A bill to amend title XIX of the Social Security Act to improve programs related to home and community based care and community supported living arrangements, and for other purposes.

SECTION 1. REFERENCES TO SOCIAL SECURITY ACT.

    Except as otherwise specifically provided, whenever in this Act an 
amendment is expressed in terms of an amendment to or repeal of a 
section or other provision, the reference shall be considered to be 
made to that section or other provision of the Social Security Act.

SEC. 2. HOME AND COMMUNITY CARE FOR THE FRAIL ELDERLY.

    (a) Definition of Functionally Disabled Elderly Individual.--
Section 1929(b)(1)(C) (42 U.S.C. 1396t(b)(1)(C)) is amended to read as 
follows:
                    ``(C) subject to section 1902(f) (as applied 
                consistent with section 1902(r)(2))--
                            ``(i) is receiving supplemental security 
                        income benefits under title XVI (or under a 
                        State plan approved under title XVI), or
                            ``(ii) at the option of the State--
                                    ``(I) is described in section 
                                1902(a)(10)(C), or
                                    ``(II) has income (as determined 
                                under section 1612 for purposes of the 
                                supplementary security income program) 
                                that does not exceed three times the 
                                maximum amount of income that an 
                                individual may have and obtain benefits 
                                under such program.''.
    (b) Determinations of Functional Disability.--Section 1929(c)(1) 
(42 U.S.C. 1396t(c)(1)) is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``3'' and inserting ``5'', and
                    (B) by striking ``toileting, transferring, and 
                eating; or'' and inserting ``bathing, dressing, 
                toileting, transferring, and eating;'',
            (2) in subparagraph (B)--
                    (A) by striking ``of the following 5 activities of 
                daily living: bathing, dressing, toileting, 
                transferring, and eating'' and inserting ``of the 5 
                activities of daily living described in subparagraph 
                (A)'', and
                    (B) by striking the period at the end and inserting 
                a semicolon, and
            (3) by adding at the end the following new subparagraphs:
                    ``(C) needs substantial supervision due to 
                cognitive or other mental impairment and needs 
                substantial assistance or supervision from another 
                individual with at least 1 of the 5 activities of daily 
                living described in subparagraph (A) or in complying 
                with a daily drug regimen; or
                    ``(D) needs substantial supervision from another 
                individual because such individual engages in 
                inappropriate behaviors that pose serious health or 
                safety hazards to such individual or others.''.
    (c) Survey and Certification for Certain Community Care Settings.--
            (1) In general.--Section 1929(i) (42 U.S.C.1395t(i)) is 
        amended--
                    (A) in paragraph (1), by adding at the end the 
                following new subparagraph:
                    ``(D) Special rule for certain small community care 
                settings.--For purposes of this paragraph, the terms 
                `community care setting' and `setting' shall not 
                include a small community care setting that is not a 
                provider of home and community care.'', and
                    (B) in paragraph (3), by adding at the end the 
                following new subparagraph:
                    ``(F) Special rule for certain small community care 
                settings.--For purposes of this paragraph, the terms 
                `community care setting' and `setting' shall not 
                include a small community care setting that is not a 
                provider of home and community care.''.
            (2) Additional responsibilities for case managers.--Section 
        1929(d)(2) (42 U.S.C. 1396t(d)(2)) is amended--
                    (A) by amending subparagraph (A) to read as 
                follows:
                    ``(A) has experience or has been trained--
                            ``(i) in establishing, and in periodically 
                        reviewing and revising, individual community 
                        care plans;
                            ``(ii) in the provision of case management 
                        services to the elderly; and
                            ``(iii) with respect to case managers for 
                        individuals residing in small community care 
                        settings that are not providers of home and 
                        community care, in reviewing the compliance of 
                        such settings with the requirements set forth 
                        in subsection (g)(2);'', and
                    (B) in subparagraph (B)--
                            (i) by striking ``and (iii)'' and inserting 
                        ``(iii)'', and
                            (ii) by striking ``occur;'' and inserting 
                        ``occur; and (iv) reviewing the compliance of 
                        small community care settings that are not 
                        providers of home and community care with the 
                        requirements set forth in subsection (g)(2) in 
                        coordination with Ombudsmen selected under the 
                        State Long-Term Care Ombudsman program 
                        (described in section 712 of the Older 
                        Americans Act of 1965) and reporting any 
                        noncompliance of such settings with such 
                        subsection to the State;''.
    (d) Limitation on Amount of Expenditures as Medical Assistance.--
Section 1929(m) (42 U.S.C. 1396t(m)) is amended--
            (1) in paragraph (1), by striking ``The amount of funds'' 
        and inserting ``Except as provided in paragraph (5), the amount 
        of funds'',
            (2) in paragraph (2)--
                    (A) by striking ``Individual Community Care Plan'' 
                and inserting ``individual community care plan'', and
                    (B) by striking ``an election period is the period 
                of 4 or more calendar quarters'' and inserting ``an 
                election period is a Federal fiscal year'',
            (3) by amending paragraph (4) to read as follows:
            ``(4) Allocation of medical assistance.--
                    ``(A) In general.--All of the funds available to be 
                expended under paragraph (1) during a fiscal year shall 
                be available as Federal medical assistance to the 
                States electing to provide services under this section 
                during such fiscal year.
                    ``(B) General allocation formula.--For each fiscal 
                year, beginning with fiscal year 1994, a State which 
                has provided a notice to the Secretary under paragraph 
                (6)(A) shall be allocated an amount of the funds that 
                may be expended under paragraph (1) for such fiscal 
                year equal to the product of--
                            ``(i) the total amount of funds that may be 
                        expended under paragraph (1) for such fiscal 
                        year; and
                            ``(ii) the amount determined by dividing--
                                    ``(I) the number of individuals age 
                                65 or older residing in such State 
                                during such fiscal year, by
                                    ``(II) the total number of 
                                individuals age 65 or older residing in 
                                all States which have submitted notices 
                                to the Secretary under such paragraph 
                                during such fiscal year.
                    ``(C) Reallocation of funds.--
                            ``(i) Formula for reallocation.--
                                    ``(I) General rule.--Except as 
                                provided in subclause (II), within 60 
                                days after the end of each fiscal year, 
                                beginning with fiscal year 1993, the 
                                Secretary shall pay to each State which 
                                provided services under this section 
                                during such fiscal year an amount equal 
                                to the product of--
                                            ``(aa) the total amount of 
                                        funds that may be expended 
                                        under paragraph (1) for such 
                                        fiscal year which remain 
                                        available at the end of such 
                                        fiscal year; and
                                            ``(bb) the amount 
                                        determined by dividing the 
                                        unavailable Federal amount (as 
                                        defined in clause (ii)) for 
                                        such State by the total 
                                        unavailable Federal amount for 
                                        all the States which provided 
                                        services under this section 
                                        during such fiscal year.
                                    ``(II) Special rule.--The amount 
                                determined for payment to a State under 
                                subclause (I) shall not exceed the 
                                unavailable Federal amount for such 
                                State.
                            ``(ii) Definition.--For purposes of this 
                        subparagraph, the term `unavailable Federal 
                        amount' means the excess of--
                                    ``(I) the amount a State would have 
                                received in Federal medical assistance 
                                based on such State's expenditures for 
                                services provided under this section 
                                but for the allocation under 
                                subparagraph (B), over
                                    ``(II) the amount of Federal 
                                medical assistance allocated to such 
                                State under subparagraph (B).'', and
            (4) by adding at the end the following new paragraphs:
            ``(5) Carryover of funds to next fiscal year.--Beginning 
        with fiscal year 1993, any funds available under the 
        limitations set forth in paragraph (1) for a fiscal year which 
        remain available at the end of such fiscal year shall be 
        available to be expended in the following fiscal year.
            ``(6) Notice to states of amounts available for 
        assistance.--
                    ``(A) In general.--
                            ``(i) Notice to secretary.--In order to 
                        receive Federal medical assistance for 
                        expenditures for home and community care under 
                        this section for any fiscal year (beginning 
                        with fiscal year 1994), a State shall submit 
                        not later than 3 months before the beginning of 
                        such fiscal year a notice to the Secretary of 
                        its intention to provide such care.
                            ``(ii) Notice to states.--Not later than 2 
                        months before the beginning of each fiscal year 
                        (beginning with fiscal year 1994), the 
                        Secretary shall notify each State that has 
                        submitted a notice to the Secretary under 
                        clause (i) for the fiscal year of the amount of 
                        Federal medical assistance that will be 
                        available to the State for such fiscal year (as 
                        established under paragraph (4)(B)).''.
    (e) Evaluations and Reports.--Section 1929 (42 U.S.C. 1396t) is 
amended by adding at the end the following new subsection:
    ``(n) Evaluations and Reports.--The Secretary shall evaluate the 
provision of home and community care by States under this section and 
shall submit to the Committees on Energy and Commerce and Ways and 
Means of the House of Representatives and the Committee on Finance of 
the Senate an annual report on the effectiveness of such care, 
including the cost effectiveness of providing such care, and any 
recommendations for appropriate legislative action.''.
    (f) Effective Date.--The amendments made by this section shall be 
effective on the date of the enactment of this Act.

SEC. 3. AMENDMENTS RELATED TO COMMUNITY SUPPORTED LIVING ARRANGEMENTS 
              SERVICES.

    (a) Developmentally Disabled Individual Defined.--Section 1930(b) 
(42 U.S.C. 1396u(b)), is amended--
            (1) by striking ``guardian'' and inserting ``guardian or'', 
        and
            (2) by striking ``3 other'' and inserting ``3''.
    (b) Carryover of Available Funds.--Section 1930(j) (42 U.S.C. 
1396u(j)) is amended by adding at the end the following new sentence: 
``Beginning with fiscal year 1993, any funds available under the 
limitations set forth in this subsection for a fiscal year which remain 
available at the end of such fiscal year shall be available to be 
expended in the following fiscal year.''.
    (c) Evaluations and Reports.--Section 1930 (42 U.S.C. 1396u) is 
amended by adding at the end the following new subsection:
    ``(k) Evaluations and Reports.--The Secretary shall evaluate the 
provision of community supported living arrangements services by States 
under this section and shall submit to the Committees on Energy and 
Commerce and Ways and Means of the House of Representatives and the 
Committee on Finance of the Senate an annual report on the 
effectiveness of such services, including the cost effectiveness of 
providing such services, and any recommendations for appropriate 
legislative action.''.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall be effective on the date 
        of the enactment of this Act.
            (2) Special rule.--In the case of any State which, on the 
        date of enactment of this Act, provides services under section 
        1930 of the Social Security Act to 4 individuals residing 
        together for purposes of subsection (b) of such section, the 
        amendment made by subsection (a)(2) shall be effective on 
        October 1, 1994.

SEC. 4. ALZHEIMER'S DISEASE DEMONSTRATION PROJECTS.

    (a) In General.--Section 9342 of the Omnibus Budget Reconciliation 
Act of 1986, as amended by section 4164(a)(2) of the Omnibus Budget 
Reconciliation Act of 1990, is amended--
            (1) in subsection (c)(1), by striking ``4 years'' and 
        inserting ``6 years'',
            (2) in subsection (d)(1), by striking ``fourth year'' and 
        inserting ``sixth year'', and
            (3) in subsection (f)--
                    (A) by striking ``$55,000,000'' and inserting 
                ``$70,000,000''; and
                    (B) by striking ``$3,000,000'' and inserting 
                ``$4,000,000''.
    (b) Effective Date.--The amendments made by this section shall be 
effective on the date of the enactment of this Act.

Summary: Amends title XIX (Medicaid) of the Social Security Act to allow the participation in home- and community-based care programs of functionally disabled elderly individuals with: (1) incomes of up to three times the maximum amount allowed under the Supplemental Security Income program, at the State's option. And (2) two of five impaired activities of daily living. Exempts small community care settings which are not providers of home- and community-based care from survey and certification requirements. Requires case managers who have been properly trained to review such small settings for compliance with applicable requirements. Revises program funding provisions to: (1) guarantee States with a certain amount of funding over one year's election period. And (2) allow remaining funds to be carried over to the next fiscal year. Requires: (1) a State to notify the Secretary of Health and Human Services of its intention to provide home- and community-based care in order to receive Federal funding for it. And (2) the Secretary to notify each State which has submitted such a notice of the Federal funding amount available to it for the fiscal year. Requires the Secretary to evaluate and report annually to specified congressional committees on the provision of home-and community-based care by States. Revises the definition of developmentally disabled individual with respect to eligibility for community supported living arrangements program services. Allows program funds remaining at the end of a fiscal year to be carried over to the next fiscal year. Requires the Secretary to evaluate and report annually to specified congressional committees on the provision of community supported living arrangement services by States. Amends the Omnibus Budget Reconciliation Act of 1986 to reauthorize Alzheimer's disease demonstration projects.