H.R. 2718

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2718 Introduced in House (IH)]

<DOC>

118th CONGRESS
1st Session
H. R. 2718

To reauthorize funding for programs to prevent, investigate, and 
prosecute elder abuse, neglect, and exploitation, and for other 
purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

April 19, 2023

Mr. Neal (for himself and Ms. Bonamici) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
to the Committees on Energy and Commerce, Education and the Workforce, 
and the Judiciary, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned

_______________________________________________________________________

A BILL

To reauthorize funding for programs to prevent, investigate, and 
prosecute elder abuse, neglect, and exploitation, and for other 
purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Elder Justice Reauthorization and 
Modernization Act of 2023''.

SEC. 2. REAUTHORIZATION OF FUNDING FOR PROGRAMS TO PREVENT AND 
INVESTIGATE ELDER ABUSE, NEGLECT, AND EXPLOITATION.

(a) Nursing Home Worker Training Grants.--Section 2041 of the 
Social Security Act (42 U.S.C. 1397m) is amended to read as follows:

``SEC. 2041. NURSING HOME WORKER TRAINING GRANTS.

``(a) In General.--
``(1) State entitlement.--
``(A) In general.--Each State shall be entitled to 
receive from the Secretary for each fiscal year 
specified in subsection (e)(1) a grant in an amount 
equal to the amount allotted to the State under 
subparagraph (B).
``(B) State allotments.--
``(i) In general.--Subject to clauses (ii) 
and (iii), the amount allotted to a State under 
this subparagraph for a fiscal year shall be--
``(I) the number of State 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 they 
are contracted.
``(d) Reports.--
``(1) State reports.--Not less frequently than annually, 
each State to which a grant has been made under this section 
shall transmit to the 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 the congress.--Not later than 3 years after 
the date of the enactment of this section, and every 4 years 
thereafter, the Secretary shall submit to the Congress a 
written report 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), 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) is 
amended--
(A) in subsection (a)(1)(A), by striking ``State 
and local'' and inserting ``State, local, and tribal'';
(B) in subsection (b)(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'';
(C) in subsection (b)(2)--
(i) in the paragraph heading, by inserting 
``for a state'' after ``payment'';
(ii) by inserting ``that remains after the 
reservation under paragraph (3)(B)'' before 
``multiplied''; and
(iii) in subparagraph (B)(i)--
(I) by inserting ``that so 
remains'' after ``such year''; and
(II) by inserting ``amount so 
appropriated'' and inserting 
``remaining amount''; and
(D) in subsection (b), by redesignating paragraphs 
(3) through (5) as paragraphs (4) through (6), 
respectively, and inserting after paragraph (2) the 
following:
``(3) Amount of payment to indian tribe or tribal 
organization.--
``(A) In general.--The Secretary, in 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) of this paragraph. 
Paragraphs (4) and (5) shall apply to grantees under 
this paragraph in the same manner in which the 
paragraphs apply to States.
``(B) Reservation of funds.--The Secretary shall 
reserve 2 percent of the amount made available by 
subsection (b)(6) for each fiscal year for grants under 
this paragraph.'';
(3) in subsection (c)--
(A) in paragraph (1), by striking ``to States'' and 
inserting ``to States, Indian tribes, and tribal 
organizations'';
(B) in paragraph (2)--
(i) in the matter preceding 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'';
(C) in paragraph (4), by inserting ``or Indian 
tribe or tribal organization'' after ``a State'' the 
first place it appears; and
(D) in paragraph (5)--
(i) by inserting ``or Indian tribe or 
tribal organization'' after ``Each State''; and
(ii) by inserting ``or Indian tribe or 
tribal organization, as the case may be'' after 
``the State''; and
(4) by adding at the end the following:
``(d) Definitions of Indian Tribe and Tribal Organization.--In this 
section, the terms `Indian tribe' and `tribal organization' have the 
meanings given the terms in section 419.''.
(c) Long-Term Care Ombudsman Program Grants and Training.--Section 
2043 of the Social 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:

``SEC. 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.--Within 2 years after the date of the 
enactment of this section, the Secretary shall establish and 
administer a program of grants to States to support the 
development or adoption of approaches to maintain or improve 
linkages between health services, human services, and legal 
services for older adults and adults with disabilities, 
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 399V of such Act), or a 
rural area (as defined in section 330J of such 
Act);
``(iii) in a minority-serving institution 
of higher learning with health, law, and social 
services professional programs;
``(iv) in a federally qualified health 
center, as described in section 330 of the 
Public Health Service Act, or look-alike, as 
described in section 1905(l)(2)(B) of this Act; 
or
``(v) in certain hospitals that are 
critical access hospitals, Medicare-dependent 
hospitals, sole community hospitals, rural 
emergency hospitals, or that serve a high 
proportion of Medicare or Medicaid patients.
``(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 the congress.--Every 4 years, the Secretary 
shall submit to the Congress a written report on the activities 
conducted under this subsection.
``(4) 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.
``(5) 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 the Congress a written report which 
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.
``(2) Social isolation.--The term `social isolation' means 
objectively being alone, or having few relationships or 
infrequent social contact.
``(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 to others socially, 
through physical, behavioral, social-cognitive, and emotional 
channels.
``(5) 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.''.
(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 which 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 the needs and 
establish and maintain structural competence within 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''.

SEC. 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.) or 
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.
<all>