[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4445 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4445

    To amend the Older Americans Act of 1965 to develop and test an 
  expanded and advanced role for direct care workers who provide long-
     term services and supports to older individuals in efforts to 
    coordinate care and improve the efficiency of service delivery.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 10, 2014

    Mr. Cartwright (for himself, Mr. Grayson, and Ms. Jackson Lee) 
 introduced the following bill; which was referred to the Committee on 
                      Education and the Workforce

_______________________________________________________________________

                                 A BILL


 
    To amend the Older Americans Act of 1965 to develop and test an 
  expanded and advanced role for direct care workers who provide long-
     term services and supports to older individuals in efforts to 
    coordinate care and improve the efficiency of service delivery.

    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 ``Improving Care for Vulnerable Older 
Citizens through Workforce Advancement Act of 2014''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) As of 2012, more than 41,000,000 Americans are age 65 
        or older. More than 75 percent of them suffer from chronic 
        conditions which require person-centered, coordinated care that 
        helps them to live in a home- or community-based setting. In 
        2012, the Government Accountability Office found that 34 
        percent of Americans 60 and older reported needing assistance 
        performing Activities of Daily Living.
            (2) Direct-care workers (referred to in this section as 
        ``DCWs'') provide an estimated 70 to 80 percent of the paid 
        hands-on long-term care and personal assistance received by 
        elders and people with disabilities or other chronic conditions 
        in the United States. These workers help their clients bathe, 
        dress, and negotiate a host of other daily tasks. They are a 
        lifeline for those they serve, as well as for families and 
        friends struggling to provide quality care.
            (3) Eldercare and disability services positions account for 
        nearly one-third of the 18,000,000 health care jobs in the 
        United States. The direct-care workforce alone accounts for 
        more than 4,000,000 jobs, expected to add 1,600,000 new 
        positions by 2020.
            (4) The majority of DCWs are now employed in home- and 
        community-based settings, and not in institutional settings 
        such as nursing care facilities or hospitals. By 2020, home- 
        and community-based DCWs are likely to outnumber facility 
        workers by more than 2 to 1.
            (5) A 2008 Institute of Medicine report, entitled ``Re-
        tooling for an Aging America: Building the Health Care 
        Workforce'', called for new models of care delivery and 
        coordination, and dedicated a chapter to the central importance 
        of the direct-care workforce in a ``re-tooled'' eldercare 
        delivery system.
            (6) An Institute of Medicine report on the future of 
        nursing, released in October of 2010, recommended nurses should 
        practice to the full extent of their education and training. 
        The report also states that all health care professionals 
        should work collaboratively in team-based models, and that the 
        goal should be to encourage care models that use every member 
        of the team to the full capacity of his or her training and 
        skills.
            (7) The Patient Protection and Affordable Care Act (Public 
        Law 111-148) emphasizes the need for improving care and 
        lowering costs by better coordination of care and integration 
        of services, particularly for consumers with multiple chronic 
        conditions. This will require developing new models of care for 
        those receiving long-term services and supports.

SEC. 3. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE 
              DELIVERY.

    Part A of title IV of the Older Americans Act of 1965 (42 U.S.C. 
3032 et seq.) is amended by adding at the end the following:

``SEC. 423. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE 
              DELIVERY.

    ``(a) Establishment of Demonstration Program.--
            ``(1) In general.--The Assistant Secretary shall carry out 
        a demonstration program in accordance with this section. Under 
        such program, the Assistant Secretary shall award grants to 
        eligible entities to carry out demonstration projects that 
        focus on care coordination and service delivery redesign for 
        older individuals with chronic illness or at risk of 
        institutional placement by--
                    ``(A) designing and testing new models of care 
                coordination and service delivery that thoughtfully and 
                effectively deploy advanced aides to improve efficiency 
                and quality of care for frail older individuals; and
                    ``(B) giving direct-care workers opportunities for 
                career advancement through additional training, an 
                expanded role, and increased compensation.
            ``(2) Direct-care worker.--In this section, the term 
        `direct-care worker' has the meaning given that term in the 
        2010 Standard Occupational Classifications of the Department of 
        Labor for Home Health Aides [31-1011], Psychiatric Aides [31-
        1013], Nursing Assistants [31-1014], and Personal Care Aides 
        [39-9021].
    ``(b) Demonstration Projects.--The demonstration program shall be 
composed of 6 demonstration projects, as follows:
            ``(1) Two demonstration projects shall focus on using the 
        abilities of direct-care workers to promote smooth transitions 
        in care and help to prevent unnecessary hospital readmissions. 
        Under these projects, direct-care workers shall be incorporated 
        as essential members of interdisciplinary care coordination 
        teams.
            ``(2) Two demonstration projects shall focus on maintaining 
        the health and improving the health status of those with 
        multiple chronic conditions and long-term care needs. Under 
        these projects, direct-care workers shall assist in monitoring 
        health status, ensuring compliance with prescribed care, and 
        educating and coaching the older individual involved and any 
        family caregivers.
            ``(3) Two demonstration projects shall focus on training 
        direct-care workers to take on deeper clinical responsibilities 
        related to specific diseases, including Alzheimer's and 
        dementia, congestive heart failure, and diabetes.
    ``(c) Eligible Entity.--In this section, the term `eligible entity' 
means a consortium that consists of--
            ``(1) at least 1--
                    ``(A) long-term care and rehabilitation facility; 
                or
                    ``(B) home personal care service provider; and
            ``(2) at least 1--
                    ``(A) hospital or health system;
                    ``(B) labor organization or labor-management 
                partnership;
                    ``(C) community-based aging service provider;
                    ``(D) patient-centered medical home;
                    ``(E) federally qualified health center;
                    ``(F) managed care entity, including a managed 
                health and long-term care program;
                    ``(G) entity that provides health services 
                training;
                    ``(H) State-based public entity engaged in building 
                new roles and related curricula for direct-care 
                workers; or
                    ``(I) any other entity that the Assistant Secretary 
                deems eligible based on integrated care criteria.
    ``(d) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Assistant Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require, which shall include--
            ``(1) a description of the care coordination and service 
        delivery models of the entity, detailed on a general, 
        organizational, and staff level;
            ``(2) a description of how the demonstration project 
        carried out by the entity will improve care quality, including 
        specific objectives and anticipated outcomes that will be used 
        to measure success; and
            ``(3) a description of how the coordinated care team 
        approach with an enhanced role for the direct-care worker under 
        the demonstration project will increase efficiency and cost 
        effectiveness compared to past practice.
    ``(e) Planning Awards Under Demonstration Program.--
            ``(1) In general.--Each eligible entity that receives a 
        grant under this section shall receive a grant for planning 
        activities related to the demonstration project to be carried 
        out by the entity, including--
                    ``(A) designing the implementation of the project;
                    ``(B) identifying competencies and developing 
                curricula for the training of participating direct-care 
                workers;
                    ``(C) developing training materials and processes 
                for other members of the interdisciplinary care team;
                    ``(D) articulating a plan for identifying and 
                tracking cost savings gained from implementation of the 
                project and for achieving long-term financial 
                sustainability; and
                    ``(E) articulating a plan for evaluating the 
                project.
            ``(2) Amount and term.--
                    ``(A) Total amount.--The amount awarded under 
                paragraph (1) for all grants shall not exceed $600,000.
                    ``(B) Term.--Activities carried out under a grant 
                awarded under paragraph (1) shall be completed not 
                later than 1 year after the grant is awarded.
    ``(f) Implementation Awards Under Demonstration Program.--
            ``(1) In general.--Each eligible entity may receive a grant 
        for implementation activities related to the demonstration 
        project to be carried out by the entity, if the Assistant 
        Secretary determines the entity--
                    ``(A) has successfully carried out the activities 
                under the grant awarded under subsection (e);
                    ``(B) offers a feasible plan for long-term 
                financial sustainability;
                    ``(C) has constructed a meaningful model of 
                advancement for direct-care workers; and
                    ``(D) aims to provide training to a sizeable number 
                of direct-care workers and to serve a sizeable number 
                of older individuals.
            ``(2) Use of funds.--The implementation activities 
        described under paragraph (1) shall include--
                    ``(A) training of all care team members in 
                accordance with the design of the demonstration 
                project; and
                    ``(B) evaluating the competency of all staff based 
                on project design.
            ``(3) Evaluation and report.--
                    ``(A) Evaluation.--Each recipient of a grant under 
                paragraph (1), in consultation with an independent 
                evaluation contractor, shall evaluate--
                            ``(i) the impact of training and deployment 
                        of direct-care workers in advanced roles, as 
                        described in this section, within each 
                        participating entity on outcomes, such as 
                        direct-care worker job satisfaction and 
                        turnover, beneficiary and family caregiver 
                        satisfaction with services, rate of 
                        hospitalization of beneficiaries, and 
                        additional measures determined by the 
                        Secretary;
                            ``(ii) the impact of such training and 
                        deployment on the long-term services and 
                        supports delivery system and resources;
                            ``(iii) statement of the potential of the 
                        use of direct-care workers in advanced roles to 
                        lower cost and improve quality of care in the 
                        Medicaid program; and
                            ``(iv) long-term financial sustainability 
                        of the model used under the grant and the 
                        impact of such model on quality of care.
                    ``(B) Reports.--Not later than 180 days after 
                completion of the demonstration program under this 
                section, each recipient of a grant under paragraph (1) 
                shall submit to the Secretary a report on the 
                implementation of activities conducted under the 
                demonstration project, including--
                            ``(i) the outcomes, performance benchmarks, 
                        lessons learned from the project;
                            ``(ii) a statement of cost savings gained 
                        from implementation of the project and how the 
                        cost savings have been reinvested to improve 
                        direct-care job quality and quality of care; 
                        and
                            ``(iii) results of the evaluation conducted 
                        under subparagraph (A) with respect to such 
                        activities, together with such recommendations 
                        for legislation or administrative action for 
                        expansion of the demonstration program on a 
                        broader scale as the Secretary determines 
                        appropriate.
            ``(4) Amount and term.--
                    ``(A) Total amount.--The amount awarded under 
                paragraph (1) for all grants shall not exceed 
                $2,900,000.
                    ``(B) Term.--Activities carried out under a grant 
                awarded under paragraph (1) shall be completed not 
                later than 3 years after the grant is awarded.''.
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