House Education & Labor Committee Issues Report on Dignity in Aging Act (Part 2 of 2)

WASHINGTON, Nov. 7 -- The House Education and Labor Committee issued a report (H.Rpt. 116-258) on legislation (H.R. 4334) to amend the Older Americans Act of 1965 to authorize appropriations for fiscal years 2020 through 2024. The report was advanced by Rep. Robert C. Scott, D-Virginia, on Oct. 28.

Continues from Part 1 of 2

Section-by-Section Analysis

Section 1. Short title

This section states that the title of the bill is the Dignity in Aging Act of 2019.

Section 101. Person-centered, trauma-informed care

This section adds access to person-centered, trauma- informed care to the objectives of OAA.

Section 102. Vaccination

This section adds immunization status screening to the list of routine health screenings allowed under the definition of disease prevention and health promotion.

Section 103. Functions of Assistant Secretary

This section clarifies that the Assistant Secretary for Aging at the Department of Health and Human Services (Assistant Secretary) shall not approve grant applications for programs that have received previous grants unless programs meet certain standards. The section further requires the Assistant Secretary to publish a list of resource centers as well as demonstration projects funded through OAA on an annual basis. Additionally, this section directs the Assistant Secretary to provide technical assistance and share best practices with states and AAAs on how to collaborate and coordinate activities and develop long-range emergency preparedness plans.

Section 104. Professional standards for nutrition official under the Assistant Secretary

This section ensures that the nutrition official under the Assistant Secretary is a Registered Dietitian/Registered Dietitian Nutritionist.

Section 105. Interagency Coordinating Committee on Age-Friendly Communities

This section re-names the Interagency Coordinating Committee on Aging as the Interagency Coordinating Committee on Age-Friendly Communities and tasks the Committee with coordinating efforts to promote safe and accessible independent living environments.

Section 106. Technical assistance on age-friendly communities

This section allows the Assistant Secretary to provide technical assistance to state agencies, AAAs, local governments, and leaders in age-friendly communities to implement best practices and the recommendations of the Interagency Coordinating Committee.

Section 107. Malnutrition

This section clarifies that screening for malnutrition is included as part of nutrition screening within broader routine health screening in the definition of disease prevention and health promotion services. Additionally, this section adds reducing malnutrition to the purpose of OAA's nutrition services programs.

Section 108. Coordination with resource centers

This section requires states and AAAs to collect data on the services needed by the populations whose needs are the focus of the centers funded by Title IV of OAA; it also requires states and AAAs to conduct outreach to identify individuals eligible for assistance under OAA, with an emphasis on these populations.

Section 109. Arts education

This section clarifies that arts education is an authorized activity as part of the functions of the Assistant Secretary and that cultural experiences--including the arts--are included in the definition of supportive services.

Section 110. Social determinants of health

This section adds social determinants of health to the purpose of Title III of OAA.

Section 111. Federal coordination of supports and services for living independently and safely at home

This section creates an initiative under the Assistant Secretary to coordinate federal resources to promote the independence and safety of adults living at home as they age, including falls prevention, home assessments, and home modifications.

Section 112. Falls Prevention and Chronic Disease Self-Management education

This section provides an authorization for the currently funded Falls Prevention and Chronic Disease Self-Management programs.

Section 113. Extension of RAISE Family Caregivers Act

This section extends by one year the authorization of the RAISE Family Caregivers Act, which requires the Secretary of Health and Human Services to develop a National Family Caregiving Strategy and convene a Family Caregiving Advisory Council.

Section 114. Support for socially-isolated older americans

This section adds social isolation screening to the definition of disease prevention and health promotion services.

Section 115. Increased focus of Assistant Secretary on social isolation

This section adds a requirement for the Assistant Secretary to develop objectives and a long-term plan to improve the prevention of, detection of, and response to social isolation.

Section 116. Advisory council on social isolation

This section requires the Assistant Secretary to convene an advisory council on social isolation and loneliness tasked with identifying best practices to address these challenges.

Section 117. Supportive services and senior centers

This section adds social isolation to the definition of health screening for the purposes of grant-making authority to senior centers and supportive services in Title III of OAA.

Section 118. Demonstration projects

This section adds projects that address social isolation and loneliness among older adults to the list of authorized grant programs under Title IV of OAA. Additionally, this section repeals section 416 of OAA, which is a technical assistance program that has never received funding.

Section 119. Younger onset Alzheimer's disease

This section clarifies that family caregivers include adult caregivers for individuals of any age with Alzheimer's disease for the purposes of OAA. Additionally, this section clarifies that individuals of any age with Alzheimer's disease can be served by the State Long-Term Care Ombudsman Program.

Section 120. Priority for the Senior Community Service Employment Program

This section adds individuals who are justice-involved as a priority population for the Senior Community Service Employment Program.

Section 121. Direct care workforce

This section adds projects that expand and improve the direct care workforce to the list of authorized grant programs and demonstration projects under Title IV and Title V of OAA.

Section 122. National resource center for older individuals experiencing the long-term and adverse consequences of trauma

This section authorizes the implementation of a national technical assistance center devoted to expanding the aging services network's capacity to deliver person-centered, trauma- informed services that meet the needs of older individuals experiencing the long-term and adverse consequences of trauma.

Section 123. National Resource Center for Women and Retirement

This section codifies the existing National Resource Center for Women and Retirement, which provides financial management, retirement planning, and other educational tools to support women and their families.

Section 124. Definition

This section defines the term "person-centered, trauma- informed."

Section 125. Review of reports

This section requires the Assistant Secretary to review reports submitted under section 307(a)(31) of OAA in relation to data collection and outreach efforts to older individuals whose needs are the focus of all centers funded under Title IV of OAA.

Section 126. Area plans

This section adds Holocaust survivors to individuals to whom AAAs must conduct outreach.

Section 127. Addressing chronic pain management

This section adds chronic pain management to the definition of disease prevention and health promotion services.

Section 128. Extension of the Supporting Grandparents Raising Grandchildren Act

This section extends the authorization period of the Supporting Grandparents Raising Grandchildren Act by one year.

Section 129. Screening for suicide risk

This section clarifies that screening for suicide risk is included in the definition of disease prevention and health promotion services.

Section 130. Traumatic brain injury

This section adds a definition for traumatic brain injury to OAA and adds brain injury screening to the list of allowable services performed with state grants.

Section 131. Addressing public health emergencies and emerging health threats

This section adds public health emergencies and emerging health threats to the definition of disease prevention and health promotion services.

Section 201. National Family Caregiver Support Program cap

This section eliminates the cap on Title III-E National Family Caregiver Support Program resources that can be allocated toward older relative caregivers, which is currently set at 10 percent of total federal and non-federal funding. This section further requires the Assistant Secretary to submit a report to Congress on the impact of lifting this cap.

Section 202. Minimum funding level for state administrative expenses

This section increases the minimum funding level for state administrative expenses from $500,000 to $750,000.

Section 203. Culturally-appropriate, medically-tailored meals

This section acknowledges flexibility for meal planning to address cultural, religious, or ethnic considerations and preferences and medically-tailored meals in Title III-C nutrition programs.

Section 204. Business acumen provisions and clarification regarding outside funding for Area Agencies on Aging

This section provides support for capacity building for AAAs. It also clarifies that AAAs can engage in the provision of privately paid services or services covered by other health care and Long-Term Supports and Services payers outside of their OAA funding.

Section 205. Other practices

This section requires state agencies to provide state policies to AAAs upon request.

Section 206. Caregiver assessments

This section defines and allows for the use of caregiver assessments in the provision of caregiver support services. Additionally, this section requires the Assistant Secretary to issue technical assistance and a report on the use of caregiver assessments.

Section 207. Research and evaluation

This section establishes a National Research, Demonstration, and Evaluation Center for the Aging Network in the Office of the Assistant Secretary. The Center is tasked with conducting, promoting, and coordinating research, research dissemination, evaluation, demonstration projects, and related technical assistance throughout OAA.

Section 208. Grant program for multigenerational collaboration

This section authorizes the Assistant Secretary to award grants to provide opportunities for older individuals to participate in multigeneration activities and civic engagement activities.

Section 301. State Long-Term Care Ombudsman Program minimum funding and maintenance of effort

This section updates minimum funding and maintenance of effort provisions for the State Long-Term Care Ombudsman Program.

Section 302. State long-term care volunteer ombudsman representatives

This section recognizes the use of volunteer representatives in the ombudsman program by clarifying that OAA funds can be used for volunteer transportation and other volunteer expenses.

Section 303. Clarification regarding board and care facilities

This section clarifies that board and care facilities are included within the definition of assisted living facility under OAA.

Section 401. Expanding supportive services for Native American aging programs

This section creates a demonstration program (new Part D) to provide grants to tribal organizations to provide in-home and supportive services. The new Part D receives a 5 percent set-aside from funds provided for Parts A and B, which receive additional funding to accommodate the set aside.

Section 402. Enhancing capacity to support Native American aging programs

This section provides an additional $500,000 for Fiscal Year 2020 for technical assistance for tribal organizations implementing OAA programs.

Section 501. Assistive technology

The section updates OAA's reference to the Assistive Technology Act of 2004.

Section 502. Technical corrections

This section makes technical and conforming amendments.

Section 503. Authorization of appropriations; Uses of funds

This section authorizes appropriations for programs under OAA.

Section 504. Effective date

This section states that the Dignity in Aging Act of 2019 shall take effect on October 1, 2019.

Explanation of Amendments

The amendments, including the amendment in the nature of a substitute, are explained in the descriptive portions of this report.

Application of Law to the Legislative Branch

H.R. 4334 does not apply to terms and conditions of employment or to access to public services or accommodations within the legislative branch.

Unfunded Mandate Statement

Pursuant to Section 423 of the Congressional Budget and Impoundment Control Act (as amended by Section 101(a)(2) of the Unfunded Mandates Reform Act, Pub. L. 104-4) H.R. 4334, as amended, contains no intergovernmental or private-sector mandates as defined by the Unfunded Mandates Reform Act (UMRA).

Earmark Statement

In accordance with clause 9 of rule XXI of the Rules of the House of Representatives, H.R. 4334 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as described in clauses 9(e), 9(f), and 9(g) of rule XXI.

Roll Call Votes

In compliance with clause 3(b) of rule XIII of the Rules of House of the Representatives, the Committee advises that no roll call votes occurred during the Committee's consideration of H.R. 4334.

Statement of Performance Goals and Objectives

Pursuant to clause 3(c) of rule XIII of the Rules of the House of Representatives, the goals of H.R. 4334 are to support the aging population and help older individuals and individuals with disabilities maintain their independence and live with dignity.

Duplication of Federal Programs

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House of Representatives, the Committee states that no provision of H.R. 4334 establishes or reauthorizes a program of the Federal Government known to be duplicative of another federal program, a program that was included in any report from the Government Accountability Office to Congress pursuant to section 21 of Public Law 111-139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance.

Hearings

Pursuant to section 103(i) of H. Res. 6 for the 116th Congress, the Subcommittee on Civil Rights and Human Services held a legislative hearing on May 15, 2019, entitled "Examining the Older Americans Act: Promoting Independence and Dignity for Older Americans," which was used to develop H.R. 4334. The hearing examined the breadth of programs and supports authorized and funded through the Older Americans Act that promote the independence and dignity of older Americans. The Committee heard testimony from: Ms. Lee Girard, MPA:HA, Director of Multnomah County Aging, Disability, and Veterans Services; Ms. Stephanie Archer-Smith, Executive Director of Meals on Wheels of Central Maryland, Inc.; Ms. Grace Whiting, J.D., President and CEO of the National Alliance for Caregiving; and Ms. Patricia Ducayet, L.M.S.W., Texas State Long-Term Care Ombudsman for Texas Health and Human Services.

Statement of Oversight Findings and Recommendations of the Committee

In compliance with clause 3(c)(1) of rule XIII and clause 2(b)(1) of rule X of the House of Representatives, the Committee's oversight findings and recommendations are reflected in the descriptive portions of the report.

New Budget Authority and CBO Cost Estimate

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the House of Representatives and section 308(a) of the Congressional Budget Act of 1974, and pursuant to clause 3(c)(3) of rule XIII of the Rules of the House of Representatives and section 402 of the Congressional Budget Act of 1974, the Committee has received the following estimate for H.R. 4334 from the Director of the Congressional Budget Office:

U.S. Congress, Congressional Budget Office, Washington, DC, October 16, 2019.

Hon. Bobby Scott, Chairman, Committee on Education and Labor, House of Representatives, Washington, DC.

Dear Mr. Chairman: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4334, the Dignity in Aging Act of 2019.

If you wish further details on this estimate, we will be pleased to provide them. The CBO staff contact is Meredith Decker.

Sincerely,

Phillip L. Swagel, Director.

Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

H.R. 4334 would amend the Older Americans Act (OAA) of 1965, which provides funding through the Department of Health and Human Services (HHS) and the Department of Labor (DOL) for services to the elderly. HHS administers most programs authorized by the act, including congregate and home-delivered meals, home and community-based supportive services (such as assistance with transportation, in-home care, and adult day care), and support for caregivers. DOL administers the Senior Community Service Employment program, which provides low-income senior citizens with work-based job training and community service opportunities. The authorization for the OAA programs expired at the end of fiscal year 2019; those programs received discretionary appropriations totaling $2.1 billion that year. H.R. 4334 also would extend the authority and obligations of the Family Caregiving Advisory Council and the Advisory Council to Support Grandparents Raising Grandchildren for an additional year to 2022. Those extensions would cost less than $500,000 in 2022.

H.R. 4334 would authorize the appropriation of $12.5 billion over the 2020-2024 period for OAA programs. Assuming appropriation of specified amounts, and based on historical spending patterns, CBO estimates that implementing the bill would cost $10.9 billion over the same period and $1.4 billion after 2024. The bill would authorize the appropriation of specific amounts for those programs, totaling $10.1 billion for HHS, and $2.4 billion for DOL over the 2020-2024 period.

For this estimate, CBO assumes that H.R. 4334 will be enacted near the beginning of 2020. The costs of the legislation, detailed in Table 1, fall within budget function 500 (education, training, employment, and social services.)

TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 4334

View table at https://www.congress.gov/congressional-report/116th-congress/house-report/258/1?s=1&r=13

The CBO staff contact for this estimate is Meredith Decker. The estimate was reviewed by H. Samuel Papenfuss, Deputy Assistant Director for Budget Analysis.

Committee Cost Estimate

Clause 3(d)(1) of rule XIII of the Rules of the House of Representatives requires an estimate and a comparison of the costs that would be incurred in carrying out H.R. 4334. However, clause 3(d)(2)(B) of that rule provides that this requirement does not apply when the committee has included in its report a timely submitted cost estimate of the bill prepared by the Director of the Congressional Budget Office under section 402 of the Congressional Budget Act of 1974.

Change in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, H.R. 4334, as reported, are shown as follows:

Changes in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics, and existing law in which no change is proposed is shown in roman):

OLDER AMERICANS ACT OF 1965

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