II 

116TH CONGRESS 

2D SESSION S. 4957 

To provide for an emergency increase in Federal funding to State Medicaid 

programs for expenditures on home and community-based services. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 3, 2020 

Mr. CASEY (for himself, Mr. BOOKER, Mr. VAN HOLLEN, Mr. BLUMENTHAL, 

Mr. MENENDEZ, Ms. SMITH, Ms. DUCKWORTH, Ms. WARREN, Ms. STABENOW, Mr. BROWN, Mrs. SHAHEEN, Mr. MERKLEY, Mr. PETERS, Mrs. 

GILLIBRAND, Mr. REED, Mr. MARKEY, Ms. BALDWIN, Ms. KLOBUCHAR, 

and Mr. SANDERS) introduced the following bill; which was read twice 

and referred to the Committee on Finance 

A BILL 

To provide for an emergency increase in Federal funding 

to State Medicaid programs for expenditures on home 

and community-based services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘COVID HCBS Relief 

5 Act of 2020’’. 


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1 SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 

2 COMMUNITY-BASED SERVICES DURING THE 

3 COVID–19 EMERGENCY PERIOD. 

4 (a) INCREASED FMAP.— 

5 (1) IN GENERAL.—Notwithstanding section 

6 1905(b) of the Social Security Act (42 U.S.C. 

7 1396d(b)), in the case of an HCBS program State, 

8 the Federal medical assistance percentage deter9 mined for the State under section 1905(b) of such 

10 Act and, if applicable, increased under subsection 

11 (y), (z), or (aa) of section 1905 of such Act (42 

12 U.S.C. 1396d), section 1915(k) of such Act (42 

13 U.S.C. 1396n(k)), or section 6008(a) of the Fami14 lies First Coronavirus Response Act (Public Law 

15 116–127), shall be increased by 10 percentage 

16 points with respect to expenditures of the State 

17 under the State Medicaid program for home and 

18 community-based services that are provided during 

19 the HCBS program improvement period. In no case 

20 may the application of the previous sentence result 

21 in the Federal medical assistance percentage deter22 mined for a State being more than 95 percent. 

23 (2) DEFINITIONS.—In this section: 

24 (A) HCBS PROGRAM IMPROVEMENT PE25 RIOD.—The term ‘‘HCBS program improveVerDate Sep 11 2014 04:12 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4957.IS S4957

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1 ment period’’ means, with respect to a State, 

2 the period— 

3 (i) beginning on October 1, 2020; and 

4 (ii) ending on September 30, 2022. 

5 (B) HCBS PROGRAM STATE.—The term 

6 ‘‘HCBS program State’’ means a State that 

7 meets the condition described in subsection (b) 

8 by submitting an application described in such 

9 subsection, which is approved by the Secretary 

10 pursuant to subsection (c). 

11 (C) HOME AND COMMUNITY-BASED SERV12 ICES.—The term ‘‘home and community-based 

13 services’’ means home health care services au14 thorized under paragraph (7) of section 1905(a) 

15 of the Social Security Act (42 U.S.C. 

16 1396d(a)), behavioral health services authorized 

17 under paragraph (13) of such section, personal 

18 care services authorized under paragraph (24) 

19 of such section, PACE services authorized 

20 under paragraph (26) of such section, services 

21 authorized under subsections (b), (c), (i), (j), 

22 and (k) of section 1915 of such Act (42 U.S.C. 

23 1396n), such services authorized under a waiver 

24 under section 1115 of such Act (42 U.S.C. 


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1 1315), and such other services specified by the 

2 Secretary. 

3 (b) CONDITION.—The condition described in this sub4 section, with respect to a State, is that the State submits 

5 an application to the Secretary, at such time and in such 

6 manner as specified by the Secretary, that includes, in ad7 dition to such other information as the Secretary shall re8 quire— 

9 (1) a description of which activities described in 

10 subsection (d) that a State plans to implement and 

11 a description of how it plans to implement such ac12 tivities; 

13 (2) assurances that the Federal funds attrib14 utable to the increase under subsection (a) will be 

15 used— 

16 (A) to implement the activities described in 

17 subsection (d); and 

18 (B) to supplement, and not supplant, the 

19 level of State funds expended for home and 

20 community-based services for eligible individ21 uals through programs in effect as of the date 

22 of the enactment of this section; and 

23 (3) assurances that the State will conduct ade24 quate oversight and ensure the validity of such data 

25 as may be required by the Secretary. 


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1 (c) APPROVAL OF APPLICATION.—Not later than 90 

2 days after the date of submission of an application of a 

3 State under subsection (b), the Secretary shall certify if 

4 the application is complete. Upon certification that an ap5 plication of a State is complete, the application shall be 

6 deemed to be approved for purposes of this section. 

7 (d) ACTIVITIES TO IMPROVE THE DELIVERY OF

8 HCBS.— 

9 (1) IN GENERAL.—A State shall work with 

10 community partners, such as Area Agencies on 

11 Aging, Centers for Independent Living, non-profit 

12 home and community-based services providers, and 

13 other entities providing home and community-based 

14 services, to implement— 

15 (A) the purposes described in paragraph 

16 (2) during the COVID–19 public health emer17 gency period; and 

18 (B) the purposes described in paragraph 

19 (3) after the end of such emergency period. 

20 (2) FOCUSED AREAS OF HCBS IMPROVE21 MENT.—The purposes described in this paragraph, 

22 with respect to a State, are the following: 

23 (A) To increase rates for home health 

24 agencies and agencies that employ direct sup25 port professionals (including independent proVerDate Sep 11 2014 04:12 Dec 11, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4957.IS S4957

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1 viders in a self-directed or consumer-directed 

2 model) to provide home and community-based 

3 services under the State Medicaid program, 

4 provided that any agency or individual that re5 ceives payment under such an increased rate in6 creases the compensation it pays its home 

7 health workers or direct support professionals. 

8 (B) To provide paid sick leave, paid family 

9 leave, and paid medical leave for home health 

10 workers and direct support professionals. 

11 (C) To provide hazard pay, overtime pay, 

12 and shift differential pay for home health work13 ers and direct support professionals. 

14 (D) To provide home and community15 based services to eligible individuals who are on 

16 waiting lists for programs approved under sec17 tions 1115 or 1915 of the Social Security Act 

18 (42 U.S.C. 1315, 1396n). 

19 (E) To expand home and community-based 

20 services to facilitate reducing the census of 

21 nursing facilities, intermediate care facilities, 

22 psychiatric facilities, and other institutional or 

23 congregate settings so that safety measures can 

24 be effectively implemented within these settings. 


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1 (F) To purchase emergency supplies and 

2 equipment, which may include items not typi3 cally covered under the Medicaid program, such 

4 as personal protective equipment, necessary to 

5 enhance access to services and to protect the 

6 health and well-being of home health workers 

7 and direct support professionals. 

8 (G) To pay for the travel of home health 

9 workers and direct support professionals to con10 duct home and community-based services. 

11 (H) To recruit new home health workers 

12 and direct support professionals. 

13 (I) To support family care providers of eli14 gible individuals with needed supplies and 

15 equipment, which may include items not typi16 cally covered under the Medicaid program, such 

17 as personal protective equipment, and pay. 

18 (J) To pay for training for home health 

19 workers and direct support professionals that is 

20 specific to the COVID–19 public health emer21 gency. 

22 (K) To pay for assistive technologies, staff23 ing, and other costs incurred during the 

24 COVID–19 public health emergency period in 

25 order to facilitate community integration and 


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1 ensure an individual’s person-centered service 

2 plan continues to be fully implemented. 

3 (L) To prepare information and public 

4 health and educational materials in accessible 

5 formats (including formats accessible to people 

6 with low literacy or intellectual disabilities) 

7 about prevention, treatment, recovery, and 

8 other aspects of COVID–19 for eligible individ9 uals, their families, and the general community 

10 served by agencies described in subparagraph 

11 (A). 

12 (M) To pay for interpreters to assist in 

13 providing home and community-based services 

14 to eligible individuals and to inform the general 

15 public about COVID–19. 

16 (N) To allow day services providers to pro17 vide home and community-based services. 

18 (O) To pay for other expenses deemed ap19 propriate by the Secretary to enhance, expand, 

20 or strengthen Home and Community-Based 

21 Services, including retainer payments, and ex22 penses which meet the criteria of the home and 

23 community-based settings rule published on 

24 January 16, 2014. 


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1 (3) PERMISSIBLE USES AFTER THE EMER2 GENCY PERIOD.—The purpose described in this 

3 paragraph, with respect to a State, is to assist eligi4 ble individuals who had to relocate to a nursing fa5 cility or institutional setting from their homes dur6 ing the COVID–19 public health emergency period 

7 in— 

8 (A) moving back to their homes (including 

9 by paying for moving costs, first month’s rent, 

10 and other one-time expenses and start-up 

11 costs); 

12 (B) resuming home and community-based 

13 services; 

14 (C) receiving mental health services and 

15 necessary rehabilitative service to regain skills 

16 lost while relocated during the public health 

17 emergency period; and 

18 (D) while funds attributable to the in19 creased FMAP under this section remain avail20 able, continuing home and community-based 

21 services for eligible individuals who were served 

22 from a waiting list for such services during the 

23 public health emergency period. 

24 (e) REPORTING REQUIREMENTS.— 


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1 (1) STATE REPORTING REQUIREMENTS.—Not 

2 later than December 31, 2023, any State with re3 spect to which an application is approved by the Sec4 retary pursuant to subsection (c) shall submit a re5 port to the Secretary that contains the following in6 formation: 

7 (A) Activities and programs that were 

8 funded using Federal funds attributable to such 

9 increase. 

10 (B) The number of eligible individuals who 

11 were served by such activities and programs. 

12 (C) The number of eligible individuals who 

13 were able to resume home and community14 based services as a result of such activities and 

15 programs. 

16 (2) HHS EVALUATION.— 

17 (A) IN GENERAL.—The Secretary shall 

18 evaluate the implementation and outcomes of 

19 this section in the aggregate using an external 

20 evaluator with experience evaluating home and 

21 community-based services, disability programs, 

22 and older adult programs. 

23 (B) EVALUATION CRITERIA.—For pur24 poses of subparagraph (A), the external eval25 uator shall— 


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1 (i) document and evaluate changes in 

2 access, availability, and quality of home 

3 and community-based services in each 

4 HCBS program State; 

5 (ii) document and evaluate aggregate 

6 changes in access, availability, and quality 

7 of home and community-based services 

8 across all such States; and 

9 (iii) evaluate the implementation and 

10 outcomes of this section based on— 

11 (I) the impact of this section on 

12 increasing funding for home and com13 munity-based services; 

14 (II) the impact of this section on 

15 achieving targeted access, availability, 

16 and quality of home and community17 based services; and 

18 (III) promising practices identi19 fied by activities conducted pursuant 

20 to subsection (d) that increase access 

21 to, availability of, and quality of home 

22 and community-based services. 

23 (C) DISSEMINATION OF EVALUATION FIND24 INGS.—The Secretary shall— 


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1 (i) disseminate the findings from the 

2 evaluations conducted under this para3 graph to— 

4 (I) all State Medicaid directors; 

5 and 

6 (II) the Committee on Energy 

7 and Commerce of the House of Rep8 resentatives, the Committee on Fi9 nance of the Senate, and the Special 

10 Committee on Aging of the Senate; 

11 and 

12 (ii) make all evaluation findings pub13 licly available in an accessible electronic 

14 format and any other accessible format de15 termined appropriate by the Secretary. 

16 (D) OVERSIGHT.—Each State with respect 

17 to which an application is approved by the Sec18 retary pursuant to subsection (c) shall ensure 

19 adequate oversight of the expenditure of Fed20 eral funds pursuant to such increase in accord21 ance with the Medicaid regulations, including 

22 section 1115 and 1915 waiver regulations and 

23 special terms and conditions for any relevant 

24 waiver or grant program. 


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1 (3) NON-APPLICATION OF THE PAPERWORK RE2 DUCTION ACT.—Chapter 35 of title 44, United 

3 States Code (commonly referred to as the ‘‘Paper4 work Reduction Act of 1995’’), shall not apply to the 

5 provisions of this subsection. 

6 (f) ADDITIONAL DEFINITIONS.—In this section: 

7 (1) COVID–19 PUBLIC HEALTH EMERGENCY

8 PERIOD.—The term ‘‘COVID–19 public health emer9 gency period’’ means the portion of the emergency 

10 period described in paragraph (1)(B) of section 

11 1135(g) of the Social Security Act (42 U.S.C. 

12 1320b–5(g)) beginning on or after the date of the 

13 enactment of this Act. 

14 (2) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 

15 individual’’ means an individual who is eligible for or 

16 enrolled for medical assistance under a State Med17 icaid program. 

18 (3) MEDICAID PROGRAM.—The term ‘‘Medicaid 

19 program’’ means, with respect to a State, the State 

20 program under title XIX of the Social Security Act 

21 (42 U.S.C. 1396 et seq.) (including any waiver or 

22 demonstration under such title or under section 

23 1115 of such Act (42 U.S.C. 1315) relating to such 

24 title). 


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1 (4) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (5) STATE.—The term ‘‘State’’ has the mean4 ing given such term for purposes of title XIX of the 

5 Social Security Act (42 U.S.C. 1396 et seq.). 

Æ 


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