IB Union Calendar No. 206 116th CONGRESS 1st Session H. R. 4334 [Report No. 116–258] IN THE HOUSE OF REPRESENTATIVES September 16, 2019 Ms. Bonamici (for herself, Ms. Stefanik , Mrs. Lee of Nevada , Mr. Comer , Ms. Wild , and Mr. Johnson of South Dakota ) introduced the following bill; which was referred to the Committee on Education and Labor October 28, 2019 Additional sponsors: Mr. Sablan , Mr. Guthrie , Ms. Stevens , Mr. Thompson of Pennsylvania , Mr. Courtney , Mr. Allen , Mr. Trone , Mr. Watkins , Mrs. Hayes , Mr. DeFazio , Mr. Fitzpatrick , Mr. Wright , Mr. David P. Roe of Tennessee , Mr. Walberg , Mr. Smucker , Mr. Meuser , Mr. Morelle , Mr. Keller , Mr. David Scott of Georgia , and Ms. Norton October 28, 2019 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed Strike out all after the enacting clause and insert the part printed in italic For text of introduced bill, see copy of bill as introduced on September 16, 2019 A BILL To amend the Older Americans Act of 1965 to authorize appropriations for fiscal years 2020 through 2024, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Dignity in Aging Act of 2019 . (b) Table of contents The table of contents of this Act is the following: Sec. 1. Short title; table of contents. Title I—Ensuring collaboration and promoting independence for older individuals Sec. 101. Person-centered, trauma-informed care. Sec. 102. Vaccination. Sec. 103. Functions of Assistant Secretary. Sec. 104.  Professional standards for nutrition official under the Assistant Secretary. Sec. 105. Interagency Coordinating Committee on Age-Friendly Communities. Sec. 106. Technical assistance on age-friendly communities. Sec. 107. Malnutrition. Sec. 108. Coordination with resource centers. Sec. 109. Arts education. Sec. 110. Social determinants of health. Sec. 111. Federal coordination of supports and services for living independently and safely at home. Sec. 112. Falls prevention and chronic disease self-management education. Sec. 113. Extension of RAISE Family Caregivers Act. Sec. 114. Support for socially-isolated older Americans. Sec. 115. Increased focus of Assistant Secretary on social isolation. Sec. 116. Advisory council on social isolation. Sec. 117. Supportive services and senior centers. Sec. 118. Demonstration projects. Sec. 119. Younger onset Alzheimer’s Disease. Sec. 120. Priority for the senior community service employment program. Sec. 121. Direct care workforce. Sec. 122. National resource center for older individuals experiencing the long-term and adverse consequences of trauma. Sec. 123. National Resource Center for Women and Retirement. Sec. 124. Definition. Sec. 125. Review of reports. Sec. 126. Area plans. Sec. 127. Addressing chronic pain management. Sec. 128. Extension of the Supporting Grandparents Raising Grandchildren Act. Sec. 129. Screening for suicide risk. Sec. 130. Traumatic brain injury. Sec. 131. Addressing public health emergencies and emerging health threats. Title II—Empowering the Aging Network to meet the needs of older individuals Sec. 201. National family caregiver support program cap. Sec. 202. Minimum funding level for State administrative expenses. Sec. 203. Culturally-appropriate, medically-tailored meals. Sec. 204. Business acumen provisions and clarification regarding outside funding for area agencies on aging. Sec. 205. Other practices. Sec. 206. Caregiver assessments. Sec. 207. Research and evaluation. Sec. 208. Grant program for multigenerational collaboration. Title III—Strengthening protections for older individuals Sec. 301. State Long-Term Care Ombudsman Program minimum funding and maintenance of effort. Sec. 302. State long-term care volunteer ombudsman representatives. Sec. 303. Clarification regarding board and care facilities. Title IV—Meeting the needs of older Native Americans Sec. 401. Expanding supportive services for Native American aging programs. Sec. 402. Enhancing capacity to support Native American aging programs. Title V—Miscellaneous Sec. 501. Technical corrections. Sec. 502. Authorization of appropriations; uses of funds. Sec. 503. Effective date. I Ensuring collaboration and promoting independence for older individuals 101. Person-centered, trauma-informed care Section 101(2) of the Older Americans Act of 1965 ( 42 U.S.C. 3001(2) ) is amended by inserting (including access to person-centered, trauma-informed care) after health . 102. Vaccination Section 102(14) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(14) ) is amended— (1) in subparagraph (B) by inserting immunization status, after oral health, , and (2) in subparagraph (D) by inserting infectious disease, and vaccine preventable disease, after disease), . 103. Functions of Assistant Secretary (a) Review of applications Section 202 of the Older Americans Act of 1965 ( 42 U.S.C. 3012 ) is amended— (1) by amending subsection (a)(4) to read as follows: (4) administer the grants provided by this Act but not approve an application submitted by an applicant for a grant for a program for which such applicant previously received a grant unless the Assistant Secretary determines— (A) the program for which such application was submitted is operating effectively to achieve its stated purpose; and (B) such applicant— (i) complied with the assurances provided to the Assistant Secretary with the application for such previous grant; and (ii) will comply with the assurances provided with the current submitted application; , and (2) by adding at the end the following: (h) The Assistant Secretary shall publish, on an annual basis, a list of centers and demonstration projects funded under each title of the Act. The Assistant Secretary shall ensure that this information is also directly provided to States and area agencies on aging. . (b) Addressing the needs of older individuals in disasters Section 202(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3012(a) ) is amended— (1) in paragraph (30) by striking and at the end, (2) in paragraph (31) by striking the period at the end and inserting ; and , and (3) by adding at the following at the end the following: (32) provide technical assistance to and share best practices with States and area agencies on aging on how to collaborate and coordinate activities and develop long-range emergency preparedness plans with local and State emergency response agencies, relief organizations, local and State governments, federal agencies as appropriate, and any other institutions that have responsibility for disaster relief service delivery. . 104. Professional standards for nutrition official under the Assistant Secretary Section 205(a)(2)(C)(ii) of the Older Americans Act of 1965 ( 42 U.S.C. 3016(a)(2)(C)(ii) is amended to read as follows: (ii) be a registered dietitian or registered dietitian nutritionist. . 105. Interagency Coordinating Committee on Age-Friendly Communities Section 203 of the Older Americans Act of 1965 ( 42 U.S.C. 3013 ) is amended— (1) in subsection (b)— (A) in paragraph (18) by striking and at the end, (B) in subparagraph (19) by striking the period at the end, and inserting , and , and (C) by adding at the end the following: (20) section 393D of the Public Health Service Act ( 42 U.S.C. 280b–1f ), relating to safety of seniors. , and (2) in subsection (c)— (A) in paragraph (1)— (i) by striking Aging and inserting Age-Friendly Communities , and (ii) by inserting to support the ability of older individuals to age in place, including through the provision of homelessness prevention services, support the ability of older individuals to access preventive health care, promote age-friendly communities, and address the ability of older individuals to access long-term care supports, including access to caregivers and home- and community-based services before the period at the end, (B) in paragraph (4) by inserting , except that the 1st term of a member appointed to the Interagency Coordinating Committee on Age-Friendly Communities shall begin not later than 1 year after the date of the enactment of the effective date of this exception before the period at the end, (C) in paragraph (5) by striking once each year and inserting semiannually , (D) in paragraph (6)— (i) in subparagraph (A)— (I) in clause (iii) by striking and at the end, (II) in clause (iv) by adding and at the end, and (III) by adding at the end the following: (v) identifying best practices for connecting older individuals to services for which they may be eligible; , (ii) by amending subparagraph (B)(ii) to read as follows: (ii) innovations in technology applications (including assistance technology devices and assistance technology services) that— (I) promote safe and accessible independent living environments; and (II) give older individuals access to information on available services or help in providing services to older individuals; , (iii) in subparagraph (E)— (I) by striking nongovernmental experts and organizations, including public health interest and research groups and foundations and inserting nongovernmental organizations, academic or research institutions, community-based organizations, and philanthropic organizations , and (II) by striking (F) and inserting (G) , (iv) by redesignating subparagraphs (E), (F), and (G) as subparagraphs (F), (G), and (H), respectively, (v) by inserting after subparagraph (D) the following: (E) work with the Centers for Disease Control and Prevention, the National Institute on Aging, Centers for Medicare and Medicaid Services, the Housing and Urban Development Office of Lead Hazard Control and Healthy Homes, and other Federal agencies as appropriate, to develop recommendations, in accordance with paragraph (1), to reduce falls among older individuals that incorporate evidence-based falls prevention programs and home modifications to reduce and prevent falls; , and (vi) by adding at the end the following: (9) In this subsection, the term age-friendly community means a community that-— (A) is taking steps— (i) to include accessible housing, accessible spaces and buildings, safe and secure paths, variable route transportation services, and programs and services designed to maintain health and well-being; (ii) to respect and include older individuals in social opportunities, civic participation, volunteerism, and employment; and (iii) to facilitate access to supportive services for older individuals; and (B) has a plan in place to meet local needs for housing, transportation, civic participation, social connectedness, and accessible spaces. . 106. Technical assistance on age-friendly communities Section 205(a)(2) of the Older Americans Act of 1965 ( 42 U.S.C. 3016(a)(2) ) is amended— (1) by redesignating subparagraph (C) as subparagraph (D), and (2) by inserting after subparagraph (B) the following: (C) The Assistant Secretary may provide technical assistance, including through the regional offices of the Administration, to State agencies, area agencies on aging, local government agencies, or leaders in age-friendly communities (as defined in section 203(c)(9)) regarding— (i) dissemination of, or consideration of ways to implement, best practices and recommendations from the Interagency Coordinating Committee on Age-Friendly Communities established under section 203(c); and (ii) methods for managing and coordinating existing programs to meet the needs of growing age-friendly communities. . 107. Malnutrition The Older Americans Act of 1965 ( 42 U.S.C. 2011 et seq.) is amended— (1) in section 102(14)(B) by inserting (including screening for malnutrition) before the semicolon at the end, and (2) in section 330(1) by striking and food insecurity and inserting , food insecurity, and malnutrition . 108. Coordination with resource centers (a) Area plans Section 306(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3026(a) ) is amended— (1) in paragraph (16) by striking and at the end, (2) in paragraph (17) by striking the period at the end and inserting ; and , and (3) by adding at the end the following: (18) provide assurances that the area agency on aging will collect data to determine the services that are needed by older individuals whose needs are the focus of all centers funded under title IV and the effectiveness of the programs, policies, and services provided by such area agency on aging in assisting these individuals. Each agency plan shall provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on those individuals whose needs are the focus of all centers established under title IV. This requirement applies to all centers funded on the day before the effective date of this paragraph. . (b) State plans Section 307(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3027 ) is amended by adding at the end the following: (31) The State shall prepare and submit to the Assistant Secretary annual reports on the data collected to determine the services that are needed by older individuals whose needs are the focus of all centers funded under title IV and the effectiveness of the programs, policies, and services provided by area agencies on aging in assisting these individuals. The reports shall describe any outreach efforts and other activities described in section 306(a)(18). This requirement applies to all centers funded on the day before the date of the enactment of the effective date of this paragraph. . 109. Arts education (a) Program design Section 202(a)(5) of the Older Americans Act of 1965 ( 42 U.S.C. 3012(a)(5) ) is amended by inserting cultural experiences, activities and services, including the arts, after education), . (b) Supportive services Section 321(a)(7) of the Older Americans Act of 1965 ( 42 U.S.C. 3030d(a)(7) ) is amended by inserting cultural experiences (including the arts), after art therapy, . 110. Social determinants of health Section 301(a)(1) of the Older Americans Act of 1965 ( 42 U.S.C. 3021(a)(1) ) is amended— (1) in subparagraph (C) by striking and at the end, (2) in subparagraph (D) by striking the period at the end and inserting ; and , and (3) by adding at the end the following: (E) address the social determinants of health of older individuals. . 111. Federal coordination of supports and services for living independently and safely at home Title II of the Older Americans Act of 1965 ( 42 U.S.C. 3011–3020 ) is amended by inserting after section 203A the following: 203B. Federal coordination of supports and services for living independently and safely at home (a) Initiative The Assistant Secretary shall carry out an initiative under this section to identify and disseminate information about Federal resources to promote falls prevention, home assessments, and home modifications, which may include in-home assistive technology, to enable older individuals to live independently and safely in a home environment. (b) Coordination of Federal efforts In carrying out the initiative under this section, the Assistant Secretary shall coordinate, through memoranda of understanding, agreements, or other appropriate means of coordination, with all Federal efforts and Federal programs in effect on the effective date of this section that support evidence-based falls prevention, home assessments, and home modifications, which may include in-home assistive technology, for older individuals, including older individuals with disabilities. (c) Reports Not later than 1 year after the effective date of this section, and triennially thereafter as needed, the Assistant Secretary shall publish a report that includes— (1) an inventory of the then current Federal programs that support evidence-based falls prevention, home assessments, and home modifications, which may include in-home assistive technology, for older individuals and older individuals with disabilities; (2) for the fiscal year of the report, statistical data on the number of older individuals and older individuals with disabilities served by each Federal program described in paragraph (1), including a demographic analysis and the approximate amount of Federal funding invested in each such program; (3) an evaluation of the impact of Federal programs that support falls prevention and home modifications, which may include in-home assistive technology, on health status and health outcomes in populations supported by such efforts and programs; and (4) information on the extent to which consumer-friendly resources, such as a brochure— (A) are available through the National Eldercare Locator Service established under section 202(a)(21); (B) are accessible to all area agencies on aging; and (C) contain information on home assessments and home modifications for older individuals attempting to live independently and safely in their homes and for the caregivers of such individuals. . 112. Falls prevention and chronic disease self-management education Section 411(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(a) ) is amended— (1) by redesignating paragraphs (13) and (14) as paragraphs (15) and (16), respectively, and (2) by inserting after paragraph (12) the following: (13) bringing to scale and sustaining evidence-based falls prevention programs that will reduce the number of falls, fear of falling, and fall-related injuries in older individuals and older individuals with disabilities; (14) bringing to scale and sustaining evidence-based chronic disease self-management programs that empower older individuals and older individuals with disabilities to better manage their chronic conditions; . 113. Extension of RAISE Family Caregivers Act Section 6 of the RAISE Family Caregivers Act ( Public Law 115–119 ; 132 Stat. 27) is amended by striking 3 and inserting 4 . 114. Support for socially-isolated older Americans Section 102(14) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(14) ) is amended— (1) in subparagraph (K) by striking and at the end, (2) in subparagraph (L) by striking (K) and inserting (L) , (3) by redesignating subparagraph (L) as subparagraph (M), and (4) by inserting after subparagraph (K) the following: (L) screening for the prevention of social isolation and coordination of supportive services and health care to address social isolation and loneliness; and . 115. Increased focus of Assistant Secretary on social isolation Section 202(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3012(a) ), as amended by section 103, is amended— (1) in paragraph (31) by striking ; and and inserting a semicolon, (2) in paragraph (32) by striking the period at the end and inserting ; and , and (3) by adding at the end the following: (33) develop objectives, priorities, and a long-term plan for supporting State and local efforts involving education about, prevention of, detection of, and response to social isolation among older individuals. . 116. Advisory council on social isolation Section 202 of the Older Americans Act of 1965 ( 42 U.S.C. 3012 ), as amended by section 103, is amended by adding at the end the following: (i) (1) The Assistant Secretary shall convene an advisory council on social isolation with aging network stakeholders, including caregivers, and select members in a manner that ensures geographic diversity of the members— (A) to review and evaluate efforts to address social isolation and loneliness among older individuals; and (B) to identify challenges, solutions, and best practices related to such efforts. (2) The advisory council convened under paragraph (1) shall— (A) ensure consideration of consumer-directed care models; and (B) submit a report to Congress on its findings. (3) The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply with respect to the advisory council convened under paragraph (1). . 117. Supportive services and senior centers Section 321(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3030d(a) ) is amended— (1) in paragraph (24) by striking and at the end, (2) by redesignating paragraph (25) as paragraph (26), and (3) by inserting after paragraph (24) the following: (25) services that promote or support social connectedness and reduce social isolation; and . 118. Demonstration projects (a) Demonstrations Section 411(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(a) ), as amended by section 112, is amended— (1) in paragraph (15) by striking and at the end, (2) by redesignating paragraph (16) as paragraph (17), and (3) by inserting after paragraph (15) the following: (16) projects that address social isolation and loneliness among older adults; and . (b) Repeal Section 416 of the Older Americans Act of 1965 ( 42 U.S.C. 3032e ) is repealed. 119. Younger onset Alzheimer’s Disease (a) Definition of family caregiver Section 302(3) of the Older Americans Act of 1965 ( 42 U.S.C. 3022(3) ) is amended by inserting of any age after an individual . (b) Definition of resident Section 711(6) of the Older Americans Act of 1965 ( 42 U.S.C. 3058(6) ) is amended by inserting of any age after individual . 120. Priority for the senior community service employment program The Older Americans Act of 1965 ( 42 U.S.C. 3001 et seq.) is amended— (1) in section 503(a)(4)(C)— (A) in clause (iii) by striking and at the end, (B) in clause (iv) by adding and at the end, and (C) by adding at the end the following: (v) eligible individuals who have been incarcerated or are under supervision following the release from prison or jail within the last 5 years; , (2) in section 514(e)(1) by inserting older individuals who have been incarcerated or are under supervision following the release from prison or jail, after need, , and (3) in section 518— (A) in subsection (a)(3)(B)(ii)— (i) in clause (IV) by striking or at the end, (ii) in clause (V) by striking the period at the end and inserting ; or , and (iii) by adding at the end the following: (VI) have been incarcerated or are under supervision following the release from prison or jail within the last 5 years. , and (B) in subsection (b)(2)— (i) in subparagraph (F) by striking or at the end, (ii) in subparagraph (G) by striking the period at the end and inserting ; or , (iii) by adding at the end the following: (H) has been incarcerated or is under supervision following the release from prison or jail within the last 5 years. . 121. Direct care workforce (a) Demonstrations Section 411(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(a) ), as amended by sections 112 and 118, is amended— (1) by redesignating paragraphs (16) and (17) as paragraphs (17) and (18), respectively, and (2) by inserting after paragraph (15) the following: (16) in coordination with the Secretary of Labor, the demonstration of new strategies for the recruitment, retention, or advancement of direct care workers, and to solicit, develop, and implement strategies— (A) to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract and retain direct care workers; (B) to provide supportive services and career planning for direct care workers; and (C) to support the advancement of direct care workers through education and workforce development programs that include necessary credential or licensing preparation, paid on-the-job training or work-based learning, and appropriate safety training; . (b) Older American community service employment program Section 502(e)(2)(B) of the Older Americans Act of 1965 ( 42 U.S.C. 3056(e)(2)(B) ) is amended— (1) in clause (iii) by striking and at the end, (2) in clause (iv) by adding and at the end, and (3) by adding at the end the following: (v) attract, retain, and advance the direct care workforce, in consultation with the Assistant Secretary, providing for wages and benefits needed to reduce barriers to entry for a diverse and high-quality direct care workforce, supportive services and career planning, and paid on-the-job training or work-based learning, with appropriate safety training; . 122. National resource center for older individuals experiencing the long-term and adverse consequences of trauma Section 411(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(a) ), as amended by sections 112, 118, and 121, is amended— (1) by redesignating paragraphs (17) and (18) as paragraphs (18) and (19), respectively, and (2) by inserting after paragraph (16) the following: (17) the implementation of a national resource center that shall— (A) provide training and technical assistance to agencies in the aging network delivering services to older individuals experiencing the long-term and adverse consequences of trauma; (B) share best practices with the aging network; and (C) make subgrants to the agencies best positioned to advance and improve the delivery of person-centered, trauma-informed services for older individuals experiencing the long-term and adverse consequences of trauma; . 123. National Resource Center for Women and Retirement Section 202 of the Older Americans Act of 1965 ( 42 U.S.C. 3012 ), as amended by sections 103 and 116, is amended by adding at the end the following: (j) (1) The Assistant Secretary shall, directly or by grant or contract, operate the National Resource Center for Women and Retirement (in this subsection referred to as the Center ). (2) The Center shall— (A) provide basic financial management, retirement planning, and other educational tools that promote financial wellness and help to identify and prevent fraud and elder exploitation, and integrate these with information on health and long-term care; (B) annually disseminate a summary of outreach provided, including work to provide user-friendly consumer information and public education materials; (C) develop targeted outreach strategies; (D) provide technical assistance to State agencies and to other public and nonprofit private agencies and organizations; and (E) develop partnerships and collaborations to address program objectives. . 124. Definition Section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 ) is amended— (1) by redesignating paragraphs (41) through (54) as paragraphs (42) through (55), and (2) by inserting after paragraph (40) the following: (41) The term person-centered, trauma-informed when used with respect to services means services provided through an aging program that— (A) use a holistic approach to providing services; (B) promote the dignity, strength and empowerment of victims of trauma; and (C) incorporate research-based practices based on knowledge about the role of trauma in trauma victims’ lives. . 125. Review of reports Sec. 308(b) of the Older Americans Act of 1965 ( 42 U.S.C. 3028(b) ) is amended by inserting at the end the following: (8) The Assistant Secretary shall review the reports submitted under section 307(a)(31), and include in the report required by section 207(a), aggregated data, including the effectiveness and outreach efforts included in 307(a)(31), on services that are needed by older individuals whose needs are the focus of all centers funded under title IV. This requirement applies to all centers funded on the day before the date of the effective date of this paragraph. . 126. Area plans Section 306(a)(4) of the Older Americans Act of 1965 ( 42 U.S.C. 3026(a)(4) ) is amended in subparagraph (B)(i)(VII) by inserting “, specifically including survivors of the Holocaust” after “placement”. 127. Addressing chronic pain management Section 102(14)(D) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(14) ) is amended by inserting chronic pain management, after substance abuse reduction, . 128. Extension of the Supporting Grandparents Raising Grandchildren Act Section 3(f) of the Supporting Grandparents Raising Grandchildren Act ( Public Law 115–196 ) is amended by striking “3” and inserting “4”. 129. Screening for suicide risk Section 102(14)(G) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(14)(G) ) is amended by inserting and screening for suicide risk after depression . 130. Traumatic brain injury (a) Definitions Section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 ), as amended by section 114, is amended— (1) in paragraph (14)— (A) in paragraph (M) by striking (L) and inserting (M) , (B) by redesignating subparagraphs (H) through (M) as subparagraphs (I) through (N), respectively, (C) by inserting after subparagraph (G) the following: (H) screening for fall-related traumatic brain injury, coordination of treatment, rehabilitation and related services, and referral services; , and (2) by adding at the end the following: (56) The term traumatic brain injury has the meaning given to it in section 339B(d) of the Public Health Service Act. . (b) Health screening Section 321(a)(8) of the Older Americans Act of 1965 (42 U.S.C.3030d(a)(8)) is amended to read as follows: (8) services designed to provide health screening (including mental and behavioral health screening, screening for social isolation and loneliness, falls prevention services screening and traumatic brain injury screening) to detect or prevent (or both) illnesses and injuries that occur most frequently in older individuals; . (c) Activities for health Section 411(a)(12) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(a)(12) ) is amended to read as follows: (12) building public awareness of cognitive impairments such as Alzheimer's disease and related disorders with neurological and organic brain dysfunction, depression, mental health disorders, and traumatic brain injury; . 131. Addressing public health emergencies and emerging health threats Section 102(14) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(14) ), as amended by sections 114 and 130, is amended— (1) in subparagraph (M) by striking and at the end, (2) in subparagraph (N) by striking (M) and inserting (N) , (3) by redesignating subparagraphs (K), (L), (M), and (N) as subparagraphs (L), (M), (N), and (O) respectively, and (4) by inserting after subparagraph (J) the following: (K) responses to public health emergencies and emerging health threats; . II Empowering the Aging Network to meet the needs of older individuals 201. National family caregiver support program cap (a) Federal share Section 373(g)(2) of the Older Americans Act of 1965 ( 42 U.S.C. 3030s–1(g)(2) ) is amended by striking subparagraph (C). (b) Monitoring the impact of the elimination of the cap on funds for older relative caregivers (1) Report Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Assistant Secretary shall submit to the Committee on Education and Labor of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the impact of the amendment made by subsection (a) to eliminate the limitation on funds that States may allocate to provide support services to older relative caregivers in the National Family Caregiver Support Program established under part E of title III of the Older Americans Act of 1965 (42 U.S.C. 3030s–3030s–2). Each such report shall also be made available to the public. (2) Contents For purposes of reports required by paragraph (1), each State that receives an allotment under such National Family Caregiver Support Program for fiscal year 2020 or a subsequent fiscal year shall report to the Assistant Secretary for the fiscal year involved the amount of funds of the total Federal and non-Federal share allotment used by the State to provide support services for caregiver support for older relative caregivers and family caregivers. 202. Minimum funding level for State administrative expenses Section 308(b)(2)(A) of the Older Americans Act of 1965 ( 42 U.S.C. 3028(b)(2)(B) ) is amended by striking $500,000 and inserting $750,000 . 203. Culturally-appropriate, medically-tailored meals Section 339(2)(A) of the Older Americans Act of 1965 ( 42 U.S.C. 3939h(2)(A) ) is amended by inserting , including cultural considerations and preferences (including needs based on religious, cultural, or ethnic requirements) and medically tailored meals before the comma at the end. 204. Business acumen provisions and clarification regarding outside funding for area agencies on aging (a) Assistance relating to growing and sustaining capacity Section 202(b)(9) of the Older Americans Act of 1965 ( 42 U.S.C. 3012(b)(9) ) is amended— (1) in subparagraph (A) by striking and after the semicolon at the end, (2) in subparagraph (B) by inserting and after the semicolon at the end, and (3) by adding at the end the following: (C) business acumen, capacity building, organizational development, innovation, and other methods of growing and sustaining the capacity of the aging network to serve older individuals and caregivers most effectively; . (b) Clarifying partnerships for area agencies on aging Section 306 of the Older Americans Act of 1965 ( 42 U.S.C. 3026 ) is amended by adding at the end the following: (g) Nothing in this Act shall restrict an area agency on aging from providing services not provided or authorized by this Act, including through— (1) contracts with health care payers; (2) consumer private pay programs; or (3) other arrangements with entities or individuals that increase the availability of home and community-based services and supports in the planning and service area supported by the area agency on aging. . 205. Other practices Section 315 of the Older Americans Act of 1965 ( 42 U.S.C. 3030c-2 ) is amended by adding at the end the following: (e) Response to area agencies on aging Upon request from an area agency on aging, the State shall make available any policies or guidance pertaining to policies under this section. . 206. Caregiver assessments (a) Definition of caregiver assessment Section 372(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3030s(a) ) is amended by adding at the end the following: (4) Caregiver assessment The term caregiver assessment means a systematic process of gathering information about the situation of a caregiver who voluntarily participates in such process to identify the caregiver’s specific needs, barriers, and existing supports as identified by the caregiver that— (A) provides the opportunity for the recognized caregiver to participate in such process; (B) requires direct contact with the caregiver and is used to appropriately target and tailor support services to the caregiver’s unique needs; and (C) includes reassessment of such specific needs, barriers, and existing supports, including to accommodate a significant change in the caregiving situation, which shall occur on a voluntary basis with the consent of the caregiver. . (b) Use of caregiver assessments Section 373(b) of the Older Americans Act of 1965 ( 42 U.S.C. 3030s–1(b) ) is amended by inserting may be informed through the use of caregiver assessments and after with, . (c) Technical assistance for caregiver assessments Section 373 of the Older Americans Act of 1965 ( 42 U.S.C. 3030s–1 ) is amended by adding at the end the following: (h) Technical assistance for caregiver assessments Not later than 1 year after the effective date of this subsection, the Assistant Secretary, in consultation with caregivers, older individuals, individuals with a disability who receive care from an older relative caregiver, the aging network, and other experts and stakeholders, shall provide technical assistance to promote and implement the use of caregiver assessments. Such technical assistance shall include sharing available tools and templates, comprehensive assessment protocols, and best practices concerning— (1) conducting caregiver assessments and reassessments; (2) implementing such assessments that are consistent across a planning and service area; and (3) implementing caregiver support service plans, including referrals to and coordination of activities with relevant State and local services. . (d) Reporting on caregiver assessment Section 373(e) of the Older Americans Act of 1965 ( 42 U.S.C. 3030s–1(e) ) is amended— (1) in paragraph (3) by inserting , including caregiver assessments used in the State, after mechanisms the 1st place it appears, and (2) by adding at the end the following: (4) Report on caregiver assessments (A) In general Not later than 3 years after the effective date of this paragraph, the Assistant Secretary shall issue a report on the use of caregiver assessments by area agencies on aging, entities contracting with such agencies, and organizations. Such report shall include— (i) an analysis of the current use of caregiver assessments, including a repository of caregiver assessment tools or templates and comprehensive assessment protocols; (ii) using objective data, an analysis of the impact of caregiver assessments on— (I) family caregivers and older relative caregivers; and (II) the individuals to whom the caregivers described in subclause (I) provide care; (iii) an analysis of the impact of using caregiver assessments on the aging network; (iv) an analysis of how caregiver assessments are being used to identify the specific needs, barriers, and existing supports of family caregivers and older relative caregivers; (v) recommendations for using caregiver assessments, including in rural or underserved areas; and (vi) feedback from State agencies and area agencies on aging, particularly in rural or underserved areas, on the implementation of caregiver assessments. (B) Submission Not later than 6 months after the issuance of the report under subparagraph (A), the Assistant Secretary shall submit the report to the Committee on Education and Labor of the House of Representatives, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Special Committee on Aging of the Senate. . 207. Research and evaluation Section 201 of the Older Americans Act of 1965 ( 42 U.S.C. 3011 ) is amended by adding at the end the following: (g) (1) The Assistant Secretary shall coordinate the research and evaluation functions of this Act under a National Research, Demonstration, and Evaluation Center for the Aging Network (in this subsection referred to as the Center ), which shall be headed by a director designated by the Assistant Secretary from individuals described in paragraph (4). (2) The purpose of the Center shall be— (A) to coordinate research, research dissemination, evaluation, demonstration projects, and related activities carried out under this Act; (B) to provide assessment of the programs authorized under this Act; and (C) to increase the repository of information on evidence-based programs and interventions available to the aging network. Such information shall be applicable to existing programs and help in the development of new evidence-based programs and interventions. (3) Activities of the Center shall include conducting, promoting, coordinating, and providing support for— (A) research and evaluation activities that support the objectives of this Act, including— (i) evaluation of new and existing programs and interventions authorized by this Act; and (ii) research on and assessment of the impacts that programs and interventions under this Act have on the health outcomes, social determinants of health, quality of life, and independence of individuals served under this Act; (B) demonstration projects that support the objectives of the Act and activities to bring effective demonstration projects to scale with a prioritization of projects that address the needs of underserved populations; (C) outreach and dissemination of research findings; and (D) technical assistance related to the activities described in this subparagraph. (4) The director shall be an individual with substantial knowledge of and experience in aging and health policy, and research administration. (5) Not later than October 1, 2020, and at 5-year intervals thereafter, the director shall prepare and publish in the Federal Register for public comment a draft of a 5-year plan that— (A) outlines priorities for research, research dissemination, evaluation, and related activities; (B) explains the basis for such priorities; and (C) describes how the plan will meet the needs of underserved populations. (6) The director shall, as appropriate, coordinate with other Federal departments and agencies involved in research in the field of aging. (7) Not later than December 31, 2020, and annually thereafter, the director shall prepare, and submit to the Secretary, the Committee on Health, Education, Labor, and Pensions of the Senate, the Special Committee on Aging of the Senate, and the Committee on Education and Labor of the House of Representatives, a report on the activities funded under this section and title IV. (8) The director shall, as appropriate, consult with experts on aging research and evaluation and aging network stakeholders on the implementation of the activities described under paragraph (3) of this subsection. (9) The director shall coordinate all research and evaluation authorities under this Act. . 208. Grant program for multigenerational collaboration Section 417 of the Older Americans Act of 1965 ( 42 U.S.C. 3032f ) is amended— (1) by amending subsection (a) to read as follows: (a) Grants and contracts The Assistant Secretary shall award grants to, and enter into contracts with, eligible organizations to carry out projects— (1) to provide opportunities for older individuals to participate in multigenerational activities and civic engagement activities that contribute to the health and wellness of older individuals and individuals in younger generations by developing— (A) meaningful roles for participants; (B) reciprocity in relationship building; (C) reduced social isolation and improved participant social connectedness; (D) improved economic well-being for older individuals; (E) increased lifelong learning; or (F) support for family caregivers by— (i) providing support for older relative caregivers (as defined in section 372) raising children (such as kinship navigator programs); or (ii) involving volunteers who are older individuals who provide support and information to families who have a child with a disability or chronic illness, or other families in need of such family support; (2) to coordinate multigenerational activities and civic engagement activities, including multigenerational nutrition and meal service programs; (3) to promote volunteerism, including becoming a mentor to young people; and (4) to facilitate development of and participation in multigenerational activities and civic engagement activities. , (2) by amending subsection (b) to read as follows: (b) Use of funds (1) In general An eligible organization shall use funds made available under a grant awarded, or a contract entered into, under this section to carry out a project described in subsection (a). (2) Provision of projects through grantees In making grants under this section, the Assistant Secretary shall ensure that awards are made for the activities and projects described in each of paragraphs (1) and (2) of subsection (a). ; (3) in subsection (c)— (A) in the matter preceding paragraph (1), by inserting that serves individuals in younger generations and older individuals after to carry out a project ; (B) in paragraph (1) by inserting , intent to carry out, or intent to partner with local organizations or multiservice organizations to carry out, after record of carrying out , (C) in paragraph (3) by striking ; and and inserting a semicolon, (D) in paragraph (4) by striking the period at the end and inserting ; and , and (E) by adding at the end the following: (5) eligible organizations proposing multigenerational activity projects that utilize shared site programs, such as collocated child care and long-term care facilities. , (4) by amending subsection (e) to read as follows: (e) Eligible organizations Organizations eligible to receive a grant or enter into a contract under subsection (a) shall— (1) be a State, an area agency on aging, or an organization that provides opportunities for older individuals to participate in activities described in such subsection; and (2) have the capacity to conduct the coordination, promotion, and facilitation described in such subsection through the use of multigenerational coordinators. , (5) by striking subsection (g), (6) in subsection (h)(2)(B)(i) by striking individuals from the generations with older individuals and inserting older individuals , (7) by redesignating subsections (b) through (f) as subsections (c) through (g), respectively, and (8) by inserting after subsection (a) the following: (b) Grant period Each grant awarded or contract made under subsection (a) shall be to carry out projects for a period of not less than 36 months. . III Strengthening protections for older individuals 301. State Long-Term Care Ombudsman Program minimum funding and maintenance of effort The Older Americans Act of 1965 ( 42 U.S.C. 3001 et seq.) is amended— (1) in section 306(a)(9)— (A) by inserting together with any other funds after Act , and (B) by striking 2000 and inserting 2019 , and (2) in section 307(a)(9)— (A) by striking an amount the 1st place it appears and inserting the total amount , (B) by striking 2000 and inserting 2019 each place it appears, and (C) by inserting from all sources including after received each place it appears. 302. State long-term care volunteer ombudsman representatives Section 712(a)(5) of the Older Americans Act of 1965 ( 42 U.S.C. 3058g(a)(5) ) is amended— (1) by redesignating subparagraph (D) as subparagraph (E), and (2) by inserting after subparagraph (C) the following: (D) Volunteer ombudsman representatives An individual designated as a volunteer ombudsman representative may receive financial support and recognition from the Office of the State Long-Term Care Ombudsman Program for expenses incurred during service. . 303. Clarification regarding board and care facilities Section 102(35)(C) of the Older Americans Act of 1965 ( 42 U.S.C. 3002(35)(C) ) is amended by striking for purposes of sections 307(a)(12) and 712, . IV Meeting the needs of older Native Americans 401. Expanding supportive services for Native American aging programs Title VI of the Older Americans Act of 1965 ( 42 U.S.C. 3057 et seq.) is amended— (1) in part D— (A) by amending section 643 to read as follows: 643. Authorization of appropriations There are authorized to be appropriated to carry out this title— (1) for parts A and B, $38,524,324 for fiscal year 2020, $40,835,783 for fiscal year 2021, $43,285,930 for fiscal year 2022, $45,883,086 for fiscal year 2023, and $48,636,071 for fiscal year 2024; and (2) for part C subject to section 644, $10,785,575 for fiscal year 2020, $11,432,710 for fiscal year 2021, $12,118,672 for fiscal year 2022, $12,845,792 for fiscal year 2023, and $13,616,540 for fiscal year 2024. , and (B) by adding at the end the following: 644. Funding set aside Of the funds appropriated under section 643(1) for a fiscal year, 5 percent shall be made available to carry out part D for such fiscal year. , (2) by redesignating part D as part E, and (3) by inserting after part C the following: D Supportive services for healthy aging and independence 636. Program (a) In general The Assistant Secretary shall carry out a demonstration program for making grants to tribal or Native Hawaiian organizations with applications approved under parts A and B, to pay for the Federal share of carrying out programs, to enable the organizations to provide a wider range of in-home and community supportive services to enable older individuals to maintain their health and independence and to avoid long-term care facility placement. (b) Supportive services (1) In general Subject to paragraph (2), supportive services described in subsection (a) may include any of the activities described in section 321(a). (2) Priority The Assistant Secretary, in making grants under this section, shall give priority to organizations that will use the grant funds for supportive services described in subsection (a) that are for in-home assistance, transportation, information and referral, case management, health and wellness programs, legal services, family caregiver support services, and other services that directly support the independence of the older individuals served. . 402. Enhancing capacity to support Native American aging programs Title II of the Older Americans Act of 1965 ( 42 U.S.C. 3011 et seq.) is amended— (1) in section 201(c)(3)(H) by inserting to ensure adequate capacity to deliver the services under such title, which technical assistance programs may include program management, data development and use, basic business skills, grant development, program and service innovations, and staff professional development and certification before the semicolon at the end, and (2) section 216 is amended to read as follows: 216. Authorization of appropriations (a) In general For purposes of carrying out this Act, there are authorized to be appropriated for administration, salaries, and expenses of the Administration $44,042,171 for fiscal year 2020, $46,684,701 for fiscal year 2021, $49,485,783 for fiscal year 2022, $52,454,930 for fiscal year 2023, and $55,602,226 for fiscal year 2024. (b) Authorization of appropriations for programs There are authorized to be appropriated— (1) to carry out section 201(g), $20,000,000 for each of the fiscal years 2020 through 2024; (2) to carry out section 202(a)(21) (relating to the National Eldercare Locator Service), $2,186,227 for fiscal year 2020, $2,317,401 for fiscal year 2021, $2,456,445 for fiscal year 2022, $2,603,832 for fiscal year 2023, and $2,760,062 for fiscal year 2024; (3) to carry out section 215, $1,992,460 for fiscal year 2020, $2,112,008 for fiscal year 2021, $2,238,728 for fiscal year 2022, $2,373,052 for fiscal year 2023, and $2,515,435 for fiscal year 2024; (4) to carry out section 202 (relating to Elder Rights Support Activities under this title), $1,375,011 for fiscal year 2020, $1,457,511 for fiscal year 2021, $1,544,962 for fiscal year 2022, $1,637,660 for fiscal year 2023, and $1,735,919 for fiscal year 2024; (5) to carry out section 202(b) (relating to the Aging and Disability Resource Centers), $8,708,043 for fiscal year 2020, $9,230,526 for fiscal year 2021, $9,784,357 for fiscal year 2022, $10,371,419 for fiscal year 2023, and $10,993,704 for fiscal year 2024; and (6) to carry out section 201(c)(3)(H) (relating to professional development and technical assistance for programs under title VI), $500,000 for fiscal year 2020. . V Miscellaneous 501. Technical corrections The Older Americans Act of 1965 ( 42 U.S.C. 3001 et seq.) is amended— (1) in section 102(37)(A) by striking paragraph (5) and inserting paragraph (26) , (2) in section 202(a)(23) by striking sections 307(a)(18) and 731(b)(2) and inserting sections 307(a)(13) and 731 , (3) in section 202(e)(1)(A) by moving the left margin of clause (i) 2 ems to the left, (4) in sections 203(c)(7), 207(b)(2)(B), and 215(i) by striking Committee on Education and the Workforce and inserting Committee on Education and Labor , (5) in section 207(b)(3)(A) by striking Administrator of the Health Care Finance Administration and inserting Administrator of the Centers for Medicare and Medicaid Services , (6) in section 304(a)(3)(C) by striking term and all that follows through does , and inserting term State does , (7) in section 306(a)— (A) by inserting the number of older individuals at risk for institutional placement residing in such area, after areas) residing in such area, the last place it appears, and (B) in paragraph (2) by striking who are victims of and inserting with , (8) in section 339 by striking Institute of Medicine of the National Academy of Sciences and inserting National Academies of Sciences, Engineering, and Medicine , (9) in section 611 by striking (a) , and (10) in section 614(c)(4) by striking “(a)(12)” and inserting “(a)(11)”. 502. Authorization of appropriations; uses of funds (a) Authorization of appropriations; uses of funds Section 303 of the Older Americans Act of 1965 ( 42 U.S.C. 3023 ) is amended to read as follows: 303. Authorization of appropriations; uses of funds (a) (1) There are authorized to be appropriated to carry out part B (relating to supportive services) $413,011,586 for fiscal year 2020, $437,792,281 for fiscal year 2021, $464,059,818 for fiscal year 2022, $491,903,407 for fiscal year 2023, and $521,417,612 for fiscal year 2024. (2) Funds appropriated under paragraph (1) shall be available to carry out section 712. (b) (1) There are authorized to be appropriated to carry out subpart 1 of part C (relating to congregate nutrition services) $531,279,663 for fiscal year 2020, $563,156,443 for fiscal year 2021, $596,945,830 for fiscal year 2022, $632,762,580 for fiscal year 2023, and $670,728,334 for fiscal year 2024. (2) There are authorized to be appropriated to carry out subpart 2 of part C (relating to home delivered nutrition services) $269,577,167 for fiscal year 2020, $285,751,797 for fiscal year 2021, $302,896,905 for fiscal year 2022, $321,070,719 for fiscal year 2023, and $340,334,963 for fiscal year 2024. (c) Grants made under part B, and subparts 1 and 2 of part C, of this title may be used for paying part of the cost of— (1) the administration of area plans by area agencies on aging designated under section 305(a)(2)(A), including the preparation of area plans on aging consistent with section 306 and the evaluation of activities carried out under such plans; and (2) the development of comprehensive and coordinated systems for supportive services, congregate and home delivered nutrition services under subparts 1 and 2 of part C, the development and operation of multipurpose senior centers, and the delivery of legal assistance. (d) There are authorized to be appropriated to carry out part D (relating to disease prevention and health promotion services) $26,650,753 for fiscal year 2020, $28,249,798 for fiscal year 2021, $29,944,786 for fiscal year 2022, $31,741,473 for fiscal year 2023, and $33,645,961 for fiscal year 2024. (e) There are authorized to be appropriated to carry out part E (relating to family caregiver support) $194,331,264 for fiscal year 2020, $205,991,140 for fiscal year 2021, $218,350,609 for fiscal year 2022, $231,451,645 for fiscal year 2023, and $245,338,744 for fiscal year 2024. . (b) Section 304(a)(3)(D) of the Older Americans Act of 1965 ( 42 U.S.C. 3024(a)(3)(D) ) is amended— (1) in clause (i) by striking 2017 through 2019 and inserting 2020 through 2024 , and (2) in clause (ii) by striking 2020 and inserting 2025 . (c) Section 311(e) of the Older Americans Act of 1965 ( 42 U.S.C. 3030a(e) ) is amended to read as follows: (e) There are authorized to be appropriated to carry out this section (other than subsection (c)(1)) $171,682,200 for fiscal year 2020, $181,983,132 for fiscal year 2021, $192,902,120 for fiscal year 2022, $204,476,247 for fiscal year 2023, and $216,744,822 for fiscal year 2024. . (d) Section 411(b) of the Older Americans Act of 1965 ( 42 U.S.C. 3032(b) ) is amended to read as follows: (b) Authorization of appropriations There are authorized to be appropriated to carry out— (1) aging network support activities under this section, $14,549,157 for fiscal year 2020, $15,422,107 for fiscal year 2021, $16,347,433 for fiscal year 2022, $17,328,279 for fiscal year 2023, and $18,367,976 for fiscal year 2024; and (2) elder rights support activities under this section, $15,650,667 for fiscal year 2020, $16,589,707 for fiscal year 2021, $17,585,090 for fiscal year 2022, $18,640,195 for fiscal year 2023, and $19,758,607 for fiscal year 2024. . (e) Section 517(a) of the Older Americans Act of 1965 ( 42 U.S.C. 3056o(a) ) is amended to read as follows: (a) In general There are authorized to be appropriated to carry out this title $429,020,486 for fiscal year 2020, $454,761,715 for fiscal year 2021, $482,047,418 for fiscal year 2022, $510,970,263 for fiscal year 2023, and $541,628,478 for fiscal year 2024. . (f) Section 702 of the Older Americans Act of 1965 (42 U.S.C.3058a) is amended to read as follows: 702. Authorization of appropriations (a) Ombudsman program There are authorized to be appropriated to carry out chapter 2, $18,110,027 for fiscal year 2020, $19,196,629 for fiscal year 2021, $20,348,427 for fiscal year 2022, $21,569,332 for fiscal year 2023, and $22,863,492 for fiscal year 2024. (b) Other programs There are authorized to be appropriated to carry out chapters 3 and 4, $5,119,287 for fiscal year 2020, $5,426,444 for fiscal year 2021, $5,752,031 for fiscal year 2022, $6,097,153 for fiscal year 2023, and $6,462,982 for fiscal year 2024. . 503. Effective date This Act shall take effect on October 1, 2019.

October 28, 2019 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed