[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3544 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 3544
To assist older Americans and people with disabilities affected by
COVID-19.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 19, 2020
Mr. Casey (for himself, Mr. Booker, Mr. Brown, Mr. Menendez, Mr. Jones,
Mr. Peters, Ms. Duckworth, Mrs. Gillibrand, Ms. Sinema, Mr. Blumenthal,
Mr. Kaine, Ms. Hassan, Mr. Reed, Ms. Warren, Ms. Smith, Mr. Tester, Mr.
Sanders, Mrs. Shaheen, Ms. Baldwin, Ms. Klobuchar, Ms. Rosen, Mr.
Markey, Ms. Cortez Masto, and Mr. Merkley) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To assist older Americans and people with disabilities affected by
COVID-19.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) In General.--This Act may be cited as the ``Coronavirus Relief
for Seniors and People with Disabilities Act of 2020''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--SUPPLEMENTAL APPROPRIATIONS
Sec. 101. Supplemental appropriations.
TITLE II--MEDICAID
Sec. 201. Expanded access to medical assistance for Medicare costs
during the COVID-19 public health
emergency.
Sec. 202. Authority to award Medicaid HCBS grants to respond to the
COVID-19 public health emergency.
TITLE III--NUTRITION SERVICES
Sec. 301. Definitions.
Sec. 302. Congregate nutrition services criteria.
Sec. 303. Home delivered nutrition services criteria.
TITLE I--SUPPLEMENTAL APPROPRIATIONS
SEC. 101. SUPPLEMENTAL APPROPRIATIONS.
The following sums are hereby appropriated, out of any money in the
Treasury not otherwise appropriated, for the fiscal year ending
September 30, 2020, and for other purposes, namely:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
survey and certification activities
For an additional amount for survey and certification activities
authorized under sections 1862(g) and 1864 of the Social Security Act
(42 U.S.C. 1395y(g), 1395aa) and section 353 of the Public Health
Service Act (42 U.S.C. 263a), $154,400,000, to remain available through
September 30, 2021: Provided, That such amount is designated by the
Congress as being for an emergency requirement pursuant to section
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Administration for Community Living
aging and disability services programs
For an additional amount for ``Aging and Disability Services
Programs'', for carrying out the Older Americans Act of 1965 (42 U.S.C.
3001 et seq.) (``OAA''), $2,851,800,000, to remain available through
September 30, 2021, of which--
(1) $1,000,000,000 shall be for providing supportive
services under part B of title III of such Act (42 U.S.C. 3030d
et seq.);
(2) $1,650,000,000 shall be for providing home delivered
nutrition services under subpart 2 of part C of title III of
such Act (42 U.S.C. 3030f et seq.);
(3) $185,900,000 shall be for providing support services
for family caregivers under part E of title III of such Act (42
U.S.C. 3030s et seq.); and
(4) $15,900,000 shall be for providing elder rights
protection activities under title VII of such Act (42 U.S.C.
3058 et seq.): Provided, That State matching requirements
under sections 304(d)(1)(D), 309(b)(2), and 373(g)(2) of the
OAA (42 U.S.C. 3024(d)(1)(D), 3029(b)(2), and 3030s-1(g)(2))
shall not apply to any amount appropriated under this heading:
Provided further, That the amount appropriated under this
heading is designated by Congress as being for an emergency
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced
Budget and Emergency Deficit Control Act of 1985 (2 U.S.C.
901(b)(2)(A)(i)).
DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
commodity assistance program
For an additional amount for ``Commodity Assistance Program'', for
necessary expenses to carry out the commodity supplemental food program
established under section 5 of the Agriculture and Consumer Protection
Act of 1973 (7 U.S.C. 612c note; Public Law 93-86), $55,000,000, to
remain available through September 30, 2021: Provided, That the amount
appropriated under this heading is designated by Congress as being for
an emergency requirement pursuant to section 251(b)(2)(A)(i) of the
Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C.
901(b)(2)(A)(i)).
TITLE II--MEDICAID
SEC. 201. EXPANDED ACCESS TO MEDICAL ASSISTANCE FOR MEDICARE COSTS
DURING THE COVID-19 PUBLIC HEALTH EMERGENCY.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(10)(E)--
(A) in clause (iii), by striking ``; and'' and
inserting a semicolon;
(B) in clause (iv), by striking the semicolon and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(v) during the period described in subsection
(ss), for making medical assistance available for
medicare cost-sharing (as defined in section
1905(p)(3)) for--
``(I) individuals who are described in
clause (ii), (iii), or (iv); and
``(II) individuals--
``(aa) who are not described in
clauses (i) through (iv) but who are
eligible for, or enrolled in, the low-
income subsidy program under section
1860D-14; and
``(bb) whose application for such
medical assistance is received by the
State (or automatically initiated
pursuant to the transmittal of data
under section 1144(c)(3)(B)) before the
end of the emergency period defined in
section 1135(g)(1)(B).''; and
(2) by adding at the end the following new subsection:
``(ss) COVID-19 Emergency Assistance Period.--For purposes of
subsection (a)(10)(E)(v), the period described in this subsection is
the period--
``(1) beginning with the date of enactment of this
subsection; and
``(2) ending with the last day of the 12th month that
begins after the emergency period defined in section
1135(g)(1)(B).''.
(b) Transmittal of Data to States and Automatic Enrollment of
Individuals.--Section 1144(c)(3) of the Social Security Act (42 U.S.C.
1320b-14(c)(3)) is amended--
(1) by striking ``Beginning on January 1, 2010'' and
inserting the following:
``(A) Transmittal of lis applications to states.--
Beginning on January 1, 2010''; and
(2) by adding at the end the following new subparagraph:
``(B) Transmittal of lis enrollment information to
states during the covid-19 public health emergency.--
During the period described in section 1902(ss), the
Secretary, in coordination with the Commissioner of
Social Security, shall electronically transmit to the
appropriate State Medicaid agency data related to each
individual who is enrolled in the low-income subsidy
program under section 1860D-14, and such transmittal
shall initiate an application of the individual for
benefits under the Medicare Savings Program with the
State Medicaid agency. In order to ensure that such
data transmittal provides effective assistance for
purposes of State adjudication of applications for
benefits under the Medicare Savings Program, the
Secretary shall consult with the States regarding the
content, form, frequency, and manner in which data (on
a uniform basis for all States) shall be transmitted
under this subparagraph.''.
(c) Additional Appropriation for Administrative Costs for the
Department of Health and Human Services and the Social Security
Administration.--
(1) In general.--There are hereby appropriated to carry out
the requirement of subparagraph (B) of section 1144(c)(3) of
the Social Security Act (42 U.S.C. 1320b-14(c)(3)), as added by
subsection (b), out of any funds in the Treasury not otherwise
appropriated--
(A) $1,000,000 to the Secretary of Health and Human
Services, to remain available until expended; and
(B) $1,000,000 to the Commissioner of Social
Security, to remain available until expended.
(2) Supplement not supplant.--Any amounts appropriated
pursuant to this subsection shall be in addition to any other
amounts otherwise appropriated pursuant to any other provision
of law.
(d) Budget Neutrality With Respect to Medicare Advantage
Payments.--The Secretary of Health and Human Services shall assess the
effect of the amendments made by subsection (a) on payments to Medicare
Advantage plans under part C of title XVIII of the Social Security Act
(42 U.S.C. 1395w-21 et seq.) and make necessary adjustments to ensure
that, during the COVID-19 emergency assistance period described in
subsection (ss) of section 1902 of the Social Security Act (42 U.S.C.
1396a) (as added by subsection (a)), risk-adjusted payments under such
part with respect to individuals newly enrolled in the Medicare Savings
Program (as defined in section 1144 of the Social Security Act (42
U.S.C. 1320b-14)) pursuant to such amendments do not exceed such
payments that would have been made under such part with respect to such
individuals if such subsection had not been enacted.
(e) Federal Medical Assistance Percentage.--Section 1905 of the
Social Security Act (42 U.S.C. 1396d) is amended--
(1) in subsection (b), by striking ``and (ff)'' and
inserting ``(ff), and (gg)''; and
(2) by adding at the end the following:
``(gg) Increased FMAP for Additional Expenditures for Medicare
Cost-Sharing Provided During the COVID-19 Public Health Emergency.--
Notwithstanding subsection (b), the Federal medical assistance
percentage for a State shall be 100 percent--
``(1) with respect to the additional amounts expended by
the State for medical assistance provided during the period
described in section 1902(ss) under the State plan under this
title or a waiver of such plan that are attributable to the
requirements imposed by section 1902(a)(10)(E)(v);
``(2) with respect to expenditures described in section
1903(a)(7) that--
``(A) are made by the State during the period
described in section 1902(ss); and
``(B) the State demonstrates to the satisfaction of
the Secretary are attributable to administrative costs
related to meeting such requirements; and
``(3) with respect to expenditures that are made by the
State to determine whether individuals who are provided medical
assistance for medicare cost-sharing under section
1902(a)(10)(E)(v)(II) remain eligible for such assistance after
the period described in section 1902(ss).''.
SEC. 202. AUTHORITY TO AWARD MEDICAID HCBS GRANTS TO RESPOND TO THE
COVID-19 PUBLIC HEALTH EMERGENCY.
(a) In General.--The Secretary is authorized to award grants to
States in accordance with this section to enhance access to home and
community-based services during the COVID-19 public health emergency
period.
(b) Definitions.--In this section:
(1) COVID-19 public health emergency period.--The term
``COVID-19 public health emergency period'' means the portion
of the emergency period defined in paragraph (1)(B) of section
1135(g) of the Social Security Act (42 U.S.C. 1320b-5(g))
beginning on or after the date of the enactment of this Act.
(2) Eligible individual.--The term ``eligible individual''
means an individual who is eligible for or enrolled for medical
assistance under a State Medicaid program.
(3) Home and community-based services.--The term ``home and
community-based services'' means, with respect to a State
Medicaid program, home and community-based services (including
home health and personal care services) that are provided under
the State's qualified HCBS program or that could be provided
under such a program but are otherwise provided under the
Medicaid program.
(4) Indian tribe.--The term ``Indian tribe'' means an
Indian tribe, a tribal organization, or an urban Indian
organization (as such terms are defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)), and
includes a tribal consortium of Indian tribes or tribal
organizations (as so defined).
(5) Medicaid program.--The term ``Medicaid program'' means,
with respect to a State, the State program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) (including any
waiver or demonstration under such title or under section 1115
of such Act (42 U.S.C. 1315) relating to such title).
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(8) Qualified hcbs program.--The term ``qualified HCBS
program'' means a program providing home and community-based
services operating under a State Medicaid program, whether or
not operating under waiver authority.
(c) Grants to States.--
(1) In general.--During the COVID-19 public health
emergency period, the Secretary may award grants to States with
applications meeting the requirements of paragraph (2).
(2) Application requirements.--A State seeking a grant
under this section shall submit an application to the Secretary
at such time, in such form and manner, and containing such
information as the Secretary shall require.
(3) Limitations.--
(A) Termination of authority.--The Secretary shall
not award any grants under this section with respect to
a State that submits an application after the date that
is 60 days after the end of the COVID-19 public health
emergency period.
(B) Use of funds.--A State to which a grant is made
under this section shall only use grant funds in
accordance with subsection (d).
(C) Maintenance of state effort.--Federal funds
paid to a State pursuant to this section must be used
to supplement, but not supplant, the level of State
funds expended for home and community-based services
for eligible individuals programs in effect for such
individuals at the time the grant is awarded under this
section.
(4) Monthly grant payment amounts.--
(A) In general.--Subject to paragraph (5), the
Secretary shall pay to each State that is awarded a
grant under this section, for each month during the
State's grant period (as defined in subparagraph (C)),
an amount equal to 15 percent of the amount determined
for the State under subparagraph (B).
(B) Average monthly hcbs expenditures.--The amount
determined for a State under this subparagraph is the
amount equal to--
(i) the sum of--
(I) the average annual amount of
State expenditures under title XIX of
the Social Security Act (42 U.S.C. 1396
et seq.) that are attributable to
providing medical assistance for home
and community-based services for the 3
most recent fiscal years for which data
is available; and
(II) the average annual amount, if
any, received by the State pursuant to
an MFP demonstration project conducted
under section 6071 of the Deficit
Reduction Act of 2005 (42 U.S.C. 1396a
note) for the 3 most recent fiscal
years for which data is available;
divided by
(ii) 12.
(C) Grant period defined.--In this paragraph, the
term ``grant period'' means, with respect to a State,
the period of months--
(i) beginning with the month in which the
Secretary approves the State's application for
a grant under this section; and
(ii) ending with the twelfth month that
begins after the end of the COVID-19 public
health emergency period.
(5) Grants to indian tribes.--
(A) In general.--During the COVID-19 public health
emergency period, the Secretary may award grants to an
Indian tribe in the same manner, and subject to the
same requirements, as apply to a State, except as
otherwise provided in this paragraph.
(B) Application.--Any Indian tribe seeking a grant
under this section shall submit to the Secretary an
application that includes (in addition to any other
information the Secretary shall require) an
identification of the population and service area or
areas to be served by the activities and programs that
will be funded by the grant.
(C) Monthly grant payment amounts.--
(i) In general.--The Secretary shall pay to
each Indian tribe that is awarded a grant under
this section, for each month during the tribe's
grant period (as defined in clause (iii)), an
amount equal to 15 percent of the amount
determined for the tribe under clause (ii).
(ii) Tribal share of monthly hcbs
expenditures.--The amount determined for an
Indian tribe under this clause is equal to--
(I) the total of the average annual
amount of State expenditures made by a
State or States under title XIX of the
Social Security Act (42 U.S.C. 1396 et
seq.) that are attributable to
providing medical assistance for home
and community-based services to
eligible individuals who reside in the
service area or areas identified by the
tribe pursuant to subparagraph (B) for
the 3 most recent fiscal years for
which data is available; divided by
(II) 12.
(iii) Grant period.--The term ``grant
period'' has the same meaning with respect to
an Indian tribe as the term has with respect to
a State under paragraph (4)(C).
(D) Reduction of state grant amounts.--If any State
in which lies a service area or areas identified by an
Indian tribe in a successful grant application pursuant
to subparagraph (B) is also awarded a grant under this
section, the Secretary shall reduce the amount payable
to such State each month under paragraph (4) by the
portion of the amount payable to the Indian tribe under
this paragraph that is attributable to expenditures by
the State.
(d) Permissible Uses of Funds.--
(1) In general.--A State to which a grant is made under
this section may use grant funds--
(A) to work with community partners such as Area
Agencies on Aging, Independent Living Centers,
nonprofit home and community based service providers,
and other entities providing home and community-based
services;
(B) during the COVID-19 public health emergency
period, for the purposes described in paragraph (2);
and
(C) after the end of such period, for the purposes
described in paragraph (3).
(2) Permissible uses during the emergency period.--The
purposes described in this paragraph for which a State may use
grant funds awarded under this section are the following:
(A) To increase rates for home health and direct
service worker agencies to provide home and community-
based services under the State Medicaid program,
provided that any agency or individual that receives
payment under such an increased rate increases the
compensation it pays its home health or direct service
workers.
(B) To provide paid sick leave, paid family leave,
and paid medical leave for home health workers and
direct service workers.
(C) To provide hazard pay, overtime pay, and shift
differential pay for home health workers and direct
service workers.
(D) To provide home and community-based services to
eligible individuals who are on waiting lists for
programs approved under sections 1115 or 1915 of the
Social Security Act (42 U.S.C. 1315, 1396n).
(E) To purchase emergency supplies and equipment
necessary to enhance access to services and to protect
the health and well-being of home health workers and
direct service workers.
(F) To pay for home health worker and direct
service worker travel to conduct home and community-
based services.
(G) To recruit new direct service workers and home
health workers.
(H) To support family care providers of eligible
individuals with needed supplies and equipment and pay.
(I) To pay for training for direct service workers
and home health workers that is specific to the COVID-
19 public health emergency.
(J) To pay for assistive technologies, staffing,
and other costs incurred during the public health
emergency in order to facility community integration
and ensure an individual's person-centered service plan
continue to be fully implemented.
(K) To support direct service workers and home
health workers going to nursing facilities, hospitals,
institutions, and quarantine settings to provide
services to eligible individuals who usually receive
home and community-based services and have chosen to
temporarily move to a more restrictive setting.
(L) To prepare information and public health and
educational materials in accessible formats about
prevention, treatment, recovery and other aspects of
COVID-19 for eligible individuals, their families, and
the general community served by home health and direct
service agencies, including formats accessible to
people with low literacy or intellectual disabilities.
(M) To pay for American sign language interpreters
to assist in providing home and community-based
services to eligible individuals and to inform the
general public about COVID-19.
(N) To allow for day service providers to shift to
providing home-based services.
(O) To pay for COVID-19 testing in home settings.
(P) To pay for other expenses deemed appropriate by
the Secretary and which meet the criteria of the home
and community-based settings rule.
(3) Permissible uses after the emergency period.--The
purpose described in this paragraph for which a State may use
grant funds awarded under this section is to assist eligible
individuals who had to relocate to a nursing facility or
institutional setting from their homes during the COVID-19
public health emergency period in--
(A) moving back to their homes (including by paying
for moving costs);
(B) resuming home and community-based services;
(C) receiving mental health services and necessary
rehabilitative service to regain skills lost while
relocated during the public health emergency period;
and
(D) continuing home and community-based services
for eligible individuals who were served from a waiting
list for such services during the public health
emergency period.
(e) Reporting Requirements.--
(1) State reporting requirements.--Not later than 18 months
after the end of the COVID-19 public health emergency period,
any State that received a grant under this section shall submit
a report to the Secretary that contains the following
information:
(A) Activities and programs that were funded using
grant amounts.
(B) The number of eligible individuals who were
served by such activities and programs.
(C) The number of eligible individuals who were
able to resume home and community-based services as a
result of such activities and programs.
(2) HHS report.--Not later than 18 months after the end of
the COVID-19 public health emergency period, the Secretary
shall issue a public summary of the grants awarded under this
section.
(f) Appropriation.--
(1) In general.--Subject to paragraph (2), there are
appropriated for fiscal year 2020 from any funds in the
Treasury not otherwise appropriated such sums as are necessary
to carry out this section, to remain available until expended.
(2) Availability of appropriations.--Amounts made available
under paragraph (1) shall not be available for the awarding of
grants to States that do not submit an application for such a
grant before the date described in subsection (c)(3)(A).
(3) Unused grant funds.--A State that receives a grant
under this section shall return to the Secretary any portion of
such grant that is unused as of the date that is 1 year after
the last day of the COVID-19 public health emergency period,
and such returned portion shall revert to the Treasury.
TITLE III--NUTRITION SERVICES
SEC. 301. DEFINITIONS.
Section 302 of the Older Americans Act of 1965 (42 U.S.C. 3022) is
amended--
(1) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(2) by inserting after paragraph (1) the following:
``(2) COVID-19 public health emergency period.--The term
`COVID-19 public health emergency period' means the portion of
the emergency period defined in paragraph (1)(B) of section
1135(g) of the Social Security Act beginning on or after the
date of the enactment of this Act.''.
SEC. 302. CONGREGATE NUTRITION SERVICES CRITERIA.
(a) Definitions.--In this section:
(1) Area agency on aging; state agency.--The terms ``area
agency on aging'' and ``State agency'' have the meanings given
the terms in section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002).
(2) COVID-19 public health emergency period.--The term
``COVID-19 public health emergency period'' has the meaning
given the term in section 302 of such Act (42 U.S.C. 3022).
(b) Transfers.--For purposes of section 308(b)(4) of the Older
Americans Act of 1965 (42 U.S.C. 3028(b)(4)), during the COVID-19
public health emergency period the Secretary of Health and Human
Services shall allow a State agency or an area agency on aging, without
prior approval, to transfer not more than 100 percent of the funds
received by the State agency or area agency on aging, respectively, and
attributable to funds appropriated under paragraph (1) or (2) of
section 303(b) of such Act (42 U.S.C. 3023(b)), between subpart 1 and
subpart 2 of part C of such Act (42 U.S.C. 3030d-21 et seq.) for such
use as the State agency or area agency on aging, respectively,
considers appropriate to meet the needs of the State or area served.
SEC. 303. HOME DELIVERED NUTRITION SERVICES CRITERIA.
Section 337 of the Older Americans Act of 1965 (42 U.S.C. 3030g) is
amended--
(1) by inserting ``(a)'' before ``The Assistant
Secretary''; and
(2) by adding at the end the following:
``(b) For purposes of determining priority for the delivery of
nutrition services under this subpart, during the COVID-19 public
health emergency period, the Assistant Secretary shall give the same
priority, as the Assistant Secretary gives to an individual who is
homebound by reason of illness, to--
``(1) an individual who is unable to obtain nutrition
because the individual is under a quarantine, practicing social
distancing, or otherwise unable to leave home, due to the
emergency;
``(2) a person under age 18, or an individual with a
disability, who resides in the same home as the recipient if,
according to criteria determined by the area agency on aging,
provision of such nutrition services to the person or
individual is in the best interest of the recipient; and
``(3) an individual with a disability who--
``(A) is at home during the public health emergency
period; and
``(B) usually receives services in a day program,
at the individual's place of work, or through a
visiting direct service worker who may not be able to
continue to provide services during the public health
emergency period.''.
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