,i #aaith ,,congress #b;d ,session ,h4 ,r4 #hjfj ,,in ,,the ,,house ,,of ,,representatives ,march #bd1 #bjbf,mr4 ,neal 7for himself and ,ms4 ,bonamici7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committees on ,energy and ,commerce1 ,education and ,workforce1 and the ,judiciary1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to reauthorize funding for programs to prevent1 investigate1 and prosecute elder abuse1 neglect1 and exploitation1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,elder ,justice ,reauthorization and ,modernization ,act of #bjbf4 #b4 ,reauthorization of funding for programs to prevent and investigate elder abuse1 neglect1 and exploitation 7a7 ,nursing home worker training grants ,section #bjda of the ,social ,security ,act 7#db ,u4,s4,c4 #acigm7 is amended to read as follows3 #bjda4 ,nursing home worker training grants 7a7 ,in general 7#a7 ,state entitlement 7,a7 ,in general ,each ,state shall be entitled to receive from the ,secretary for each fiscal year specified in subsection 7e77#a7 a grant in an amount equal to the amount allotted to the ,state under subparagraph 7,b74 7,b7 ,state allotments 7i7 ,in general ,subject to clauses 7ii7 and 7iii71 the amount allotted to a ,state under this subparagraph for a fiscal year shall be-- 7,i7 the number of ,state residents who have attained #fe years of age or have a disability 7as defined in section #baf7;i77#a771 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 set2 divided by 7,,ii7 the total number of such residents of all ,states4 7ii7 ,limitation ,the amount allotted to a ,state under this subparagraph for a fiscal year shall be not less than #j4be percent of the available amount for the fiscal year4 7iii7 ,adjustment of ,state allotments ,subject to clause 7ii71 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 ,states4 7iv7 ,redeterminations 7,i7 ,frequency ,the ,secretary shall make the determination referred to in clause 7i77,i7 every #e years4 7,,ii7 ,limitation ,subject to clause 7ii71 the amount allotted to a ,state under this subparagraph1 on the basis of such a determination1 for a fiscal year after fiscal year #bjca shall be-- 7aa7 not less than #ij percent of the amount of the grant made to the ,state under this subparagraph for the then preceding fiscal year2 and 7bb7 not more than #aaj percent of the amount referred to in item 7aa74 7#b7 ,grants to ,indian tribes and tribal organizations 7,a7 ,in general ,the ,secretary1 in consultation with the ,secretary of the ,interior1 shall make grants in accordance with this section to ,indian tribes and tribal organizations who operate at least #a eligible setting4 7,b7 ,grant formula ,the ,secretary1 in consultation with the ,secretary of the ,interior1 shall devise a formula for distributing among ,indian tribes and tribal organizations the amount required to be reserved by subsection 7e77#a7 for each fiscal year4 7#c7 ,sub-grants ,a ,state1 ,indian tribe1 or tribal organization to which an amount is paid under this section may use the amount to make sub-grants to local organizations1 including community organizations1 local nonprofits1 elder rights and justice groups1 labor organizations1 joint labor-management organizations1 and workforce development boards for any purpose described in paragraph 7#a7 or 7#b7 of subsection 7b74 7b7 ,use of funds 7#a7 ,required uses ,a ,state to which an amount is paid under this section shall use the amount to-- 7,a7 provide wage subsidies to eligible individuals2 7,b7 provide tuition assistance to1 and directly pay the cost of applicable licensing exam fees for1 eligible individuals for a degree or certification in a field relevant to their position referred to in subsection 7f77#a77;,a72 7,c7 provide1 subsidize1 or facilitate access to child care for eligible individuals1 including help with referrals1 co-pays1 or other direct assistance as needed2 and 7,d7 provide assistance where necessary with obtaining appropriate transportation1 including public transportation if available1 or gas money or transit vouchers for ride share1 taxis1 and similar types of transportation if public transportation is unavailable or impractical based on work hours or location4 7#b7 ,authorized uses ,a ,state to which an amount is paid under this section may use the amount to-- 7,a7 establish a reserve fund for financial assistance to eligible individuals in emergency situations2 7,b7 provide in-kind resource donations1 such as interview clothing and conference attendance fees2 7,c7 provide assistance with programs and activities1 including legal assistance1 deemed necessary to address arrest or conviction records that are an employment barrier2 7,d7 support employers operating an eligible setting in the ,state in providing employees with not less than #b weeks of paid leave per year2 or 7,e7 provide other support services the ,secretary deems necessary to allow for successful recruitment and retention of workers4 7#c7 ,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 individual4 7#d7 ,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 recruiting1 supporting1 or retaining employees in an eligible setting4 7#e7 ,obligation deadline ,a ,state1 ,indian tribe1 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 #b years after the end of the fiscal year4 7c7 ,administration ,a ,state to which a grant is made under this section shall reserve not more than #aj percent of the grant to-- 7#a7 administer subgrants in accordance with this section2 7#b7 provide technical assistance and support for applying for and accessing such a subgrant opportunity2 7#c7 publicize the availability of the subgrants2 7#d7 carry out activities to increase the supply of eligible individuals2 and 7#e7 provide technical assistance to help subgrantees find and train individuals to provide the services for which they are contracted4 7d7 ,reports 7#a7 ,state reports ,not less frequently than annually1 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 report1 which shall include a specification of-- 7,a7 the total amount expended in the ,state for each type of use described in paragraph 7#a7 or 7#b7 of subsection 7b72 7,b7 the total number of non-,state organizations in the ,state to which grant funds were provided1 and the amount so provided to each such organization2 7,c7 the change in the number of individuals working in each job category described in subsection 7f77#a77;,a7 in an eligible setting in the ,state due to programs or services funded with grants under this section2 7,d7 the average duration of employment for each such job category for individuals receiving1 or who previously received1 services or supports from a grant under this section2 7,e7 wages of workers in each job category described in subsection 7f77#a77;,a7 in an eligible setting in the ,state with support from grants under this section1 as compared to all other workers in the same eligible setting in the ,state2 7,f7 the average amount of paid time off to which a worker in each job category described in subsection 7f77#a77;,a7 in an eligible setting in the ,state is entitled by their contract among workers with support from a grant under this section1 as compared to all workers in eligible settings in the ,state2 and 7,g7 such other data elements as the ,secretary deems relevant4 7#b7 ,report to the ,congress ,not later than #c years after the date of the enactment of this section1 and every #d years thereafter1 the ,secretary shall submit to the ,congress a written report outlining how the ,states have used the grants made under this section during the period covered by the report1 which shall include-- 7,a7 the total amount expended in each ,state for each type of use described in paragraph 7#a7 or 7#b7 of subsection 7b72 7,b7 the total number of non-,state organizations in each ,state to which grant funds were provided1 and the amount so provided to each such organization2 7,c7 an analysis of the data provided in the ,state reports2 and 7,d7 such other data elements as the ,secretary deems relevant4 7e7 ,appropriation ,out of any funds in the ,treasury not otherwise appropriated1 there is appropriated to the ,secretary #daj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this section1 of which-- 7#a7 #b percent for each fiscal year shall be reserved for grants to ,indian tribes and tribal organizations2 and 7#b7 #b percent for each fiscal year shall be reserved for administrative costs associated with ,federal staffing for grantmaking and independent evaluation activities under this section4 7f7 ,definitions ,in this section3 7#a7 ,available amount ,the term available amount means1 with respect to a fiscal year1 the amount specified in subsection 7e7 that remains after the reservation required by such subsection for the fiscal year1 plus all amounts remitted to the ,secretary under subsection 7b77#e7 that have not been reallotted under subsection 7a77#a77;,b77iii74 7#b7 ,eligible individual ,the term eligible individual means an individual who-- 7,a7 7i7 is a qualified home health aide1 as defined in section #dhd4hj7;a7 of title #db1 ,code of ,federal ,regulations2 7ii7 is a nurse aide approved by the ,state as meeting the requirements of sections #dhc4aej through #dhc4aed of such title1 and is listed in good standing on the ,state nurse aide registry2 7iii7 is a personal care aide approved by the ,state1 and furnishes personal care services1 as defined in section #ddj4afg of such title2 7iv7 is a qualified hospice aide1 as defined in section #dah4gf of such title2 7v7 is a licensed practical nurse or a licensed or certified social worker2 or 7vi7 is receiving training to be certified or licensed as such an aide1 nurse1 or social worker2 and 7,b7 provides 7or1 in the case of a trainee1 intends to provide7 services as such an aide1 nurse1 or social worker in an eligible setting4 7#c7 ,eligible setting ,the term eligible setting means-- 7,a7 a skilled nursing facility1 as defined in section #ahai2 7,b7 a nursing facility1 as defined in section #aiai2 7,c7 a home health agency1 as defined in section #ahia2 7,d7 a facility approved to deliver home or community-based services authorized under ,state options described in subsection 7c7 or 7i7 of section #aiae or1 as relevant1 demonstration projects authorized under section #aaae2 7,e7 a hospice1 as defined in section #ahad2 or 7,f7 a tribal assisted living facility4 7#d7 ,tribal organization ,the term tribal organization has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 4 7b7 ,adult protective services functions and grant programs 7#a7 ,direct funding2 ,state entitlement ,section #bjdb of the ,social ,security ,act 7#db ,u4,s4,c4 #acigm-#a7 is amended-- 7,a7 in subsection 7a71 by striking paragraph 7#b7 and inserting the following3 7#b7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #aj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this section4 2 7,b7 in subsection 7b7-- 7i7 in paragraph 7#b71 by striking the availability of appropriations and2 and 7ii7 by striking paragraph 7#e7 and inserting the following3 7#e7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #ejj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this section4 2 and 7,c7 in subsection 7c71 by striking paragraph 7#f7 and inserting the following3 7#f7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #hj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this section4 4 7#b7 ,state entitlement2 grants to ,indian tribes and tribal organizations ,section #bjdb of such ,act 7#db ,u4,s4,c4 #acigm-#a7 is amended-- 7,a7 in subsection 7a77#a77;,a71 by striking ,state and local and inserting ,state1 local1 and tribal2 7,b7 in subsection 7b77#a71 by striking the ,secretary shall annually award grants to ,states in the amounts calculated under paragraph 7#b7 and inserting each ,state shall be entitled to annually receive from the ,secretary in the amounts calculated under paragraph 7#b71 and the ,secretary may annually award to each ,indian tribe and tribal organization in accordance with paragraph 7#c71 grants2 7,c7 in subsection 7b77#b7-- 7i7 in the paragraph heading1 by inserting for a ,state after payment2 7ii7 by inserting that remains after the reservation under paragraph 7#c77;,b7 before multiplied2 and 7iii7 in subparagraph 7,b77i7-- 7,i7 by inserting that so remains after such year2 and 7,,ii7 by inserting amount so appropriated and inserting remaining amount2 and 7,d7 in subsection 7b71 by redesignating paragraphs 7#c7 through 7#e7 as paragraphs 7#d7 through 7#f71 respectively1 and inserting after paragraph 7#b7 the following3 7#c7 ,amount of payment to ,indian tribe or tribal organization 7,a7 ,in general ,the ,secretary1 in consultation with ,indian tribes and tribal organizations1 shall determine the amount of any grant to be made to each ,indian tribe and tribal organization from the amount reserved under subparagraph 7,b7 of this paragraph4 ,paragraphs 7#d7 and 7#e7 shall apply to grantees under this paragraph in the same manner in which the paragraphs apply to ,states4 7,b7 ,reservation of funds ,the ,secretary shall reserve #b percent of the amount made available by subsection 7b77#f7 for each fiscal year for grants under this paragraph4 2 7#c7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking to ,states and inserting to ,states1 ,indian tribes1 and tribal organizations2 7,b7 in paragraph 7#b7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting and ,indian tribes and tribal organizations after government2 and 7ii7 in subparagraph 7,d71 by inserting or ,indian tribe or tribal organization1 as the case may be after government2 7,c7 in paragraph 7#d71 by inserting or ,indian tribe or tribal organization after a ,state the first place it appears2 and 7,d7 in paragraph 7#e7-- 7i7 by inserting or ,indian tribe or tribal organization after ,each ,state2 and 7ii7 by inserting or ,indian tribe or tribal organization1 as the case may be after the ,state2 and 7#d7 by adding at the end the following3 7d7 ,definitions of ,indian tribe and tribal organization ,in this section1 the terms ,indian tribe and tribal organization have the meanings given the terms in section #dai4 4 7c7 ,long-,term care ombudsman program grants and training ,section #bjdc of the ,social ,security ,act 7#db ,u4,s4,c4 #acigm-#b7 is amended-- 7#a7 in subsection 7a71 by striking paragraph 7#b7 and inserting the following3 7#b7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary to carry out this subsection-- 7,a7 #bc1jjj1jjj for fiscal year #bjbg2 and 7,b7 #cj1jjj1jjj for each of fiscal years #bjbh and #bjbi4 2 and 7#b7 in subsection 7b71 by striking paragraph 7#b7 and inserting the following3 7#b7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #cj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this subsection4 4 7d7 ,incentives for developing and sustaining structural competency in providing health and human services 7#a7 ,in general ,part ,,ii of subtitle ,b of title ,,xx of the ,social ,security ,act 7#db ,u4,s4,c4 #cigm-#e7 is amended by adding at the end the following3 #bjdg4 ,incentives for developing and sustaining structural competency in providing health and human services 7a7 ,grants to ,states ,to support linkages to legal services and medical-,legal partnerships 7#a7 ,in general ,within #b years after the date of the enactment of this section1 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 services1 human services1 and legal services for older adults and adults with disabilities1 including through the following3 7,a7 ,medical-legal partnerships ,the establishment and support of medical-legal partnerships1 the incorporation of the partnerships in the elder justice framework and health and human services safety net1 and the implementation and operation of such a partnership by an eligible grantee-- 7i7 at the option of a ,state1 in conjunction with an area agency on aging2 7ii7 in a solo provider practice in a health professional shortage area 7as defined in section #ccb7;a7 of the ,public ,health ,service ,act71 a medically underserved community 7as defined in section #cii,v of such ,act71 or a rural area 7as defined in section #ccj;,j of such ,act72 7iii7 in a minority-serving institution of higher learning with health1 law1 and social services professional programs2 7iv7 in a federally qualified health center1 as described in section #ccj of the ,public ,health ,service ,act1 or look-alike1 as described in section #aije7l77#b77;,b7 of this ,act2 or 7v7 in certain hospitals that are critical access hospitals1 ,medicare-dependent hospitals1 sole community hospitals1 rural emergency hospitals1 or that serve a high proportion of ,medicare or ,medicaid patients4 7,b7 ,legal hotlines development or expansion ,the provision of incentives to develop1 enhance1 and integrate platforms1 such as legal assistance hotlines1 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 7,a74 7#b7 ,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 subsection1 which shall include assessments of the effectiveness of the activities with respect to-- 7,a7 the number of unique individuals identified through the mechanism outlined in paragraph 7#a77;,b7 who are referred to services described in paragraph 7#a77;,a71 and the average time period associated with resolving issues2 7,b7 the success rate for referrals to community-based resources2 and 7,c7 other factors determined relevant by the ,secretary4 7#c7 ,report to the ,congress ,every #d years1 the ,secretary shall submit to the ,congress a written report on the activities conducted under this subsection4 7#d7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #abe1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this subsection4 7#e7 ,supplement not supplant ,support provided to area agencies on aging1 ,state units on aging1 eligible entities1 or other community-based organizations pursuant to this subsection shall be used to supplement and not supplant any other ,federal1 ,state1 or local funds expended to provide the same or comparable services described in this subsection4 7b7 ,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 7#a7 ,grants ,the ,secretary shall make grants to eligible area agencies on aging or other community-based organizations for the purpose of-- 7,a7 conducting outreach to individuals at risk for1 or already experiencing1 social isolation or loneliness1 through established screening tools or other methods identified by the ,secretary2 7,b7 developing community-based interventions for the purposes of mitigating loneliness or social isolation 7including independently evaluated evidence-based programs1 developed with multi-stakeholder input for the purposes of promoting social connection1 mitigating social isolation or loneliness1 or preventing social isolation or loneliness7 among at-risk individuals2 7,c7 connecting at-risk individuals with community social and clinical supports2 and 7,d7 evaluating the effect of programs developed and implemented under subparagraphs 7,b7 and 7,c74 7#b7 ,training 7,a7 ,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 disabilities4 7,b7 ,prioritization authority ,for purposes of connecting at-risk individuals with existing community social and clinical supports1 the ,secretary may1 in carrying out subparagraph 7,a71 prioritize models that incorporate training and service delivery in coordination with medical-legal partnerships4 7#c7 ,evaluation ,not later than #c years after the date of the enactment of this section and every #c years thereafter1 the ,secretary shall submit to the ,congress a written report which provides-- 7,a7 a discussion of the status of implementing the programs developed under this subsection2 and 7,b7 an update on the independent research and evaluation being conducted on the effects and outcomes of the programs4 7#d7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary #fc1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this subsection4 7#e7 ,coordination ,the ,secretary shall coordinate with resource centers1 grant programs1 or other funding mechanisms established under section #daa7;a77#ah7 of the ,older ,americans ,act 7#db ,u4,s4,c4 #cjcb7;a77#ah771 section #dag7;a77#a7 of such ,act 7#db ,u4,s4,c4 #cjcb;,f7a77#a771 or other programs as determined by the ,secretary4 7c7 ,definitions ,in this section3 7#a7 ,area agency on aging ,the term area agency on aging means an area agency on aging designated under section #cje of the ,older ,americans ,act of #aife4 7#b7 ,social isolation ,the term social isolation means objectively being alone1 or having few relationships or infrequent social contact4 7#c7 ,loneliness ,the term loneliness means subjectively feeling alone1 or the discrepancy between one's desired level of social connection and one's actual level of social connection4 7#d7 ,social connection ,the term social connection means the variety of ways one can connect to others socially1 through physical1 behavioral1 social-cognitive1 and emotional channels4 7#e7 ,community-based organization ,the term community-based organization includes1 except as otherwise provided by the ,secretary1 a nonprofit community-based organization1 a consortium of nonprofit community-based organizations1 a national nonprofit organization acting as an intermediary for a community-based organization1 or a community-based organization that has a fiscal sponsor that allows the organization to function as an organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code4 4 7#b7 ,clarification that medical-legal partnerships are authorized adult protective services activities ,section #bjaa of such ,act 7#db ,u4,s4,c4 #acig;j7 is amended-- 7,a7 in paragraph 7#b77;,d71 by inserting 1 including through a medical-legal partnership before the period2 and 7,b7 by redesignating paragraphs 7#af7 through 7#bb7 as paragraphs 7#ag7 through 7#bc71 respectively1 and inserting after paragraph 7#ae7 the following3 7#af7 ,medical-legal partnership ,the term medical-legal partnership means an arrangement in a health care or human services setting which integrates lawyers and social workers to address the needs of an individual patient related to social determinants of health1 and to help clinicians1 case managers1 and social workers address structural problems at the root of many health inequities1 including a multidisciplinary team integrated into such a setting to address the needs and establish and maintain structural competence within clinicians1 case managers1 and social workers to best address structural problems at the root of many health inequities4 4 7e7 ,technical amendment ,section #bjaa7ab77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;j7#ab77;,a77 is amended by striking #dej;b and inserting #ecjd4 #c4 ,assessment reports 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 and not less frequently than once every #b years thereafter1 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 programs1 coordinating bodies1 registries1 and activities established or authorized under subtitle ,b of title ,,xx of the ,social ,security ,act 7#db ,u4,s4,c4 #acigl et seq47 or section #fgjc7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acie;i-#c;a7b774 ,each such report shall include-- 7#a7 an update on any ongoing independently conducted evaluations of the extent to which such programs1 coordinating bodies1 registries1 and activities have improved access to1 and the quality of1 resources available to older adults1 adults with disabilities1 and their caregivers to ultimately prevent1 detect1 and treat abuse1 neglect1 and exploitation2 and 7#b7 as appropriate1 recommendations to ,congress on funding levels and policy changes to help these programs1 coordinating bodies1 registries1 and activities better prevent1 detect1 and treat abuse1 neglect1 and exploitation of older adults and adults with disabilities4 7b7 ,clarification of the independence of federally funded research and evaluation ,section #bjbc of the ,social ,security ,act 7#db ,u4,s4,c4 #acigk-#b7 is amended by adding at the end the following3 7c7 ,independence of federally funded research and evaluation ,the ,secretary shall continue to maintain and support with adequate staffing and resources the ,office of ,performance and ,evaluation at the ,administration for ,community ,living1 which shall conduct independent research and evaluation activities associated with the programs and policies provided for in this subtitle4 ,the research and evaluation activities shall reflect the rigor1 relevance and utility1 independence and objectivity1 transparency1 and ethical principles specified in the evaluation policy established for the ,department of ,health and ,human ,services under section #cac of title #e1 ,united ,states ,code4 4 7c7 ,appropriation ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary of ,health and ,human ,services #aj1jjj1jjj for each of fiscal years #bjbg through #bjcj to carry out this section4