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109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     109-716

======================================================================



 
                   LIFESPAN RESPITE CARE ACT OF 2006

                                _______
                                

December 5, 2006.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3248]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3248) to amend the Public Health Service Act to 
establish a program to assist family caregivers in accessing 
affordable and high-quality respite care, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     9
Committee Consideration..........................................     9
Committee Votes..................................................     9
Committee Oversight Findings.....................................     9
Statement of General Performance Goals and Objectives............     9
New Budget Authority, Entitlement Authority, and Tax Expenditures     9
Earmark..........................................................     9
Committee Cost Estimate..........................................    10
Congressional Budget Office Estimate.............................    10
Federal Mandates Statement.......................................    11
Advisory Committee Statement.....................................    11
Constitutional Authority Statement...............................    11
Applicability to Legislative Branch..............................    11
Section-by-Section Analysis of the Legislation...................    12
Changes in Existing Law Made by the Bill, as Reported............    13

                              Amendment   

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Lifespan Respite Care Act of 2006''.

SEC. 2. LIFESPAN RESPITE CARE.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

                  ``TITLE XXIX--LIFESPAN RESPITE CARE

``SEC. 2901. DEFINITIONS.

    ``In this title:
          ``(1) Adult with a special need.--The term `adult with a 
        special need' means a person 18 years of age or older who 
        requires care or supervision to--
                  ``(A) meet the person's basic needs;
                  ``(B) prevent physical self-injury or injury to 
                others; or
                  ``(C) avoid placement in an institutional facility.
          ``(2) Aging and disability resource center.--The term `aging 
        and disability resource center' means an entity administering a 
        program established by the State, as part of the State's system 
        of long-term care, to provide a coordinated system for 
        providing--
                  ``(A) comprehensive information on available public 
                and private long-term care programs, options, and 
                resources;
                  ``(B) personal counseling to assist individuals in 
                assessing their existing or anticipated long-term care 
                needs, and developing and implementing a plan for long-
                term care designed to meet their specific needs and 
                circumstances; and
                  ``(C) consumer access to the range of publicly 
                supported long-term care programs for which consumers 
                may be eligible, by serving as a convenient point of 
                entry for such programs.
          ``(3) Child with a special need.--The term `child with a 
        special need' means an individual less than 18 years of age who 
        requires care or supervision beyond that required of children 
        generally to--
                  ``(A) meet the child's basic needs; or
                  ``(B) prevent physical injury, self-injury, or injury 
                to others.
          ``(4) Eligible state agency.--The term `eligible State 
        agency' means a State agency that--
                  ``(A) administers the State's program under the Older 
                Americans Act of 1965, administers the State's program 
                under title XIX of the Social Security Act, or is 
                designated by the Governor of such State to administer 
                the State's programs under this title;
                  ``(B) is an aging and disability resource center;
                  ``(C) works in collaboration with a public or private 
                nonprofit statewide respite care coalition or 
                organization; and
                  ``(D) demonstrates--
                          ``(i) an ability to work with other State and 
                        community-based agencies;
                          ``(ii) an understanding of respite care and 
                        family caregiver issues across all age groups, 
                        disabilities, and chronic conditions; and
                          ``(iii) the capacity to ensure meaningful 
                        involvement of family members, family 
                        caregivers, and care recipients.
          ``(5) Family caregiver.--The term `family caregiver' means an 
        unpaid family member, a foster parent, or another unpaid adult, 
        who provides in-home monitoring, management, supervision, or 
        treatment of a child or adult with a special need.
          ``(6) Lifespan respite care.--The term `lifespan respite 
        care' means a coordinated system of accessible, community-based 
        respite care services for family caregivers of children or 
        adults with special needs.
          ``(7) Respite care.--The term `respite care' means planned or 
        emergency care provided to a child or adult with a special need 
        in order to provide temporary relief to the family caregiver of 
        that child or adult.
          ``(8) State.--The term `State' means any of the several 
        States, the District of Columbia, the Virgin Islands of the 
        United States, the Commonwealth of Puerto Rico, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.

``SEC. 2902. LIFESPAN RESPITE CARE GRANTS AND COOPERATIVE AGREEMENTS.

    ``(a) Purposes.--The purposes of this section are--
          ``(1) to expand and enhance respite care services to family 
        caregivers;
          ``(2) to improve the statewide dissemination and coordination 
        of respite care; and
          ``(3) to provide, supplement, or improve access and quality 
        of respite care services to family caregivers, thereby reducing 
        family caregiver strain.
    ``(b) Authorization.--Subject to subsection (e), the Secretary is 
authorized to award grants or cooperative agreements for the purposes 
described in subsection (a) to eligible State agencies for which an 
application is submitted pursuant to subsection (d).
    ``(c) Federal Lifespan Approach.--In carrying out this section, the 
Secretary shall work in cooperation with the National Family Caregiver 
Support Program of the Administration on Aging and other respite care 
programs within the Department of Health and Human Services to ensure 
coordination of respite care services for family caregivers of children 
and adults with special needs.
    ``(d) Application.--
          ``(1) Submission.--Each Governor desiring the eligible State 
        agency of his or her State to receive a grant or cooperative 
        agreement under this section shall submit an application on 
        behalf of such agency to the Secretary at such time, in such 
        manner, and containing such information as the Secretary shall 
        require.
          ``(2) Contents.--Each application submitted under this 
        section shall include--
                  ``(A) a description of the eligible State agency's--
                          ``(i) ability to work with other State and 
                        community-based agencies;
                          ``(ii) understanding of respite care and 
                        family caregiver issues across all age groups, 
                        disabilities, and chronic conditions; and
                          ``(iii) capacity to ensure meaningful 
                        involvement of family members, family 
                        caregivers, and care recipients;
                  ``(B) with respect to the population of family 
                caregivers to whom respite care information or services 
                will be provided or for whom respite care workers and 
                volunteers will be recruited and trained, a description 
                of--
                          ``(i) the population of family caregivers;
                          ``(ii) the extent and nature of the respite 
                        care needs of that population;
                          ``(iii) existing respite care services for 
                        that population, including numbers of family 
                        caregivers being served and extent of unmet 
                        need;
                          ``(iv) existing methods or systems to 
                        coordinate respite care information and 
                        services to the population at the State and 
                        local level and extent of unmet need;
                          ``(v) how respite care information 
                        dissemination and coordination, respite care 
                        services, respite care worker and volunteer 
                        recruitment and training programs, or training 
                        programs for family caregivers that assist such 
                        family caregivers in making informed decisions 
                        about respite care services will be provided 
                        using grant or cooperative agreement funds;
                          ``(vi) a plan for administration, 
                        collaboration, and coordination of the proposed 
                        respite care activities with other related 
                        services or programs offered by public or 
                        private, nonprofit entities, including area 
                        agencies on aging;
                          ``(vii) how the population, including family 
                        caregivers, care recipients, and relevant 
                        public or private agencies, will participate in 
                        the planning and implementation of the proposed 
                        respite care activities;
                          ``(viii) how the proposed respite care 
                        activities will make use, to the maximum extent 
                        feasible, of other Federal, State, and local 
                        funds, programs, contributions, other forms of 
                        reimbursements, personnel, and facilities;
                          ``(ix) respite care services available to 
                        family caregivers in the eligible State 
                        agency's State or locality, including unmet 
                        needs and how the eligible State agency's plan 
                        for use of funds will improve the coordination 
                        and distribution of respite care services for 
                        family caregivers of children and adults with 
                        special needs;
                          ``(x) the criteria used to identify family 
                        caregivers eligible for respite care services;
                          ``(xi) how the quality and safety of any 
                        respite care services provided will be 
                        monitored, including methods to ensure that 
                        respite care workers and volunteers are 
                        appropriately screened and possess the 
                        necessary skills to care for the needs of the 
                        care recipient in the absence of the family 
                        caregiver; and
                          ``(xii) the results expected from proposed 
                        respite care activities and the procedures to 
                        be used for evaluating those results;
                  ``(C) assurances that, where appropriate, the 
                eligible State agency will have a system for 
                maintaining the confidentiality of care recipient and 
                family caregiver records; and
                  ``(D) a memorandum of agreement regarding the joint 
                responsibility for the eligible State agency's lifespan 
                respite program between--
                          ``(i) the eligible State agency; and
                          ``(ii) a public or private nonprofit 
                        statewide respite coalition or organization.
    ``(e) Priority; Considerations.--When awarding grants or 
cooperative agreements under this section, the Secretary shall--
          ``(1) give priority to eligible State agencies that the 
        Secretary determines show the greatest likelihood of 
        implementing or enhancing lifespan respite care statewide; and
          ``(2) give consideration to eligible State agencies that are 
        building or enhancing the capacity of their long-term care 
        systems to respond to the comprehensive needs, including 
        respite care needs, of their residents.
    ``(f) Use of Grant or Cooperative Agreement Funds.--
          ``(1) In general.--
                  ``(A) Required uses of funds.--Each eligible State 
                agency awarded a grant or cooperative agreement under 
                this section shall use all or part of the funds--
                          ``(i) to develop or enhance lifespan respite 
                        care at the State and local levels;
                          ``(ii) to provide respite care services for 
                        family caregivers caring for children or 
                        adults;
                          ``(iii) to train and recruit respite care 
                        workers and volunteers;
                          ``(iv) to provide information to caregivers 
                        about available respite and support services; 
                        and
                          ``(v) to assist caregivers in gaining access 
                        to such services.
                  ``(B) Optional uses of funds.--Each eligible State 
                agency awarded a grant or cooperative agreement under 
                this section may use part of the funds for--
                          ``(i) training programs for family caregivers 
                        to assist such family caregivers in making 
                        informed decisions about respite care services;
                          ``(ii) other services essential to the 
                        provision of respite care as the Secretary may 
                        specify; or
                          ``(iii) training and education for new 
                        caregivers.
          ``(2) Subcontracts.--Each eligible State agency awarded a 
        grant or cooperative agreement under this section may carry out 
        the activities described in paragraph (1) directly or by grant 
        to, or contract with, public or private entities.
          ``(3) Matching funds.--
                  ``(A) In general.--With respect to the costs of the 
                activities to be carried out under paragraph (1), a 
                condition for the receipt of a grant or cooperative 
                agreement under this section is that the eligible State 
                agency agrees to make available (directly or through 
                donations from public or private entities) non-Federal 
                contributions toward such costs in an amount that is 
                not less than 25 percent of such costs.
                  ``(B) Determination of amount contributed.--Non-
                Federal contributions required by subparagraph (A) may 
                be in cash or in kind, fairly evaluated, including 
                plant, equipment, or services. Amounts provided by the 
                Federal Government, or services assisted or subsidized 
                to any significant extent by the Federal Government, 
                may not be included in determining the amount of such 
                non-Federal contributions.
    ``(g) Term of Grants or Cooperative Agreements.--
          ``(1) In general.--The Secretary shall award grants or 
        cooperative agreements under this section for terms that do not 
        exceed 5 years.
          ``(2) Renewal.--The Secretary may renew a grant or 
        cooperative agreement under this section at the end of the term 
        of the grant or cooperative agreement determined under 
        paragraph (1).
    ``(h) Maintenance of Effort.--Funds made available under this 
section shall be used to supplement and not supplant other Federal, 
State, and local funds available for respite care services.

``SEC. 2903. NATIONAL LIFESPAN RESPITE RESOURCE CENTER.

    ``(a) Establishment.--The Secretary may award a grant or 
cooperative agreement to a public or private nonprofit entity to 
establish a National Resource Center on Lifespan Respite Care (referred 
to in this section as the `center').
    ``(b) Purposes of the Center.--The center shall--
          ``(1) maintain a national database on lifespan respite care;
          ``(2) provide training and technical assistance to State, 
        community, and nonprofit respite care programs; and
          ``(3) provide information, referral, and educational programs 
        to the public on lifespan respite care.

``SEC. 2904. REPORT.

    ``Not later than January 1, 2009, the Secretary shall report to the 
Congress on the activities undertaken under this title. Such report 
shall evaluate--
          ``(1) the number of States that have lifespan respite care 
        programs;
          ``(2) the demographics of the caregivers receiving respite 
        care services through grants or cooperative agreements under 
        this title; and
          ``(3) the effectiveness of entities receiving grants or 
        cooperative agreements under this title.

``SEC. 2905. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out this title--
          ``(1) $30,000,000 for fiscal year 2007;
          ``(2) $40,000,000 for fiscal year 2008;
          ``(3) $53,330,000 for fiscal year 2009;
          ``(4) $71,110,000 for fiscal year 2010; and
          ``(5) $94,810,000 for fiscal year 2011.''.

                          Purpose and Summary

    H.R. 3248, the Lifespan Respite Care Act of 2006, amends 
the Public Health Service Act to authorize the Secretary of the 
Department of Health and Human Services (HHS) to award grants 
to State-designated Aging and Disability Resource Centers 
(ADRCs). Grants are to be awarded for the purposes of 
developing lifespan respite care programs at the State and 
local levels; providing planned or emergency respite care 
services for family caregivers of children and adults; training 
and recruiting respite workers and volunteers; providing 
information to caregivers about available respite and support 
services; and assisting caregivers in gaining access to such 
services.

                  Background and Need for Legislation

    It is estimated that 25 million Americans currently care 
for a sick, aged, or disabled loved one at home. For family 
caregivers, the time, stress, effort, and physical toil 
involved with caring for a loved one is compounded with the 
numerous responsibilities of daily life. The physical, 
emotional, and financial problems that result impede 
caregivers' ability to continue in their role as caregiver and 
may have an adverse impact on other aspects of their lives. 
Respite care is intended to give caregivers a break from caring 
for their loved ones, usually for a short period of time. 
Respite care affords caregivers the opportunity to go to the 
store, meet health care appointments, and perform necessary 
tasks of daily living outside of their caregiver roles. Respite 
care services can be delivered on either a planned or emergency 
basis. For example, emergency respite care may be required when 
a caregiver must leave the home for scheduled or unscheduled 
surgery. The term ``respite care'' refers to a broad array of 
in-home and out-of-home services, from home health and adult 
day care services to volunteer respite services. What 
distinguishes respite care from other forms of long term care 
support is that the focus is primarily on the needs of the 
caregiver.
    Evidence suggests that the availability of respite care 
presents significant benefits to the caregiver, the sick, 
elderly, or disabled individual, and the rest of society. In a 
1985 study, researchers Cohen and Warren concluded that respite 
care could improve family functioning, improve satisfaction 
with life, enhance the caregiver's capacity to cope with 
stress, and improve attitudes toward the family member with an 
illness or disability. A more recent study conducted at 
Oklahoma State University found that the number of 
hospitalizations as well as the number of medical care claims 
decreased as the number of respite days increased. A 1996 
evaluation of the Iowa Respite Child Care Project, which offers 
respite care for families parenting a child with developmental 
disabilities, found that when respite care is available, there 
is a statistically significant decrease in foster care 
placements. Other evidence suggests that respite care is 
equally beneficial to those caring for the elderly. A survey 
conducted by Theit et al. in 1994 found that over half of 
caregivers for the elderly receiving only four hours of respite 
a week for one year reported improved physical and emotional 
health. The Theit survey also found that half of caregivers 
reported improved health for the sick or disabled elderly 
person.
    The benefits of respite care can extend to third-party 
payers for long term care services. This is because the 
availability of effective respite care has shown the 
possibility of delaying or preventing entry into more expensive 
institutional long-term care facilities. The Theit survey found 
that 40 percent of caregivers were less likely to 
institutionalize the care recipient because of the respite they 
had received.
    The trend toward greater spending on long-term care is 
likely to continue. National spending for long-term care was 
almost $160 billion in 2002, representing about 12 percent of 
all personal health care expenditures. Almost half of this 
spending was through the Federal-State Medicaid program, 
primarily paying for care in nursing homes. On average, a 
year's nursing home charges can range from $60,000 to $70,000. 
The Government Accountability Office estimates that by 2020 the 
number of adults requiring assistance with daily living will 
increase to almost 40 million and the number of elderly persons 
requiring long-term care will double. Respite care, offered as 
part of a comprehensive range of in home and community-based 
care, can present sick, elderly, and disabled individuals and 
their families with less expensive alternatives to nursing home 
care. No estimates of the actual savings for public programs 
such as Medicaid were available.
    In recent years, both Congress and the Executive Branch 
have ascribed greater importance to respite care in the 
assortment of long-term care support options. The Older 
Americans Act Amendments of 2000 created the National Family 
Caregiver Support Program (NFCSP). NFCSP provides assistance 
and services to families who care for the frail elderly. 
Services are targeted to Americans age 60 and older and include 
information and assistance to caregivers, counseling services, 
support groups, respite services, and other home and community-
based services to provide families temporary caregiver relief. 
Other Federal initiatives involving or providing respite care 
include Section 1915(c) and Section 1115 Medicaid waivers that 
allow States to include respite care services in their home and 
community-based programs; Real Choice Systems Grants launched 
in 2003 that include respite care feasibility studies and 
development grants; and several demonstration projects and 
model grants tied to respite care for families of children with 
developmental disabilities authorized under the Developmental 
Disabilities Act. Other initiatives such as the 
administration's New Freedom Initiative, Money Follows the 
Person, and Choices for Independence recognize the crucial role 
of respite care in allowing families to provide care at home.
    States have also begun to take the lead with innovative 
respite care programs. States including Oregon, Nebraska, and 
Wisconsin have enacted so-called ``lifespan respite care 
acts,'' that establish State and local infrastructures for 
developing, providing, coordinating, and improving access to 
respite care services for eligible residents across the 
lifespan, encompassing people of many different ages, 
disabilities, and special needs. Oklahoma implemented such a 
lifespan respite care program without legislation. Several 
other States are actively considering or piloting similar 
programs or legislation.
    Volunteer, non-profit, and faith-based organizations have 
also begun to build the capacity and infrastructure necessary 
to meet the Nation's respite care needs. The online National 
Respite Locator Service (see http://www.respitelocator.org/
index.htm), lists hundreds of organizations around the country 
providing respite care referrals and services as a free public 
service by the ARCH National Respite Network.
    Rather than attempting to supplant, replace, or duplicate 
other Federal, State, local, and private respite care 
development efforts, the Lifespan Respite Care Act is intended 
to facilitate coordination between programs and reduce 
duplication of effort. It is also intended to assist in the 
development of respite care infrastructure at the state and 
local levels.
    In carrying out the Act, the Committee urges the Secretary 
to ensure that State agencies and ADRCs use the funds provided 
by this Act to serve all age groups and disability categories 
without preference. In addition, assurances should be made that 
ADRCs will reach and serve family caregivers who remain at 
greatest risk of having no respite services, especially 
caregivers caring for individuals with Multiple Sclerosis, ALS, 
autism, spinal cord injury, traumatic brain injury, adults with 
developmental and cognitive disabilities, individuals--
including children--with emotional or mental health conditions, 
and children with all other types of developmental disabilities 
and chronic conditions.
    When considering a Federal agency to take the lead in 
implementation of this program, the Committee urges the 
Secretary of HHS to select an agency that is not limited in 
scope or mission by any age or disability category, has 
experience in serving all populations across disability and age 
groups, and will ensure that the ADRC is collaborating fully 
and sharing joint responsibility with a private or public 
nonprofit State respite coalition or organization in 
implementing a State lifespan respite program. In addition, 
current respite programs across Federal agencies shall be 
consulted in the ongoing implementation of the Lifespan Respite 
Care program, including programs administered by HRSA, MCHB, 
ACF, SAMSHA, CMS, and ADD.
    Some Federal, State, and private programs currently 
support, or have the potential to support, planned and 
emergency or crisis respite care for caregivers of individuals 
who may not meet the bill's definition of special needs. There 
are also caregivers who are in continuously stressful 
situations due to extenuating circumstances or their own 
physical or mental health conditions, or who are in emergency 
situations that might put themselves or the person they are 
caring for in harm's way and rely on emergency respite services 
that might be provided by the State. Since the intent of the 
Committee in approving the bill is to reduce duplication and 
fragmentation of services and maximize existing resources, the 
Committee would like to emphasize that there is nothing in this 
bill that would preclude a grantee, in implementing State or 
local respite programs, from coordinating with these existing 
public or private programs.
    The intent of this legislation is to improve the delivery 
and quality of respite services available to families across 
age and disability groups by establishing coordinated lifespan 
respite systems. At a minimum, all family caregivers, 
regardless of the age, disability, or chronic condition of 
their loved ones, should be able to access a lifespan respite 
program for information on how and where to find a respite 
provider that meets their needs, and on how to pay for 
services. It is the responsibility of the Lifespan Respite Care 
program to have first identified all the current respite 
funding streams in the State and assist a family in determining 
for which existing private, State, or federally funded respite 
program they might be eligible. If that family does not qualify 
for any existing services, the Lifespan Respite Care program 
may use its funds to help families pay for respite care.
    Within 24 months of receiving an ADRC grant, ADRC grantees 
must describe how they will institute eligibility screening and 
programmatic eligibility determinations for all individuals who 
may be eligible for publicly funded programs. In view of the 
limited resources available and existing requirements for ADRCs 
description of eligibility determinations, it is anticipated 
that ADRCs will provide information in their grant applications 
or as otherwise specified by the Secretary on how they will 
determine which families are eligible for financial assistance. 
However, no family should be turned away from seeking 
information on how or where to find or pay for respite care.
    The Committee would like to clarify that the definition of 
family caregivers includes grandparents of any age who are the 
primary caretakers of children or adults with special needs. 
Also, ``unpaid family caregivers'' means family caregivers who 
do not receive funds to provide care as their primary means of 
income (i.e., nonprofessional family caregivers). The language 
is not meant to exclude family caregivers who receive minimal 
payments from State or Federal sources from receiving lifespan 
respite information or services. Such sources include funds 
received under Home and Community Based Services (HCBS) Waiver 
developmental disability programs, Independence Plus and 1115 
Waivers (Cash and Counseling programs included), and other 
State or Federal family support programs, to help assist with 
the person in their care, but this source of income is not what 
they rely on as primary income.
    Finally, in the definition of children up to age 18 with 
special needs, the Committee intends the phrase ``beyond that 
required of children generally'' to mean care beyond that 
typically required of children of the same age. Clarification 
is necessary since ``care required by children generally'' is 
dependent on age. It would be typical to provide total 24-hour 
care, including feeding, dressing, toileting, safety, mobility, 
supervision, etc., to an infant; however, such care may not be 
typical for a seventeen-year old.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Wednesday, September 20, 2006, the Committee on Energy 
and Commerce met in open markup session and ordered H.R. 3248 
favorably reported to the House, amended, by a voice vote, a 
quorum being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 3248 reported. A motion by Mr. Barton to order H.R. 3248 
favorably reported to the House, amended, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The goals and objectives of the Lifespan Respite Care Act 
are to promote respite care programs at the State and local 
levels; provide planned or emergency respite services for 
family caregivers of children and adults; train and recruit 
respite workers and volunteers; provide information to 
caregivers about available respite and support services; and 
assist caregivers in gaining access to such services.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
3248, the Lifespan Respite Care Act of 2006, would result in no 
new or increased budget authority, entitlement authority, or 
tax expenditures or revenues.

                                Earmark

    In compliance with H. Res. 1000 as passed the House of 
Representatives on September 14, 2006, the Committee finds that 
H.R. 3248, the Lifespan Respite Care Act of 2006, contains no 
earmarks.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:
                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 27, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3248, the Lifespan 
Respite Care Act of 2005.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Camile 
Williams.
            Sincerely,
                                         Robert A. Sunshine
                           (for Donald B. Marron, Acting Director).
    Enclosure.

H.R. 3248--Lifespan Respite Care Act of 2005

    Summary: H.R. 3248 would amend the Public Health Service 
Act to authorize the Secretary of Health and Human Services to 
award grants and enter into cooperative agreements with states 
to expand and enhance services for lifespan respite care. 
Lifespan respite care is a coordinated system of community-
based services that provide temporary relief from caregiving 
obligations to family members who normally provide care to a 
relative with special needs.
    CBO estimates that implementing the H.R. 3248 would cost $9 
million in fiscal year 2007 and $191 million over the 2007-2011 
period, assuming appropriation of the specified amounts. 
Enacting H.R. 3248 would not affect direct spending of 
revenues.
    H.R. 3248 contains no private-sector or intergovernmental 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated Cost to the Federal Government: The estimated 
budgetary impact of H.R. 3248 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                               -------------------------------------------------
                                                                  2007      2008      2009      2010      2011
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level.................................        30        40        53        71        95
Estimated Outlays.............................................         9        25        39        54        64
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    Basis of estimate: H.R. 3248 would amend the Public Health 
Service Act to authorize the Secretary of Health and Human 
Services to make grants to states to expand the availability of 
respite care to caregivers, recruit and train individuals who 
provide respite care, and disseminate information about the 
availability of respite care services.
    The bill also would direct the Secretary to award grants or 
enter into cooperative agreements with public or private 
nonprofit entities to establish the National Resource Center on 
Lifespan Respite Care. The National Resource Center would 
maintain a national database on lifespan respite care, provide 
training and technical assistance to state, community, and 
nonprofit programs involving respite care, and provide referral 
and educational programs to the public on respite care.
    The bill would authorize the appropriation of $30 million 
for fiscal year 2007 and $289 million over the 2007-2011 
period. Based on historical patterns of spending for similar 
activities, CBO estimates that implementing the bill would cost 
$9 million in the fiscal year 2007 and $191 million over the 
2007-2011 period, assuming the appropriation of the specified 
amounts.
    Intergovernmental and Private-Sector Impact: H.R. 3248 
contains no private-sector or intergovernmental mandates as 
defined in UMRA. State governments would benefit from grant 
funding authorized by the bill as long as they agree to provide 
a 25 percent match, either in cash or in kind. Any costs 
incurred by states to qualify for such grants would be incurred 
voluntarily as conditions of federal assistance.
    Estimate Prepared by: Federal Costs: Camile Williams. 
Impact on State, Local, and Tribal Governments: Leo Lex. Impact 
on the Private Sector: Paige Shelvin.
    Estimate approved by: Robert A. Sunshine, Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title as the ``Lifespan 
Respite Care Act of 2006''.

Section 2. Amendments to the Public Health Service Act

    Section 2 would establish a new Title XXIX in the Public 
Health Service Act to create a grant program for the 
development of respite care programs in the states.

Section 2901. Definitions

    New Section 2901 would identify and define the elements of 
a new respite care grant program, including the terms ``adult 
with a special need,'' ``aging and disability resource 
center,'' ``child with a special need,'' ``eligible state 
agency,'' ``family caregiver,'' ``lifespan respite care,'' 
``respite care,'' and ``State.''
    The definition of the term ``adult with a special need'' 
contains several parts. Persons may meet this definition if 
they are 18 years of age or older and require care or 
supervision to meet their basic needs (such as food, clothing, 
shelter, etc.), to prevent them from physically injuring 
themselves or others, or to avoid placement in an institutional 
facility.
    Avoiding placement in an institutional facility may 
encompass many factors, including whether or not the 
individual's needs, financial assets and income, or health 
insurance status place that individual at high risk for being 
placed in an institutional facility.
    The definition of the term ``aging and disability resource 
center'' (ADRC) also has several parts. ADRCs are envisioned as 
State-based entities tasked with providing comprehensive 
information on the array of long-term support services 
available, including both public and private options. ADRCs 
will serve as a resource for individuals who need long-term 
support, their family caregivers, and those planning for future 
long-term support needs. Functions performed by the ADRCs 
include eligibility screening for public assistance, assistance 
in gaining access to long-term support services that may be 
paid for with private funds, and referral to other programs and 
benefits that can help people to provide for their long-term 
support needs.

Section 2902. Lifespan Respite Care grants and cooperative agreements

    New Section 2902 authorizes the Secretary of HHS to award 
Lifespan Respite Care grants and cooperative agreements. It 
defines a ``Federal lifespan approach,'' which is intended to 
ensure cooperation and coordination between existing federal 
respite programs.

Section 2903. National Lifespan Respite Resource Center

    New Section 2903 of the Public Health Service Act 
authorizing the creation of the National Lifespan Respite 
Resource Center to maintain a database of respite care 
information and provide training, technical assistance, and 
information on respite care programs.

Section 2904. Report

    New Section 2904 requires the Secretary of HHS to report to 
Congress on the activities undertaken under this legislation, 
including information on State-level respite care programs and 
demographic information on caregivers receiving respite care 
services under the legislation.

Section 2905. Authorization of appropriations

    New Section 2905 of the Public Health Service Act, 
authorizing appropriations to carry out program activities.

         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 (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

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                   TITLE XXIX--LIFESPAN RESPITE CARE

SEC. 2901. DEFINITIONS.

    In this title:
          (1) Adult with a special need.--The term ``adult with 
        a special need'' means a person 18 years of age or 
        older who requires care or supervision to--
                  (A) meet the person's basic needs;
                  (B) prevent physical self-injury or injury to 
                others; or
                  (C) avoid placement in an institutional 
                facility.
          (2) Aging and disability resource center.--The term 
        ``aging and disability resource center'' means an 
        entity administering a program established by the 
        State, as part of the State's system of long-term care, 
        to provide a coordinated system for providing--
                  (A) comprehensive information on available 
                public and private long-term care programs, 
                options, and resources;
                  (B) personal counseling to assist individuals 
                in assessing their existing or anticipated 
                long-term care needs, and developing and 
                implementing a plan for long-term care designed 
                to meet their specific needs and circumstances; 
                and
                  (C) consumer access to the range of publicly 
                supported long-term care programs for which 
                consumers may be eligible, by serving as a 
                convenient point of entry for such programs.
          (3) Child with a special need.--The term ``child with 
        a special need'' means an individual less than 18 years 
        of age who requires care or supervision beyond that 
        required of children generally to--
                  (A) meet the child's basic needs; or
                  (B) prevent physical injury, self-injury, or 
                injury to others.
          (4) Eligible state agency.--The term ``eligible State 
        agency'' means a State agency that--
                  (A) administers the State's program under the 
                Older Americans Act of 1965, administers the 
                State's program under title XIX of the Social 
                Security Act, or is designated by the Governor 
                of such State to administer the State's 
                programs under this title;
                  (B) is an aging and disability resource 
                center;
                  (C) works in collaboration with a public or 
                private nonprofit statewide respite care 
                coalition or organization; and
                  (D) demonstrates--
                          (i) an ability to work with other 
                        State and community-based agencies;
                          (ii) an understanding of respite care 
                        and family caregiver issues across all 
                        age groups, disabilities, and chronic 
                        conditions; and
                          (iii) the capacity to ensure 
                        meaningful involvement of family 
                        members, family caregivers, and care 
                        recipients.
          (5) Family caregiver.--The term ``family caregiver'' 
        means an unpaid family member, a foster parent, or 
        another unpaid adult, who provides in-home monitoring, 
        management, supervision, or treatment of a child or 
        adult with a special need.
          (6) Lifespan respite care.--The term ``lifespan 
        respite care'' means a coordinated system of 
        accessible, community-based respite care services for 
        family caregivers of children or adults with special 
        needs.
          (7) Respite care.--The term ``respite care'' means 
        planned or emergency care provided to a child or adult 
        with a special need in order to provide temporary 
        relief to the family caregiver of that child or adult.
          (8) State.--The term ``State'' means any of the 
        several States, the District of Columbia, the Virgin 
        Islands of the United States, the Commonwealth of 
        Puerto Rico, Guam, American Samoa, and the Commonwealth 
        of the Northern Mariana Islands.

SEC. 2902. LIFESPAN RESPITE CARE GRANTS AND COOPERATIVE AGREEMENTS.

    (a) Purposes.--The purposes of this section are--
          (1) to expand and enhance respite care services to 
        family caregivers;
          (2) to improve the statewide dissemination and 
        coordination of respite care; and
          (3) to provide, supplement, or improve access and 
        quality of respite care services to family caregivers, 
        thereby reducing family caregiver strain.
    (b) Authorization.--Subject to subsection (e), the 
Secretary is authorized to award grants or cooperative 
agreements for the purposes described in subsection (a) to 
eligible State agencies for which an application is submitted 
pursuant to subsection (d).
    (c) Federal Lifespan Approach.--In carrying out this 
section, the Secretary shall work in cooperation with the 
National Family Caregiver Support Program of the Administration 
on Aging and other respite care programs within the Department 
of Health and Human Services to ensure coordination of respite 
care services for family caregivers of children and adults with 
special needs.
    (d) Application.--
          (1) Submission.--Each Governor desiring the eligible 
        State agency of his or her State to receive a grant or 
        cooperative agreement under this section shall submit 
        an application on behalf of such agency to the 
        Secretary at such time, in such manner, and containing 
        such information as the Secretary shall require.
          (2) Contents.--Each application submitted under this 
        section shall include--
                  (A) a description of the eligible State 
                agency's--
                          (i) ability to work with other State 
                        and community-based agencies;
                          (ii) understanding of respite care 
                        and family caregiver issues across all 
                        age groups, disabilities, and chronic 
                        conditions; and
                          (iii) capacity to ensure meaningful 
                        involvement of family members, family 
                        caregivers, and care recipients;
                  (B) with respect to the population of family 
                caregivers to whom respite care information or 
                services will be provided or for whom respite 
                care workers and volunteers will be recruited 
                and trained, a description of--
                          (i) the population of family 
                        caregivers;
                          (ii) the extent and nature of the 
                        respite care needs of that population;
                          (iii) existing respite care services 
                        for that population, including numbers 
                        of family caregivers being served and 
                        extent of unmet need;
                          (iv) existing methods or systems to 
                        coordinate respite care information and 
                        services to the population at the State 
                        and local level and extent of unmet 
                        need;
                          (v) how respite care information 
                        dissemination and coordination, respite 
                        care services, respite care worker and 
                        volunteer recruitment and training 
                        programs, or training programs for 
                        family caregivers that assist such 
                        family caregivers in making informed 
                        decisions about respite care services 
                        will be provided using grant or 
                        cooperative agreement funds;
                          (vi) a plan for administration, 
                        collaboration, and coordination of the 
                        proposed respite care activities with 
                        other related services or programs 
                        offered by public or private, nonprofit 
                        entities, including area agencies on 
                        aging;
                          (vii) how the population, including 
                        family caregivers, care recipients, and 
                        relevant public or private agencies, 
                        will participate in the planning and 
                        implementation of the proposed respite 
                        care activities;
                          (viii) how the proposed respite care 
                        activities will make use, to the 
                        maximum extent feasible, of other 
                        Federal, State, and local funds, 
                        programs, contributions, other forms of 
                        reimbursements, personnel, and 
                        facilities;
                          (ix) respite care services available 
                        to family caregivers in the eligible 
                        State agency's State or locality, 
                        including unmet needs and how the 
                        eligible State agency's plan for use of 
                        funds will improve the coordination and 
                        distribution of respite care services 
                        for family caregivers of children and 
                        adults with special needs;
                          (x) the criteria used to identify 
                        family caregivers eligible for respite 
                        care services;
                          (xi) how the quality and safety of 
                        any respite care services provided will 
                        be monitored, including methods to 
                        ensure that respite care workers and 
                        volunteers are appropriately screened 
                        and possess the necessary skills to 
                        care for the needs of the care 
                        recipient in the absence of the family 
                        caregiver; and
                          (xii) the results expected from 
                        proposed respite care activities and 
                        the procedures to be used for 
                        evaluating those results;
                  (C) assurances that, where appropriate, the 
                eligible State agency will have a system for 
                maintaining the confidentiality of care 
                recipient and family caregiver records; and
                  (D) a memorandum of agreement regarding the 
                joint responsibility for the eligible State 
                agency's lifespan respite program between--
                          (i) the eligible State agency; and
                          (ii) a public or private nonprofit 
                        statewide respite coalition or 
                        organization.
    (e) Priority; Considerations.--When awarding grants or 
cooperative agreements under this section, the Secretary 
shall--
          (1) give priority to eligible State agencies that the 
        Secretary determines show the greatest likelihood of 
        implementing or enhancing lifespan respite care 
        statewide; and
          (2) give consideration to eligible State agencies 
        that are building or enhancing the capacity of their 
        long-term care systems to respond to the comprehensive 
        needs, including respite care needs, of their 
        residents.
    (f) Use of Grant or Cooperative Agreement Funds.--
          (1) In general.--
                  (A) Required uses of funds.--Each eligible 
                State agency awarded a grant or cooperative 
                agreement under this section shall use all or 
                part of the funds--
                          (i) to develop or enhance lifespan 
                        respite care at the State and local 
                        levels;
                          (ii) to provide respite care services 
                        for family caregivers caring for 
                        children or adults;
                          (iii) to train and recruit respite 
                        care workers and volunteers;
                          (iv) to provide information to 
                        caregivers about available respite and 
                        support services; and
                        (v) to assist caregivers in gaining 
                        access to such services.
                  (B) Optional uses of funds.--Each eligible 
                State agency awarded a grant or cooperative 
                agreement under this section may use part of 
                the funds for--
                          (i) training programs for family 
                        caregivers to assist such family 
                        caregivers in making informed decisions 
                        about respite care services;
                          (ii) other services essential to the 
                        provision of respite care as the 
                        Secretary may specify; or
                        (iii) training and education for new 
                        caregivers.
          (2) Subcontracts.--Each eligible State agency awarded 
        a grant or cooperative agreement under this section may 
        carry out the activities described in paragraph (1) 
        directly or by grant to, or contract with, public or 
        private entities.
          (3) Matching funds.--
                  (A) In general.--With respect to the costs of 
                the activities to be carried out under 
                paragraph (1), a condition for the receipt of a 
                grant or cooperative agreement under this 
                section is that the eligible State agency 
                agrees to make available (directly or through 
                donations from public or private entities) non-
                Federal contributions toward such costs in an 
                amount that is not less than 25 percent of such 
                costs.
                  (B) Determination of amount contributed.--
                Non-Federal contributions required by 
                subparagraph (A) may be in cash or in kind, 
                fairly evaluated, including plant, equipment, 
                or services. Amounts provided by the Federal 
                Government, or services assisted or subsidized 
                to any significant extent by the Federal 
                Government, may not be included in determining 
                the amount of such non-Federal contributions.
    (g) Term of Grants or Cooperative Agreements.--
          (1) In general.--The Secretary shall award grants or 
        cooperative agreements under this section for terms 
        that do not exceed 5 years.
          (2) Renewal.--The Secretary may renew a grant or 
        cooperative agreement under this section at the end of 
        the term of the grant or cooperative agreement 
        determined under paragraph (1).
    (h) Maintenance of Effort.--Funds made available under this 
section shall be used to supplement and not supplant other 
Federal, State, and local funds available for respite care 
services.

SEC. 2903. NATIONAL LIFESPAN RESPITE RESOURCE CENTER.

    (a) Establishment.--The Secretary may award a grant or 
cooperative agreement to a public or private nonprofit entity 
to establish a National Resource Center on Lifespan Respite 
Care (referred to in this section as the ``center'').
    (b) Purposes of the Center.--The center shall--
          (1) maintain a national database on lifespan respite 
        care;
          (2) provide training and technical assistance to 
        State, community, and nonprofit respite care programs; 
        and
          (3) provide information, referral, and educational 
        programs to the public on lifespan respite care.

SEC. 2904. REPORT.

    Not later than January 1, 2009, the Secretary shall report 
to the Congress on the activities undertaken under this title. 
Such report shall evaluate--
          (1) the number of States that have lifespan respite 
        care programs;
          (2) the demographics of the caregivers receiving 
        respite care services through grants or cooperative 
        agreements under this title; and
          (3) the effectiveness of entities receiving grants or 
        cooperative agreements under this title.

SEC. 2905. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated to carry out this 
title--
          (1) $30,000,000 for fiscal year 2007;
          (2) $40,000,000 for fiscal year 2008;
          (3) $53,330,000 for fiscal year 2009;
          (4) $71,110,000 for fiscal year 2010; and
          (5) $94,810,000 for fiscal year 2011.

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