II 

114TH CONGRESS 

1ST SESSION S. 1604 

To establish the Transition to Independence Medicaid Buy-In Option 

demonstration program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 18, 2015 

Mr. GRASSLEY (for himself, Mr. WYDEN, and Mr. CASEY) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To establish the Transition to Independence Medicaid BuyIn Option 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’’. 

6 SEC. 2. TRANSITION TO INDEPENDENCE MEDICAID BUY-IN 

7 OPTION DEMONSTRATION PROGRAM. 

8 (a) ESTABLISHMENT.—The Secretary shall establish 

9 a demonstration program under which a State that is a 

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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 MEDICAID BUY-IN OPTION.— 

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) ELIGIBILITY REQUIREMENTS FOR INDI21 VIDUAL PARTICIPANTS.—The minimum standards 

22 shall require a Medicaid Buy-In State participating 

23 in the demonstration program to— 

24 (A) establish an assets or resources test 

25 for participation by an individual in the TransiVerDate Sep 11 2014 02:24 Jun 23, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1604.IS S1604

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1 tion to Independence Medicaid Buy-In Option 

2 that is not less than $20,000; 

3 (B) establish an income requirement for 

4 participation by an individual in the Transition 

5 to Independence Medicaid Buy-In Option that 

6 is at least up to 400 percent of the poverty line; 

7 and 

8 (C) establish such other requirements for 

9 an individual’s participation in the Transition 

10 to Independence Medicaid Buy-In Option as the 

11 Secretary shall specify. 

12 (3) WORK INCENTIVES COORDINATOR.—The 

13 minimum standards shall require a Medicaid Buy-In 

14 State participating in the demonstration program to 

15 provide work incentives coordinators who have been 

16 trained as work incentive specialists under a commu17 nity-based work incentives planning and assistance 

18 program established under section 1149 of the So19 cial Security Act (42 U.S.C. 1320b–20) to assist the 

20 individuals who elect to participate in the Transition 

21 to Independence Medicaid Buy-In Option in order to 

22 ensure the individuals are provided with appropriate 

23 items and services. 

24 (4) VOLUNTARY PARTICIPATION.—The min25 imum standards shall require a Medicaid Buy-In 


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1 State participating in the demonstration program to 

2 allow an individual’s participation in the Transition 

3 to Independence Medicaid Buy-In Option to be vol4 untary and to not preclude an individual who elects 

5 to participate in the Transition to Independence 

6 Medicaid Buy-In Option from also electing to enroll 

7 in a qualified health plan offered through an Amer8 ican Health Benefit Exchange and— 

9 (A) being deemed to be an applicable tax10 payer for purposes of section 36B of the Inter11 nal Revenue Code of 1986, notwithstanding the 

12 provisions of subsection (c)(1)(A) of such sec13 tion; 

14 (B) being deemed to be an eligible insured 

15 for purposes of section 1402 of the Patient Pro16 tection and Affordable Care Act (42 U.S.C. 

17 18071), notwithstanding the provisions of sub18 section (b)(2) of such section; and 

19 (C) not being subject to the enrollment 

20 provisions of section 1413 of such Act (42 

21 U.S.C. 18083) with respect to the State in22 volved. 

23 (c) APPLICATION AND SELECTION REQUIRE24 MENTS.— 


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

2 2016, the Secretary shall solicit applications from 

3 Medicaid Buy-In States and select 10 Medicaid Buy4 In States to participate in the demonstration pro5 gram. 

6 (2) APPLICATION REQUIREMENTS.—An applica7 tion to participate in the demonstration program 

8 shall include the following: 

9 (A) Data and information regarding the 

10 numbers of working-age individuals with dis11 abilities who are receiving Medicaid-funded 

12 home or community-based services in the Med13 icaid Buy-In State who are in individual inte14 grated employment, subminimum wage work, 

15 congregate setting work, or facility-based day 

16 habilitation or day treatment, respectively. 

17 (B) Data and information verifying that 

18 the Medicaid Buy-In State is prepared to meet 

19 the minimum standards established by the Sec20 retary for the Transition to Independence Med21 icaid Buy-In Option. 

22 (C) A plan for promoting the Transition to 

23 Independence Medicaid Buy-In Option to poten24 tially eligible individuals that includes— 


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

2 multi-media information on how to enroll 

3 in the Transition to Independence Med4 icaid Buy-In Option on the websites for 

5 the Medicaid Buy-In State’s Medicaid and 

6 Disability Determination Services Agen7 cies; and 

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

9 which individuals who apply for a deter10 mination of eligibility for the Transition to 

11 Independence Medicaid Buy-In Option are 

12 also determined if they are eligible for an 

13 applicable State health subsidy program in 

14 accordance with section 1413 of the Pa15 tient Protection and Affordable Care Act 

16 (42 U.S.C. 18083) (including the State 

17 Medicaid program under another eligibility 

18 pathway), informed of the results of such 

19 determinations and, depending on their eli20 gibility, provided with the option to volun21 tarily elect to participate in the Transition 

22 to Independence Medicaid Buy-In Option 

23 or an applicable State health subsidy pro24 gram. 


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1 (D) Verification that the Medicaid Buy-In 

2 State will use independent contractors to deter3 mine whether an individual who is potentially 

4 eligible to participate in the demonstration pro5 gram but who is not receiving disability insur6 ance benefits under title II of the Social Secu7 rity Act (42 U.S.C. 401 et seq.) or supple8 mental security income benefits under title XVI 

9 of such Act (42 U.S.C. 1381 et seq.) is deter10 mined to be eligible for such benefits within 90 

11 days of applying to participate in the dem12 onstration program and treated as if the indi13 vidual were receiving Medicaid-funded home or 

14 community-based services solely for purposes of 

15 participating in the demonstration program. 

16 (E) Verification that the Medicaid Buy-In 

17 State shall establish a Stakeholder Advisory 

18 Committee that meets the requirements of 

19 paragraph (3) and shall consult with and con20 sider recommendations of the Committee while 

21 conducting the demonstration program. 

22 (F) Such other information as the Sec23 retary may require relating to the demonstra24 tion program. 


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1 (3) STAKEHOLDER ADVISORY COMMITTEE RE2 QUIREMENTS.— 

3 (A) MEMBERSHIP.—In establishing the 

4 Stakeholder Advisory Committee required for 

5 the demonstration program, the Medicaid Buy6 In State shall ensure that— 

7 (i) at least 50 percent of the members 

8 of the Stakeholder Advisory Committee are 

9 individuals with disabilities; and 

10 (ii) at least 1 member of the Com11 mittee is a provider of services to individ12 uals with disabilities. 

13 (B) DUTIES.—The Stakeholder Advisory 

14 Committee shall— 

15 (i) analyze outcomes data and other 

16 information related to the conduct of the 

17 demonstration program; and 

18 (ii) regularly submit recommenda19 tions, including for specific actions by the 

20 Medicaid Buy-In State participating in the 

21 demonstration program, that the Com22 mittee determines appropriate with respect 

23 to the conduct of the demonstration by the 

24 State. 


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1 (d) REQUIREMENT FOR SELECTING STATES.—In se2 lecting Medicaid Buy-In States to participate in the dem3 onstration program, the Secretary shall ensure that the 

4 Medicaid Buy-In States selected include Medicaid Buy-In 

5 States with low, medium, and high numbers of working6 age individuals with disabilities who are receiving Med7 icaid-funded home or community-based services and are 

8 in individual integrated employment, subminimum wage 

9 work, congregate setting work, or facility-based day habili10 tation or day treatment, respectively. 

11 (e) LENGTH OF DEMONSTRATION PROGRAM.—The 

12 demonstration program shall be conducted for a period of 

13 5 fiscal years, beginning with fiscal year 2017. 

14 (f) PERFORMANCE BONUS PAYMENTS.— 

15 (1) IN GENERAL.—For each year in which the 

16 demonstration program is conducted, a Medicaid 

17 Buy-In State participating in the demonstration pro18 gram during that year may qualify for a perform19 ance bonus payment. 

20 (2) STATE-SPECIFIED CRITERIA AND PERFORM21 ANCE PLANS.—In order to participate in the dem22 onstration program, a Medicaid Buy-In State shall 

23 submit criteria and a plan for achieving each of the 

24 mandatory benchmarks described in paragraph (3) 

25 and each of the additional benchmarks described in 


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1 paragraph (4). The Secretary shall establish a meth2 odology for assessing State performance with respect 

3 to the State-specified criteria for the mandatory and 

4 additional benchmarks. 

5 (3) MANDATORY BENCHMARKS.—The manda6 tory benchmarks described in this paragraph are the 

7 following: 

8 (A) REDUCED PARTICIPATION IN SEG9 REGATED PROGRAMS AND INCREASED PARTICI10 PATION IN INDIVIDUAL INTEGRATED EMPLOY11 MENT.— 

12 (i) REDUCED POPULATION CENSUS OF

13 SEGREGATED PROGRAMS.— 

14 (I) IN GENERAL.—Achieving a 

15 reduction in the population in the 

16 State of working-age individuals with 

17 disabilities who are receiving Med18 icaid-funded home or community19 based services or who are receiving 

20 services through an Intermediate Care 

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1 imum wage work, congregate setting 

2 work, or facility-based day habilitation 

3 or day treatment. 

4 (II) MINIMUM PERCENT REDUC5 TIONS; BONUS BASED ON ACHIEVE6 MENT OF DIFFERING TIERS.—In 

7 order to receive a bonus payment for 

8 a year under this clause, a Medicaid 

9 Buy-In State shall achieve a reduction 

10 of the population described in sub11 clause (I) of at least 10 percent below 

12 the State’s most recent prior year’s 

13 census of the eligible population in 

14 subminimum wage work, congregate 

15 setting work, or facility based day ha16 bilitation or day treatment. Subject to 

17 paragraph (5)(B), the Secretary shall 

18 award an increased bonus payment 

19 for a year to a Medicaid Buy-In State 

20 that achieves a percentage reduction 

21 of 20, 30, 40 or more with respect to 

22 the prior year’s census of such popu23 lation. 

24 (III) RULE OF CONSTRUCTION.— 

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1 ability shall be deemed as counting to2 wards a percentage reduction for pur3 poses of this clause if the individual is 

4 employed in an integrated individual 

5 employment setting for at least 10 

6 hours a week on average over a 120- 

7 day period during the year involved or 

8 is receiving integrated day services 

9 supported by the State. 

10 (ii) INCREASED POPULATION CENSUS

11 OF INDIVIDUAL INTEGRATED EMPLOY12 MENT.— 

13 (I) IN GENERAL.—Achieving an 

14 increase in the population in the State 

15 of working-age individuals with dis16 abilities who are receiving Medicaid17 funded home or community-based 

18 services and are in individual inte19 grated employment. 

20 (II) MINIMUM PERCENT IN21 CREASES; BONUS BASED ON ACHIEVE22 MENT OF CERTAIN TIERS.—In order 

23 to receive a bonus payment for a year 

24 under this clause, a Medicaid Buy-In 

25 State shall achieve an increase in the 


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1 population described in subclause (I) 

2 of at least 10 percent above the 

3 State’s most recent prior year’s cen4 sus of the eligible population in indi5 vidual integrated employment. Subject 

6 to paragraph (5)(B), the Secretary 

7 shall award an increased bonus pay8 ment for a year to a Medicaid Buy-In 

9 State that achieves a percentage in10 crease of 20, 30, 40 or more with re11 spect to the prior year’s census of 

12 such population. 

13 (III) RULE OF CONSTRUCTION.— 

14 A working-age individual with a dis15 ability shall be deemed as counting to16 wards a percentage increase for pur17 poses of this clause if the individual is 

18 employed in an integrated individual 

19 employment setting for at least 10 

20 hours a week on average over a 120- 

21 day period during the year involved. 

22 (B) MEETING THE TRANSITION TO INDE23 PENDENCE MEDICAID BUY-IN STANDARDS.— 

24 Meeting the minimum standards established by 


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1 the Secretary for the Transition to Independ2 ence Medicaid Buy-In Option. 

3 (4) ADDITIONAL BENCHMARKS.—The addi4 tional benchmarks described in this paragraph are 

5 the following: 

6 (A) ELIMINATION OF NEW PLACEMENT AP7 PROVALS.—Eliminating new approvals for 

8 placement in the State of working-age individ9 uals with disabilities who are receiving Med10 icaid-funded home or community-based services 

11 in subminimum wage work, congregate setting 

12 work, or facility-based day habilitation or day 

13 treatment, in accordance with criteria estab14 lished by the Secretary. 

15 (B) DEMONSTRATION OF INTER-AGENCY

16 COLLABORATION.—Demonstrating inter-agency 

17 collaboration between the State agencies re18 sponsible for administering Medicaid, vocational 

19 rehabilitation, and education (and, if the State 

20 is participating the Promoting Readiness of Mi21 nors in Supplemental Security Income initiative 

22 (PROMISE), including coordination with that 

23 initiative), in determining payer of last resort 

24 rules and rules for providing individuals with a 

25 seamless transition of services provided under 


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1 such agencies, in accordance with criteria estab2 lished by the Secretary. 

3 (C) TERMINATION OF VOCATIONAL REHA4 BILITATION FUNDING.—Ending vocational re5 habilitation funding for subminimum wage 

6 work, congregate setting work, or facility-based 

7 day habilitation or day treatment, in accordance 

8 with criteria established by the Secretary. 

9 (D) WORKFORCE DEVELOPMENT.—Dem10 onstrating in accordance with criteria estab11 lished by the Secretary satisfaction of at least 

12 2 of the following strategies to promote work13 force development: 

14 (i) Increasing Medicaid payments for 

15 supported employment providers for indi16 viduals with disabilities by an amount nec17 essary to ensure an adequately supported 

18 employment network, as determined by the 

19 Secretary. 

20 (ii) Adopting employment strategies 

21 that result in working-age individuals with 

22 disabilities who are receiving Medicaid23 funded home or community-based services 

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1 time employees of State government or by 

2 contractors or State government. 

3 (iii) Developing a State equivalent of 

4 section 503 of the Rehabilitation Act of 

5 1973 (29 U.S.C. 793) to recruit, hire, pro6 mote, and retain working-age individuals 

7 with disabilities who are receiving Med8 icaid-funded home or community-based 

9 services with a utilization goal of at least 

10 7 percent of the State government work11 force. 

12 (iv) Developing a special hiring au13 thority mechanism akin to the Schedule A 

14 appointing authority under section 

15 213.3102(u) of title 5 of the Code of Fed16 eral Regulations (commonly referred to as 

17 the ‘‘Schedule A Hiring Authority’’) to as18 sist in easing the hiring of working-age in19 dividuals with disabilities who are receiving 

20 Medicaid-funded home or community-based 

21 services within the State government with 

22 an accompanying plan submitted to the 

23 Secretary outlining targeted implementa24 tion goals for the amount of individuals 

25 with disabilities within State government. 


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1 (v) Increasing the hiring of working2 age individuals with disabilities who are re3 ceiving Medicaid-funded home or commu4 nity-based services in employment for 

5 which the individual is compensated at or 

6 above the minimum wage, through collabo7 ration with the State vocational rehabilita8 tion and workforce development programs 

9 and Federal contractors. 

10 (vi) Providing State tax credits to em11 ployers for hiring new workers who are 

12 working-age individuals with disabilities 

13 who are receiving Medicaid-funded home or 

14 community-based services. 

15 (5) PAYMENT TO STATES.— 

16 (A) IN GENERAL.—Subject to the suc17 ceeding provisions of this paragraph, the Sec18 retary shall make a performance bonus pay19 ment to each Medicaid Buy-In State partici20 pating in the demonstration program that 

21 qualifies for such a payment with respect to a 

22 fiscal year as a single payment not later than 

23 the last day of the first calendar quarter of the 

24 fiscal year following the fiscal year to which the 

25 performance bonus payments applies. Payments 


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1 to States made under this paragraph shall be 

2 considered to have been made under, and are 

3 subject to the requirements of, section 1903 of 

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

5 (B) DETERMINATION OF PAYMENT.—The 

6 performance bonus payment for a Medicaid 

7 Buy-In State shall consist of the additional 

8 amount that the State would have been paid for 

9 providing medical assistance to individuals en10 rolled in the Transition to Independence Med11 icaid Buy-In Option during the preceding fiscal 

12 year if the regular FMAP applicable to such as13 sistance were increased (subject to subpara14 graph (C)) as follows: 

15 (i) 2 percentage points for achieving 

16 the minimum 10 percent reduction in the 

17 mandatory benchmark described in para18 graph (3)(A) during the preceding fiscal 

19 year (or 2.4 percentage points for achiev20 ing a reduction of at least 20, but not 

21 more than 30 percent, 2.6 percentage 

22 points for achieving a reduction of at least 

23 30, but not more than 40 percent, and 2.8 

24 percentage points for achieving a reduction 

25 of at least 40 percent). 


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1 (ii) 2 percentage points for achieving 

2 the minimum 10 percent increase in the 

3 mandatory benchmark described in para4 graph (3)(B) during the preceding fiscal 

5 year (or 2.4 percentage points for achiev6 ing an increase of at least 20, but not 

7 more than 30 percent, 2.6 percentage 

8 points for achieving an increase of at least 

9 30, but not more than 40 percent, and 2.8 

10 percentage points for achieving an increase 

11 of at least 40 percent). 

12 (iii) 0.5 percentage points for each ad13 ditional benchmark described in paragraph 

14 (4) that the State achieves during the pre15 ceding fiscal year. 

16 (C) LIMITATIONS.—In no case may— 

17 (i) the increase in the regular FMAP 

18 resulting from the application of subpara19 graph (B) for any Medicaid Buy-In State 

20 exceed 100 percent of the costs for pro21 viding medical assistance to individuals en22 rolled in the Transition to Independence 

23 Medicaid Buy-In Option with respect to 

24 each fiscal year of the 5-year period in 


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1 which the demonstration project is con2 ducted; or 

3 (ii) payments be made to a Medicaid 

4 Buy-In State under this paragraph after 

5 December 31, 2021. 

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) STATE REPORTS.— 

16 (A) PERIODIC REPORTS.—Each Medicaid 

17 Buy-In State participating in the demonstration 

18 program shall submit reports to the Secretary 

19 regarding the State’s conduct of the demonstra20 tion program, at such time and in such manner, 

21 as the Secretary shall require. Such reports 

22 shall include, in addition to data and informa23 tion regarding State performance with respect 

24 the mandatory and additional benchmarks de25 scribed in paragraphs (3) and (4) of subsection 


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1 (f) and such other information as the Secretary 

2 may require, data and information regarding 

3 the extent to which, since the start of the dem4 onstration 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. 

25 (B) ANNUAL REPORT.— 


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1 (i) IN GENERAL.—Each Medicaid 

2 Buy-In State participating in the dem3 onstration program annually shall submit a 

4 detailed report to the Secretary regarding 

5 the State’s efforts to transition individuals 

6 with disabilities who are participating in 

7 the demonstration program to individual 

8 integrated employment during the pre9 ceding year. Each annual report shall 

10 specify the full spectrum of employment 

11 outcomes for such individuals, best prac12 tices for successfully achieving such transi13 tions, and lessons learned. 

14 (ii) DISSEMINATION TO ALL PARTICI15 PATING AND NON-PARTICIPATING

16 STATES.—The Secretary shall disseminate 

17 the annual reports submitted under clause 

18 (i) by Medicaid Buy-In States participating 

19 in the demonstration program to all 

20 States. 

21 (2) REPORTS AND RECOMMENDATIONS TO CON22 GRESS.— 

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

24 1, 2017, and January 1 of each of the 6 years 

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1 gress a report on the demonstration program. 

2 Each such report shall include data and infor3 mation regarding State performance with re4 spect to each of the mandatory and additional 

5 benchmarks described in paragraphs (3) and 

6 (4) of subsection (f) and other data and infor7 mation reported by States under paragraph (1) 

8 and an assessment of the extent to which the 

9 demonstration program is successful in 

10 transitioning working-age individuals with dis11 abilities to independent living and work in their 

12 communities. 

13 (B) RECOMMENDATIONS.—Not later than 

14 December 31, 2019, the Secretary shall submit 

15 to Congress recommendations regarding wheth16 er the demonstration program should be contin17 ued, expanded, modified, or terminated. 

18 (h) DEFINITIONS.—In this section: 

19 (1) CONGREGATE SETTING WORK.—The term 

20 ‘‘congregate setting work’’ means a nonprofit, for21 profit, or State agency entity that employs a major22 ity of individuals with disabilities and receives Med23 icaid or other State funds for the purpose of pro24 viding employment services, or a facility or sub-unit 

25 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 Medicaid Buy-In Option Demonstra4 tion Program established 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 enclaves, mobile work crews, or other set17 tings in which the location and nature of em18 ployment is determined by the individual’s dis19 ability. 

20 (5) INTEGRATED DAY SERVICES.—The term 

21 ‘‘integrated day services’’ means services integrated 

22 in and supporting the full access of individuals with 

23 disabilities to the greater community to the same de24 gree as individuals not receiving services that are 

25 provided consistent with all of the following: 


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1 (A) No overall facility or program schedule 

2 for the individuals receiving such services. 

3 (B) Each individual receiving such services 

4 has a unique schedule reflecting the individual’s 

5 interests and goals. 

6 (C) Activities take place on an individual 

7 basis or in small groups of individuals who 

8 choose to be served together. 

9 (D) The majority of time spent receiving 

10 such services takes place within the broader 

11 community rather than within a single-site, 

12 fixed site, or center-based program for individ13 uals with disabilities, regardless of the program 

14 size. 

15 (E) The services are provided consistent 

16 with the requirements of section 441.710 of 

17 title 42, Code of Federal Regulations. 

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

19 the program for medical assistance established under 

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

21 et seq.). 

22 (7) MEDICAID BUY-IN STATE.—The term ‘‘Med23 icaid Buy-In State’’ means a State that, under sub24 clause (XIII), (XV), or (XVI) of section 

25 1902(a)(10)(A)(ii) of the Social Security Act (42 


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

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

3 1315, 1396n), or other authority, has a program 

4 under which individuals with disabilities with earn5 ings and assets that would otherwise make them in6 eligible for medical assistance under the State’s 

7 Medicaid program are able to maintain their eligi8 bility for such assistance. 

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

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

11 1919(a) of the Social Security Act (42 U.S.C. 

12 1396r(a)). 

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

14 has the meaning given that term in section 

15 2110(c)(5) of the Social Security Act (42 U.S.C. 

16 1397jj(c)(5)). 

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

18 FMAP’’ means the Federal medical assistance per19 centage applicable to the State (as determined under 

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

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

22 in that percentage applicable under subsections (y), 

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

24 under any other provision of law. 


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•S 1604 IS

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

2 means the Secretary of Health and Human Services. 

3 (12) SUBMINIMUM WAGE WORK.—The term 

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

5 which individuals with disabilities are paid less than 

6 minimum wage under a certificate issued in accord7 ance with section 14(c) of the Fair Labor Standards 

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

9 (13) SUPPORTED EMPLOYMENT.—The term 

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

11 term in section 7 of the Rehabilitation Act of 1973 

12 (29 U.S.C. 705). 

13 (14) STATE.—The term ‘‘State’’ has the mean14 ing given such term for purposes of title XIX of the 

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

16 (15) TITLE II DISABILITY BENEFICIARY.—The 

17 term ‘‘title II disability beneficiary’’ means an indi18 vidual entitled to disability insurance benefits under 

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

20 423) or to monthly insurance benefits under section 

21 202 of such Act (42 U.S.C. 402) based on such indi22 vidual’s disability (as defined in section 223(d) of 

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

24 (16) TITLE XVI DISABILITY BENEFICIARY.— 

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


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•S 1604 IS

1 individual eligible for supplemental security income 

2 benefits under title XVI of the Social Security Act 

3 (42 U.S.C. 1381 et seq.) on the basis of blindness 

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

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

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

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

8 (17) WORKING-AGE INDIVIDUAL WITH A DIS9 ABILITY RECEIVING MEDICAID-FUNDED HOME OR

10 COMMUNITY-BASED SERVICES.—The term ‘‘working11 age individual with a disability receiving Medicaid12 funded home or community-based services’’ means a 

13 title II disability beneficiary or a title XVI disability 

14 beneficiary who has attained age 18, but has not at15 tained age 65, and is receiving home or community16 based services— 

17 (A) under a waiver approved under sub18 section (c) or (d) of section 1915 the Social Se19 curity Act (42 U.S.C. 1396n); 

20 (B) under the State Medicaid plan in ac21 cordance with subsection (i), (j), or (k) of such 

22 section; or 


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•S 1604 IS

1 (C) under a Medicaid waiver approved 

2 under section 1115 of the Social Security Act 

3 (42 U.S.C. 1315). 

Æ 


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