparagraph (A), the State agency or area agency on 
                aging may utilize existing case management services 
                delivery networks if--
                            ``(i) the networks have adequate safeguards 
                        against potential conflicts of interest; and
                            ``(ii) the State agency or area agency on 
                        aging includes a description of such safeguards 
                        in the grant application.
                    ``(C) Care plan.--The State shall provide for 
                development of a care plan for each eligible individual 
                served, in consultation with the eligible individual 
                and their caregiver, as appropriate. In developing the 
                care plan, the State shall explain the option of 
                consumer directed care and assist an individual, who so 
                requests, with developing a consumer-directed care plan 
                that shall include arranging for support services and 
                funding. Such assistance shall include providing 
                information and outreach to individuals in the 
                hospital, in a nursing home for post-acute care, or 
                undergoing changes in their health status or caregiver 
                situation.
    ``(g) Eligible Individuals.--In this section, the term `eligible 
individual' means an individual--
            ``(1) who has been determined by the State to be at high 
        functional risk of nursing home placement, as defined by the 
        State agency in the State agency's grant application;
            ``(2) who is not eligible for medical assistance under 
        title XIX; and
            ``(3) who meets the income and asset eligibility 
        requirements established by the State and included in such 
        State's grant application for approval by the Secretary.
    ``(h) Federal Share.--
            ``(1) In general.--The Federal share of the cost described 
        in subsection (b) shall be, for a State and for a fiscal year, 
        the sum of--
                    ``(A) the Federal medical assistance percentage 
                applicable to the State for the year under section 
                1905(b); and
                    ``(B) 5 percentage points.
            ``(2) Non-federal share.--The State may provide the non-
        Federal share of the cost in cash or in-kind, fairly evaluated, 
        including plant, equipment, or services. The State may provide 
        the non-Federal share from State, local, or private sources.
    ``(i) Funding.--
            ``(1) In general.--The Secretary shall use amounts made 
        available under paragraph (2) to make the grants described in 
        subsection (b).
            ``(2) Funding.--There are authorized to be appropriated to 
        carry out this section--
                    ``(A) $111,825,137 for fiscal year 2010;
                    ``(B) $337,525,753 for fiscal year 2011;
                    ``(C) $650,098,349 for fiscal year 2012;
                    ``(D) $865,801,631 for fiscal year 2013;
                    ``(E) $988,504,887 for fiscal year 2014;
                    ``(F) $1,124,547,250 for fiscal year 2015;
                    ``(G) $1,276,750,865 for fiscal year 2016;
                    ``(H) $1,364,488,901 for fiscal year 2017;
                    ``(I) $1,466,769,052 for fiscal year 2018;
                    ``(J) $1,712,755,702 for fiscal year 2019; and
                    ``(K) $1,712,755,702 for fiscal year 2020.
            ``(3) Availability.--Funds appropriated under paragraph (2) 
        shall remain available until expended.

   ``Subtitle D--Administration, Evaluation, and Technical Assistance

``SEC. 2241. ADMINISTRATION, EVALUATION, AND TECHNICAL ASSISTANCE.

    ``(a) Administration and Expenses.--For purposes of carrying out 
this title, there are authorized to be appropriated for administration 
and expenses--
            ``(1) of the area agencies on aging--
                    ``(A) $16,825,895 for fiscal year 2010;
                    ``(B) $39,246,141 for fiscal year 2011;
                    ``(C) $50,766,948 for fiscal year 2012;
                    ``(D) $66,999,101 for fiscal year 2013;
                    ``(E) $76,979,152 for fiscal year 2014;
                    ``(F) $87,163,513 for fiscal year 2015;
                    ``(G) $98,780,562 for fiscal year 2016;
                    ``(H) $106,063,792 for fiscal year 2017;
                    ``(I) $114,324,642 for fiscal year 2018;
                    ``(J) $123,312,948 for fiscal year 2019; and
                    ``(K) $133,215,845 for fiscal year 2020;
            ``(2) of the State agencies--
                    ``(A) $8,412,948 for fiscal year 2010;
                    ``(B) $19,623,071 for fiscal year 2011;
                    ``(C) $25,383,474 for fiscal year 2012;
                    ``(D) $33,499,551 for fiscal year 2013;
                    ``(E) $38,489,576 for fiscal year 2014;
                    ``(F) $43,581,756 for fiscal year 2015;
                    ``(G) $49,390,281 for fiscal year 2016;
                    ``(H) $53,031,896 for fiscal year 2017;
                    ``(I) $57,162,321 for fiscal year 2018;
                    ``(J) $61,656,474 for fiscal year 2019; and
                    ``(K) $66,607,923 for fiscal year 2020; and
            ``(3) of the Administration--
                    ``(A) $2,103,237 for fiscal year 2010;
                    ``(B) $4,905,768 for fiscal year 2011;
                    ``(C) $6,345,868 for fiscal year 2012;
                    ``(D) $8,374,888 for fiscal year 2013;
                    ``(E) $9,622,394 for fiscal year 2014;
                    ``(F) $10,895,439 for fiscal year 2015;
                    ``(G) $12,347,570 for fiscal year 2016;
                    ``(H) $13,257,974 for fiscal year 2017;
                    ``(I) $14,290,580 for fiscal year 2018;
                    ``(J) $15,414,118 for fiscal year 2019; and
                    ``(K) $16,651,981 for fiscal year 2020.
    ``(b) Evaluation and Technical Assistance.--
            ``(1) Conditions to receipt of grant.--In awarding grants 
        under this title, the Secretary shall condition receipt of the 
        grant for the second and subsequent grant years on a 
        satisfactory determination that the State agency is meeting 
        benchmarks specified in the grant agreement for each grant 
        awarded under this title.
            ``(2) Evaluations.--The Secretary shall measure and 
        evaluate, either directly or through grants or contracts, the 
        impact of the programs authorized under this title. Not later 
        than June 1 of the year that is 6 years after the year of the 
        date of enactment of the Project 2020: Building on the Promise 
        of Home- and Community-Based Services Act of 2009 and every 2 
        years thereafter, the Secretary shall--
                    ``(A) compile the reports of the measures and 
                evaluations of the grantees;
                    ``(B) establish benchmarks to show progress toward 
                savings; and
                    ``(C) present a compilation of the information 
                under this paragraph to Congress.
            ``(3) Technical assistance grants.--The Secretary shall 
        award technical assistance grants, including State specific 
        grants whenever practicable, to carry out the programs 
        authorized under this title.
            ``(4) Transfer.--There are authorized to be appropriated 
        for such evaluation and technical assistance under this 
        subsection--
                    ``(A) $4,206,474 for fiscal year 2010;
                    ``(B) $9,811,535 for fiscal year 2011;
                    ``(C) $8,461,158 for fiscal year 2012;
                    ``(D) $11,166,517 for fiscal year 2013;
                    ``(E) $12,829,859 for fiscal year 2014;
                    ``(F) $14,527,252 for fiscal year 2015;
                    ``(G) $16,463,427 for fiscal year 2016;
                    ``(H) $17,677,299 for fiscal year 2017;
                    ``(I) $19,054,107 for fiscal year 2018;
                    ``(J) $20,552,158 for fiscal year 2019; and
                    ``(K) $22,202,641 for fiscal year 2020.
    ``(c) Availability.--Funds appropriated under this section shall 
remain available until expended.''.
                                 <all>