THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY BAKER, GINGRICH, MICOZZIE, CAUSER, CALTAGIRONE, CARROLL, CLYMER, CONKLIN, D. COSTA, J. EVANS, FRANKEL, GEIST, GEORGE, GOODMAN, GROVE, HARKINS, HARRIS, HENNESSEY, HORNAMAN, HUTCHINSON, JOSEPHS, KAUFFMAN, M. K. KELLER, KORTZ, LONGIETTI, MAJOR, MILLER, MUNDY, D. O'BRIEN, O'NEILL, PICKETT, RAPP, READSHAW, REICHLEY, SCAVELLO, K. SMITH, VULAKOVICH, WATSON, HESS, MURT, GILLEN, GIBBONS, BROOKS, BISHOP, FLECK, MARSHALL, FARRY, BEAR, MOUL, DePASQUALE AND CURRY, JANUARY 25, 2011

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, OCTOBER 4, 2011  

AN ACT

Amending the act of December 19, 1990 (P.L.1234, No.204),

entitled "An act establishing a program to assist persons who

bear primary responsibility for the at-home care of

functionally dependent older adults and victims of chronic

dementia," further providing for intent, for definitions, for

caregiver support program, for reimbursements and for

entitlement not created.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Sections 1, 2, 3, 4, 5 and 6 of the act of

December 19, 1990 (P.L.1234, No.204), known as the Family

Caregiver Support Act, are amended to read:

Section 1.  Short title.

This act shall be known and may be cited as the [Family] 

Pennsylvania Caregiver Support Act.

Section 2.  Intent.

It is the intent of this act to ease the strain of caregiving

and to assist [relatives] adult family members and other

individuals who bear primary responsibility for the at-home care

of functionally dependent older adults and other adults who are

victims of chronic dementia by providing resources for services

such as the following:

(1)  Assistance to the primary caregiver to assure that

supports to the [functionally dependent older adult or adult

suffering from a chronic dementia] care receiver are adequate

and appropriate to maintain these individuals in the home.

(2)  Intermittent, planned or emergency relief to the

primary caregiver.

(3)  Restoration or maintenance of the primary 

caregiver's well-being.

(4)  Preservation of the primary caregiver's informal

supports such as family and friends.

(5)  Supportive social services to the primary caregiver.

(6)  Affordable services through a cost-sharing mechanism

developed by the department for those families whose

household incomes do not exceed 380% of the [poverty level] 

Federal poverty guidelines.

Section 3.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

["Adult."  A person 18 years of age or older residing within

this Commonwealth who is suffering from a chronic dementia such

as Alzheimer's disease.]

"Adult with chronic dementia."  A person 18 years of age or

older residing within this Commonwealth who has an irreversible

global loss of cognitive function causing evident intellectual

impairment which always includes memory loss, without alteration

of state of consciousness as diagnosed by a physician and is

severe enough to interfere with work or social activities, or

both, and to require continuous care or supervision.

"Area agency on aging."  The single local agency designated

by the department within each planning and service area to

administer the delivery of a comprehensive and coordinated plan

of social and other services and activities in the planning and

service area.

"Care receiver."  A functionally dependent older adult or

other adult with chronic dementia who is being cared for by a

primary caregiver.

["Chronic dementia."  An irreversible global loss of

cognitive function causing evident intellectual impairment which

always includes memory loss, without alteration of state of

consciousness as diagnosed by a physician and is severe enough

to interfere with work or social activities, or both and to

require continuous care or supervision.]

"Department."  The Department of Aging of the Commonwealth.

"Federal poverty guidelines."  The poverty guidelines updated

periodically in the Federal Register by the Department of Health

and Human Services under the authority of section 673 of the

Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35, 42

U.S.C. § 9902(2)).

"Functionally dependent older adult."  A person 60 years of

age or older residing within this Commonwealth who, because of

his or her inability to perform tasks required for daily living

as defined through regulation and as assessed by the area agency

on aging, needs continuous care or supervision.

"Home modification."  Reasonable modifications to the

structure of a home for the purpose of reducing the caregiving

burden of the primary caregiver, as approved by the department.

Modifications do not include repairs, and payment for such

repairs is prohibited.

"Household income."  The income of all members of the

household with the exception of a minor or dependent student.

"Income."  All income, from whatever source derived,

including, but not limited to, wages, salaries, Social Security

or railroad retirement income, public assistance income,

realized capital gains and workmen's compensation. The

department shall determine income amounts and inclusions for

purposes of this act through regulation.

"Primary caregiver."  The one identified [relative] adult

family member or other individual who has assumed the primary

responsibility for the provision of care needed to maintain the

physical or mental health of a [functionally dependent older

adult or other adult suffering from chronic dementia, who lives

in the same residence with such individual on a continuous basis

and] care receiver and who does not receive financial

compensation for the care provided. A substantiated case of

abuse, neglect, exploitation, abandonment as defined in the act

of November 6, 1987 (P.L.381, No.79), known as the Older Adults

Protective Services Act, or pursuant to any other civil or

criminal statute regarding an older adult, shall prohibit a

primary caregiver from receiving benefits under this act unless

authorized by the department to prevent further abuse.

["Relative."  A spouse or parent, child, stepparent,

stepchild, grandparent, grandchild, brother, sister, half-

brother, half-sister, aunt, great aunt, uncle, great uncle,

niece, nephew, by blood, marriage or adoption.]

"Respite care service."  A regular, intermittent or emergency

service which provides the primary caregiver of a [functionally

dependent older adult or other adult suffering from a chronic

dementia] care receiver with relief from normal caregiving

duties and responsibilities.

Section 4.  [Caregiver] Primary caregiver support program.

(a)  Description.--The persons to be served under this act

are unpaid, primary[, unpaid] caregivers who [live with and] 

provide continuous care to a [functionally dependent older adult

or other adult suffering from a chronic dementia such as

Alzheimer's disease] care receiver.

(b)  Authority.--

(1)  The department shall develop operating procedures

and guidelines and shall contract with area agencies on aging

to provide the benefits set forth in this act.

(2)  The department shall have the authority to develop

criteria through regulation relating to eligibility for

primary caregivers to receive assistance pursuant to this

act.

(3)  After all eligibility criteria have been met, the

department shall give priority in awarding assistance paid

for by the State Lottery Fund to primary caregivers who

provide care for a functionally dependent older adult and an

adult 60 years of age or older with chronic dementia, such as

Alzheimer's disease.

(c)  Supportive services.--The department shall identify by

regulation supportive services which are directly related to the

provision of care to the [functionally dependent older adult or

other adult suffering from chronic dementia] care receiver.

Supportive services include, but are not limited to:

(1)  Benefits counseling and primary caregiver

counseling, education and training.

(2)  Reimbursement to primary caregivers whose care

receivers' households financially qualify for assistance

[pursuant to] under section 5 and as set forth through

regulation for expenses incurred in obtaining day or night

respite care services, transportation to respite care service

locations or other supportive services defined by regulation,

and consumable supplies such as incontinence pads.

(3)  Reimbursement to primary caregivers whose care

receivers' households financially qualify for assistance

[pursuant to] under section 5 and as developed through

regulation for expenses incurred in obtaining home

modifications or assistive devices as approved by the

department which help the [functionally dependent older adult

or adult suffering from chronic dementia] care receiver to

carry out tasks required for daily living such as grab bars,

safety devices and wheelchair ramps.

Section 5.  Reimbursements.

(a)  General rule.--The department through contracts with

area agencies on aging shall provide the services described [in] 

under section 4(c)(1) and shall reimburse qualified primary

caregivers for purchase of approved services described [in] 

under section 4(c)(2) and (3).

(b)  Maximum amounts.--

(1)  The maximum amount available to a qualified primary

caregiver whose care receivers' household income is under

200% of [poverty level] the Federal poverty guidelines shall

be established by regulation, but shall not exceed [$200] 

<--

$600 per month, for out-of-pocket expenses incurred for

services described [in] under section 4(c)(2)[.] subject to

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the following:

(i)  Except as otherwise provided under subparagraph

(ii), in individual cases where there is a demonstrated

need, the maximum amount available to a qualified primary

caregiver may exceed $200 but shall not be more than

$500. The need must be specifically documented in the

care receiver's care plan.

(ii)  Reimbursement under subparagraph (i) shall be

limited to $200 if an Area Agency on Aging's average

monthly reimbursement exceeds $300 across its entire

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caregiver support program caseload.

(2)  The maximum amount available to a qualified primary

caregiver whose care receivers' household income is under

200% of [poverty level] the Federal poverty guidelines shall

be established by regulation, but shall not exceed [$2,000] 

<--

$6,000 for the entire duration of the case, for expenses

incurred for home modifications or assistive devices as

described [in] under section 4(c)(3).

(c)  Scale of benefits.--A sliding benefits scale shall be

established by the department by regulation to ensure that

primary caregivers [who] whose care receivers qualify under this

act and whose household [income exceeds 200% of poverty level] 

incomes exceed 200% of the Federal poverty guidelines shall pay

some portion of the out-of-pocket expenses for services

described [in] under section 4(c). In no event will primary 

caregivers whose care receivers' household [incomes exceeds 380%

of the poverty level] incomes exceed 380% of the Federal poverty

guidelines be considered eligible for benefits under this act.

Section 6.  Entitlement not created.

Nothing in this act creates or provides any individual with

an entitlement to services or benefits. [It is the intent of the

General Assembly that services] Services under this act shall be

made available only to the extent of the availability and level

of appropriations made by the General Assembly.

Section 2.  This act shall take effect in 60 days.