,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #ddde  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #aj1 #bjad ,mr4
 ,c>twright 7= himself1 ,mr4 ,grayson1 &
 ,ms4 ,jackson ,lee7 introduc$ ! foll[+ 
bill2 :i* 0 ref]r$ to ! ,committee on   
,education & ! ,work=ce  ,a ,,bill  ,to 
am5d ! ,old] ,am]icans ,act ( #aife to  
develop & te/ an exp&$ & advanc$ role = 
direct c>e work]s :o provide long-t]m   
s]vices & supports to old] individuals 9
 ef=ts to coord9ate c>e & improve !     
effici5cy ( s]vice deliv]y4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,improv+
 ,c>e = ,vuln]able ,old] ,citiz5s ?r\gh 
,work=ce ,advancem5t ,act ( #bjad4  #b4 
,f9d+s ,congress f9ds ! foll[+3  7#a7 ,z
 ( #bjab1 m ?an #da1jjj1jjj ,am]icans   
are age #fe or old]4 ,m ?an #ge p]c5t ( 
!m suff] f *ronic conditions :i* require
 p]son-c5t]$1 coord9at$ c>e t helps !m  
to live 9 a home- or community-bas$     
sett+4 ,9 #bjab1 ! ,gov]nm5t            
,acc\ntability ,(fice f\nd t #cd p]c5t (
 ,am]icans #fj & old] report$ ne$+      

assi/ance p]=m+ ,activities ( ,daily    
,liv+4  7#b7 ,direct-c>e work]s 7ref]r$ 
to 9 ?is section z ,d,c,ws7 provide an  
e/imat$ #gj to #hj p]c5t ( ! paid h&s-on
 long-t]m c>e & p]sonal assi/ance       
receiv$ by eld]s & p ) disabilities or  
o!r *ronic conditions 9 ! ,unit$ ,/ates4
 ,^! work]s help _! cli5ts ba!1 dress1 &
 negotiate a ho/ ( o!r daily tasks4 ,!y 
are a lifel9e = ^? !y s]ve1 z well z =  
families & fri5ds /ruggl+ to provide    
quality c>e4  7#c7 ,eld]c>e & disability
 s]vices positions acc\nt = ne>ly       
"o-?ird ( ! #ah1jjj1jjj heal? c>e jobs 9
 ! ,unit$ ,/ates4 ,! direct-c>e work=ce 
alone acc\nts = m ?an #d1jjj1jjj jobs1  
expect$ to add #a1fjj1jjj new positions 
by #bjbj4  7#d7 ,! majority ( ,d,c,ws   
are n[ employ$ 9 home- & community-bas$ 
sett+s1 & n 9 in/itutional sett+s su* z 
nurs+ c>e facilities or hospitals4 ,by  
#bjbj1 home- & community-bas$ ,d,c,ws   
are likely to outnumb] facility work]s  
by m ?an #b to #a4  7#e7 ,a #bjjh       
,in/itute ( ,m$ic9e report1 entitl$     

,re-tool+ = an ,ag+ ,am]ica3 ,build+ !  
,heal? ,c>e ,work=ce1 call$ = new models
 ( c>e deliv]y & coord9ation1 & d$icat$ 
a *apt] to ! c5tral importance ( !      
direct-c>e work=ce 9 a re-tool$ eld]c>e 
deliv]y sy/em4  7#f7 ,an ,in/itute (    
,m$ic9e report on ! future ( nurs+1     
releas$ 9 ,octob] ( #bjaj1 recomm5d$    
nurses %\ld practice to ! full ext5t (  
_! education & tra9+4 ,! report also    
/ates t all heal? c>e pr(essionals %\ld 
"w collaboratively 9 team-bas$ models1 &
 t ! goal %\ld be to enc\rage c>e models
 t use e memb] ( ! team to ! full       
capacity ( 8 or h] tra9+ & skills4  7#g7
 ,! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7,public ,law #aaa-adh7 emphasizes
 ! ne$ = improv+ c>e & l[]+ co/s by     
bett] coord9ation ( c>e & integration ( 
s]vices1 p>ticul>ly = consum]s )        
multiple *ronic conditions4 ,?is w      
require develop+ new models ( c>e = ^?  
receiv+ long-t]m s]vices & supports4    
#c4 ,demon/ration program on c>e        
coord9ation & s]vice deliv]y ,"p ,a (   

title ,,iv ( ! ,old] ,am]icans ,act (   
#aife 7#db ,u4,s4,c4 #cjcb et seq47 is  
am5d$ by add+ at ! end ! foll[+3  #dbc4 
,demon/ration program on c>e coord9ation
 & s]vice deliv]y  7a7 ,e/abli%m5t (    
demon/ration program  7#a7 ,9 g5]al ,!  
,assi/ant ,secret>y %all c>ry out a     
demon/ration program 9 accordance ) ?is 
section4 ,"u su* program1 ! ,assi/ant   
,secret>y %all aw>d grants to eligible  
entities to c>ry out demon/ration       
projects t focus on c>e coord9ation &   
s]vice deliv]y r$esign = old]           
individuals ) *ronic illness or at risk 
( in/itutional placem5t by--  7,a7      
design+ & te/+ new models ( c>e         
coord9ation & s]vice deliv]y t          
?\ghtfully & effectively deploy advanc$ 
aides to improve effici5cy & quality (  
c>e = frail old] individuals2 &  7,b7   
giv+ direct-c>e work]s opportunities =  
c>e] advancem5t ?r\gh additional tra9+1 
an exp&$ role1 & increas$ comp5sation4  
7#b7 ,direct-c>e work] ,9 ?is section1 !
 t]m direct-c>e work] has ! mean+ giv5 t

 t]m 9 ! #bjaj ,/&>d ,occupational      
,classifications ( ! ,dep>tm5t ( ,labor 
= ,home ,heal? ,aides #ca-ajaa1         
,psy*iatric ,aides #ca-ajac1 ,nurs+     
,assi/ants #ca-ajad1 & ,p]sonal ,c>e    
,aides #ci-ijba4  7b7 ,demon/ration     
projects ,! demon/ration program %all be
 compos$ ( #f demon/ration projects1 z  
foll[s3  7#a7 ,two demon/ration projects
 %all focus on us+ ! abilities (        
direct-c>e work]s to promote smoo?      
transitions 9 c>e & help to prev5t      
unnecess>y hospital readmissions4 ,"u ^!
 projects1 direct-c>e work]s %all be    
incorporat$ z ess5tial memb]s (         
int]discipl9>y c>e coord9ation teams4   
7#b7 ,two demon/ration projects %all    
focus on ma9ta9+ ! heal? & improv+ !    
heal? /atus ( ^? ) multiple *ronic      
conditions & long-t]m c>e ne$s4 ,"u ^!  
projects1 direct-c>e work]s %all assi/ 9
 monitor+ heal? /atus1 ensur+ compliance
 ) prescrib$ c>e1 & educat+ & coa*+ !   
old] individual involv$ & any family    
c>egiv]s4  7#c7 ,two demon/ration       

projects %all focus on tra9+ direct-c>e 
work]s to take on deep] cl9ical         
responsibilities relat$ to specific     
diseases1 includ+ ,alzheim]'s & dem5tia1
 conge/ive he>t failure1 & diabetes4    
7c7 ,eligible entity ,9 ?is section1 !  
t]m eligible entity means a consortium t
 consi/s (--  7#a7 at lea/ #a--  7,a7   
long-t]m c>e & rehabilitation facility2 
or  7,b7 home p]sonal c>e s]vice        
provid]2 &  7#b7 at lea/ #a--  7,a7     
hospital or heal? sy/em2  7,b7 labor    
organization or labor-managem5t         
p>tn]%ip2  7,c7 community-bas$ ag+      
s]vice provid]2  7,d7 pati5t-c5t]$      
m$ical home2  7,e7 f$]ally qualifi$     
heal? c5t]2  7,f7 manag$ c>e entity1    
includ+ a manag$ heal? & long-t]m c>e   
program2  7,g7 entity t provides heal?  
s]vices tra9+2  7,h7 ,/ate-bas$ public  
entity engag$ 9 build+ new roles &      
relat$ curricula = direct-c>e work]s2 or
  7,i7 any o!r entity t ! ,assi/ant     
,secret>y deems eligible bas$ on        
integrat$ c>e crit]ia4  7d7 ,application

 ,to be eligible to receive a grant "u  
?is section1 an eligible entity %all    
submit to ! ,assi/ant ,secret>y an      
application at su* "t1 9 su* mann]1 &   
conta9+ su* in=mation z ! ,secret>y may 
require1 :i* %all include--  7#a7 a     
description ( ! c>e coord9ation & s]vice
 deliv]y models ( ! entity1 detail$ on a
 g5]al1 organizational1 & /aff level2   
7#b7 a description ( h[ ! demon/ration  
project c>ri$ out by ! entity w improve 
c>e quality1 includ+ specific objectives
 & anticipat$ outcomes t w be us$ to    
measure success2 &  7#c7 a description (
 h[ ! coord9at$ c>e team approa* ) an   
enhanc$ role = ! direct-c>e work] "u !  
demon/ration project w increase         
effici5cy & co/ effectiv5ess comp>$ to  
pa/ practice4  7e7 ,plann+ aw>ds "u     
demon/ration program  7#a7 ,9 g5]al ,ea*
 eligible entity t receives a grant "u  
?is section %all receive a grant =      
plann+ activities relat$ to !           
demon/ration project to be c>ri$ out by 
! entity1 includ+--  7,a7 design+ !     

implem5tation ( ! project2  7,b7        
id5tify+ compet5cies & develop+         
curricula = ! tra9+ ( p>ticipat+        
direct-c>e work]s2  7,c7 develop+ tra9+ 
mat]ials & processes = o!r memb]s ( !   
int]discipl9>y c>e team2  7,d7          
articulat+ a plan = id5tify+ & track+   
co/ sav+s ga9$ f implem5tation ( !      
project & = a*iev+ long-t]m f9ancial    
su/a9ability2 &  7,e7 articulat+ a plan 
= evaluat+ ! project4  7#b7 ,am\nt & t]m
  7,a7 ,total am\nt ,! am\nt aw>d$ "u   
p>agraph 7#a7 = all grants %all n exce$ 
#fjj1jjj4  7,b7 ,t]m ,activities c>ri$  
out "u a grant aw>d$ "u p>agraph 7#a7   
%all be complet$ n lat] ?an #a ye> aft] 
! grant is aw>d$4  7f7 ,implem5tation   
aw>ds "u demon/ration program  7#a7 ,9  
g5]al ,ea* eligible entity may receive a
 grant = implem5tation activities relat$
 to ! demon/ration project to be c>ri$  
out by ! entity1 if ! ,assi/ant         
,secret>y det]m9es ! entity--  7,a7 has 
successfully c>ri$ out ! activities "u !
 grant aw>d$ "u subsection 7e72  7,b7   

(f]s a feasible plan = long-t]m f9ancial
 su/a9ability2  7,c7 has con/ruct$ a    
mean+ful model ( advancem5t = direct-c>e
 work]s2 &  7,d7 aims to provide tra9+  
to a sizeable numb] ( direct-c>e work]s 
& to s]ve a sizeable numb] ( old]       
individuals4  7#b7 ,use ( funds ,!      
implem5tation activities describ$ "u    
p>agraph 7#a7 %all include--  7,a7 tra9+
 ( all c>e team memb]s 9 accordance ) ! 
design ( ! demon/ration project2 &  7,b7
 evaluat+ ! compet5cy ( all /aff bas$ on
 project design4  7#c7 ,evaluation &    
report  7,a7 ,evaluation ,ea* recipi5t (
 a grant "u p>agraph 7#a71 9            
consultation ) an indep5d5t evaluation  
contractor1 %all evaluate--  7i7 !      
impact ( tra9+ & deploym5t ( direct-c>e 
work]s 9 advanc$ roles1 z describ$ 9 ?is
 section1 )9 ea* p>ticipat+ entity on   
outcomes1 su* z direct-c>e work] job    
satisfaction & turnov]1 b5efici>y &     
family c>egiv] satisfaction ) s]vices1  
rate ( hospitalization ( b5efici>ies1 & 
additional measures det]m9$ by !        

,secret>y2  7ii7 ! impact ( su* tra9+ & 
deploym5t on ! long-t]m s]vices &       
supports deliv]y sy/em & res\rces2      
7iii7 /atem5t ( ! pot5tial ( ! use (    
direct-c>e work]s 9 advanc$ roles to l[]
 co/ & improve quality ( c>e 9 !        
,m$icaid program2 &  7iv7 long-t]m      
f9ancial su/a9ability ( ! model us$ "u !
 grant & ! impact ( su* model on quality
 ( c>e4  7,b7 ,reports ,n lat] ?an #ahj 
days aft] completion ( ! demon/ration   
program "u ?is section1 ea* recipi5t ( a
 grant "u p>agraph 7#a7 %all submit to !
 ,secret>y a report on ! implem5tation (
 activities conduct$ "u ! demon/ration  
project1 includ+--  7i7 ! outcomes1     
p]=mance b5*m>ks1 lessons le>n$ f !     
project2  7ii7 a /atem5t ( co/ sav+s    
ga9$ f implem5tation ( ! project & h[ ! 
co/ sav+s h be5 re9ve/$ to improve      
direct-c>e job quality & quality ( c>e2 
&  7iii7 results ( ! evaluation conduct$
 "u subp>agraph 7,a7 ) respect to su*   
activities1 toge!r ) su* recomm5dations 
= legislation or adm9i/rative action =  

expansion ( ! demon/ration program on a 
broad] scale z ! ,secret>y det]m9es     
appropriate4  7#d7 ,am\nt & t]m  7,a7   
,total am\nt ,! am\nt aw>d$ "u p>agraph 
7#a7 = all grants %all n exce$          
#b1ijj1jjj4  7,b7 ,t]m ,activities c>ri$
 out "u a grant aw>d$ "u p>agraph 7#a7  
%all be complet$ n lat] ?an #c ye>s aft]
 ! grant is aw>d$4  4