Family Caregiver Support Act of 1993

Summary: Family Caregiver Support Act of 1993 - Amends the Social Security Act (SSA) to establish a program to enable States to furnish services to support informal caregivers of eligible individuals with functional disabilities. 
Outlines State plan requirements for such caregiver support services, including requirements that:  (1) States support 50 percent of program administration costs; (2) program services may not supplant services otherwise available to eligible recipients under Medicare or Medicaid (SSA titles XVIII and XIX) or any other public or private health insurance plan; and (3) persons with incomes exceeding 200 percent of the Federal poverty level must make co-payments on a sliding scale basis established by the State. 
Caps total annual Federal expenditures per eligible recipient. 
Authorizes appropriations.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Family Caregiver Support Act of 
1993''.

SEC. 2. FAMILY CAREGIVER SUPPORT PROGRAM ESTABLISHED.

    (a) In General.--The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end thereof the following new title:

  ``TITLE XXI--GRANTS TO STATES FOR FAMILY CAREGIVER SUPPORT PROGRAMS

          ``purpose of title; authorization of appropriations

    ``Sec. 2101. For the purpose of enabling each State to furnish 
services to support informal caregivers of individuals with functional 
limitations by providing services designed to facilitate and strengthen 
informal support systems to help maintain individuals with functional 
limitations within the community, there are authorized to be 
appropriated for each fiscal year such sums as may be necessary to 
carry out the purposes of this title. The sums made available under 
this section shall be used for making payments to States which have 
submitted, and had approved by the Secretary, State plans for family 
caregiver support services.

          ``state plans for family caregiver support services

    ``Sec. 2102. A State plan for family caregiver support services 
must--
            ``(1) provide that it shall be in effect in all political 
        subdivisions of the State, and if administered by them, be 
        mandatory upon them;
            ``(2) provide for financial participation by the State 
        equal to not less than 50 percent of the administrative costs 
        of operating the program in the State;
            ``(3) provide either for the establishment or designation 
        of a single State agency or agencies (such agency may be the 
        same agency established or designated under section 1902 of 
        this Act) to administer or supervise the administration of the 
        plan in coordination with home and community-based services 
        provided under title XIX of this Act;
            ``(4) describe the steps that will be taken to ensure that 
        all State government agencies responsible for the provision of 
        family caregiver support services funded under this title with 
        other Federal or State agencies or both on behalf of 
        individuals with functional limitations and their caregivers 
        shall be included in the development of the State plan so that 
        all such services are coordinated with all other types of 
        services and benefits such individuals and their caregivers may 
        be receiving (or are eligible to receive);
            ``(5) describe the steps to be taken to ensure equitable 
        access to family caregiver support services funded under this 
        title for individuals of all ages with functional limitations 
        and their caregivers, including individuals who have cognitive, 
        mental, developmental, physical, sensory, or other impairments 
        that meet the criteria of section 2104(b)(1);
            ``(6) describe the manner in which family caregiver support 
        services funded under this title will be organized, delivered, 
        and coordinated, statewide and within the various localities of 
        the State, in order to achieve the objectives specified in 
        subparagraphs (4) and (5) of this subsection;
            ``(7) specify the procedures used in notifying and 
        obtaining input on the contents of the State plan from non-
        governmental organizations and individuals with an interest in 
        the welfare of individuals with functional limitations;
            ``(8) provide that the State agency or agencies--
                    ``(A) make a determination of the need for family 
                caregiver support services for the individual with 
                functional limitations;
                    ``(B) establish quality assurance for the delivery 
                of family caregiver support services, including 
                evaluation of individual and family satisfaction with 
                the services provided;
                    ``(C) establish a family caregiver support plan for 
                each individual with functional limitations for 
                services under this title, and provide for periodic 
                review and revision as necessary; and
                    ``(D) establish reimbursement levels for family 
                caregiver support services;
            ``(9) provide that family caregiver support services funded 
        under this title to an individual with functional limitations 
        shall not supplant services otherwise provided to such 
        individual for which such individual is eligible under titles 
        XVIII or XIX of this Act or under any other public or private 
        program;
            ``(10) provide--
                    ``(A) that no copayment shall be required for 
                individuals with functional limitations with incomes 
                below 200 percent of the income official poverty line 
                (as determined by the Office of Management and Budget 
                and revised annually in accordance with section 673(2) 
                of the Omnibus Budget Reconciliation Act of 1981); and
                    ``(B) that a copayment shall be required on a 
                sliding scale basis (as determined by the State) for 
                individuals with functional limitations with incomes in 
                excess of 200 percent of such income line; and
            ``(11) provide for making family caregiver support services 
        available, including at least the care and services described 
        in paragraphs (1) through (4) of section 2104(a) to all 
        individuals with functional limitations.

                          ``payment to states

    ``Sec. 2103. (a)(1) The Secretary (except as otherwise provided in 
this section) shall pay to each State which has a plan approved under 
this title, for each quarter, beginning with the quarter commencing 
January 1, 1994--
            ``(A) an amount equal to 100 percent of the total amount 
        expended during such quarter as family caregiver support 
        services under the State plan subject to the applicable Federal 
        payment limitation described in paragraph (2); and
            ``(B) an amount equal to 50 percent of so much of the sums 
        expended during such quarter as found necessary by the 
        Secretary for the proper and efficient administration of the 
        State plan (including costs of needs determination and care 
        planning).
    ``(2)(A) The applicable Federal payment limitation described in 
this paragraph is $2,400 per calendar year per individual with 
functional limitations, reduced by the offset, if any, described in 
subparagraph (B).
    ``(B) The total Federal payment to any State for each individual 
with functional limitations for a calendar year shall be reduced by the 
amount of any copayment paid by such an individual for family caregiver 
support services funded under this title in accordance with paragraph 
(10) of section 2102.
    ``(b) No payment shall be made under this title with respect to any 
amount expended for family caregiver support services in a calendar 
quarter for any individual with functional limitations with an income 
in excess of $75,000 per year.

                             ``definitions

    ``Sec. 2104. (a) For purposes of this title, the term `family 
caregiver support services' means care and services in the home, or in 
the community, provided on a temporary, short term, intermittent, or 
emergency basis to support a caregiver in caring for an individual with 
functional limitations, including--
            ``(1) companion services;
            ``(2) homemaker services;
            ``(3) personal assistance;
            ``(4) day services in the community;
            ``(5) temporary care in accredited or licensed facilities 
        (admission to a hospital or nursing home for out-of-home care 
        for a brief stay); and
            ``(6) such other services, as specified in State plan.
    ``(b)(1) For purposes of this title, an `individual with functional 
limitations'--
            ``(A) is an individual 18 years of age or over who--
                    ``(i) cannot perform (without substantial human 
                assistance, including supervision) at least 3 of the 
                activities of daily living described in subparagraphs 
                (A) through (E) of paragraph (2); or
                    ``(ii) needs substantial human assistance or 
                supervision because of cognitive or other mental 
                impairment that--
                            ``(I) impedes ability to function; or
                            ``(II) causes behavior that poses a serious 
                        health or safety hazard to such individual or 
                        others; or
            ``(B) is a child who is receiving disability payments, or 
        would be eligible for such payments, but for the income or 
        resource limitations considered for determining eligibility 
        under title XVI of this Act.
    ``(2) The activities of daily living described in this paragraph 
are--
                    ``(A) toileting;
                    ``(B) eating;
                    ``(C) transferring;
                    ``(D) dressing; and
                    ``(E) bathing.
    ``(c) For purposes of this title, the term `caregiver' means a 
spouse, parent, child, relative or other person who--
            ``(A) has primary responsibility (as defined by the 
        Secretary) of providing care for one individual with functional 
        limitations;
            ``(B) does not receive financial remuneration for providing 
        such care for such individual; and
            ``(C) who has provided such care to such individual for a 
        period of not less than 3 months.
    ``(d) For purposes of this title, the term `family caregiver 
support plan' means a written plan, developed in cooperation with the 
caregiver and the individual with functional limitations to reflect 
their choices and preferences for the type, frequency, and duration of 
family caregiver support services to be provided under the plan.

                        ``maintenance of effort

    ``Sec. 2105. States receiving payments under section 2103 must 
maintain current levels of funding for family caregiver support 
services to individuals with functional limitations and their 
caregivers in order to be eligible to continue to receive payments for 
such services under this title.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
become effective with respect to services furnished on or after January 
1, 1994.