II 

111TH CONGRESS 

1ST SESSION S. 1257 

To amend the Social Security Act to build on the aging network to establish 

long-term services and supports through single-entry point systems, evidence-based disease prevention and health promotion programs, and enhanced nursing home diversion programs. 

IN THE SENATE OF THE UNITED STATES 

JUNE 11, 2009 

Ms. CANTWELL (for herself and Ms. STABENOW) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend the Social Security Act to build on the aging 

network to establish long-term services and supports 

through single-entry point systems, evidence-based disease prevention and health promotion programs, and enhanced nursing home diversion programs. 

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 ‘‘Project 2020: Building 

5 on the Promise of Home- and Community-Based Services 

6 Act of 2009’’. 


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1 SEC. 2. LONG-TERM SERVICES AND SUPPORTS. 

2 The Social Security Act (42 U.S.C. 301 et seq.) is 

3 amended by adding at the end the following: 

4 ‘‘TITLE XXII—LONG-TERM 

5 SERVICES AND SUPPORTS 

6 ‘‘SEC. 2201. DEFINITIONS. 

7 ‘‘Except as otherwise provided, the terms used in this 

8 title have the meanings given the terms in section 102 of 

9 the Older Americans Act of 1965 (42 U.S.C. 3002). 

10 ‘‘Subtitle A—Single-Entry Point 

11 System Program 

12 ‘‘SEC. 2211. STATE SINGLE-ENTRY POINT SYSTEMS. 

13 ‘‘(a) DEFINITIONS.—In this title: 

14 ‘‘(1) LONG-TERM SERVICES AND SUPPORTS.— 

15 The term ‘long-term services and supports’ means 

16 any service (including a disease prevention and 

17 health promotion service, an in-home service, or a 

18 case management service), care, or item (including 

19 an assistive device) that is— 

20 ‘‘(A) intended to assist individuals in cop21 ing with, and, to the extent practicable, com22 pensating for, functional impairment in car23 rying out activities of daily living; 

24 ‘‘(B) furnished at home, in a community 

25 care setting, including a small community care 

26 setting (as defined in section 1929(g)(1)) and a 


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1 large community care setting (as defined in sec2 tion 1929(h)(1)), or in a long-term care facility; 

3 and 

4 ‘‘(C) not furnished to diagnose, treat, or 

5 cure a medical disease or condition. 

6 ‘‘(2) SINGLE-ENTRY POINT SYSTEM.—The term 

7 ‘single-entry point system’ means any coordinated 

8 system for providing— 

9 ‘‘(A) comprehensive information to con10 sumers and caregivers on the full range of 

11 available public and private long-term services 

12 and supports, options, service providers, and re13 sources, including information on the avail14 ability of integrated long-term care, including 

15 consumer directed care options; 

16 ‘‘(B) personal counseling to assist individ17 uals in assessing their existing or anticipated 

18 long-term care needs, and developing and imple19 menting a plan for long-term care designed to 

20 meet their specific needs and circumstances; 

21 and 

22 ‘‘(C) consumers and caregivers access to 

23 the range of publicly supported and privately 

24 supported long-term services and supports that 

25 are available. 


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1 ‘‘(b) PROGRAM.—The Secretary shall establish and 

2 carry out a single-entry point system program. In carrying 

3 out the program, the Secretary shall make grants to 

4 States, from allotments described in subsection (c), to pay 

5 for the Federal share of the cost of establishing State sin6 gle-entry point systems. 

7 ‘‘(c) ALLOTMENTS.— 

8 ‘‘(1) ALLOTMENTS TO INDIAN TRIBES AND

9 TERRITORIES.— 

10 ‘‘(A) RESERVATION.—The Secretary shall 

11 reserve from the funds made available under 

12 subsection (g)— 

13 ‘‘(i) for fiscal year 2010, $1,962,456; 

14 and 

15 ‘‘(ii) for each subsequent fiscal year, 

16 $1,962,456, increased by the percentage 

17 increase in the Consumer Price Index for 

18 All Urban Consumers, between October of 

19 the fiscal year preceding the subsequent 

20 fiscal year and October, 2007. 

21 ‘‘(B) ALLOTMENTS.—The Secretary shall 

22 use the funds reserved under subparagraph (A) 

23 to make allotments to— 

24 ‘‘(i) Indian tribes; and 


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1 ‘‘(ii) Guam, American Samoa, the 

2 Commonwealth of the Northern Mariana 

3 Islands, the Commonwealth of Puerto 

4 Rico, and the United States Virgin Islands. 

5 ‘‘(2) ALLOTMENTS TO STATES.— 

6 ‘‘(A) IN GENERAL.— 

7 ‘‘(i) AMOUNT.—The Secretary shall 

8 allot to each eligible State for a fiscal year 

9 the sum of the fixed amount determined 

10 under subparagraph (B), and the alloca11 tion determined under subparagraph (C), 

12 for the State. 

13 ‘‘(ii) SUBGRANTS TO AREA AGENCIES

14 ON AGING.— 

15 ‘‘(I) IN GENERAL.—Each State 

16 agency receiving an allotment under 

17 clause (i) shall use such allotment to 

18 make subgrants to area agencies on 

19 aging that can demonstrate perform20 ance capacity to carry out activities 

21 described in this section whether such 

22 area agency on aging carries out the 

23 activities directly or through contract 

24 with an aging network or disability 

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1 siring a subgrant shall establish or 

2 designate a collaborative board to en3 sure meaningful involvement of stake4 holders in the development, planning, 

5 implementation, and evaluation of a 

6 single-entry point system consistent 

7 with the following: 

8 ‘‘(aa) The collaborative 

9 board shall be composed of— 

10 ‘‘(AA) individuals rep11 resenting all populations 

12 served by the agency’s sin13 gle-entry point system, in14 cluding older adults and in15 dividuals from diverse back16 grounds who have a dis17 ability or a chronic condition 

18 requiring long-term support; 

19 ‘‘(BB) a representative 

20 from the local center for 

21 independent living (as de22 fined in section 702 of the 

23 Rehabilitation Act of 1973 

24 (29 U.S.C. 796a)), and rep25 resentatives from other orVerDate Nov 24 2008 02:55 Jun 12, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1257.IS S1257

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1 ganizations that provide 

2 services to the individuals 

3 served by the system and 

4 those who advocate on be5 half of such individuals; and 

6 ‘‘(CC) representatives 

7 of the government and non8 governmental agencies that 

9 are affected by the system. 

10 ‘‘(bb) The agency shall work 

11 in conjunction with the collabo12 rative board on— 

13 ‘‘(AA) the design and 

14 operations of the single15 entry point system; 

16 ‘‘(BB) stakeholder 

17 input; and 

18 ‘‘(CC) other program 

19 and policy development 

20 issues related to the single21 entry point system. 

22 ‘‘(cc) An advisory board es23 tablished under the Real Choice 

24 Systems Change Program or for 

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1 tem may be used to carry out the 

2 activities of a collaborative board 

3 under this subclause if such advi4 sory board meets the require5 ments under item (aa). 

6 ‘‘(II) SUBGRANTS TO OTHER EN7 TITIES.—A State agency may make 

8 subgrants described in subclause (I) 

9 to other qualified aging network or 

10 disability entities only if the area 

11 agency on aging chooses not to apply 

12 for a subgrant or is not able to dem13 onstrate performance capacity to 

14 carry out the activities described in 

15 this section. 

16 ‘‘(III) SUBGRANTEE RECIPIENT

17 SUBGRANTS.—An administrator of a 

18 single-entry point system established 

19 by a State receiving an allotment 

20 under clause (i) shall make any nec21 essary subgrants to key partners in22 volved in developing, planning, or im23 plementing the single-entry point sys24 tem. Such partners may include cen25 ters for independent living (as defined 


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1 in section 702 of the Rehabilitation 

2 Act of 1973 (29 U.S.C. 796a)). 

3 ‘‘(B) FIXED AMOUNTS FOR STATES.— 

4 ‘‘(i) RESERVATION.—The Secretary 

5 shall reserve from the funds made available 

6 under subsection (g)— 

7 ‘‘(I) for fiscal year 2010, 

8 $15,759,000; and 

9 ‘‘(II) for each subsequent fiscal 

10 year, $15,759,000, increased by the 

11 percentage increase in the Consumer 

12 Price Index for All Urban Consumers, 

13 between October of the fiscal year 

14 preceding the subsequent fiscal year 

15 and October, 2007. 

16 ‘‘(ii) FIXED AMOUNTS.—The Sec17 retary shall use the funds reserved under 

18 clause (i) to provide equal fixed amounts to 

19 the States. 

20 ‘‘(C) ALLOCATION FOR STATES.—The Sec21 retary shall allocate to each eligible State for a 

22 fiscal year an amount that bears the same rela23 tionship to the funds made available under sub24 section (g) (and not reserved under paragraph 

25 (1) or subparagraph (B)) for that fiscal year as 


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1 the number of persons who are either older in2 dividuals or individuals with disabilities in that 

3 State bears to the number of such persons or 

4 individuals in all the States. 

5 ‘‘(D) DETERMINATION OF NUMBER OF

6 PERSONS.— 

7 ‘‘(i) OLDER INDIVIDUALS.—The num8 ber of older individuals in any State and in 

9 all States shall be determined by the Sec10 retary on the basis of the most recent data 

11 available from the Bureau of the Census, 

12 and other reliable demographic data satis13 factory to the Secretary. 

14 ‘‘(ii) INDIVIDUALS WITH DISABIL15 ITIES.—The number of individuals with 

16 disabilities in any State and in all States 

17 shall be determined by the Secretary on 

18 the basis of the most recent data available 

19 from the American Community Survey, 

20 and other reliable demographic data satis21 factory to the Secretary, on individuals 

22 who have a sensory disability, physical dis23 ability, mental disability, self-care dis24 ability, go-outside-home disability, or em25 ployment disability. 


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1 ‘‘(3) ELIGIBILITY.—In addition to the States 

2 determined by the Secretary to be eligible for a 

3 grant under this section, a State that receives a 

4 Federal grant for an aging and disability resource 

5 center is eligible for a grant under this section. 

6 ‘‘(4) DEFINITION.—In this subsection, the term 

7 ‘State’ shall not include any jurisdiction described in 

8 paragraph (1)(B)(ii). 

9 ‘‘(d) APPLICATIONS.— 

10 ‘‘(1) IN GENERAL.—To be eligible to receive an 

11 initial grant under this section, a State agency shall, 

12 after consulting and coordinating with consumers, 

13 other stakeholders, centers for independent living in 

14 the State, if any, and area agencies on aging in the 

15 State, if any, submit an application to the Secretary 

16 at such time, in such manner, and containing the 

17 following information: 

18 ‘‘(A) Evidence of substantial involvement 

19 of stakeholders and agencies in the State that 

20 are administering programs that will be the 

21 subject of referrals. 

22 ‘‘(B) The applicant’s plan for providing— 

23 ‘‘(i) comprehensive information on the 

24 full range of available public and private 

25 long-term services and supports options, 


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1 providers, and resources, including building 

2 awareness of the single-entry point system 

3 as a resource; 

4 ‘‘(ii) objective, neutral, and personal 

5 information, counseling, and assistance to 

6 individuals and their caregivers in assess7 ing their existing or anticipated long-term 

8 care needs, and developing and imple9 menting a plan for long-term care to meet 

10 their needs; 

11 ‘‘(iii) for eligibility screening and re12 ferral for services; 

13 ‘‘(iv) for stakeholder input; 

14 ‘‘(v) for a management information 

15 system; and 

16 ‘‘(vi) for an evaluation of the effective17 ness of the single-entry point system. 

18 ‘‘(C) A specification of the period of the 

19 grant request, which shall include not less than 

20 3 consecutive fiscal years in the 5-fiscal-year 

21 period beginning with fiscal year 2010. 

22 ‘‘(D) Such other information as the Sec23 retary determines appropriate. 

24 ‘‘(2) APPLICATION FOR CONTINUATION.— 


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1 ‘‘(A) IN GENERAL.—A State that receives 

2 an initial grant under this section shall apply, 

3 after consulting and coordinating with the area 

4 agencies on aging, for a continuation of the ini5 tial grant, which includes a description of any 

6 significant changes to the information provided 

7 in the initial application and such data con8 cerning performance measures related to the re9 quirements in the initial application as the Sec10 retary shall require. 

11 ‘‘(B) EFFECT.—The requirement under 

12 subparagraph (A) shall be in effect through fis13 cal year 2020. 

14 ‘‘(e) USE OF FUNDS.— 

15 ‘‘(1) IN GENERAL.—A State that receives a 

16 grant under this section shall use the funds made 

17 available through the grant to— 

18 ‘‘(A) establish a State single-entry point 

19 system, to enable older individuals and individ20 uals with disabilities and their caregivers to ob21 tain resources concerning long-term services 

22 and supports options; and 

23 ‘‘(B) provide information on, access to, 

24 and assistance regarding long-term services and 

25 supports. 


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1 ‘‘(2) SERVICES.—In particular, the State sin2 gle-entry point system shall be the referral source 

3 to— 

4 ‘‘(A) provide information about long-term 

5 care planning and available long-term services 

6 and supports through a variety of media (such 

7 as websites, seminars, and pamphlets); 

8 ‘‘(B) provide assistance with making deci9 sions about long-term services and supports and 

10 determining the most appropriate services 

11 through options counseling, future financial 

12 planning, and case management; 

13 ‘‘(C) provide streamlined access to and as14 sistance with applying for federally funded long15 term care benefits (including medical assistance 

16 under title XIX, Medicare skilled nursing facil17 ity services, services under title III of the Older 

18 Americans Act of 1965 (42 U.S.C. 3021 et 

19 seq.), the services of Aging and Disability Re20 source Centers), and State-funded and privately 

21 funded long-term care benefits, through efforts 

22 to shorten and simplify the eligibility processes 

23 for older individuals and individuals with dis24 abilities; 


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1 ‘‘(D) provide referrals to the State evi2 dence-based disease prevention and health pro3 motion programs under subtitle B; 

4 ‘‘(E) allocate the State funds available 

5 under subtitle C and carry out the State en6 hanced nursing home diversion program under 

7 subtitle C; and 

8 ‘‘(F) and provide information about, other 

9 services available in the State that may assist 

10 an individual to remain in the community, in11 cluding the Medicare and Medicaid programs, 

12 the State health insurance assistance program, 

13 the supplemental nutrition assistance program 

14 established under the Food and Nutrition Act 

15 of 2008 (7 U.S.C. 2011 et seq.), and the Low16 Income Home Energy Assistance Program 

17 under the Low-Income Home Energy Assist18 ance Act of 1981 (42 U.S.C. 8621 et seq.), and 

19 such other services, as the State shall include. 

20 ‘‘(3) COLLABORATIVE ARRANGEMENTS.— 

21 ‘‘(A) CENTER FOR INDEPENDENT LIV22 ING.—Each entity receiving an allotment under 

23 subsection (c) shall involve in the planning and 

24 implementation of the single-entry point system 

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1 fined in section 702 of the Rehabilitation Act of 

2 1973 (29 U.S.C. 796a)), which provides infor3 mation, referral, assistance, or services to indi4 viduals with disabilities. 

5 ‘‘(B) OTHER ENTITIES.—To the extent 

6 practicable, the State single-entry point system 

7 shall enter into collaborative arrangements with 

8 aging and disability programs, service pro9 viders, agencies, the direct care work force, and 

10 other entities in order to ensure that informa11 tion about such services may be made available 

12 to individuals accessing the State single-entry 

13 point system. 

14 ‘‘(f) FEDERAL SHARE.— 

15 ‘‘(1) IN GENERAL.—The Federal share of the 

16 cost described in subsection (b) shall be 75 percent. 

17 ‘‘(2) NON-FEDERAL SHARE.—The State may 

18 provide the non-Federal share of the cost in cash or 

19 in-kind, fairly evaluated, including plant, equipment, 

20 or services. The State may provide the non-Federal 

21 share from State, local, or private sources. 

22 ‘‘(g) FUNDING.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall use 

24 amounts made available under paragraph (2) to 

25 make the grants described in subsection (b). 


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1 ‘‘(2) FUNDING.—There are authorized to be ap2 propriated to carry out this section— 

3 ‘‘(A) $30,900,000 for fiscal year 2010; 

4 ‘‘(B) $38,264,000 for fiscal year 2011; 

5 ‘‘(C) $48,410,000 for fiscal year 2012; 

6 ‘‘(D) $53,560,000 for fiscal year 2013; 

7 ‘‘(E) $63,860,000 for fiscal year 2014; 

8 ‘‘(F) $69,010,000 for fiscal year 2015; 

9 ‘‘(G) $74,160,000 for fiscal year 2016; 

10 ‘‘(H) $79,310,000 for fiscal year 2017; 

11 ‘‘(I) $84,460,000 for fiscal year 2018; 

12 ‘‘(J) $89,610,000 for fiscal year 2019; and 

13 ‘‘(K) $95,790,000 for fiscal year 2020. 

14 ‘‘(3) AVAILABILITY.—Funds appropriated 

15 under paragraph (2) shall remain available until ex16 pended. 

17 ‘‘Subtitle B—Healthy Living 

18 Program 

19 ‘‘SEC. 2221. EVIDENCE-BASED DISEASE PREVENTION AND 

20 HEALTH PROMOTION PROGRAMS. 

21 ‘‘(a) PROGRAM.—The Secretary shall establish and 

22 carry out a healthy living program. In carrying out the 

23 program, the Secretary shall make grants to State agen24 cies, from allotments described in subsection (b), to pay 


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1 for the Federal share of the cost of carrying out evidence2 based disease prevention and health promotion programs. 

3 ‘‘(b) ALLOTMENTS.— 

4 ‘‘(1) ALLOTMENTS TO INDIAN TRIBES AND

5 TERRITORIES.— 

6 ‘‘(A) RESERVATION.—The Secretary shall 

7 reserve from the funds made available under 

8 subsection (g)— 

9 ‘‘(i) for fiscal year 2010, $1,500,952; 

10 and 

11 ‘‘(ii) for each subsequent fiscal year, 

12 $1,500,952, increased by the percentage 

13 increase in the Consumer Price Index for 

14 All Urban Consumers, between October of 

15 the fiscal year preceding the subsequent 

16 fiscal year and October, 2007. 

17 ‘‘(B) ALLOTMENTS.—The Secretary shall 

18 use the reserved funds under subparagraph (A) 

19 to make allotments to— 

20 ‘‘(i) Indian tribes; and 

21 ‘‘(ii) Guam, American Samoa, the 

22 Commonwealth of the Northern Mariana 

23 Islands, the Commonwealth of Puerto 

24 Rico, and the United States Virgin Islands. 

25 ‘‘(2) IN GENERAL.— 


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1 ‘‘(A) AMOUNTS.— 

2 ‘‘(i) IN GENERAL.—Except as pro3 vided in paragraph (3), the Secretary shall 

4 allot to each eligible State for a fiscal year 

5 an amount that bears the same relation6 ship to the funds made available under this 

7 section and not reserved under paragraph 

8 (1) for that fiscal year as the number of 

9 older individuals in the State bears to the 

10 number of older individuals in all the 

11 States. 

12 ‘‘(ii) OLDER INDIVIDUALS.—The 

13 number of older individuals in any State 

14 and in all States shall be determined by 

15 the Secretary on the basis of the most re16 cent data available from the Bureau of the 

17 Census, and other reliable demographic 

18 data satisfactory to the Secretary. 

19 ‘‘(B) SUBGRANTS.— 

20 ‘‘(i) IN GENERAL.—Each State agency 

21 that receives an amount under subpara22 graph (A) shall award subgrants to area 

23 agencies on aging that can demonstrate 

24 performance capacity to carry out activities 

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1 cy on aging carries out the activities di2 rectly or through contract with an aging 

3 network entity. 

4 ‘‘(ii) SUBGRANTS TO OTHER ENTI5 TIES.—A State agency may make sub6 grants described in clause (i) to other 

7 qualified aging network entities only if the 

8 area agency on aging chooses not to apply 

9 for a subgrant or is not able to dem10 onstrate performance capacity to carry out 

11 the activities described in this section. 

12 ‘‘(3) MINIMUM ALLOTMENT.—No State shall 

13 receive an allotment under this section for a fiscal 

14 year that is less than 0.5 percent of the funds made 

15 available to carry out this section for that fiscal year 

16 and not reserved under paragraph (1). 

17 ‘‘(4) ELIGIBILITY.—In addition to the States 

18 determined by the Secretary to be eligible for a 

19 grant under this section, a State that receives a 

20 Federal grant for evidence-based disease prevention 

21 is eligible for a grant under this section. 

22 ‘‘(c) APPLICATIONS.—To be eligible to receive a grant 

23 under this section, a State agency shall, after consulting 

24 and coordinating with consumers, other stakeholders, and 

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1 plication to the Secretary at such time, in such manner, 

2 and containing the following information: 

3 ‘‘(1) A description of the evidence-based disease 

4 prevention and health promotion program. 

5 ‘‘(2) Sufficient information to demonstrate that 

6 the infrastructure exists to support the program. 

7 ‘‘(3) A specification of the period of the grant 

8 request, which shall include not less than 3 consecu9 tive fiscal years in the 5-fiscal-year period beginning 

10 with fiscal year 2010. 

11 ‘‘(4) Such other information as the Secretary 

12 determines appropriate. 

13 ‘‘(d) APPLICATION FOR CONTINUATION.— 

14 ‘‘(1) IN GENERAL.—A State that receives an 

15 initial grant under this section shall apply, after con16 sulting and coordinating with the area agencies on 

17 aging, for a continuation of the initial grant, which 

18 application shall include— 

19 ‘‘(A) a description of any significant 

20 changes to the information provided in the ini21 tial application; and 

22 ‘‘(B) such data concerning performance 

23 measures related to the requirements in the ini24 tial application as the Secretary shall require. 


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1 ‘‘(2) EFFECT.—The requirement under para2 graph (1) shall be in effect through fiscal year 2020. 

3 ‘‘(e) USE OF FUNDS.—A State that receives a grant 

4 under this section shall use the funds made available 

5 through the grant to carry out— 

6 ‘‘(1) an evidence-based chronic disease self7 management program; 

8 ‘‘(2) an evidence-based falls prevention pro9 gram; or 

10 ‘‘(3) another evidence-based disease prevention 

11 and health promotion program. 

12 ‘‘(f) FEDERAL SHARE.— 

13 ‘‘(1) IN GENERAL.—The Federal share of the 

14 cost described in subsection (a) shall be 85 percent. 

15 ‘‘(2) NON-FEDERAL SHARE.—The State may 

16 provide the non-Federal share of the cost in cash or 

17 in-kind, fairly evaluated, including plant, equipment, 

18 or services. The State may provide the non-Federal 

19 share from State, local, or private sources. 

20 ‘‘(g) FUNDING.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall use 

22 amounts made available under paragraph (2) to 

23 make the grants described in subsection (a). 

24 ‘‘(2) FUNDING.—There are authorized to be ap25 propriated to carry out this section— 


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1 ‘‘(A) $36,050,000 for fiscal year 2010; 

2 ‘‘(B) $41,200,000 for fiscal year 2011; 

3 ‘‘(C) $56,650,000 for fiscal year 2012; 

4 ‘‘(D) $77,250,000 for fiscal year 2013; 

5 ‘‘(E) $92,700,000 for fiscal year 2014; 

6 ‘‘(F) $103,000,000 for fiscal year 2015; 

7 ‘‘(G) $118,450,000 for fiscal year 2016; 

8 ‘‘(H) $133,900,000 for fiscal year 2017; 

9 ‘‘(I) $149,350,000 for fiscal year 2018; 

10 ‘‘(J) $157,590,000 for fiscal year 2019; 

11 and 

12 ‘‘(K) $173,040,000 for fiscal year 2020. 

13 ‘‘(3) AVAILABILITY.—Funds appropriated 

14 under paragraph (2) shall remain available until ex15 pended. 

16 ‘‘Subtitle C—Diversion Programs 

17 ‘‘SEC. 2231. ENHANCED NURSING HOME DIVERSION PRO18 GRAMS. 

19 ‘‘(a) DEFINITION.—In this section: 

20 ‘‘(1) LOW-INCOME SENIOR.—The term ‘low-in21 come senior’ means an individual who— 

22 ‘‘(A) is age 75 or older; and 

23 ‘‘(B) is from a household with a household 

24 income that is not less than 150 percent, and 

25 not more than 300 percent, of the poverty line. 


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1 ‘‘(2) NURSING HOME.—The term ‘nursing 

2 home’ means— 

3 ‘‘(A) a skilled nursing facility, as defined 

4 in section 1819(a); or 

5 ‘‘(B) a nursing facility, as defined in sec6 tion 1919(a). 

7 ‘‘(b) PROGRAM.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall estab9 lish and carry out a diversion program. In carrying 

10 out the program, the Secretary shall make grants to 

11 States, from allotments described in subsection (c), 

12 to pay for the Federal share of the cost of carrying 

13 out enhanced nursing home diversion programs. 

14 ‘‘(2) COHORTS.—The Secretary shall make the 

15 grants to— 

16 ‘‘(A) a first year cohort consisting of one 

17 third of the States, for fiscal year 2010; 

18 ‘‘(B) a second year cohort consisting of the 

19 cohort described in subparagraph (A) and an 

20 additional one third of the States, for fiscal 

21 year 2011; and 

22 ‘‘(C) a third year cohort consisting of all 

23 the eligible States, for fiscal year 2012 and 

24 each subsequent fiscal year. 


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1 ‘‘(3) READINESS.—In determining whether to 

2 include an eligible State in the first year, second 

3 year, or third year and subsequent year cohort, the 

4 Secretary shall consider the readiness of the State to 

5 carry out an enhanced nursing home diversion pro6 gram under this section. Readiness shall be deter7 mined based on a consideration of the following fac8 tors: 

9 ‘‘(A) Availability of a comprehensive array 

10 of home- and community-based services. 

11 ‘‘(B) Sufficient home- and community12 based services provider capacity. 

13 ‘‘(C) Availability of housing. 

14 ‘‘(D) Availability of supports for consumer15 directed services, including whether a fiscal 

16 intermediary is in place. 

17 ‘‘(E) Ability to perform timely eligibility 

18 determinations and assessment for services. 

19 ‘‘(F) Existence of a quality assessment and 

20 improvement program for home- and commu21 nity-based services. 

22 ‘‘(G) Such other factors as the Secretary 

23 determines appropriate. 

24 ‘‘(c) ALLOTMENTS.— 

25 ‘‘(1) IN GENERAL.— 


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1 ‘‘(A) AMOUNT.—The Secretary shall allot 

2 to an eligible State (within the applicable co3 hort) for a fiscal year an amount that bears the 

4 same relationship to the funds made available 

5 under subsection (i) for that fiscal year as the 

6 number of low-income seniors in the State bears 

7 to the number of low-income seniors within 

8 States in the applicable cohort for that fiscal 

9 year. 

10 ‘‘(B) LOW-INCOME SENIORS.—The number 

11 of low-income seniors in any State and in all 

12 States shall be determined by the Secretary on 

13 the basis of the most recent data available from 

14 the American Community Survey, and other re15 liable demographic data satisfactory to the Sec16 retary. 

17 ‘‘(2) ELIGIBILITY.—In addition to the States 

18 determined by the Secretary to be eligible for a 

19 grant under this section, a State that receives a 

20 Federal grant for a nursing home diversion is eligi21 ble for a grant under this section. 

22 ‘‘(d) APPLICATIONS.—To be eligible to receive a 

23 grant under this section, a State agency shall, after con24 sulting and coordinating with consumers, other stake25 holders, and area agencies on aging in the State, if any, 


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1 submit an application to the Secretary at such time, in 

2 such manner, and containing such information as the Sec3 retary may require, including a specification of the period 

4 of the grant request, which shall include not less than 3 

5 consecutive fiscal years in the 5-fiscal-year period begin6 ning with the fiscal year prior to the year of application. 

7 ‘‘(e) APPLICATION FOR CONTINUATION.— 

8 ‘‘(1) IN GENERAL.—A State that receives an 

9 initial grant under this section shall apply, after con10 sulting and coordinating with the area agencies on 

11 aging, for a continuation of the initial grant, which 

12 application shall include— 

13 ‘‘(A) a description of any significant 

14 changes to the information provided in the ini15 tial application; and 

16 ‘‘(B) such data concerning performance 

17 measures related to the requirements in the ini18 tial application as the Secretary shall require. 

19 ‘‘(2) EFFECT.—The requirement under para20 graph (1) shall be in effect through fiscal year 2020. 

21 ‘‘(f) USE OF FUNDS.— 

22 ‘‘(1) IN GENERAL.—A State that receives a 

23 grant under this section shall carry out the fol24 lowing: 


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1 ‘‘(A) Use the funds made available through 

2 the grant to carry out an enhanced nursing 

3 home diversion program that enables eligible in4 dividuals to avoid admission into nursing homes 

5 by enabling the individuals to obtain alternative 

6 long-term services and supports and remain in 

7 their communities. 

8 ‘‘(B) Award subgrants to area agencies on 

9 aging that can demonstrate performance capac10 ity to carry out activities under this section 

11 whether such area agency on aging carries out 

12 the activities directly or through contract with 

13 an aging network entity. A State may make 

14 subgrants to other qualified aging network enti15 ties only if the area agency on aging chooses 

16 not to apply for a subgrant or is not able to 

17 demonstrate performance capacity to carry out 

18 the activities described in this section. 

19 ‘‘(2) CASE MANAGEMENT.— 

20 ‘‘(A) IN GENERAL.—The State, through 

21 the State single-entry point system established 

22 under subtitle A, shall provide for case manage23 ment services to the eligible individuals. 

24 ‘‘(B) USE OF EXISTING SERVICES.—In 

25 carrying out subparagraph (A), the State agenVerDate Nov 24 2008 02:55 Jun 12, 2009 Jkt 079200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1257.IS S1257

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1 cy or area agency on aging may utilize existing 

2 case management services delivery networks 

3 if— 

4 ‘‘(i) the networks have adequate safe5 guards against potential conflicts of inter6 est; and 

7 ‘‘(ii) the State agency or area agency 

8 on aging includes a description of such 

9 safeguards in the grant application. 

10 ‘‘(C) CARE PLAN.—The State shall provide 

11 for development of a care plan for each eligible 

12 individual served, in consultation with the eligi13 ble individual and their caregiver, as appro14 priate. In developing the care plan, the State 

15 shall explain the option of consumer directed 

16 care and assist an individual, who so requests, 

17 with developing a consumer-directed care plan 

18 that shall include arranging for support services 

19 and funding. Such assistance shall include pro20 viding information and outreach to individuals 

21 in the hospital, in a nursing home for post22 acute care, or undergoing changes in their 

23 health status or caregiver situation. 

24 ‘‘(g) ELIGIBLE INDIVIDUALS.—In this section, the 

25 term ‘eligible individual’ means an individual— 


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1 ‘‘(1) who has been determined by the State to 

2 be at high functional risk of nursing home place3 ment, as defined by the State agency in the State 

4 agency’s grant application; 

5 ‘‘(2) who is not eligible for medical assistance 

6 under title XIX; and 

7 ‘‘(3) who meets the income and asset eligibility 

8 requirements established by the State and included 

9 in such State’s grant application for approval by the 

10 Secretary. 

11 ‘‘(h) FEDERAL SHARE.— 

12 ‘‘(1) IN GENERAL.—The Federal share of the 

13 cost described in subsection (b) shall be, for a State 

14 and for a fiscal year, the sum of— 

15 ‘‘(A) the Federal medical assistance per16 centage applicable to the State for the year 

17 under section 1905(b); and 

18 ‘‘(B) 5 percentage points. 

19 ‘‘(2) NON-FEDERAL SHARE.—The State may 

20 provide the non-Federal share of the cost in cash or 

21 in-kind, fairly evaluated, including plant, equipment, 

22 or services. The State may provide the non-Federal 

23 share from State, local, or private sources. 

24 ‘‘(i) FUNDING.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall use 

2 amounts made available under paragraph (2) to 

3 make the grants described in subsection (b). 

4 ‘‘(2) FUNDING.—There are authorized to be ap5 propriated to carry out this section— 

6 ‘‘(A) $111,825,137 for fiscal year 2010; 

7 ‘‘(B) $337,525,753 for fiscal year 2011; 

8 ‘‘(C) $650,098,349 for fiscal year 2012; 

9 ‘‘(D) $865,801,631 for fiscal year 2013; 

10 ‘‘(E) $988,504,887 for fiscal year 2014; 

11 ‘‘(F) $1,124,547,250 for fiscal year 2015; 

12 ‘‘(G) $1,276,750,865 for fiscal year 2016; 

13 ‘‘(H) $1,364,488,901 for fiscal year 2017; 

14 ‘‘(I) $1,466,769,052 for fiscal year 2018; 

15 ‘‘(J) $1,712,755,702 for fiscal year 2019; 

16 and 

17 ‘‘(K) $1,712,755,702 for fiscal year 2020. 

18 ‘‘(3) AVAILABILITY.—Funds appropriated 

19 under paragraph (2) shall remain available until ex20 pended. 


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1 ‘‘Subtitle D—Administration, Eval2 uation, and Technical Assist3 ance 

4 ‘‘SEC. 2241. ADMINISTRATION, EVALUATION, AND TECH5 NICAL ASSISTANCE. 

6 ‘‘(a) ADMINISTRATION AND EXPENSES.—For pur7 poses of carrying out this title, there are authorized to 

8 be appropriated for administration and expenses— 

9 ‘‘(1) of the area agencies on aging— 

10 ‘‘(A) $16,825,895 for fiscal year 2010; 

11 ‘‘(B) $39,246,141 for fiscal year 2011; 

12 ‘‘(C) $50,766,948 for fiscal year 2012; 

13 ‘‘(D) $66,999,101 for fiscal year 2013; 

14 ‘‘(E) $76,979,152 for fiscal year 2014; 

15 ‘‘(F) $87,163,513 for fiscal year 2015; 

16 ‘‘(G) $98,780,562 for fiscal year 2016; 

17 ‘‘(H) $106,063,792 for fiscal year 2017; 

18 ‘‘(I) $114,324,642 for fiscal year 2018; 

19 ‘‘(J) $123,312,948 for fiscal year 2019; 

20 and 

21 ‘‘(K) $133,215,845 for fiscal year 2020; 

22 ‘‘(2) of the State agencies— 

23 ‘‘(A) $8,412,948 for fiscal year 2010; 

24 ‘‘(B) $19,623,071 for fiscal year 2011; 

25 ‘‘(C) $25,383,474 for fiscal year 2012; 


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1 ‘‘(D) $33,499,551 for fiscal year 2013; 

2 ‘‘(E) $38,489,576 for fiscal year 2014; 

3 ‘‘(F) $43,581,756 for fiscal year 2015; 

4 ‘‘(G) $49,390,281 for fiscal year 2016; 

5 ‘‘(H) $53,031,896 for fiscal year 2017; 

6 ‘‘(I) $57,162,321 for fiscal year 2018; 

7 ‘‘(J) $61,656,474 for fiscal year 2019; and 

8 ‘‘(K) $66,607,923 for fiscal year 2020; 

9 and 

10 ‘‘(3) of the Administration— 

11 ‘‘(A) $2,103,237 for fiscal year 2010; 

12 ‘‘(B) $4,905,768 for fiscal year 2011; 

13 ‘‘(C) $6,345,868 for fiscal year 2012; 

14 ‘‘(D) $8,374,888 for fiscal year 2013; 

15 ‘‘(E) $9,622,394 for fiscal year 2014; 

16 ‘‘(F) $10,895,439 for fiscal year 2015; 

17 ‘‘(G) $12,347,570 for fiscal year 2016; 

18 ‘‘(H) $13,257,974 for fiscal year 2017; 

19 ‘‘(I) $14,290,580 for fiscal year 2018; 

20 ‘‘(J) $15,414,118 for fiscal year 2019; and 

21 ‘‘(K) $16,651,981 for fiscal year 2020. 

22 ‘‘(b) EVALUATION AND TECHNICAL ASSISTANCE.— 

23 ‘‘(1) CONDITIONS TO RECEIPT OF GRANT.—In 

24 awarding grants under this title, the Secretary shall 

25 condition receipt of the grant for the second and 


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1 subsequent grant years on a satisfactory determina2 tion that the State agency is meeting benchmarks 

3 specified in the grant agreement for each grant 

4 awarded under this title. 

5 ‘‘(2) EVALUATIONS.—The Secretary shall meas6 ure and evaluate, either directly or through grants 

7 or contracts, the impact of the programs authorized 

8 under this title. Not later than June 1 of the year 

9 that is 6 years after the year of the date of enact10 ment of the Project 2020: Building on the Promise 

11 of Home- and Community-Based Services Act of 

12 2009 and every 2 years thereafter, the Secretary 

13 shall— 

14 ‘‘(A) compile the reports of the measures 

15 and evaluations of the grantees; 

16 ‘‘(B) establish benchmarks to show 

17 progress toward savings; and 

18 ‘‘(C) present a compilation of the informa19 tion under this paragraph to Congress. 

20 ‘‘(3) TECHNICAL ASSISTANCE GRANTS.—The 

21 Secretary shall award technical assistance grants, in22 cluding State specific grants whenever practicable, 

23 to carry out the programs authorized under this 

24 title. 


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1 ‘‘(4) TRANSFER.—There are authorized to be 

2 appropriated for such evaluation and technical as3 sistance under this subsection— 

4 ‘‘(A) $4,206,474 for fiscal year 2010; 

5 ‘‘(B) $9,811,535 for fiscal year 2011; 

6 ‘‘(C) $8,461,158 for fiscal year 2012; 

7 ‘‘(D) $11,166,517 for fiscal year 2013; 

8 ‘‘(E) $12,829,859 for fiscal year 2014; 

9 ‘‘(F) $14,527,252 for fiscal year 2015; 

10 ‘‘(G) $16,463,427 for fiscal year 2016; 

11 ‘‘(H) $17,677,299 for fiscal year 2017; 

12 ‘‘(I) $19,054,107 for fiscal year 2018; 

13 ‘‘(J) $20,552,158 for fiscal year 2019; and 

14 ‘‘(K) $22,202,641 for fiscal year 2020. 

15 ‘‘(c) AVAILABILITY.—Funds appropriated under this 

16 section shall remain available until expended.’’. 

Æ 


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