[Senate Report 109-337]
[From the U.S. Government Publishing Office]






                                                       Calendar No. 617
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-337

======================================================================



 
                           ELDER JUSTICE ACT

                                _______
                                

               September 19, 2006.--Ordered to be printed

                                _______
                                

  Mr. Grassley, from the Committee on Finance, submitted the following

                              R E P O R T

                         [To accompany S. 2010]

    The Committee on Finance, to which was referred the bill 
(S. 2010) to amend the Social Security Act to enhance the 
Social Security of the Nation by ensuring adequate public-
private infrastructure and to resolve to prevent, detect, 
treat, intervene in, and prosecute elder abuse, neglect, and 
exploitation, and for other purposes, reports favorably thereon 
with an amendment in the nature of a substitute and recommends 
the bill, as amended, do pass.

                             I. BACKGROUND

    More than a quarter of a century has passed since the first 
Congressional hearings on elder abuse declared it to be a 
national disgrace. Throughout this period, Congressional action 
has remained limited. From a policy perspective, elder justice 
means assuring that adequate public-private infrastructure and 
resources exist to prevent, detect, treat, understand, 
intervene in and, where appropriate, prosecute elder abuse, 
neglect, and exploitation. From an individual perspective, 
elder justice is the right of every older individual to be free 
of abuse, neglect, and exploitation.
    There are between 500,000 and 5 million older individuals 
who are abused in this country every year. Despite the dearth 
of data to quantify precisely the number of seniors subjected 
to abuse, experts agree that we have only seen the tip of the 
iceberg. In fact, according to the National Elder Abuse 
Incidence Study conducted by the National Center on Elder 
Abuse, 84 percent of all cases of elder abuse are never 
reported. It is clear that abuse and neglect shorten the 
victim's life, often triggering a downward spiral, ``tipping 
over'' an otherwise productive, self-sufficient older 
individual. There are three main types of elder abuse: abuse 
and neglect in homes and domestic settings; abuse and neglect 
in institutions and other types of residential care; and 
financial fraud and exploitation.
    Studying the results of efforts to respond to other family 
violence issues, such as domestic violence and child abuse, has 
resulted in the conclusion that abuse, neglect, and 
exploitation require a multi-faceted solution, including public 
health, social service, and law enforcement approaches. While 
these other types of abuse have been recognized and receive 
sizable Federal funding, elder abuse remains under-researched, 
under-reported, and under-funded. The Elder Justice Act 
provides Federal leadership to those on the front lines who are 
fighting elder abuse with scarce resources and fragmented 
systems.
    Highlights of the Elder Justice Act include the following:
    Elevating elder justice issues to national attention. The 
bill will establish within the Department of Health and Human 
Services programmatic, grant-making, policy and technical 
assistance functions relating to elder justice; creation of a 
public-private Coordinating Council to coordinate activities of 
all relevant Federal agencies, States, communities, and private 
and not-for-profit entities; and provide a consistent funding 
stream and national coordination for Adult Protective Services 
(APS).
    Improving the quality, quantity, and accessibility of 
information. An elder justice national data repository will be 
developed to increase the knowledge base and collect data about 
elder abuse, neglect, and exploitation.
    Increasing knowledge and supporting promising projects. To 
help overcome the lack of research on elder abuse and related 
issues, the Elder Justice Act will enhance research, clinical 
practice, training, and dissemination of information relating 
to these issues. Priorities include jump-starting intervention 
research, developing community strategies to make elders safer, 
and enhancing multi-disciplinary efforts.
    Developing forensic capacity. There is scant data to assist 
in the detection of elder abuse, neglect, and exploitation. 
Creating new forensic expertise (similar to that in child 
abuse) will promote detection and increase expertise. New 
programs will train health professionals in both forensic 
pathology and geriatrics.
    Increasing prosecution. The Elder Justice Act establishes 
new penalties for failure to promptly report crimes in 
residential care facilities and to provide notice of nursing 
home closings.
    Training. The Act supports training to combat elder abuse, 
neglect, and exploitation both within individual disciplines 
and in multi-disciplinary (such as public health-social 
service-law enforcement) settings.
    Model State Laws and Practices. A study will review State 
practices and laws relating to elder justice.
    Increasing Security, Collaboration, and Consumer 
Information in Long-Term Care. The bill will:
           Improve prompt reporting of crimes in long-
        term care settings,
           Enhance long-term care staffing,
           Enhance the long-term care ombudsman 
        program,
           Require a study on establishment of a 
        national nurse aide registry to enable background 
        checks on nurse's aids,
           Provide information about long-term care for 
        consumers through a Consumer Clearinghouse,
           Require new reporting of crimes in nursing 
        homes on the official Federal website, and
           Require establishment of consumer 
        information on nursing homes on the official Federal 
        website.
    Evaluations/Accountability. The bill contains provisions to 
determine what works and assure funds are properly spent.

                          LEGISLATIVE HISTORY

    After dozens of hearings in various Senate and House 
committees from 1979 to the present, the Elder Justice Act, S. 
2933, was first introduced by Senator John Breaux (D-LA) and 
Senator Orrin G. Hatch (R-UT) on September 12, 2002, and 
referred to the Senate Finance Committee. Under the 
Chairmanship of Senator Max Baucus (D-MT), the Senate Finance 
Committee held a hearing on June 18, 2002, entitled Elder 
Justice: Protecting Seniors from Abuse and Neglect. Five 
experts on elder abuse testified, including Robert Blancato, 
President, National Committee for Prevention of Elder Abuse; 
Catherine Hawes, Ph.D., Professor, Department of Health Policy 
and Management, School of Rural Public Health, Texas A&M 
University; Joanne Otto, M.S.W., Executive Director, National 
Association of Adult Protective Services Administrators; Carmel 
Dyer, M.D., Associate Professor of Medicine, Baylor College of 
Medicine; Randolph Thomas, M.A., Law Enforcement Instructor, 
South Carolina Department of Public Safety, Criminal Justice 
Academy; and Richard Bonnie, J.D., Chair, Panel to Review Risk 
and Prevalence of Elder Abuse and Neglect, Committee on 
National Statistics of the National Research Council. Prominent 
in the discussion were the findings of the National Research 
Council publication entitled Elder Mistreatment: Abuse, 
Neglect, and Exploitation in an Aging America. The National 
Research Council was directed by Congress to assess the current 
state of knowledge in the area of elder mistreatment and to 
formulate a set of recommendations for a research agenda in the 
field. The National Research Council reported that it was 
unable to formulate a research agenda for several reasons, 
including unclear and inconsistent definitions; unclear and 
inadequate measures; incomplete professional accounts; lack of 
population-based data; lack of prospective data; lack of 
control group; and lack of systematic evaluation studies. No 
legislative action was taken during the 107th Congress.
    Senators Breaux and Hatch introduced the Elder Justice Act, 
S. 333, again during the 108th Congress on February 10, 2003, 
and the bill was referred to the Senate Finance Committee.
    On September 28, 2004, under the leadership of Chairman 
Charles E. Grassley (R-IA), the Senate Finance Committee 
considered the bill in Executive Session and reported it 
unanimously. It was placed on the Legislative Calendar, but the 
Senate failed to act on the bill.
    Senator Orrin G. Hatch and Senator Blanche L. Lincoln (D-
AR) introduced the Elder Justice Act, S. 2010, again during the 
109th Congress on November 15, 2005, and the bill was referred 
to the Senate Finance Committee. Under the leadership of 
Chairman Charles E. Grassley, the Senate Finance Committee 
considered the bill in Executive Session on August 4, 2006 and, 
for the second time, unanimously reported it as an amendment in 
the nature of a substitute.

                    II. SECTION-BY-SECTION ANALYSIS


Short Title; Table of Contents; Definitions

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The bill sets forth the title of the Act as the Elder 
Justice Act and outlines the table of contents. It also 
specifies that any term defined in new amendment to title XX of 
the Social Security Act has the meaning set forth by the 
Committee Bill.

Findings

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The Committee Bill describes the following findings of 
Congress:
          1. The proportion of the United States population age 
        60 years or older will drastically increase in the next 
        30 years as more than 76,000,000 baby boomers approach 
        retirement and old age.
          2. Each year, anywhere between 500,000 and 5,000,000 
        elders in the United States are abused, neglected, or 
        exploited.
          3. Elder abuse, neglect, and exploitation have no 
        boundaries and cross all racial, social class, gender, 
        and geographic lines.
          4. Victims of elder abuse, neglect, and exploitation 
        are not only subject to injury from mistreatment and 
        neglect, they are also 3.1 times more likely than 
        elders who were not victims of elder abuse, neglect, 
        and exploitation to die at an earlier age than 
        expected.
          5. There is a general dearth of data as to the nature 
        and scope of elder abuse, neglect, and exploitation.
          6. Despite the dearth of data in the field, experts 
        agree that most cases of elder abuse, neglect, and 
        exploitation are never reported and that abuse, 
        neglect, and exploitation shorten a victim's life, 
        often triggering a downward spiral of an otherwise 
        productive, self-sufficient elder's life. Programs 
        addressing other difficult issues such as domestic 
        violence and child abuse and neglect have demonstrated 
        the need for a multi-faceted law, combining public 
        health, social service, and law enforcement approaches.
          7. For over 20 years, Congress has been presented 
        with facts and testimony calling for a coordinated 
        Federal effort to combat elder abuse, neglect, and 
        exploitation.
          8. The Federal Government has been slow to respond to 
        the needs of victims of elder abuse, neglect, and 
        exploitation or to undertake prevention efforts.
          9. No Federal law has been enacted that adequately 
        and comprehensively addresses the issues of abuse, 
        neglect, and exploitation, and there are very limited 
        resources available to those in the field who directly 
        deal with the issues.
          10. Differences in State laws and practices in the 
        areas of elder abuse, neglect, and exploitation lead to 
        significant disparities in prevention, protective and 
        social services, treatment systems, and law enforcement 
        and lead to other inequities.
          11. The Federal Government has played an important 
        role in promoting research, training, public safety, 
        data collection, the identification, development, and 
        dissemination of promising health care, social, and 
        protective services, and law enforcement practices 
        relating to child abuse and neglect, domestic violence, 
        and violence against women. The Federal Government 
        should promote similar efforts and protections relating 
        to elder abuse, neglect, and exploitation.
          12. The Federal Government should provide leadership 
        and assist States and communities in their efforts to 
        protect elders in the United States by--
          (A) promoting coordinated planning among all levels 
        of government;
          (B) generating and sharing knowledge relevant to 
        protecting elders;
          (C) providing leadership to combat the abuse, 
        neglect, and exploitation of the Nation's elders; and
          (D) providing resources to States and communities to 
        promote elder justice.
          13. The problem of elder abuse, neglect, and 
        exploitation requires a comprehensive approach that--
          (A) integrates the work of health, legal, and social 
        services agencies and organizations;
          (B) emphasizes the need for prevention, reporting, 
        investigation, assessment, treatment, and prosecution 
        of elder abuse, neglect, and exploitation at all levels 
        of government;
          (C) ensures that sufficient numbers of properly 
        trained personnel with specialized knowledge are in 
        place to--
          (i) treat, assess, and provide services relating to 
        elder abuse, neglect, and exploitation; and
          (ii) carry out elder protection duties;
          (D) is sensitive to ethnic and cultural diversity;
          (E) recognizes the role of mental health, disability, 
        dementia, substance abuse, medication mismanagement, 
        and family dysfunction problems in increasing and 
        exacerbating elder abuse, neglect, and exploitation; 
        and
          (F) balances elders' right to self-determination with 
        society's responsibility to protect elders.
          14. The human, social, and economic cost of abuse, 
        neglect, and exploitation is high and includes 
        unnecessary expenditures of funds from many public 
        programs.
          15. The failure to coordinate activities relating to, 
        and comprehensively prevent and treat, elder abuse, 
        neglect, and exploitation threatens the future and 
        well-being of millions of elders in the United States.
          16. All elements of society in the United States have 
        a shared responsibility in responding to a national 
        problem of elder abuse, neglect, and exploitation.

Purposes

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The Committee Bill defines the purposes of the Elder 
Justice Act, as follows:
    1. To enhance the social security of the Nation by ensuring 
adequate public-private infrastructure and resolve to prevent, 
detect, treat, understand, and intervene in, and where 
appropriate, aid in the prosecution of, elder abuse, neglect, 
and exploitation.
    2. To bring a comprehensive approach to preventing and 
combating elder abuse, neglect, and exploitation, a long 
invisible problem that afflicts the most vulnerable among the 
aging population of the United States.
    3. To raise the issue of elder abuse, neglect, and 
exploitation to national attention, and to create the 
infrastructure at the Federal, State and local levels to ensure 
that individuals and organizations on the front lines, who are 
fighting elder abuse, neglect, and exploitation with scarce 
resources and fragmented systems, have the resources and 
information needed to carry out their fight.
    4. To bring a comprehensive multidisciplinary approach to 
elder justice.
    5. To set in motion research and data collection to fill 
gaps in knowledge about elder abuse, neglect, and exploitation.
    6. To supplement activities of service providers and 
programs, to enhance training, and to leverage scarce resources 
efficiently, in order to ensure that elder justice receives the 
attention it deserves as the Nation's population ages.
    7. To recognize and address the role of mental health, 
disability, dementia, substance abuse, medication 
mismanagement, and family dysfunction problems in increasing 
and exacerbating elder abuse, neglect, and exploitation.
    8. To create short- and long-term strategic plans for the 
development and coordination of elder justice research, 
programs, studies, training, and other efforts nationwide.
    9. To promote collaborative efforts and diminish overlap 
and gaps in efforts in developing the important field of elder 
justice.
    10. To honor and respect the right of all persons with 
diminished capacity to decision making, autonomy, self-
determination, and dignity of choice.
    11. To respect the wishes of individuals with diminished 
capacity and their family members in providing supportive 
services and care plans intended to protect elders from abuse, 
neglect (including self-neglect), and exploitation.

Definitions

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    Section 4 adopts the meaning of any term used in Section 
2011 of the Social Security Act, unless specifically provided 
otherwise in the Committee Bill.

Elder justice

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    Section 5 of the Committee Bill would amend the Social 
Security Act by adding ``Elder Justice'' to an amended title 
XX, entitled ``Block Grants to States for Social Services and 
Elder Justice'' and adding a new ``Subtitle 2--Elder Justice''.

Definitions

                              PRESENT LAW

    Under current law, ``abuse,'' ``exploitation,'' ``long term 
care facility,'' and ``neglect'' are defined in the ``Older 
Americans Act.''

                             COMMITTEE BILL

    For data collection and other purposes of the bill, the 
Committee Bill defines the following terms: adult protective 
services, caregiver, direct care, elder, elder justice, 
eligible entity, exploitation, fiduciary, grant, guardianship, 
Indian tribe, law enforcement, long-term care, long-term care 
facility, neglect, self-neglect, serious bodily injury, 
criminal sexual abuse, social, State, State legal assistance 
developer, and State long-term care ombudsman.
    Definitions related to some of the purposes of the amended 
title XX are defined in other related statutes. Related 
statutes are as follows:

               PRESENT LAW AND COMMITTEE BILL: DEFINITIONS
------------------------------------------------------------------------
              Term                    Present law       Committee Bill
------------------------------------------------------------------------
Abuse...........................  Section 102(13) of  ``Abuse'' is
                                   the Older           defined as the
                                   Americans Act:      knowing
                                   ``Abuse'' of an     infliction of
                                   older person is     physical or
                                   defined as the      psychological
                                   willful             harm or the
                                   infliction of       knowing
                                   injury,             deprivation of
                                   unreasonable        goods or services
                                   confinement,        that are
                                   intimidation, or    necessary to meet
                                   cruel punishment    essential needs
                                   with resulting      or to avoid
                                   physical harm,      physical or
                                   pain, or mental     psychological
                                   anguish, or         harm.
                                   deprivation by a
                                   person, including
                                   a caregiver, of
                                   goods or services
                                   that are
                                   necessary to
                                   avoid physical
                                   harm, mental
                                   anguish or mental
                                   illness.
Exploitation....................  Section 102(24) of  ``Exploitation''
                                   the Older           is defined as the
                                   Americans Act:      fraudulent or
                                   ``Exploitation''    otherwise
                                   of an older         illegal,
                                   person is defined   unauthorized, or
                                   as the illegal or   improper act or
                                   improper act or     process of an
                                   process of an       individual,
                                   individual,         including a
                                   including a         caregiver or
                                   caregiver, using    fiduciary, that
                                   the resources of    uses the
                                   an older            resources of an
                                   individual for      elder for
                                   monetary or         monetary or
                                   personal benefit,   personal benefit,
                                   profit, or gain.    profit, or gain,
                                                       or that results
                                                       in depriving an
                                                       elder of rightful
                                                       access to, or use
                                                       of, benefits,
                                                       resources,
                                                       belongings, or
                                                       assets.
Long-term care facility.........  Section 102(32) of  ``Long-term care
                                   the Older           facility'' is
                                   Americans Act:      defined as a
                                   ``Long term care    residential care
                                   facility'' is       provider that
                                   defined as a        arranges for, or
                                   skilled nursing     directly
                                   facility as         provides, long-
                                   defined in          term care.
                                   Section 1819(a)
                                   of the Social
                                   Security Act; any
                                   nursing facility
                                   as defined in
                                   Section 1919(a)
                                   of the Social
                                   Security Act; and
                                   for purposes of
                                   the title III and
                                   title VII
                                   provisions for
                                   elder abuse
                                   prevention, a
                                   board and care
                                   facility.
Neglect.........................  Section 102(34) of  ``Neglect'' is
                                   the Older           defined as the
                                   Americans Act:      failure of a
                                   ``Neglect'' is      caregiver or
                                   defined as the      fiduciary to
                                   failure to          provide the goods
                                   provide for         or services that
                                   oneself the goods   are necessary to
                                   or services that    maintain the
                                   are necessary to    health or safety
                                   avoid physical      of an elder, or
                                   harm, mental        self-neglect.
                                   anguish, or
                                   mental illness;
                                   or the failure of
                                   a caregiver to
                                   provide the goods
                                   or services.
Criminal sexual abuse...........  Title XVII of the   ``Criminal sexual
                                   Violent Crime       abuse'' is
                                   Control and         defined as
                                   Enforcement Act:    serious bodily
                                   A ``sexually        injury that shall
                                   violent offense''   be considered to
                                   is defined as any   have occurred if
                                   criminal offense    the conduct
                                   that consists of    causing the
                                   aggravated sexual   injury is conduct
                                   abuse or sexual     constituting
                                   abuse (as defined   aggravated sexual
                                   by 18 U.S.C.        abuse under
                                   Section 2241 and    Section 2241, or
                                   2242 or as          sexual abuse
                                   defined by State    under 18 U.S.C.
                                   law) or an          or any similar
                                   offense that has    offense under
                                   as its elements     State law.
                                   engaging in
                                   physical contact
                                   with another
                                   person with
                                   intent to commit
                                   aggravated sexual
                                   abuse or sexual
                                   abuse.
------------------------------------------------------------------------

General provisions

(a) Protection of privacy

                              PRESENT LAW

    The Health Insurance Portability and Accountability Act of 
1996 (HIPAA), Section 264 governs the protection of individual 
health privacy.

                             COMMITTEE BILL

    The activities that would be carried out under this Part 
must ensure the protection of individual health privacy 
consistent with the regulations under Section 264(c) of the 
Health Insurance Portability and Accountability Act of 1996 
(HIPAA) and any State and local privacy regulations.

(b) Rule of construction

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    Includes a provision to accommodate religious beliefs in 
health care when determining whether there is abuse for data 
collection purposes.

 Part A--National Coordination of Elder Justice Activities and Research


Elder Justice Coordinating Council

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The bill would establish an Elder Justice Coordinating 
Council in the Office of the Secretary of HHS.
    Membership. The Council would be composed of the following 
members: the Secretary of HHS (or designee) who will chair the 
Council and the Attorney General (or designee). Membership 
would also include the head of each Federal department or 
agency having administrative responsibility for administering 
programs related to elder abuse, neglect, or exploitation. 
Members must be officers or employees of the Federal 
Government.
    Meetings. The Council is to meet at least twice a year.
    Duties and Reports. The Council would be required to make 
recommendations to the Secretary for the coordination of 
activities of the Department of Health and Human Services, the 
Department of Justice, and other relevant Federal, State, 
local, and private agencies and entities, relating to elder 
abuse, neglect, and exploitation and other crimes against 
elders. The Council would be required to submit a report to 
Congress that describes its activities and challenges and make 
recommendations for legislation, model laws, and other actions 
deemed appropriate. The report is to be submitted to Congress 
within 2 years of enactment of the Elder Justice Act and every 
2 years thereafter.
    Other Requirements. The Committee Bill also sets forth 
requirements for powers of the Council, vacancies in 
membership, travel expenses, and detail of Federal Government 
employees to the Council.

Advisory Board on Elder Abuse, Neglect, and Exploitation

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The bill would establish the Advisory Board on Elder Abuse, 
Neglect and Exploitation.
    Solicitation of Nominations, Membership, and Terms. The 
Secretary of HHS would be required to publish a notice in the 
Federal Register soliciting nominations for Advisory Board 
membership. The Board would be composed of 27 members appointed 
by the Secretary and must have experience and expertise in 
prevention of elder abuse, neglect, and exploitation. Each 
member would be appointed for a 3-year term, except for the 
first members of the Board whose terms would be staggered.
    Duties and Reports. The Board would be required to create a 
short and long-term multidisciplinary plan for development of 
the field of elder justice.
    Within 18 months of the Committee Bill's enactment and 
annually thereafter, the Advisory Board would be required to 
prepare and submit to the Elder Justice Coordinating Council 
and the appropriate committees of Congress, a report containing 
information on Federal, State, and local public and private 
elder justice activities. The report is also to contain 
recommendations on programs, research, services, practice, 
enforcement, and coordination among entities that carry out 
elder justice and other related activities; modifications 
needed in Federal and State laws, research, training, and 
national data collection; and on a multidisciplinary strategic 
plan to guide the field of elder justice.
    Other Requirements. The Committee Bill sets forth 
requirements relating to powers of the Board, vacancies, 
expired terms, election of officers, travel expenses, and 
detail of government employees to the Board.

Research protections

                              PRESENT LAW

    Definition of Legally Authorized Representative. Subpart A 
of part 46 of title 45, Code of Federal Regulations, known as 
the Common Rule, that governs most federally-funded human 
subjects research, currently defines the term ``legally 
authorized representative'' as ``an individual or judicial or 
other body authorized under applicable law to consent on behalf 
of a prospective subject to the subject's participation in the 
procedure(s) involved in the research.''
    Researcher Guidelines. No guidelines are currently in place 
to assist researchers who work in the areas of elder abuse, 
neglect, and exploitation with issues relating to human 
subjects research.

                             COMMITTEE BILL

    The Bill would define ``legally authorized 
representative,'' for purposes of research under the proposed 
title XX, to mean, unless otherwise provided by law, the 
individual, or judicial or other body authorized under the 
applicable law to consent to medical treatment on behalf of 
another person.''
    It would also require the Secretary, acting through the 
Director of the National Institute on Aging (NIA), to 
promulgate guidelines to assist researchers working in the 
areas of elder abuse, neglect, and exploitation, with issues 
relating to human subjects research.

Authorization of appropriations

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    To carry out the functions under subtitle A (the Federal 
Elder Justice System), the Committee Bill authorizes $6.5 
million for FY 2007, and $7 million for each of FYs 2008-2010.

   Subpart 2--Elder Abuse, Neglect, and Exploitation Forensic Centers


Establishment and support of Elder Abuse, Neglect, and Exploitation 
        Forensic Centers

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The Bill would require the Secretary, in consultation with 
the Attorney General, to award grants to eligible entities to 
establish and operate both stationary and mobile forensic 
centers and to develop forensic expertise pertaining to elder 
abuse, neglect, and exploitation. With respect to the 
stationary forensic centers, the Committee Bill would require 
the Secretary to make four grants to higher education 
institutions with demonstrated expertise in forensics or 
commitment to preventing or treating elder abuse, neglect, or 
exploitation; and with respect to mobile forensic centers, the 
Committee Bill would require the Secretary to make six grants 
to appropriate entities.
    Funding would be authorized for the centers to: (1) develop 
forensic markers that would determine whether abuse or neglect 
occurred and whether a crime was committed, and determine 
methodologies for how and when intervention should occur; (2) 
develop forensic expertise with respect to elder abuse, 
neglect, and exploitation in order to provide relevant 
evaluation, intervention, support and advocacy, case review and 
tracking; and (3) in coordination with the Attorney General, 
use data made available by grant recipients under this section 
to develop the capacity of geriatric health care professionals 
and law enforcement to collect forensic evidence, including 
forensic evidence relating to a potential determination of 
elder abuse, neglect, or exploitation. The Committee Bill would 
also require the Secretary, in consultation with the Attorney 
General, to use data to develop the capacity to collect 
forensic evidence.
    The Committee Bill would authorize $4 million in funding 
for FY 2007, $6 million for FY 2008, and $8 million for each of 
FYs 2009-2010.

               Part B--Programs To Promote Elder Justice


Enhancement of long-term care

                              PRESENT LAW

    Nursing homes that receive Federal funds are required to 
meet certain Federal laws and standards to receive funding. 
These laws require nursing aides, who work on a full-time basis 
for more than 4 months, to complete a training and/or 
competency evaluation program and be competent to provide care. 
Nursing homes must also provide regular performance reviews and 
in-service education (including training for individuals 
providing nursing and nursing-related services to residents 
with cognitive impairments) to assure that nursing aides are 
competent to perform services. Regulations also require nursing 
aides to complete a training program lasting no less than 75 
clock hours of training, at least 16 of which must be 
supervised practical training, in order to be certified.
    A number of States have also used enhanced Medicaid funding 
to improve recruitment and retention of nursing aides working 
in nursing homes. For these States, some portion of an increase 
in State Medicaid payments (and other public funding sources) 
to long-term care providers must be (or intended to be) used to 
increase wages and or benefits for nursing aides. Typically, 
this ``wage pass-though'' legislation has either designated 
some specified dollar amount (e.g., $.50 or $1.00) or a certain 
percentage of increased State payments to be used for wages and 
or benefits.
    Nursing Home Compare is a website hosted by the Department 
of Health and Human Services that allows consumers to search 
for data on certain quality indicators for nursing homes 
certified to participate in Medicare and/or Medicaid across the 
country. The information reported on this site includes 
selected findings of the Survey and Certification surveys 
conducted by State Survey agencies during the three most recent 
inspections and complaint investigations. Specifically, the 
website contains data on the Federal regulatory requirements 
that the nursing home failed to meet as reported on form HCFA-
2567. There is currently no requirement that information about 
the adjudication of criminal violations be reported on this 
website.

                             COMMITTEE BILL

    The Bill would require the Secretary of HHS to carry out 
activities that provide incentives for individuals to train 
for, seek, and maintain employment providing direct care in 
long-term care facilities.
    Coordination of Federal Agencies to Train Long-Term Care 
Staff. The Secretary of HHS would be required to coordinate 
activities with the Secretary of Labor and the Assistant 
Secretary of ACF to provide incentives to welfare-to-work and 
TANF recipients to train for and seek employment as direct care 
providers in long-term care facilities.
    Career Ladders, Wage and Benefit Grants. The Secretary of 
HHS would be required to award grants to long-term care 
facilities to conduct programs that offer direct care employees 
continuing training and varying levels of certification. Grants 
would also be used to provide for or make arrangements with 
employers to pay bonuses, or other increased compensation or 
benefits, to employees who obtain certification. To receive 
grant funds, long-term care facilities would submit 
applications directly to the Secretary.
    Management Improvement. The Secretary of HHS would be 
required to award grants to long-term care facilities for 
training and technical assistance. Eligible recipients could 
include administrators, directors of nursing, staff developers, 
charge nurses, and others who establish or implement management 
practices for direct care employees. Training and technical 
assistance would be intended to promote retention and could 
include: (1) the establishment of human resource policies 
rewarding high performance, including policies that provide for 
improved wages and benefits on the basis of job reviews; (2) 
the establishment of motivational organizational practices; (3) 
the creation of a workplace culture that respects and values 
caregivers and their needs; (4) the promotion of a workplace 
culture that respects the rights of residents and results in 
improvements in their care; and (5) the establishment of other 
programs that promote high quality care, such as continuing 
education for certified nursing aide employees. Long-term care 
facilities would submit applications to the Administrator to 
qualify for grant funds. The Secretary would be required to 
develop accountability measures to ensure that funded 
activities under this title benefit eligible employees and 
increase the stability of the long-term care workforce.
    Informatics Systems Grant Program. The Secretary is 
authorized to make grants to long-term care facilities for the 
purpose of assisting such entities in off-setting the costs 
related to purchasing, leasing, developing, and implementing 
standardized clinical health care informatics systems designed 
to improve patient safety and reduce adverse events and health 
care complications resulting from medication errors.
    Inclusion of Certain Crimes on Nursing Home Compare 
Website. The Secretary is required to ensure that information 
relating to the number of criminal convictions by nursing 
facilities or by an employee of a nursing facility are part of 
the information provided for comparison of nursing facilities 
on the official Internet website of the Federal Government for 
medicare beneficiaries.
    Consumer Rights Information Page on Nursing Home Compare 
Website. The Secretary shall ensure that the Nursing Home 
Compare Medicare website develops and includes a consumer 
rights information page that includes documentation on 
available nursing facilities, consumer rights, the survey 
process, and services available through the State long-term 
care ombudsman.
    Standards Involving Clinical Data by Long-Term Care 
Facilities. The Secretary shall develop and adopt uniform open 
electronic standards for transactions involving clinical data 
by long-term care facilities.
    The Committee bill would authorize $20 million for FY 2007, 
$17.5 million for FY 2008, and $15 million for FY 2009 and FY 
2010.

Adult protective services functions and grant programs

Adult protective services--Functions

                              PRESENT LAW

    Provisions related to some functions of adult protective 
services are found in title XX of the Social Security Act 
(Social Services Block Grant) (administered by the 
Administration on Children and Families (ACF)) and the Older 
Americans Act (administered by AoA), both in DHHS, as follows.
    Title XX of the Social Security Act. Title XX provides 
funds to States to carry out a wide range of social services on 
behalf of various groups. The statute sets out a number of 
goals for the use of these funds, including the goal of 
``preventing or remedying neglect, abuse, or exploitation of 
children and adults unable to protect their own interests. . . 
.''
    Funds are generally administered by State social services 
or human services agencies (for this purpose, sometimes 
referred to as adult protective services offices), and/or State 
agencies on aging.
    No match is required for Federal title XX funds, and 
Federal law does not specify a sub-State allocation formula. In 
other words, States have complete discretion for the 
distribution of funds within their borders. Based on the 2002 
Annual Report for the Social Services Block Grant, 34 States 
used some portion of title XX funds for adult protective 
services, and approximately 425,000 adults received adult 
protective services that were funded in whole or in part with 
title XX funds. Of all State expenditures under title XX for 
2002, 5.8 percent were for protective services for adults.\1\ 
---------------------------------------------------------------------------
    \1\A percentage of expenditures differs from a percentage of the 
title XX appropriation. Title XX expenditures include spending from 
funds transferred from the Temporary Assistance for Needy Families 
(TANF) program to title XX.
---------------------------------------------------------------------------
    Older Americans Act. Title II of the Older Americans Act 
requires the Assistant Secretary on Aging in DHHS to establish 
a National Center on Elder Abuse. The Center is required to, 
among other things, compile, publish and disseminate research 
and training materials on prevention of elder abuse, neglect, 
and exploitation; maintain a clearinghouse on programs showing 
promise in preventing elder abuse, neglect, and exploitation; 
conduct research and demonstration projects that identify 
causes, prevention, and treatment; and provide technical 
assistance to State agencies and other organizations in 
planning and improving prevention programs. AoA awards funds to 
six organizations that share the funds: the National 
Association of State Units on Aging, which administers the 
Center, in cooperation with the National Protective Services 
Association; the National Committee for the Prevention of Elder 
Abuse; the American Bar Association; and the Clearinghouse on 
Abuse, Neglect, and Exploitation.
    Funding history for the Center is as follows: FY 1998, 
$250,000; FY 1999, $200,000; FY 2000, $815,250; FY 2001, 
$815,000; FY 2002, $815,000, and FY 2003, $815,000. The 2000 
amendments to the Act required that the Center receive at least 
the same amount of funds as it received in FY 2000.
    Title III of the Older Americans Act authorizes, but does 
not require, State agencies on aging to conduct various 
activities related to prevention of elder abuse, neglect, and 
exploitation. No Federal funds are separately allotted for this 
purpose under title III, and States decide how much of their 
title III allotments are to be used for prevention activities. 
In many States, State agencies on aging administer funds for 
adult protective services funded under title XX of the Social 
Security Act (described below).
    Title VII of the Older Americans Act authorizes a program 
of grants to States to carry out activities related to 
prevention of elder abuse, neglect, and exploitation. Funds are 
administered by State agencies on aging. In FY 2006, the 
appropriation level for this program under title VII is $5.2 
million.
    Section 1128E of the Social Security Act requires the 
Secretary to maintain a national health care fraud and abuse 
data collection program for the reporting of final adverse 
actions (not including settlements in which no findings of 
liability have been made), including health care related civil 
judgments and criminal convictions of health care 
practitioners, providers, and suppliers. The database is 
directed by HHS, acting through the office of the Attorney 
General, and is named the Healthcare Integrity and Protection 
Data Bank (HIPDB).
    For the purposes of this database, Medicaid regulation 42 
CFR Sec. 455.12 requires that State agencies report the number 
of complaints of fraud and abuse made to the agency that 
warrant preliminary investigation. For each case, reports 
should include the provider's name and number; the source of 
the complaint; the type of provider; the nature of the 
complaint; the approximate range of dollars involved; and the 
legal and administrative disposition of the case, including 
actions taken by law enforcement officials to whom the case has 
been referred. Section 1128E requires the Secretary to include 
procedures assuring that the privacy of individuals receiving 
health care services is appropriately protected.
    The Secretary makes available the information in the 
database to government agencies and health plans and, upon 
request, to health care providers, suppliers, and practitioners 
who wish to self-query. The Secretary may establish or approve 
fees sufficient to recover the full costs of the databases' 
operation.
    According to Section 1128E(g)(1)(A) of the Social Security 
Act, a final adverse action includes: (1) civil judgments 
related to the delivery of a health care item or service that 
are against a health care provider or practitioner in Federal 
or State court; (2) Federal or State criminal convictions 
related to the delivery of health care; (3) certain actions by 
Federal or State agencies responsible for the licensing and 
certification of providers and licensed practitioners; (4) 
prohibition against participating in Federal or State health 
care programs; or (5) any other adjudicated actions or 
decisions established by the Secretary under regulation. 
Medicaid regulation 42 CFR Sec. 483.374 also requires 
facilities to report each serious occurrence to both the State 
Medicaid agency and, unless prohibited by State law, the State-
designated protection and advocacy system.

                             COMMITTEE BILL

    The Bill would establish certain functions with respect to 
Adult Protective Services (APS) to be administered by the 
Secretary.
    Adult Protective Services--Functions. Functions include 
providing funding and support to State and local adult 
protective services offices that investigate reports of abuse, 
neglect and exploitation of elders and vulnerable adults; 
collecting and disseminating information on abuse in 
coordination with the Department of Justice; developing and 
disseminating information on best practices; conducting 
research and providing technical assistance to States that 
provide or fund protective services; and reporting crimes on 
the Nursing Home Compare website.
    To carry out these functions, the Committee Bill authorizes 
$3 million for FY 2007 and $4 million for each of FYs 2008-
2010.

Adult protective service grant program (State formula grants)

                              PRESENT LAW

    No provision in current law for State formula grants that 
are solely and specifically targeted at providing adult 
protective services and carrying out projects to employ workers 
having caseloads of elders alone.
    Some other legislation is related to adult protective 
services, as follows.
    Title XX of the Social Security Act. Title XX provides 
funds to States to carry out a wide range of social services on 
behalf of various groups. The statute sets out a number of 
goals for the use of these funds, including the goal of 
``preventing or remedying neglect, abuse, or exploitation of 
children and adults unable to protect their own interests....'' 
Funds are generally administered by State social services or 
human services agencies (for this purpose, sometimes referred 
to as adult protective services offices), and/or State agencies 
on aging.
    Title III of the Older Americans Act authorizes, but does 
not require, State agencies on aging to conduct various 
activities related to prevention of elder abuse, neglect, and 
exploitation, which may include adult protective services. No 
Federal funds are separately appropriated for this purpose 
under title III, and States decide how much of their title III 
allotments are to be used for these activities. In many States, 
State agencies on aging administer funds for adult protective 
services funded under title XX of the Social Security Act 
(described below).
    Title VII of the Older Americans Act authorizes a program 
of grants to States to carry out activities related to 
prevention of elder abuse, neglect, and exploitation. Funds are 
administered by State agencies on aging. In FY 2006, the 
appropriation level for this program under title VII is $5.2 
million.

                             COMMITTEE BILL

    The Bill provides for grants to improve Adult Protective 
Services.
    Grants to Improve Worker Caseloads for Adult Protective 
Services. The Secretary would be required to award annual 
grants to enhance adult protective service programs provided by 
States and local governments.
    Formula for Distribution of Funds. Distribution of funds to 
States would be based on a formula that takes into account the 
number of elders (people age 60 or older) residing in a State 
relative to the total U.S. population of elders. States would 
receive no less than 0.75 percent of the grant program's annual 
appropriation. The District of Columbia, Puerto Rico, the U.S. 
Virgin Islands, Guam, and American Samoa would receive no less 
than 0.1 percent of the annual appropriation. In order to 
comply with these minimum amount requirements, the Secretary is 
required to make pro rata reductions in amounts to be allotted.
    Use of Funds. Funds may be used only by States and local 
governments to provide adult protective services. States 
receiving funds would be required to provide these funds to the 
agency or unit of State government having legal responsibility 
for providing adult protective services in the State. Each 
State would be required to use these funds to supplement and 
not supplant other Federal, State, and local public funds 
expended to provide adult protective services.
    Reports. Each State would be required to submit a report to 
the Secretary on the number of elders served by the grants. The 
Secretary would be required to submit to the appropriate 
congressional committees a report compiling, summarizing, and 
analyzing the State reports.
    The Committee Bill would authorize $100 million for each of 
FYs 2007-2010.

State adult protective service grants (Demonstration program)

                              PRESENT LAW

    No provision in current law specifically authorizes a 
dedicated amount of funds for State adult protective service 
demonstration programs. However, the Older American Act 
authorizes a related demonstration program (as follows), but no 
specific authorization is specified by law.
    Section 413 of the Older Americans Act, Older Individuals' 
Protection from Violence Projects, requires the Assistant 
Secretary to award funds to States' area agencies on aging, and 
nonprofit organizations, or tribal organizations, to carry out 
a wide range of projects related to protection of older persons 
from violence. Funds are to be used to: support local 
communities to coordinate activities regarding intervention in 
and prevention of abuse, neglect, and exploitation; develop 
outreach to assist victims; expand access to family violence 
and sexual assault programs (including shelters, rape crisis 
centers, and support groups) as well as mental health services, 
safety planning and other services; and promote research on 
legal organization and training impediments to providing 
services through shelters and other programs.

                             COMMITTEE BILL

    The Bill would require the Secretary to establish grants to 
States for adult protective service demonstration programs. 
Funds may be used by State and local units of government to 
conduct demonstration programs that test: training modules 
developed for the purpose of detecting or preventing elder 
abuse; methods to detect or prevent financial exploitation and 
elder abuse; whether training on elder abuse forensics enhances 
the detection of abuse by employees of State or local 
government; and other related matters. States would be required 
to submit applications to the Secretary.
    Each State receiving funds would be required to submit a 
report on the demonstration to the Secretary. The Secretary 
would be required to submit to the appropriate congressional 
committees a report compiling, summarizing, and analyzing the 
State reports, as well making recommendations for appropriate 
legislative or administrative action.
    The Committee Bill would authorize $25 million for each of 
FYs 2007-2010.

Long-Term Care Ombudsman program grants and training

                              PRESENT LAW

    Title II of the Older Americans Act requires the Assistant 
Secretary on Aging to establish the National Ombudsman Resource 
Center under the Director of the Long-Term Care Ombudsman 
program. The Center is required to, through grants and 
contracts, conduct research and provide training, technical 
assistance, and information to State long-term care ombudsmen; 
and to assist State long-term care ombudsmen in the 
implementation of the State long-term care ombudsman program. 
Funds awarded to the Center are not separately authorized, but 
are not to be less than the amount made available to the Center 
for FY 2000. Funds for the Center are awarded through title IV 
of the Older Americans Act (Research, Training, and 
Demonstration Projects and Programs). The State long-term care 
ombudsman program is authorized by title VII of the Act 
(Allotments for Vulnerable Elder Rights Protection Activities).

                             COMMITTEE BILL

    The Committee Bill requires the Secretary to provide grants 
to improve the capacity of ombudsman programs to respond to and 
resolve complaints about abuse and neglect; conduct pilot 
programs; provide support for the resource center; and improve 
training. This provision is authorized at $5 million for FY 
2007, $7.5 million for FY 2008, and $10 million for FY 2009 and 
FY 2010.
    The Secretary shall establish programs to provide and 
improve ombudsman training with respect to elder abuse, neglect 
and exploitation for national organizations and State long-term 
care ombudsman programs. These programs are authorized at $10 
million for each of the fiscal years FY 2007 through FY 2010.

  Part C--Collection of Data, Dissemination of Information and Studies


Collection of uniform national data on elder abuse, neglect and 
        exploitation

                              PRESENT LAW

    No provision that establishes an ongoing, uniform national 
data collection process or provides grants to States to assist 
with data collection.
    A related law, the Family Violence Prevention and Services 
Act of 1992 (P.L. 102-295), required HHS to conduct a study of 
the national incidence of abuse, neglect, and exploitation of 
elderly persons. This study, referred to as ``the National 
Elder Abuse Incidence Study,'' used a nationally-representative 
sample of 20 counties in 15 States and combined local Adult 
Protective Services (APS) reports with reports from other 
community service agencies to estimate the number of new elder 
abuse and neglect cases over a given period. The final report 
for this study was released by HHS in 1998.
    In addition to the study described above, the Federal 
Government has periodically surveyed State APS units over the 
last 20 years on the prevalence of elder abuse, neglect, and 
exploitation. In these surveys, there was significant variation 
among the States in the definitions used and the 
comprehensiveness of data collected. This variation has created 
challenges in establishing a national data set and identifying 
trends in abuse, neglect, and exploitation.

                             COMMITTEE BILL

    The Bill would establish as the purpose of the section the 
improvement, streamlining, and promotion of uniform collection, 
maintenance, and dissemination of national data regarding elder 
abuse, neglect, and exploitation. The activities of the 
Secretary would be carried out in three phases.
    The Secretary would be required to develop, under Phase I, 
a method for collecting national data regarding elder abuse, 
neglect, and exploitation and uniform national data reporting 
forms adapted to each relevant entity or discipline (e.g., 
health, public safety, social and protective services, and law 
enforcement). The Secretary would be required to consult with 
the Attorney General to develop this method for national data 
collection. The national data reporting forms must include the 
definitions of title XX for determining whether an event will 
be reportable. Finally, the activities that would be carried 
out under this section must ensure the protection of individual 
health privacy consistent with the regulations under Section 
264 of the Health Insurance Portability and Accountability Act 
of 1996 (HIPAA) and any State and local privacy regulations. 
Phase I must occur no later than 1 year after the date of 
enactment.
    Phase II would require the Secretary to ensure that the 
national data reporting forms and data collection methods 
(developed under Phase I) would be pilot tested in six States 
selected by the Secretary. After pilot testing the data 
collection efforts, the Secretary must review the findings, 
consult with the Attorney General and other relevant experts, 
and adjust the national data reporting forms and data 
collection methods as necessary. Phase II must occur no later 
than 1 year following the completion of activities under Phase 
I.
    Phase III would require the Secretary to submit the 
national data reporting forms and instructions to: (1) the 
heads of the relevant Federal entities as may be appropriate, 
and (2) the Governor's office of each State for collection from 
all relevant State entities of data including health care, 
social services, and law enforcement data.
    In Phase III, the Secretary would be authorized to award 
grants to States to improve data collection activities relating 
to elder abuse, neglect, and exploitation. Each State that 
wants to apply for a grant must submit an application to the 
Administrator following the prescribed requirements. Each State 
receiving a grant in a fiscal year would be required to submit 
data for the calendar year that begins during that year using 
the national data forms.
    The amount of each grant to a State must be distributed 
using the following method: For the first fiscal year in which 
a State receives grant funds, the Secretary would be required 
to initially distribute 50 percent of those funds. The 
remaining funds are to be distributed at the end of the 
calendar year that begins during that fiscal year if the 
Secretary determines that the State has properly reported data 
required under this section for the calendar year. For 
subsequent years, the Secretary would be required to distribute 
grant funds to a State for a fiscal year if the State properly 
reported required data for the calendar year that ends during 
that fiscal year. The reports submitted by States must indicate 
the State and year in which the event occurred and identify the 
total number of events that occurred in each State during the 
year and the type of event.
    The Secretary would be required to submit a report no later 
than 1 year after the enactment date regarding the activities 
required by this section to Congress, including the Senate 
Committee on Finance and the House Committee on Ways and Means, 
and the House Committee on Energy and Commerce.
    To carry out the activities of this section, the Committee 
Bill would authorize $10 million for FY 2007, $30 million for 
FY 2008, and $100 million for each of FYs 2009 and 2010.

Long-term care consumer clearinghouse

                              PRESENT LAW

    No provision requiring establishment of a long-term care 
consumer clearinghouse.
    In related activities, DHHS has funded some States to 
establish State-based consumer-friendly access to information 
about long-term care services. In FY 2003 through FY 2006, the 
Centers for Medicare and Medicaid Services (CMS) and AoA 
awarded approximately $18 million in grants to States for the 
purpose of assisting States in their efforts to create a 
single, coordinated system of information and access for all 
persons seeking long-term care to minimize confusion, enhance 
individual choice, and support informed decision-making. A 
total of 24 States have received grants for this purpose. Some 
of the common activities under this grant program include 
information and referral, outreach, counseling about public 
benefits and long-term care options, and case management. 
States' methods for implementing the grant may vary; some 
States have established an actual physical location, and other 
States have established a State-wide clearinghouse through a 
toll-free number or a web-based information site.
    In addition, CMS has made available to the public, via its 
website, a comparison of Medicare and Medicaid-certified 
nursing homes and home health agencies. The information 
provides detailed facility and agency information and 
characteristics, and contains several measures of quality 
(e.g., improvement in mobility). This website does not cover 
assisted living facilities, group homes and other residential 
facilities that are not nursing facilities; nor does it cover 
non-medical, non-certified, home- and community-based long-term 
care services.

                             COMMITTEE BILL

    The Bill would require the Secretary to establish a long-
term care consumer clearinghouse which must provide 
comprehensive detailed information, in a consumer-friendly 
form, to consumers about choices relating to long-term care 
providers.
    The clearinghouse is to include information about obtaining 
the services of, and employing, caregivers; options for 
residential long-term care (e.g., the type of care provided by 
nursing facilities, and the type of care provided by group 
homes and other residential facilities); benefits available 
through the Federal health care programs; and links to Federal 
and State websites that describe the care available through 
specific long-term care facilities including information about 
the satisfaction of those residents and their families with the 
care provided. The clearinghouse must also provide information 
(from States and other sources) on long-term care providers, 
including assisted living facilities, board and care 
facilities, congregate care facilities, home health care 
providers, and other long-term care providers.
    To carry out the activities of this section, the Committee 
Bill would authorize $2 million for FY 2007, $3 million for FY 
2008, and $4 million for each of FYs 2009 and 2010.

Consumer information about the continuum of residential long-term care 
        facilities

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The Bill would require the Secretary, in consultation with 
the Attorney General, to conduct a study on consumer concerns 
relating to residential long-term care facilities other than 
nursing facilities. The study may be carried out either 
directly or through a grant. The organization conducting the 
study must develop definitions for classes of residential long-
term care facilities and collect information on the following 
features of these facilities: prices, level of services, 
oversight and enforcement provisions, and admission and 
discharge criteria.
    The Secretary would be required to prepare a report 
containing the results of the study and submit the report to 
the appropriate committees.
    To carry out the study, the Committee Bill would authorize 
$3 million for each of FYs 2007-2010.

Evaluations of elder justice programs

                              PRESENT LAW

    No provision.

                             COMMITTEE BILL

    The Bill would require the Secretary of HHS to reserve a 
portion of the funds appropriated in each program under title 
XX to be used to provide assistance to eligible entities to 
conduct validated evaluations of the effectiveness of the 
activities funded under each program under title XX. To be 
eligible to receive these funds, an eligible entity must submit 
an application to the Secretary following the timing and 
requirements prescribed by the Secretary, including a proposal 
for the evaluation.
    Entities would be required to submit to the Secretary and 
appropriate congressional committees a report containing the 
results of the evaluation together with any recommendations 
deemed appropriate. The report would be due by the date 
specified by the Secretary.

Report

                              PRESENT LAW

    Currently, no provision exists concerning Federal agency 
coordination to encourage the employment of welfare recipients 
or recipients of Temporary Assistance to Needy Families (TANF) 
in long-term care facilities.

                             COMMITTEE BILL

    The Committee Bill requires, not later than October 1, 
2011, a report from the Secretary to the Elder Justice 
Coordinating Council and appropriate committees, summarizing: 
(1) State reports submitted under section 2042; (2) results of 
the study under section 2053; (3) recommendations for 
legislative or administrative action; and (4) a requirement for 
State plans under the program for Temporary Assistance for 
Needy Families.

Amendments to Part A, Title XI of the Social Security Act--Long-term 
        care facilities

                              PRESENT LAW

    No Federal provisions for mandatory reporting of crimes in 
federally funded long-term care facilities. There are some 
Federal laws and regulations under Medicare and Medicaid in the 
event that a facility participating in either of those programs 
closes.
    Reporting. Based on a 2000 survey of State Adult Protective 
Services systems, all States had elder/adult abuse reporting 
laws. State laws varied in who was a mandated reporter and who 
was encouraged to report incidents of elder/adult abuse. Many 
States and territories named health care professionals, such as 
nurses, physicians and nursing aides, as mandated reporters of 
elder/adult abuse. Five States did not list anyone as a 
mandated reporter.
    Eleven States reported that there were no statutory 
consequences for failure of mandated reporters to report abuse; 
the remaining States and the District of Columbia and Guam had 
a specified consequence. The most common consequence for 
failing to report was a misdemeanor with a possible fine and/or 
jail sentence. State law also varied with regard to specifying 
a time frame within which reporters were required to report 
suspicion of abuse. Nineteen States had no time frame. Of those 
that specified a time frame, the requirements varied from 
immediately to more than 4 days.
    Notification of Facility Closure. If a long-term care 
facility that receives Federal funds through participation in 
Medicare or Medicaid closes, current Federal laws and 
regulations provide some guidance on the parties that need to 
be notified and the process for relocating residents. If a 
facility wants to terminate its status as a Medicare provider 
(for example, due to facility closure), the facility must 
notify both CMS and the public no later than 15 days in advance 
of the proposed termination date. If a facility wants to 
terminate its status as a Medicaid provider, Federal 
regulations do not specify a timeframe for notifying Federal or 
State agencies; however, the facility is required to notify 
Medicaid residents at least 30 days before transferring or 
discharging him or her. Facility closure is one circumstance in 
which a resident would need to be transferred.
    The State Medicaid agency has the primary responsibility 
for relocating Medicaid patients and for ensuring their safe 
and orderly transfer from a facility that no longer 
participates in Medicaid to a participating facility that meets 
acceptable standards. CMS has provided guidance to States 
concerning relocating patients. Each State is expected to have 
a plan that describes the relocation of patients. Additionally, 
the notice to residents is to include information as to how to 
contact the ombudsman established by the Older Americans Act.

                             COMMITTEE BILL

    Reporting of Crimes in Federally Funded Facilities. The 
Committee Bill would require reporting to law enforcement of 
crimes occurring in federally funded long-term care facilities 
that receive at least $10,000 in Federal funds during the 
preceding year. The owner or operator of these facilities would 
be required to annually notify each individual who is an owner, 
operator, employee, manager, agent, or contractor of a long-
term care facility that they are required to report any 
reasonable suspicion of a crime against any person who is a 
resident of or receiving care from the facility. These 
individuals are referred to in this section as ``covered 
individuals.'' Suspected crimes must be reported to the 
Secretary and one or more law enforcement entities for the 
political subdivision in which the facility is located.
    Timing of Reporting. If the events that cause the suspicion 
of a crime result in serious bodily injury, the covered 
individual must report the suspicion immediately, but not later 
than 2 hours after forming the suspicion. If the events that 
cause the suspicion do not result in serious bodily injury, the 
individual must report the suspicion not later than 24 hours 
after forming the suspicion.
    Penalties for Non-Reporting. If a covered individual does 
not report suspicion of a crime within the timeframe described 
above, the individual will be subject to a civil money penalty 
of up to $200,000, or the Secretary shall classify the 
individual as an ``excluded individual'' (i.e., any employer of 
the individual is unable to receive Federal funds) for a period 
of not more than 3 years. If a covered individual does not 
report suspicion of a crime within the timeframe described 
above and this violation exacerbates the harm to the victim, or 
results in harm to another person, the individual will be 
subject to a civil money penalty of up to $300,000, and the 
Secretary shall classify the individual as an ``excluded 
individual'' (i.e., any employer of the individual is unable to 
receive Federal funds) for a period of not more than 3 years.
    If an individual is classified as an ``excluded 
individual,'' any entity that employs that individual will not 
be eligible to receive Federal funds. The Secretary may take 
into account the financial burden on providers with underserved 
populations in determining any penalty to be imposed under this 
section. Underserved populations are defined as the population 
of an area designated by the Secretary as an area or population 
group with a shortage of elder justice programs. These may 
include those that are geographically isolated, racial and 
ethnic minority populations, and populations underserved 
because of special needs (such as language barriers, 
disabilities, alien status, or age).
    Additional Penalties for Retaliation. A long-term care 
facility may not retaliate against an employee for making a 
report, causing a report to be made, or for taking steps to 
make a report. Retaliation includes discharge, demotion, 
suspension, threats, harassment, denial of a promotion or other 
employment-related benefit, or any other manner of 
discrimination against an employee in the terms and conditions 
of employment because of lawful acts done by the employee. 
Long-term care facilities may also not retaliate against a 
nurse by filing a complaint or report with the appropriate 
State professional disciplinary agency because of lawful acts 
done by the nurse.
    If a long-term care facility does retaliate, it shall be 
subject to a civil money penalty of up to $200,000 or the 
Secretary may exclude it from participation in any Federal 
health care program for a period of 2 years.
    Notice to Employees. Each long-term care facility must post 
conspicuously, in an appropriate location, a sign specifying 
rights of employees under this section. The sign shall include 
a statement that an employee may file a complaint against a 
long-term care facility that violates the provisions of this 
section with the Secretary. The notice must also contain 
information as to how to file a complaint.
    Notification of Public Agencies and Safety of Residents in 
the Event of Facility Closure. In addition, if a long-term care 
facility (that received at least $10,000 in Federal funds 
during the previous year) is going to close, the owner or 
operator of the facility must submit to the Secretary and the 
appropriate State regulatory agency written notification of an 
impending closure within 60 days prior to the closure date. In 
the notice, the owner or operator must include a plan for 
transfer and adequate relocation of residents, including 
assurances that residents will be moved to the most appropriate 
facility in terms of quality, services, and location. Within 10 
days after the facility closes, the owner or operator of the 
facility must submit to the Secretary, and the appropriate 
State agency, information on where the residents were 
transferred to and when.
    Anyone who owns a skilled nursing facility that fails to 
comply with the notification of closure and reporting 
requirements shall be subject to a civil monetary penalty of up 
to $1,000,000, exclusion from participation in the programs 
under the Social Security Act, and any other civil monetary 
penalties and assessments.
    A civil monetary penalty or assessment will be imposed in 
the same manner as a civil monetary penalty, assessment or 
exclusion under Section 1128A of the Social Security Act.

Amendments to Part A, Title XI of the Social Security Act--National 
        nursing aide registry study and report

                              PRESENT LAW

    Section 1819(b)(5)(F) (Medicare law) and 1919(b)(5)(F) 
(Medicaid law) of the Social Security Act define nursing aides 
as individuals providing nursing or nursing-related services to 
residents in nursing facilities as well as registered 
dieticians or persons who volunteer to provide such services 
without monetary compensation. Nursing aides do not include 
physicians; physician assistants; nurse practitioners; 
physical, speech, or occupational therapists; physical or 
occupational therapy assistants; registered professional 
nurses; licensed practical nurses; or licensed certified social 
workers. For Medicare-certified facilities, nursing aides also 
exclude registered respiratory therapists or certified 
respiratory therapy technicians.
    No present law exists concerning a nursing aide registry 
study.

                             COMMITTEE BILL

    The Secretary shall conduct a study on establishing a 
national nursing aide registry that shall include an evaluation 
of who should be included in the registry; how the registry 
would comply with Federal and State privacy laws and 
regulations; how data would be collected for the registry; what 
entities and individuals would have access to the data 
collected; how the registry would provide appropriate 
information regarding violations of Federal and State law by 
individuals included in the registry; how the functions of the 
registry would be coordinated with the pilot program for 
national and State background checks on direct care patient 
access employees of long-term care facilities; and how the 
information in State nursing aide registries would be 
maintained in a national registry.
    After receiving the report submitted to Secretary, the 
Committee on Ways and Means and the Committee on Energy and 
Commerce of the House of Representatives and the Committee on 
Finance of the Senate shall, as they deem appropriate, take 
action based on the recommendations contained in the report.
    Not later than 18 months after the date of enactment of 
this Act, the Secretary shall submit a report to the Elder 
Justice Coordinating Council, the Committee on Ways and Means 
and the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Finance of the Senate 
containing the findings and recommendations of the study. 
Funding for the study shall not exceed $500,000.

                III. REGULATORY IMPACT AND OTHER MATTERS


                          A. Regulatory Impact

    Pursuant to paragraph 11(b) of rule XXVI of the Standing 
Rules of the Senate, the Committee makes the following 
statement concerning the regulatory impact that might be 
incurred in carrying out the provisions of the bill as amended.

Impact on individuals and businesses

    The provisions of the bill are not expected to impose 
additional administrative requirements or regulatory burdens on 
individuals or businesses.

                     B. Unfunded Mandates Statement


Impact on personal privacy and paperwork

    The provisions of the bill do not reduce personal privacy.
    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (P.L. 104-4).
    The Committee has determined that the provisions of the 
bill contain no Federal private sector mandates.
    The Committee has determined that the provisions of the 
bill do not impose a Federal intergovernmental mandate on 
State, local, or tribal governments.

                           IV. COST ESTIMATE

                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, September 8, 2006.
Hon. Charles E. Grassley,
Chairman, Committee on Finance,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 2010, the Elder 
Justice Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Christina 
Hawley Anthony.
            Sincerely,
                                          Donald B. Marron,
                                                   Acting Director.
    Enclosure.

S. 2010--Elder Justice Act

    Summary: S. 2010 would amend Title XX of the Social 
Security Act by creating a new subtitle dealing with elder 
justice issues. The bill would authorize appropriations 
totaling $974 million over the 2007-2011 period for grants and 
other activities authorized in the new subtitle. Assuming 
appropriation of the authorized amounts, CBO estimates the bill 
would result in additional outlays of $32 million in 2007 and 
$894 million over the 2007-2011 period. Enacting the bill would 
not affect direct spending. CBO estimates that the civil 
monetary penalties authorized by the bill would have a 
negligible effect on revenues.
    S. 2010 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA). 
The bill would benefit state, local, and tribal governments and 
any costs they incur would result from complying with 
conditions of federal assistance.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of is shown in the following table. The costs 
of this legislation fall within budget function 500 (education, 
employment, training, and social services).
    Basis of estimate: The bill would amend Title XX of the 
Social Security Act to create a new subtitle for ``Elder 
Justice'' that would authorize programs aimed at providing 
legal protection and services to older individuals. S. 2010 
would authorize discretionary appropriations totaling $189 
million in 2007 and $974 million over the 2007-2011 period for 
administrative activities and grants. Assuming appropriation of 
the authorized amounts, CBO estimates that enacting the bill 
would increase outlays by $32 million in 2007 and by $894 
million from 2007 to 2011. For this estimate, CBO assumes the 
bill will be enacted early in fiscal year 2007, that the 
authorized amounts are appropriated for each year, and that 
outlays will follow historical spending patterns of similar 
programs.

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                               -------------------------------------------------
                                                                  2007      2008      2009      2010      2011
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

                     Part A: National Coordination of Elder Justice Activities and Research

Coordination of Elder Justice Activities:
    Authorization Level.......................................         7         7         7         7         0
    Estimated Outlays.........................................         4         7         7         7         3
Forensic Centers:
    Authorization Level.......................................         4         6         8         8         0
    Estimated Outlays.........................................         2         5         7         8         4

                                    Part B: Programs to Promote Elder Justice

Grants and Incentives for Long-Term Care:
    Authorization Level.......................................        20        18        15        15         0
    Estimated Outlays.........................................         2        12        16        16        14
Secretarial Responsibilities:
    Authorization Level.......................................         3         4         4         4         0
    Estimated Outlays.........................................         2         4         4         4         1
Adult Protective Services Grant Programs:
    Authorization Level.......................................       100       100       100       100         0
    Estimated Outlays.........................................        10        60        90       100        90
Adult Protective Services Demonstrations:
    Authorization Level.......................................        25        25        25        25         0
    Estimated Outlays.........................................         3        15        23        25        23
Long-Term Care Ombudsman Grants:
    Authorization Level.......................................         5         8        10        10         0
    Estimated Outlays.........................................         1         3         6         9         9
Ombudsman Training:
    Authorization Level.......................................        10        10        10        10         0
    Estimated Outlays.........................................         1         6         9        10         9

                      Part C: Collection of Data, Dissemination of Information, and Studies

Data Collection:
    Authorization Level.......................................        10        30       100       100         0
    Estimated Outlays.........................................         5        20        65       100        50
Long-Term Care Clearinghouse:
    Authorization Level.......................................         2         3         4         4         0
    Estimated Outlays.........................................         1         3         4         4         2
Consumer Information on Residential Long-Term Care:
    Authorization Level.......................................         3         3         3         3         0
    Estimated Outlays.........................................         2         3         3         3         2
National Nurses Aid Registry:
    Authorization Level.......................................         1         0         0         0         0
    Estimated Outlays.........................................         *         *         *         0         0
    Total Spending Under S. 2010:
        Authorization Level...................................       189       213       286       286         0
        Estimated Outlays.....................................        32       137       234       286       205
----------------------------------------------------------------------------------------------------------------
NOTE: * = less than $500,000.

Spending subject to appropriation

    Part A: National Coordination of Elder Justice Activities 
and Research. Part A of the new subtitle would establish an 
Elder Justice Coordinating Council and an advisory board on 
Elder Abuse, Neglect, and Exploitation. The bill would 
authorize the appropriation of $6.5 million for fiscal year 
2007 and $7 million annually for fiscal years 2008 through 2010 
for those activities.
    In addition, Part A would establish stationary and mobile 
centers for the provision of forensic services relating to 
elder abuse, neglect, and exploitation. For example, such 
centers would establish indicators of crimes related to elder 
abuse as well as methodologies for determining whether and how 
various service providers should intervene if such abuse is 
indicated. The bill would authorize appropriations of $4 
million for fiscal year 2007, $6 million for fiscal year 2008, 
and $8 million for each of fiscal years 2009 and 2010 to 
establish those centers.
    Part B: Programs to Promote Elder Justice. Part B would 
provide grants and incentives to long-term care facilities that 
would improve management practices, and encourage training, 
recruitment, and retention of employees. In addition, part B 
would authorize grants to long-term care facilities to improve 
and upgrade computer software and hardware that would improve 
patient safety and reduce health care complications resulting 
from mediation errors. The bill would authorize appropriations 
of $20 million for fiscal year 2007, $18 million for fiscal 
year 2008, and $15 million for each of fiscal years 2009 and 
2010 for those purposes.
    Part B also would authorize funding for state and local 
adult protective service offices that would investigate reports 
of the abuse, neglect, and exploitation of elders, and would 
require the Department of Health and Human Services (HHS) to 
collect and disseminate data related to elder abuse. The bill 
would authorize appropriations of $3 million for fiscal year 
2007 and $4 million for each of fiscal years 2008 through 2010 
for the administrative responsibilities of HHS, and $100 
million for each of fiscal years 2007 through 2010 for grants 
to states. In addition, the bill would authorize demonstration 
programs for states and local governments to test methods aimed 
at detecting and preventing elder abuse. Those demonstration 
programs would be authorized at $25 million per year for the 
2007-2010 period.
    The bill would authorize grants to support the existing 
long-term care ombudsman program by improving the capacity of 
state programs to respond to and resolve complaints about abuse 
and neglect, conducting pilot programs with state or local 
offices and providing support for those programs through a 
national resource center. Those grants would be authorized at 
$5 million for fiscal year 2007, $7.5 million for fiscal year 
2008, and $10 million for each of fiscal years 2009 and 2010.
    Finally, Part B would authorize appropriations of $10 
million in each of fiscal years 2007 through 2010 for ombudsman 
training programs.
    Part C: Collection of Data, Dissemination of Information, 
and Studies. The bill would establish standards for the 
collection, maintenance and dissemination of data relating to 
elder abuse, neglect, and exploitation under Part C of the new 
subtitle. In the first year after enactment of the bill, HHS 
would develop methods for collecting national data relating to 
elder abuse, neglect, and exploitation. In the following year, 
the data reporting forms and collection methods would be tested 
in six states, and adjusted as necessary, before being 
distributed nationally. The bill would authorize HHS to provide 
grants to states to improve their data collection activities 
relating to elder abuse, neglect, and exploitation. For those 
data collection activities, S. 2010 would authorize 
appropriations of $10 million for fiscal year 2007, $30 million 
for fiscal year 2008, and $100 million for each of fiscal years 
2009 and 2010.
    In addition, the bill would establish a consumer 
clearinghouse on long-term care that would provide information 
about choices relating to long-term care. For that purpose, the 
bill would authorize appropriations of $2 million for fiscal 
year 2007, $3 million for fiscal year 2008, and $4 million for 
each of fiscal years 2009 and 2010.
    The bill also would authorize a study on consumer concerns 
relating to residential long-term care facilities (other than 
nursing facilities). funding for that study would be authorized 
at $3 million for each of fiscal years 2007 through 2010.
    Finally, the bill would authorize a national nurses aide 
registry, but funding for the registry could not exceed 
$500,000.

Revenues

    S. 2010 could affect revenues through the creation of 
several new civil penalties for violations relating to non-
reporting of crimes against residents in long-term care 
facilities. Collections of such penalties are recorded as 
revenues and deposited in the Treasury; however, CBO expects 
that any increase in revenues related to those penalties would 
be negligible.
    Intergovernmental and private-sector impact: S. 2010 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. The bill would authorize grants to state, 
local, and tribal governments for prevention and intervention 
programs, training, and multidisiplinary and collaborative 
programs tied to elder abuse, neglect, and exploitations. The 
costs of any requirements tied to these grants would be 
incurred voluntarily.
    Estimate prepared by: Federal Costs: Christina Hawley 
Anthony; Impact on state, local, and tribal governments: Lisa 
Ramirez-Branum; Impact on the private sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       V. VOTES OF THE COMMITTEE

    In compliance with paragraph 7(b) of rule XXVI of the 
Standing Rules of the Senate, the following statements are made 
concerning the votes taken on the Committee's consideration of 
the bill.
    On August 3, 2006, the bill, as modified, was ordered 
favorably reported by roll call vote--20 ayes, 0 nays.
                      VI. CHANGES IN EXISTING LAW

     In compliance with paragraph 12 of Rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

SOCIAL SECURITY ACT

           *       *       *       *       *       *       *



TITLE IV--GRANTS TO STATES FOR AID AND SERVICES TO NEEDY FAMILIES WITH 
                CHILDREN AND FOR CHILD-WELFARE SERVICES

   PART A--BLOCK GRANTS TO STATES FOR TEMPORARY ASSISTANCE FOR NEEDY 
FAMILIES

           *       *       *       *       *       *       *



                      ELIGIBLE STATES; STATE PLAN

    Sec. 402. (a) In General.--As used in this part, the term 
``eligible State'' means, with respect to a fiscal year, a 
State that, during the 27-month period ending with the close of 
the 1st quarter of the fiscal year, has submitted to the 
Secretary a plan that the Secretary has found includes the 
following:
          (1) Outline of family assistance program.--
                  (A) General provisions.--A written document 
                that outlines how the State intends to do the 
                following:
                          (i) Conduct a program, designed to 
                        serve all political subdivisions in the 
                        State (not necessarily in a uniform 
                        manner), that provides assistance to 
                        needy families with (or expecting) 
                        children and provides parents with job 
                        preparation, work and support services 
                        to enable them to leave the program and 
                        become self-sufficient.

           *       *       *       *       *       *       *

                          (vii) Coordinate the program with 
                        activities carried out by the Secretary 
                        under section 2041(a) in order to 
                        facilitate such activities and provide 
                        incentives for individuals to train 
                        for, seek, and maintain employment 
                        providing direct care in a long-term 
                        care facility (as such terms are 
                        defined in section 2011).

           *       *       *       *       *       *       *


                             USE OF GRANTS

    Sec.  404. (a) General Rules.--Subject to this part, a 
State to which a grant is made under section 403 may use the 
grant--

           *       *       *       *       *       *       *

    (d) Authority To Use Portion of Grant for Other Purposes.--
          (1) In general.--Subject to paragraph (2), a State 
        may use not more than 30 percent of the amount of any 
        grant made to the State under section 403(a) for a 
        fiscal year to carry out a State program pursuant to 
        any or all of the following provisions of law:
                  (A) Subtitle 1 of title XX of this Act.
                  (B) The Child Care and Development Block 
                Grant Act of 1990.
          (2) Limitation on amount transferable to subtitle 1 
        of title xx programs.--
                  (A) In general.--A State may use not more 
                than the applicable percent of the amount of 
                any grant made to the State under section 
                403(a) for a fiscal year to carry out State 
                programs pursuant to subtitle 1 of title XX.
                  (B) Applicable percent.--For purposes of 
                subparagraph (A), the applicable percent is 
                4.25 percent in the case of fiscal year 2001 
                and each succeeding fiscal year.
          (3) Applicable rules.--
                  (A) In general.--Except as provided in 
                subparagraph (B) of this paragraph, any amount 
                paid to a State under this part that is used to 
                carry out a State program pursuant to a 
                provision of law specified in paragraph (1) 
                shall not be subject to the requirements of 
                this part, but shall be subject to the 
                requirements that apply to Federal funds 
                provided directly under the provision of law to 
                carry out the program, and the expenditure of 
                any amount so used shall not be considered to 
                be an expenditure under this part.
                  (B) Exception relating to subtitle 1 of  
                title xx programs.--All amounts paid to a State 
                under this part that are used to carry out 
                State programs pursuant to subtitle 1 of title 
                XX shall be used only for programs and services 
                to children or their families whose income is 
                less than 200 percent of the income official 
                poverty line (as defined by the Office of 
                Management and Budget, and revised annually in 
                accordance with section 673(2) of the Omnibus 
                Budget Reconciliation Act of 1981) applicable 
                to a family of the size involved.

           *       *       *       *       *       *       *


                   PART B--CHILD AND FAMILY SERVICES


                   Subpart 1--Child Welfare Services


                             APPROPRIATION

    Sec.  420. (a) * * *

           *       *       *       *       *       *       *


                 STATE PLANS FOR CHILD WELFARE SERVICES

    Sec.  422. (a) In order to be eligible for payment under 
this subpart, a State must have a plan for child welfare 
services which has been developed jointly by the Secretary and 
the State agency designated pursuant to subsection (b)(1), and 
which meets the requirements of subsection (b).
    (b) Each plan for child welfare services under this subpart 
shall--
          (1) provide that (A) the individual or agency that 
        administers or supervises the administration of the 
        State's services program under subtitle 1 of title XX 
        will administer or supervise the administration of the 
        plan (except as otherwise provided in section 103(d) of 
        the Adoption Assistance and Child Welfare Act of 1980), 
        and (B) to the extent that child welfare services are 
        furnished by the staff of the State agency or local 
        agency administering the plan, a single organizational 
        unit in such State or local agency, as the case may be, 
        will be responsible for furnishing such child welfare 
        services;
          (2) provide for coordination between the services 
        provided for children under the plan and the services 
        and assistance provided under subtitle 1 of title XX, 
        under the State program funded under part A, under the 
        State plan approved under subpart 2 of this part, under 
        the State plan approved under the State plan approved 
        under part E, and under other State programs having a 
        relationship to the program under this subpart, with a 
        view to provision of welfare and related services which 
        will best promote the welfare of such children and 
        their families;
          (3) provide that the standards and requirements 
        imposed with respect to child day care under subtitle 1 
        of title XX shall apply with respect to day care 
        services under this subpart, except insofar as 
        eligibility for such services is involved;

           *       *       *       *       *       *       *


PART E--FEDERAL PAYMENTS FOR FOSTER CARE AND ADOPTION ASSISTANCE

           *       *       *       *       *       *       *



           STATE PLAN FOR FOSTER CARE AND ADOPTION ASSISTANCE

    Sec.  471. (a) In order for a State to be eligible for 
payments under this part, it shall have a plan approved by the 
Secretary which--
          (1) provides for foster care maintenance payments in 
        accordance with section 472 and for adoption assistance 
        in accordance with section 473;
          (2) provides that the State agency responsible for 
        administering the program authorized by subpart 1 of 
        part B of this title shall administer, or supervise the 
        administration of, the program authorized by this part;
          (3) provides that the plan shall be in effect in all 
        political subdivisions of the State, and, if 
        administered by them, be mandatory upon them;
          (4) provides that the State shall assure that the 
        programs at the local level assisted under this part 
        will be coordinated with the programs at the State or 
        local level assisted under parts A and B of this title, 
        under subtitle 1 of title XX of this Act, and under any 
        other appropriate provision of Federal law;

           *       *       *       *       *       *       *


                FOSTER CARE MAINTENANCE PAYMENTS PROGRAM

    Sec. 472. (a) Each State with a plan approved under this 
part shall make foster care maintenance payments (as defined in 
section 475(4)) under this part with respect to a child who 
would have met the requirements of section 406(a) or of section 
407 (as such sections were in effect on July 16, 1996) but for 
his removal from the home of a relative (specified in section 
406(a) (as so in effect)), if--

           *       *       *       *       *       *       *

          (h)(1) For purposes of titles XIX, any child with 
        respect to whom foster care maintenance payments are 
        made under this section is deemed to be a dependent 
        child as defined in section 406 (as in effect as of 
        July 16, 1996) and deemed to be a recipient of aid to 
        families with dependent children under part A of this 
        title (as so in effect). For purposes of subtitle 1 of 
        title XX, any child with respect to whom foster care 
        maintenance payments are made under this section is 
        deemed to be a minor child in a needy family under a 
        State program funded under part A of this title and is 
        deemed to be a recipient of assistance under such part.

           *       *       *       *       *       *       *


                      ADOPTION ASSISTANCE PROGRAM

    Sec.  473. (a)(1)(A) Each State having a plan approved 
under this part shall enter into adoption assistance agreements 
(as defined in section 475(3)) with the adoptive parents of 
children with special needs.

           *       *       *       *       *       *       *

    (b)(1) For purposes of title XIX, any child who is 
described in paragraph (3) is deemed to be a dependent child as 
defined in section 406 (as in effect as of July 16, 1996) and 
deemed to be a recipient of aid to families with dependent 
children under part A of this title (as so in effect) in the 
State where such child resides.
          (2) For purposes of subtitle 1 of title XX, any child 
        who is described in paragraph (3) is deemed to be a 
        minor child in a needy family under a State program 
        funded under part A of this title and deemed to be a 
        recipient of assistance under such part.

           *       *       *       *       *       *       *


     TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION

                       PART A--GENERAL PROVISIONS


                              DEFINITIONS

    Sec. 1101. (a) When used in this Act--
          (1) The term ``State'', except where otherwise 
        provided, includes the District of Columbia and the 
        Commonwealth of Puerto Rico, and when used in titles 
        IV, V, VII, XI, XIX, and XXI includes the Virgin 
        Islands and Guam. Such term when used in titles III, 
        IX, and XII also includes the Virgin Islands. Such term 
        when used in title V and in part B of this title also 
        includes American Samoa, the Northern Mariana Islands, 
        and the Trust Territory of the Pacific Islands. Such 
        term when used in titles XIX and XXI also includes the 
        Northern Mariana Islands and American Samoa. In the 
        case of Puerto Rico, the Virgin Islands, and Guam, 
        titles I, X, and XIV, and title XVI (as in effect 
        without regard to the amendment made by section 301 of 
        the Social Security Amendments of 1972) shall continue 
        to apply, and the term ``State'' when used in such 
        titles (but not in title XVI as in effect pursuant to 
        such amendment after December 31, 1973) includes Puerto 
        Rico, the Virgin Islands, and Guam. Such term when used 
        in title XX also includes the Virgin Islands, Guam, 
        American Samoa, and the Northern Mariana Islands. Such 
        term when used in title IV also includes American 
        Samoa.

           *       *       *       *       *       *       *


  EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN 
                MEDICARE AND STATE HEALTH CARE PROGRAMS

    Sec. 1128. (a) Mandatory Exclusion.--The Secretary shall 
exclude the following individuals and entities from 
participation in any Federal health care program (as defined in 
section 1128B(f)):

           *       *       *       *       *       *       *

    (h) Definition of State Health Care Program.--For purposes 
of this section and sections 1128A and 1128B, the term ``State 
health care program'' means--
          (1) a State plan approved under title XIX,
          (2) any program receiving funds under title V or from 
        an allotment to a State under such title,
          (3) any program receiving funds under subtitle 1 of 
        title XX or from an allotment to a State under [such 
        title] such subtitle, or
          (4) a State child health plan approved under title 
        XXI.

           *       *       *       *       *       *       *


                        CIVIL MONETARY PENALTIES

    Sec. 1128A. (a) Any person (including an organization, 
agency, or other entity, but excluding a beneficiary, as 
defined in subsection (i)(5)) that--

           *       *       *       *       *       *       *

    (i) For the purposes of this section:
          (1) The term ``State agency'' means the agency 
        established or designated to administer or supervise 
        the administration of the State plan under title XIX of 
        this Act or designated to administer the State's 
        program under title V or subtitle 1 of title XX of this 
        Act.

           *       *       *       *       *       *       *


 STATE GRANTS FOR WORK INCENTIVES ASSISTANCE TO DISABLED BENEFICIARIES

    Sec.  1150. * * *

           *       *       *       *       *       *       *


 REPORTING TO LAW ENFORCEMENT OF CRIMES OCCURRING IN FEDERALLY FUNDED 
                       LONG-TERM CARE FACILITIES

    Sec. 1150A.  (a) Determination and Notification.--
          (1) Determination.--The owner or operator of each 
        long-term care facility that receives Federal funds 
        under this Act shall annually determine whether the 
        facility received at least $10,000 in such Federal 
        funds during the preceding year.
          (2) Notification.--If the owner or operator 
        determines under paragraph (1) that the facility 
        received at least $10,000 in such Federal funds during 
        the preceding year, such owner or operator shall 
        annually notify each covered individual (as defined in 
        paragraph (3)) of that individual's obligation to 
        comply with the reporting requirements described in 
        subsection (b).
          (3) Covered individual defined.--In this section, the 
        term ``covered individual'' means each individual who 
        is an owner, operator, employee, manager, agent, or 
        contractor of a long-term care facility that is the 
        subject of a determination described in paragraph (1).
    (b) Reporting Requirements.--
          (1) In general.--Each covered individual shall report 
        to the Secretary and 1 or more law enforcement entities 
        for the political subdivision in which the facility is 
        located any reasonable suspicion of a crime (as defined 
        by the law of the applicable political subdivision) 
        against any individual who is a resident of, or is 
        receiving care from, the facility.
          (2) Timing.--If the events that cause the suspicion--
                  (A) result in serious bodily injury, the 
                individual shall report the suspicion 
                immediately, but not later than 2 hours after 
                forming the suspicion; and
                  (B) do not result in serious bodily injury, 
                the individual shall report the suspicion not 
                later than 24 hours after forming the 
                suspicion.
  (c) Penalties.--
          (1) In general.--If a covered individual violates 
        subsection (b)--
                  (A) the covered individual shall be subject 
                to a civil money penalty of not more than 
                $200,000; or
                  (B) the Secretary shall classify the covered 
                individual as an excluded individual, for a 
                period of not more than 3 years.
          (2) Increased harm.--If a covered individual violates 
        subsection (b) and the violation exacerbates the harm 
        to the victim of the crime or results in harm to 
        another individual--
                  (A) the covered individual shall be subject 
                to a civil money penalty of not more than 
                $300,000; and
                  (B) the Secretary shall classify the covered 
                individual as an excluded individual, for a 
                period of not more than 3 years.
          (3) Excluded individual.--During any period for which 
        a covered individual is classified as an excluded 
        individual under paragraph (1)(B) or (2)(B), a long-
        term care facility that employs such individual shall 
        be ineligible to receive Federal funds under this Act.
          (4) Extenuating circumstances.--
                  (A) In general.--The Secretary may take into 
                account the financial burden on providers with 
                underserved populations in determining any 
                penalty to be imposed under this subsection.
                  (B) Underserved population defined.--In this 
                paragraph, the term ``underserved population'' 
                means the population of an area designated by 
                the Secretary as an area with a shortage of 
                elder justice programs or a population group 
                designated by the Secretary as having a 
                shortage of such programs. Such areas or groups 
                designated by the Secretary may include--
                          (i) areas or groups that are 
                        geographically isolated (such as 
                        isolated in a rural area);
                          (ii) racial and ethnic minority 
                        populations; and
                          (iii) populations underserved because 
                        of special needs (such as language 
                        barriers, disabilities, alien status, 
                        or age).
  (d) Additional Penalties for Retaliation.--
          (1) In general.--A long-term care facility may not--
                  (A) discharge, demote, suspend, threaten, 
                harass, or deny a promotion or other 
                employment-related benefit to an employee, or 
                in any other manner discriminate against an 
                employee in the terms and conditions of 
                employment because of lawful acts done by the 
                employee; or
                  (B) file a complaint or a report against a 
                nurse or other employee with the appropriate 
                State professional disciplinary agency because 
                of lawful acts done by the nurse or employee,
        for making a report, causing a report to be made, or 
        for taking steps in furtherance of making a report 
        pursuant to subsection (b)(1).
          (2) Penalties for retaliation.--If a long-term care 
        facility violates subparagraph (A) or (B) of paragraph 
        (1) the facility shall be subject to a civil money 
        penalty of not more than $200,000 or the Secretary may 
        classify the entity as an excluded entity for a period 
        of 2 years pursuant to section 1128(b), or both.
          (3) Requirement to post notice.--Each long-term care 
        facility shall post conspicuously in an appropriate 
        location a sign (in a form specified by the Secretary) 
        specifying the rights of employees under this section. 
        Such sign shall include a statement that an employee 
        may file a complaint with the Secretary against a long-
        term care facility that violates the provisions of this 
        subsection and information with respect to the manner 
        of filing such a complaint.
  (e) Procedure.--The provisions of section 1128A (other than 
subsections (a) and (b) and the second sentence of subsection 
(f)) shall apply to a civil money penalty under this section in 
the same manner as such provisions apply to a penalty or 
proceeding under section 1128A(a).
  (f) Definitions.--In this section, the terms ``elder 
justice'', ``long-term care facility'', and ``law enforcement'' 
have the meanings given those terms in section 2011.

   ENSURING SAFETY OF RESIDENTS WHEN FEDERALLY FUNDED LONG-TERM CARE 
                            FACILITIES CLOSE

    Sec. 1150B.  (a) Notification of Facility Closure.--If the 
owner or operator determines under section 1150A(a)(1) that a 
long-term care facility received at least $10,000 in Federal 
funds under this Act during the preceding year, the owner or 
operator of the facility shall--
          (1) submit to the Secretary and the appropriate State 
        regulatory agency written notification of an impending 
        closure not later than the date that is 60 days prior 
        to the date of such closure;
          (2) include in the notice a plan for the transfer and 
        adequate relocation of the residents of the facility 
        prior to closure, including assurances that the 
        residents will be transferred to the most appropriate 
        facility in terms of quality, services, and location; 
        and
          (3) not later than 10 days after the facility 
        closure, submit to the Secretary and the appropriate 
        State agency information identifying where residents of 
        the closed facility were transferred and on what date.
  (b) Sanctions.--Any person owning or operating a long-term 
care facility that fails to comply with the requirements of 
subsection (a) shall be subject to--
          (1) a civil monetary penalty of up to $1,000,000;
          (2) exclusion from participation in the programs 
        under this Act (in accordance with the procedures of 
        section 1128); and
          (3) any other applicable civil monetary penalties and 
        assessments.
  (c) Procedure.--The provisions of section 1128A (other than 
subsections (a) and (b) and the second sentence of subsection 
(f)) shall apply to a civil money penalty or assessment under 
this section in the same manner as such provisions apply to a 
penalty or proceeding under section 1128A(a).
  (d) Definition.--In this section, the term ``long-term care 
facility'' has the meaning given that term in section 2011.

           *       *       *       *       *       *       *


 TITLE XX--BLOCK GRANTS TO STATES FOR SOCIAL SERVICES AND ELDER JUSTICE

         Subtitle 1--Block Grants to States for Social Services

     PURPOSES OF [TITLE] SUBTITLE; AUTHORIZATION OF APPROPRIATIONS

    Sec.  2001. For the purposes of consolidating Federal 
assistance to States for social services into a single grant, 
increasing State flexibility in using social service grants, 
and encouraging each State, as far as practicable under the 
conditions in that State, to furnish services directed at the 
goals of--
          (1) achieving or maintaining economic self-support to 
        prevent, reduce, or eliminate dependency;
          (2) achieving or maintaining self-sufficiency, 
        including reduction or prevention of dependency;
          (3) preventing or remedying neglect, abuse, or 
        exploitation of children and adults unable to protect 
        their own interests, or preserving, rehabilitating or 
        reuniting families;
          (4) preventing or reducing inappropriate 
        institutional care by providing for community-based 
        care, home-based care, or other forms of less intensive 
        care; and
          (5) securing referral or admission for institutional 
        care when other forms of care are not appropriate, or 
        providing services to individuals in institutions,
there are authorized to be appropriated for each fiscal year 
such sums as may be necessary to carry out the purposes of 
[this title] this subtitle.

                           PAYMENTS TO STATES

    Sec.  2002. (a)(1) Each State shall be entitled to payment 
under [this title] this subtitle for each fiscal year in an 
amount equal to its allotment for such fiscal year, to be used 
by such State for services directed at the goals set forth in 
section 2001, subject to the requirements of [this title] this 
subtitle.
          (2) For purposes of paragraph (1)--
                  (A) services which are directed at the goals 
                set forth in section 2001 include, but are not 
                limited to, child care services, protective 
                services for children and adults, services for 
                children and adults in foster care, services 
                related to the management and maintenance of 
                the home, day care services for adults, 
                transportation services, family planning 
                services, training and related services, 
                employment services, information, referral, and 
                counseling services, the preparation and 
                delivery of meals, health support services and 
                appropriate combinations of services designed 
                to meet the special needs of children, the 
                aged, the mentally retarded, the blind, the 
                emotionally disturbed, the physically 
                handicapped, and alcoholics and drug addicts; 
                and
                  (B) expenditures for such services may 
                include expenditures for--
                          (i) administration (including 
                        planning and evaluation);
                          (ii) personnel training and 
                        retraining directly related to the 
                        provision of those services (including 
                        both short- and long-term training at 
                        educational institutions through grants 
                        to such institutions or by direct 
                        financial assistance to students 
                        enrolled in such institutions); and
                          (iii) conferences or workshops, and 
                        training or retraining through grants 
                        to nonprofit organizations within the 
                        meaning of section 501(c)(3) of the 
                        Internal Revenue Code of 1954 or to 
                        individuals with social services 
                        expertise, or through financial 
                        assistance to individuals participating 
                        in such conferences, workshops, and 
                        training or retraining (and this clause 
                        shall apply with respect to all persons 
                        involved in the delivery of such 
                        services).
    (b) The Secretary shall make payments in accordance with 
section 6503 of title 31, United States Code, to each State 
from its allotment for use under [this title] this subtitle.
    (c) Payments to a State from its allotment for any fiscal 
year must be expended by the State in such fiscal year or in 
the succeeding fiscal year.
    (d) A State may transfer up to 10 percent of its allotment 
under section 2003 for any fiscal year for its use for that 
year under other provisions of Federal law providing block 
grants for support of health services, health promotion and 
disease prevention activities, or low-income home energy 
assistance (or any combination of those activities). Amounts 
allotted to a State under any provisions of Federal law 
referred to in the preceding sentence and transferred by a 
State for use in carrying out the purposes of [this title] this 
subtitle shall be treated as if they were paid to the State 
under [this title] this subtitle but shall not affect the 
computation of the State's allotment under [this title] this 
subtitle. The State shall inform the Secretary of any such 
transfer of funds.
    (e) A State may use a portion of the amounts described in 
subsection (a) for the purpose of purchasing technical 
assistance from public or private entities if the State 
determines that such assistance is required in developing, 
implementing, or administering programs funded under [this 
title] this subtitle.
    (f) A State may use funds provided under [this title] this 
subtitle to provide vouchers, for services directed at the 
goals set forth in section 2001, to families, including--
          (1) families who have become ineligible for 
        assistance under a State program funded under part A of 
        title IV by reason of a durational limit on the 
        provision of such assistance; and
          (2) families denied cash assistance under the State 
        program funded under part A of title IV for a child who 
        is born to a member of the family who is--
                  (A) a recipient of assistance under the 
                program; or
                  (B) a person who received such assistance at 
                any time during the 10-month period ending with 
                the birth of the child.

                               ALLOTMENTS

    Sec.  2003. (a) The allotment for any fiscal year to each 
of the jurisdictions of Puerto Rico, Guam, the Virgin Islands, 
and the Northern Mariana Islands shall be an amount which bears 
the same ratio to the amount specified in subsection (c) as the 
amount which was specified for allocation to the particular 
jurisdiction involved for the fiscal year 1981 under section 
2002(a)(2)(C) of this Act (as in effect prior to the enactment 
of this section) bore to $2,900,000,000. The allotment for 
fiscal year 1989 and each succeeding fiscal year to American 
Samoa shall be an amount which bears the same ratio to the 
amount allotted to the Northern Mariana Islands for that fiscal 
year as the population of American Samoa bears to the 
population of the Northern Mariana Islands determined on the 
basis of the most recent data available at the time such 
allotment is determined.

           *       *       *       *       *       *       *


                          STATE ADMINISTRATION

    Sec.  2004. Prior to expenditure by a State of payments 
made to it under section 2002 for any fiscal year, the State 
shall report on the intended use of the payments the State is 
to receive under [this title] this subtitle, including 
information on the types of activities to be supported and the 
categories or characteristics of individuals to be served. The 
report shall be transmitted to the Secretary and made public 
within the State in such manner as to facilitate comment by any 
person (including any Federal or other public agency) during 
development of the report and after its completion. The report 
shall be revised throughout the year as may be necessary to 
reflect substantial changes in the activities assisted under 
[this title] this subtitle, and any revision shall be subject 
to the requirements of the previous sentence.

                      LIMITATIONS ON USE OF GRANTS

    Sec.  2005. (a) Except as provided in subsection (b), 
grants made under [this title] this subtitle may not be used by 
the State, or by any other person with which the State makes 
arrangements to carry out the purposes of [this title] this 
subtitle--
          (1) for the purchase or improvement of land, or the 
        purchase, construction, or permanent improvement (other 
        than minor remodeling) of any building or other 
        facility;
          (2) for the provision of cash payments for costs of 
        subsistence or for the provision of room and board 
        (other than costs of subsistence during rehabilitation, 
        room and board provided for a short term as an integral 
        but subordinate part of a social service, or temporary 
        emergency shelter provided as a protective service);
          (3) for payment of the wages of any individual as a 
        social service (other than payment of the wages of 
        welfare recipients employed in the provision of child 
        day care services);
          (4) for the provision of medical care (other than 
        family planning services, rehabilitation services, or 
        initial detoxification of an alcoholic or drug 
        dependent individual) unless it is an integral but 
        subordinate part of a social service for which grants 
        may be used under [this title] this subtitle;
          (5) for social services (except services to an 
        alcoholic or drug dependent individual or 
        rehabilitation services) provided in and by employees 
        of any hospital, skilled nursing facility, intermediate 
        care facility, or prison, to any individual living in 
        such institution;
          (6) for the provision of any educational service 
        which the State makes generally available to its 
        residents without cost and without regard to their 
        income;
          (7) for any child day care services unless such 
        services meet applicable standards of State and local 
        law;
          (8) for the provision of cash payments as a service 
        (except as otherwise provided in this section);
          (9) for payment for any item or service (other than 
        an emergency item or service) furnished--
                  (A) by an individual or entity during the 
                period when such individual or entity is 
                excluded under [this title] this subtitle or 
                title V, XVIII, or XIX pursuant to section 
                1128, 1128A, 1156, or 1842(j)(2), or
                  (B) at the medical direction or on the 
                prescription of a physician during the period 
                when the physician is excluded under [this 
                title] this subtitle or title V, XVIII, or XIX 
                pursuant to section 1128, 1128A, 1156, or 
                1842(j)(2) and when the person furnishing such 
                item or service knew or had reason to know of 
                the exclusion (after a reasonable time period 
                after reasonable notice has been furnished to 
                the person); or
          (10) in a manner inconsistent with the Assisted 
        Suicide Funding Restriction Act of 1997.
    (b) The Secretary may waive the limitation contained in 
subsection (a)(1) and (4) upon the State's request for such a 
waiver if he finds that the request describes extraordinary 
circumstances to justify the waiver and that permitting the 
waiver will contribute to the State's ability to carry out the 
purposes of [this title] this subtitle.

                           REPORTS AND AUDITS

    Sec.  2006. (a) Each State shall prepare reports on its 
activities carried out with funds made available (or 
transferred for use) under [this title] this subtitle. Reports 
shall be prepared annually, covering the most recently 
completed fiscal year, and shall be in such form and contain 
such information (including but not limited to the information 
specified in subsection (c)) as the State finds necessary to 
provide an accurate description of such activities, to secure a 
complete record of the purposes for which funds were spent, and 
to determine the extent to which funds were spent in a manner 
consistent with the reports required by section 2004. The State 
shall make copies of the reports required by this section 
available for public inspection within the State and shall 
transmit a copy to the Secretary. Copies shall also be 
provided, upon request, to any interested public agency, and 
each such agency may provide its views on these reports to the 
Congress.
    (b) Each State shall, not less often than every two years, 
audit its expenditures from amounts received (or transferred 
for use) under [this title] this subtitle. Such State audits 
shall be conducted by an entity independent of any agency 
administering activities funded under [this title] this 
subtitle, in accordance with generally accepted auditing 
principles. Within 30 days following the completion of each 
audit, the State shall submit a copy of that audit to the 
legislature of the State and to the Secretary. Each State shall 
repay to the United States amounts ultimately found not to have 
been expended in accordance with [this title] this subtitle, or 
the Secretary may offset such amounts against any other amount 
to which the State is or may become entitled under [this title] 
this subtitle.
    (c) Each report prepared and transmitted by a State under 
subsection (a) shall set forth (with respect to the fiscal year 
covered by the report)--
          (1) the number of individuals who received services 
        paid for in whole or in part with funds made available 
        under [this title] this subtitle, showing separately 
        the number of children and the number of adults who 
        received such services, and broken down in each case to 
        reflect the types of services and circumstances 
        involved;

           *       *       *       *       *       *       *


                           ADDITIONAL GRANTS

    Sec. 2007. (a) Entitlement.-- * * *

           *       *       *       *       *       *       *

    (f) Definitions.--As Used In This Section:
          (1) Qualified empowerment zone.-- * * *

           *       *       *       *       *       *       *

          (6) Urban area.--The term ``urban area'' has the 
        meaning given such term in section 1393(a)(3) of the 
        Internal Revenue Code of 1986.

           *       *       *       *       *       *       *


                       Subtitle 2--Elder Justice

SEC. 2011. DEFINITIONS.

    In this subtitle:
          (1) Abuse.--The term ``abuse'' means the knowing 
        infliction of physical or psychological harm or the 
        knowing deprivation of goods or services that are 
        necessary to meet essential needs or to avoid physical 
        or psychological harm.
          (2) Adult protective services.--The term ``adult 
        protective services'' means such services provided to 
        adults as the Secretary may specify and includes 
        services such as--
                  (A) disseminating reports of adult abuse, 
                neglect, or exploitation;
                  (B) investigating the reports described in 
                subparagraph (A);
                  (C) case planning, monitoring, evaluation, 
                and other case work and services; and
                  (D) providing, arranging for, or facilitating 
                the provision of medical, social service, 
                economic, legal, housing, law enforcement, or 
                other protective, emergency, or support 
                services.
          (3) Caregiver.--The term ``caregiver'' means an 
        individual who has the responsibility for the care of 
        an elder, either voluntarily, by contract, by receipt 
        of payment for care, or as a result of the operation of 
        law, and means a family member or other individual who 
        provides (on behalf of such individual or of a public 
        or private agency, organization, or institution) 
        compensated or uncompensated care to an elder who needs 
        supportive services in any setting.
          (4) Direct care.--The term ``direct care'' means care 
        by an employee or contractor who provides assistance or 
        long-term care services to a recipient.
          (5) Elder.--The term ``elder'' means an individual 
        age 60 or older.
          (6) Elder justice.--The term ``elder justice'' 
        means--
                  (A) from a societal perspective, efforts to--
                          (i) prevent, detect, treat, intervene 
                        in, and prosecute elder abuse, neglect, 
                        and exploitation; and
                          (ii) protect elders with diminished 
                        capacity while maximizing their 
                        autonomy; and
                  (B) from an individual perspective, the 
                recognition of an elder's rights, including the 
                right to be free of abuse, neglect, and 
                exploitation.
          (7) Eligible entity.--The term ``eligible entity'' 
        means a State or local government agency, Indian tribe 
        or tribal organization, or any other public or private 
        entity that is engaged in and has expertise in issues 
        relating to elder justice or in a field necessary to 
        promote elder justice efforts.
          (8) Exploitation.--The term ``exploitation'' means 
        the fraudulent or otherwise illegal, unauthorized, or 
        improper act or process of an individual, including a 
        caregiver or fiduciary, that uses the resources of an 
        elder for monetary or personal benefit, profit, or 
        gain, or that results in depriving an elder of rightful 
        access to, or use of, benefits, resources, belongings, 
        or assets.
          (9) Fiduciary.--The term ``fiduciary''--
                  (A) means a person or entity with the legal 
                responsibility--
                          (i) to make decisions on behalf of 
                        and for the benefit of another person; 
                        and
                          (ii) to act in good faith and with 
                        fairness; and
                  (B) includes a trustee, a guardian, a 
                conservator, an executor, an agent under a 
                financial power of attorney or health care 
                power of attorney, or a representative payee.
          (10) Grant.--The term ``grant'' includes a contract, 
        cooperative agreement, or other mechanism for providing 
        financial assistance.
          (11) Guardianship.--The term ``guardianship'' means--
                  (A) the process by which a State court 
                determines that an adult individual lacks 
                capacity to make decisions about self-care and 
                property, and appoints another individual or 
                entity known as a guardian, as a conservator, 
                or by a similar term, as a surrogate 
                decisionmaker;
                  (B) the manner in which the court-appointed 
                surrogate decisionmaker carries out duties to 
                the individual and the court; or
                  (C) the manner in which the court exercises 
                oversight of the surrogate decisionmaker.
          (12) Indian tribe.--
                  (A) In general.--The term ``Indian tribe'' 
                has the meaning given such term in section 4 of 
                the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450b).
                  (B) Inclusion of pueblo and rancheria.--The 
                term ``Indian tribe'' includes any Pueblo or 
                Rancheria.
          (13) Law enforcement.--The term ``law enforcement'' 
        means the full range of potential responders to elder 
        abuse, neglect, and exploitation including--
                  (A) police, sheriffs, detectives, public 
                safety officers, and corrections personnel;
                  (B) prosecutors;
                  (C) medical examiners;
                  (D) investigators; and
                  (E) coroners.
          (14) Long-term care.--
                  (A) In general.--The term ``long-term care'' 
                means supportive and health services specified 
                by the Secretary for individuals who need 
                assistance because the individuals have a loss 
                of capacity for self-care due to illness, 
                disability, or vulnerability.
                  (B) Loss of capacity for self-care.--For 
                purposes of subparagraph (A), the term ``loss 
                of capacity for self-care'' means an inability 
                to engage in 1 or more activities of daily 
                living, including eating, dressing, bathing, 
                and management of one's financial affairs.
          (15) Long-term care facility.--The term ``long-term 
        care facility'' means a residential care provider that 
        arranges for, or directly provides, long-term care.
          (16) Neglect.--The term ``neglect'' means--
                  (A) the failure of a caregiver or fiduciary 
                to provide the goods or services that are 
                necessary to maintain the health or safety of 
                an elder; or
                  (B) self-neglect.
          (17) Nursing facility.--
                  (A) In general.--The term ``nursing 
                facility'' has the meaning given such term 
                under section 1919(a).
                  (B) Inclusion of skilled nursing facility.--
                The term ``nursing facility'' includes a 
                skilled nursing facility (as defined in section 
                1819(a)).
          (18) Self-neglect.--The term ``self-neglect'' means 
        an adult's inability, due to physical or mental 
        impairment or diminished capacity, to perform essential 
        self-care tasks including--
                  (A) obtaining essential food, clothing, 
                shelter, and medical care;
                  (B) obtaining goods and services necessary to 
                maintain physical health, mental health, or 
                general safety; or
                  (C) managing one's own financial affairs.
          (19) Serious bodily injury.--
                  (A) In general.--The term ``serious bodily 
                injury'' means an injury--
                          (i) involving extreme physical pain;
                          (ii) involving substantial risk of 
                        death;
                          (iii) involving protracted loss or 
                        impairment of the function of a bodily 
                        member, organ, or mental faculty; or
                          (iv) requiring medical intervention 
                        such as surgery, hospitalization, or 
                        physical rehabilitation.
                  (B) Criminal sexual abuse.--Serious bodily 
                injury shall be considered to have occurred if 
                the conduct causing the injury is conduct 
                described in section 2241 (relating to 
                aggravated sexual abuse) or 2242 (relating to 
                sexual abuse) of title 18, United States Code, 
                or any similar offense under State law.
          (20) Social.--The term ``social'', when used with 
        respect to a service, includes adult protective 
        services.
          (21) State legal assistance developer.--The term 
        ``State legal assistance developer'' means an 
        individual described in section 731 of the Older 
        Americans Act of 1965.
          (22) State long-term care ombudsman.--The term 
        ``State Long-Term Care Ombudsman'' means the State 
        Long-Term Care Ombudsman described in section 712(a)(2) 
        of the Older Americans Act of 1965.

SEC. 2012. GENERAL PROVISIONS.

  (a) Protection of Privacy.--In pursuing activities under this 
subtitle, the Secretary shall ensure the protection of 
individual health privacy consistent with the regulations 
promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 and applicable State 
and local privacy regulations.
  (b) Rule of Construction.--Nothing in this subtitle shall be 
construed to interfere with or abridge an elder's right to 
practice his or her religion through reliance on prayer alone 
for healing when this choice--
          (1) is contemporaneously expressed, either orally or 
        in writing, with respect to a specific illness or 
        injury which the elder has at the time of the decision 
        by an elder who is competent at the time of the 
        decision;
          (2) is previously set forth in a living will, health 
        care proxy, or other advance directive document that is 
        validly executed and applied under State law; or
          (3) may be unambiguously deduced from the elder's 
        life history.

 PART A--NATIONAL COORDINATION OF ELDER JUSTICE ACTIVITIES AND RESEARCH

  Subpart 1--Elder Justice Coordinating Council and Advisory Board on 
                 Elder Abuse, Neglect, and Exploitation

SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL.

    (a) Establishment.--There is established within the Office 
of the Secretary an Elder Justice Coordinating Council (in this 
section referred to as the ``Council'').
    (b) Membership.--
          (1) In general.--The Council shall be composed of the 
        following members:
                  (A) The Secretary (or the Secretary's 
                designee).
                  (B) The Attorney General (or the Attorney 
                General's designee).
                  (C) The head of each Federal department or 
                agency or other governmental entity identified 
                by the Chair referred to in subsection (d) as 
                having responsibilities, or administering 
                programs, relating to elder abuse, neglect, and 
                exploitation.
          (2) Requirement.--Each member of the Council shall be 
        an officer or employee of the Federal Government.
  (c) Vacancies.--Any vacancy in the Council shall not affect 
its powers, but shall be filled in the same manner as the 
original appointment was made.
  (d) Chair.--The member described in subsection (b)(1)(A) 
shall be Chair of the Council.
  (e) Meetings.--The Council shall meet at least 2 times per 
year, as determined by the Chair.
  (f) Duties.--
          (1) In general.--The Council shall make 
        recommendations to the Secretary for the coordination 
        of activities of the Department of Health and Human 
        Services, the Department of Justice, and other relevant 
        Federal, State, local, and private agencies and 
        entities, relating to elder abuse, neglect, and 
        exploitation and other crimes against elders.
          (2) Report.--Not later than the date that is 2 years 
        after the date of enactment of the Elder Justice Act 
        and every 2 years thereafter, the Council shall submit 
        to the Committee on Finance of the Senate and the 
        Committee on Ways and Means and the Committee on Energy 
        and Commerce of the House of Representatives a report 
        that--
                  (A) describes the activities and 
                accomplishments of, and challenges faced by--
                          (i) the Council; and
                          (ii) the entities represented on the 
                        Council; and
                  (B) makes such recommendations for 
                legislation, model laws, or other action as the 
                Council determines to be appropriate.
  (g) Powers of the Council.--
          (1) Information from federal agencies.--Subject to 
        the requirements of section 2012(a), the Council may 
        secure directly from any Federal department or agency 
        such information as the Council considers necessary to 
        carry out this section. Upon request of the Chair of 
        the Council, the head of such department or agency 
        shall furnish such information to the Council.
          (2) Postal services.--The Council may use the United 
        States mails in the same manner and under the same 
        conditions as other departments and agencies of the 
        Federal Government.
  (h) Travel Expenses.--The members of the Council shall not 
receive compensation for the performance of services for the 
Council. The members shall be allowed travel expenses, 
including per diem in lieu of subsistence, at rates authorized 
for employees of agencies under subchapter I of chapter 57 of 
title 5, United States Code, while away from their homes or 
regular places of business in the performance of services for 
the Council. Notwithstanding section 1342 of title 31, United 
States Code, the Secretary may accept the voluntary and 
uncompensated services of the members of the Council.
  (i) Detail of Government Employees.--Any Federal Government 
employee may be detailed to the Council without reimbursement, 
and such detail shall be without interruption or loss of civil 
service status or privilege.
  (j) Status as Permanent Council.--Section 14 of the Federal 
Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
Council.

SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, AND EXPLOITATION.

  (a) Establishment.--There is established a board to be known 
as the ``Advisory Board on Elder Abuse, Neglect, and 
Exploitation'' (in this section referred to as the ``Advisory 
Board'') to create short- and long-term multidisciplinary 
strategic plans for the development of the field of elder 
justice and to make recommendations to the Elder Justice 
Coordinating Council established under section 2021.
  (b) Composition.--The Advisory Board shall be composed of 27 
members appointed by the Secretary from among members of the 
general public who are individuals with experience and 
expertise in elder abuse, neglect, and exploitation prevention, 
detection, treatment, intervention, or prosecution.
  (c) Solicitation of Nominations.--The Secretary shall publish 
a notice in the Federal Register soliciting nominations for the 
appointment of members of the Advisory Board under subsection 
(b).
  (d) Terms.--
          (1) In general.--Each member of the Advisory Board 
        shall be appointed for a term of 3 years, except that, 
        of the members first appointed--
                  (A) 9 shall be appointed for a term of 3 
                years;
                  (B) 9 shall be appointed for a term of 2 
                years; and
                  (C) 9 shall be appointed for a term of 1 
                year.
          (2) Vacancies.--
                  (A) In general.--Any vacancy in the Advisory 
                Board shall not affect its powers, but shall be 
                filled in the same manner as the original 
                appointment was made.
                  (B) Filling unexpired term.--An individual 
                chosen to fill a vacancy shall be appointed for 
                the unexpired term of the member replaced.
          (3) Expiration of terms.--The term of any member 
        shall not expire before the date on which the member's 
        successor takes office.
  (e) Election of Officers.--The Advisory Board shall elect a 
Chair and Vice Chair from among its members. The Advisory Board 
shall elect its initial Chair and Vice Chair at its initial 
meeting.
  (f) Duties.--
          (1) Enhance communication on promoting quality of, 
        and preventing abuse and neglect in, long-term care.--
        The Advisory Board shall develop collaborative and 
        innovative approaches to improve the quality of, 
        including preventing abuse and neglect in, long-term 
        care.
          (2) Collaborative efforts to develop consensus around 
        the management of certain quality-related factors.--
                  (A) In general.--The Advisory Board shall 
                establish multidisciplinary panels to address, 
                and develop consensus on, subjects relating to 
                improving the quality of long-term care. At 
                least 1 such panel shall address, and develop 
                consensus on, methods for managing resident-to-
                resident abuse in long-term care.
                  (B) Activities conducted.--The 
                multidisciplinary panels established under 
                subparagraph (A) shall examine relevant 
                research and data, identify best practices with 
                respect to the subject of the panel, determine 
                the best way to carry out those best practices 
                in a practical and feasible manner, and 
                determine an effective manner of distributing 
                information on such subject.
          (3) Report.--Not later than the date that is 18 
        months after the date of enactment of the Elder Justice 
        Act, and annually thereafter, the Advisory Board shall 
        prepare and submit to the Elder Justice Coordinating 
        Council, the Committee on Finance of the Senate, and 
        the Committee on Ways and Means and the Committee on 
        Energy and Commerce of the House of Representatives a 
        report containing--
                  (A) information on the status of Federal, 
                State, and local public and private elder 
                justice activities;
                  (B) recommendations (including recommended 
                priorities) regarding--
                          (i) elder justice programs, research, 
                        training, services, practice, 
                        enforcement, and coordination;
                          (ii) coordination between entities 
                        pursuing elder justice efforts and 
                        those involved in related areas that 
                        may inform or overlap with elder 
                        justice efforts, such as activities to 
                        combat violence against women and child 
                        abuse and neglect; and
                          (iii) activities relating to adult 
                        fiduciary systems, including 
                        guardianship and other fiduciary 
                        arrangements;
                  (C) recommendations for specific 
                modifications needed in Federal and State laws 
                (including regulations) or for programs, 
                research, and training to enhance prevention, 
                detection, and treatment (including diagnosis) 
                of, intervention in (including investigation 
                of), and prosecution of elder abuse, neglect, 
                and exploitation;
                  (D) recommendations on methods for the most 
                effective coordinated national data collection 
                with respect to elder justice, and elder abuse, 
                neglect, and exploitation; and
                  (E) recommendations for a multidisciplinary 
                strategic plan to guide the effective and 
                efficient development of the field of elder 
                justice.
  (g) Powers of the Advisory Board.--
          (1) Information from federal agencies.--Subject to 
        the requirements of section 2012(a), the Advisory Board 
        may secure directly from any Federal department or 
        agency such information as the Advisory Board considers 
        necessary to carry out this section. Upon request of 
        the Chair of the Advisory Board, the head of such 
        department or agency shall furnish such information to 
        the Advisory Board.
          (2) Sharing of data and reports.--The Advisory Board 
        may request from any entity pursuing elder justice 
        activities under the Elder Justice Act or an amendment 
        made by that Act, any data, reports, or recommendations 
        generated in connection with such activities.
          (3) Postal services.--The Advisory Board may use the 
        United States mails in the same manner and under the 
        same conditions as other departments and agencies of 
        the Federal Government.
  (h) Travel Expenses.--The members of the Advisory Board shall 
not receive compensation for the performance of services for 
the Advisory Board. The members shall be allowed travel 
expenses for up to 4 meetings per year, including per diem in 
lieu of subsistence, at rates authorized for employees of 
agencies under subchapter I of chapter 57 of title 5, United 
States Code, while away from their homes or regular places of 
business in the performance of services for the Advisory Board. 
Notwithstanding section 1342 of title 31, United States Code, 
the Secretary may accept the voluntary and uncompensated 
services of the members of the Advisory Board.
  (i) Detail of Government Employees.--Any Federal Government 
employee may be detailed to the Advisory Board without 
reimbursement, and such detail shall be without interruption or 
loss of civil service status or privilege.
  (j) Status as Permanent Advisory Committee.--Section 14 of 
the Federal Advisory Committee Act (5 U.S.C. App.) shall not 
apply to the advisory board.

SEC. 2023. RESEARCH PROTECTIONS.

  (a) Guidelines.--The Secretary shall promulgate guidelines to 
assist researchers working in the area of elder abuse, neglect, 
and exploitation, with issues relating to human subject 
protections.
  (b) Definition of Legally Authorized Representative for 
Application of Regulations.--For purposes of the application of 
subpart A of part 46 of title 45, Code of Federal Regulations, 
to research conducted under this subpart, the term ``legally 
authorized representative'' means, unless otherwise provided by 
law, the individual or judicial or other body authorized under 
the applicable law to consent to medical treatment on behalf of 
another person.

SEC. 2024. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated to carry out this 
subpart--
          (1) for fiscal year 2007, $6,500,000; and
          (2) for each of fiscal years 2008 through 2010, 
        $7,000,000.

   Subpart 2--Elder Abuse, Neglect, and Exploitation Forensic Centers

SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER ABUSE, NEGLECT, AND 
                    EXPLOITATION FORENSIC CENTERS.

  (a) In General.--The Secretary, in consultation with the 
Attorney General, shall make grants to eligible entities to 
establish and operate stationary and mobile forensic centers, 
to develop forensic expertise regarding, and provide services 
relating to, elder abuse, neglect, and exploitation.
  (b) Stationary Forensic Centers.--The Secretary shall make 4 
of the grants described in subsection (a) to institutions of 
higher education with demonstrated expertise in forensics or 
commitment to preventing or treating elder abuse, neglect, or 
exploitation, to establish and operate stationary forensic 
centers.
  (c) Mobile Centers.--The Secretary shall make 6 of the grants 
described in subsection (a) to appropriate entities to 
establish and operate mobile forensic centers.
  (d) Authorized Activities.--
          (1) Development of forensic markers and 
        methodologies.--An eligible entity that receives a 
        grant under this section shall use funds made available 
        through the grant to assist in determining whether 
        abuse, neglect, or exploitation occurred and whether a 
        crime was committed and to conduct research to describe 
        and disseminate information on--
                  (A) forensic markers that indicate a case in 
                which elder abuse, neglect, or exploitation may 
                have occurred; and
                  (B) methodologies for determining, in such a 
                case, when and how health care, emergency 
                service, social and protective services, and 
                legal service providers should intervene and 
                when the providers should report the case to 
                law enforcement authorities.
          (2) Development of forensic expertise.--An eligible 
        entity that receives a grant under this section shall 
        use funds made available through the grant to develop 
        forensic expertise regarding elder abuse, neglect, and 
        exploitation in order to provide medical and forensic 
        evaluation, therapeutic intervention, victim support 
        and advocacy, case review, and case tracking.
          (3) Collection of evidence.--The Secretary, in 
        coordination with the Attorney General, shall use data 
        made available by grant recipients under this section 
        to develop the capacity of geriatric health care 
        professionals and law enforcement to collect forensic 
        evidence, including collecting forensic evidence 
        relating to a potential determination of elder abuse, 
        neglect, or exploitation.
  (e) Application.--To be eligible to receive a grant under 
this section, an entity shall submit an application to the 
Secretary at such time, in such manner, and containing such 
information as the Secretary may require.
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for fiscal year 2007, $4,000,000;
          (2) for fiscal year 2008, $6,000,000; and
          (3) for each of fiscal years 2009 and 2010, 
        $8,000,000.

               PART B--PROGRAMS TO PROMOTE ELDER JUSTICE

SEC. 2041. ENHANCEMENT OF LONG-TERM CARE.

  (a) Grants and Incentives for Long-Term Care Staffing.--
          (1) In general.--The Secretary shall carry out 
        activities, including activities described in 
        paragraphs (2) and (3), to provide incentives for 
        individuals to train for, seek, and maintain employment 
        providing direct care in a long-term care facility.
          (2) Specific programs to enhance training, 
        recruitment, and retention of staff.--
                  (A) Coordination with other programs to 
                recruit and train long-term care staff.--The 
                Secretary shall coordinate activities under 
                this subsection with the Secretary of Labor and 
                the Assistant Secretary for the Administration 
                for Children and Families in order to provide 
                incentives to participants in programs carried 
                out under part A of title IV to train for and 
                seek employment providing direct care in a 
                long-term care facility.
                  (B) Career ladders and wage or benefit 
                increases to increase staffing in long-term 
                care facilities.--
                          (i) In general.--The Secretary shall 
                        make grants to long-term care 
                        facilities to carry out programs 
                        through which the facilities--
                                  (I) offer, to employees who 
                                provide direct care to 
                                residents of a long-term care 
                                facility, continuing training 
                                and varying levels of 
                                certification, based on 
                                observed clinical care 
                                practices and the amount of 
                                time the employees spend 
                                providing direct care; and
                                  (II) provide, or make 
                                arrangements to provide, 
                                bonuses or other increased 
                                compensation or benefits to 
                                employees who achieve 
                                certification under such a 
                                program.
                          (ii) Application.--To be eligible to 
                        receive a grant under this 
                        subparagraph, a long-term care facility 
                        shall submit an application to the 
                        Secretary at such time, in such manner, 
                        and containing such information as the 
                        Secretary may require (which may 
                        include evidence of consultation with 
                        the State in which the long-term care 
                        facility is located with respect to 
                        carrying out activities funded under 
                        the grant).
                          (iii) Authority to limit number of 
                        applicants.--Nothing in this 
                        subparagraph shall be construed as 
                        prohibiting the Secretary from limiting 
                        the number of applicants for a grant 
                        under this subparagraph.
          (3) Specific programs to improve management 
        practices.--
                  (A) In general.--The Secretary shall make 
                grants to long-term care facilities to enable 
                the facilities to provide training and 
                technical assistance to eligible employees.
                  (B) Authorized activities.--A long-term care 
                facility that receives a grant under 
                subparagraph (A) shall use funds made available 
                through the grant to provide training and 
                technical assistance to eligible employees 
                regarding management practices using methods 
                that are demonstrated to promote retention of 
                individuals who provide direct care to 
                residents of the long-term care facility, such 
                as--
                          (i) the establishment of standard 
                        human resource policies that reward 
                        high performance, including policies 
                        that provide for improved wages and 
                        benefits on the basis of job reviews;
                          (ii) the establishment of 
                        motivational and thoughtful work 
                        organization practices;
                          (iii) the creation of a workplace 
                        culture that respects and values 
                        caregivers and their needs;
                          (iv) the promotion of a workplace 
                        culture that respects the rights of 
                        residents of a long-term care facility 
                        and results in improved care for the 
                        residents; and
                          (v) the establishment of other 
                        programs that promote the provision of 
                        high quality care, such as a continuing 
                        education program that provides 
                        additional hours of training, including 
                        on-the-job training, for employees who 
                        are certified nurse aides.
                  (C) Application.--To be eligible to receive a 
                grant under this paragraph, a long-term care 
                facility shall submit an application to the 
                Secretary at such time, in such manner, and 
                containing such information as the Secretary 
                may require (which may include evidence of 
                consultation with the State in which the long-
                term care facility is located with respect to 
                carrying out activities funded under the 
                grant).
                  (D) Authority to limit number of 
                applicants.--Nothing in this paragraph shall be 
                construed as prohibiting the Secretary from 
                limiting the number of applicants for a grant 
                under this paragraph.
                  (E) Eligible employee defined.--In this 
                paragraph, the term ``eligible employee'' means 
                an individual who establishes or implements 
                management practices applicable with respect to 
                individuals who provide direct care to 
                residents of a long-term care facility and 
                includes administrators, directors of nursing, 
                staff developers, and charge nurses.
          (4) Accountability measures.--The Secretary shall 
        develop accountability measures to ensure that the 
        activities conducted using funds made available under 
        this subsection benefit eligible employees and increase 
        the stability of the long-term care workforce.
  (b) Informatics Systems Grant Program.--
          (1) Grants authorized.--The Secretary is authorized 
        to make grants to long-term care facilities for the 
        purpose of assisting such entities in offsetting the 
        costs related to purchasing, leasing, developing, and 
        implementing standardized clinical health care 
        informatics systems designed to improve patient safety 
        and reduce adverse events and health care complications 
        resulting from medication errors.
          (2) Use of grant funds.--Funds provided under grants 
        under this subsection may be used for any of the 
        following:
                  (A) Purchasing, leasing, and installing 
                computer software and hardware, including 
                handheld computer technologies.
                  (B) Making improvements to existing computer 
                software and hardware.
                  (C) Making upgrades and other improvements to 
                existing computer software and hardware to 
                enable e-prescribing.
                  (D) Providing education and training to 
                eligible long-term care facility staff on the 
                use of technology to implement the electronic 
                transmission of prescription and patient 
                information.
          (3) Application.--To be eligible to receive a grant 
        under this subsection, a long-term care facility shall 
        submit an application to the Secretary at such time, in 
        such manner, and containing such information as the 
        Secretary may require (which may include evidence of 
        consultation with the State in which the long-term care 
        facility is located with respect to carrying out 
        activities funded under the grant).
          (4) Authority to limit number of applicants.--Nothing 
        in this subsection shall be construed as prohibiting 
        the Secretary from limiting the number of applicants 
        for a grant under this subsection.
          (5) Accountability measures.--The Secretary shall 
        develop accountability measures to ensure that the 
        activities conducted using funds made available under 
        this subsection help improve patient safety and reduce 
        adverse events and health care complications resulting 
        from medication errors.
  (c) Inclusion of Adjudicated Crimes on Nursing Home Compare 
Website.--Not later than 1 year after the date of enactment of 
the Elder Justice Act, the Secretary shall ensure that the 
Department of Health and Human Services includes, as part of 
the information provided for comparison of nursing facilities 
on the official Internet website of the Federal Government for 
Medicare beneficiaries (commonly referred to as the ``Nursing 
Home Compare'' Medicare website), the number of adjudicated 
instances of criminal violations by a nursing facility or 
crimes committed by an employee of a nursing facility--
          (1) that were committed inside of the facility; and
          (2) with respect to such instances of violations or 
        crimes committed outside of the facility, that were the 
        violations or crimes of elder abuse, neglect, and 
        exploitation, criminal sexual abuse of an elder, or 
        other violations or crimes that resulted in the serious 
        bodily injury of an elder.
  (d) Development of Consumer Rights Information Page on 
Nursing Home Compare Website.--Not later than 1 year after the 
date of enactment of the Elder Justice Act, the Secretary shall 
ensure that the Department of Health and Human Services, as 
part of the information provided for comparison of nursing 
facilities on the Nursing Home Compare Medicare website 
develops and includes a consumer rights information page that 
contains links to descriptions of, and information with respect 
to, the following:
          (1) The documentation on nursing facilities that is 
        available to the public.
          (2) General information and tips on choosing a 
        nursing facility that meets the needs of the 
        individual.
          (3) General information on consumer rights with 
        respect to nursing facilities.
          (4) The nursing facility survey process (on a 
        national and State-specific basis).
          (5) On a State-specific basis, the services available 
        through the State long-term care ombudsman for such 
        State.
  (e) Development and Adoption of Standards for Transactions 
Involving Clinical Data by Long-Term Care Facilities.--
          (1) Standards.--The Secretary shall develop and adopt 
        uniform open electronic standards for transactions 
        involving clinical data by long-term care facilities. 
        Such standards shall include messaging and nomenclature 
        standards.
          (2) Compatibility with other standards.--The 
        standards developed and adopted under paragraph (1) 
        shall be compatible with standards established under 
        part C of title XI, standards established under 
        subsections (b)(2)(B)(i) and (e)(4) of section 1860D-4, 
        and with general health information technology 
        standards.
          (3) Electronic submission of data to the secretary.--
                  (A) In general.--Not later than 10 years 
                after the date of enactment of the Elder 
                Justice Act, the Secretary shall have 
                procedures in place to accept the optional 
                electronic submission of clinical data by long-
                term care facilities pursuant to the standards 
                developed and adopted under paragraph (1).
                  (B) Rule of construction.--Nothing in this 
                subsection shall be construed to require a 
                long-term care facility to submit clinical data 
                electronically to the Secretary.
  (f) Regulations.--The Secretary shall promulgate regulations 
to carry out subsections (c), (d), and (e) of this section. 
Such regulations shall require a State, as a condition of the 
receipt of funds under this part, to conduct such data 
collection and reporting as the Secretary determines are 
necessary to satisfy the requirements of such subsections.
  (g) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for fiscal year 2007, $20,000,000;
          (2) for fiscal year 2008, $17,500,000; and
          (3) for each of fiscal years 2009 and 2010, 
        $15,000,000.

SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND GRANT PROGRAMS.

  (a) Secretarial Responsibilities.--
          (1) In general.--The Secretary shall ensure that the 
        Department of Health and Human Services--
                  (A) provides funding authorized by this part 
                to State and local adult protective services 
                offices that investigate reports of the abuse, 
                neglect, and exploitation of elders;
                  (B) collects and disseminates data annually 
                relating to the abuse, exploitation, and 
                neglect of elders in coordination with the 
                Department of Justice;
                  (C) develops and disseminates information on 
                best practices regarding, and provides training 
                on, carrying out adult protective services;
                  (D) conducts research related to the 
                provision of adult protective services; and
                  (E) provides technical assistance to States 
                and other entities that provide or fund the 
                provision of adult protective services, 
                including through grants made under subsections 
                (b) and (c).
          (2) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, $3,000,000 for fiscal year 2007 and 
        $4,000,000 for each of fiscal years 2008 through 2010.
  (b) Grants to Enhance the Provision of Adult Protective 
Services.--
          (1) Establishment.--There is established an adult 
        protective services grant program under which the 
        Secretary shall annually award grants to States in the 
        amounts calculated under paragraph (2) for the purposes 
        of enhancing adult protective services provided by 
        States and local units of government.
          (2) Amount of payment.--
                  (A) In general.--Subject to the availability 
                of appropriations and subparagraphs (B) and 
                (C), the amount paid to a State for a fiscal 
                year under the program under this subsection 
                shall equal the amount appropriated for that 
                year to carry out this subsection multiplied by 
                the percentage of the total number of elders 
                who reside in the United States who reside in 
                that State.
                  (B) Guaranteed minimum payment amount.--
                          (i) 50 states.--Subject to clause 
                        (ii), if the amount determined under 
                        subparagraph (A) for a State for a 
                        fiscal year is less than 0.75 percent 
                        of the amount appropriated for such 
                        year, the Secretary shall increase such 
                        determined amount so that the total 
                        amount paid under this subsection to 
                        the State for the year is equal to 0.75 
                        percent of the amount so appropriated.
                          (ii) Territories.--In the case of a 
                        State other than 1 of the 50 States, 
                        clause (i) shall be applied as if each 
                        reference to ``0.75'' were a reference 
                        to ``0.1''.
                  (C) Pro rata reductions.--The Secretary shall 
                make such pro rata reductions to the amounts 
                described in subparagraph (A) as are necessary 
                to comply with the requirements of subparagraph 
                (B).
          (3) Authorized activities.--
                  (A) Adult protective services.--Funds made 
                available pursuant to this subsection may only 
                be used by States and local units of government 
                to provide adult protective services and may 
                not be used for any other purpose.
                  (B) Use by agency.--Each State receiving 
                funds pursuant to this subsection shall provide 
                such funds to the agency or unit of State 
                government having legal responsibility for 
                providing adult protective services within the 
                State.
                  (C) Supplement not supplant.--Each State or 
                local unit of government shall use funds made 
                available pursuant to this subsection to 
                supplement and not supplant other Federal, 
                State, and local public funds expended to 
                provide adult protective services in the State.
          (4) State reports.--Each State receiving funds under 
        this subsection shall submit to the Secretary, at such 
        time and in such manner as the Secretary may require, a 
        report on the number of elders served by the grants 
        awarded under this subsection.
          (5) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, $100,000,000 for each of fiscal years 2007 
        through 2010.
  (c) State Demonstration Programs.--
          (1) Establishment.--The Secretary shall award grants 
        to States for the purposes of conducting demonstration 
        programs in accordance with paragraph (2).
          (2) Demonstration programs.--Funds made available 
        pursuant to this subsection may be used by States and 
        local units of government to conduct demonstration 
        programs that test--
                  (A) training modules developed for the 
                purpose of detecting or preventing elder abuse;
                  (B) methods to detect or prevent financial 
                exploitation of elders;
                  (C) methods to detect elder abuse;
                  (D) whether training on elder abuse forensics 
                enhances the detection of elder abuse by 
                employees of the State or local unit of 
                government; or
                  (E) other matters relating to the detection 
                or prevention of elder abuse.
          (3) Application.--To be eligible to receive a grant 
        under this subsection, a State shall submit an 
        application to the Secretary at such time, in such 
        manner, and containing such information as the 
        Secretary may require.
          (4) State reports.--Each State that receives funds 
        under this subsection shall submit a report to the 
        Secretary at such time, in such manner, and containing 
        such information as the Secretary may require on the 
        results of the demonstration program conducted by the 
        State using funds made available under this subsection.
          (5) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, $25,000,000 for each of fiscal years 2007 
        through 2010.

SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM GRANTS AND TRAINING.

  (a) Grants to Support the Long-Term Care Ombudsman Program.--
          (1) In general.--The Secretary shall make grants to 
        eligible entities with relevant expertise and 
        experience in abuse and neglect in long-term care 
        facilities or long-term care ombudsman programs and 
        responsibilities, for the purpose of--
                  (A) improving the capacity of State long-term 
                care ombudsman programs to respond to and 
                resolve complaints about abuse and neglect;
                  (B) conducting pilot programs with State 
                long-term care ombudsman offices or local 
                ombudsman entities; and
                  (C) providing support for such State long-
                term care ombudsman programs and such pilot 
                programs (such as through the establishment of 
                a national long-term care ombudsman resource 
                center).
          (2) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection--
                  (A) for fiscal year 2007, $5,000,000;
                  (B) for fiscal year 2008, $7,500,000; and
                  (C) for each of fiscal years 2009 and 2010, 
                $10,000,000.
  (b) Ombudsman Training Programs.--
          (1) In general.--The Secretary shall establish 
        programs to provide and improve ombudsman training with 
        respect to elder abuse, neglect, and exploitation for 
        national organizations and State long-term care 
        ombudsman programs.
          (2) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, for each of fiscal years 2007 through 2010, 
        $10,000,000.

 PART C--COLLECTION OF DATA, DISSEMINATION OF INFORMATION, AND STUDIES

SEC. 2051. COLLECTION OF UNIFORM NATIONAL DATA ON ELDER ABUSE, NEGLECT, 
                    AND EXPLOITATION.

  (a) Purpose.--The purpose of this section is to improve, 
streamline, and promote uniform collection, maintenance, and 
dissemination of national data relating to the various types of 
elder abuse, neglect, and exploitation.
  (b) Phase I--Development.--
          (1) In general.--Not later than the date that is 1 
        year after the date of enactment of the Elder Justice 
        Act, the Secretary, after consultation with the 
        Attorney General, shall develop--
                  (A) a method for collecting national data 
                regarding elder abuse, neglect, and 
                exploitation; and
                  (B) uniform national data reporting forms 
                adapted to each relevant entity or discipline 
                (such as health, public safety, social and 
                protective services, and law enforcement) 
                reflecting--
                          (i) the distinct manner in which each 
                        entity or discipline receives and 
                        maintains information; and
                          (ii) the sequence and history of 
                        reports to, or involvement of, 
                        different entities or disciplines, 
                        independently, or the sequence and 
                        history of reports from 1 entity or 
                        discipline to another over time.
          (2) Forms.--Subject to the requirements of section 
        2012(a), the national data reporting forms described in 
        paragraph (1)(B) shall incorporate the definitions of 
        this subtitle for use in determining whether an event 
        is reportable.
  (c) Phase II--Pilot Tests.--
          (1) In general.--Not later than the date that is 1 
        year after the date on which the activities described 
        in subsection (b)(1) are completed, the Secretary shall 
        ensure that the national data reporting forms and data 
        collection methods developed in accordance with such 
        subsection are pilot tested in 6 States selected by the 
        Secretary.
          (2) Adjustments to the form and methods.--The 
        Secretary, after considering the results of the pilot 
        testing described in paragraph (1) and consultation 
        with the Attorney General, shall adjust the national 
        data reporting forms and data collection methods as 
        necessary.
  (d) Phase III--National Distribution.--
          (1) Distribution of national data reporting forms.--
        After completion of the adjustment to the national data 
        reporting forms under subsection (c)(2), the Secretary 
        shall submit the national data reporting forms along 
        with instructions to--
                  (A) the heads of the relevant Federal 
                entities as may be appropriate; and
                  (B) the appropriate office of each State for 
                collection from all relevant State entities of 
                data, including health care, social services, 
                and law enforcement data.
          (2) Data collection grants.--
                  (A) Authorization.--The Secretary is 
                authorized to award grants to States to improve 
                data collection activities relating to elder 
                abuse, neglect, and exploitation.
                  (B) Application.--To be eligible to receive a 
                grant under this paragraph, a State shall 
                submit an application to the Secretary at such 
                time, in such manner, and containing such 
                information as the Secretary may require.
                  (C) Requirements.--Each State receiving a 
                grant under this paragraph for a fiscal year 
                shall report data for the calendar year that 
                begins during that fiscal year, using the 
                national data reporting forms described in 
                paragraph (1).
                  (D) Funding.--
                          (i) First year.--For the first fiscal 
                        year for which a State receives grant 
                        funds under this paragraph, the 
                        Secretary shall initially distribute 50 
                        percent of such funds to the State. The 
                        Secretary shall distribute the 
                        remaining funds to the State at the end 
                        of the calendar year that begins during 
                        that fiscal year, if the Secretary 
                        determines that the State has properly 
                        reported data required under this 
                        paragraph for the calendar year.
                          (ii) Subsequent years.--Except as 
                        provided in clause (i), the Secretary 
                        shall distribute grant funds to a State 
                        under this paragraph for a fiscal year 
                        if the Secretary determines that the 
                        State properly reported data required 
                        under this paragraph for the calendar 
                        year that ends during that fiscal year.
                  (E) Required information.--Each report 
                submitted under this paragraph shall--
                          (i) indicate the State and year in 
                        which each event occurred; and
                          (ii) identify the total number of 
                        events that occurred in each State 
                        during the year and the type of each 
                        event.
  (e) Report.--Not later than 1 year after the date of 
enactment of the Elder Justice Act and annually thereafter, the 
Secretary shall prepare and submit to the Committee on Finance 
of the Senate and the Committee on Ways and Means and the 
Committee on Energy and Commerce of the House of 
Representatives a report regarding activities conducted under 
this section.
  (f) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for fiscal year 2007, $10,000,000;
          (2) for fiscal year 2008, $30,000,000; and
          (3) for each of fiscal years 2009 and 2010, 
        $100,000,000.

SEC. 2052. LONG-TERM CARE CONSUMER CLEARINGHOUSE.

  (a) Establishment.--The Secretary shall establish a long-term 
care consumer clearinghouse.
  (b) Information.--The clearinghouse shall provide 
comprehensive detailed information, in a consumer-friendly 
form, to consumers about choices relating to long-term care 
providers, such as information about--
          (1) obtaining the services of, and employing, 
        caregivers who provide long-term care at an 
        individual's home; and
          (2) options for residential long-term care, such as--
                  (A)(i) the type of care provided by nursing 
                facilities; and
                  (ii) the type of care provided by group homes 
                and other residential long-term care facilities 
                that are not nursing facilities;
                  (B) the benefits related to long-term care 
                that are available through the programs carried 
                out under titles XVIII and XIX; and
                  (C) links to Federal and State Internet 
                websites that describe the care available 
                through specific long-term care facilities, 
                including data on the satisfaction level of 
                residents of, and families of residents of, the 
                facilities.
  (c) Providers.--In providing information on long-term care 
providers under this section, the clearinghouse shall provide 
information (from States and other sources) on assisted living 
facilities, board and care facilities, congregate care 
facilities, home health care providers, and other long-term 
care providers.
  (d) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for fiscal year 2007, $2,000,000;
          (2) for fiscal year 2008, $3,000,000; and
          (3) for each of fiscal years 2009 and 2010, 
        $4,000,000.

SEC. 2053. CONSUMER INFORMATION ABOUT THE CONTINUUM OF RESIDENTIAL 
                    LONG-TERM CARE FACILITIES.

  (a) Study.--
          (1) In general.--The Secretary, after consultation 
        with the Attorney General, shall, directly or through a 
        grant, conduct a study on consumer concerns relating to 
        residential long-term care facilities, other than 
        nursing facilities.
          (2) Specific topics.--The entity conducting the study 
        shall--
                  (A) develop definitions for classes of the 
                residential long-term care facilities described 
                in paragraph (1); and
                  (B) collect information on the prices of, 
                level of services provided by, oversight and 
                enforcement provisions of, and admission and 
                discharge criteria of, the facilities.
  (b) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, for each of fiscal 
years 2007 through 2010, $3,000,000.

SEC. 2054. PROVISION OF INFORMATION REGARDING, AND EVALUATIONS OF, 
                    ELDER JUSTICE PROGRAMS.

  (a) Provision of Information.--To be eligible to receive a 
grant under this part, an applicant shall agree--
          (1) except as provided in paragraph (2), to provide 
        the eligible entity conducting an evaluation under 
        subsection (b) of the activities funded through the 
        grant with such information as the eligible entity may 
        require in order to conduct such evaluation; or
          (2) in the case of an applicant for a grant under 
        section 2041(b), to provide the Secretary with such 
        information as the Secretary may require to conduct an 
        evaluation or audit under subsection (c).
  (b) Use of Eligible Entities To Conduct Evaluations.--
          (1) Evaluations required.--Except as provided in 
        paragraph (2), the Secretary shall--
                  (A) reserve a portion (not less than 2 
                percent) of the funds appropriated with respect 
                to each program carried out under this part; 
                and
                  (B) use the funds reserved under subparagraph 
                (A) to provide assistance to eligible entities 
                to conduct evaluations of the activities funded 
                under each program carried out under this part.
          (2) Informatics systems grant program not included.--
        The provisions of this subsection shall not apply to 
        the informatics systems grant program under section 
        2041(b).
          (3) Authorized activities.--A recipient of assistance 
        described in paragraph (1)(B) shall use the funds made 
        available through the assistance to conduct a validated 
        evaluation of the effectiveness of the activities 
        funded under a program carried out under this part.
          (4) Applications.--To be eligible to receive 
        assistance under paragraph (1)(B), an entity shall 
        submit an application to the Secretary at such time, in 
        such manner, and containing such information as the 
        Secretary may require, including a proposal for the 
        evaluation.
          (5) Reports.--Not later than a date specified by the 
        Secretary, an eligible entity receiving assistance 
        under paragraph (1)(B) shall submit to the Secretary, 
        the Committee on Ways and Means and the Committee on 
        Energy and Commerce of the House of Representatives, 
        and the Committee on Finance of the Senate a report 
        containing the results of the evaluation conducted 
        using such assistance together with such 
        recommendations as the entity determines to be 
        appropriate.
  (c) Evaluations and Audits of Informatics Systems Grant 
Program by the Secretary.--
          (1) Evaluations.--The Secretary shall conduct an 
        evaluation of the activities funded under the 
        informatics systems grant program under section 
        2041(b). Such evaluation shall include an evaluation of 
        whether the funding provided under the grant is 
        expended only for the purposes for which it is made.
          (2) Audits.--The Secretary shall conduct appropriate 
        audits of grants made under section 2041(b).

SEC. 2055. REPORT.

  Not later than October 1, 2011, the Secretary shall submit to 
the Elder Justice Coordinating Council, the Committee on 
Finance of the Senate, and the Committee on Ways and Means and 
the Committee on Energy and Commerce of the House of 
Representatives a report--
          (1) compiling, summarizing, and analyzing the 
        information contained in the State reports submitted 
        under subsections (b)(4) and (c)(4) of section 2042; 
        and
          (2) containing--
                  (A) the results of the study conducted under 
                section 2053; and
                  (B) such recommendations for legislative or 
                administrative action as the Secretary 
                determines to be appropriate.''

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