Summary: S.243 — 102nd Congress (1991-1992)All Information (Except Text)

Bill summaries are authored by CRS.

Shown Here:
Indefinitely postponed in Senate (11/12/1991)

Older Americans Act Reauthorization Amendments of 1991 - Title I: Objectives and Definitions - Amends the Older Americans Act of 1965 (OAA) to establish as an OAA objective the provision of support to family members and other persons providing voluntary care to older individuals needing long-term care services.

Adds the definitions of various terms to OAA, including such terms as "elder abuse, neglect, and exploitation", "conflict of interest", and "case management services", that are to be used later in this Act. Makes the OAA poverty line reflective of the Office of Management and Budget's official poverty line.

Title II: Administration - Adds the following as new functions of the Associate Commissioner on American Indian, Alaskan Native, and Native Hawaiian Aging: (1) promoting coordination between programs established under OAA titles III (Grants for State and Community Programs on Aging) and IV (Training, Research, and Discretionary Projects and Programs); (2) acting as an advocate for older Native Americans with the Indian Health Service; and (3) collecting and disseminating information regarding elder abuse, in-home care, health programs, and other problems unique to Native Americans.

Establishes the Office of Long-Term Care Ombudsman Programs in the Administration on Aging (AOA) to be headed by an Associate Commissioner for Ombudsman Services who shall serve as an advocate on behalf of long-term care facility residents, within the Department of Health and Human Services (HHS) and with other Federal departments and agencies.

Requires the AOA Commissioner to: (1) establish a National Ombudsman Resource Center to provide technical assistance and training to State long-term care ombudsman programs, to analyze laws, regulations, policies, and actions affecting such residents, and to provide assistance regarding recruitment and retention of volunteer ombudsmen; (2) establish a National Aging Data Center to compile, analyze, publish, and disseminate various statistical data on aging, older individuals, and the services provided to them as well as to provide technical assistance, training, and other means of assistance to State agencies, area agencies on aging, and service providers regarding State and local data collection and analysis; (3) establish and operate a National Center on Elder Abuse and in the process compile, publish, and disseminate a summary of research and training materials on elder abuse, neglect, and exploitation; develop and maintain an information clearinghouse on programs which show promise of preventing, identifying, and treating elder abuse, neglect and exploitation; provide technical assistance to State agencies and other public and nonprofit agencies involved in prevention of elder abuse, neglect, and exploitation; and conduct research and demonstration projects regarding the causes, prevention, identification, and treatment of elder abuse, neglect, and exploitation; (4) develop and maintain, along with State and area agencies on aging, a national aging network that ensures a responsive community-based services system for older individuals; (5) establish information and assistance services as priority services; (6) develop guidelines for area agencies in choosing and evaluating legal assistance providers; (7) develop a model job description for legal assistance developers; (8) study ways in which Federal funds might be more effectively targeted to low-income, minority, and rural older individuals to better meet the needs of States with a disproportionate number of older individuals with the greatest social and economic need; (9) study ways in which Federal funds might be more effectively targeted to better meet the needs of States with a disproportionate number of older individuals; and (10) report the findings of such studies to the House Committee on Education and Labor and the Senate Committee on Labor and Human Resources.

Outlines funding requirements for the National Ombudsman Resource Center and the National Center on Elder Abuse.

Requires the AOA Commissioner to advise, consult, and cooperate with the Department of Labor (DOL) in carrying out the Community Service Employment Program for Older Americans and with ACTION in carrying out OAA. Requires DOL to consult and cooperate with the AOA Commissioner in carrying out the Job Training Partnership Act. Requires the head of each agency administering programs and services substantially related to those under OAA to collaborate with the AOA Commissioner and to develop an analysis of the impact of such programs and services on the elderly (with particular attention on older low-income minorities) and on the functions and responsibilities of State and area agencies on aging. Includes as programs related to the purposes of OAA the Edward Byrne Memorial State and Local Law Enforcement Assistance Programs under the Omnibus Crime Control and Safe Streets Act of 1968.

Requires the AOA Commissioner to consult and coordinate with State agencies, area agencies on aging, and Native American grant recipients in the development of Federal goals, regulations, program instructions, policies, and procedures under OAA.

Establishes class memberships for individuals newly appointed to serve on the Federal Council on the Aging. Authorizes increased appropriations through FY 1995 for the Council. Makes mandatory currently discretionary interim Council reports to the President. Requires the HHS Secretary to evaluate the Council in the manner required for OAA programs.

Establishes an Interagency Task Force on Aging headed by the AOA Commissioner to coordinate related aging policies and programs among member Federal agencies.

Makes the permanent funding authorization for OAA program administrative expenses applicable only for FY 1992 through 1995.

Requires that the annual report on the long-term care ombudsman program be compiled by March 1, of each year, rather than by January 15, as is currently required.

Requires the AOA Commissioner to: (1) establish a task force to develop recommendations identifying a core set of statistical data regarding OAA funded programs and activities as well as other specified data and a methodology for collecting information on gaps in services needed by older individuals, and, based on such recommendations, to develop a proposal for a revised system to collect such data; and (2) provide technical assistance, training, and other means of assistance to State and area agencies on aging and service providers regarding State and local data collection and analysis.

Requires a study by the AOA Commissioner and a report to specified congressional committees on the effectiveness of State long-term care ombudsman programs in providing services to long-term care facility residents and on the adequacy of Federal and other resources to carry out such a program in each State.

Adds the AOA Commissioner's position to the list of Level IV positions on the Executive Schedule.

Title III: State and Community Programs on Aging - Subtitle A: General Provisions - Amends OAA title III (State and Community Programs on Aging) to add: (1) the securing of the opportunity for older individuals to receive managed in-home and community-based long-term care services to the list of purposes for such title; and (2) other State agencies, including agencies that administer home and community programs, and organizations representing or employing older individuals or their families to the list of entities that are to cooperate with State and area agencies on aging.

Reauthorizes and extends OAA title III through FY 1995, including new components relating to: (1) congregate nutrition services and intergenerational activities of schools; and (2) supportive activities for individuals who provide in-home services. Eliminates: (1) the separate funding authorization for the title III component relating to the prevention of elder abuse, neglect, and exploitation which is shifted by title VI of this Act to a new OAA title VII (Grants to States for Vulnerable Elder Rights Protection Activities); and (2) the trigger which precludes appropriations for certain programs unless total appropriations for programs funded in FY 1987 exceed the previous year's level by at least five percent. Authorizes use of title III funds for provision of a State or area volunteer service coordinator. Prohibits the appropriation of funds for congregate nutrition services and intergenerational activities in schools unless the funds appropriated for the congregate and home-delivered meals programs exceed those appropriated for such meals programs in FY 1990. Sets: (1) a minimum annual allotment of $50,000 per State for supportive services for individuals who provide in-home services to frail older individuals; and (2) the Federal matching amount for the ombudsman program at 85 percent.

Mandates withholding of allotments for those States which have not had their intrastate funding formula approved.

Makes the designated State agency primarily responsible for the planning, policy development, administration, coordination, priority setting, and evaluation of all State activities related to OAA purposes. Requires the intrastate funding formula to be developed in consultation with area agencies and to take into account older individuals distributed both throughout the State and, with respect to older individuals with the greatest economic and social need, among agency planning and services areas, with particular attention to older low-income minorities. Requires such formula to be submitted to the AOA Commissioner who shall approve it, rather than review and comment upon it as currently required, once it is found to fulfill OAA requirements. Requires the designated State agency to provide assurances that it will require the use of certain outreach services described below under State plan provisions. Prohibits a State from being eligible for OAA title III funds until the AOA Commissioner approves the formula. Requires States to receive a hearing before the AOA Commissioner disapproves the formula. Requires the designated State agency to: (1) set specific goals, in consultation with area agencies, for each planning and service area for providing services to older low-income minorities; (2) provide an assurance that it will undertake specific program development, advocacy, and outreach efforts focused on the needs of such minorities; and (3) provide a description of its efforts in this regard. Provides that whenever a State agency initiates an action or proceeding to revoke the designation of an area agency, to designate an additional planning and service area, to divide the State into different such areas, or to otherwise affect planning and service area boundaries, it must establish procedures to provide due process to affected parties. Requires each State agency to periodically review and evaluate planning and service area boundaries, taking into consideration changing demographics and the views of older individuals and area agencies, among others.

Revises area plan provisions to require each area agency to: (1) place emphasis on linking services available to older individuals who are isolated and older individuals with Alzheimer's disease or related disorders and the uncompensated caretakers of such individuals; (2) assure that specific goals will be set for serving older low-income minorities; (3) provide information on the extent to which those goals are met; (4) assure that outreach efforts will be used to identify OAA program eligible individuals and to inform such individuals and caretakers of the availability of program assistance; (5) assure that agency activities are focused on the needs of older low-income minorities; (6) furnish timely information to area supportive or nutrition services providers or multipurpose senior centers; (7) regarding the provision of OAA title III services, enter into arrangements and coordinate with designated community action agencies or programs or with successor organizations that meet specified Community Services Block Grant Act requirements; (8) coordinate area entities receiving OAA assistance and conduct other Federal programs for older individuals at the local level; (9) conduct efforts to include the development of case management services as a component of long-term care services designed to retain individuals in their homes; (10) list its telephone number in area directories; (11) establish informal grievance procedures for older individuals who are dissatisfied with or denied services; (12) give priority in providing legal assistance to matters related to income, health care, long-term care, nutrition, housing and utilities, defense of guardianship, abuse and neglect, and age discrimination; (13) assist organizations that provide housing to older individuals; (14) assure that, in carrying out the State long-term care ombudsman program, not less than the total amount of funds appropriated under OAA and expended by it in FY 1991 will be expended; (15) provide for an area volunteer services coordinator, if appropriate; (16) describe all agency activities in its plan; (17) assure that such activities conform with agency responsibilities and applicable State laws; (18) assure that any relationship with the private sector relates to the purposes of OAA; (19) assure that OAA title III and VI programs are coordinated where applicable; (20) assure that activities will be pursued in order to increase older Native American access to applicable agency programs; (21) specify in its plan ways to implement such activities; and (22) provide that OAA title III case management services will not duplicate case management services provided through other Federal and State programs, will be coordinated with certain services, and will be provided by a public or nonpublic agency that meets certain criteria.

Permits State agencies to: (1) withhold a portion of the funds made available under OAA title III if it is found that the area agency has failed to comply with Federal or State laws; and (2) use funds withheld to administer directly, for a specified period, OAA title III programs in the area agency's planning and service area.

Requires State plans to provide that the State agency will: (1) use, by FY 1994, the methodology discussed above in evaluating the need for supportive and nutrition services and multipurpose senior centers within the State in order to determine the extent to which existing public or private programs meet such need; and (2) establish and publish procedures for requesting and conducting the hearings made available under current law to area agencies and service providers.

Provides that in conducting evaluations of, and public hearings on, activities and projects carried out under State plans, the State agency shall solicit the views and experiences of entities that are knowledgeable about the needs and concerns of older low-income minorities.

Revises State plan provisions to require assurances that State agencies will: (1) carry out a State Long-Term Care Ombudsman program in accordance with OAA titles III and VII and expend an amount not less than the total amount expended for ombudsman services in FY 1991 in doing so; (2) expend funds appropriated for supportive activities for individuals who provide in-home services to older frail individuals only for authorized purposes; (3) submit an elder rights plan; (4) coordinate programs under OAA titles III and VII where applicable; (5) pursue activities to increase older Native American access to applicable agency programs; and (6) require outreach efforts to identify older individuals who are eligible for OAA title III assistance and inform such individuals and caretakers of the availability of such assistance (requires special emphasis on identifying those older individuals who have the greatest economic or social need, reside in rural areas, are isolated, or have Alzheimer's disease or a related disorder).

Requires State agencies to: (1) assure that area agencies will give priority to the legal problems listed above and that special efforts will be made to provide technical assistance to minority service providers; (2) specify ways to implement the activities mentioned above; (3) provide for a State volunteer services coordinator if at least one-half of the area plans in the State provide for an area volunteer services coordinator; (4) require establishment of a State advisory group to advise State agencies on State plan matters; (5) include in the State plan a numerical statement regarding the intrastate funding formula and a demonstration of the funding allocation to each planning and service area; and (6) require that each nutrition project must provide nutrition education on at least a quarterly basis to nutrition service participants and comply with applicable State or local laws regarding sanitary handling of meals.

Prohibits the AOA Commissioner from approving a State plan unless the statement and demonstration discussed above have also been approved.

Requires State plans to: (1) ensure compliance with area plan requirements added above concerning case management service provision under OAA title III; and (2) identify, for each fiscal year, additional costs of providing OAA title III services, including the cost of providing access to such services, to older rural area residents.

Allows a State to transfer not more than 30 percent of its allotted funds for congregate and home-delivered nutrition services between such allotments. Requires the State agency electing such a funding transfer to indicate such election in the information submitted to comply with State plan nutrition service requirements. Requires approval by the AOA Commissioner before a State may transfer more than 30 percent between such allotments.

Prohibits a State agency from delegating the authority to make funding transfers.

Requires the AOA Commissioner to annually collect, and include in the Commissioner's report to the President and the Congress, data regarding nutrition service funding transfers.

Allows the AOA Commissioner to reimburse States for supplies in the event of a major disaster declared by the President in accordance with the Disaster Relief and Emergency Assistance Act. Requires the AOA Commissioner to advance up to 75 percent of the funds available for disaster relief within five working days of the President's declaration of the disaster.

Directs the Secretary of Agriculture to maintain, for FY 1992, a level of assistance equal to the greater of: (1) a per meal reimbursement rate equal to the amount appropriated divided by the number of meals served in the preceding fiscal year; or (2) 61 cents per meal. Provides that for FY 1993 and subsequent fiscal years the annual programmed level of assistance shall be equal to the greater of: (1) a per meal reimbursement rate equal to the amount appropriated for the fiscal year divided by the number of meals served in the preceding fiscal year; or (2) 61 cents per meal adjusted for changes in Consumer Price Index (for the series for food away from home). Provides that the reimbursement levels described above may not be reduced below 61 cents per meal in any fiscal year.

Authorizes appropriations for the surplus commodities distribution program through FY 1995.

Subtitle B: Supportive Services and Senior Centers - Adds to the list of supportive services authorized under OAA title III: (1) music, art, and dance/movement therapy services; (2) services to meet the needs of older individuals who are caregivers of disabled adult children; (3) services to support family members and other persons providing voluntary care to older individuals who need long-term care services; (4) services to provide information and training for individuals who are or may become guardians or representative payees of older individuals; and (5) services to encourage and facilitate regular interaction between school-age children and older individuals.

Subtitle C: Nutrition Services - Requires agencies that establish and operate congregate and home delivered nutrition service projects to ensure that project meals comply with HHS and Department of Agriculture dietary guidelines and provide a five-day time-averaged intake of: (1) 33 1/3 percent of the daily recommended dietary allowances established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences, if the project serves one meal per day; (2) 66 2/3 percent of the allowances, if the project services two meals per day; and (3) 100 percent of the allowances, if the project services three meals per day.

Adds two new subparts entitled "School-Based Meals for Volunteer Older Individuals and Intergenerational Programs" and "General Nutrition Service Provisions" to part C (Nutrition Services) of OAA title III under which the AOA Commissioner shall: (1) establish and carry out a State grant program to provide hot meals to older individuals who volunteer in schools, to provide intergenerational activities for students and older individuals to interact, and to provide social and recreational activities for older individuals and opportunities for them to participate in school activities; and (2) employ a National Dietary Professional to be responsible for congregate and home-delivered nutrition program administration and establish a task force to recommend minimum criteria and guidelines for furnishing meals under such programs. Sets forth provisions with respect to such school-based meal and intergenerational program concerning funding, selection of providers, and evaluation reports to the AOA Commissioner. Authorizes the AOA Commissioner and the Secretary of Agriculture to provide technical assistance to agencies carrying out nutrition education programs.

Subtitle D: In-Home Services for Frail Older Individuals - Adds a new subpart entitled "Supportive Activities for Certain Individuals Who Provide In-Home Services to Frail Older Individuals" to OAA title III part D (In-Home Services for Frail Older Individuals) under which the AOA Commissioner shall carry out a State grant program to provide supportive activities for individuals (including family members) who, without compensation, provide in-home services to frail older individuals. Lists those activities which constitute supportive activities. Includes the maintenance of lists of individuals who provide respite services as a supportive activity.

Subtitle E: Additional Assistance for Special Needs of Older Individuals - Adds music, art, and dance/movement therapy services to the list of services authorized under OAA title III part E (Additional Assistance For Special Needs of Older Individuals).

Subtitle F: Preventive Health Services - Gives OAA title III part F (Preventive Health Services) the new name "Disease Prevention and Health Promotion Services" and adds additional services which may be provided under such part, such as health risk assessments, health promotion and physical fitness programs, and counseling on osteoporosis, cardiovascular diseases, and Alzheimer's disease. States that the services provided under part F shall not include those services for which payment may be made under the Medicare program (title XVIII of the Social Security Act (SSA)).

Subtitle G: Programs for Prevention of Abuse, Neglect, and Exploitation - Modifies and shifts to a new OAA title VII (Grants for Vulnerable Elder Rights Protection Activities) the OAA title III part G program for the prevention of abuse, neglect, and exploitation of older individuals. Includes in such new title VII program a component providing grants for Native American elder rights protection activities. Repeals the old part G program.

Title IV: Training, Research, and Discretionary Projects and Programs - Amends OAA title IV (Training, Research, and Discretionary Projects and Programs) to require the AOA Commissioner to: (1) consult with State and area agencies and with Native American grant recipients in developing priorities for grants and contracts and in reviewing applications under such title; (2) ensure that cooperative agreements are equitably awarded to entities representing minorities; (3) give special consideration to demonstration projects that meet the service needs of elderly caregivers with disabled adult children and that advance the understanding of the efficacy and benefits of providing music, art, and dance/movement therapy to older individuals; (4) award grants to eligible agencies to establish demonstration programs to provide supportive services in federally assisted housing and to establish housing ombudsman demonstration programs; (5) establish a Clearinghouse to provide information about education and training projects and research and demonstration projects; (6) establish procedures specifying the length of time that the Clearinghouse shall provide such information with respect to a particular project; and (7) make grants to institutions of higher education, historically Black colleges or universities, Hispanic Centers of Excellence in Health Professions Education, and other educational institutions that serve the needs of minority students in order to provide education and training to prepare students for careers in the field of aging.

Makes such education and training projects emphasize attracting minority personnel to the field of aging in order to help meet critical shortages of adequately trained personnel for programs in that field.

Requires in-service training to emphasize using culturally sensitive practices to respond to the needs of older individuals. Includes as in-service training for grant and contract purposes annual training of Native American program directors.

Earmarks a specified amount of OAA title IV funding for professional and service provider advanced clinical training programs concerning problems of aging.

Adds schools of social work and psychology to the list of schools for which multidisciplinary centers of gerontology are required to help develop training programs in the field of aging with OAA title IV funds.

Authorizes the AOA Commissioner to award grants to eligible communities (with a preference for applicants experienced in operating community programs and programs meeting the independent living needs of older individuals) to establish neighborhood senior care programs to draw on the professional and volunteer services of local residents to provide health and social services and volunteer services to elderly neighbors who might otherwise have to be admitted to nursing homes and hospitals. Requires the AOA Commissioner, to the extent appropriations are available, to contract for the establishment of a technical resource center that will: (1) assist the Commissioner in developing criteria for, and in awarding grants to communities to establish, neighborhood senior care programs; (2) assist communities interested in establishing such a program; (3) coordinate such programs; (4) provide ongoing analysis and data collection of such programs and provide data to the Commissioner; (5) serve as a liaison to State agencies interested in establishing neighborhood senior care programs; and (6) take any further actions as established in regulation by the Commissioner.

Authorizes the AOA Commissioner to: (1) make grants to selected State and area agencies to support improvement of information and assistance services, and systems of services, operated at State and local levels; and (2) make grants to organizations to provide training and technical assistance to State and area agencies and service providers to continue support of a national telephone access service to link older individuals, families, and caregivers to State and local information and assistance services funded under this Act and to support improvement of information and assistance services, and systems of services, operated at State and local levels.

Requires the AOA Commissioner to establish and carry out Senior Transportation Demonstration Programs for the purpose of improving the mobility of, and transportation services for, older individuals.

Requires the AOA Commissioner to make grants to, or enter into contracts with, eligible entities to establish and operate Resource Centers on Native American Elders to gather information and perform research on priority areas of concern regarding older Native Americans, such as long-term care and elder abuse. Requires such centers to provide for dissemination of research results and to provide technical assistance and training to entities that provide services to older Native Americans.

Authorizes demonstration programs for older individuals with developmental disabilities and their caretakers.

Revises provisions relating to special projects in comprehensive long-term care to require the AOA Commissioner to award grants to, or enter into contracts or cooperative agreements with, eligible entities to support: (1) the establishment or operation of Resource Centers for Long-Term Care; and (2) the establishment or conduct of projects to improve delivery of long-term care services.

Allows legal assistance agencies to participate in ombudsman and advocacy demonstration projects for developmental disabilities and mental illness.

Reauthorizes and extends OAA title IV part B (Research, Demonstration, and Other Activities) through FY 1995, except with respect to: (1) ombudsman and advocacy demonstration projects for developmental disabilities and mental illness which are authorized for appropriations for FY 1993 (with funds remaining available for expenditure for FY 1994); (2) the neighborhood senior care program which is authorized for FY 1993 and 1994; (3) the supportive services in federally assisted housing demonstration program and the housing ombudsman demonstration program which are authorized for FY 1992 and each of the subsequent fiscal years; (4) the information and assistance systems development projects which are authorized for FY 1992 and subsequent fiscal years; (5) the senior transportation demonstration program which is authorized for FY 1992 through 1995; (6) the Resource Centers on Native American Elders which are authorized for FY 1992 through 1995; and (7) the demonstration programs for older individuals with developmental disabilities which are authorized for FY 1992 through 1995. Authorizes increased appropriations for part B projects and activities in existence before enactment of this Act, except with respect to: (1) ombudsman and advocacy demonstration projects for developmental disabilities and mental illness which are reauthorized at the current level; and (2) consumer protection demonstration projects for services provided in the home which are reauthorized at unspecified levels.

Title V: Other Older Americans Programs - Subtitle A: Community Service Employment for Older Americans - Amends the Older American Community Service Employment Act (OACSEA) to: (1) specify that the purpose of the community service employment program is to promote employment opportunities for persons who, in addition to being 55 years of age or older, have poor employment prospects; (2) require a national organization or other program sponsor receiving funds under such Act to submit a description of the project to be developed with those funds to the appropriate area agency for the area where the project is to take place, in addition to the State agency; (3) require the DOL Secretary to coordinate with the AOA Commissioner to increase job opportunities available to older individuals; and (4) reauthorize and extend such Act through FY 1995 at increased levels.

Provides that the DOL Secretary, after making the allocations required under provisions concerning national grants or contracts and State allotments for projects, shall ensure that the funds allocated are distributed in accordance with this paragraph. Provides that if the amount appropriated to carry out OACSEA for a fiscal year exceeds 102 percent of the amount appropriated to carry out OACSEA in FY 1991, the DOL Secretary shall: (1) make available a portion of such increased appropriations that is determined to be appropriate by the Secretary (which portion shall be not less than 25 percent of such increased appropriations) for national grants and contracts with public or private nonprofit organizations for each year until the year (which shall be not later than FY 1995) in which the amount awarded to each such grant recipient or contractor in the fiscal year equals, at a minimum, 1.3 percent of the total amount appropriated under OACSEA in FY 1991; or (2) make available not less than 1.3 percent of such total amount to each such grant recipient or contractor for each year thereafter. Requires the DOL Secretary to reserve such sums as may be necessary for national grants or contracts with public or nonprofit national Indian aging organizations with the ability to provide employment services to older Indians and with national public or nonprofit Pacific Island and Asian American aging organizations with the ability to provide employment services to older Pacific Island and Asian Americans. Requires the DOL Secretary to reserve an amount that is not less than one percent and not more than three percent of the amount appropriated in excess of the amount appropriated for FY 1978 for the purpose of entering into agreements relating to improving the transition to private employment.

Amends the Older Workers Benefit Protection Act to provide that with respect to any employee benefits provided in accordance with a collective bargaining agreement that is a result of pattern collective bargaining in an industry where the agreement setting the pattern was ratified after September 20, 1990, but prior to the date of enactment of such Act, and the final agreement in the industry adhering to the pattern was ratified after such date of enactment but not later than November 20, 1990, the older workers benefit protection afforded under such Act shall not apply until the termination of such collective bargaining agreement or June 1, 1992, whichever occurs first.

Subtitle B: Grants for Native Americans - Amends OAA title X (Grants for Native Americans) to: (1) require applicants for grants under parts A (Indian Program) and B (Native Hawaiian Program) to assure that they will coordinate programs under OAA titles III and X where applicable; (2) require the AOA Commissioner, for FY 1992 and subsequent fiscal years, to fund organizations which receive grants in FY 1991 in an amount at least equal to their FY 1991 amount and to award any funds appropriated in excess of FY 1991 levels to organizations that received grants in FY 1980 for part A activities and that had their funding for such activities reduced in subsequent fiscal years due to an increased number of applicants for the part A program; (3) reauthorize and extend title X through FY 1995 at increased levels, except with respect to multipurpose senior centers; and (4) eliminate the separate funding for such parts based on FY 1987 appropriations.

Title VI: Elder Rights Services - Adds to OAA the new title VII (Grants for Vulnerable Elder Rights Protection Activities) described in Subtitle F of title III of this Act.

Establishes the following parts of new OAA title VII: (1) part A (General Provisions); (2) part B (Ombudsman Programs); (3) part C (Programs for Prevention of Abuse, Neglect, and Exploitation); (4) part D (State Elder Rights and Legal Assistance Development Programs); and (5) part E (Outreach, Counseling, and Assistance Program). Authorizes appropriations for FY 1992 through 1995 to carry out parts B through E.

Provides that under part A, the AOA Commissioner is to: (1) make allotments to States to pay the Federal share of carrying out elder rights activities in parts B through E; and (2) make grants to eligible entities to carry out priority Native American elder rights activities under such parts. Sets forth requirements concerning allotments, reallotments, and withholding of funds. Requires that in order for a State to be eligible for such allotments: (1) the State, the State agency, and the area agency must demonstrate eligibility and comply with certain applicable OAA title III requirements; and (2) the State must submit a plan to the AOA Commissioner which must include certain assurances, including assurances that the State will establish programs under parts B through E and has or will submit an OAA title III State plan. Requires the AOA Commissioner to approve any State plan that makes such assurances. Sets forth procedures for hearing and appeals and for withholding and disbursement of funds in the event that a State is found ineligible for OAA title VII funds. Provides that in carrying out the elder rights activities described in parts B through E, a State agency or an eligible entity may, either directly or through a contract or agreement, enter into agreements with public or private nonprofit agencies or organizations. Authorizes the AOA Commissioner to request technical assistance and cooperation of Federal departments and agencies as appropriate. Requires the AOA Commissioner to provide technical assistance and training to OAA title VII programs and to individuals designated to be representatives of such programs. Sets forth requirements for Federal audits.

Outlines provisions detailing part B Ombudsman programs. Mirrors under such part requirements from OAA title III for the establishment of the State long-term care ombudsman program. Adds certain additional requirements, such as the requirement that a State agency must establish and operate an Office of State Long-Term Care Ombudsman to be headed by the State Long-Term Care Ombudsman (Ombudsman) who meets the requirements specified under title II of this Act for the Associate Commissioner for Ombudsman Services. Sets out the duties of the Ombudsman. Allows the State agency to establish and operate the Office and carry out the program directly or by contract or other arrangement with any public agency or other appropriate private nonprofit organization. Outlines requirements for such a contract or arrangement. Authorizes the Ombudsman to designate an entity as an area or local ombudsman and to designate an employee or volunteer to represent the entity. Sets out the duties of an individual so designated as well as criteria entities and individuals must meet in order to receive their respective designation above. Requires the State agency to: (1) establish policies and procedures for monitoring such area and local ombudsman entities, in consultation with area agencies on aging under certain circumstances, and in accordance with OAA title II confidentiality and conflict of interest requirements described below; (2) establish procedures to ensure that representatives of the Office shall have immediate access to long-term care facilities and facility residents, as well as certain access to medical, administrative, and licensing and certification records; (3) establish a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in facilities and to submit the data to the State agency responsible for licensing or certifying facilities, other State and Federal agencies, as determined appropriate, and to the AOA Commissioner; (4) establish procedures for disclosure of program files and the types of records mentioned above that are maintained by the program; (5) consider views of area agencies on aging, older individuals, and provider entities in planning and operating the program; and (6) ensure that adequate legal counsel and representation is available and that the Office pursues administrative, legal, and other appropriate remedies on behalf of residents. Requires the State agency to establish mechanisms to identify and remove specified conflicts of interest involving the designation of the Ombudsman and area and local ombudsman entities. Outlines administrative provisions detailing duties and functions the State agency is mandated to require the Office to fulfill. Requires the AOA Commissioner to issue and periodically update regulations on conflicts of interest.

Outlines provisions detailing part C programs for prevention of abuse, neglect, and exploitation of older individuals. Requires a State agency, in consultation with area agencies, to develop and enhance elder abuse programs as a condition for receiving an allotment under new OAA title VII part A to carry out, through such programs, an expanded variety of specified activities to prevent, treat, and remedy elder abuse, neglect, and exploitation, including promoting development of an elder abuse, neglect, and exploitation system. Requires the State agency to use a comprehensive approach in developing and enhancing such programs and to coordinate such programs with other State and local programs and services for protection of vulnerable older individuals. Outlines additional requirements for State agencies in developing and enhancing such programs, including those requiring State agencies to prohibit involuntary or coerced participation by alleged victims, abusers, or members of their households.

Outlines provisions detailing part D programs to provide leadership for expanding the quality and quantity of legal and advocacy assistance as a means for ensuring a comprehensive elder rights system. Requires a State agency, in order to be eligible to receive an allotment under new OAA title VII part A, to establish such a program and carry it out in accordance with specified requirements. Provides that in carrying out part D, the State agency shall: (1) establish a focal point for elder rights policy review, analysis, and advocacy at the State level, including such issues as guardianship, age discrimination, pension and health benefits, insurance, consumer protection, surrogate decisionmaking, protective services, public benefits, and dispute resolution; (2) provide a State legal assistance developer and other personnel sufficient to ensure State leadership in securing legal rights of older individuals and capacity to promote financial management services for older individuals at risk of conservatorship; (3) develop, in conjunction with area agencies and legal assistance providers, statewide standards for delivery of legal assistance to older individuals; (4) provide for education and training of professionals, volunteers, and older individuals concerning elder rights, requirements and benefits of specific laws, and methods for enhancing and coordination of services; (5) promote, and provide as appropriate, education and training for individuals who are or might become guardians or representative payees of older individuals; (6) promote development of, and provide technical assistance concerning, pro bono legal assistance programs, State and local bar committees on aging, legal hot lines, alternative dispute resolution, aging law curricula in law schools and other appropriate educational institutions, and other methods to expand access by older individuals to legal assistance and other advocacy and elder rights services; (7) provide for periodic assessments of the status of elder rights in the State; and (8) develop working agreements with appropriate State and Federal entities.

Outlines provisions detailing part E programs to provide outreach, counseling, and assistance in order to assist older individuals in obtaining benefits under: (1) public and private health insurance, long-term care insurance, and life insurance programs; and (2) public benefit programs in which the individuals are entitled to participate, including the Medicare and Medicaid programs (respectively, SSA titles XVIII and XIX) and the food stamp and home energy assistance programs. Sets forth requirements State agencies must meet in order to carry out such programs, including requirements regarding allotments, administration, and coordination of health insurance information, counseling, and assistance provided by the State under the Omnibus Budget Reconciliation Act of 1990 with activities provided by the State agency under new OAA title VII part E programs.

Title VII: Other Programs - Subtitle A: Long-Term Health Care Workers - Requires the Director of the National Center for Health Statistics of the Centers for Disease Control to collect and prepare a report on certain demographic information on home health care aides and nursing home nurse aides and, in particular, information on the role of the aides in providing home-based and community-based long-term care. Requires the Director to transmit such report to the AOA Commissioner.

Requires the DOL Secretary to: (1) collect and prepare a report on certain information on home health care aides, including information on conditions of employment and employment benefits; (2) collect and prepare a report on similar information with respect to nursing home nurse aides; (3) transmit such reports to the AOA Commissioner; (4) transmit to the AOA Commissioner a plan for collection of described information concerning employment conditions and benefits of home health care aides; and (5) include a separate occupation code for each such aid in DOL wage surveys conducted after enactment of this Act.

Requires the AOA Commissioner to submit to appropriate congressional committees a report containing such reports, comments, and additional information regarding the roles of nursing home nurse aides and home health care aides in providing long-term care obtained through the State Long-Term Care Ombudsman program.

Subtitle B: National Student Lunch Act - Amends the National School Lunch Act (NSLA) to: (1) revise the definition of "adult day care center" to include entities licensed to provide adult day care services to individuals in a group living arrangement; and (2) require HHS meal reimbursement guidelines to ensure that NSLA meal reimbursement does not duplicate Medicare or Medicaid reimbursement.

Subtitle C: White House Conference on Aging - Amends the Older Americans Act Amendments of 1987 to authorize the President to call a White House Conference on Aging in 1993.

Lists as Conference purposes to: (1) increase public awareness of the interdependence of generations and the essential contributions of older individuals to society for the well-being of all generations; (2) identify problems facing older individuals and the commonalities with problems of younger generations; (3) develop specific and comprehensive recommendations for action to maintain and improve the well-being of the aging; (4) develop recommendations for the coordination of Federal policy with State and local needs and the implementation of such recommendations; and (5) review the status and intergenerational value of previously adopted Conference recommendations. Authorize appropriations.

Provides that from amounts appropriated for Health Care Financing Administration Medicare contracts the HHS Secretary shall continue to operate the beneficiaries toll free telephone lines under the Medicare program as they were operated prior to July 1, 1991, and shall reinstate reimbursement to carriers for operation and maintenance of provider toll free telephone lines as such lines were operated prior to July 1, 1991.

Title VIII: Native American Programs Act - Native American Programs Act of 1974 Amendments Act - Amends the Native American Programs Act of 1974 to establish in HHS the Administration for Native Americans (Administration) and in the Office of the HHS Secretary (Secretary) the Intra-Departmental Council on Native American Affairs (Council).

Requires the Commissioner of the Administration (Commissioner) to: (1) administer HHS financial assistance programs; (2) coordinate HHS activities affecting Native Americans; (3) serve as the advocate for Native Americans within HHS; and (4) compile and disseminate pertinent information, especially for the Secretary's annual report. Requires the Council to: (1) prepare a plan to allow tribal governments add other eligible Native American organizations to consolidate HHS grants; (2) designate a single office to oversee and audit such grants; and (3) recommend the plan to the Secretary.

Makes Alaska Native organizations in urban or rural nonreservation areas as well as Indian organizations eligible for financial assistance.

Makes the Office of Hawaiian Affairs of Hawaii (Office) the recipient of grants from the Secretary for a revolving loan fund for economic development in Hawaii. Repeals the termination of such loan fund after a five-year demonstration period (thus making the fund permanent). Requires the Office to provide matching non-Federal contributions to the fund for each grant. Authorizes appropriations for FY 1992 through 1994.

Repeals provisions of the Native American Programs Act Amendments of 1987 that require the deposit of certain funds into the Treasury.

Directs the Commissioner (in place of the Secretary) to provide: (1) technical assistance to potential and denied grant applicants; and (2) short-term training for persons carrying out funded projects.

Authorizes an organization whose grant application is denied on grounds of ineligibility to file an administrative appeal.

Authorizes the Commissioner to extend employment preference to Native Americans, based on the requirement that the Administration staff have knowledge of social and economic conditions characteristic of Native Americans.

Authorizes appropriations through FY 1996, including appropriations for FY 1992 to continue the development of a detailed plan, together with contributory research demonstration projects, to establish a National Center for Native American Studies and Indian Policy Development.

Title IX: Social Security Earnings Test Eliminated - Older Americans' Freedom to Work Act of 1990 - Amends SSA title II (Old Age, Survivors and Disability Insurance) to remove the limitation on the amount of outside income which beneficiaries who have attained retirement age may earn without incurring a reduction in benefits.

Title X: General Provisions - Specifies the effective dates of this Act. Provides that the amendments made by this Act shall not apply with respect to any area or State plan that is approved for any fiscal year beginning before the enactment of this Act.