[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1574 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1574

To amend the Older Americans Act of 1965 to establish a community care 
wrap-around support demonstration program, a pilot project on services 
 for recipients of federally assisted housing, and a national campaign 
    to raise awareness of the aging network and to promote advance 
      integrated long-term care planning, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 15, 2015

  Mr. Merkley 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 establish a community care 
wrap-around support demonstration program, a pilot project on services 
 for recipients of federally assisted housing, and a national campaign 
    to raise awareness of the aging network and to promote advance 
      integrated long-term care planning, 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 ``Older Americans Community Access 
Revitalization and Education Act'' or the ``CARE Act''.

SEC. 2. COMMUNITY CARE WRAP-AROUND SUPPORT DEMONSTRATION PROGRAM.

    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. COMMUNITY CARE WRAP-AROUND SUPPORT DEMONSTRATION PROGRAM.

    ``(a) Definitions.--
            ``(1) Community care wrap-around support partnership.--The 
        term `community care wrap-around support partnership' means a 
        partnership that--
                    ``(A) carries out a program that serves not fewer 
                than 30 eligible older individuals;
                    ``(B) includes--
                            ``(i) a designated care coordinator, who 
                        may be a nurse, registered dietitian, case 
                        manager, health coach, or social worker, from 
                        an eligible entity and who, in consultation 
                        with a primary care physician or another 
                        relevant specialist described in clause (ii), 
                        will be responsible for coordinating services 
                        and supports offered under title III for an 
                        older individual; and
                            ``(ii) a consulting primary care physician, 
                        or other relevant specialist, receiving 
                        compensation for participation in the 
                        partnership in a manner determined by the 
                        Assistant Secretary; and
                    ``(C) may include an individual--
                            ``(i) who is listed in the plan for the 
                        community care wrap-around support partnership 
                        described in subsection (c)(2)(A);
                            ``(ii) for whom the eligible older 
                        individual gives consent to participate in the 
                        community care wrap-around support partnership, 
                        as that partnership relates to the eligible 
                        older individual; and
                            ``(iii) whose relationship to the older 
                        individual is that of--
                                    ``(I) a family member, close 
                                personal friend, or unpaid designated 
                                caregiver;
                                    ``(II) a legal or financial 
                                advisor;
                                    ``(III) a home care provider;
                                    ``(IV) a provider of 
                                transportation;
                                    ``(V) a registered dietitian; or
                                    ``(VI) a rehabilitation 
                                professional.
            ``(2) Eligible entity.--The term `eligible entity' means--
                    ``(A) an area agency on aging;
                    ``(B) a home or community-based provider of the 
                activities described in subsection (d) (such as a home 
                care agency, or entity operating a senior center or 
                adult day care facility); or
                    ``(C) another qualified entity the Assistant 
                Secretary determines to be appropriate to carry out the 
                activities described in subsection (d).
            ``(3) Eligible older individual.--The term `eligible older 
        individual' means an older individual--
                    ``(A) who is age 65 or older;
                    ``(B) who is eligible to receive assistance under 
                this Act;
                    ``(C) who elects to enroll in the demonstration 
                program, as described in subsection (e); and
                    ``(D) who--
                            ``(i) has difficulty completing 2 or more 
                        activities of daily living;
                            ``(ii) has had at least 1 nonelective 
                        hospital admission within the past 12 months;
                            ``(iii) has received acute or subacute 
                        rehabilitation services within the past 12 
                        months; or
                            ``(iv) meets such other criteria as the 
                        Assistant Secretary determines to be 
                        appropriate.
    ``(b) Program Authorized.--
            ``(1) In general.--The Assistant Secretary shall establish 
        a demonstration program (referred to in this section as the 
        `demonstration program' and to be commonly known as the 
        `community care initiative') through which the Assistant 
        Secretary shall make grants to eligible entities in order to 
        enable such eligible entities to--
                    ``(A) establish community care wrap-around support 
                partnerships; and
                    ``(B) support the partnerships, enabling the 
                partnerships to carry out the activities described in 
                subsection (d).
            ``(2) Duration.--Each grant awarded under this section 
        shall be for a period of 2 years.
    ``(c) Application.--
            ``(1) In general.--Each eligible entity desiring a grant 
        under this section shall submit an application to the Assistant 
        Secretary at such time, in such manner, and accompanied by such 
        information as the Assistant Secretary may reasonably require.
            ``(2) Contents.--The application described in this 
        subsection shall include, at a minimum--
                    ``(A) a plan listing the individuals, as described 
                in subsection (a)(1)(C), that will, upon consent of an 
                eligible older individual, participate in the community 
                care wrap-around support partnership as that 
                partnership relates to the eligible older individual;
                    ``(B) a clear description of--
                            ``(i) the protocols the eligible entity 
                        will implement to identify the needs of older 
                        individuals receiving services and supports 
                        through the partnership;
                            ``(ii) the range of intervention and 
                        supportive services and supports that the 
                        eligible entity will implement; and
                            ``(iii) preliminary evidence of the 
                        efficacy or effectiveness of the approach the 
                        eligible entity proposes to use in providing 
                        services and supports through the partnership; 
                        and
                    ``(C) an assurance that the partnership will 
                collect the information determined by the Assistant 
                Secretary under subsection (h)(1).
    ``(d) Use of Funds.--An eligible entity that receives a grant under 
this section shall use the grant funds to establish a community care 
wrap-around support partnership and support the partnership, including 
requiring the partnership to--
            ``(1) connect each participant with the community care 
        wrap-around support partnership;
            ``(2) assess each eligible older individual using a 
        standardized assessment instrument, such as a comprehensive 
        assessment reporting evaluation;
            ``(3) establish longitudinal care plans for each eligible 
        older individual; and
            ``(4) provide comprehensive, coordinated, and continuous 
        virtual or in-person access to the services and supports 
        offered under this Act, tailored to the specific needs of the 
        older individual involved, which may include 1 or more of the 
        following:
                    ``(A) Medication management.
                    ``(B) Medical nutrition therapy with a registered 
                dietitian for individuals requiring dietary 
                modification for chronic disease management.
                    ``(C) Limited environmental modifications, such as 
                safety equipment for showering, bathing, or toileting 
                or installation of safety, health, and wellness 
                monitoring technologies for an eligible older 
                individual.
                    ``(D) Nutritional and dietary supports, which may 
                include nutrition counseling, education, and the 
                delivery of meals to the home or assistance with 
                purchasing groceries in order to--
                            ``(i) assure an appropriate diet consistent 
                        with the medical needs, cultural background, 
                        and faith traditions of an eligible older 
                        individual; and
                            ``(ii) identify opportunities for 
                        socialization within the home or the community 
                        of an eligible older individual in order to 
                        enhance the ability to participate in healthy 
                        nutritional habits.
                    ``(E) Transportation in order to meet the medical 
                and social needs of an eligible older individual.
                    ``(F) Psychosocial supports to prevent isolation 
                and the potential for depression and cognitive decline, 
                which often accompany the lack of human interaction.
                    ``(G) Opportunities for exercise, as tolerable and 
                appropriate, to prevent further physical decline that 
                may lead to preventable disability.
                    ``(H) Opportunities for enjoyment through 
                activities or interactions, in person or virtually, 
                that enhance an eligible older individual's life, 
                relationships, well-being, or sense of productivity, 
                including providing the opportunities through the use 
                of technology products.
    ``(e) Election To Participate.--The Assistant Secretary shall 
determine and carry out an appropriate method of ensuring that eligible 
older individuals have agreed to enroll in a community care wrap-around 
support partnership program. Enrollment in the demonstration program 
shall be voluntary.
    ``(f) Compliance With Other Laws.--
            ``(1) Regulations.--Notwithstanding any provision of this 
        section, each eligible entity receiving a grant under this 
        section shall ensure that the activities carried out under the 
        grant comply with the regulations promulgated pursuant to 
        section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (42 U.S.C. 1320d-2 note), the Health 
        Information Technology for Economic and Clinical Health Act 
        (title XIII of division A and title IV of division B of Public 
        Law 111-5), and the amendments made by such Act.
            ``(2) Guidance.--The Assistant Secretary shall ensure that 
        the activities carried out under this section are consistent 
        with the guidance issued by the Secretary on June 6, 2014, for 
        implementing standards for person-centered planning and self-
        direction in home and community-based services programs, under 
        section 2402(a) of the Patient Protection and Affordable Care 
        Act (42 U.S.C. 1396n note).
    ``(g) Partnership Information Collection.--
            ``(1) During the first year of the demonstration program.--
                    ``(A) In general.--During the first year of the 
                demonstration program, the community care wrap-around 
                support partnership, through the designated care 
                coordinator described in subsection (a)(1)(B)(i), shall 
                maintain a record for each eligible older individual 
                who is served through the demonstration program. Such 
                record shall include detailed information about the 
                services and supports provided to the eligible older 
                individual through the demonstration program and shall 
                be incorporated into the electronic health record of 
                the eligible older individual.
                    ``(B) Contents.--The Assistant Secretary shall 
                determine the information to be collected in each 
                record described in subparagraph (A), which may include 
                information on the types of services and supports 
                provided, referrals, members of the community care 
                wrap-around support partnership, and an impact 
                statement on the health of the eligible older 
                individual served.
            ``(2) During the second year of the demonstration 
        program.--During the second year of the demonstration program, 
        in addition to maintaining the record described in paragraph 
        (1), the designated care coordinator described in subsection 
        (a)(1)(B)(i) shall ensure that, through the record described in 
        paragraph (1), the community care wrap-around support 
        partnership is able to--
                    ``(A) determine gaps in the provision of services 
                that can assist in the provision of comprehensive 
                health and wellness care for the eligible older 
                individual;
                    ``(B) connect the eligible older individual to 
                services under this Act that will address any such 
                gaps; and
                    ``(C) subject to the consent of the eligible older 
                individual, make appointments for the eligible older 
                individual to receive needed services and ensure that 
                the primary care physician and caregiver of such 
                eligible older individual receive notice of the needs 
                of such individual.
    ``(h) Determination of the Demonstration Program Effect on Patient 
Outcomes.--
            ``(1) Transfer of information.--Each eligible entity shall 
        collect, from each community care wrap-around partnership 
        supported by the eligible entity, and report to the Assistant 
        Secretary (in such form and manner, and at such frequency, as 
        shall be specified by the Assistant Secretary) such data as the 
        Assistant Secretary determines to be appropriate to monitor and 
        analyze the demonstration program.
            ``(2) Independent analysis of the demonstration program.--
        The Assistant Secretary shall enter into an agreement with an 
        entity to conduct an independent analysis, in consultation with 
        the Administrator for the Centers for Medicare & Medicaid 
        Services, and make a determination of whether the activities 
        described in subsection (d) result in--
                    ``(A) a reduced number of hospital days (other than 
                days an eligible older individual elects to remain in 
                the hospital);
                    ``(B) reduced hospital readmissions for eligible 
                older individuals;
                    ``(C) reduced emergency room visits for eligible 
                older individuals;
                    ``(D) improved health outcomes commensurate, in 
                each individual case, with the eligible older 
                individual's stage of chronic illness;
                    ``(E) improved efficiency of care, such as a 
                reduction of duplicative diagnostic and laboratory 
                tests, for eligible older individuals;
                    ``(F) a reduced cost of health care services;
                    ``(G) improved or maintained nutrition status, to 
                manage chronic disease;
                    ``(H) any delay of entry of eligible older 
                individuals into institutional care; and
                    ``(I) any other outcomes measures the Assistant 
                Secretary determines to be appropriate.
            ``(3) Impact study.--
                    ``(A) Evaluation.--The Assistant Secretary, in 
                consultation with the Administrator for the Centers for 
                Medicare & Medicaid Services and using the information 
                and data collected under this subsection and subsection 
                (g), shall conduct an evaluation of the demonstration 
                program, including comparing the well-being and costs 
                of care of participants in a community care wrap-around 
                support partnership program, to the well-being and such 
                costs for patients who have not participated in such a 
                program, to determine the impact of the additional 
                services and supports provided through such a program 
                and shall prepare findings from the evaluation.
                    ``(B) Determination on expansion.--Based on the 
                evaluation conducted under subparagraph (A) and the 
                independent analysis conducted under paragraph (2), the 
                Assistant Secretary, in consultation with the 
                Administrator for the Centers for Medicare & Medicaid 
                Services, shall determine whether expansion of the 
                demonstration program is appropriate. If the 
                determination is that such expansion is appropriate, 
                the Assistant Secretary, in consultation with such 
                Administrator, shall prepare a plan specifying--
                            ``(i) whether the expanded program should 
                        involve a greater number of grants to eligible 
                        entities, for community care wrap-around 
                        support partnership programs based on 
                        subsections (a) through (g);
                            ``(ii) whether the expanded program should 
                        involve grants to regional, statewide, or 
                        multi-State combinations of eligible entities 
                        to engage corresponding community care wrap-
                        around support partnerships in corresponding 
                        areas, for such programs based on subsections 
                        (a) through (g); and
                            ``(iii) whether the expanded program should 
                        be carried out through the Administration on 
                        Aging and the Center for Medicare and Medicaid 
                        Innovation.
            ``(4) Report to congress.--Not later than 1 year after the 
        end of the demonstration program, the Assistant Secretary shall 
        submit to Congress a report containing the findings, the 
        results of the independent analysis, the determination, and any 
        plan, prepared under paragraphs (1) through (3).
            ``(5) Expanded program.--Subject to the availability of 
        appropriations, if the report contains a plan prepared under 
        paragraph (3)(B), the Assistant Secretary may implement the 
        expanded program, in accordance with the plan, not sooner than 
        6 months after submission of the report.
    ``(i) Implementation Date.--Not later than January 1, 2016, the 
Assistant Secretary shall issue a request for proposals to carry out 
this section.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2016 through 2018.''.

SEC. 3. PILOT PROJECT ON SERVICES FOR RECIPIENTS OF FEDERALLY ASSISTED 
              HOUSING.

    Part A of title IV of the Older Americans Act of 1965 (42 U.S.C. 
3032 et seq.), as amended by section 2, is further amended by adding at 
the end the following:

``SEC. 424. PILOT PROJECT ON SERVICES FOR RECIPIENTS OF FEDERALLY 
              ASSISTED HOUSING.

    ``(a) Definition.--In this section, the term `federally assisted 
housing' means--
            ``(1) multifamily housing financed, insured, or subsidized 
        by the Rural Housing Service of the Department of Agriculture 
        or by the Department of Housing and Urban Development; or
            ``(2) any housing with respect to which a credit is allowed 
        under the low-income housing tax credit under section 42 of the 
        Internal Revenue Code of 1986.
    ``(b) Funding.--The Assistant Secretary may provide funding for a 
service provided under this Act (including title V) packaged and 
targeted for residents of federally assisted housing. The Assistant 
Secretary may provide such funding for a period of 2 years.
    ``(c) Recipients.--The Assistant Secretary shall provide funding 
made available under subsection (b) through area agencies on aging, 
other entities approved by the Assistant Secretary, or designees of the 
agencies or entities, to not-for-profit owners or managers of the 
housing.
    ``(d) Evaluations and Reports.--
            ``(1) Evaluations.--Each agency, entity, or designee that 
        receives funding under this section shall evaluate the 
        effectiveness of the services provided through the funding.
            ``(2) Reports.--The agency, entity, or designee shall, not 
        later than 90 days after the end of the funding period, prepare 
        and submit to the Assistant Secretary a report containing the 
        results of the evaluation.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2016 through 2018. Such sums shall remain 
available through fiscal year 2019 for the purpose of carrying out the 
evaluations and reports under subsection (d).''.

SEC. 4. NATIONAL CAMPAIGN TO RAISE AWARENESS OF THE AGING NETWORK AND 
              TO PROMOTE ADVANCE INTEGRATED LONG-TERM CARE PLANNING.

    (a) In General.--Section 202(b)(6) of the Older Americans Act of 
1965 (42 U.S.C. 3012(b)(6)) is amended to read as follows:
            ``(6) promote, through a coordinated public education and 
        outreach campaign carried out by the National Eldercare Locator 
        Service described in subsection (a)(21) and in coordination 
        with other appropriate Federal agencies--
                    ``(A) enhanced awareness by the public of the 
                importance of planning in advance for integrated long-
                term care; and
                    ``(B) the availability of national, State, and 
                local information and resources to assist in such 
                planning, as well as the existence of area agencies on 
                aging and other aging service providers to provide 
                direct assistance with such planning;''.
    (b) Authorization of Appropriations.--Section 216 of the Older 
Americans Act of 1965 (42 U.S.C. 3020f) is amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following:
    ``(c) National Campaign on Integrated Long-Term Care Planning.--
There are authorized to be appropriated to carry out section 202(b)(6) 
such sums as may be necessary for each of fiscal years 2016 through 
2018.''.
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