[Congressional Record Volume 152, Number 44 (Friday, April 7, 2006)]
[Senate]
[Pages S3390-S3394]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON:
  S. 2620. A bill to amend the Older Americans Act of 1965 to authorize 
the Assistant Secretary for Aging to provide older individuals with 
financial assistance to select a flexible range of home and community-
based long-term care services or supplies, provided in a manner that 
respects the individuals' choices and preferences; to the Committee on 
Health, Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, I am pleased today to introduce the 
Community-Based Choices for Older Americans Act of 2006. This 
legislation would take several important steps toward helping older 
Americans meet their long-term care needs.
  Issues related to long-term care are of growing concern to many in 
New York and around the country, especially as baby boomers begin to 
require more of these important services. Older Americans are 
struggling to afford costly care and to maintain dignity and choice 
regarding these services.
  As I talk with seniors around the State of New York and throughout 
the country, what I hear most is that people want to stay in their 
homes for as long as they can. However, too many individuals struggle 
to afford quality home and community-based care and, as a result, are 
forced into institutional care: A more costly outcome they do not 
desire and that places additional burden on the Medicaid program.
  That is why I am introducing this legislation today. The Community-
Based Choices for Older Americans Act will assist individuals age 60 or 
older who grapple with daily living activities or with a disability, 
yet are above a State's Medicaid eligibility threshold, in meeting 
their long-term care needs.
  This bill will establish a matching grant program to States to help 
these individuals pay for a broad range of health, social, and 
supportive services based on the individuals' personal choices and 
preferences in collaboration with a service coordinator. Eligible 
individuals will be able to purchase services and supports that would 
be provided in home or community-based settings, such as home 
modifications like a wheelchair or ramp, assistance with grocery 
shopping or meal preparation, or adult day services.
  This legislation is based on the Cash and Counseling model 
successfully used in demonstration projects in 15 States. This 
consumer-directed approach offers individuals more choice, flexibility, 
and control in managing their daily lives.
  Through this bill, State Agencies on Aging throughout the country 
will be given the tools to develop a community-based, long-term care 
system where seniors choose the services and the providers they want so 
they are able to maintain independence and dignity while they age in 
place in the

[[Page S3391]]

homes and communities where they have often lived for decades.
  This year marks the first year that the baby boom population turns 
60. Development of a consumer-friendly, home and community-based system 
of long-term care is a critical step in planning services for this 
population.
  I look forward to working with all of my colleagues to ensure passage 
of this bill to help our seniors choose the long-term care resources 
and services they need to remain independent.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2620

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Community-Based Choices for 
     Older Americans Act of 2006''.

     SEC. 2. PURPOSE.

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

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

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

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

     ``SEC. 801. DEFINITIONS.

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

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       ``(A) provides service coordination for an eligible 
     individual; and
       ``(B) is trained or experienced in the skills that are 
     required to facilitate consumer choice and carry out the 
     functions described in paragraph (13)(B).
       ``(15) State.--The term `State' means each of the 50 
     States, the District of Columbia, the Commonwealth of Puerto 
     Rico, Guam, the United States Virgin Islands, American Samoa, 
     and the Commonwealth of the Northern Mariana Islands.

     ``SEC. 802. ALLOTMENTS TO ELIGIBLE STATES.

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

     ``SEC. 803. ALLOTMENTS.

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

     ``SEC. 804. STATE PLANS.

       ``(a) In General.--In order to receive an allotment made 
     under section 802 for an eligible State for a fiscal year, 
     the State shall submit to the Assistant Secretary for 
     approval a State plan that includes the information and 
     assurances described in subsection (b).
       ``(b) Contents.--
       ``(1) Eligibility.--The plan shall include descriptions of 
     the eligibility criteria and methodologies that the State 
     will apply, consistent with section 801(4), to determine 
     whether an individual is an eligible individual for the 
     program carried out in the State under this title.
       ``(2) Priority for eligible individuals with greatest 
     economic need.--The plan shall include an assurance that, in 
     establishing and applying the eligibility criteria and 
     methodologies described in paragraph (1), the State will give 
     priority to providing assistance to those eligible 
     individuals who have the greatest economic need, as defined 
     by the State.
       ``(3) Needs and preferences of eligible individuals.--The 
     plan shall include a description of how the State will ensure 
     that the needs and preferences of an eligible individual are 
     addressed in all aspects of the program.
       ``(4) Payments for services.--The plan shall include an 
     assurance that the State will make payments, at the election 
     of an eligible individual, in accordance with section 
     806(b)(2), and will provide a fiscal intermediary for each 
     eligible individual electing to receive a payment as 
     described in section 806(b)(2)(B).
       ``(5) Services and supplies.--The plan shall describe the 
     services and supplies that the State will make available to 
     an eligible individual, consistent with the definition of 
     covered long-term services or supplies specified in section 
     801(3).
       ``(6) Cost-sharing.--The plan shall include a description 
     of the methodologies to be used--
       ``(A) to calculate the ability of an eligible individual to 
     pay for covered long-term care services or supplies without 
     assistance under the program carried out under this title;
       ``(B) based on the calculation of ability to pay, to 
     determine the amount of cost-sharing that the eligible 
     individual will be responsible for under the program, set on 
     a sliding scale based on income;
       ``(C) to collect cost-sharing amounts, both in cases in 
     which the State makes payments directly to a qualified 
     provider as described in section 806(b)(2)(A), and in cases 
     in which the State makes payments to a fiscal intermediary on 
     behalf of an eligible individual, as described in section 
     806(b)(2)(B); and
       ``(D) to track expenditures by eligible individuals for the 
     purchase of covered long-term care services or supplies.
       ``(7) Cost-sharing requirements for providers.--The plan 
     shall provide an assurance that the State will require each 
     provider involved in the program carried out in the State 
     under this title--
       ``(A) to protect the privacy and confidentiality of each 
     eligible individual with respect to the income, and any cost-
     sharing amount determined under paragraph (6), of an eligible 
     individual;
       ``(B) to establish appropriate procedures to account for 
     cost-sharing amounts; and
       ``(C) to widely distribute State-created written materials 
     in languages reflecting the reading abilities of eligible 
     individuals that describe the criteria for cost-sharing, and 
     the State's sliding scale described in paragraph (6)(B).
       ``(8) Coordination with other programs.--The plan shall 
     include a description of the methods by which the State will, 
     as appropriate, refer individuals who apply for assistance 
     under a program carried out under this title for eligibility 
     determinations under--
       ``(A) the State medicaid program carried out under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
       ``(B) the medicare program carried out under title XVIII of 
     such Act (42 U.S.C. 1395 et seq.);
       ``(C) a program funded under title XX of such Act (42 
     U.S.C. 1397 et seq.);
       ``(D) other programs funded under this Act; and
       ``(E) other Federal or State programs that provide long-
     term care.
       ``(9) Entities and procedures.--The plan shall include a 
     description of the entities and procedures that the State 
     will use to carry out the following functions:
       ``(A) Establishing eligibility for the program carried out 
     under this title.
       ``(B) Assessing the need of an eligible individual for 
     covered long-term care services or supplies.
       ``(C) Determining the amount of payments described in 
     section 806(b) to be made for the eligible individual under 
     the program.
       ``(D) Evaluating the cost-sharing by the eligible 
     individual under the program.
       ``(E) In the case of an eligible individual who elects to 
     receive payments as described in section 806(b)(2)(B), 
     helping the eligible individual or the eligible individual's 
     representative (as appropriate) identify, retain, and 
     negotiate and terminate agreements with, qualified providers 
     of covered long-term services or supplies.
       ``(F) Monitoring payments made for an eligible individual 
     to ensure that--
       ``(i) the cost-sharing amounts that the eligible individual 
     is responsible for under the State plan are paid;
       ``(ii) the payments made by the State for the eligible 
     individual--

       ``(I) are made in a timely fashion; and
       ``(II) do not exceed the annual assistance amount 
     established for the eligible individual under section 806(a); 
     and

       ``(iii) when appropriate, the payments are made by the 
     State in an expedited manner to account for health status 
     changes of an eligible individual that require rapid 
     responses.
       ``(G) Establishing a quality assurance system that assesses 
     the covered long-term services or supplies provided for the 
     eligible individual to ensure that the qualified provider of 
     such services or supplies meets such

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     licensing, quality, or other standards as the State may 
     establish in accordance with paragraph (11).
       ``(H) Providing information to eligible individuals about 
     average market rates for covered long-term care services or 
     supplies.
       ``(I) Administering payments in a timely fashion and in 
     accordance with a written care plan described in section 
     805(1) for an eligible individual (that takes into account 
     payment rates established by the eligible individual or a 
     representative of the eligible individual (as appropriate)), 
     including the methods for--
       ``(i) making payments directly to a qualified provider as 
     described in section 806(b)(2)(A);
       ``(ii) making payments to a fiscal intermediary on behalf 
     of an eligible individual, as described in section 
     806(b)(2)(B), for the purchase of such services or supplies; 
     and
       ``(iii) making payments (when appropriate) in an expedited 
     manner to account for health status changes of the eligible 
     individual that require rapid responses.
       ``(J) Carrying out such other activities as the eligible 
     State determines are appropriate with respect to the eligible 
     individual or the program carried out under this title.
       ``(10) Service coordinators.--The plan shall include a 
     description of how the State will--
       ``(A) provide a service coordinator (directly or by 
     contract) for each eligible individual receiving assistance 
     under the program carried out under this title; and
       ``(B) ensure that the service coordinator carries out the 
     responsibilities described in section 805, including any 
     responsibilities assigned by the State under section 805(5).
       ``(11) Qualified providers.--The plan shall include a 
     description of any licensing, quality, or other standards for 
     qualified providers (including both providers paid directly 
     by the State as described in section 806(b)(2)(A) or through 
     payments made to a fiscal intermediary on behalf of an 
     eligible individual, as described in section 806(b)(2)(B).
       ``(12) Quality assurance.--The plan shall include a 
     description of the procedures to be used to ensure the 
     quality and appropriateness of the covered long-term care 
     services or supplies provided to an eligible individual and 
     the program carried out under this title, which shall 
     include--
       ``(A) a quality assessment and improvement strategy that 
     establishes--
       ``(i) standards that provide for access to covered long-
     term care services or supplies within reasonable time frames 
     and that are designed to ensure the continuity and adequacy 
     of such services or supplies; and
       ``(ii) procedures for monitoring and evaluating the quality 
     and appropriateness of the covered long-term care services or 
     supplies provided to eligible individuals under the program 
     carried out under this title; and
       ``(B) a mechanism for obtaining feedback from eligible 
     individuals and others regarding their experiences with, and 
     recommendations for improvement of, the program carried out 
     under this title.
       ``(13) Outreach.--The plan shall include a description of 
     the procedures by which the State will conduct outreach for 
     enrollment (including outreach to persons residing in 
     naturally occurring retirement communities) in the program 
     carried out under this title.
       ``(14) Indians.--The plan shall include a description of 
     the procedures by which the State will ensure the provision 
     of assistance under the program carried out under this title 
     to eligible individuals who are Indians (as defined in 
     section 4(c) of the Indian Health Care Improvement Act (25 
     U.S.C. 1603(c))) or Native Hawaiians, as defined in section 
     625.
       ``(15) Data collection.--The plan shall include an 
     assurance that the State will annually collect and report to 
     the Assistant Secretary such data and information related to 
     the program carried out under this title as the Assistant 
     Secretary may require, including the information required 
     under section 807(a)(1)(B).

     ``SEC. 805. RESPONSIBILITIES OF SERVICE COORDINATORS.

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

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

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

     ``SEC. 807. ANNUAL REPORTS.

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

[[Page S3394]]

       ``(c) Report to Congress.--At the end of each fiscal year, 
     the Assistant Secretary shall prepare and submit to the 
     Committee on Education and the Workforce of the House of 
     Representatives and the Committee of Health, Education, 
     Labor, and Pensions of the Senate a report that contains a 
     summary of the data submitted under subsection (a)(1)(B) and 
     a description of any implementations issues with the programs 
     carried out under this title.

     ``SEC. 808. AUTHORIZATION OF APPROPRIATIONS.

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

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