[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6149 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 6149
To amend the Public Health Service Act to develop and test an expanded
and advanced role for direct-care workers who provide long-term
services and supports to older adults and people with disabilities in
efforts to coordinate care and improve the efficiency of service
delivery, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 7, 2021
Mr. Cartwright (for himself and Mr. McKinley) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to develop and test an expanded
and advanced role for direct-care workers who provide long-term
services and supports to older adults and people with disabilities in
efforts to coordinate care and improve the efficiency of service
delivery, 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 ``Improving Care for Vulnerable Older
Citizens and People with Disabilities through Workforce Advancement Act
of 2021''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) As of 2019, more than 54,000,000 Americans were age 65
or older. By 2030, the Census Bureau projects that one in five
Americans will be 65 or older. More than 80 percent of older
Americans suffer from chronic conditions which require person-
centered, coordinated care that helps them to live in a home-
or community-based setting. In 2012, the Government
Accountability Office (GAO) found that 34 percent of Americans
who are age 60 or older reported needing assistance performing
activities of daily living. According to a 2015 GAO report,
between 67 and 78 percent of older adults who likely need home-
based care receive limited or no help with their difficulties.
(2) Direct-care workers (referred to in this section as
``DCWs'') provide an estimated 70 to 80 percent of the paid
hands-on long-term care and personal assistance received by
elders and people with disabilities or other chronic conditions
in the United States. These workers help their clients bathe,
dress, and negotiate a range of other daily tasks. They are a
lifeline for those they serve, as well as for families and
friends struggling to provide high-quality care.
(3) Eldercare and disability services positions account for
nearly one-third of the 18,000,000 health care jobs in the
United States. The direct-care workforce alone accounts for
nearly 4,600,000 jobs and is expected to add nearly 1,300,000
new positions within the next decade.
(4) The majority of DCWs are now employed in home- and
community-based settings, and not in institutional settings
such as nursing care facilities or hospitals. In 2019, DCWs
providing home-based care already outnumbered DCWs in nursing
homes by more than 4 to 1.
(5) A 2008 Institute of Medicine report, entitled ``Re-
tooling for an Aging America: Building the Health Care
Workforce'', called for new models of care delivery and
coordination, and dedicated a chapter to the central importance
of the direct-care workforce in a ``re-tooled'' eldercare
delivery system.
(6) An Institute of Medicine report on the future of
nursing, released in 2016, recommended nurses should practice
to the full extent of their education and training. The report
also states that all health care professionals should work
collaboratively in team-based models, and that the goal should
be to encourage care models that use every member of the team
to the full capacity of his or her training and skills.
(7) The Patient Protection and Affordable Care Act (Public
Law 111-148) emphasizes the need for improving care and
lowering costs by better coordination of care and integration
of services, particularly for consumers with multiple chronic
conditions. This has required developing new models of care for
those receiving long-term services and supports.
SEC. 3. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE
DELIVERY.
Title III of the Public Health Service Act is amended by inserting
after section 330N of such Act (42 U.S.C. 254c-20) the following:
``SEC. 330O. DEMONSTRATION PROGRAM ON CARE COORDINATION AND SERVICE
DELIVERY.
``(a) Establishment of Demonstration Program.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall carry out a demonstration program in
accordance with this section. Under such program, the Secretary
shall award grants to eligible entities to carry out
demonstration projects that focus on care coordination and
service delivery redesign for older adults and people with
disabilities who have chronic illness or are at risk of
institutional placement by--
``(A) designing and testing new models of care
coordination and service delivery that thoughtfully and
effectively deploy direct-care workers in advanced
roles to improve efficiency and quality of care for
older adults and people with disabilities; and
``(B) giving direct-care workers opportunities for
career advancement through additional training, an
expanded role, and increased compensation.
``(2) Direct-care worker.--In this section, the term
`direct-care worker' has the meaning given that term in the
2010 Standard Occupational Classifications of the Department of
Labor for Home Health Aides [31-1011], Psychiatric Aides [31-
1013], Nursing Assistants [31-1014], and Personal Care Aides
[39-9021].
``(b) Demonstration Projects.--The demonstration program under this
section shall be composed of 4 demonstration projects, as follows:
``(1) Two demonstration projects shall focus on using the
abilities of direct-care workers to promote smooth transitions
in care and help to prevent unnecessary hospital readmissions.
Under these projects, direct-care workers shall be incorporated
as essential members of interdisciplinary care coordination
teams.
``(2) Two demonstration projects shall focus on maintaining
the health and improving the health status of those with
multiple chronic conditions and long-term care needs or on
training direct-care workers to take on greater
responsibilities related to specific diseases, including
Alzheimer's disease and dementia, congestive heart failure, and
diabetes. Under these projects, direct-care workers shall
assist in monitoring health status, ensuring compliance with
prescribed care, and educating and coaching the older adults
and people with disabilities involved, as well as any family
caregivers and other members of the care team.
``(c) Eligible Entity.--In this section, the term `eligible entity'
means a consortium that consists of--
``(1) at least 1--
``(A) skilled nursing facility or other residential
long-term care provider; or
``(B) home health and personal care service
provider; and
``(2) at least 1--
``(A) hospital or health system;
``(B) labor organization or labor-management
partnership;
``(C) community-based aging and disability services
provider;
``(D) patient-centered medical home;
``(E) federally qualified health center;
``(F) managed care entity, including a managed
health and long-term care program;
``(G) entity that provides health services
training;
``(H) State-based public entity engaged in building
new roles and related curricula for direct-care
workers; or
``(I) any other entity that the Secretary deems
eligible based on integrated care criteria.
``(d) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require, which shall include--
``(1) a description of the care coordination and service
delivery models of the entity, detailed on a general,
organizational, and staff level;
``(2) a description of how the demonstration project
carried out by the entity will improve care quality, including
specific objectives and anticipated outcomes that will be used
to measure success; and
``(3) a description of how the coordinated care team
approach with an enhanced role for the direct-care worker under
the demonstration project will increase efficiency and cost
effectiveness compared to past practice.
``(e) Planning Awards Under Demonstration Program.--
``(1) In general.--Each eligible entity that receives a
grant under this section shall receive a grant for planning
activities related to the demonstration project to be carried
out by the entity, including--
``(A) designing the implementation of the project;
``(B) identifying competencies and developing
curricula for the training of participating direct-care
workers;
``(C) developing training materials and processes
for other members of the interdisciplinary care team;
``(D) articulating a plan for identifying and
tracking cost savings gained from implementation of the
project and for achieving long-term financial
sustainability; and
``(E) articulating a plan for evaluating the
project, encompassing workforce outcomes, care
outcomes, and cost outcomes.
``(2) Amount and term.--
``(A) Total amount.--The amount awarded under
paragraph (1) for all grants shall not exceed $600,000.
``(B) Term.--Activities carried out under a grant
awarded under paragraph (1) shall be completed not
later than 1 year after the grant is awarded.
``(f) Implementation Awards Under Demonstration Program.--
``(1) In general.--Each eligible entity may receive a grant
for implementation activities related to the demonstration
project to be carried out by the entity, if the Secretary
determines the entity--
``(A) has successfully carried out the activities
under the grant awarded under subsection (e);
``(B) offers a feasible plan for long-term
financial sustainability;
``(C) has constructed a meaningful model of
advancement for direct-care workers; and
``(D) aims to provide training to a sizeable number
of direct-care workers and to serve a sizeable number
of older adults and people with disabilities.
``(2) Use of funds.--The implementation activities
described under paragraph (1) shall include--
``(A) training of all care team members in
accordance with the design of the demonstration
project; and
``(B) evaluating the competency of all staff based
on project design.
``(3) Evaluation and report.--
``(A) Evaluation.--Each recipient of a grant under
paragraph (1), in consultation with an independent
evaluation contractor, shall evaluate--
``(i) the impact of training and deployment
of direct-care workers in advanced roles, as
described in this section, within each
participating entity on outcomes, such as
direct-care worker job satisfaction and
turnover, beneficiary and family caregiver
satisfaction with services, rate of
hospitalization of beneficiaries, and
additional measures determined by the
Secretary;
``(ii) the impact of such training and
deployment on the long-term services and
supports delivery system and resources;
``(iii) statement of the potential of the
use of direct-care workers in advanced roles to
lower cost and improve quality of care; and
``(iv) long-term financial sustainability
of the model used under the grant and the
impact of such model on quality of care.
``(B) Reports.--Not later than 180 days after
completion of the demonstration program under this
section, each recipient of a grant under paragraph (1)
shall submit to the Secretary a report on the
implementation of activities conducted under the
demonstration project, including--
``(i) the outcomes, performance benchmarks,
and lessons learned from the project;
``(ii) a statement of cost savings gained
from implementation of the project and how the
cost savings have been reinvested to improve
direct-care job quality and quality of care;
and
``(iii) results of the evaluation conducted
under subparagraph (A) with respect to such
activities, together with such recommendations
for legislation or administrative action for
expansion of the demonstration program under
this section on a broader scale as the
Secretary determines appropriate.
``(4) Amount and term.--
``(A) Total amount.--The amount awarded under
paragraph (1) for all grants shall not exceed
$2,900,000.
``(B) Term.--Activities carried out under a grant
awarded under paragraph (1) shall be completed not
later than 3 years after the grant is awarded.''.
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