II 

114TH CONGRESS 

1ST SESSION S. 1574 

To amend the Older Americans Act of 1965 to establish a community care 

wrap-around support demonstration program, a pilot project on services 

for recipients of federally assisted housing, and a national campaign 

to raise awareness of the aging network and to promote advance integrated long-term care planning, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 15, 2015 

Mr. MERKLEY 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 establish 

a community care wrap-around support demonstration 

program, a pilot project on services for recipients of 

federally assisted housing, and a national campaign to 

raise awareness of the aging network and to promote 

advance integrated long-term care planning, and for 

other purposes. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Older Americans Com3 munity Access Revitalization and Education Act’’ or the 

4 ‘‘CARE Act’’. 

5 SEC. 2. COMMUNITY CARE WRAP-AROUND SUPPORT DEM6 ONSTRATION PROGRAM. 

7 Part A of title IV of the Older Americans Act of 1965 

8 (42 U.S.C. 3032 et seq.) is amended by adding at the end 

9 the following: 

10 ‘‘SEC. 423. COMMUNITY CARE WRAP-AROUND SUPPORT 

11 DEMONSTRATION PROGRAM. 

12 ‘‘(a) DEFINITIONS.— 

13 ‘‘(1) COMMUNITY CARE WRAP-AROUND SUP14 PORT PARTNERSHIP.—The term ‘community care 

15 wrap-around support partnership’ means a partner16 ship that— 

17 ‘‘(A) carries out a program that serves not 

18 fewer than 30 eligible older individuals; 

19 ‘‘(B) includes— 

20 ‘‘(i) a designated care coordinator, 

21 who may be a nurse, registered dietitian, 

22 case manager, health coach, or social work23 er, from an eligible entity and who, in con24 sultation with a primary care physician or 

25 another relevant specialist described in 

26 clause (ii), will be responsible for coordiVerDate Sep 11 2014 02:22 Jun 18, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1574.IS S1574

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1 nating services and supports offered under 

2 title III for an older individual; and 

3 ‘‘(ii) a consulting primary care physi4 cian, or other relevant specialist, receiving 

5 compensation for participation in the part6 nership in a manner determined by the As7 sistant Secretary; and 

8 ‘‘(C) may include an individual— 

9 ‘‘(i) who is listed in the plan for the 

10 community care wrap-around support part11 nership described in subsection (c)(2)(A); 

12 ‘‘(ii) for whom the eligible older indi13 vidual gives consent to participate in the 

14 community care wrap-around support part15 nership, as that partnership relates to the 

16 eligible older individual; and 

17 ‘‘(iii) whose relationship to the older 

18 individual is that of— 

19 ‘‘(I) a family member, close per20 sonal friend, or unpaid designated 

21 caregiver; 

22 ‘‘(II) a legal or financial advisor; 

23 ‘‘(III) a home care provider; 

24 ‘‘(IV) a provider of transpor25 tation; 


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1 ‘‘(V) a registered dietitian; or 

2 ‘‘(VI) a rehabilitation profes3 sional. 

4 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en5 tity’ means— 

6 ‘‘(A) an area agency on aging; 

7 ‘‘(B) a home or community-based provider 

8 of the activities described in subsection (d) 

9 (such as a home care agency, or entity oper10 ating a senior center or adult day care facility); 

11 or 

12 ‘‘(C) another qualified entity the Assistant 

13 Secretary determines to be appropriate to carry 

14 out the activities described in subsection (d). 

15 ‘‘(3) ELIGIBLE OLDER INDIVIDUAL.—The term 

16 ‘eligible older individual’ means an older indi17 vidual— 

18 ‘‘(A) who is age 65 or older; 

19 ‘‘(B) who is eligible to receive assistance 

20 under this Act; 

21 ‘‘(C) who elects to enroll in the demonstra22 tion program, as described in subsection (e); 

23 and 

24 ‘‘(D) who— 


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1 ‘‘(i) has difficulty completing 2 or 

2 more activities of daily living; 

3 ‘‘(ii) has had at least 1 nonelective 

4 hospital admission within the past 12 

5 months; 

6 ‘‘(iii) has received acute or subacute 

7 rehabilitation services within the past 12 

8 months; or 

9 ‘‘(iv) meets such other criteria as the 

10 Assistant Secretary determines to be ap11 propriate. 

12 ‘‘(b) PROGRAM AUTHORIZED.— 

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

14 shall establish a demonstration program (referred to 

15 in this section as the ‘demonstration program’ and 

16 to be commonly known as the ‘community care ini17 tiative’) through which the Assistant Secretary shall 

18 make grants to eligible entities in order to enable 

19 such eligible entities to— 

20 ‘‘(A) establish community care wrap21 around support partnerships; and 

22 ‘‘(B) support the partnerships, enabling 

23 the partnerships to carry out the activities de24 scribed in subsection (d). 


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1 ‘‘(2) DURATION.—Each grant awarded under 

2 this section shall be for a period of 2 years. 

3 ‘‘(c) APPLICATION.— 

4 ‘‘(1) IN GENERAL.—Each eligible entity desir5 ing a grant under this section shall submit an appli6 cation to the Assistant Secretary at such time, in 

7 such manner, and accompanied by such information 

8 as the Assistant Secretary may reasonably require. 

9 ‘‘(2) CONTENTS.—The application described in 

10 this subsection shall include, at a minimum— 

11 ‘‘(A) a plan listing the individuals, as de12 scribed in subsection (a)(1)(C), that will, upon 

13 consent of an eligible older individual, partici14 pate in the community care wrap-around sup15 port partnership as that partnership relates to 

16 the eligible older individual; 

17 ‘‘(B) a clear description of— 

18 ‘‘(i) the protocols the eligible entity 

19 will implement to identify the needs of 

20 older individuals receiving services and 

21 supports through the partnership; 

22 ‘‘(ii) the range of intervention and 

23 supportive services and supports that the 

24 eligible entity will implement; and 


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1 ‘‘(iii) preliminary evidence of the effi2 cacy or effectiveness of the approach the 

3 eligible entity proposes to use in providing 

4 services and supports through the partner5 ship; and 

6 ‘‘(C) an assurance that the partnership will 

7 collect the information determined by the As8 sistant Secretary under subsection (h)(1). 

9 ‘‘(d) USE OF FUNDS.—An eligible entity that receives 

10 a grant under this section shall use the grant funds to 

11 establish a community care wrap-around support partner12 ship and support the partnership, including requiring the 

13 partnership to— 

14 ‘‘(1) connect each participant with the commu15 nity care wrap-around support partnership; 

16 ‘‘(2) assess each eligible older individual using 

17 a standardized assessment instrument, such as a 

18 comprehensive assessment reporting evaluation; 

19 ‘‘(3) establish longitudinal care plans for each 

20 eligible older individual; and 

21 ‘‘(4) provide comprehensive, coordinated, and 

22 continuous virtual or in-person access to the services 

23 and supports offered under this Act, tailored to the 

24 specific needs of the older individual involved, which 

25 may include 1 or more of the following: 


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1 ‘‘(A) Medication management. 

2 ‘‘(B) Medical nutrition therapy with a reg3 istered dietitian for individuals requiring dietary 

4 modification for chronic disease management. 

5 ‘‘(C) Limited environmental modifications, 

6 such as safety equipment for showering, bath7 ing, or toileting or installation of safety, health, 

8 and wellness monitoring technologies for an eli9 gible older individual. 

10 ‘‘(D) Nutritional and dietary supports, 

11 which may include nutrition counseling, edu12 cation, and the delivery of meals to the home or 

13 assistance with purchasing groceries in order 

14 to— 

15 ‘‘(i) assure an appropriate diet con16 sistent with the medical needs, cultural 

17 background, and faith traditions of an eli18 gible older individual; and 

19 ‘‘(ii) identify opportunities for social20 ization within the home or the community 

21 of an eligible older individual in order to 

22 enhance the ability to participate in 

23 healthy nutritional habits. 


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1 ‘‘(E) Transportation in order to meet the 

2 medical and social needs of an eligible older in3 dividual. 

4 ‘‘(F) Psychosocial supports to prevent iso5 lation and the potential for depression and cog6 nitive decline, which often accompany the lack 

7 of human interaction. 

8 ‘‘(G) Opportunities for exercise, as toler9 able and appropriate, to prevent further phys10 ical decline that may lead to preventable dis11 ability. 

12 ‘‘(H) Opportunities for enjoyment through 

13 activities or interactions, in person or virtually, 

14 that enhance an eligible older individual’s life, 

15 relationships, well-being, or sense of produc16 tivity, including providing the opportunities 

17 through the use of technology products. 

18 ‘‘(e) ELECTION TO PARTICIPATE.—The Assistant 

19 Secretary shall determine and carry out an appropriate 

20 method of ensuring that eligible older individuals have 

21 agreed to enroll in a community care wrap-around support 

22 partnership program. Enrollment in the demonstration 

23 program shall be voluntary. 

24 ‘‘(f) COMPLIANCE WITH OTHER LAWS.— 


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1 ‘‘(1) REGULATIONS.—Notwithstanding any pro2 vision of this section, each eligible entity receiving a 

3 grant under this section shall ensure that the activi4 ties carried out under the grant comply with the reg5 ulations promulgated pursuant to section 264(c) of 

6 the Health Insurance Portability and Accountability 

7 Act of 1996 (42 U.S.C. 1320d–2 note), the Health 

8 Information Technology for Economic and Clinical 

9 Health Act (title XIII of division A and title IV of 

10 division B of Public Law 111–5), and the amend11 ments made by such Act. 

12 ‘‘(2) GUIDANCE.—The Assistant Secretary shall 

13 ensure that the activities carried out under this sec14 tion are consistent with the guidance issued by the 

15 Secretary on June 6, 2014, for implementing stand16 ards for person-centered planning and self-direction 

17 in home and community-based services programs, 

18 under section 2402(a) of the Patient Protection and 

19 Affordable Care Act (42 U.S.C. 1396n note). 

20 ‘‘(g) PARTNERSHIP INFORMATION COLLECTION.— 

21 ‘‘(1) DURING THE FIRST YEAR OF THE DEM22 ONSTRATION PROGRAM.— 

23 ‘‘(A) IN GENERAL.—During the first year 

24 of the demonstration program, the community 

25 care wrap-around support partnership, through 


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1 the designated care coordinator described in 

2 subsection (a)(1)(B)(i), shall maintain a record 

3 for each eligible older individual who is served 

4 through the demonstration program. Such 

5 record shall include detailed information about 

6 the services and supports provided to the eligi7 ble older individual through the demonstration 

8 program and shall be incorporated into the elec9 tronic health record of the eligible older indi10 vidual. 

11 ‘‘(B) CONTENTS.—The Assistant Secretary 

12 shall determine the information to be collected 

13 in each record described in subparagraph (A), 

14 which may include information on the types of 

15 services and supports provided, referrals, mem16 bers of the community care wrap-around sup17 port partnership, and an impact statement on 

18 the health of the eligible older individual served. 

19 ‘‘(2) DURING THE SECOND YEAR OF THE DEM20 ONSTRATION PROGRAM.—During the second year of 

21 the demonstration program, in addition to maintain22 ing the record described in paragraph (1), the des23 ignated care coordinator described in subsection 

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1 scribed in paragraph (1), the community care wrap2 around support partnership is able to— 

3 ‘‘(A) determine gaps in the provision of 

4 services that can assist in the provision of com5 prehensive health and wellness care for the eli6 gible older individual; 

7 ‘‘(B) connect the eligible older individual to 

8 services under this Act that will address any 

9 such gaps; and 

10 ‘‘(C) subject to the consent of the eligible 

11 older individual, make appointments for the eli12 gible older individual to receive needed services 

13 and ensure that the primary care physician and 

14 caregiver of such eligible older individual receive 

15 notice of the needs of such individual. 

16 ‘‘(h) DETERMINATION OF THE DEMONSTRATION

17 PROGRAM EFFECT ON PATIENT OUTCOMES.— 

18 ‘‘(1) TRANSFER OF INFORMATION.—Each eligi19 ble entity shall collect, from each community care 

20 wrap-around partnership supported by the eligible 

21 entity, and report to the Assistant Secretary (in 

22 such form and manner, and at such frequency, as 

23 shall be specified by the Assistant Secretary) such 

24 data as the Assistant Secretary determines to be apVerDate Sep 11 2014 02:22 Jun 18, 2015 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1574.IS S1574

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1 propriate to monitor and analyze the demonstration 

2 program. 

3 ‘‘(2) INDEPENDENT ANALYSIS OF THE DEM4 ONSTRATION PROGRAM.—The Assistant Secretary 

5 shall enter into an agreement with an entity to con6 duct an independent analysis, in consultation with 

7 the Administrator for the Centers for Medicare & 

8 Medicaid Services, and make a determination of 

9 whether the activities described in subsection (d) re10 sult in— 

11 ‘‘(A) a reduced number of hospital days 

12 (other than days an eligible older individual 

13 elects to remain in the hospital); 

14 ‘‘(B) reduced hospital readmissions for eli15 gible older individuals; 

16 ‘‘(C) reduced emergency room visits for eli17 gible older individuals; 

18 ‘‘(D) improved health outcomes commensu19 rate, in each individual case, with the eligible 

20 older individual’s stage of chronic illness; 

21 ‘‘(E) improved efficiency of care, such as a 

22 reduction of duplicative diagnostic and labora23 tory tests, for eligible older individuals; 

24 ‘‘(F) a reduced cost of health care services; 


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1 ‘‘(G) improved or maintained nutrition sta2 tus, to manage chronic disease; 

3 ‘‘(H) any delay of entry of eligible older in4 dividuals into institutional care; and 

5 ‘‘(I) any other outcomes measures the As6 sistant Secretary determines to be appropriate. 

7 ‘‘(3) IMPACT STUDY.— 

8 ‘‘(A) EVALUATION.—The Assistant Sec9 retary, in consultation with the Administrator 

10 for the Centers for Medicare & Medicaid Serv11 ices and using the information and data col12 lected under this subsection and subsection (g), 

13 shall conduct an evaluation of the demonstra14 tion program, including comparing the well15 being and costs of care of participants in a 

16 community care wrap-around support partner17 ship program, to the well-being and such costs 

18 for patients who have not participated in such 

19 a program, to determine the impact of the addi20 tional services and supports provided through 

21 such a program and shall prepare findings from 

22 the evaluation. 

23 ‘‘(B) DETERMINATION ON EXPANSION.— 

24 Based on the evaluation conducted under sub25 paragraph (A) and the independent analysis 


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1 conducted under paragraph (2), the Assistant 

2 Secretary, in consultation with the Adminis3 trator for the Centers for Medicare & Medicaid 

4 Services, shall determine whether expansion of 

5 the demonstration program is appropriate. If 

6 the determination is that such expansion is ap7 propriate, the Assistant Secretary, in consulta8 tion with such Administrator, shall prepare a 

9 plan specifying— 

10 ‘‘(i) whether the expanded program 

11 should involve a greater number of grants 

12 to eligible entities, for community care 

13 wrap-around support partnership programs 

14 based on subsections (a) through (g); 

15 ‘‘(ii) whether the expanded program 

16 should involve grants to regional, state17 wide, or multi-State combinations of eligi18 ble entities to engage corresponding com19 munity care wrap-around support partner20 ships in corresponding areas, for such pro21 grams based on subsections (a) through 

22 (g); and 

23 ‘‘(iii) whether the expanded program 

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1 tration on Aging and the Center for Medi2 care and Medicaid Innovation. 

3 ‘‘(4) REPORT TO CONGRESS.—Not later than 1 

4 year after the end of the demonstration program, 

5 the Assistant Secretary shall submit to Congress a 

6 report containing the findings, the results of the 

7 independent analysis, the determination, and any 

8 plan, prepared under paragraphs (1) through (3). 

9 ‘‘(5) EXPANDED PROGRAM.—Subject to the 

10 availability of appropriations, if the report contains 

11 a plan prepared under paragraph (3)(B), the Assist12 ant Secretary may implement the expanded pro13 gram, in accordance with the plan, not sooner than 

14 6 months after submission of the report. 

15 ‘‘(i) IMPLEMENTATION DATE.—Not later than Janu16 ary 1, 2016, the Assistant Secretary shall issue a request 

17 for proposals to carry out this section. 

18 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section 

20 such sums as may be necessary for each of fiscal years 

21 2016 through 2018.’’. 


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1 SEC. 3. PILOT PROJECT ON SERVICES FOR RECIPIENTS OF 

2 FEDERALLY ASSISTED HOUSING. 

3 Part A of title IV of the Older Americans Act of 1965 

4 (42 U.S.C. 3032 et seq.), as amended by section 2, is fur5 ther amended by adding at the end the following: 

6 ‘‘SEC. 424. PILOT PROJECT ON SERVICES FOR RECIPIENTS 

7 OF FEDERALLY ASSISTED HOUSING. 

8 ‘‘(a) DEFINITION.—In this section, the term ‘feder9 ally assisted housing’ means— 

10 ‘‘(1) multifamily housing financed, insured, or 

11 subsidized by the Rural Housing Service of the De12 partment of Agriculture or by the Department of 

13 Housing and Urban Development; or 

14 ‘‘(2) any housing with respect to which a credit 

15 is allowed under the low-income housing tax credit 

16 under section 42 of the Internal Revenue Code of 

17 1986. 

18 ‘‘(b) FUNDING.—The Assistant Secretary may pro19 vide funding for a service provided under this Act (includ20 ing title V) packaged and targeted for residents of feder21 ally assisted housing. The Assistant Secretary may provide 

22 such funding for a period of 2 years. 

23 ‘‘(c) RECIPIENTS.—The Assistant Secretary shall 

24 provide funding made available under subsection (b) 

25 through area agencies on aging, other entities approved 

26 by the Assistant Secretary, or designees of the agencies 


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1 or entities, to not-for-profit owners or managers of the 

2 housing. 

3 ‘‘(d) EVALUATIONS AND REPORTS.— 

4 ‘‘(1) EVALUATIONS.—Each agency, entity, or 

5 designee that receives funding under this section 

6 shall evaluate the effectiveness of the services pro7 vided through the funding. 

8 ‘‘(2) REPORTS.—The agency, entity, or des9 ignee shall, not later than 90 days after the end of 

10 the funding period, prepare and submit to the As11 sistant Secretary a report containing the results of 

12 the evaluation. 

13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 such sums as may be necessary for each of fiscal years 

16 2016 through 2018. Such sums shall remain available 

17 through fiscal year 2019 for the purpose of carrying out 

18 the evaluations and reports under subsection (d).’’. 

19 SEC. 4. NATIONAL CAMPAIGN TO RAISE AWARENESS OF 

20 THE AGING NETWORK AND TO PROMOTE AD21 VANCE INTEGRATED LONG-TERM CARE 

22 PLANNING. 

23 (a) IN GENERAL.—Section 202(b)(6) of the Older 

24 Americans Act of 1965 (42 U.S.C. 3012(b)(6)) is amend25 ed to read as follows: 


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1 ‘‘(6) promote, through a coordinated public 

2 education and outreach campaign carried out by the 

3 National Eldercare Locator Service described in sub4 section (a)(21) and in coordination with other appro5 priate Federal agencies— 

6 ‘‘(A) enhanced awareness by the public of 

7 the importance of planning in advance for inte8 grated long-term care; and 

9 ‘‘(B) the availability of national, State, and 

10 local information and resources to assist in such 

11 planning, as well as the existence of area agen12 cies on aging and other aging service providers 

13 to provide direct assistance with such plan14 ning;’’. 

15 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

16 216 of the Older Americans Act of 1965 (42 U.S.C. 

17 3020f) is amended— 

18 (1) by redesignating subsection (c) as sub19 section (d); and 

20 (2) by inserting after subsection (b) the fol21 lowing: 

22 ‘‘(c) NATIONAL CAMPAIGN ON INTEGRATED LONG23 TERM CARE PLANNING.—There are authorized to be ap24 propriated to carry out section 202(b)(6) such sums as 


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1 may be necessary for each of fiscal years 2016 through 

2 2018.’’. 

Æ 


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