I

103D CONGRESS

1ST SESSION H. R. 2002

To amend the Social Security Act to provide assistance to States in providing

services to support informal caregivers of individuals with functional

limitations.

IN THE HOUSE OF REPRESENTATIVES

MAY 5, 1993

Mr. LEVIN (for himself, Mr. MARKEY, and Mr. LEWIS of Georgia) introduced

the following bill; which was referred jointly to the Committees on Ways

and Means and Energy and Commerce

A BILL

To amend the Social Security Act to provide assistance to

States in providing services to support informal

caregivers of individuals with functional limitations.

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 ‘‘Family Caregiver Sup5 port Act of 1993’’.
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1 SEC. 2. FAMILY CAREGIVER SUPPORT PROGRAM ESTAB2 LISHED.

3 (a) IN GENERAL.—The Social Security Act (42

4 U.S.C. 301 et seq.) is amended by adding at the end there5 of the following new title:

6 ‘‘TITLE XXI—GRANTS TO STATES FOR FAMILY

7 CAREGIVER SUPPORT PROGRAMS

8 ‘‘PURPOSE OF TITLE; AUTHORIZATION OF

9 APPROPRIATIONS

10 ‘‘SEC. 2101. For the purpose of enabling each State

11 to furnish services to support informal caregivers of indi12 viduals with functional limitations by providing services

13 designed to facilitate and strengthen informal support sys14 tems to help maintain individuals with functional limita15 tions within the community, there are authorized to be ap16 propriated for each fiscal year such sums as may be nec17 essary to carry out the purposes of this title. The sums

18 made available under this section shall be used for making

19 payments to States which have submitted, and had ap20 proved by the Secretary, State plans for family caregiver

21 support services.

22 ‘‘STATE PLANS FOR FAMILY CAREGIVER SUPPORT

23 SERVICES

24 ‘‘SEC. 2102. A State plan for family caregiver sup25 port services must—
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1 ‘‘(1) provide that it shall be in effect in all po2 litical subdivisions of the State, and if administered

3 by them, be mandatory upon them;

4 ‘‘(2) provide for financial participation by the

5 State equal to not less than 50 percent of the ad6 ministrative costs of operating the program in the

7 State;

8 ‘‘(3) provide either for the establishment or des9 ignation of a single State agency or agencies (such

10 agency may be the same agency established or des11 ignated under section 1902 of this Act) to admin12 ister or supervise the administration of the plan in

13 coordination with home and community-based serv14 ices provided under title XIX of this Act;

15 ‘‘(4) describe the steps that will be taken to en16 sure that all State government agencies responsible

17 for the provision of family caregiver support services

18 funded under this title with other Federal or State

19 agencies or both on behalf of individuals with func20 tional limitations and their caregivers shall be in21 cluded in the development of the State plan so that

22 all such services are coordinated with all other types

23 of services and benefits such individuals and their

24 caregivers may be receiving (or are eligible to re25 ceive);
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1 ‘‘(5) describe the steps to be taken to ensure

2 equitable access to family caregiver support services

3 funded under this title for individuals of all ages

4 with functional limitations and their caregivers, in5 cluding individuals who have cognitive, mental, de6 velopmental, physical, sensory, or other impairments

7 that meet the criteria of section 2104(b)(1);

8 ‘‘(6) describe the manner in which family

9 caregiver support services funded under this title will

10 be organized, delivered, and coordinated, statewide

11 and within the various localities of the State, in

12 order to achieve the objectives specified in subpara13 graphs (4) and (5) of this subsection;

14 ‘‘(7) specify the procedures used in notifying

15 and obtaining input on the contents of the State

16 plan from non-governmental organizations and indi17 viduals with an interest in the welfare of individuals

18 with functional limitations;

19 ‘‘(8) provide that the State agency or agen20 cies—

21 ‘‘(A) make a determination of the need for

22 family caregiver support services for the individ23 ual with functional limitations;

24 ‘‘(B) establish quality assurance for the

25 delivery of family caregiver support services, in-
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1 cluding evaluation of individual and family sat2 isfaction with the services provided;

3 ‘‘(C) establish a family caregiver support

4 plan for each individual with functional limita5 tions for services under this title, and provide

6 for periodic review and revision as necessary;

7 and

8 ‘‘(D) establish reimbursement levels for

9 family caregiver support services;

10 ‘‘(9) provide that family caregiver support serv11 ices funded under this title to an individual with

12 functional limitations shall not supplant services oth13 erwise provided to such individual for which such in14 dividual is eligible under titles XVIII or XIX of this

15 Act or under any other public or private program;

16 ‘‘(10) provide—

17 ‘‘(A) that no copayment shall be required

18 for individuals with functional limitations with

19 incomes below 200 percent of the income offi20 cial poverty line (as determined by the Office of

21 Management and Budget and revised annually

22 in accordance with section 673(2) of the Omni23 bus Budget Reconciliation Act of 1981); and

24 ‘‘(B) that a copayment shall be required on

25 a sliding scale basis (as determined by the
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1 State) for individuals with functional limitations

2 with incomes in excess of 200 percent of such

3 income line; and

4 ‘‘(11) provide for making family caregiver sup5 port services available, including at least the care

6 and services described in paragraphs (1) through (4)

7 of section 2104(a) to all individuals with functional

8 limitations.

9 ‘‘PAYMENT TO STATES

10 ‘‘SEC. 2103. (a)(1) The Secretary (except as other11 wise provided in this section) shall pay to each State which

12 has a plan approved under this title, for each quarter, be13 ginning with the quarter commencing January 1, 1994—

14 ‘‘(A) an amount equal to 100 percent of the

15 total amount expended during such quarter as fam16 ily caregiver support services under the State plan

17 subject to the applicable Federal payment limitation

18 described in paragraph (2); and

19 ‘‘(B) an amount equal to 50 percent of so much

20 of the sums expended during such quarter as found

21 necessary by the Secretary for the proper and effi22 cient administration of the State plan (including

23 costs of needs determination and care planning).

24 ‘‘(2)(A) The applicable Federal payment limitation

25 described in this paragraph is $2,400 per calendar year
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1 per individual with functional limitations, reduced by the

2 offset, if any, described in subparagraph (B).

3 ‘‘(B) The total Federal payment to any State for each

4 individual with functional limitations for a calendar year

5 shall be reduced by the amount of any copayment paid

6 by such an individual for family caregiver support services

7 funded under this title in accordance with paragraph (10)

8 of section 2102.

9 ‘‘(b) No payment shall be made under this title with

10 respect to any amount expended for family caregiver sup11 port services in a calendar quarter for any individual with

12 functional limitations with an income in excess of $75,000

13 per year.

14 ‘‘DEFINITIONS

15 ‘‘SEC. 2104. (a) For purposes of this title, the term

16 ‘family caregiver support services’ means care and services

17 in the home, or in the community, provided on a tem18 porary, short term, intermittent, or emergency basis to

19 support a caregiver in caring for an individual with func20 tional limitations, including—

21 ‘‘(1) companion services;

22 ‘‘(2) homemaker services;

23 ‘‘(3) personal assistance;

24 ‘‘(4) day services in the community;
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1 ‘‘(5) temporary care in accredited or licensed

2 facilities (admission to a hospital or nursing home

3 for out-of-home care for a brief stay); and

4 ‘‘(6) such other services, as specified in a State

5 plan.

6 ‘‘(b)(1) For purposes of this title, an ‘individual with

7 functional limitations’—

8 ‘‘(A) is an individual 18 years of age or over

9 who—

10 ‘‘(i) cannot perform (without substantial

11 human assistance, including supervision) at

12 least 3 of the activities of daily living described

13 in subparagraphs (A) through (E) of paragraph

14 (2); or

15 ‘‘(ii) needs substantial human assistance or

16 supervision because of cognitive or other mental

17 impairment that—

18 ‘‘(I) impedes ability to function; or

19 ‘‘(II) causes behavior that poses a se20 rious health or safety hazard to such indi21 vidual or others; or

22 ‘‘(B) is a child who is receiving disability pay23 ments, or would be eligible for such payments, but

24 for the income or resource limitations considered for

25 determining eligibility under title XVI of this Act.
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1 ‘‘(2) The activities of daily living described in this

2 paragraph are—

3 ‘‘(A) toileting;

4 ‘‘(B) eating;

5 ‘‘(C) transferring;

6 ‘‘(D) dressing; and

7 ‘‘(E) bathing.

8 ‘‘(c) For purposes of this title, the term ‘caregiver’

9 means a spouse, parent, child, relative or other person

10 who—

11 ‘‘(A) has primary responsibility (as defined by

12 the Secretary) of providing care for one individual

13 with functional limitations;

14 ‘‘(B) does not receive financial remuneration for

15 providing such care for such individual; and

16 ‘‘(C) who has provided such care to such indi17 vidual for a period of not less than 3 months.

18 ‘‘(d) For purposes of this title, the term ‘family

19 caregiver support plan’ means a written plan, developed

20 in cooperation with the caregiver and the individual with

21 functional limitations to reflect their choices and pref22 erences for the type, frequency, and duration of family

23 caregiver support services to be provided under the plan.

24 ‘‘MAINTENANCE OF EFFORT

25 ‘‘SEC. 2105. States receiving payments under section

26 2103 must maintain current levels of funding for family
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1 caregiver support services to individuals with functional

2 limitations and their caregivers in order to be eligible to

3 continue to receive payments for such services under this

4 title.’’.

5 (b) EFFECTIVE DATE.—The amendment made by

6 subsection (a) shall become effective with respect to serv7 ices furnished on or after January 1, 1994.

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