I 
118TH CONGRESS 
1ST SESSION H. R. 2718 
To reauthorize funding for programs to prevent, investigate, and prosecute 
elder abuse, neglect, and exploitation, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 19, 2023 
Mr. NEAL (for himself and Ms. BONAMICI) introduced the following bill; which 
was referred to the Committee on Ways and Means, and in addition to 
the Committees on Energy and Commerce, Education and the Workforce, 
and the Judiciary, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To reauthorize funding for programs to prevent, investigate, 
and prosecute elder abuse, neglect, and exploitation, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Elder Justice Reau-
thorization and Modernization Act of 2023’’. 
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SEC. 2. REAUTHORIZATION OF FUNDING FOR PROGRAMS 
TO 
PREVENT 
AND 
INVESTIGATE 
ELDER 
ABUSE, NEGLECT, AND EXPLOITATION. 
(a) NURSING HOME WORKER TRAINING GRANTS.— 
Section 2041 of the Social Security Act (42 U.S.C. 
1397m) is amended to read as follows: 
‘‘SEC. 2041. NURSING HOME WORKER TRAINING GRANTS. 
‘‘(a) IN GENERAL.— 
‘‘(1) STATE ENTITLEMENT.— 
‘‘(A) IN GENERAL.—Each State shall be 
entitled to receive from the Secretary for each 
fiscal year specified in subsection (e)(1) a grant 
in an amount equal to the amount allotted to 
the State under subparagraph (B). 
‘‘(B) STATE ALLOTMENTS.— 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii) and (iii), the amount allotted to a 
State under this subparagraph for a fiscal 
year shall be— 
‘‘(I) the number of State resi-
dents who have attained 65 years of 
age or have a disability (as defined in 
section 216(i)(1)), as determined by 
the Secretary using the most recent 
version of the American Community 
Survey published by the Bureau of the 
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Census or a successor data set; di-
vided by 
‘‘(II) the total number of such 
residents of all States. 
‘‘(ii) LIMITATION.—The amount allot-
ted to a State under this subparagraph for 
a fiscal year shall be not less than 0.25 
percent of the available amount for the fis-
cal year. 
‘‘(iii) ADJUSTMENT OF STATE ALLOT-
MENTS.—Subject to clause (ii), the Sec-
retary shall proportionately increase or de-
crease the amounts allotted under this sub-
paragraph for a fiscal year as necessary to 
ensure that the available amount for the 
fiscal year is allotted among the States. 
‘‘(iv) REDETERMINATIONS.— 
‘‘(I) 
FREQUENCY.—The 
Sec-
retary shall make the determination 
referred to in clause (i)(I) every 5 
years. 
‘‘(II) LIMITATION.—Subject to 
clause (ii), the amount allotted to a 
State under this subparagraph, on the 
basis of such a determination, for a 
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fiscal year after fiscal year 2028 shall 
be— 
‘‘(aa) not less than 90 per-
cent of the amount of the grant 
made to the State under this 
subparagraph for the then pre-
ceding fiscal year; and 
‘‘(bb) not more than 110 
percent of the amount referred to 
in item (aa). 
‘‘(2) GRANTS TO INDIAN TRIBES AND TRIBAL 
ORGANIZATIONS.— 
‘‘(A) IN GENERAL.—The Secretary, in con-
sultation with the Secretary of the Interior, 
shall make grants in accordance with this sec-
tion to Indian tribes and tribal organizations 
who operate at least 1 eligible setting. 
‘‘(B) GRANT FORMULA.—The Secretary, in 
consultation with the Secretary of the Interior, 
shall devise a formula for distributing among 
Indian tribes and tribal organizations the 
amount required to be reserved by subsection 
(e)(1) for each fiscal year. 
‘‘(3) SUB-GRANTS.—A State, Indian tribe, or 
tribal organization to which an amount is paid under 
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this section may use the amount to make sub-grants 
to local organizations, including community organi-
zations, local non-profits, elder rights and justice 
groups, and workforce development boards for any 
purpose described in paragraph (1) or (2) of sub-
section (b). 
‘‘(b) USE OF FUNDS.— 
‘‘(1) REQUIRED USES.—A State to which an 
amount is paid under this section shall use the 
amount to— 
‘‘(A) provide wage subsidies to eligible in-
dividuals; 
‘‘(B) provide tuition assistance to, and di-
rectly pay the cost of applicable licensing exam 
fees for, eligible individuals for a degree or cer-
tification in a field relevant to their position re-
ferred to in subsection (f)(1)(A); 
‘‘(C) provide, subsidize, or facilitate access 
to child care for eligible individuals, including 
help with referrals, co-pays, or other direct as-
sistance as needed; and 
‘‘(D) provide assistance where necessary 
with obtaining appropriate transportation, in-
cluding public transportation if available, or gas 
money or transit vouchers for ride share, taxis, 
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and similar types of transportation if public 
transportation is unavailable or impractical 
based on work hours or location. 
‘‘(2) AUTHORIZED USES.—A State to which an 
amount is paid under this section may use the 
amount to— 
‘‘(A) establish a reserve fund for financial 
assistance to eligible individuals in emergency 
situations; 
‘‘(B) provide in-kind resource donations, 
such as interview clothing and conference at-
tendance fees; 
‘‘(C) provide assistance with programs and 
activities, including legal assistance, deemed 
necessary to address arrest or conviction 
records that are an employment barrier; 
‘‘(D) support employers operating an eligi-
ble setting in the State in providing employees 
with not less than 2 weeks of paid leave per 
year; or 
‘‘(E) provide other support services the 
Secretary deems necessary to allow for success-
ful recruitment and retention of workers. 
‘‘(3) PROVISION
OF
FUNDS
ONLY
FOR
THE 
BENEFIT
OF
ELIGIBLE
INDIVIDUALS
IN
ELIGIBLE 
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SETTINGS.—A State to which an amount is paid 
under this section may provide the amount to only 
an eligible individual or a partner organization serv-
ing an eligible individual. 
‘‘(4) NONSUPPLANTATION.—A State to which 
an amount is paid under this section shall not use 
the amount to supplant the expenditure of any State 
funds for recruiting, supporting, or retaining em-
ployees in an eligible setting. 
‘‘(5) OBLIGATION DEADLINE.—A State, Indian 
tribe, or tribal organization shall remit to the Sec-
retary for reallotment under this section any amount 
paid under this section for a fiscal year that is not 
obligated within 2 years after the end of the fiscal 
year. 
‘‘(c) ADMINISTRATION.—A State to which a grant is 
made under this section shall reserve not more than 10 
percent of the grant to— 
‘‘(1) administer subgrants in accordance with 
this section; 
‘‘(2) provide technical assistance and support 
for applying for and accessing such a subgrant op-
portunity; 
‘‘(3) publicize the availability of the subgrants; 
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‘‘(4) carry out activities to increase the supply 
of eligible individuals; and 
‘‘(5) provide technical assistance to help sub-
grantees find and train individuals to provide the 
services for which they are contracted. 
‘‘(d) REPORTS.— 
‘‘(1) STATE
REPORTS.—Not less frequently 
than annually, each State to which a grant has been 
made under this section shall transmit to the Sec-
retary a written report describing the activities un-
dertaken by the State pursuant to this section dur-
ing the period covered by the report, which shall in-
clude a specification of— 
‘‘(A) the total amount expended in the 
State for each type of use described in para-
graph (1) or (2) of subsection (b); 
‘‘(B) the total number of non-State organi-
zations in the State to which grant funds were 
provided, and the amount so provided to each 
such organization; 
‘‘(C) the change in the number of individ-
uals working in each job category described in 
subsection (f)(1)(A) in an eligible setting in the 
State due to programs or services funded with 
grants under this section; 
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‘‘(D) the average duration of employment 
for each such job category for individuals re-
ceiving, or who previously received, services or 
supports from a grant under this section; 
‘‘(E) wages of workers in each job category 
described in subsection (f)(1)(A) in an eligible 
setting in the State with support from grants 
under this section, as compared to all other 
workers in the same eligible setting in the 
State; 
‘‘(F) the average amount of paid time off 
to which a worker in each job category de-
scribed in subsection (f)(1)(A) in an eligible set-
ting in the State is entitled by their contract 
among workers with support from a grant 
under this section, as compared to all workers 
in eligible settings in the State; and 
‘‘(G) such other data elements as the Sec-
retary deems relevant. 
‘‘(2) REPORT TO THE CONGRESS.—Not later 
than 3 years after the date of the enactment of this 
section, and every 4 years thereafter, the Secretary 
shall submit to the Congress a written report out-
lining how the States have used the grants made 
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under this section during the period covered by the 
report, which shall include— 
‘‘(A) the total amount expended in each 
State for each type of use described in para-
graph (1) or (2) of subsection (b); 
‘‘(B) the total number of non-State organi-
zations in each State to which grant funds were 
provided, and the amount so provided to each 
such organization; 
‘‘(C) an analysis of the data provided in 
the State reports; and 
‘‘(D) such other data elements as the Sec-
retary deems relevant. 
‘‘(e) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Secretary $400,000,000 for each of fiscal 
years 2024 through 2027 to carry out this section, of 
which 2 percent shall be reserved for grants to Indian 
tribes and tribal organizations. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) AVAILABLE AMOUNT.—The term ‘available 
amount’ means, with respect to a fiscal year, the 
amount specified in subsection (e) that remains after 
the reservation required by such subsection for the 
fiscal year, plus all amounts remitted to the Sec-
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retary under subsection (b)(5) that have not been 
reallotted under subsection (a)(1)(B)(iii). 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual who— 
‘‘(A)(i) is a qualified home health aide, as 
defined in section 484.80(a) of title 42, Code of 
Federal Regulations; 
‘‘(ii) is a nurse aide approved by the State 
as meeting the requirements of sections 
483.150 through 483.154 of such title, and is 
listed in good standing on the State nurse aide 
registry; 
‘‘(iii) is a personal care aide approved by 
the State, and furnishes personal care services, 
as defined in section 440.167 of such title; 
‘‘(iv) is a qualified hospice aide, as defined 
in section 418.76 of such title; 
‘‘(v) is a licensed practical nurse or a li-
censed or certified social worker; or 
‘‘(vi) is receiving training to be certified or 
licensed as such an aide, nurse, or social work-
er; and 
‘‘(B) provides (or, in the case of a trainee, 
intends to provide) services as such an aide, 
nurse, or social worker in an eligible setting. 
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‘‘(3) ELIGIBLE
SETTING.—The term ‘eligible 
setting’ means— 
‘‘(A) a skilled nursing facility, as defined 
in section 1819; 
‘‘(B) a nursing facility, as defined in sec-
tion 1919; 
‘‘(C) a home health agency, as defined in 
section 1891; 
‘‘(D) a facility approved to deliver home or 
community-based services authorized under 
State options described in subsection (c) or (i) 
of section 1915 or, as relevant, demonstration 
projects authorized under section 1115; 
‘‘(E) a hospice, as defined in section 1814; 
or 
‘‘(F) a tribal assisted living facility. 
‘‘(4) TRIBAL ORGANIZATION.—The term ‘tribal 
organization’ has the meaning given the term in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act.’’. 
(b) ADULT PROTECTIVE SERVICES FUNCTIONS AND 
GRANT PROGRAMS.— 
(1) DIRECT FUNDING; STATE ENTITLEMENT.— 
Section 2042 of the Social Security Act (42 U.S.C. 
1397m–1) is amended— 
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(A) in subsection (a), by striking para-
graph (2) and inserting the following: 
‘‘(2) APPROPRIATION.—Out of any money in 
the Treasury not otherwise appropriated, there are 
appropriated to the Secretary $8,000,000 for each of 
fiscal years 2024 through 2027 to carry out this sec-
tion.’’; 
(B) in subsection (b)— 
(i) in paragraph (2), by striking ‘‘the 
availability of appropriations and’’; and 
(ii) by striking paragraph (5) and in-
serting the following: 
‘‘(5) APPROPRIATION.—Out of any money in 
the Treasury not otherwise appropriated, there are 
appropriated to the Secretary $400,000,000 for each 
of fiscal years 2024 through 2027 to carry out this 
section.’’; and 
(C) in subsection (c), by striking para-
graph (6) and inserting the following: 
‘‘(6) APPROPRIATION.—Out of any money in 
the Treasury not otherwise appropriated, there are 
appropriated to the Secretary $75,000,000 for each 
of fiscal years 2024 through 2027 to carry out this 
section.’’. 
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(II) by inserting ‘‘amount so ap-
propriated’’ and inserting ‘‘remaining 
amount’’; and 
(D) in subsection (b), by redesignating 
paragraphs (3) through (5) as paragraphs (4) 
through (6), respectively, and inserting after 
paragraph (2) the following: 
‘‘(3) AMOUNT OF PAYMENT TO INDIAN TRIBE 
OR TRIBAL ORGANIZATION.— 
‘‘(A) IN GENERAL.—The Secretary, in con-
sultation with Indian tribes and tribal organiza-
tions, shall determine the amount of any grant 
to be made to each Indian tribe and tribal orga-
nization from the amount reserved under sub-
paragraph (B) of this paragraph. Paragraphs 
(4) and (5) shall apply to grantees under this 
paragraph in the same manner in which the 
paragraphs apply to States. 
‘‘(B) RESERVATION OF FUNDS.—The Sec-
retary shall reserve 2 percent of the amount 
made available by subsection (b)(6) for each fis-
cal year for grants under this paragraph.’’; 
(3) in subsection (c)— 
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(A) in paragraph (1), by striking ‘‘to 
States’’ and inserting ‘‘to States, Indian tribes, 
and tribal organizations’’; 
(B) in paragraph (2)— 
(i) in the matter preceding subpara-
graph (A), by inserting ‘‘and Indian tribes 
and tribal organizations’’ after ‘‘govern-
ment’’; and 
(ii) in subparagraph (D), by inserting 
‘‘or Indian tribe or tribal organization, as 
the case may be’’ after ‘‘government’’; 
(C) in paragraph (4), by inserting ‘‘or In-
dian tribe or tribal organization’’ after ‘‘a 
State’’ the first place it appears; and 
(D) in paragraph (5)— 
(i) by inserting ‘‘or Indian tribe or 
tribal organization’’ after ‘‘Each State’’; 
and 
(ii) by inserting ‘‘or Indian tribe or 
tribal organization, as the case may be’’ 
after ‘‘the State’’; and 
(4) by adding at the end the following: 
‘‘(d) DEFINITIONS OF INDIAN TRIBE AND TRIBAL 
ORGANIZATION.—In this section, the terms ‘Indian tribe’ 
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and ‘tribal organization’ have the meanings given the 
terms in section 419.’’. 
(c) LONG-TERM
CARE
OMBUDSMAN
PROGRAM 
GRANTS AND TRAINING.—Section 2043 of the Social Se-
curity Act (42 U.S.C. 1397m–2) is amended— 
(1) in subsection (a), by striking paragraph (2) 
and inserting the following: 
‘‘(2) APPROPRIATION.—Out of any money in 
the Treasury not otherwise appropriated, there are 
appropriated to the Secretary to carry out this sub-
section— 
‘‘(A) $22,500,000 for fiscal year 2024; and 
‘‘(B) $30,000,000 for each of fiscal years 
2025 and 2026.’’; and 
(2) in subsection (b), by striking paragraph (2) 
and inserting the following: 
‘‘(2) APPROPRIATION.—Out of any money in 
the Treasury not otherwise appropriated, there are 
appropriated to the Secretary $30,000,000 for each 
of fiscal years 2024 through 2027 to carry out this 
subsection.’’. 
(d) INCENTIVES FOR DEVELOPING AND SUSTAINING 
STRUCTURAL COMPETENCY IN PROVIDING HEALTH AND 
HUMAN SERVICES.— 
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(1) IN GENERAL.—Part II of subtitle B of title 
XX of the Social Security Act (42 U.S.C. 397m–5) 
is amended by adding at the end the following: 
‘‘SEC. 2047. INCENTIVES FOR DEVELOPING AND SUS-
TAINING STRUCTURAL COMPETENCY IN PRO-
VIDING HEALTH AND HUMAN SERVICES. 
‘‘(a) GRANTS TO STATES TO SUPPORT LINKAGES TO 
LEGAL
SERVICES
AND
MEDICAL-LEGAL
PARTNER-
SHIPS.— 
‘‘(1) IN GENERAL.—Within 2 years after the 
date of the enactment of this section, the Secretary 
shall establish and administer a program of grants 
to States to support the development or adoption of 
approaches to maintain or improve linkages between 
health services, human services, and legal services 
for older adults and adults with disabilities, includ-
ing through the following: 
‘‘(A) MEDICAL-LEGAL
PARTNERSHIPS.— 
The establishment and support of medical-legal 
partnerships, the incorporation of the partner-
ships in the elder justice framework and health 
and human services safety net, and the imple-
mentation and operation of such a partnership 
by an eligible grantee— 
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‘‘(i) at the option of a State, in con-
junction with an area agency on aging; 
‘‘(ii) in a solo provider practice in a 
health professional shortage area (as de-
fined in section 332(a) of the Public 
Health Service Act), a medically under-
served community (as defined in section 
399V of such Act), or a rural area (as de-
fined in section 330J of such Act); 
‘‘(iii) in a minority-serving institution 
of higher learning with health, law, and so-
cial services professional programs; 
‘‘(iv) in a federally qualified health 
center, as described in section 330 of the 
Public Health Service Act, or look-alike, as 
described in section 1905(l)(2)(B) of this 
Act; or 
‘‘(v) in certain hospitals that are crit-
ical access hospitals, Medicare-dependent 
hospitals, sole community hospitals, rural 
emergency hospitals, or that serve a high 
proportion of Medicare or Medicaid pa-
tients. 
‘‘(B) LEGAL HOTLINES DEVELOPMENT OR 
EXPANSION.—The provision of incentives to de-
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