**Selected provisions of H.R. 5293 related to**

**Choices for Independence**

June 20, 2006 (2:57 PM) Version Passed by the House

**[Changes to Title I]{.underline}**

DEFINITIONS

''(4) The term **'Aging and Disability Resource Center'** means a
program established by a State as part of the State's system of
long-term care, to provide a coordinated system for providing---

''(A) comprehensive information on available public and private
long-term care programs, options, and resources;

''(B) personal counseling to assist individuals in assessing their
existing or anticipated long-term care needs, and developing and
implementing a plan for long-term care designed to meet their specific
needs and circumstances; and

''(C) consumer access to the range of publicly-supported long-term care
programs for which they may be eligible, by serving as a convenient
point of entry for such programs.'',

''(9) The term '**at risk for institutional placement'** means, with
respect to an older individual, that such individual is unable to
perform at least two activities of daily living without substantial
human assistance (including verbal reminding, physical cuing, or
supervision) and is determined by the State to be

in need of placement in a long-term care facility.'',

''(31) The term **'long-term care'** means any services, care, or items
(including assistive devices), including disease prevention and health
promotion services, in-home services, and case management service---

''(A) intended to assist individuals in coping with, and to the extent
practicable compensate for, functional impairments in carrying out
activities of daily living;

''(B) furnished at home, in a community care setting (including a small
community care setting as defined in subsection (g)(1), and a large
community care setting as defined in subsection (h)(1), of section 1929
of the Social Security Act (42 U.S.C. 1396t)), or in a long-term care
facility; and

''(C) not furnished to prevent, diagnose, treat, or cure a medical
disease or condition.'',

''(44) The term '**self-directed care'** means an approach to providing
services (including programs, benefits, supports, and technology) under
this Act intended to an older individual to assist such individual with
activities of daily living, in which

''(A) such services (including the amount, duration, scope, provider,
and location of such services) are planned, budgeted, and purchased
under the direction and control of such individual;

''(B) such individual is provided with such information and assistance
as necessary and appropriate to enable such individual to make informed
decisions about his or her care options;

''(C) the needs, capabilities, and preferences of such individual with
respect to such services, and such individual's ability to direct and
control his or her receipt of such services, are assessed by the area
agency on aging (or other agency designated by the area agency on
aging);

''(D) based on the assessment made under subparagraph (C), the area
agency on aging (or other agency designated by the area agency on aging)
develops together with such individual and his or her family, caregiver,
or legal

representative---

''(i) a plan of services for such individual that specifies which
services such individual will be responsible for directing;

''(ii) a determination of the role of family members (and others whose
participation is sought by such individual) in providing services under
such plan; and

''(iii) a budget for such services; and

''(E) the area agency on aging or State agency provides for oversight of
such individual's self-directed receipt of services, including steps to
ensure the quality of services provided and the appropriate use of funds
under this Act.

''(50) The term **'State system of long-term care'** means the Federal,
State, and local programs and activities administered by a State that
provide, support, or facilitate access to long-term care to individuals
in

such State.''.

**[Changes to Title III]{.underline}**

FUNCTIONS OF THE ASSISTANT SECRETARY

''(b) To promote the development and implementation of comprehensive,
coordinated systems at Federal, State, and local levels for providing
long-term care in home and community-based settings, in a manner
responsive to the needs and preferences of older individuals and their
family caregivers, the Assistant Secretary shall, consistent with the
applicable provisions of this title---

''(1) collaborate, coordinate, and consult with other Federal agencies
and departments responsible for formulating and implementing programs,
benefits, and services related to providing long-term care, and may make
grants, contracts, and cooperative agreements with funds received from
other Federal entities;

''(2) conduct research and demonstration projects to identify
innovative, cost-effective strategies for modifying State systems of
long-term care to---

''(A) respond to the needs and preferences of older individuals and
family caregivers; and

''(B) target services to individuals at risk for institutional
placement, to permit such individuals to remain in home and
community-based care settings;

''(3) establish criteria and promote the implementation (through area
agencies on aging, service providers, and such other entities as the
Assistant Secretary determines to be appropriate) of evidence-based
programs to assist older individuals and their family caregivers in
learning about and making behavioral changes intended to reduce the risk
of injury, disease, and disability among older individuals;

''(4) facilitate, in coordination with the Centers

for Medicare & Medicaid Services, the Cash and

Counseling National Program Office, and other Federal entities as
appropriate, the provision of long-

term care in home and community-based settings, including the provision
of self-directed care models that---

''(A) provide for the assessment of the needs and preferences of an
individual at risk for institutional placement to help such individual
avoid unnecessary nursing home placement and depletion of income and
assets to qualify for Medicaid eligibility;

''(B) respond to the needs and preferences of such individual and
provide the option for the individual (or representative, as
appropriate) to direct and control the receipt of support services
provided;

''(C) assist an older individual (or a representative, as appropriate)
develop a plan for long-term support, including the selecting,
budgeting, and purchasing of home and community-based long-term care and
supportive services; (for purposes of this paragraph, the term
'representative' means a person appointed by the eligible individual, or
legally acting on the individual's behalf, to represent or advise the
individual in financial or service coordination matters);

''(5) provide for the Administration to play a lead role with respect to
issues concerning home and community-based long-term care, including---

''(A) directing (as the Secretary or the President determines to be
appropriate) or otherwise participating in departmental and
interdepartmental activities concerning long-term care;

''(B) reviewing and commenting on departmental rules, regulations, and
policies related to providing long-term care; and

''(C) making recommendations to the Secretary with respect to home and
community-based long-term care, including recommendations based on
findings made through projects conducted under paragraph (2);

''(6) promote, in coordination with other appropriate Federal agencies,
enhanced awareness by the public of the importance of planning in
advance for long-term care and the availability of information and
resources to assist in such planning;

''(7) implement in all States Aging and Disability Resource Centers---

''(A) to serve as visible and trusted sources of information on the full
range of long-term care options that are available in the community,
including both institutional and home and community-based care;

''(B) to provide personalized and consumer friendly assistance to
empower people to make informed decisions about their care options;

''(C) to provide coordinated and streamlined access to all publicly
supported long-term care options so that consumers can obtain the care
they need though a single intake, assessment and eligibility
determination process;

''(D) to help people to plan ahead for their future long-term care
needs; and

''(E) to assist, in coordination with the State Health Insurance
Assistance Program, Medicare beneficiaries in understanding and
accessing the Prescription Drug Coverage and preventative health
benefits available under the Medicare Modernization Act;

''(8) establish, either directly or through grants or contracts,
national technical assistance programs to assist State agencies, area
agencies on aging, and community-based service providers funded under
this

Act in implementing---

''(A) such home and community-based long-term care systems, including
evidence-based programs; and

''(B) such evidence-based health promotion and disease prevention
programs;

''(9) develop, in collaboration with the Administrator of the Centers
for Medicare & Medicaid Services, performance standards and measures for
use by States to determine the extent to which their systems of
long-term care fulfill the objectives described in this subsection; and

''(10) conduct such other activities as the Assistant Secretary
determines to be appropriate.

**[Changes to Title III]{.underline}**

ORGANIZATION.

''(3) the State agency shall, consistent with this section, promote the
development and implementation of a comprehensive, coordinated system in
such State for providing long-term care in home and community-based
settings, in a manner responsive to the needs and preferences of older
individuals and their family caregivers, by---

''(A) collaborating, coordinating, and consulting with other agencies in
such State responsible for formulating, implementing, and administering
programs, benefits, and services related to providing long-term care;

''(B) participating in any State government activities concerning
long-term care, including reviewing and commenting on any State rules,
regulations, and policies related thereto;

''(C) conducting analyses and making recommendations, and implementing
programs and strategies to modify the

State's system of long-term care to better---

''(i) respond to the needs and preferences of older individuals and
family caregivers;

''(ii) facilitate the provision of long-term care in home and
community-based settings through service providers; and

''(iii) target services to individuals at risk for institutional
placement, to permit such individuals to remain in home and
community-based care settings;

''(D) implement (through area agencies on aging, service providers, and
such other entities as the State determines to be appropriate)
evidence-based programs to assist older individuals and their family
caregivers in learning about and making behavioral changes intended to
reduce the risk of injury, disease, and disability among older
individuals; and

''(E) providing for the availability and distribution (through public
education campaigns, aging and disability resource centers, area
agencies on aging, and other appropriate means) of information relating
to---

''(i) the need to plan in advance for long-term care; and

''(ii) the range of available public and private long-term care
programs, options, and resources.''

AREA PLANS

''(7) provide that the area agency on aging shall, consistent with this
section, facilitate the area-wide development and implementation of a
comprehensive, coordinated system for providing long-term care in home
and community-based settings, in a manner responsive to the needs and
preferences of older individuals and their family caregivers, by---

''(A) collaborating, coordinating, and consulting with other local
public and private agencies and organizations responsible for
administering programs, benefits, and services related to providing
long-term care;

''(B) conducting analyses, making recommendations, and implementing
programs with respect to strategies for modifying the local system of
long-term care to better---

''(i) respond to the needs and preferences of older individuals and
family caregivers;

''(ii) facilitate the provision, through service providers, of long-term
care in home and community-based settings; and

''(iii) target services to older individuals at risk for institutional
placement, to permit such individuals to remain in home and
community-based care settings;

''(C) implement, through the agency or service providers, evidence-based
programs to assist older individuals and their family caregivers in
learning about and making behavioral changes intended to reduce the risk
of injury, disease, and disability among older individuals; and

''(D) provide for the availability and distribution (through public
education campaigns, aging and disability resource centers, and other
appropriate means) of information relating to---

''(i) the need to plan in advance for long-term care; and

''(ii) the range of available public and private long-term care
programs, options, and resources;'',