Division A—Block Grants to States for Social Services
§1397. Purposes of division; authorization of appropriations
For the purposes of consolidating Federal assistance to States for social services into a single grant, increasing State flexibility in using social service grants, and encouraging each State, as far as practicable under the conditions in that State, to furnish services directed at the goals of—
(1) achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency;
(2) achieving or maintaining self-sufficiency, including reduction or prevention of dependency;
(3) preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests, or preserving, rehabilitating or reuniting families;
(4) preventing or reducing inappropriate institutional care by providing for community-based care, home-based care, or other forms of less intensive care; and
(5) securing referral or admission for institutional care when other forms of care are not appropriate, or providing services to individuals in institutions,
there are authorized to be appropriated for each fiscal year such sums as may be necessary to carry out the purposes of this division.
(Aug. 14, 1935, ch. 531, title XX, §2001, as added
Editorial Notes
Prior Provisions
A prior section 1397, act Aug. 14, 1935, ch. 531, title XX, §2001, as added Jan. 4, 1975,
Amendments
2010—
Statutory Notes and Related Subsidiaries
Effective Date
Study of State Social Service Programs; Report to Congress
§1397a. Payments to States
(a) Amount; covered services
(1) Each State shall be entitled to payment under this division for each fiscal year in an amount equal to its allotment for such fiscal year, to be used by such State for services directed at the goals set forth in
(2) For purposes of paragraph (1)—
(A) services which are directed at the goals set forth in
(B) expenditures for such services may include expenditures for—
(i) administration (including planning and evaluation);
(ii) personnel training and retraining directly related to the provision of those services (including both short- and long-term training at educational institutions through grants to such institutions or by direct financial assistance to students enrolled in such institutions); and
(iii) conferences or workshops, and training or retraining through grants to nonprofit organizations within the meaning of section 501(c)(3) of the Internal Revenue Code of 1986 or to individuals with social services expertise, or through financial assistance to individuals participating in such conferences, workshops, and training or retraining (and this clause shall apply with respect to all persons involved in the delivery of such services).
(b) Funding requirements
The Secretary shall make payments in accordance with
(c) Expenditure of funds
Payments to a State from its allotment for any fiscal year must be expended by the State in such fiscal year or in the succeeding fiscal year.
(d) Transfers of funds
A State may transfer up to 10 percent of its allotment under
(e) Use of portion of funds
A State may use a portion of the amounts described in subsection (a) for the purpose of purchasing technical assistance from public or private entities if the State determines that such assistance is required in developing, implementing, or administering programs funded under this division.
(f) Authority to use vouchers
A State may use funds provided under this division to provide vouchers, for services directed at the goals set forth in
(1) families who have become ineligible for assistance under a State program funded under part A of subchapter IV by reason of a durational limit on the provision of such assistance; and
(2) families denied cash assistance under the State program funded under part A of subchapter IV for a child who is born to a member of the family who is—
(A) a recipient of assistance under the program; or
(B) a person who received such assistance at any time during the 10-month period ending with the birth of the child.
(Aug. 14, 1935, ch. 531, title XX, §2002, as added
Editorial Notes
References in Text
Section 501 of the Internal Revenue Code of 1986, referred to in subsec. (a)(2)(B)(iii), is classified to
Prior Provisions
A prior section 1397a, acts Aug. 14, 1935, ch. 531, title XX, §2002, as added Jan. 4, 1975,
Amendments
2010—
1996—Subsec. (f).
1986—Subsec. (a)(2)(B)(iii).
1984—Subsec. (b).
Statutory Notes and Related Subsidiaries
Effective Date of 1984 Amendment
Amendment by
Temporary Suspension of Child Day Care Services Requirements
Reimbursement of Expenditures for Social Services Provided by States Prior to October 1, 1975; Authorization of Appropriations; Procedures Applicable to Payment of Unpaid Claims of States
Payments to States for Fiscal Period Beginning July 1, 1976, and Ending September 30, 1976, and Fiscal Years Ending September 30, 1977, 1978, and 1979, Computation Amounts, Limitations, Etc.
Requirements of Child Day Care Services
§1397b. Allotments
(a) Computation of amounts for jurisdictions of Puerto Rico, Guam, etc.
The allotment for any fiscal year to each of the jurisdictions of Puerto Rico, Guam, the Virgin Islands, and the Northern Mariana Islands shall be an amount which bears the same ratio to the amount specified in subsection (c) as the amount which was specified for allocation to the particular jurisdiction involved for the fiscal year 1981 under
(b) Computation of amounts for each State other than jurisdictions of Puerto Rico, Guam, etc.
The allotment for any fiscal year for each State other than the jurisdictions of Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands shall be an amount which bears the same ratio to—
(1) the amount specified in subsection (c), reduced by
(2) the total amount allotted to those jurisdictions for that fiscal year under subsection (a),
as the population of that State bears to the population of all the States (other than Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands) as determined by the Secretary (on the basis of the most recent data available from the Department of Commerce) and promulgated prior to the first day of the third month of the preceding fiscal year.
(c) Appropriations
The amount specified for purposes of subsections (a) and (b) shall be—
(1) $2,400,000,000 for the fiscal year 1982;
(2) $2,450,000,000 for the fiscal year 1983;
(3) $2,700,000,000 for the fiscal years 1984, 1985, 1986, 1987, and 1989;
(4) $2,750,000,000 for the fiscal year 1988;
(5) $2,800,000,000 for each of the fiscal years 1990 through 1995;
(6) $2,381,000,000 for the fiscal year 1996;
(7) $2,380,000,000 for the fiscal year 1997;
(8) $2,299,000,000 for the fiscal year 1998;
(9) $2,380,000,000 for the fiscal year 1999;
(10) $2,380,000,000 for the fiscal year 2000; and
(11) $1,700,000,000 for the fiscal year 2001 and each fiscal year thereafter.
(Aug. 14, 1935, ch. 531, title XX, §2003, as added
Editorial Notes
Prior Provisions
A prior section 1397b, act Aug. 14, 1935, ch. 531, title XX, §2003, as added Jan. 4, 1975,
Amendments
1998—Subsec. (c)(7).
Subsec. (c)(8).
Subsec. (c)(9) to (11).
1996—Subsec. (c)(5) to (8).
1989—Subsec. (c)(3).
Subsec. (c)(5).
1987—Subsec. (a).
Subsec. (b).
Subsec. (c)(2).
Subsec. (c)(3).
Subsec. (c)(4).
1986—Subsec. (b).
Subsec. (d).
1983—Subsec. (c)(3).
Subsec. (c)(4), (5).
1982—Subsec. (b).
Statutory Notes and Related Subsidiaries
Effective Date of 1998 Amendments
Amendment by
Effective Date of 1987 Amendment
Amendment by section 9135(a)(2) of
Effective Date of 1982 Amendment
Amendment by
Requirement That Additional Funds Supplement and Not Supplant Funds Available From Other Sources
"(A) be used only for the purpose of providing additional services under title XX of the Social Security Act [
"(B) be expended only to supplement the level of any funds that would, in the absence of the additional funds appropriated pursuant to such amendments, be available from other sources (including any amounts available under title XX of the Social Security Act without regard to such amendments) for services in accordance with such title, and shall in no case supplant such funds from other sources or reduce the level thereof."
Appropriations
"(a)(1) Notwithstanding any provision of title XX of the Social Security Act [
"(2) In addition to any other amounts appropriated under this resolution [
"(3) Amounts appropriated under this section shall remain available until September 30, 1985, without regard to section 102 of this resolution.
"(4) Except as otherwise provided in this section, each State's allotment of the additional amounts authorized and appropriated under this section shall be the same proportion of $25,000,000 as such State's proportional allotment of other title XX funds for fiscal year 1985, as determined under section 2003 of the Social Security Act [
"(b) The additional $25,000,000 made available to the States for fiscal year 1985 pursuant to subsection (a) shall—
"(1) be used only for the purpose of providing training and retraining (including training in the prevention of child abuse in child care settings) to providers of licensed or registered child care services, operators and staffs (including those receiving in-service training) of facilities where licensed or registered child care services are provided, State licensing and enforcement officials, and parents;
"(2) be expended only to supplement the level of any funds that would, in the absence of the additional funds appropriated under this section, be available from other sources (including any amounts available under title XX of the Social Security Act [
"(3) be separately accounted for in the reports and audits provided for in section 2006 of the Social Security Act [
"(c)(1) In order to provide guidance and assistance to the States in utilizing funds allocated pursuant to title XX of the Social Security Act [
"(A) minimum licensing or registration standards for day care centers, group homes, and family day care homes regarding matters including—
"(i) the training, development, supervision, and evaluation of staff;
"(ii) staff qualification requirements, by job classification;
"(iii) staff-child ratios;
"(iv) probation periods for new staff;
"(v) employment history checks for staff; and
"(vi) parent visitation; and
"(2)(A) Any State receiving an allotment under such title from the funds made available as a result of subsection (a) shall have in effect, not later than September 30, 1985—
"(i) procedures, established by State law or regulation, to provide for employment history and background checks; and
"(ii) provisions of State law, enacted in accordance with the provisions of
for all operators, staff or employees, or prospective operators, staff or employees of child care facilities (including any facility or program having primary custody of children for 20 hours or more per week), juvenile detention, correction or treatment facilities, with the objective of protecting the children involved and promoting such children's safety and welfare while receiving service through such facilities or programs.
"(B) In the case of any State not meeting the requirements of subparagraph (A) by September 30, 1985, such State's allotment for fiscal year 1986 or 1987 shall be reduced in the aggregate by an amount equal to one-half of the amount by which such State's allotment under such title was increased for fiscal year 1985 as a result of subsection (a).
"(d) The determination and promulgation required by section 2003(b) of the Social Security Act [
§1397c. State reporting requirements
Prior to expenditure by a State of payments made to it under
(Aug. 14, 1935, ch. 531, title XX, §2004, as added
Editorial Notes
Prior Provisions
A prior section 1397c, act Aug. 14, 1935, ch. 531, title XX, §2004, as added Jan. 4, 1975,
Amendments
2010—
§1397d. Limitation on use of grants; waiver
(a) Except as provided in subsection (b), grants made under this division may not be used by the State, or by any other person with which the State makes arrangements to carry out the purposes of this division—
(1) for the purchase or improvement of land, or the purchase, construction, or permanent improvement (other than minor remodeling) of any building or other facility;
(2) for the provision of cash payments for costs of subsistence or for the provision of room and board (other than costs of subsistence during rehabilitation, room and board provided for a short term as an integral but subordinate part of a social service, or temporary emergency shelter provided as a protective service);
(3) for payment of the wages of any individual as a social service (other than payment of the wages of welfare recipients employed in the provision of child day care services);
(4) for the provision of medical care (other than family planning services, rehabilitation services, or initial detoxification of an alcoholic or drug dependent individual) unless it is an integral but subordinate part of a social service for which grants may be used under this division;
(5) for social services (except services to an alcoholic or drug dependent individual or rehabilitation services) provided in and by employees of any hospital, skilled nursing facility, intermediate care facility, or prison, to any individual living in such institution;
(6) for the provision of any educational service which the State makes generally available to its residents without cost and without regard to their income;
(7) for any child day care services unless such services meet applicable standards of State and local law;
(8) for the provision of cash payments as a service (except as otherwise provided in this section);
(9) for payment for any item or service (other than an emergency item or service) furnished—
(A) by an individual or entity during the period when such individual or entity is excluded under this division or subchapter V, XVIII, or XIX pursuant to
(B) at the medical direction or on the prescription of a physician during the period when the physician is excluded under this division or subchapter V, XVIII, or XIX pursuant to
(10) in a manner inconsistent with the Assisted Suicide Funding Restriction Act of 1997 [
(b) The Secretary may waive the limitation contained in subsection (a)(1) and (4) upon the State's request for such a waiver if he finds that the request describes extraordinary circumstances to justify the waiver and that permitting the waiver will contribute to the State's ability to carry out the purposes of this division.
(Aug. 14, 1935, ch. 531, title XX, §2005, as added
Editorial Notes
References in Text
The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (a)(10), is
Prior Provisions
A prior section 1397d, act Aug. 14, 1935, ch. 531, title XX, §2005, as added Jan. 4, 1975,
Amendments
2010—
1997—Subsec. (a)(10).
1988—Subsec. (a)(9)(A), (B).
1987—Subsec. (a)(9).
Subsec. (a)(9)(A), (B).
Statutory Notes and Related Subsidiaries
Effective Date of 1997 Amendment
Amendment by
Effective Date of 1988 Amendments
Amendment by
Except as specifically provided in section 411 of
Effective Date of 1987 Amendment
Amendment by
§1397e. Administrative and fiscal accountability
(a) Reporting requirements; form, contents, etc.
Each State shall prepare reports on its activities carried out with funds made available (or transferred for use) under this division. Reports shall be prepared annually, covering the most recently completed fiscal year, and shall be in such form and contain such information (including but not limited to the information specified in subsection (c)) as the State finds necessary to provide an accurate description of such activities, to secure a complete record of the purposes for which funds were spent, and to determine the extent to which funds were spent in a manner consistent with the reports required by
(b) Audits; implementation, etc.
Each State shall, not less often than every two years, audit its expenditures from amounts received (or transferred for use) under this division. Such State audits shall be conducted by an entity independent of any agency administering activities funded under this division, in accordance with generally accepted auditing principles. Within 30 days following the completion of each audit, the State shall submit a copy of that audit to the legislature of the State and to the Secretary. Each State shall repay to the United States amounts ultimately found not to have been expended in accordance with this division, or the Secretary may offset such amounts against any other amount to which the State is or may become entitled under this division.
(c) State reports on expenditure and use of social services funds
Each report prepared and transmitted by a State under subsection (a) shall set forth (with respect to the fiscal year covered by the report)—
(1) the number of individuals who received services paid for in whole or in part with funds made available under this division, showing separately the number of children and the number of adults who received such services, and broken down in each case to reflect the types of services and circumstances involved;
(2) the amount spent in providing each such type of service, showing separately for each type of service the amount spent per child recipient and the amount spent per adult recipient;
(3) the criteria applied in determining eligibility for services (such as income eligibility guidelines, sliding fee scales, the effect of public assistance benefits, and any requirements for enrollment in school or training programs); and
(4) the methods by which services were provided, showing separately the services provided by public agencies and those provided by private agencies, and broken down in each case to reflect the types of services and circumstances involved.
The Secretary shall establish uniform definitions of services for use by the States in preparing the information required by this subsection, and make such other provision as may be necessary or appropriate to assure that compliance with the requirements of this subsection will not be unduly burdensome on the States.
(d) Additional accounting requirements
For other provisions requiring States to account for Federal grants, see
(Aug. 14, 1935, ch. 531, title XX, §2006, as added
Editorial Notes
Prior Provisions
A prior section 1397e, act Aug. 14, 1935, ch. 531, title XX, §2006, as added Jan. 4, 1975,
A prior section 1397e–1, act Aug. 14, 1935, ch. 531, title XX, §2007, as added Jan. 2, 1980,
Amendments
2010—
1988—Subsec. (a).
Subsecs. (c), (d).
1984—Subsec. (c).
Statutory Notes and Related Subsidiaries
Effective Date of 1984 Amendment
Amendment by
§1397f. Additional grants
(a) Entitlement
(1) In general
In addition to any payment under
(A) 2 grants under this section for each qualified empowerment zone in the State; and
(B) 1 grant under this section for each qualified enterprise community in the State.
(2) Amount of grants
(A) Empowerment grants
The amount of each grant to a State under this section for a qualified empowerment zone shall be—
(i) if the zone is designated in an urban area, $50,000,000, multiplied by that proportion of the population of the zone that resides in the State; or
(ii) if the zone is designated in a rural area, $20,000,000, multiplied by such proportion.
(B) Enterprise grants
The amount of the grant to a State under this section for a qualified enterprise community shall be 1/95 of $280,000,000, multiplied by that proportion of the population of the community that resides in the State.
(C) Population determinations
The Secretary shall make population determinations for purposes of this paragraph based on the most recent decennial census data available.
(3) Timing of grants
(A) Qualified empowerment zones
With respect to each qualified empowerment zone, the Secretary shall make—
(i) 1 grant under this section to each State in which the zone lies, on the date of the designation of the zone under part I of subchapter U of
(ii) 1 grant under this section to each such State, on the 1st day of the 1st fiscal year that begins after the date of the designation.
(B) Qualified enterprise communities
With respect to each qualified enterprise community, the Secretary shall make 1 grant under this section to each State in which the community lies, on the date of the designation of the community under part I of subchapter U of
(4) Funding
$1,000,000,000 shall be made available to the Secretary for grants under this section.
(b) Program options
Notwithstanding
(1) In order to prevent and remedy the neglect and abuse of children, a State may use amounts paid under this section to make grants to, or enter into contracts with, entities to provide residential or nonresidential drug and alcohol prevention and treatment programs that offer comprehensive services for pregnant women and mothers, and their children.
(2) In order to assist disadvantaged adults and youths in achieving and maintaining self-sufficiency, a State may use amounts paid under this section to make grants to, or enter into contracts with—
(A) organizations operated for profit or not for profit, for the purpose of training and employing disadvantaged adults and youths in construction, rehabilitation, or improvement of affordable housing, public infrastructure, and community facilities; and
(B) nonprofit organizations and community or junior colleges, for the purpose of enabling such entities to provide short-term training courses in entrepreneurism and self-employment, and other training that will promote individual self-sufficiency and the interests of the community.
(3) A State may use amounts paid under this section to make grants to, or enter into contracts with, nonprofit community-based organizations to enable such organizations to provide activities designed to promote and protect the interests of children and families, outside of school hours, including keeping schools open during evenings and weekends for mentoring and study.
(4) In order to assist disadvantaged adults and youths in achieving and maintaining economic self-support, a State may use amounts paid under this section to—
(A) fund services designed to promote community and economic development in qualified empowerment zones and qualified enterprise communities, such as skills training, job counseling, transportation services, housing counseling, financial management, and business counseling;
(B) assist in emergency and transitional shelter for disadvantaged families and individuals; or
(C) support programs that promote home ownership, education, or other routes to economic independence for low-income families and individuals.
(c) Use of grants
(1) In general
Subject to subsection (d) of this section, each State that receives a grant under this section with respect to an area shall use the grant—
(A) for services directed only at the goals set forth in paragraphs (1), (2), and (3) of
(B) in accordance with the strategic plan for the area; and
(C) for activities that benefit residents of the area for which the grant is made.
(2) Technical assistance
A State may use a portion of any grant made under this section in the manner described in
(d) Remittance of certain amounts
(1) Portion of grant upon termination of designation
Each State to which an amount is paid under this subsection during a fiscal year with respect to an area the designation of which under part I of subchapter U of
(2) Amounts paid to the States and not obligated within 2 years
Each State shall remit to the Secretary any amount paid to the State under this section that is not obligated by the end of the 2-year period that begins with the date of the payment.
(e) Reallocation of remaining funds
(1) Remitted amounts
The amount specified in
(2) Amounts not paid to the States
The amount specified in
(f) Definitions
As used in this section:
(1) Qualified empowerment zone
The term "qualified empowerment zone" means, with respect to a State, an area—
(A) which has been designated (other than by the Secretary of the Interior) as an empowerment zone under part I of subchapter U of
(B) with respect to which the designation is in effect;
(C) the strategic plan for which is a qualified plan; and
(D) part or all of which is in the State.
(2) Qualified enterprise community
The term "qualified enterprise community" means, with respect to a State, an area—
(A) which has been designated (other than by the Secretary of the Interior) as an enterprise community under part I of subchapter U of
(B) with respect to which the designation is in effect;
(C) the strategic plan for which is a qualified plan; and
(D) part or all of which is in the State.
(3) Strategic plan
The term "strategic plan" means, with respect to an area, the plan contained in the application for designation of the area under part I of subchapter U of
(4) Qualified plan
The term "qualified plan" means, with respect to an area, a plan that—
(A) includes a detailed description of the activities proposed for the area that are to be funded with amounts provided under this section;
(B) contains a commitment that the amounts provided under this section to any State for the area will not be used to supplant Federal or non-Federal funds for services and activities which promote the purposes of this section;
(C) was developed in cooperation with the local government or governments with jurisdiction over the area; and
(D) to the extent that any State will not use the amounts provided under this section for the area in the manner described in subsection (b), explains the reasons why not.
(5) Rural area
The term "rural area" has the meaning given such term in section 1393(a)(2) of the Internal Revenue Code of 1986.
(6) Urban area
The term "urban area" has the meaning given such term in section 1393(a)(3) of the Internal Revenue Code of 1986.
(Aug. 14, 1935, ch. 531, title XX, §2007, as added
Editorial Notes
References in Text
The Internal Revenue Code of 1986, referred to in subsecs. (a)(3), (d)(1), and (f), is classified generally to Title 26, Internal Revenue Code.
Prior Provisions
A prior section 1397f, act Aug. 14, 1935, ch. 531, title XX, §2007, as added Aug. 13, 1981,
Another prior section 1397f, act Aug. 14, 1935, ch. 531, title XX, §2008, formerly §2007, as added Jan. 4, 1975,
Amendments
1994—Subsecs. (e), (f).
§1397g. Demonstration projects to address health professions workforce needs
(a) Demonstration projects to provide low-income individuals with opportunities for education, training, and career advancement to address health professions workforce needs
(1) Authority to award grants
The Secretary, in consultation with the Secretary of Labor, shall award grants to eligible entities to conduct demonstration projects that are designed to provide eligible individuals with the opportunity to obtain education and training for occupations in the health care field that pay well and are expected to either experience labor shortages or be in high demand.
(2) Requirements
(A) Aid and supportive services
(i) In general
A demonstration project conducted by an eligible entity awarded a grant under this section shall, if appropriate, provide eligible individuals participating in the project with financial aid, child care, case management, and other supportive services.
(ii) Treatment
Any aid, services, or incentives provided to an eligible beneficiary participating in a demonstration project under this section shall not be considered income, and shall not be taken into account for purposes of determining the individual's eligibility for, or amount of, benefits under any means-tested program.
(B) Consultation and coordination
An eligible entity applying for a grant to carry out a demonstration project under this section shall demonstrate in the application that the entity has consulted with the State agency responsible for administering the State TANF program, the local workforce investment board in the area in which the project is to be conducted (unless the applicant is such board), the State workforce development board established under
(C) Assurance of opportunities for Indian populations
The Secretary shall award at least 3 grants under this subsection to an eligible entity that is an Indian tribe, tribal organization, or Tribal College or University.
(3) Reports and evaluation
(A) Eligible entities
An eligible entity awarded a grant to conduct a demonstration project under this subsection shall submit interim reports to the Secretary on the activities carried out under the project and a final report on such activities upon the conclusion of the entities' participation in the project. Such reports shall include assessments of the effectiveness of such activities with respect to improving outcomes for the eligible individuals participating in the project and with respect to addressing health professions workforce needs in the areas in which the project is conducted.
(B) Evaluation
The Secretary shall, by grant, contract, or interagency agreement, evaluate the demonstration projects conducted under this subsection. Such evaluation shall include identification of successful activities for creating opportunities for developing and sustaining, particularly with respect to low-income individuals and other entry-level workers, a health professions workforce that has accessible entry points, that meets high standards for education, training, certification, and professional development, and that provides increased wages and affordable benefits, including health care coverage, that are responsive to the workforce's needs.
(C) Report to Congress
The Secretary shall submit interim reports and, based on the evaluation conducted under subparagraph (B), a final report to Congress on the demonstration projects conducted under this subsection.
(4) Definitions
In this subsection:
(A) Eligible entity
The term "eligible entity" means a State, an Indian tribe or tribal organization, an institution of higher education, a local workforce development board established under
(B) Eligible individual
(i) In general
The term "eligible individual" means a 1 individual receiving assistance under the State TANF program.
(ii) Other low-income individuals
Such term may include other low-income individuals described by the eligible entity in its application for a grant under this section.
(C) Indian tribe; tribal organization
The terms "Indian tribe" and "tribal organization" have the meaning given such terms in
(D) Institution of higher education
The term "institution of higher education" has the meaning given that term in
(E) State
The term "State" means each of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, and American Samoa.
(F) State TANF program
The term "State TANF program" means the temporary assistance for needy families program funded under part A of subchapter IV.
(G) Tribal College or University
The term "Tribal College or University" has the meaning given that term in
(b) Demonstration project to develop training and certification programs for personal or home care aides
(1) Authority to award grants
Not later than 18 months after March 23, 2010, the Secretary shall award grants to eligible entities that are States to conduct demonstration projects for purposes of developing core training competencies and certification programs for personal or home care aides. The Secretary shall—
(A) evaluate the efficacy of the core training competencies described in paragraph (3)(A) for newly hired personal or home care aides and the methods used by States to implement such core training competencies in accordance with the issues specified in paragraph (3)(B); and
(B) ensure that the number of hours of training provided by States under the demonstration project with respect to such core training competencies are not less than the number of hours of training required under any applicable State or Federal law or regulation.
(2) Duration
A demonstration project shall be conducted under this subsection for not less than 3 years.
(3) Core training competencies for personal or home care aides
(A) In general
The core training competencies for personal or home care aides described in this subparagraph include competencies with respect to the following areas:
(i) The role of the personal or home care aide (including differences between a personal or home care aide employed by an agency and a personal or home care aide employed directly by the health care consumer or an independent provider).
(ii) Consumer rights, ethics, and confidentiality (including the role of proxy decision-makers in the case where a health care consumer has impaired decision-making capacity).
(iii) Communication, cultural and linguistic competence and sensitivity, problem solving, behavior management, and relationship skills.
(iv) Personal care skills.
(v) Health care support.
(vi) Nutritional support.
(vii) Infection control.
(viii) Safety and emergency training.
(ix) Training specific to an individual consumer's needs (including older individuals, younger individuals with disabilities, individuals with developmental disabilities, individuals with dementia, and individuals with mental and behavioral health needs).
(x) Self-Care.
(B) Implementation
The implementation issues specified in this subparagraph include the following:
(i) The length of the training.
(ii) The appropriate trainer to student ratio.
(iii) The amount of instruction time spent in the classroom as compared to on-site in the home or a facility.
(iv) Trainer qualifications.
(v) Content for a "hands-on" and written certification exam.
(vi) Continuing education requirements.
(4) Application and selection criteria
(A) In general
(i) Number of States
The Secretary shall enter into agreements with not more than 6 States to conduct demonstration projects under this subsection.
(ii) Requirements for States
An agreement entered into under clause (i) shall require that a participating State—
(I) implement the core training competencies described in paragraph (3)(A); and
(II) develop written materials and protocols for such core training competencies, including the development of a certification test for personal or home care aides who have completed such training competencies.
(iii) Consultation and collaboration with community and vocational colleges
The Secretary shall encourage participating States to consult with community and vocational colleges regarding the development of curricula to implement the project with respect to activities, as applicable, which may include consideration of such colleges as partners in such implementation.
(B) Application and eligibility
A State seeking to participate in the project shall—
(i) submit an application to the Secretary containing such information and at such time as the Secretary may specify;
(ii) meet the selection criteria established under subparagraph (C); and
(iii) meet such additional criteria as the Secretary may specify.
(C) Selection criteria
In selecting States to participate in the program, the Secretary shall establish criteria to ensure (if applicable with respect to the activities involved)—
(i) geographic and demographic diversity;
(ii) that participating States offer medical assistance for personal care services under the State Medicaid plan;
(iii) that the existing training standards for personal or home care aides in each participating State—
(I) are different from such standards in the other participating States; and
(II) are different from the core training competencies described in paragraph (3)(A);
(iv) that participating States do not reduce the number of hours of training required under applicable State law or regulation after being selected to participate in the project; and
(v) that participating States recruit a minimum number of eligible health and long-term care providers to participate in the project.
(D) Technical assistance
The Secretary shall provide technical assistance to States in developing written materials and protocols for such core training competencies.
(5) Evaluation and report
(A) Evaluation
The Secretary shall develop an experimental or control group testing protocol in consultation with an independent evaluation contractor selected by the Secretary. Such contractor shall evaluate—
(i) the impact of core training competencies described in paragraph (3)(A), including curricula developed to implement such core training competencies, for personal or home care aides within each participating State on job satisfaction, mastery of job skills, beneficiary and family caregiver satisfaction with services, and additional measures determined by the Secretary in consultation with the expert panel;
(ii) the impact of providing such core training competencies on the existing training infrastructure and resources of States; and
(iii) whether a minimum number of hours of initial training should be required for personal or home care aides and, if so, what minimum number of hours should be required.
(B) Reports
(i) Report on initial implementation
Not later than 2 years after March 23, 2010, the Secretary shall submit to Congress a report on the initial implementation of activities conducted under the demonstration project, including any available results of the evaluation conducted under subparagraph (A) with respect to such activities, together with such recommendations for legislation or administrative action as the Secretary determines appropriate.
(ii) Final report
Not later than 1 year after the completion of the demonstration project, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under subparagraph (A), together with such recommendations for legislation or administrative action as the Secretary determines appropriate.
(6) Definitions
In this subsection:
(A) Eligible health and long-term care provider
The term "eligible health and long-term care provider" means a personal or home care agency (including personal or home care public authorities), a nursing home, a home health agency (as defined in
(i) is licensed or authorized to provide services in a participating State; and
(ii) receives payment for services under subchapter XIX.
(B) Personal care services
The term "personal care services" has the meaning given such term for purposes of subchapter XIX.
(C) Personal or home care aide
The term "personal or home care aide" means an individual who helps individuals who are elderly, disabled, ill, or mentally disabled (including an individual with Alzheimer's disease or other dementia) to live in their own home or a residential care facility (such as a nursing home, assisted living facility, or any other facility the Secretary determines appropriate) by providing routine personal care services and other appropriate services to the individual.
(D) State
The term "State" has the meaning given that term for purposes of subchapter XIX.
(c) Funding
(1) In general
Subject to paragraph (2), out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out subsections (a) and (b), $85,000,000 for each of fiscal years 2010 through 2019.
(2) Training and certification programs for personal and home care aides
With respect to the demonstration projects under subsection (b), the Secretary shall use $5,000,000 of the amount appropriated under paragraph (1) for each of fiscal years 2010 through 2012 to carry out such projects. No funds appropriated under paragraph (1) shall be used to carry out demonstration projects under subsection (b) after fiscal year 2012.
(d) Nonapplication
(1) In general
Except as provided in paragraph (2), the preceding sections of this division shall not apply to grant 2 awarded under this section.
(2) Limitations on use of grants
(Aug. 14, 1935, ch. 531, title XX, §2008, as added and amended
Editorial Notes
References in Text
The Act of August 16, 1937, referred to in subsec. (a)(2)(B), (4)(A), is act Aug. 16, 1937, ch. 663,
Part A of subchapter IV, referred to in subsec. (a)(4)(F), is classified to §601 et seq. of this title.
Amendments
2018—Subsec. (c)(1).
2015—Subsec. (c)(1).
2014—Subsec. (a)(2)(B).
Subsec. (a)(4)(A).
Subsec. (c)(1).
2010—Subsec. (d).
Statutory Notes and Related Subsidiaries
Effective Date of 2014 Amendment
Amendment by
Extension of Demonstration Projects To Address Health Professions Workforce Needs
1 So in original. Probably should be "an".
§1397h. Program for early detection of certain medical conditions related to environmental health hazards
(a) Program establishment
The Secretary shall establish a program in accordance with this section to make competitive grants to eligible entities specified in subsection (b) for the purpose of—
(1) screening at-risk individuals (as defined in subsection (c)(1)) for environmental health conditions (as defined in subsection (c)(3)); and
(2) developing and disseminating public information and education concerning—
(A) the availability of screening under the program under this section;
(B) the detection, prevention, and treatment of environmental health conditions; and
(C) the availability of Medicare benefits for certain individuals diagnosed with environmental health conditions under
(b) Eligible entities
(1) In general
For purposes of this section, an eligible entity is an entity described in paragraph (2) which submits an application to the Secretary in such form and manner, and containing such information and assurances, as the Secretary determines appropriate.
(2) Types of eligible entities
The entities described in this paragraph are the following:
(A) A hospital or community health center.
(B) A Federally qualified health center.
(C) A facility of the Indian Health Service.
(D) A National Cancer Institute-designated cancer center.
(E) An agency of any State or local government.
(F) A nonprofit organization.
(G) Any other entity the Secretary determines appropriate.
(c) Definitions
In this section:
(1) At-risk individual
The term "at-risk individual" means an individual who—
(A)(i) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified under paragraph (2), during a period ending—
(I) not less than 10 years prior to the date of such individual's application under subparagraph (B); and
(II) prior to the implementation of all the remedial and removal actions specified in the Record of Decision for Operating Unit 4 and the Record of Decision for Operating Unit 7; or
(ii) meets such other criteria as the Secretary determines appropriate considering the type of environmental health condition at issue; and
(B) has submitted an application (or has an application submitted on the individual's behalf), to an eligible entity receiving a grant under this section, for screening under the program under this section.
(2) Emergency declaration
The term "emergency declaration" means a declaration of a public health emergency under
(3) Environmental health condition
The term "environmental health condition" means—
(A) asbestosis, pleural thickening, or pleural plaques, as established by—
(i) interpretation by a "B Reader" qualified physician of a plain chest x-ray or interpretation of a computed tomographic radiograph of the chest by a qualified physician, as determined by the Secretary; or
(ii) such other diagnostic standards as the Secretary specifies;
(B) mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by—
(i) pathologic examination of biopsy tissue;
(ii) cytology from bronchioalveolar lavage; or
(iii) such other diagnostic standards as the Secretary specifies; and
(C) any other medical condition which the Secretary determines is caused by exposure to a hazardous substance or pollutant or contaminant at a Superfund site to which an emergency declaration applies, based on such criteria and as established by such diagnostic standards as the Secretary specifies.
(4) Hazardous substance; pollutant; contaminant
The terms "hazardous substance", "pollutant", and "contaminant" have the meanings given those terms in
(5) Superfund site
The term "Superfund site" means a site included on the National Priorities List developed by the President in accordance with
(d) Health coverage unaffected
Nothing in this section shall be construed to affect any coverage obligation of a governmental or private health plan or program relating to an at-risk individual.
(e) Funding
(1) In general
Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary, to carry out the program under this section—
(A) $23,000,000 for the period of fiscal years 2010 through 2014; and
(B) $20,000,000 for each 5-fiscal year period thereafter.
(2) Availability
Funds appropriated under paragraph (1) shall remain available until expended.
(f) Nonapplication
(1) In general
Except as provided in paragraph (2), the preceding sections of this subchapter shall not apply to grants awarded under this section.
(2) Limitations on use of grants
(Aug. 14, 1935, ch. 531, title XX, §2009, as added
Editorial Notes
Codification
§1397i. Additional funding for aging and disability services programs
(a) Appropriation
In addition to amounts otherwise available, there is appropriated for fiscal year 2021, out of any money in the Treasury not otherwise appropriated, $276,000,000, to remain available until expended, to carry out the programs described in division B of this subchapter.
(b) Use of funds
Of the amounts made available by subsection (a)—
(1) $88,000,000 shall be made available to carry out the programs described in division B of this subchapter in fiscal year 2021, of which not less than an amount equal to $100,0000,000 minus the amount previously provided in fiscal year 2021 to carry out
(2) $188,000,000 shall be made available to carry out the programs described in division B of this subchapter in fiscal year 2022, of which not less than $100,000,000 shall be for activities described in
(Aug. 14, 1935, ch. 531, title XX, §2010, as added