II 

109TH CONGRESS 

2D SESSION S. 2620 

To amend the Older Americans Act of 1965 to authorize the Assistant 

Secretary for Aging to provide allotments to eligible States to provide 

older individuals with financial assistance to select a flexible range of 

home and community-based long-term care services or supplies, provided 

in a manner that respects the individuals’ choices and preferences. 

IN THE SENATE OF THE UNITED STATES 

APRIL 7, 2006 

Mrs. CLINTON introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Older Americans Act of 1965 to authorize 

the Assistant Secretary for Aging to provide allotments 

to eligible States to provide older individuals with financial assistance to select a flexible range of home and 

community-based long-term care services or supplies, 

provided in a manner that respects the individuals’ 

choices and preferences. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Community-Based 

5 Choices for Older Americans Act of 2006’’. 


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1 SEC. 2. PURPOSE. 

2 The purpose of this Act is to provide grants to States 

3 in order to achieve the following: 

4 (1) To enable eligible individuals to make in5 formed choices about the long-term care services and 

6 supplies that best meet their needs and preferences. 

7 (2) To provide financial assistance to older indi8 viduals to purchase a flexible range of long-term 

9 care services or supplies in a manner that respects 

10 the individuals’ cultural, ethnic, and lifestyle pref11 erences in the least restrictive settings possible. 

12 (3) To make the purchase of long-term care 

13 services and supplies delivered in a home or commu14 nity-based setting, such as a naturally occurring re15 tirement community, more affordable for individuals 

16 with financial need. 

17 (4) To help families continue to care for their 

18 older relatives with long-term care needs, including 

19 older individuals with physical and cognitive impair20 ments, and to help reduce the number of older indi21 viduals who are forced to impoverish themselves in 

22 order to pay for the long-term care services and sup23 plies they need. 

24 (5) To help relieve financial pressure on the 

25 medicaid program by delaying or preventing older 


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1 individuals from spending down their income and as2 sets to medicaid eligibility thresholds. 

3 (6) To concentrate the resources made available 

4 under this Act to those individuals with the greatest 

5 economic need for long-term care services and sup6 plies. 

7 SEC. 3. ESTABLISHMENT OF THE NATIONAL LONG-TERM 

8 CARE CHOICE PROGRAM. 

9 The Older Americans Act of 1965 (42 U.S.C. 3001 

10 et seq.) is amended by adding at the end the following: 

11 ‘‘TITLE VIII—NATIONAL LONG12 TERM CARE CHOICE PROGRAM 

13 ‘‘SEC. 801. DEFINITIONS. 

14 ‘‘In this title: 

15 ‘‘(1) CAREGIVER.—The term ‘caregiver’ means 

16 an adult family member, or another individual, who 

17 is a paid or unpaid provider of home or community18 based care to an eligible individual. 

19 ‘‘(2) CONSUMER CHOICE.—The term ‘consumer 

20 choice’ means the opportunity for an eligible indi21 vidual— 

22 ‘‘(A) to have greater control over the cov23 ered long-term care services and supplies the in24 dividual receives; and 

25 ‘‘(B) to elect— 


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1 ‘‘(i) to receive a payment under this 

2 title through a fiscal intermediary as de3 scribed in section 806(b)(2)(B) for the 

4 purpose of purchasing covered long-term 

5 care services or supplies; or 

6 ‘‘(ii) to receive such services or sup7 plies from a provider paid by the State in8 volved (or its designee) as described in sec9 tion 806(b)(2)(A). 

10 ‘‘(3) COVERED LONG-TERM CARE SERVICES OR

11 SUPPLIES.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), the term ‘covered long-term care 

14 services or supplies’ means any of the following 

15 services or supplies, but only if, with respect to 

16 an eligible individual, such services or supplies 

17 are not available or not eligible for payment by 

18 any entity carrying out a program described in 

19 section 804(b)(8) or a similar third party: 

20 ‘‘(i) Adult day services (including 

21 health and social day care services). 

22 ‘‘(ii) Bill paying. 

23 ‘‘(iii) Care-related supplies and equip24 ment. 

25 ‘‘(iv) Companion services. 


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1 ‘‘(v) Congregate meals. 

2 ‘‘(vi) Environmental modifications. 

3 ‘‘(vii) Fiscal intermediary services. 

4 ‘‘(viii) Home-delivered meals. 

5 ‘‘(ix) Home health services. 

6 ‘‘(x) Homemaker services (including 

7 chore services). 

8 ‘‘(xi) Mental and behavioral health 

9 services. 

10 ‘‘(xii) Nutritional counseling. 

11 ‘‘(xiii) Personal care services. 

12 ‘‘(xiv) Personal emergency response 

13 systems. 

14 ‘‘(xv) Respite care. 

15 ‘‘(xvi) Telemedicine devices. 

16 ‘‘(xvii) Transition services for individ17 uals who have a plan that meets such re18 quirements as a State shall establish, to 

19 relocate from a nursing home to a home or 

20 community-based setting within 60 days. 

21 ‘‘(xviii) Transportation. 

22 ‘‘(xix) Any service or supply that a 

23 State describes in its State plan and is ap24 proved by the Assistant Secretary. 


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1 ‘‘(xx) Any service or supply that is re2 quested by an eligible individual (in coordi3 nation with the individual’s service coordi4 nator) and that is approved by the State. 

5 ‘‘(B) EXCLUSIONS.— 

6 ‘‘(i) SERVICE COORDINATION.—Such 

7 term does not include a service directly 

8 provided by the service coordinator for an 

9 eligible individual as part of service coordi10 nation under this title. 

11 ‘‘(ii) SERVICES FOR NURSING HOME

12 RESIDENTS.—Such term does not include 

13 any service for a resident of a nursing 

14 home, except a service described in sub15 paragraph (A)(xvii). 

16 ‘‘(4) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

17 individual’ means an individual— 

18 ‘‘(A) who is age 60 or older; 

19 ‘‘(B) who is not eligible for medical assist20 ance under the medicaid program established 

21 under title XIX of the Social Security (42 

22 U.S.C. 1396 et seq.); 

23 ‘‘(C) who meets such income eligibility and 

24 total asset criteria as a State may establish; 

25 ‘‘(D) who— 


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1 ‘‘(i)(I) is unable to perform (without 

2 substantial assistance from another indi3 vidual) at least 2 activities of daily living 

4 (such as eating, toileting, transferring, 

5 bathing, dressing, and continence); or 

6 ‘‘(II) at the option of the State, is un7 able to perform at least 3 such activities 

8 without such assistance; 

9 ‘‘(ii) has a level of disability similar 

10 (as determined by the State) to the level of 

11 disability described in clause (i); or 

12 ‘‘(iii) requires substantial supervision 

13 due to cognitive or mental impairment; and 

14 ‘‘(E) who satisfies such other eligibility cri15 teria as the State may establish in accordance 

16 with such guidance as the Assistant Secretary 

17 may provide. 

18 ‘‘(5) ELIGIBLE STATE.—The term ‘eligible 

19 State’ means a State with an approved State plan 

20 under section 804. 

21 ‘‘(6) FISCAL INTERMEDIARY.—The term ‘fiscal 

22 intermediary’ means an entity that— 

23 ‘‘(A) assists individuals who choose to em24 ploy providers of covered long-term care serv25 ices or supplies directly, to— 


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1 ‘‘(i) carry out employer-related re2 sponsibilities, as designated by a State 

3 with the approval of the Assistant Sec4 retary; 

5 ‘‘(ii) assure compliance with Federal, 

6 State, and local law; and 

7 ‘‘(iii) assure compliance with other re8 quirements designated by the State; and 

9 ‘‘(B) receives and disburses, as described 

10 in section 806(b)(2)(B), payments described in 

11 section 806(b). 

12 ‘‘(7) FISCAL INTERMEDIARY SERVICE.—The 

13 term ‘fiscal intermediary service’ means a service to 

14 enable an eligible individual to carry out a responsi15 bility described in subparagraph (A)(i) or (B) of 

16 paragraph (6) or assure compliance with Federal, 

17 State, or local law, or another requirement des18 ignated by the State. 

19 ‘‘(8) LONG-TERM CARE.—The term ‘long-term 

20 care’ means a wide range of supportive social, 

21 health, and mental health services for individuals 

22 who do not have the capacity for self-care due to ill23 ness or frailty. 

24 ‘‘(9) NATURALLY OCCURRING RETIREMENT

25 COMMUNITY.—The term ‘naturally occurring retireVerDate Aug 31 2005 22:34 Apr 12, 2006 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2620.IS S2620

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1 ment community’ means a residential area (such as 

2 an apartment building, housing complex or develop3 ment, or neighborhood) not originally built for older 

4 individuals but in which a substantial number of in5 dividuals have aged in place and become older indi6 viduals. 

7 ‘‘(10) NURSING HOME.—The term ‘nursing 

8 home’ means— 

9 ‘‘(A) a nursing facility, as defined in sec10 tion 1919(a) of the Social Security Act (42 

11 U.S.C. 1396r(a)); 

12 ‘‘(B) a skilled nursing facility, as defined 

13 in section 1819(a) of such Act (42 U.S.C. 

14 1395i–3(a)); and 

15 ‘‘(C) a residential care facility that directly 

16 provides care or services described in paragraph 

17 (1) of section 1919(a) of the Social Security 

18 Act (42 U.S.C. 1396r(a)) but does not receive 

19 payment for such care or services under the 

20 medicare or medicaid programs established 

21 under titles XVIII and XIX, respectively, of the 

22 Social Security Act (42 U.S.C. 1395 et seq., 

23 1396 et seq.). 

24 ‘‘(11) QUALIFIED PROVIDER.—The term ‘quali25 fied provider’ means a provider of covered long-term 


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1 care services or supplies who meets such licensing, 

2 quality, and other standards as the State may estab3 lish. 

4 ‘‘(12) REPRESENTATIVE.—The term ‘represent5 ative’ means a person appointed by the eligible indi6 vidual, or legally acting on the individual’s behalf, to 

7 represent or advise the individual in financial or 

8 service coordination matters. 

9 ‘‘(13) SERVICE COORDINATION.—The term 

10 ‘service coordination’ means a service that— 

11 ‘‘(A) is provided to an eligible individual, 

12 at the direction of the eligible individual or a 

13 representative of the eligible individual (as ap14 propriate); and 

15 ‘‘(B) consists of facilitating consumer 

16 choice or carrying out— 

17 ‘‘(i) a function described in section 

18 805; or 

19 ‘‘(ii) a function described in section 

20 804(9), as determined appropriate by the 

21 State involved. 

22 ‘‘(14) SERVICE COORDINATOR.—The term 

23 ‘service coordinator’ means an individual who— 

24 ‘‘(A) provides service coordination for an 

25 eligible individual; and 


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1 ‘‘(B) is trained or experienced in the skills 

2 that are required to facilitate consumer choice 

3 and carry out the functions described in para4 graph (13)(B). 

5 ‘‘(15) STATE.—The term ‘State’ means each of 

6 the 50 States, the District of Columbia, the Com7 monwealth of Puerto Rico, Guam, the United States 

8 Virgin Islands, American Samoa, and the Common9 wealth of the Northern Mariana Islands. 

10 ‘‘SEC. 802. ALLOTMENTS TO ELIGIBLE STATES. 

11 ‘‘(a) ALLOTMENTS.— 

12 ‘‘(1) IN GENERAL.—The Assistant Secretary 

13 shall make an allotment to each eligible State for a 

14 fiscal year, to enable the State to carry out a pro15 gram that pays for the Federal share of the cost of 

16 providing covered long-term care services and sup17 plies for eligible individuals under this title. The As18 sistant Secretary shall make the allotment in an 

19 amount determined under section 803. 

20 ‘‘(2) LIMITATIONS.—From an allotment made 

21 under paragraph (1) for a program carried out in a 

22 State under this title for a fiscal year, not more than 

23 15 percent may be used to pay for administrative 

24 costs (other than service coordination) of the pro25 gram. 


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1 ‘‘(b) FEDERAL SHARE.—From that allotment for 

2 that fiscal year— 

3 ‘‘(1) funds from the allotment shall be available 

4 to such State for paying a Federal share equal to 

5 such percentage as the State determines to be ap6 propriate, but not more than 75 percent, of the cost 

7 of administration of the program carried out in the 

8 State under this title; and 

9 ‘‘(2) the remainder of such allotment shall be 

10 available to such State only for paying a Federal 

11 share equal to such percentage as the State deter12 mines to be appropriate, but not more than 85 per13 cent, of the cost of providing covered long-term care 

14 services and supplies through the program. 

15 ‘‘(c) SUPPLEMENT, NOT SUPPLANT.—Allotments 

16 made to a State under this section shall supplement and 

17 not supplant other Federal or State payments that are 

18 made for the provision of long-term care services or sup19 ports under— 

20 ‘‘(1) the medicaid program carried out under 

21 title XIX of the Social Security Act (42 U.S.C. 1396 

22 et seq.); 

23 ‘‘(2) a program funded under title XX of such 

24 Act (42 U.S.C. 1397 et seq.); 


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1 ‘‘(3) a program funded under title III of this 

2 Act; or 

3 ‘‘(4) any other Federal or State program. 

4 ‘‘SEC. 803. ALLOTMENTS. 

5 ‘‘(a) ALLOTMENTS.— 

6 ‘‘(1) IN GENERAL.—Subject to subsection (b), 

7 from sums appropriated for a fiscal year to carry 

8 out this title, the Assistant Secretary shall allot to 

9 each eligible State an amount that bears the same 

10 relationship to such sums as the number of individ11 uals who are age 60 or older and whose income does 

12 not exceed 100 percent of the poverty line who re13 side in the State bears to the total number of such 

14 individuals who reside in all States. 

15 ‘‘(2) DATA.—For purposes of paragraph (1), 

16 the number of individuals described in that para17 graph shall be determined on the basis of the most 

18 recent available data from the Bureau of the Cen19 sus. 

20 ‘‘(3) DEFINITION.—In paragraph (1), the term 

21 ‘State’ does not include a State specified in sub22 section (b). 

23 ‘‘(b) ALLOTMENTS TO TERRITORIES.—Of the sums 

24 appropriated for a fiscal year to carry out this title, the 

25 Assistant Secretary shall allot an amount equal to 0.25 


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1 percent of such sums among the following commonwealths 

2 and territories according to the percentage specified for 

3 each such commonwealth or territory: 

4 ‘‘(1) The Commonwealth of Puerto Rico, 91.6 

5 percent. 

6 ‘‘(2) Guam, 3.5 percent. 

7 ‘‘(3) The United States Virgin Islands, 2.6 per8 cent. 

9 ‘‘(4) American Samoa, 1.2 percent. 

10 ‘‘(5) The Commonwealth of the Northern Mar11 iana Islands, 1.1 percent. 

12 ‘‘(c) AVAILABILITY OF AMOUNTS ALLOTTED.— 

13 ‘‘(1) IN GENERAL.—Except as provided in para14 graph (2), an amount allotted to an eligible State for 

15 a fiscal year shall remain available for expenditure 

16 by the State for the 2 succeeding fiscal years. 

17 ‘‘(2) AVAILABILITY OF REDISTRIBUTED

18 AMOUNTS.—An amount redistributed to an eligible 

19 State under subsection (d) in a fiscal year shall be 

20 available for expenditure by the State for the suc21 ceeding fiscal year. 

22 ‘‘(d) REDISTRIBUTION OF UNSPENT FUNDS.—An 

23 amount that is not expended by an eligible State during 

24 the period in which such amount is available under sub25 section (c) shall be redistributed by the Assistant SecVerDate Aug 31 2005 22:34 Apr 12, 2006 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S2620.IS S2620

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1 retary according to a formula determined by the Assistant 

2 Secretary that takes into account the extent to which an 

3 eligible State has exhausted, or is likely to exhaust, its 

4 allotment for that fiscal year. 

5 ‘‘SEC. 804. STATE PLANS. 

6 ‘‘(a) IN GENERAL.—In order to receive an allotment 

7 made under section 802 for an eligible State for a fiscal 

8 year, the State shall submit to the Assistant Secretary for 

9 approval a State plan that includes the information and 

10 assurances described in subsection (b). 

11 ‘‘(b) CONTENTS.— 

12 ‘‘(1) ELIGIBILITY.—The plan shall include de13 scriptions of the eligibility criteria and methodologies 

14 that the State will apply, consistent with section 

15 801(4), to determine whether an individual is an eli16 gible individual for the program carried out in the 

17 State under this title. 

18 ‘‘(2) PRIORITY FOR ELIGIBLE INDIVIDUALS

19 WITH GREATEST ECONOMIC NEED.—The plan shall 

20 include an assurance that, in establishing and apply21 ing the eligibility criteria and methodologies de22 scribed in paragraph (1), the State will give priority 

23 to providing assistance to those eligible individuals 

24 who have the greatest economic need, as defined by 

25 the State. 


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1 ‘‘(3) NEEDS AND PREFERENCES OF ELIGIBLE

2 INDIVIDUALS.—The plan shall include a description 

3 of how the State will ensure that the needs and pref4 erences of an eligible individual are addressed in all 

5 aspects of the program. 

6 ‘‘(4) PAYMENTS FOR SERVICES.—The plan 

7 shall include an assurance that the State will make 

8 payments, at the election of an eligible individual, in 

9 accordance with section 806(b)(2), and will provide 

10 a fiscal intermediary for each eligible individual 

11 electing to receive a payment as described in section 

12 806(b)(2)(B). 

13 ‘‘(5) SERVICES AND SUPPLIES.—The plan shall 

14 describe the services and supplies that the State will 

15 make available to an eligible individual, consistent 

16 with the definition of covered long-term services or 

17 supplies specified in section 801(3). 

18 ‘‘(6) COST-SHARING.—The plan shall include a 

19 description of the methodologies to be used— 

20 ‘‘(A) to calculate the ability of an eligible 

21 individual to pay for covered long-term care 

22 services or supplies without assistance under 

23 the program carried out under this title; 

24 ‘‘(B) based on the calculation of ability to 

25 pay, to determine the amount of cost-sharing 


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1 that the eligible individual will be responsible 

2 for under the program, set on a sliding scale 

3 based on income; 

4 ‘‘(C) to collect cost-sharing amounts, both 

5 in cases in which the State makes payments di6 rectly to a qualified provider as described in 

7 section 806(b)(2)(A), and in cases in which the 

8 State makes payments to a fiscal intermediary 

9 on behalf of an eligible individual, as described 

10 in section 806(b)(2)(B); and 

11 ‘‘(D) to track expenditures by eligible indi12 viduals for the purchase of covered long-term 

13 care services or supplies. 

14 ‘‘(7) COST-SHARING REQUIREMENTS FOR PRO15 VIDERS.—The plan shall provide an assurance that 

16 the State will require each provider involved in the 

17 program carried out in the State under this title— 

18 ‘‘(A) to protect the privacy and confiden19 tiality of each eligible individual with respect to 

20 the income, and any cost-sharing amount deter21 mined under paragraph (6), of an eligible indi22 vidual; 

23 ‘‘(B) to establish appropriate procedures to 

24 account for cost-sharing amounts; and 


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1 ‘‘(C) to widely distribute State-created 

2 written materials in languages reflecting the 

3 reading abilities of eligible individuals that de4 scribe the criteria for cost-sharing, and the 

5 State’s sliding scale described in paragraph 

6 (6)(B). 

7 ‘‘(8) COORDINATION WITH OTHER PRO8 GRAMS.—The plan shall include a description of the 

9 methods by which the State will, as appropriate, 

10 refer individuals who apply for assistance under a 

11 program carried out under this title for eligibility de12 terminations under— 

13 ‘‘(A) the State medicaid program carried 

14 out under title XIX of the Social Security Act 

15 (42 U.S.C. 1396 et seq.); 

16 ‘‘(B) the medicare program carried out 

17 under title XVIII of such Act (42 U.S.C. 1395 

18 et seq.); 

19 ‘‘(C) a program funded under title XX of 

20 such Act (42 U.S.C. 1397 et seq.); 

21 ‘‘(D) other programs funded under this 

22 Act; and 

23 ‘‘(E) other Federal or State programs that 

24 provide long-term care. 


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1 ‘‘(9) ENTITIES AND PROCEDURES.—The plan 

2 shall include a description of the entities and proce3 dures that the State will use to carry out the fol4 lowing functions: 

5 ‘‘(A) Establishing eligibility for the pro6 gram carried out under this title. 

7 ‘‘(B) Assessing the need of an eligible indi8 vidual for covered long-term care services or 

9 supplies. 

10 ‘‘(C) Determining the amount of payments 

11 described in section 806(b) to be made for the 

12 eligible individual under the program. 

13 ‘‘(D) Evaluating the cost-sharing by the el14 igible individual under the program. 

15 ‘‘(E) In the case of an eligible individual 

16 who elects to receive payments as described in 

17 section 806(b)(2)(B), helping the eligible indi18 vidual or the eligible individual’s representative 

19 (as appropriate) identify, retain, and negotiate 

20 and terminate agreements with, qualified pro21 viders of covered long-term services or supplies. 

22 ‘‘(F) Monitoring payments made for an eli23 gible individual to ensure that— 


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1 ‘‘(i) the cost-sharing amounts that the 

2 eligible individual is responsible for under 

3 the State plan are paid; 

4 ‘‘(ii) the payments made by the State 

5 for the eligible individual— 

6 ‘‘(I) are made in a timely fash7 ion; and 

8 ‘‘(II) do not exceed the annual 

9 assistance amount established for the 

10 eligible individual under section 

11 806(a); and 

12 ‘‘(iii) when appropriate, the payments 

13 are made by the State in an expedited 

14 manner to account for health status 

15 changes of an eligible individual that re16 quire rapid responses. 

17 ‘‘(G) Establishing a quality assurance sys18 tem that assesses the covered long-term services 

19 or supplies provided for the eligible individual 

20 to ensure that the qualified provider of such 

21 services or supplies meets such licensing, qual22 ity, or other standards as the State may estab23 lish in accordance with paragraph (11). 


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1 ‘‘(H) Providing information to eligible indi2 viduals about average market rates for covered 

3 long-term care services or supplies. 

4 ‘‘(I) Administering payments in a timely 

5 fashion and in accordance with a written care 

6 plan described in section 805(1) for an eligible 

7 individual (that takes into account payment 

8 rates established by the eligible individual or a 

9 representative of the eligible individual (as ap10 propriate)), including the methods for— 

11 ‘‘(i) making payments directly to a 

12 qualified provider as described in section 

13 806(b)(2)(A); 

14 ‘‘(ii) making payments to a fiscal 

15 intermediary on behalf of an eligible indi16 vidual, as described in section 

17 806(b)(2)(B), for the purchase of such 

18 services or supplies; and 

19 ‘‘(iii) making payments (when appro20 priate) in an expedited manner to account 

21 for health status changes of the eligible in22 dividual that require rapid responses. 

23 ‘‘(J) Carrying out such other activities as 

24 the eligible State determines are appropriate 


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1 with respect to the eligible individual or the 

2 program carried out under this title. 

3 ‘‘(10) SERVICE COORDINATORS.—The plan shall 

4 include a description of how the State will— 

5 ‘‘(A) provide a service coordinator (directly 

6 or by contract) for each eligible individual re7 ceiving assistance under the program carried 

8 out under this title; and 

9 ‘‘(B) ensure that the service coordinator 

10 carries out the responsibilities described in sec11 tion 805, including any responsibilities assigned 

12 by the State under section 805(5). 

13 ‘‘(11) QUALIFIED PROVIDERS.—The plan shall 

14 include a description of any licensing, quality, or 

15 other standards for qualified providers (including 

16 both providers paid directly by the State as de17 scribed in section 806(b)(2)(A) or through payments 

18 made to a fiscal intermediary on behalf of an eligible 

19 individual, as described in section 806(b)(2)(B). 

20 ‘‘(12) QUALITY ASSURANCE.—The plan shall 

21 include a description of the procedures to be used to 

22 ensure the quality and appropriateness of the cov23 ered long-term care services or supplies provided to 

24 an eligible individual and the program carried out 

25 under this title, which shall include— 


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1 ‘‘(A) a quality assessment and improve2 ment strategy that establishes— 

3 ‘‘(i) standards that provide for access 

4 to covered long-term care services or sup5 plies within reasonable time frames and 

6 that are designed to ensure the continuity 

7 and adequacy of such services or supplies; 

8 and 

9 ‘‘(ii) procedures for monitoring and 

10 evaluating the quality and appropriateness 

11 of the covered long-term care services or 

12 supplies provided to eligible individuals 

13 under the program carried out under this 

14 title; and 

15 ‘‘(B) a mechanism for obtaining feedback 

16 from eligible individuals and others regarding 

17 their experiences with, and recommendations 

18 for improvement of, the program carried out 

19 under this title. 

20 ‘‘(13) OUTREACH.—The plan shall include a de21 scription of the procedures by which the State will 

22 conduct outreach for enrollment (including outreach 

23 to persons residing in naturally occurring retirement 

24 communities) in the program carried out under this 

25 title. 


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1 ‘‘(14) INDIANS.—The plan shall include a de2 scription of the procedures by which the State will 

3 ensure the provision of assistance under the program 

4 carried out under this title to eligible individuals 

5 who are Indians (as defined in section 4(c) of the 

6 Indian Health Care Improvement Act (25 U.S.C. 

7 1603(c))) or Native Hawaiians, as defined in section 

8 625. 

9 ‘‘(15) DATA COLLECTION.—The plan shall in10 clude an assurance that the State will annually col11 lect and report to the Assistant Secretary such data 

12 and information related to the program carried out 

13 under this title as the Assistant Secretary may re14 quire, including the information required under sec15 tion 807(a)(1)(B). 

16 ‘‘SEC. 805. RESPONSIBILITIES OF SERVICE COORDINATORS. 

17 ‘‘Each eligible State shall ensure that the service co18 ordinator for an eligible individual receiving assistance 

19 under the program carried out under this title, at a min20 imum, carries out the following responsibilities: 

21 ‘‘(1)(A) Assisting an eligible individual and the 

22 eligible individual’s representative (as appropriate) 

23 with the development of a written care plan for the 

24 eligible individual that— 


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1 ‘‘(i) specifies the covered long-term care 

2 services or supplies that best meet the needs 

3 and preferences of the eligible individual; and 

4 ‘‘(ii) takes into account the ability of care5 givers to provide adequate and safe care. 

6 ‘‘(B) Assuring that the care plan is coordinated 

7 with other care plans that may be developed for the 

8 eligible individual under other Federal or State pro9 grams (including care plans applicable to naturally 

10 occurring retirement communities). 

11 ‘‘(2) Reassessing and, as appropriate, assisting 

12 with revising the care plan for the eligible indi13 vidual— 

14 ‘‘(A) not less than annually; and 

15 ‘‘(B) whenever there is a change of health 

16 status or other event that requires a reassess17 ment of the care plan. 

18 ‘‘(3) Educating— 

19 ‘‘(A) an eligible individual who elects to re20 ceive payments as described in section 

21 806(b)(2)(B) about available qualified providers 

22 of covered long-term care services or supplies; 

23 and 

24 ‘‘(B) an eligible individual about specific 

25 covered long-term care services or supplies. 


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1 ‘‘(4) Recommending, as appropriate, methods 

2 for community integration for an eligible individual 

3 who resides in a nursing home and who is relocating 

4 to a home or community-based setting. 

5 ‘‘(5) Carrying out any other responsibilities as6 signed to the service coordinator by the State. 

7 ‘‘SEC. 806. PAYMENTS FOR COVERED LONG-TERM CARE 

8 SERVICES OR SUPPLIES. 

9 ‘‘(a) ANNUAL ASSISTANCE AMOUNT.— 

10 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

11 an eligible State shall establish an annual assistance 

12 amount for each eligible individual enrolled in the 

13 program carried out under this title based on an as14 sessment of the eligible individual. 

15 ‘‘(2) COST-SHARING AMOUNT.—The State shall 

16 subtract from the annual assistance amount the in17 dividual’s cost-sharing amount determined under 

18 section 804(b)(6) to obtain the amount of the pay19 ments described in subsection (b). 

20 ‘‘(3) LIMITATION.—The annual assistance 

21 amount made for an eligible individual under a pro22 gram carried out under this title may not exceed— 

23 ‘‘(A) in the case of fiscal year 2007, 

24 $8,000; and 


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1 ‘‘(B) in the case of any subsequent fiscal 

2 year, the amount described in this paragraph 

3 for the preceding fiscal year increased by the 

4 percentage increase in the Consumer Price 

5 Index for all urban consumers (all items: U.S. 

6 city average) for the preceding fiscal year. 

7 ‘‘(b) PAYMENTS.— 

8 ‘‘(1) WRITTEN CARE PLANS.—Under a program 

9 carried out under this title, an eligible State (or its 

10 designee) shall make payments for the provision or 

11 purchase of covered long-term care services or sup12 plies for eligible individuals in accordance with the 

13 written care plans established for such individuals. 

14 ‘‘(2) ELECTIONS.—At the election of an eligible 

15 individual, the payments shall be made by the State 

16 (or its designee)— 

17 ‘‘(A) directly to a qualified provider of cov18 ered long-term care services or supplies; or 

19 ‘‘(B) to a fiscal intermediary on behalf of 

20 the eligible individual, to enable the fiscal inter21 mediary to disburse the payments for the pur22 chase of such services or supplies— 

23 ‘‘(i) in advance to the provider or the 

24 eligible individual; or 


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1 ‘‘(ii) as reimbursement for the eligible 

2 individual. 

3 ‘‘(c) LIMITATIONS.—In making payments under this 

4 section, a State shall ensure that not more than 10 per5 cent of the funds made available to the State under section 

6 802(a) shall be used to pay for service coordination. 

7 ‘‘(d) EXCLUSION FROM INCOME.—Payments made 

8 for an eligible individual under this section for a program 

9 carried out under this title shall not be— 

10 ‘‘(1) included in the gross income of the eligible 

11 individual for purposes of the Internal Revenue Code 

12 of 1986; or 

13 ‘‘(2) treated as income, assets, or benefits, or 

14 otherwise be taken into account, for purposes of de15 termining the individual’s eligibility for, the amount 

16 of benefits under, or the amount of cost-sharing re17 quired by, any other Federal or State program. 

18 ‘‘SEC. 807. ANNUAL REPORTS. 

19 ‘‘(a) STATE REPORTS.— 

20 ‘‘(1) IN GENERAL.—Each eligible State shall— 

21 ‘‘(A) evaluate the establishment and oper22 ation of the State plan under this title in each 

23 fiscal year for which the State receives allot24 ments under section 802; and 


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1 ‘‘(B) prepare and submit to the Assistant 

2 Secretary, not later than January 1 of the suc3 ceeding fiscal year, a report that includes the 

4 following: 

5 ‘‘(i) The number of total unduplicated 

6 eligible individuals and the amount of ex7 penditures made for the individuals, ana8 lyzed by type of payment specified in sub9 paragraph (A) or (B) of section 806(b)(2) 

10 in the program carried out under this title 

11 in the State. 

12 ‘‘(ii) The number of eligible individ13 uals in the program that received each of 

14 the categories of covered long-term care 

15 services or supplies described in clauses (i) 

16 through (xx) of section 801(3)(A), ana17 lyzed, for each category by type of pay18 ment specified in subparagraph (A) or (B) 

19 of section 806(b)(2). 

20 ‘‘(iii) The total amount of cost-shar21 ing amounts that the State received from 

22 eligible individuals in the program. 

23 ‘‘(iv) Information on the age and in24 come of the eligible individuals. 


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1 ‘‘(2) FORMAT.—The Assistant Secretary shall 

2 provide guidance to eligible States regarding the for3 mat for the information included in the report re4 quired under paragraph (1) in such manner as to 

5 allow for comparison of the information provided 

6 across such States. 

7 ‘‘(3) PUBLIC AVAILABILITY.—The Assistant 

8 Secretary shall make the State reports submitted 

9 under paragraph (1) available to the public. 

10 ‘‘(b) REPORTS BY FISCAL INTERMEDIARIES AND

11 QUALIFIED PROVIDERS.—The State shall require fiscal 

12 intermediaries and qualified providers participating in the 

13 program carried out in the State under this title to pre14 pare and submit to the State, not less often than twice 

15 a year, reports containing such information as is necessary 

16 for the State to meet the reporting requirements described 

17 in subsection (a) and as is necessary for the administra18 tion of the program. 

19 ‘‘(c) REPORT TO CONGRESS.—At the end of each fis20 cal year, the Assistant Secretary shall prepare and submit 

21 to the Committee on Education and the Workforce of the 

22 House of Representatives and the Committee of Health, 

23 Education, Labor, and Pensions of the Senate a report 

24 that contains a summary of the data submitted under subVerDate Aug 31 2005 22:34 Apr 12, 2006 Jkt 049200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S2620.IS S2620

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1 section (a)(1)(B) and a description of any implementa2 tions issues with the programs carried out under this title. 

3 ‘‘SEC. 808. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There are authorized to be appropriated to the Sec5 retary to carry out this title, such sums as may be nec6 essary for each of fiscal years 2007 through 2012.’’. 

Æ 


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