II 118th CONGRESS 1st Session S. 1198 IN THE SENATE OF THE UNITED STATES April 19, 2023 Mr. Wyden (for himself and Mr. Casey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To reauthorize funding for programs to prevent and investigate elder abuse, neglect, and exploitation, and for other purposes.

1. Short title This Act may be cited as the Elder Justice Reauthorization and Modernization Act of 2023 . 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: 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 residents 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 Census (or a successor data set); divided by (II) the total number of such residents of all States. (ii) Limitation The amount allotted to a State under this subparagraph for a fiscal year shall be not less than 0.25 percent of the available amount for the fiscal year. (iii) Adjustment of State allotments Subject to clause (ii), the Secretary shall proportionately increase or decrease the amounts allotted under this subparagraph 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 Secretary 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 fiscal year after fiscal year 2028 shall be— (aa) not less than 90 percent of the amount of the grant made to the State under this subparagraph for the then preceding 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 consultation with the Secretary of the Interior, shall make grants in accordance with this section 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 this section may use the amount to make sub-grants to local organizations, including community organizations, local non-profits, elder rights and justice groups, and workforce development boards for any purpose described in paragraph (1) or (2) of subsection (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 individuals; (B) provide tuition assistance to, and directly pay the cost of applicable licensing exam fees for, eligible individuals for a degree or certification in a field relevant to their position referred 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 assistance as needed; and (D) provide assistance where necessary with obtaining appropriate transportation, including public transportation if available, or gas money or transit vouchers for ride share, taxis, 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 attendance 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 eligible 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 successful recruitment and retention of workers. (3) Provision of funds only for the benefit of eligible individuals in eligible 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 serving 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 employees in an eligible setting. (5) Obligation deadline A State, Indian tribe, or tribal organization shall remit to the Secretary 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 opportunity; (3) publicize the availability of the subgrants; (4) carry out activities to increase the supply of eligible individuals; and (5) provide technical assistance to help subgrantees find and train individuals to provide the services for which such individuals 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 Secretary a written report describing the activities undertaken by the State pursuant to this section during the period covered by the report, which shall include a specification of— (A) the total amount expended in the State for each type of use described in paragraph (1) or (2) of subsection (b); (B) the total number of non-State organizations 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 individuals 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; (D) the average duration of employment for each such job category for individuals receiving, 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 described in subsection (f)(1)(A) in an eligible setting 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 Secretary deems relevant. (2) Report to 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 Congress a written report outlining how the States have used the grants made 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 paragraph (1) or (2) of subsection (b); (B) the total number of non-State organizations 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 Secretary deems relevant. (e) Appropriation Out of any funds in the Treasury not otherwise appropriated, there is appropriated 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 Secretary 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 licensed or certified social worker; or (vi) is receiving training to be certified or licensed as such an aide, nurse, or social worker; 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. (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 section 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 section 4 of the Indian Self-Determination and Education 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— (A) 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 $8,000,000 for each of fiscal years 2024 through 2027 to carry out this section. ; (B) in subsection (b)— (i) in paragraph (2)(A), by striking the availability of appropriations and ; and (ii) by striking paragraph (5) and inserting 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 paragraph (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. . (2) State entitlement; grants to Indian tribes and tribal organizations Section 2042 of such Act ( 42 U.S.C. 1397m–1 ), as amended by paragraph (1), is amended— (A) in subsection (a)(1)(A), by striking State and local and inserting State, local, and tribal ; (B) in subsection (b)— (i) in paragraph (1), by striking the Secretary shall annually award grants to States in the amounts calculated under paragraph (2) and inserting each State shall be entitled to annually receive from the Secretary in the amounts calculated under paragraph (2), and the Secretary may annually award to each Indian tribe and tribal organization in accordance with paragraph (3), grants ; (ii) in paragraph (2)— (I) in the paragraph heading, by inserting for a State after payment ; (II) in subparagraph (A), by inserting that remains after the reservation under paragraph (3)(B) before multiplied ; and (III) in subparagraph (B)(i)— (aa) by inserting that so remains after such year ; and (bb) by striking amount so appropriated and inserting remaining amount ; and (iii) 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 consultation with Indian tribes and tribal organizations, shall determine the amount of any grant to be made to each Indian tribe and tribal organization from the amount reserved under subparagraph (B). Paragraphs (4) and (5) shall apply to grantees under this paragraph in the same manner in which such paragraphs apply to States. (B) Reservation of funds The Secretary shall reserve 2 percent of the amount made available by subsection (b)(6) for each fiscal year for grants under this paragraph. ; (C) in subsection (c)— (i) in paragraph (1), by striking to States and inserting to States, Indian tribes, and tribal organizations ; (ii) in paragraph (2)— (I) in the matter preceding subparagraph (A), by inserting and Indian tribes and tribal organizations after government ; and (II) in subparagraph (D), by inserting or Indian tribe or tribal organization, as the case may be after government ; (iii) in paragraph (4), by inserting or Indian tribe or tribal organization after a State the first place it appears; and (iv) 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 (D) by adding at the end the following: (d) Definition of tribal organization In this section, the term tribal organization has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act. . (c) Long-Term care ombudsman program grants and training Section 2043 of the Social Security 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 subsection— (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 (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: 2047. Incentives for developing and sustaining structural competency in providing health and human services (a) Grants to States To support linkages to legal services and medical legal partnerships (1) In general Not later than 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, including through the following: (A) Medical-legal partnerships The establishment and support of medical-legal partnerships, the incorporation of the partnerships in the elder justice framework and health and human services safety net, and the implementation and operation of such a partnership by an eligible grantee— (i) at the option of a State, in conjunction with an area agency on aging; (ii) in a solo provider practice in a health professional shortage area (as defined in section 332(a) of the Public Health Service Act), a medically underserved community (as defined in section 399B of such Act), or a rural area (as defined in section 330J(e) of such Act); (iii) in a minority-serving institution (defined for purposes of this section as an eligible institution described in section 371(a) of the Higher Education Act of 1965) with health, law, and social services professional programs; (iv) in an entity receiving funding section 330 of the Public Health Service Act or a look-alike, as described in section 1905(l)(2)(B); or (v) in certain hospitals that are critical access hospitals (as defined in section 1861(mm)(1)), medicare-dependent, small rural hospitals (as defined in subsection (d)(5)(G)(iv)), sole community hospitals (as defined in section 1886(d)(5)(D)(iii)), rural emergency hospitals (as defined in section 1861(kkk)), or hospitals that receive disproportionate share hospital payments under section 1886(d)(5)(F) or section 1923. (B) Legal hotlines development or expansion The provision of incentives to develop, enhance, and integrate platforms, such as legal assistance hotlines, that help to facilitate the identification of older adults and adults with disabilities who could benefit from linkages to available legal services such as those described in subparagraph (A). (2) State reports Each State to which a grant is made under this subsection shall submit to the Secretary biannual reports on the activities carried out by the State pursuant to this subsection, which shall include assessments of the effectiveness of the activities with respect to— (A) the number of unique individuals identified through the mechanism outlined in paragraph (1)(B) who are referred to services described in paragraph (1)(A), and the average time period associated with resolving issues; (B) the success rate for referrals to community-based resources; and (C) other factors determined relevant by the Secretary. (3) Report to Congress Not less than once every 2 years, the Secretary shall submit to Congress a report that analyzes the data provided by the State reports and the extent to which grantees are establishing linkages to medical-legal partnerships and other legal services for older adults and adults with disabilities. (4) Report to Congress Not less that once every 4 years, the Secretary shall submit to Congress a written report on the activities conducted under this subsection. (5) Appropriation Out of any money in the Treasury not otherwise appropriated, there are appropriated to the Secretary $125,000,000 for each of fiscal years 2024 through 2027 to carry out this subsection. (6) Supplement not supplant Support provided to area agencies on aging, State units on aging, eligible entities, or other community-based organizations pursuant to this subsection shall be used to supplement and not supplant any other Federal, State, or local funds expended to provide the same or comparable services described in this subsection. (b) Grants and training To support area agencies on aging or other community-Based organizations To address social isolation among older adults and adults with disabilities (1) Grants The Secretary shall make grants to eligible area agencies on aging or other community-based organizations for the purpose of— (A) conducting outreach to individuals at risk for, or already experiencing, social isolation or loneliness, through established screening tools or other methods identified by the Secretary; (B) developing community-based interventions for the purposes of mitigating loneliness or social isolation (including evidence-based programs, as defined by the Secretary, developed with multi-stakeholder input for the purposes of promoting social connection, mitigating social isolation or loneliness, or preventing social isolation or loneliness) among at-risk individuals; (C) connecting at-risk individuals with community social and clinical supports; and (D) evaluating the effect of programs developed and implemented under subparagraphs (B) and (C). (2) Training (A) In general The Secretary shall establish programs to provide and improve training for area agencies on aging or community-based organizations with respect to addressing and preventing social isolation and loneliness among older adults and adults with disabilities. (B) Prioritization authority For purposes of connecting at-risk individuals with existing community social and clinical supports, the Secretary may, in carrying out subparagraph (A), prioritize models that incorporate training and service delivery in coordination with medical-legal partnerships. (3) Evaluation Not later than 3 years after the date of the enactment of this section and every 3 years thereafter, the Secretary shall submit to Congress a written report that assesses the extent to which the programs established under this subsection address social isolation and loneliness among older adults and adults with disabilities. (4) Appropriation Out of any money in the Treasury not otherwise appropriated, there are appropriated to the Secretary $62,500,000 for each of fiscal years 2024 through 2027 to carry out this subsection. (5) Coordination The Secretary shall coordinate with resource centers, grant programs, or other funding mechanisms established under section 411(a)(18) of the Older Americans Act ( 42 U.S.C. 3032(a)(18) ), section 417(a)(1) of such Act ( 42 U.S.C. 3032F(a)(1) ), or other programs as determined by the Secretary. (c) Definitions In this section: (1) Area agency on aging The term area agency on aging means an area agency on aging designated under section 305 of the Older Americans Act of 1965 ( 42 U.S.C. 3025 ). (2) Community-based organization The term community-based organization includes, except as otherwise provided by the Secretary, a nonprofit community-based organization, a consortium of nonprofit community-based organizations, a national nonprofit organization acting as an intermediary for a community-based organization, or a community-based organization that has a fiscal sponsor that allows the organization to function as an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code. (3) Loneliness The term loneliness means subjectively feeling alone, or the discrepancy between one’s desired level of social connection and one’s actual level of social connection. (4) Social connection The term social connection means the variety of ways one can connect with others socially, through physical, behavioral, social-cognitive, and emotional channels. (5) Social isolation The term social isolation means objectively being alone, or having few relationships or infrequent social contact. . (2) Clarification that medical-legal partnerships are authorized adult protective services activities Section 2011 of such Act ( 42 U.S.C. 1397j ) is amended— (A) in paragraph (2)(D), by inserting , including through a medical-legal partnership before the period; and (B) by redesignating paragraphs (16) through (22) as paragraphs (17) through (23), respectively, and inserting after paragraph (15) the following: (16) Medical-legal partnership The term medical-legal partnership means an arrangement in a health care or human services setting that integrates lawyers and social workers to address the needs of an individual patient related to social determinants of health, and to help clinicians, case managers, and social workers address structural problems at the root of many health inequities, including a multidisciplinary team integrated into such a setting to address such needs and to establish and maintain structural competence among clinicians, case managers, and social workers to best address structural problems at the root of many health inequities. . (e) Technical amendment Section 2011(12)(A) of the Social Security Act ( 42 U.S.C. 1397j(12)(A) ) is amended by striking 450b and inserting 5304 . 3. Assessment reports (a) In general Not later than 2 years after the date of enactment of this Act, and not less frequently than once every 2 years thereafter, the Secretary of Health and Human Services shall submit a report to the Committee on Ways and Means of the House of Representatives and the Committee on Finance and the Special Committee on Aging of the Senate on the programs, coordinating bodies, registries, and activities established or authorized under subtitle B of title XX of the Social Security Act ( 42 U.S.C. 1397l et seq. ), as amended by sections 2 and 3, section 1150B of such Act ( 42 U.S.C. 1320b–25 , or paragraphs (1) and (2) of section 6703(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 1395i–3a(b)). Each such report shall assess the extent to which such programs, coordinating bodies, registries, and activities have improved access to, and the quality of, resources available to older adults, adults with disabilities, and their caregivers to ultimately prevent, detect, and treat abuse, neglect, and exploitation, and shall include, as appropriate, recommendations to Congress on funding levels and policy changes to help these programs, coordinating bodies, registries, and activities better prevent, detect, and treat abuse, neglect, and exploitation of older adults and adults with disabilities. (b) Appropriation Out of any money in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $5,000,000 for each of fiscal years 2024 through 2027 to carry out this section.