[Congressional Record Volume 155, Number 87 (Thursday, June 11, 2009)]
[Senate]
[Pages S6564-S6568]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. CANTWELL (for herself and Ms. Stabenow):
  S. 1257. 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; to the Committee on Finance.
  Ms. CANTWELL. Mr. President, I rise today to introduce Project 2020: 
Building on the Promise of Home and Community-Based Services Act with 
my colleague from Michigan, Senator Stabenow. By the year 2020, almost 
1 in 6 Americans will be over the age of 65 and the population of 
people over the age of 85, the fastest growing segment of the 
population, will double. Our current long term care financing structure 
is unsustainable as the population in need of such services rapidly 
increases. As such, we must turn our focus to reforming the long term 
care system to provide the best care available to this vulnerable 
population.
  The average cost of a nursing home in this country is $70,000 a year, 
making this an unrealistic option for most Americans. In fact, most 
people who end up in a nursing home last just six months before they 
have spent so much they become poor enough to qualify for Medicaid. 
This situation is expensive for consumers, for states, and for the 
federal government. Fortunately, there is a clear answer. It costs 
Medicaid one third as much to provide someone with home and community 
based care as it would cost to care for them in a nursing home. In 
addition, most people want to stay in their own home or community 
whenever possible. An independent analysis conducted by the Lewin Group 
shows that Project 2020 would reach over 40 million Americans, while 
simultaneously reducing Medicare and Medicaid costs by more than $2.8 
billion over 5 years.
  Project 2020 addresses the urgent need to shift away from 
institutional care and towards home and community based services in 
three distinct ways: through enhanced nursing home diversion; by 
increasing the use of person-centered access to information; and by 
utilizing evidence-based disease and injury prevention. As I previously 
mentioned, increased nursing home diversion will not only provide 
significant savings to the Medicaid program, it will also allow 
families to stay together and let people be active members of their 
communities. Through the creation of a person-center access point to 
information, consumers, family members, and caregivers will be given 
the tools necessary to make well informed decisions about long term 
care. Finally, this bill will provide for programs that help consumers 
get proven education about avoiding preventable diseased and injuries, 
such as falls and malnutrition, which result in thousands of 
unnecessary hospitalizations every year.
  As you can see, these three programs constitute a common-sense, 
multifaceted approach to improving the quality of life of individuals 
and their families, while providing a substantial amount of savings to 
the health care system.
  I am pleased to introduce this important legislation along with my 
colleague Senator Stabenow and I look forward to working with the rest 
of my Senate colleagues to provide families with the long term care 
services and support they need.
  Mr. President, I ask unanimous consent that the text of the 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. 1257

       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;

[[Page S6565]]

       ``(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

[[Page S6566]]

     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).

[[Page S6567]]

       ``(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--

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       ``(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.''.

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