I 

115TH CONGRESS 

2D SESSION H. R. 4931 

To establish the Transition to Independence demonstration program. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 5, 2018 

Mr. LANGEVIN (for himself, Mr. HARPER, Mr. BEYER, Mr. SESSIONS, and 

Mr. FOSTER) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To establish the Transition to Independence demonstration 

program. 

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 ‘‘Transition to Inde5 pendence Act of 2018’’. 

6 SEC. 2. TRANSITION TO INDEPENDENCE DEMONSTRATION 

7 PROGRAM. 

8 (a) ESTABLISHMENT.—The Secretary shall establish 

9 a demonstration program under which a State that is a 

10 Medicaid Buy-In State and meets certain criteria may reVerDate Sep 11 2014 02:43 Feb 09, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4931.IH H4931

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1 ceive bonus payments for meeting specific measurable 

2 benchmarks in expanding individual integrated employ3 ment and reducing subminimum wage work, congregate 

4 setting work, or facility-based day habilitation placements 

5 for working-age individuals with a disability receiving 

6 Medicaid-funded home or community-based services and 

7 for taking other actions conducive to expanding employ8 ment opportunities for individuals with disabilities within 

9 the State. 

10 (b) REQUIREMENTS FOR THE TRANSITION TO INDE11 PENDENCE DEMONSTRATION PROGRAM.— 

12 (1) MINIMUM STANDARDS.—The Secretary 

13 shall establish minimum standards for Medicaid 

14 Buy-In States participating in the demonstration 

15 program to comply with in establishing eligibility re16 quirements for individual participants, benefits, and 

17 administrative requirements for the Transition to 

18 Independence Medicaid Buy-In Option offered under 

19 the demonstration program. 

20 (2) PREFERENCE GIVEN TO CERTAIN STATES

21 FOR DEMONSTRATION PARTICIPATION.—The Sec22 retary shall give preference in selecting States to 

23 participate in the demonstration program to States 

24 that have Medicaid Buy-In programs that— 


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1 (A) establish an assets or resources test 

2 for participation by an individual in the Med3 icaid Buy-In Option that is not less than 

4 $20,000; 

5 (B) establish an income requirement for 

6 participation by an individual in the Medicaid 

7 Buy-In Option that is at least up to 400 per8 cent of the poverty line; 

9 (C) offer home and community-based serv10 ices, including employment-based services and 

11 supports, in the Medicaid Buy-In Option; and 

12 (D) establish such other requirements for 

13 an individual’s participation in the Medicaid 

14 Buy-In Option as the Secretary shall specify. 

15 (3) WORK INCENTIVES COORDINATOR.—The 

16 minimum standards shall require a Medicaid Buy-In 

17 State participating in the demonstration program to 

18 provide work incentives coordinators who have been 

19 trained as work incentive specialists under a commu20 nity-based work incentives planning and assistance 

21 program established under section 1149 of the So22 cial Security Act (42 U.S.C. 1320b–20) to assist the 

23 individuals who elect to participate in the Medicaid 

24 Buy-In Option in order to ensure the individuals are 

25 provided with appropriate items and services. 


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1 (c) APPLICATION AND SELECTION REQUIRE2 MENTS.— 

3 (1) IN GENERAL.—Not later than June 30, 

4 2019, the Secretary shall solicit applications from 

5 Medicaid Buy-In States and select 15 Medicaid Buy6 In States to participate in the demonstration pro7 gram. 

8 (2) APPLICATION REQUIREMENTS.—An applica9 tion to participate in the demonstration program 

10 shall include the following: 

11 (A) Data and information regarding the 

12 numbers of working-age individuals with dis13 abilities who are receiving Medicaid-funded 

14 home or community-based services in the Med15 icaid Buy-In State who are in individual inte16 grated employment, subminimum wage work, 

17 congregate setting work, or facility-based day 

18 habilitation or day treatment, respectively. 

19 (B) Data and information verifying that 

20 the Medicaid Buy-In State is prepared to meet 

21 the minimum standards established by the Sec22 retary for the Medicaid Buy-In Option. 

23 (C) A plan for promoting the Medicaid 

24 Buy-In Option to potentially eligible individuals 

25 that includes— 


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1 (i) clear and easy-to-understand, 

2 multi-media information on how to enroll 

3 in the Medicaid Buy-In Option on the Web 

4 sites for the Medicaid Buy-In State’s Med5 icaid and Disability Determination Services 

6 Agencies; and 

7 (ii) a ‘‘no-wrong door’’ policy under 

8 which individuals who apply for a deter9 mination of eligibility for the Medicaid 

10 Buy-In Option are also determined if they 

11 are eligible for an applicable State health 

12 subsidy program in accordance with sec13 tion 1413 of the Patient Protection and 

14 Affordable Care Act (42 U.S.C. 18083) 

15 (including the State Medicaid program 

16 under another eligibility pathway), in17 formed of the results of such determina18 tions and, depending on their eligibility, 

19 provided with the option to voluntarily 

20 elect to participate in the Medicaid Buy-In 

21 Option or an applicable State health sub22 sidy program. 

23 (D)(i) An assurance that the State will es24 tablish and build capacity for an eligibility proc25 ess to make eligibility determinations for the 


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1 Medicaid Buy-In program. Such process shall 

2 provide for a determination of eligibility not 

3 later than 90 days after the date that an appli4 cation to participate in the program is filed, in5 cluding for individuals who are not receiving 

6 disability insurance benefits under title II of the 

7 Social Security Act (42 U.S.C. 401 et seq.) or 

8 supplemental security income benefits under 

9 title XVI of such Act (42 U.S.C. 1381 et seq.). 

10 (ii) A description of the eligibility criteria 

11 the State will use, the process it will use to de12 termine eligibility, for individuals who do not 

13 qualify for such title II or SSI benefits and the 

14 staff who will be responsible for making those 

15 determinations. This eligibility process shall not 

16 use the disability determination process used by 

17 the Social Security Administration for such title 

18 II and SSI benefits. 

19 (E) Verification that the Medicaid Buy-In 

20 State shall establish a Stakeholder Advisory 

21 Committee that meets the requirements of 

22 paragraph (3) and shall consult with and con23 sider recommendations of the Committee while 

24 conducting the demonstration program. 


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1 (F) A description of the person-centered 

2 planning process that the State intends to use 

3 for participants in the demonstration program. 

4 (G) Such other information as the Sec5 retary may require relating to the demonstra6 tion program. 

7 (3) STAKEHOLDER ADVISORY COMMITTEE RE8 QUIREMENTS.— 

9 (A) MEMBERSHIP.—In establishing the 

10 Stakeholder Advisory Committee required for 

11 the demonstration program, the Medicaid Buy12 In State shall ensure that— 

13 (i) at least 50 percent of the members 

14 of the Stakeholder Advisory Committee are 

15 individuals with disabilities; and 

16 (ii) at least 1 member of the Com17 mittee is a provider of services to individ18 uals with disabilities. 

19 (B) DUTIES.—The Stakeholder Advisory 

20 Committee shall— 

21 (i) analyze outcomes data and other 

22 information related to the conduct of the 

23 demonstration program; and 

24 (ii) regularly submit recommenda25 tions, including for specific actions by the 


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1 Medicaid Buy-In State participating in the 

2 demonstration program, that the Com3 mittee determines appropriate with respect 

4 to the conduct of the demonstration pro5 gram by the State. 

6 (d) REQUIREMENT FOR SELECTING STATES.—In se7 lecting Medicaid Buy-In States to participate in the dem8 onstration program, the Secretary shall ensure that the 

9 Medicaid Buy-In States selected include Medicaid Buy-In 

10 States with low, medium, and high numbers of working11 age individuals with disabilities who are receiving Med12 icaid-funded home or community-based services and are 

13 in individual integrated employment, subminimum wage 

14 work, congregate setting work, or facility-based day habili15 tation or day treatment, respectively. 

16 (e) LENGTH OF DEMONSTRATION PROGRAM.—The 

17 demonstration program shall be conducted for a period of 

18 5 fiscal years, beginning with fiscal year 2020. 

19 (f) PERFORMANCE BONUS PAYMENTS.— 

20 (1) IN GENERAL.—For each fiscal year in 

21 which the demonstration program is conducted, a 

22 Medicaid Buy-In State participating in the dem23 onstration program during that fiscal year may qual24 ify for a performance bonus payment. 


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1 (2) STATE-SPECIFIED CRITERIA AND PERFORM2 ANCE PLANS.—In order to participate in the dem3 onstration program, a Medicaid Buy-In State shall 

4 submit criteria and a plan for achieving each of the 

5 mandatory benchmarks described in paragraph (3) 

6 and a selection of the additional benchmarks de7 scribed in paragraph (4) as determined by the Sec8 retary. The Secretary shall establish a methodology 

9 for assessing State performance with respect to the 

10 State-specified criteria for the mandatory and addi11 tional benchmarks. 

12 (3) MANDATORY BENCHMARKS.—The manda13 tory benchmarks described in this paragraph are the 

14 following: 

15 (A) REDUCED PARTICIPATION IN SEG16 REGATED PROGRAMS AND INCREASED PARTICI17 PATION IN INDIVIDUAL INTEGRATED EMPLOY18 MENT.— 

19 (i) REDUCED POPULATION CENSUS OF

20 SEGREGATED PROGRAMS.— 

21 (I) IN GENERAL.—Achieving a 

22 reduction in the population in the 

23 State of working-age individuals with 

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1 based services or who are receiving 

2 services through an Intermediate Care 

3 Facility for Persons with Develop4 mental Disabilities (ICF–DD), a nurs5 ing facility, an institution for individ6 uals with mental illness, or other con7 gregate facilities and are in submin8 imum wage work, congregate setting 

9 work, or facility-based day habilitation 

10 or day treatment. 

11 (II) MINIMUM PERCENT REDUC12 TIONS; BONUS BASED ON ACHIEVE13 MENT OF DIFFERING TIERS.—In 

14 order to receive a bonus payment for 

15 a fiscal year under this clause, a Med16 icaid Buy-In State shall achieve a re17 duction of the population described in 

18 subclause (I) of at least 10 percent 

19 below the State’s most recent prior 

20 fiscal year’s census of the eligible pop21 ulation in subminimum wage work, 

22 congregate setting work, or facility23 based day habilitation or day treat24 ment. Subject to paragraph (5)(B), 

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1 creased bonus payment for a fiscal 

2 year to a Medicaid Buy-In State that 

3 achieves a percentage reduction of 20, 

4 30, 40 or more with respect to the 

5 prior fiscal year’s census of such pop6 ulation. 

7 (III) REQUIREMENTS FOR MEET8 ING BENCHMARK.—A working-age in9 dividual with a disability shall be 

10 deemed as counting towards a per11 centage reduction for purposes of this 

12 clause if the individual is— 

13 (aa) employed in a competi14 tive, integrated employment set15 ting for at least 10 hours a week 

16 on average over a 120-day period 

17 during the year involved; 

18 (bb) receiving integrated day 

19 services that reach the level of 

20 care required in the individual’s 

21 person-centered plan; or 

22 (cc) a combination of items 

23 (aa) and (bb), 

24 enabling the individual to achieve, if 

25 desired, a comparable level of benefit 


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1 as before the change in placement. 

2 The State must report aggregate data 

3 to the Secretary on the outcome of all 

4 individuals transitioning out of con5 gregate settings being counted to6 wards fulfillment of this benchmark. 

7 (ii) INCREASED POPULATION CENSUS

8 OF INDIVIDUAL INTEGRATED EMPLOY9 MENT.— 

10 (I) IN GENERAL.—Achieving an 

11 increase in the population in the State 

12 of working-age individuals with dis13 abilities who are receiving Medicaid14 funded home or community-based 

15 services and are in individual inte16 grated employment. 

17 (II) MINIMUM PERCENT IN18 CREASES; BONUS BASED ON ACHIEVE19 MENT OF CERTAIN TIERS.—In order 

20 to receive a bonus payment for a fis21 cal year under this clause, a Medicaid 

22 Buy-In State shall achieve an increase 

23 in the population described in sub24 clause (I) of at least 10 percent above 

25 the State’s most recent prior fiscal 


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1 year’s census of the eligible population 

2 in individual integrated employment. 

3 Subject to paragraph (5)(B), the Sec4 retary shall award an increased bonus 

5 payment for a fiscal year to a Med6 icaid Buy-In State that achieves a 

7 percentage increase of 20, 30, 40 or 

8 more with respect to the prior fiscal 

9 year’s census of such population. 

10 (III) REQUIREMENTS FOR MEET11 ING BENCHMARK.—A working-age in12 dividual with a disability shall be 

13 deemed as counting towards a per14 centage increase for purposes of this 

15 clause if the individual is employed in 

16 an integrated individual employment 

17 setting for at least 10 hours a week 

18 on average over a 120-day period dur19 ing the fiscal year involved. 

20 (B) MEETING THE MEDICAID BUY-IN

21 STANDARDS.—Meeting the minimum standards 

22 established by the Secretary for the Medicaid 

23 Buy-In Option. 


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1 (4) ADDITIONAL BENCHMARKS.—The addi2 tional benchmarks described in this paragraph are 

3 the following: 

4 (A) ELIMINATION OF NEW PLACEMENT AP5 PROVALS.—Eliminating new approvals for 

6 placement in the State of working-age individ7 uals with disabilities who are receiving Med8 icaid-funded home or community-based services 

9 in subminimum wage work, congregate setting 

10 work, or facility-based day habilitation or day 

11 treatment, in accordance with criteria estab12 lished by the Secretary. 

13 (B) DEMONSTRATION OF INTER-AGENCY

14 COLLABORATION.—Demonstrating inter-agency 

15 collaboration between the State agencies re16 sponsible for administering Medicaid, vocational 

17 rehabilitation, and education (and, if the State 

18 is participating the Promoting Readiness of Mi19 nors in Supplemental Security Income initiative 

20 (PROMISE), including coordination with that 

21 initiative), in determining payer of last resort 

22 rules and rules for providing individuals with a 

23 seamless transition of services provided under 

24 such agencies, in accordance with criteria estab25 lished by the Secretary. 


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1 (C) TERMINATION OF VOCATIONAL REHA2 BILITATION FUNDING.—Ending the use of voca3 tional rehabilitation funding for subminimum 

4 wage work, congregate setting work, or facility5 based day habilitation or day treatment, in ac6 cordance with criteria established by the Sec7 retary. 

8 (D) WORKFORCE DEVELOPMENT.—Dem9 onstrating in accordance with criteria estab10 lished by the Secretary satisfaction of at least 

11 two of the following strategies to promote work12 force development: 

13 (i) Increasing Medicaid payments for 

14 supported employment providers for indi15 viduals with disabilities by an amount nec16 essary to ensure an adequately supported 

17 employment network, as determined by the 

18 Secretary. 

19 (ii) Adopting employment strategies 

20 that result in working-age individuals with 

21 disabilities who are receiving Medicaid22 funded home or community-based services 

23 being recruited, hired, and retained as full24 time employees of State government or by 

25 contractors of State government. 


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1 (iii) Developing a State equivalent of 

2 section 503 of the Rehabilitation Act of 

3 1973 (29 U.S.C. 793) to recruit, hire, pro4 mote, and retain working-age individuals 

5 with disabilities who are receiving Med6 icaid-funded home or community-based 

7 services with a utilization goal of at least 

8 7 percent of the State government work9 force. 

10 (iv) Developing a special hiring au11 thority mechanism akin to the Schedule A 

12 appointing authority under section 

13 213.3102(u) of title 5 of the Code of Fed14 eral Regulations (commonly referred to as 

15 the ‘‘Schedule A Hiring Authority’’) to as16 sist in easing the hiring of working-age in17 dividuals with disabilities who are receiving 

18 Medicaid-funded home or community-based 

19 services within the State government with 

20 an accompanying plan submitted to the 

21 Secretary outlining targeted implementa22 tion goals for the amount of individuals 

23 with disabilities within State government. 

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1 ceiving Medicaid-funded home or commu2 nity-based services in employment for 

3 which the individual is compensated at or 

4 above the minimum wage, through collabo5 ration with the State vocational rehabilita6 tion and workforce development programs 

7 and Federal contractors. 

8 (vi) Providing State tax credits to em9 ployers for hiring new workers who are 

10 working-age individuals with disabilities 

11 who are receiving Medicaid-funded home or 

12 community-based services. 

13 (5) PAYMENT TO STATES.— 

14 (A) IN GENERAL.—Subject to the suc15 ceeding provisions of this paragraph, the Sec16 retary shall make a performance bonus pay17 ment to each Medicaid Buy-In State partici18 pating in the demonstration program that 

19 qualifies for such a payment with respect to a 

20 fiscal year as a single payment not later than 

21 the last day of the first calendar quarter of the 

22 fiscal year following the fiscal year to which the 

23 performance bonus payments applies. Payments 

24 to States made under this paragraph shall be 

25 considered to have been made under, and are 


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1 subject to the requirements of, section 1903 of 

2 the Social Security Act (42 U.S.C. 1396b). 

3 (B) DETERMINATION OF PAYMENT.—The 

4 performance bonus payment for a Medicaid 

5 Buy-In State shall consist of the additional 

6 amount that the State would have been paid for 

7 providing medical assistance to individuals en8 rolled in the State’s Medicaid Buy-In Option 

9 during the preceding fiscal year if the regular 

10 FMAP applicable to such assistance were in11 creased (subject to subparagraph (C)) as fol12 lows: 

13 (i) Two percentage points for achiev14 ing the minimum 10 percent reduction in 

15 the mandatory benchmark described in 

16 paragraph (3)(A) during the preceding fis17 cal year (or 2.4 percentage points for 

18 achieving a reduction of at least 20 percent 

19 (but not more than 30 percent), 2.6 per20 centage points for achieving a reduction of 

21 at least 30 percent (but not more than 40 

22 percent), and 2.8 percentage points for 

23 achieving a reduction of at least 40 per24 cent). 


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1 (ii) Two percentage points for achiev2 ing the minimum 10 percent increase in 

3 the mandatory benchmark described in 

4 paragraph (3)(B) during the preceding fis5 cal year (or 2.4 percentage points for 

6 achieving an increase of at least 20 percent 

7 (but not more than 30 percent), 2.6 per8 centage points for achieving an increase of 

9 at least 30 percent (but not more than 40 

10 percent), and 2.8 percentage points for 

11 achieving an increase of at least 40 per12 cent). 

13 (iii) One-half percentage points for 

14 each additional benchmark described in 

15 paragraph (4) that the State achieves dur16 ing the preceding fiscal year. 

17 (C) LIMITATIONS.—In no case may— 

18 (i) the increase in the regular FMAP 

19 resulting from the application of subpara20 graph (B) for any Medicaid Buy-In State 

21 exceed 100 percent of the costs for pro22 viding medical assistance to individuals en23 rolled in the Medicaid Buy-In Option with 

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1 year period in which the demonstration 

2 project is conducted; or 

3 (ii) payments be made to a Medicaid 

4 Buy-In State under this paragraph after 

5 December 31, 2023. 

6 (D) USE OF PAYMENTS.—A Medicaid Buy7 In State receiving a performance bonus pay8 ment under this paragraph shall use the pay9 ment only to expand individual integrated em10 ployment and community integration for work11 ing-age individuals with disabilities who are re12 ceiving Medicaid-funded home or community13 based services. 

14 (g) REPORTS; RECOMMENDATIONS.— 

15 (1) ANNUAL STATE REPORTS.— 

16 (A) IN GENERAL.—Each Medicaid Buy-In 

17 State participating in the demonstration pro18 gram annually shall submit a detailed report to 

19 the Secretary regarding the State’s conduct of 

20 the demonstration program. 

21 (B) INFORMATION TO BE INCLUDED.— 

22 Such annual reports shall include, in addition 

23 to data and information regarding State per24 formance with respect the mandatory and addi25 tional benchmarks described in paragraphs (3) 


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1 and (4) of subsection (f) and such other infor2 mation as the Secretary may require, data and 

3 information regarding the extent to which, since 

4 the start of the demonstration program— 

5 (i) the State has reduced the State 

6 population of individuals with disabilities 

7 who have attained age 18 but have not at8 tained age 31, are receiving Medicaid-fund9 ed home or community-based services or 

10 services through an Intermediate Care Fa11 cility for Persons with Developmental Dis12 abilities (ICF–DD), a nursing facility, an 

13 institution for individuals with mental ill14 ness, or other congregate facilities, and 

15 were in subminimum wage work, con16 gregate setting work, or facility-based day 

17 habilitation or day treatment; and 

18 (ii) the State has increased the State 

19 population of individuals with disabilities 

20 who have attained age 18 but have not at21 tained age 31, are receiving Medicaid-fund22 ed home or community-based services, and 

23 are engaged in individual integrated em24 ployment. 


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1 (C) ADDITIONAL INFORMATION ON

2 TRANSITIONING INDIVIDUALS TO INTEGRATED

3 EMPLOYMENT.—Each such annual report shall 

4 include information regarding— 

5 (i) the State’s efforts to transition in6 dividuals with disabilities who are partici7 pating in the demonstration program to in8 dividual integrated employment during the 

9 preceding fiscal year; 

10 (ii) the full spectrum of employment 

11 outcomes for such individuals; 

12 (iii) best practices for successfully 

13 achieving such transitions; and 

14 (iv) lessons learned. 

15 (D) PROMOTING PUBLIC PARTICIPATION.— 

16 To promote transparency with respect to such 

17 annual reports, each Medicaid Buy-In State 

18 shall— 

19 (i) provide, before submission of each 

20 such report— 

21 (I) for posting of a draft of the 

22 report for review by the public on a 

23 publicly accessible Web site of the 

24 State; 


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1 (II) for providing a period of not 

2 less than 30 days for the receipt of 

3 public comments on the draft report; 

4 and 

5 (III) for at least two public hear6 ings regarding the draft report; and 

7 (ii) include in the report so submitted 

8 a response to public comments received 

9 during such period (along with a descrip10 tion of whether changes have been made in 

11 the report in response to such comments). 

12 With respect to each such State report sub13 mitted, the Secretary, at the Federal level, shall 

14 provide for another 30-day public comment pe15 riod to receive comments on such report. 

16 (E) POSTING OF REPORTS ON PUBLICLY

17 ACCESSIBLE WEB SITE.—The Secretary shall 

18 post each of the annual reports submitted 

19 under this paragraph, with a summary of the 

20 comments received under subparagraph (D), on 

21 a publicly accessible Web site. 

22 (2) REPORTS AND RECOMMENDATIONS TO CON23 GRESS.— 

24 (A) IN GENERAL.—Not later than January 

25 1, 2020, and January 1 of each of the 6 years 


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1 thereafter, the Secretary shall submit to Con2 gress a report on the demonstration program. 

3 Each such report shall include data and infor4 mation regarding State performance with re5 spect to each of the mandatory and additional 

6 benchmarks described in paragraphs (3) and 

7 (4) of subsection (f) and other data and infor8 mation reported by States under paragraph (1) 

9 and an assessment of the extent to which the 

10 demonstration program is successful in 

11 transitioning working-age individuals with dis12 abilities to independent living and work in their 

13 communities. 

14 (B) RECOMMENDATIONS.—Not later than 

15 December 31, 2021, the Secretary shall submit 

16 to Congress recommendations regarding wheth17 er the demonstration program should be contin18 ued, expanded, modified, or terminated. 

19 (3) RESEARCH AND EVALUATION.— 

20 (A) IN GENERAL.—The Secretary, acting 

21 through the Administration on Community Liv22 ing, directly or through grant or contract, shall 

23 provide for research on, and a national evalua24 tion of, the demonstration program, including 


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1 assistance to the Secretary in preparing the 

2 final report required under subparagraph (C). 

3 (B) CONTENTS OF EVALUATION.—Such 

4 national evaluation shall include an analysis of 

5 the characteristics and outcomes of the individ6 uals participating in the demonstration program 

7 and the best practices developed to achieve the 

8 goals of the demonstration program. 

9 (C) FINAL REPORT.—Not later than June 

10 30, 2022, the Secretary shall submit to the 

11 President and Congress a final report that re12 flects the evaluation under subparagraph (A), 

13 that provides findings and conclusions on the 

14 conduct and effectiveness of demonstration pro15 gram, and that includes a summary of the pub16 lic comments received under paragraph (1)(D). 

17 (h) DEFINITIONS.—In this section: 

18 (1) CONGREGATE SETTING WORK.—The term 

19 ‘‘congregate setting work’’ means a nonprofit, for20 profit, or State agency entity that employs a major21 ity of individuals with disabilities and receives Med22 icaid or other State funds for the purpose of pro23 viding employment services, or a facility or sub-unit 

24 of any such agency that meets such criteria. 


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1 (2) DEMONSTRATION PROGRAM.—The term 

2 ‘‘demonstration program’’ means the Transition to 

3 Independence Demonstration Program established 

4 under this section. 

5 (3) FACILITY-BASED DAY HABILITATION OR

6 DAY TREATMENT.—The term ‘‘facility-based day ha7 bilitation or day treatment’’ has the meaning estab8 lished by the Secretary for that term for purposes of 

9 the demonstration program and shall include non10 residential day services which take place predomi11 nantly or in large part at a single site, fixed site, or 

12 center-based program for individuals with disabil13 ities. In establishing the meaning of such term, the 

14 Secretary shall provide clear instructions distin15 guishing facility-based day habilitation or day treat16 ment from integrated day habilitation or day treat17 ment programs taking place in settings within the 

18 broader community and which do not isolate individ19 uals participating in such integrated day habilitation 

20 or day treatment programs from mainstream life. 

21 (4) INDIVIDUAL INTEGRATED EMPLOYMENT.— 

22 (A) IN GENERAL.—The term ‘‘individual 

23 integrated employment’’ means the ongoing 

24 supports to an individual who, because of the 

25 individual’s disabilities, needs intensive on-going 


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1 supports to obtain and maintain an individual 

2 job in competitive or customized employment, 

3 self-employment, or in an integrated working 

4 setting in the general workforce for which the 

5 individual is compensated at or above the min6 imum wage, but not less than the customary 

7 wage and level of benefits paid by the employer 

8 for the same or similar work performed by an 

9 individual without a disability. 

10 (B) CUSTOMIZED EMPLOYMENT SERVICES

11 INCLUDED.—Such term includes customized 

12 employment services in which an individual re13 ceives support to craft a job description around 

14 their strengths and challenges. 

15 (C) EXCLUSIONS.—Such term does not in16 clude segregated enclaves, segregated mobile 

17 work crews, or other employment scenarios 

18 where an individual is placed solely based on 

19 the individual’s disability. In this subparagraph, 

20 the term ‘‘segregated’’ means, with respect to a 

21 setting or work crew, a setting or work crew in 

22 which individuals with disabilities are separated 

23 (in place or in rates of pay) from individuals 

24 without disabilities. 


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1 (5) INTEGRATED DAY HABILITATION SERV2 ICES.—The term ‘‘integrated day habilitation serv3 ices’’ means services that are provided outside of dis4 ability specific programs or facilities, in a setting 

5 that supports the full access of individuals with dis6 abilities to the greater community to the same de7 gree as individuals not receiving services, and con8 sistent with the following: 

9 (A) Each individual receiving such services 

10 has an individually tailored schedule that is di11 rectly related to and reflects the individual’s 

12 specific interests and goals. 

13 (B) Activities take place on an individual 

14 basis or in small groups of individuals who 

15 choose to be served together. 

16 (C) The majority of time spent receiving 

17 such services takes place within the broader 

18 community rather than within a single-site, 

19 fixed site, or center-based program for individ20 uals with disabilities, regardless of the program 

21 size. 

22 (D) The services are provided consistent 

23 with the requirements of section 441.710 of 

24 title 42, Code of Federal Regulations. 


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1 (6) MEDICAID.—The term ‘‘Medicaid’’ means 

2 the program for medical assistance established under 

3 title XIX of the Social Security Act (42 U.S.C. 1396 

4 et seq.). 

5 (7) MEDICAID BUY-IN STATE.—The term ‘‘Med6 icaid Buy-In State’’ means a State that, under sub7 clause (XIII), (XV), or (XVI) of section 

8 1902(a)(10)(A)(ii) of the Social Security Act (42 

9 U.S.C. 1396a(a)(10)(A)(ii)), a waiver approved 

10 under section 1115 or 1915 of such Act (42 U.S.C. 

11 1315, 1396n), or other authority, has a program 

12 under which individuals with disabilities with earn13 ings and assets that would otherwise make them in14 eligible for medical assistance under the State’s 

15 Medicaid program are able to maintain their eligi16 bility for such assistance. 

17 (8) NURSING FACILITY.—The term ‘‘nursing 

18 facility’’ has the meaning given that term in section 

19 1919(a) of the Social Security Act (42 U.S.C. 

20 1396r(a)). 

21 (9) POVERTY LINE.—The term ‘‘poverty line’’ 

22 has the meaning given that term in section 

23 2110(c)(5) of the Social Security Act (42 U.S.C. 

24 1397jj(c)(5)). 


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1 (10) REGULAR FMAP.—The term ‘‘regular 

2 FMAP’’ means the Federal medical assistance per3 centage applicable to the State (as determined under 

4 section 1905(b) of the Social Security Act (42 

5 U.S.C. 1396d(b))) without regard to any increases 

6 in that percentage applicable under subsection (y), 

7 (z), (aa), or (dd) of section 1905 of such Act or 

8 under any other provision of law. 

9 (11) SECRETARY.—The term ‘‘Secretary’’ 

10 means the Secretary of Health and Human Services. 

11 (12) SUBMINIMUM WAGE WORK.—The term 

12 ‘‘subminimum wage work’’ means any setting in 

13 which individuals with disabilities are paid less than 

14 minimum wage under a certificate issued in accord15 ance with section 14(c) of the Fair Labor Standards 

16 Act of 1938 (29 U.S.C. 214(c)). 

17 (13) SUPPORTED EMPLOYMENT.—The term 

18 ‘‘supported employment’’ has the meaning given that 

19 term in section 7 of the Rehabilitation Act of 1973 

20 (29 U.S.C. 705). 

21 (14) STATE.—The term ‘‘State’’ has the mean22 ing given such term for purposes of title XIX of the 

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

24 (15) TITLE II DISABILITY BENEFICIARY.—The 

25 term ‘‘title II disability beneficiary’’ means an indiVerDate Sep 11 2014 02:43 Feb 09, 2018 Jkt 079200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H4931.IH H4931

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1 vidual entitled to disability insurance benefits under 

2 section 223 of the Social Security Act (42 U.S.C. 

3 423) or to monthly insurance benefits under section 

4 202 of such Act (42 U.S.C. 402) based on such indi5 vidual’s disability (as defined in section 223(d) of 

6 such Act (42 U.S.C. 423(d))). 

7 (16) TITLE XVI DISABILITY BENEFICIARY.— 

8 The term ‘‘title XVI disability beneficiary’’ means an 

9 individual eligible for supplemental security income 

10 benefits under title XVI of the Social Security Act 

11 (42 U.S.C. 1381 et seq.) on the basis of blindness 

12 (within the meaning of section 1614(a)(2) of such 

13 Act (42 U.S.C. 1382c(a)(2))) or disability (within 

14 the meaning of section 1614(a)(3) of such Act (42 

15 U.S.C. 1382c(a)(3))). 

16 (17) WORKING-AGE INDIVIDUAL WITH A DIS17 ABILITY RECEIVING MEDICAID-FUNDED HOME OR

18 COMMUNITY-BASED SERVICES.—The term ‘‘working19 age individual with a disability receiving Medicaid20 funded home or community-based services’’ means a 

21 title II disability beneficiary or a title XVI disability 

22 beneficiary who has attained age 18, but has not at23 tained age 65, and is receiving home or community24 based services— 


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1 (A) under a waiver approved under sub2 section (c) or (d) of section 1915 the Social Se3 curity Act (42 U.S.C. 1396n); 

4 (B) under the State Medicaid plan in ac5 cordance with subsection (i), (j), or (k) of such 

6 section; or 

7 (C) under a Medicaid waiver approved 

8 under section 1115 of the Social Security Act 

9 (42 U.S.C. 1315). 

Æ 


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