II

107TH CONGRESS

1ST SESSION S. 1298

To amend title XIX of the Social Security Act to provide individuals with

disabilities and older Americans with equal access to community-based

attendant services and supports, and for other purposes.

IN THE SENATE OF THE UNITED STATES

AUGUST 1, 2001

Mr. HARKIN (for himself, Mr. SPECTER, Mr. KENNEDY, Mr. BIDEN, and Mrs.

CLINTON) introduced the following bill; which was read twice and referred

to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to provide

individuals with disabilities and older Americans with

equal access to community-based attendant services and

supports, and for other purposes.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicaid Community-Based Attendant Services and

6 Supports Act of 2001’’.

7 (b) TABLE OF CONTENTS.—The table of contents for

8 this Act is as follows:
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Sec. 1. Short title; table of contents.

Sec. 2. Findings and purposes.

TITLE I—ESTABLISHMENT OF MEDICAID PLAN BENEFIT

Sec. 101. Coverage of community-based attendant services and supports under

the medicaid program.

Sec. 102. Enhanced FMAP for ongoing activities of early coverage States that

enhance and promote the use of community-based attendant

services and supports.

Sec. 103. Increased Federal financial participation for certain expenditures.

TITLE II—PROMOTION OF SYSTEMS CHANGE AND CAPACITY

BUILDING

Sec. 201. Grants to promote systems change and capacity building.

Sec. 202. Demonstration project to enhance coordination of care under the

medicare and medicaid programs for non-elderly dual eligible

individuals.

1 SEC. 2. FINDINGS AND PURPOSES.

2 (a) FINDINGS.—Congress makes the following find3 ings:

4 (1) Long-term services and supports provided

5 under the medicaid program established under title

6 XIX of the Social Security Act (42 U.S.C. 1396 et

7 seq.) must meet the ability and life choices of indi8 viduals with disabilities and older Americans, includ9 ing the choice to live in one’s own home or with

10 one’s own family and to become a productive mem11 ber of the community.

12 (2) Research on the provision of long-term serv13 ices and supports under the medicaid program (con14 ducted by and on behalf of the Department of

15 Health and Human Services) has revealed a signifi16 cant funding bias toward institutional care. Only

17 about 27 percent of long term care funds expended
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1 under the medicaid program, and only about 9 per2 cent of all funds expended under that program, pay

3 for services and supports in home and community4 based settings.

5 (3) In the case of medicaid beneficiaries who

6 need long term care, the only long-term care service

7 currently guaranteed by Federal law in every State

8 is nursing home care. Only 27 States have adopted

9 the benefit option of providing personal care services

10 under the medicaid program. Although every State

11 has chosen to provide certain services under home

12 and community-based waivers, these services are un13 evenly available within and across States, and reach

14 a small percentage of eligible individuals. In fiscal

15 year 2000, only 3 States spent 50 percent or more

16 of their medicaid long term care funds under the

17 medicaid program on home and community-based

18 care.

19 (4) Despite the funding bias and the uneven

20 distribution of home and community-based services,

21 21 ⁄2 times more people are served in home and com22 munity-based settings than in institutional settings.

23 (5) The goals of the Nation properly include

24 providing families of children with disabilities, work-
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1 ing-age adults with disabilities, and older Americans

2 with—

3 (A) a meaningful choice of receiving long4 term services and supports in the most inte5 grated setting appropriate to their needs;

6 (B) the greatest possible control over the

7 services received and, therefore, their own lives

8 and futures; and

9 (C) quality services that maximize inde10 pendence in the home and community, including

11 in the workplace.

12 (b) PURPOSES.—The purposes of this Act are the fol13 lowing:

14 (1) To reform the medicaid program established

15 under title XIX of the Social Security Act (42

16 U.S.C. 1396 et seq.) to provide equal access to com17 munity-based attendant services and supports.

18 (2) To provide financial assistance to States as

19 they reform their long-term care systems to provide

20 comprehensive statewide long-term services and sup21 ports, including community-based attendant services

22 and supports that provide consumer choice and di23 rection, in the most integrated setting appropriate.
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1 TITLE I—ESTABLISHMENT OF

2 MEDICAID PLAN BENEFIT

3 SEC. 101. COVERAGE OF COMMUNITY-BASED ATTENDANT

4 SERVICES AND SUPPORTS UNDER THE MED5 ICAID PROGRAM.

6 (a) MANDATORY COVERAGE.—Section

7 1902(a)(10)(D) of the Social Security Act (42 U.S.C.

8 1396a(a)(10)(D)) is amended—

9 (1) by inserting ‘‘(i)’’ after ‘‘(D)’’;

10 (2) by adding ‘‘and’’ after the semicolon; and

11 (3) by adding at the end the following new

12 clause:

13 ‘‘(ii) subject to section 1935, for the inclu14 sion of community-based attendant services and

15 supports for any individual who—

16 ‘‘(I) is eligible for medical assistance

17 under the State plan;

18 ‘‘(II) with respect to whom there has

19 been a determination that the individual

20 requires the level of care provided in a

21 nursing facility or an intermediate care fa22 cility for the mentally retarded (whether or

23 not coverage of such intermediate care fa24 cility is provided under the State plan);

25 and
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1 ‘‘(III) who chooses to receive such

2 services and supports;’’.

3 (b) COMMUNITY-BASED ATTENDANT SERVICES AND

4 SUPPORTS.—

5 (1) IN GENERAL.—Title XIX of the Social Se6 curity Act (42 U.S.C. 1396 et seq.) is amended—

7 (A) by redesignating section 1935 as sec8 tion 1936; and

9 (B) by inserting after section 1934 the fol10 lowing:

11 ‘‘COMMUNITY-BASED ATTENDANT SERVICES AND

12 SUPPORTS

13 ‘‘SEC. 1935. (a) REQUIRED COVERAGE.—

14 ‘‘(1) IN GENERAL.—Not later than October 1,

15 2005, a State shall provide through a plan amend16 ment for the inclusion of community-based attendant

17 services and supports (as defined in subsection

18 (g)(1)) for individuals described in section

19 1902(a)(10)(D)(ii) in accordance with this section.

20 ‘‘(2) ENHANCED FMAP AND ADDITIONAL FED21 ERAL FINANCIAL SUPPORT FOR EARLIER COV22 ERAGE.—Notwithstanding section 1905(b), during

23 the period that begins on or after October 1, 2001,

24 and ends on September 30, 2005, in the case of a

25 State with an approved plan amendment under this

26 section during that period that also satisfies the re-
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1 quirements of subsection (c) the Federal medical as2 sistance percentage shall be equal to the enhanced

3 FMAP described in section 2105(b) with respect to

4 medical assistance in the form of community-based

5 attendant services and supports provided to individ6 uals described in section 1902(a)(10)(D)(ii) in ac7 cordance with this section.

8 ‘‘(b) DEVELOPMENT AND IMPLEMENTATION OF BEN9 EFIT.—In order for a State plan amendment to be ap10 proved under this section, a State shall provide the Sec11 retary with the following assurances:

12 ‘‘(1) ASSURANCE OF DEVELOPMENT AND IM13 PLEMENTATION COLLABORATION.—That the State

14 has developed and shall implement the provision of

15 community-based attendant services and supports

16 under the State plan through active collaboration

17 with—

18 ‘‘(A) individuals with disabilities;

19 ‘‘(B) elderly individuals;

20 ‘‘(C) representatives of such individuals;

21 and

22 ‘‘(D) providers of, and advocates for, serv23 ices and supports for such individuals.

24 ‘‘(2) ASSURANCE OF PROVISION ON A STATE25 WIDE BASIS AND IN MOST INTEGRATED SETTING.—
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1 That community-based attendant services and sup2 ports will be provided under the State plan to indi3 viduals described in section 1902(a)(10)(D)(ii) on a

4 statewide basis and in a manner that provides such

5 services and supports in the most integrated setting

6 appropriate for each individual eligible for such serv7 ices and supports.

8 ‘‘(3) ASSURANCE OF NONDISCRIMINATION.—

9 That the State will provide community-based attend10 ant services and supports to an individual described

11 in section 1902(a)(10)(D)(ii) without regard to the

12 individual’s age, type of disability, or the form of

13 community-based attendant services and supports

14 that the individual requires in order to lead an inde15 pendent life.

16 ‘‘(4) ASSURANCE OF MAINTENANCE OF EF17 FORT.—That the level of State expenditures for op18 tional medical assistance that—

19 ‘‘(A) is described in a paragraph other

20 than paragraphs (1) through (5), (17) and (21)

21 of section 1905(a) or that is provided under a

22 waiver under section 1915, section 1115, or

23 otherwise; and

24 ‘‘(B) is provided to individuals with disabil25 ities or elderly individuals for a fiscal year,
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1 shall not be less than the level of such expenditures

2 for the fiscal year preceding the fiscal year in which

3 the State plan amendment to provide community4 based attendant services and supports in accordance

5 with this section is approved.

6 ‘‘(c) REQUIREMENTS FOR ENHANCED FMAP FOR

7 EARLY COVERAGE.—In addition to satisfying the other re8 quirements for an approved plan amendment under this

9 section, in order for a State to be eligible under subsection

10 (a)(2) during the period described in that subsection for

11 the enhanced FMAP for early coverage under subsection

12 (a)(2), the State shall satisfy the following requirements:

13 ‘‘(1) SPECIFICATIONS.—With respect to a fiscal

14 year, the State shall provide the Secretary with the

15 following specifications regarding the provision of

16 community-based attendant services and supports

17 under the plan for that fiscal year:

18 ‘‘(A)(i) The number of individuals who are

19 estimated to receive community-based attendant

20 services and supports under the plan during the

21 fiscal year.

22 ‘‘(ii) The number of individuals that re23 ceived such services and supports during the

24 preceding fiscal year.
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1 ‘‘(B) The maximum number of individuals

2 who will receive such services and supports

3 under the plan during that fiscal year.

4 ‘‘(C) The procedures the State will imple5 ment to ensure that the models for delivery of

6 such services and supports are consumer con7 trolled (as defined in subsection (g)(2)(B)).

8 ‘‘(D) The procedures the State will imple9 ment to inform all potentially eligible individ10 uals and relevant other individuals of the avail11 ability of such services and supports under the

12 this title, and of other items and services that

13 may be provided to the individual under this

14 title or title XVIII.

15 ‘‘(E) The procedures the State will imple16 ment to ensure that such services and supports

17 are provided in accordance with the require18 ments of subsection (b)(1).

19 ‘‘(F) The procedures the State will imple20 ment to actively involve individuals with disabil21 ities, elderly individuals, and representatives of

22 such individuals in the design, delivery, admin23 istration, and evaluation of the provision of

24 such services and supports under this title.
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1 ‘‘(2) PARTICIPATION IN EVALUATIONS.—The

2 State shall provide the Secretary with such sub3 stantive input into, and participation in, the design

4 and conduct of data collection, analyses, and other

5 qualitative or quantitative evaluations of the provi6 sion of community-based attendant services and sup7 ports under this section as the Secretary deems nec8 essary in order to determine the effectiveness of the

9 provision of such services and supports in allowing

10 the individuals receiving such services and supports

11 to lead an independent life to the maximum extent

12 possible.

13 ‘‘(d) QUALITY ASSURANCE PROGRAM.—

14 ‘‘(1) STATE RESPONSIBILITIES.—In order for a

15 State plan amendment to be approved under this

16 section, a State shall establish and maintain a qual17 ity assurance program with respect to community18 based attendant services and supports that provides

19 for the following:

20 ‘‘(A) The State shall establish require21 ments, as appropriate, for agency-based and

22 other delivery models that include—

23 ‘‘(i) minimum qualifications and train24 ing requirements for agency-based and

25 other models;
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1 ‘‘(ii) financial operating standards;

2 and

3 ‘‘(iii) an appeals procedure for eligi4 bility denials and a procedure for resolving

5 disagreements over the terms of an individ6 ualized plan.

7 ‘‘(B) The State shall modify the quality as8 surance program, as appropriate, to maximize

9 consumer independence and consumer control

10 in both agency-provided and other delivery mod11 els.

12 ‘‘(C) The State shall provide a system that

13 allows for the external monitoring of the quality

14 of services and supports by entities consisting

15 of consumers and their representatives, dis16 ability organizations, providers, families of dis17 abled or elderly individuals, members of the

18 community, and others.

19 ‘‘(D) The State shall provide for ongoing

20 monitoring of the health and well-being of each

21 individual who receives community-based at22 tendant services and supports.

23 ‘‘(E) The State shall require that quality

24 assurance mechanisms appropriate for the indi-
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1 vidual be included in the individual’s written

2 plan.

3 ‘‘(F) The State shall establish a process

4 for the mandatory reporting, investigation, and

5 resolution of allegations of neglect, abuse, or ex6 ploitation in connection with the provision of

7 such services and supports.

8 ‘‘(G) The State shall obtain meaningful

9 consumer input, including consumer surveys,

10 that measure the extent to which an individual

11 receives the services and supports described in

12 the individual’s plan and the individual’s satis13 faction with such services and supports.

14 ‘‘(H) The State shall make available to the

15 public the findings of the quality assurance pro16 gram.

17 ‘‘(I) The State shall establish an ongoing

18 public process for the development, implementa19 tion, and review of the State’s quality assurance

20 program.

21 ‘‘(J) The State shall develop and imple22 ment a program of sanctions for providers of

23 community-based services and supports that

24 violate the terms or conditions for the provision

25 of such services and supports.
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1 ‘‘(2) FEDERAL RESPONSIBILITIES.—

2 ‘‘(A) PERIODIC EVALUATIONS.—The Sec3 retary shall conduct a periodic sample review of

4 outcomes for individuals who receive commu5 nity-based attendant services and supports

6 under this title.

7 ‘‘(B) INVESTIGATIONS.—The Secretary

8 may conduct targeted reviews and investiga9 tions upon receipt of an allegation of neglect,

10 abuse, or exploitation of an individual receiving

11 community-based attendant services and sup12 ports under this section.

13 ‘‘(C) DEVELOPMENT OF PROVIDER SANC14 TION GUIDELINES.—The Secretary shall de15 velop guidelines for States to use in developing

16 the sanctions required under paragraph (1)(J).

17 ‘‘(e) REPORTS.—The Secretary shall submit to Con18 gress periodic reports on the provision of community-based

19 attendant services and supports under this section, par20 ticularly with respect to the impact of the provision of

21 such services and supports on—

22 ‘‘(1) individuals eligible for medical assistance

23 under this title;

24 ‘‘(2) States; and

25 ‘‘(3) the Federal Government.
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1 ‘‘(f) NO EFFECT ON ABILITY TO PROVIDE COV2 ERAGE UNDER A WAIVER.—

3 ‘‘(1) IN GENERAL.—Nothing in this section

4 shall be construed as affecting the ability of a State

5 to provide coverage under the State plan for commu6 nity-based attendant services and supports (or simi7 lar coverage) under a waiver approved under section

8 1915, section 1115, or otherwise.

9 ‘‘(2) ELIGIBILITY FOR ENHANCED MATCH.—In

10 the case of a State that provides coverage for such

11 services and supports under a waiver, the State shall

12 not be eligible under subsection (a)(2) for the en13 hanced FMAP for the early provision of such cov14 erage unless the State submits a plan amendment to

15 the Secretary that meets the requirements of this

16 section.

17 ‘‘(g) DEFINITIONS.—In this title:

18 ‘‘(1) COMMUNITY-BASED ATTENDANT SERVICES

19 AND SUPPORTS.—

20 ‘‘(A) IN GENERAL.—The term ‘community21 based attendant services and supports’ means

22 attendant services and supports furnished to an

23 individual, as needed, to assist in accomplishing

24 activities of daily living, instrumental activities

25 of daily living, and health-related functions
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1 through hands-on assistance, supervision, or

2 cueing—

3 ‘‘(i) under a plan of services and sup4 ports that is based on an assessment of

5 functional need and that is agreed to by

6 the individual or, as appropriate, the indi7 vidual’s representative;

8 ‘‘(ii) in a home or community setting,

9 which may include a school, workplace, or

10 recreation or religious facility, but does not

11 include a nursing facility or an inter12 mediate care facility for the mentally re13 tarded;

14 ‘‘(iii) under an agency-provider model

15 or other model (as defined in paragraph

16 (2)(C)); and

17 ‘‘(iv) the furnishing of which is se18 lected, managed, and dismissed by the in19 dividual, or, as appropriate, with assistance

20 from the individual’s representative.

21 ‘‘(B) INCLUDED SERVICES AND SUP22 PORTS.—Such term includes—

23 ‘‘(i) tasks necessary to assist an indi24 vidual in accomplishing activities of daily
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1 living, instrumental activities of daily liv2 ing, and health-related functions;

3 ‘‘(ii) the acquisition, maintenance, and

4 enhancement of skills necessary for the in5 dividual to accomplish activities of daily

6 living, instrumental activities of daily liv7 ing, and health-related functions;

8 ‘‘(iii) backup systems or mechanisms

9 (such as the use of beepers) to ensure con10 tinuity of services and supports; and

11 ‘‘(iv) voluntary training on how to se12 lect, manage, and dismiss attendants.

13 ‘‘(C) EXCLUDED SERVICES AND SUP14 PORTS.—Subject to subparagraph (D), such

15 term does not include—

16 ‘‘(i) the provision of room and board

17 for the individual;

18 ‘‘(ii) special education and related

19 services provided under the Individuals

20 with Disabilities Education Act and voca21 tional rehabilitation services provided

22 under the Rehabilitation Act of 1973;

23 ‘‘(iii) assistive technology devices and

24 assistive technology services;

25 ‘‘(iv) durable medical equipment; or
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1 ‘‘(v) home modifications.

2 ‘‘(D) FLEXIBILITY IN TRANSITION TO

3 COMMUNITY-BASED HOME SETTING.—Such

4 term may include expenditures for transitional

5 costs, such as rent and utility deposits, first

6 month’s rent and utilities, bedding, basic kitch7 en supplies, and other necessities required for

8 an individual to make the transition from a

9 nursing facility or intermediate care facility for

10 the mentally retarded to a community-based

11 home setting where the individual resides.

12 ‘‘(2) ADDITIONAL DEFINITIONS.—

13 ‘‘(A) ACTIVITIES OF DAILY LIVING.—The

14 term ‘activities of daily living’ includes eating,

15 toileting, grooming, dressing, bathing, and

16 transferring.

17 ‘‘(B) CONSUMER CONTROLLED.—The term

18 ‘consumer controlled’ means a method of pro19 viding services and supports that allow the indi20 vidual, or where appropriate, the individual’s

21 representative, maximum control of the commu22 nity-based attendant services and supports, re23 gardless of who acts as the employer of record.

24 ‘‘(C) DELIVERY MODELS.—
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1 ‘‘(i) AGENCY-PROVIDER MODEL.—The

2 term ‘agency-provider model’ means, with

3 respect to the provision of community4 based attendant services and supports for

5 an individual, a method of providing con6 sumer controlled services and supports

7 under which entities contract for the provi8 sion of such services and supports.

9 ‘‘(ii) OTHER MODELS.—The term

10 ‘other models’ means methods, other than

11 an agency-provider model, for the provision

12 of consumer controlled services and sup13 ports. Such models may include the provi14 sion of vouchers, direct cash payments, or

15 use of a fiscal agent to assist in obtaining

16 services.

17 ‘‘(D) HEALTH-RELATED FUNCTIONS.—The

18 term ‘health-related functions’ means functions

19 that can be delegated or assigned by licensed

20 health-care professionals under State law to be

21 performed by an attendant.

22 ‘‘(E) INSTRUMENTAL ACTIVITIES OF DAILY

23 LIVING.—The term ‘instrumental activities of

24 daily living’ includes meal planning and prepa25 ration, managing finances, shopping for food,
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1 clothing, and other essential items, performing

2 essential household chores, communicating by

3 phone and other media, and traveling around

4 and participating in the community.

5 ‘‘(F) INDIVIDUAL’S REPRESENTATIVE.—

6 The term ‘individual’s representative’ means a

7 parent, a family member, a guardian, an advo8 cate, or an authorized representative of an indi9 vidual.’’.

10 (c) CONFORMING AMENDMENTS.—

11 (1) MANDATORY BENEFIT.—Section

12 1902(a)(10)(A) of the Social Security Act (42

13 U.S.C. 1396a(a)(10)(A)) is amended, in the matter

14 preceding clause (i), by striking ‘‘(17) and (21)’’ and

15 inserting ‘‘(17), (21), and (27)’’.

16 (2) DEFINITION OF MEDICAL ASSISTANCE.—

17 Section 1905(a) of the Social Security Act (42

18 U.S.C. 1396d) is amended—

19 (A) by striking ‘‘and’’ at the end of para20 graph (26);

21 (B) by redesignating paragraph (27) as

22 paragraph (28); and

23 (C) by inserting after paragraph (26) the

24 following:
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1 ‘‘(27) community-based attendant services and

2 supports (to the extent allowed and as defined in

3 section 1935); and’’.

4 (3) IMD/ICFMR REQUIREMENTS.—Section

5 1902(a)(10)(C)(iv) of the Social Security Act (42

6 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting

7 ‘‘and (27)’’ after ‘‘(24)’’.

8 (d) EFFECTIVE DATES.—

9 (1) IN GENERAL.—Except as provided in para10 graph (2), the amendments made by this section

11 (other than the amendment made by subsection

12 (c)(1)) take effect on October 1, 2001, and apply to

13 medical assistance provided for community-based at14 tendant services and supports described in section

15 1935 of the Social Security Act furnished on or

16 after that date.

17 (2) MANDATORY BENEFIT.—The amendment

18 made by subsection (c)(1) takes effect on October 1,

19 2005.
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1 SEC. 102. ENHANCED FMAP FOR ONGOING ACTIVITIES OF

2 EARLY COVERAGE STATES THAT ENHANCE

3 AND PROMOTE THE USE OF COMMUNITY4 BASED ATTENDANT SERVICES AND SUP5 PORTS.

6 (a) IN GENERAL.—Section 1935 of the Social Secu7 rity Act, as added by section 101(b), is amended—

8 (1) by redesignating subsections (d) through (g)

9 as subsections (f) through (i), respectively;

10 (2) in subsection (a)(1), by striking ‘‘subsection

11 (g)(1)’’ and inserting ‘‘subsection (i)(1)’’;

12 (3) in subsection (a)(2), by inserting ‘‘, and

13 with respect to expenditures described in subsection

14 (d), the Secretary shall pay the State the amount

15 described in subsection (d)(1)’’ before the period;

16 (4) in subsection (c)(1)(C), by striking ‘‘sub17 section (g)(2)(B)’’ and inserting ‘‘subsection

18 (i)(2)(B)’’; and

19 (5) by inserting after subsection (c), the fol20 lowing:

21 ‘‘(d) INCREASED FEDERAL FINANCIAL PARTICIPA22 TION FOR EARLY COVERAGE STATES THAT MEET CER23 TAIN BENCHMARKS.—

24 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

25 for purposes of subsection (a)(2), the amount and

26 expenditures described in this subsection are an
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1 amount equal to the Federal medical assistance per2 centage, increased by 10 percentage points, of the

3 expenditures incurred by the State for the provision

4 or conduct of the services or activities described in

5 paragraph (3).

6 ‘‘(2) EXPENDITURE CRITERIA.—A State shall—

7 ‘‘(A) develop criteria for determining the

8 expenditures described in paragraph (1) in col9 laboration with the individuals and representa10 tives described in subsection (b)(1); and

11 ‘‘(B) submit such criteria for approval by

12 the Secretary.

13 ‘‘(3) SERVICES AND ACTIVITIES DESCRIBED.—

14 For purposes of paragraph (1), the services and ac15 tivities described in this subparagraph are the fol16 lowing:

17 ‘‘(A) One-stop intake, referral, and institu18 tional diversion services.

19 ‘‘(B) Identifying and remedying gaps and

20 inequities in the State’s current provision of

21 long-term services, particularly those services

22 that are provided based on such factors as age,

23 disability type, ethnicity, income, institutional

24 bias, or other similar factors.
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1 ‘‘(C) Establishment of consumer participa2 tion and consumer governance mechanisms,

3 such as cooperatives and regional service au4 thorities, that are managed and controlled by

5 individuals with significant disabilities who use

6 community-based services and supports or their

7 representatives.

8 ‘‘(D) Activities designed to enhance the

9 skills, earnings, benefits, supply, career, and fu10 ture prospects of workers who provide commu11 nity-based attendant services and supports.

12 ‘‘(E) Continuous improvement activities

13 that are designed to ensure and enhance the

14 health and well-being of individuals who rely on

15 community-based attendant services and sup16 ports, particularly activities involving or initi17 ated by consumers of such services and sup18 ports or their representatives.

19 ‘‘(F) Family support services to augment

20 the efforts of families and friends to enable in21 dividuals with disabilities of all ages to live in

22 their own homes and communities.

23 ‘‘(G) Health promotion and wellness serv24 ices and activities.
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1 ‘‘(H) Provider recruitment and enhance2 ment activities, particularly such activities that

3 encourage the development and maintenance of

4 consumer controlled cooperatives or other small

5 businesses or microenterprises that provide

6 community-based attendant services and sup7 ports or related services.

8 ‘‘(I) Activities designed to ensure service

9 and systems coordination.

10 ‘‘(J) Any other services or activities that

11 the Secretary deems appropriate.’’.

12 (b) EFFECTIVE DATE.—The amendments made by

13 subsection (a) take effect on October 1, 2001.

14 SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION

15 FOR CERTAIN EXPENDITURES.

16 (a) IN GENERAL.—Section 1935 of the Social Secu17 rity Act, as added by section 101(b) and amended by sec18 tion 102, is amended by inserting after subsection (d) the

19 following:

20 ‘‘(e) INCREASED FEDERAL FINANCIAL PARTICIPA21 TION FOR CERTAIN EXPENDITURES.—

22 ‘‘(1) ELIGIBILITY FOR PAYMENT.—

23 ‘‘(A) IN GENERAL.—In the case of a State

24 that the Secretary determines satisfies the re25 quirements of subparagraph (B), the Secretary
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1 shall pay the State the amounts described in

2 paragraph (2) in addition to any other pay3 ments provided for under section 1903 or this

4 section for the provision of community-based at5 tendant services and supports.

6 ‘‘(B) REQUIREMENTS.—The requirements

7 of this subparagraph are the following:

8 ‘‘(i) The State has an approved plan

9 amendment under this section.

10 ‘‘(ii) The State has incurred expendi11 tures described in paragraph (2).

12 ‘‘(iii) The State develops and submits

13 to the Secretary criteria to identify and se14 lect such expenditures in accordance with

15 the requirements of paragraph (3).

16 ‘‘(iv) The Secretary determines that

17 payment of the applicable percentage of

18 such expenditures (as determined under

19 paragraph (2)(B)) would enable the State

20 to provide a meaningful choice of receiving

21 community-based services and supports to

22 individuals with disabilities and elderly in23 dividuals who would otherwise only have

24 the option of receiving institutional care.
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1 ‘‘(2) AMOUNTS AND EXPENDITURES DE2 SCRIBED.—

3 ‘‘(A) EXPENDITURES IN EXCESS OF 150

4 PERCENT OF BASELINE AMOUNT.—The

5 amounts and expenditures described in this

6 paragraph are an amount equal to the applica7 ble percentage, as determined by the Secretary

8 in accordance with subparagraph (B), of the ex9 penditures incurred by the State for the provi10 sion of community-based attendant services and

11 supports to an individual that exceed 150 per12 cent of the average cost of providing nursing fa13 cility services to an individual who resides in

14 the State and is eligible for such services under

15 this title, as determined in accordance with cri16 teria established by the Secretary.

17 ‘‘(B) APPLICABLE PERCENTAGE.—The

18 Secretary shall establish a payment scale for

19 the expenditures described in subparagraph (A)

20 so that the Federal financial participation for

21 such expenditures gradually increases from 70

22 percent to 90 percent as such expenditures in23 crease.
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1 ‘‘(3) SPECIFICATION OF ORDER OF SELECTION

2 FOR EXPENDITURES.—In order to receive the

3 amounts described in paragraph (2), a State shall—

4 ‘‘(A) develop, in collaboration with the in5 dividuals and representatives described in sub6 section (b)(1) and pursuant to guidelines estab7 lished by the Secretary, criteria to identify and

8 select the expenditures submitted under that

9 paragraph; and

10 ‘‘(B) submit such criteria to the Sec11 retary.’’.

12 (b) EFFECTIVE DATE.—The amendment made by

13 subsection (a) takes effect on October 1, 2001.

14 TITLE II—PROMOTION OF SYS15 TEMS CHANGE AND CAPACITY

16 BUILDING

17 SEC. 201. GRANTS TO PROMOTE SYSTEMS CHANGE AND CA18 PACITY BUILDING.

19 (a) AUTHORITY TO AWARD GRANTS.—

20 (1) IN GENERAL.—The Secretary of Health and

21 Human Services (in this section referred to as the

22 ‘‘Secretary’’) shall award grants to eligible States to

23 carry out the activities described in subsection (b).

24 (2) APPLICATION.—In order to be eligible for a

25 grant under this section, a State shall submit to the
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1 Secretary an application in such form and manner,

2 and that contains such information, as the Secretary

3 may require.

4 (b) PERMISSIBLE ACTIVITIES.—A State that receives

5 a grant under this section may use funds provided under

6 the grant for any of the following activities, focusing on

7 areas of need identified by the State and the Consumer

8 Task Force established under subsection (c):

9 (1) The development and implementation of the

10 provision of community-based attendant services and

11 supports under section 1935 of the Social Security

12 Act (as added by section 101(b) and amended by

13 sections 102 and 103) through active collaboration

14 with—

15 (A) individuals with disabilities;

16 (B) elderly individuals;

17 (C) representatives of such individuals; and

18 (D) providers of, and advocates for, serv19 ices and supports for such individuals.

20 (2) Substantially involving individuals with sig21 nificant disabilities and representatives of such indi22 viduals in jointly developing, implementing, and con23 tinually improving a mutually acceptable comprehen24 sive, effectively working statewide plan for pre-
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1 venting and alleviating unnecessary institutionaliza2 tion of such individuals.

3 (3) Engaging in system change and other ac4 tivities deemed necessary to achieve any or all of the

5 goals of such statewide plan.

6 (4) Identifying and remedying disparities and

7 gaps in services to classes of individuals with disabil8 ities and elderly individuals who are currently expe9 riencing or who face substantial risk of unnecessary

10 institutionalization.

11 (5) Building and expanding system capacity to

12 offer quality consumer controlled community-based

13 services and supports to individuals with disabilities

14 and elderly individuals, including by—

15 (A) seeding the development and effective

16 use of community-based attendant services and

17 supports cooperatives, independent living cen18 ters, small businesses, microenterprises and

19 similar joint ventures owned and controlled by

20 individuals with disabilities or representatives of

21 such individuals and community-based attend22 ant services and supports workers;

23 (B) enhancing the choice and control indi24 viduals with disabilities and elderly individuals

25 exercise, including through their representa-
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1 tives, with respect to the personal assistance

2 and supports they rely upon to lead inde3 pendent, self-directed lives;

4 (C) enhancing the skills, earnings, benefits,

5 supply, career, and future prospects of workers

6 who provide community-based attendant serv7 ices and supports;

8 (D) engaging in a variety of needs assess9 ment and data gathering;

10 (E) developing strategies for modifying

11 policies, practices, and procedures that result in

12 unnecessary institutional bias or the

13 overmedicalization of long-term services and

14 supports;

15 (F) engaging in interagency coordination

16 and single point of entry activities;

17 (G) providing training and technical assist18 ance with respect to the provision of commu19 nity-based attendant services and supports;

20 (H) engaging in—

21 (i) public awareness campaigns;

22 (ii) facility-to-community transitional

23 activities; and

24 (iii) demonstrations of new ap25 proaches; and
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1 (I) engaging in other systems change ac2 tivities necessary for developing, implementing,

3 or evaluating a comprehensive statewide system

4 of community-based attendant services and sup5 ports.

6 (6) Ensuring that the activities funded by the

7 grant are coordinated with other efforts to increase

8 personal attendant services and supports,

9 including—

10 (A) programs funded under or amended by

11 the Ticket to Work and Work Incentives Im12 provement Act of 1999 (Public Law 106–170;

13 113 Stat. 1860);

14 (B) grants funded under the Families of

15 Children With Disabilities Support Act of 2000

16 (42 U.S.C. 15091 et seq.); and

17 (C) other initiatives designed to enhance

18 the delivery of community-based services and

19 supports to individuals with disabilities and el20 derly individuals.

21 (7) Engaging in transition partnership activities

22 with nursing facilities and intermediate care facili23 ties for the mentally retarded that utilize and build

24 upon items and services provided to individuals with

25 disabilities or elderly individuals under the medicaid
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1 program under title XIX of the Social Security Act,

2 or by Federal, State, or local housing agencies, inde3 pendent living centers, and other organizations con4 trolled by consumers or their representatives.

5 (c) CONSUMER TASK FORCE.—

6 (1) ESTABLISHMENT AND DUTIES.—To be eli7 gible to receive a grant under this section, each

8 State shall establish a Consumer Task Force (re9 ferred to in this subsection as the ‘‘Task Force’’) to

10 assist the State in the development, implementation,

11 and evaluation of real choice systems change initia12 tives.

13 (2) APPOINTMENT.—Members of the Task

14 Force shall be appointed by the Chief Executive Of15 ficer of the State in accordance with the require16 ments of paragraph (3), after the solicitation of rec17 ommendations from representatives of organizations

18 representing a broad range of individuals with dis19 abilities, elderly individuals, representatives of such

20 individuals, and organizations interested in individ21 uals with disabilities and elderly individuals.

22 (3) COMPOSITION.—

23 (A) IN GENERAL.—The Task Force shall

24 represent a broad range of individuals with dis25 abilities from diverse backgrounds and shall in-
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1 clude representatives from Developmental Dis2 abilities Councils, Mental Health Councils,

3 State Independent Living Centers and Councils,

4 Commissions on Aging, organizations that pro5 vide services to individuals with disabilities and

6 consumers of long-term services and supports.

7 (B) INDIVIDUALS WITH DISABILITIES.—A

8 majority of the members of the Task Force

9 shall be individuals with disabilities or rep10 resentatives of such individuals.

11 (C) LIMITATION.—The Task Force shall

12 not include employees of any State agency pro13 viding services to individuals with disabilities

14 other than employees of entities described in

15 the Developmental Disabilities Assistance and

16 Bill of Rights Act of 2000 (42 U.S.C. 15001 et

17 seq.).

18 (d) ANNUAL REPORT.—

19 (1) STATES.—A State that receives a grant

20 under this section shall submit an annual report to

21 the Secretary on the use of funds provided under the

22 grant in such form and manner as the Secretary

23 may require.
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1 (2) SECRETARY.—The Secretary shall submit

2 to Congress an annual report on the grants made

3 under this section.

4 (e) AUTHORIZATION OF APPROPRIATIONS.—

5 (1) IN GENERAL.—There is authorized to be

6 appropriated to carry out this section, $50,000,000

7 for each of fiscal years 2002 through 2004.

8 (2) AVAILABILITY.—Amounts appropriated to

9 carry out this section shall remain available without

10 fiscal year limitation.

11 SEC. 202. DEMONSTRATION PROJECT TO ENHANCE CO12 ORDINATION OF CARE UNDER THE MEDI13 CARE AND MEDICAID PROGRAMS FOR NON14 ELDERLY DUAL ELIGIBLE INDIVIDUALS.

15 (a) DEFINITIONS.—In this section:

16 (1) NON-ELDERLY DUALLY ELIGIBLE INDI17 VIDUAL.—The term ‘‘non-elderly dually eligible indi18 vidual’’ means an individual who—

19 (A) has not attained age 65; and

20 (B) is enrolled in the medicare and med21 icaid programs established under titles XVIII

22 and XIX, respectively, of the Social Security

23 Act (42 U.S.C. 1395 et seq., 1396 et seq.).
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1 (2) PROJECT.—The term ‘‘project’’ means the

2 demonstration project authorized to be conducted

3 under this section.

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

5 the Secretary of Health and Human Services.

6 (b) AUTHORITY TO CONDUCT PROJECT.—The Sec7 retary shall conduct a project under this section for the

8 purpose of evaluating service coordination and cost-shar9 ing approaches with respect to the provision of commu10 nity-based services and supports to non-elderly dually eli11 gible individuals.

12 (c) REQUIREMENTS.—

13 (1) NUMBER OF PARTICIPANTS.—Not more

14 than 5 States may participate in the project.

15 (2) APPLICATION.—A State that desires to par16 ticipate in the project shall submit an application to

17 the Secretary, at such time and in such form and

18 manner as the Secretary shall specify.

19 (3) DURATION.—The project shall be conducted

20 for at least 5, but not more than 10 years.

21 (d) EVALUATION AND REPORT.—

22 (1) EVALUATION.—Not later than 1 year prior

23 to the termination date of the project, the Secretary,

24 in consultation with States participating in the

25 project, representatives of non-elderly dually eligible
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1 individuals, and others, shall evaluate the impact

2 and effectiveness of the project.

3 (2) REPORT.—The Secretary shall submit a re4 port to Congress that contains the findings of the

5 evaluation conducted under paragraph (1) along

6 with recommendations regarding whether the project

7 should be extended or expanded, and any other legis8 lative or administrative actions that the Secretary

9 considers appropriate as a result of the project.

10 (e) AUTHORIZATION OF APPROPRIATIONS.—There

11 are authorized to be appropriated such sums as are nec12 essary to carry out this section.

Æ