[DOCID: f:hr716.109]
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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
----------------------------------------------------------------------------------------------------------------
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
* * * * * * *
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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