Disability Community Act of 2016

Summary: Disability Community Act of 2016 This bill amends title XIX (Medicaid) of the Social Security Act to temporarily establish a higher federal matching rate&nbsp;with respect to&nbsp;Medicaid expenditures for certain services furnished to individuals with developmental disabilities if such expenditures are attributable to compliance with specified regulations. In the case of a state Medicaid program that does not require the use of&nbsp;an electronic visit verification&nbsp;system for personal care services and home health services, the federal matching rate for medical assistance expended on such services shall be incrementally reduced. 

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Disability Community Act of 2016''.

SEC. 2. HIGHER FMAP FOR CERTAIN MEDICAID EXPENDITURES ASSOCIATED WITH 
              CERTAIN REGULATION COMPLIANCE.

    (a) In General.--Section 1903(a)(5) of the Social Security Act (42 
U.S.C. 1396b(a)(5)) is amended--
            (1) by striking ``an amount equal to'' and inserting ``(A) 
        an amount equal to'';
            (2) by striking ``supplies;'' and inserting ``supplies; 
        and''; and
            (3) by adding at the end the following:
            ``(B) an amount equal to 90 percent of the sum of the 
        amounts expended during a quarter in 2017, 2018, or 2019, for 
        items and services furnished in an intermediate care facility 
        for the mentally retarded or for home and community-based 
        services furnished to individuals with intellectual and 
        developmental disabilities, as the Secretary determines are 
        attributable to compliance with any of the regulations 
        specified in--
                    ``(i) part 591 of title 29, Code of Federal 
                Regulations;
                    ``(ii) part 552 of title 29, Code of Federal 
                Regulations; or
                    ``(iii) part 430, 431, 435, 436, 440, 441, or 447 
                of title 42, Code of Federal Regulations;''.
    (b) Conforming Terminology for Intermediate Care Facilities.--Title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended--
            (1) by striking ``intermediate care facility for the 
        mentally retarded'' each time such term appears (including in 
        headings) and inserting ``intermediate care facility for 
        individuals with intellectual and developmental disabilities'';
            (2) by striking ``intermediate care facilities for the 
        mentally retarded'' each time such term appears (including in 
        headings) and inserting ``intermediate care facilities for 
        individuals with intellectual and developmental disabilities'';
            (3) by striking ``State mental retardation or developmental 
        disability authority'' each time such term appears and 
        inserting ``State intellectual or developmental disability 
        authority'';
            (4) in section 1905(d)--
                    (A) in the matter before paragraph (1), by striking 
                ``thereof) for the mentally retarded or persons'' and 
                inserting ``thereof) for individuals with intellectual 
                or developmental disabilities or'';
                    (B) in paragraph (1), by striking ``mentally 
                retarded individuals'' and inserting ``individuals with 
                intellectual or developmental disabilities''; and
                    (C) in paragraph (2), by striking ``the mentally 
                retarded individual'' and inserting ``the individual 
                with an intellectual or developmental disability'';
            (5) in section 1915(c)(7)(C), by striking ``mental 
        retardation'' and inserting ``intellectual or developmental 
        disabilities'';
            (6) in section 1919(b)--
                    (A) in paragraph (3)--
                            (i) in subparagraph (E), by striking 
                        ``mentally retarded'' and inserting ``has 
                        intellectual or developmental disabilities''; 
                        and
                            (ii) in subparagraph (F)--
                                    (I) in the heading, by striking 
                                ``and mentally retarded individuals'' 
                                and inserting ``individuals and 
                                individuals with intellectual or 
                                developmental disabilities''; and
                                    (II) in clause (ii)--
                                            (aa) by striking ``is 
                                        mentally retarded'' and 
                                        inserting ``has an intellectual 
                                        or developmental disability''; 
                                        and
                                            (bb) by striking ``for 
                                        mental retardation'' and 
                                        inserting ``for intellectual or 
                                        developmental disabilities'';
                    (B) in paragraph (4)--
                            (i) in subparagraph (A)(vii), by striking 
                        ``mentally ill and mentally retarded 
                        residents'' and inserting ``residents who are 
                        mentally ill or who have intellectual or 
                        developmental disabilities''; and
                            (ii) in subparagraph (C)(ii)(IV), by 
                        striking ``the mentally retarded'' and 
                        inserting ``individuals with intellectual or 
                        developmental disabilities''; and
            (7) in section 1919(e)--
                    (A) in paragraph (7)--
                            (i) in subparagraph (A)(i), by striking 
                        ``mentally ill and mentally retarded 
                        individuals'' and inserting ``individuals who 
                        are mentally ill or who have intellectual or 
                        developmental disabilities'';
                            (ii) in subparagraph (B)--
                                    (I) by striking ``mental 
                                retardation'' each place such term 
                                appears and inserting ``intellectual or 
                                developmental disability'';
                                    (II) in clause (ii)--
                                            (aa) in the heading, by 
                                        striking ``mentally retarded 
                                        residents'' and inserting 
                                        ``residents with intellectual 
                                        or developmental 
                                        disabilities''; and
                                            (bb) in the matter 
                                        preceding subclause (I), by 
                                        striking ``is mentally 
                                        retarded'' and inserting ``has 
                                        an intellectual or 
                                        developmental disability''; and
                                    (III) in clause (iii), by striking 
                                ``mentally ill or mentally retarded 
                                resident'' and inserting ``resident who 
                                is mentally ill or who has an 
                                intellectual or developmental 
                                disability'';
                            (iii) in subparagraph (C), by striking 
                        ``mental retardation'' each place such term 
                        appears and inserting ``intellectual or 
                        developmental disability'';
                            (iv) in subparagraph (E)--
                                    (I) by striking ``are mentally 
                                retarded or'' and inserting ``have 
                                intellectual or developmental 
                                disabilities or are''; and
                                    (II) by striking ``mental 
                                retardation'' and inserting 
                                ``intellectual or developmental 
                                disability''; and
                            (v) in subparagraph (G)(ii)--
                                    (I) by striking ``be `mentally 
                                retarded''' and inserting ``have `an 
                                intellectual or developmental 
                                disability'''; and
                                    (II) by striking ``is mentally 
                                retarded or a person with'' and 
                                inserting ``has an intellectual or 
                                developmental disability or''.

SEC. 3. ELECTRONIC VISIT VERIFICATION SYSTEM REQUIRED FOR PERSONAL CARE 
              SERVICES AND HOME HEALTH CARE SERVICES UNDER MEDICAID.

    (a) In General.--Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by inserting after subsection (k) the following new 
subsection:
    ``(l)(1) Subject to paragraphs (3) and (4), with respect to any 
amount expended for personal care services or home health care services 
requiring an in-home visit by a provider that are provided under a 
State plan under this title (or under a waiver of the plan) and 
furnished in a calendar quarter beginning on or after January 1, 2019 
(or, in the case of home health care services, on or after January 1, 
2023), unless a State requires the use of an electronic visit 
verification system for such services furnished in such quarter under 
the plan or such waiver, the Federal medical assistance percentage 
shall be reduced--
                    ``(A) in the case of personal care services--
                            ``(i) for calendar quarters in 2019 and 
                        2020, by .25 percentage points;
                            ``(ii) for calendar quarters in 2021, by .5 
                        percentage points;
                            ``(iii) for calendar quarters in 2022, by 
                        .75 percentage points; and
                            ``(iv) for calendar quarters in 2023 and 
                        each year thereafter, by 1 percentage point; 
                        and
                    ``(B) in the case of home health care services--
                            ``(i) for calendar quarters in 2023 and 
                        2024, by .25 percentage points;
                            ``(ii) for calendar quarters in 2025, by .5 
                        percentage points;
                            ``(iii) for calendar quarters in 2026, by 
                        .75 percentage points; and
                            ``(iv) for calendar quarters in 2027 and 
                        each year thereafter, by 1 percentage point.
            ``(2) Subject to paragraphs (3) and (4), in implementing 
        the requirement for the use of an electronic visit verification 
        system under paragraph (1), a State shall--
                    ``(A) consult with agencies and entities that 
                provide personal care services, home health care 
                services, or both under the State plan (or under a 
                waiver of the plan) to ensure that such system--
                            ``(i) is minimally burdensome;
                            ``(ii) takes into account existing best 
                        practices and electronic visit verification 
                        systems in use in the State; and
                            ``(iii) is conducted in accordance with the 
                        requirements of HIPAA privacy and security law 
                        (as defined in section 3009 of the Public 
                        Health Service Act);
                    ``(B) take into account a stakeholder process that 
                includes input from beneficiaries, family caregivers, 
                personal care or home health care services workers, and 
                other stakeholders, as determined by the State in 
                accordance with guidance from the Secretary; and
                    ``(C) ensure that individuals who furnish personal 
                care services, home health care services, or both under 
                the State plan (or under a waiver of the plan) are 
                provided the opportunity for training on the use of 
                such system.
            ``(3) Paragraphs (1) and (2) shall not apply in the case of 
        a State that, as of the date of the enactment of this 
        subsection, requires the use of any system for the electronic 
        verification of visits conducted as part of both personal care 
        services and home health care services.
            ``(4)(A) In the case of a State described in subparagraph 
        (B), the reduction under paragraph (1) shall not apply--
                    ``(i) in the case of personal care services, for 
                calendar quarters in 2019; and
                    ``(ii) in the case of home health care services, 
                for calendar quarters in 2023.
            ``(B) For purposes of subparagraph (A), a State described 
        in this subparagraph is a State that demonstrates to the 
        Secretary that the State--
                    ``(i) has made a good faith effort to comply with 
                the requirements of paragraphs (1) and (2) (including 
                by taking steps to adopt the technology used for an 
                electronic visit verification system); or
                    ``(ii) in implementing such a system, has 
                encountered unavoidable system delays.
            ``(5) In this subsection:
                    ``(A) The term `electronic visit verification 
                system' means, with respect to personal care services 
                or home health care services, a system under which 
                visits conducted as part of such services are 
                electronically verified with respect to--
                            ``(i) the type of service performed;
                            ``(ii) the individual receiving the 
                        service;
                            ``(iii) the date of the service;
                            ``(iv) the location of service delivery;
                            ``(v) the individual providing the service; 
                        and
                            ``(vi) the time the service begins and 
                        ends.
                    ``(B) The term `home health care services' means 
                services described in section 1905(a)(7) provided under 
                a State plan under this title (or under a waiver of the 
                plan).
                    ``(C) The term `personal care services' means 
                personal care services provided under a State plan 
                under this title (or under a waiver of the plan), 
                including services provided under section 1905(a)(24), 
                1915(c), 1915(i), 1915(j), or 1915(k) or under a wavier 
                under section 1115.
            ``(6)(A) In the case in which a State requires personal 
        care service and home health care service providers to utilize 
        an electronic visit verification system operated by the State 
        or a contractor on behalf of the State, the Secretary shall pay 
        to the State, for each quarter, an amount equal to 90 per 
        centum of so much of the sums expended during such quarter as 
        are attributable to the design, development, or installation of 
        such system, and 75 per centum of so much of the sums for the 
        operation and maintenance of such system.
            ``(B) Subparagraph (A) shall not apply in the case in which 
        a State requires personal care service and home health care 
        service providers to utilize an electronic visit verification 
        system that is not operated by the State or a contractor on 
        behalf of the State.''.
    (b) Collection and Dissemination of Best Practices.--Not later than 
January 1, 2018, the Secretary of Health and Human Services shall, with 
respect to electronic visit verification systems (as defined in 
subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C. 
1396b), as inserted by subsection (a)), collect and disseminate best 
practices to State Medicaid Directors with respect to--
            (1) training individuals who furnish personal care 
        services, home health care services, or both under the State 
        plan under title XIX of such Act (or under a waiver of the 
        plan) on such systems and the operation of such systems and the 
        prevention of fraud with respect to the provision of personal 
        care services or home health care services (as defined in such 
        subsection (l)(5)); and
            (2) the provision of notice and educational materials to 
        family caregivers and beneficiaries with respect to the use of 
        such electronic visit verification systems and other means to 
        prevent such fraud.
    (c) Rules of Construction.--
            (1) No employer-employee relationship established.--Nothing 
        in the amendment made by this section may be construed as 
        establishing an employer-employee relationship between the 
        agency or entity that provides for personal care services or 
        home health care services and the individuals who, under a 
        contract with such an agency or entity, furnish such services 
        for purposes of part 552 of title 29, Code of Federal 
        Regulations (or any successor regulations).
            (2) No particular or uniform electronic visit verification 
        system required.--Nothing in the amendment made by this section 
        shall be construed to require the use of a particular or 
        uniform electronic visit verification system (as defined in 
        subsection (l)(5) of section 1903 of the Social Security Act, 
        as inserted by subsection (a)) by all agencies or entities that 
        provide personal care services or home health care under a 
        State plan under title XIX of the Social Security Act (or under 
        a waiver of the plan) (42 U.S.C. 1396 et seq.).
            (3) No limits on provision of care.--Nothing in the 
        amendment made by this section may be construed to limit, with 
        respect to personal care services or home health care services 
        provided under a State plan under title XIX of the Social 
        Security Act (or under a waiver of the plan) (42 U.S.C. 1396 et 
        seq.), provider selection, constrain beneficiaries' selection 
        of a caregiver, or impede the manner in which care is 
        delivered.
            (4) No prohibition on state quality measures 
        requirements.--Nothing in the amendment made by this section 
        shall be construed as prohibiting a State, in implementing an 
        electronic visit verification system (as defined in subsection 
        (l)(5) of section 1903 of the Social Security Act, as inserted 
        by subsection (a)), from establishing requirements related to 
        quality measures for such system.