I 

118TH CONGRESS 

1ST SESSION H. R. 6296 

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

programs for expenditures on home and community-based services. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 8, 2023 

Mrs. DINGELL introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To provide for an emergency increase in Federal funding 

to State Medicaid programs for expenditures on home 

and community-based services. 

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

3 SECTION 1. SHORT TITLE. 

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

5 2023’’. 

6 SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 

7 COMMUNITY-BASED SERVICES. 

8 (a) INCREASED FMAP.— 

9 (1) IN GENERAL.—Notwithstanding section 

10 1905(b) of the Social Security Act (42 U.S.C. 


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1 1396d(b)), in the case of an HCBS program State, 

2 the Federal medical assistance percentage deter3 mined for the State under section 1905(b) of such 

4 Act and, if applicable, increased under subsection 

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

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

7 U.S.C. 1396n(k)), shall be increased by 10 percent8 age points with respect to expenditures of the State 

9 under the State Medicaid program for home and 

10 community-based services that are provided during 

11 fiscal years 2024 and 2025. In no case may the ap12 plication of the previous sentence result in the Fed13 eral medical assistance percentage determined for a 

14 State being more than 95 percent. 

15 (2) DEFINITIONS.—In this section: 

16 (A) HCBS PROGRAM STATE.—The term 

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

18 meets the condition described in subsection (b) 

19 by submitting an application described in such 

20 subsection, which is approved by the Secretary 

21 pursuant to subsection (c). 

22 (B) HOME AND COMMUNITY-BASED SERV23 ICES.—The term ‘‘home and community-based 

24 services’’ means home health care services au25 thorized under paragraph (7) of section 1905(a) 


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

2 1396d(a)), behavioral health services authorized 

3 under paragraph (13) of such section, personal 

4 care services authorized under paragraph (24) 

5 of such section, PACE services authorized 

6 under paragraph (26) of such section, services 

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

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

9 1396n), such services authorized under a waiver 

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

11 1315), and such other services specified by the 

12 Secretary. 

13 (b) CONDITION.—The condition described in this sub14 section, with respect to a State, is that the State submits 

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

16 manner as specified by the Secretary, that includes, in ad17 dition to such other information as the Secretary shall re18 quire— 

19 (1) a description of which activities described in 

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

21 a description of how it plans to implement such ac22 tivities; 

23 (2) assurances that all Federal funds attrib24 utable to the increase under subsection (a) will be— 


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1 (A) expended by the State in accordance 

2 with this section not later than September 30, 

3 2027; and 

4 (B) used— 

5 (i) to implement the activities de6 scribed in subsection (d); 

7 (ii) to supplement, and not supplant, 

8 the level of State funds expended for home 

9 and community-based services for eligible 

10 individuals through programs in effect as 

11 of the date of the enactment of this sec12 tion; and 

13 (iii) to increase reimbursement rates 

14 for home and community-based services to 

15 a level that will support recruitment and 

16 retention of a sufficient workforce to pro17 vide home and community-based services 

18 to eligible individuals; and 

19 (3) assurances that the State will conduct ade20 quate oversight and ensure the validity of such data 

21 as may be required by the Secretary. 

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

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

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

25 the application is complete. Upon certification that an apVerDate Sep 11 2014 02:35 Nov 16, 2023 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6296.IH H6296

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1 plication of a State is complete, the application shall be 

2 deemed to be approved for purposes of this section. 

3 (d) ACTIVITIES TO IMPROVE THE DELIVERY OF

4 HCBS.— 

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

6 community partners, such as Area Agencies on 

7 Aging, Centers for Independent Living, non-profit 

8 home and community-based services providers, and 

9 other entities providing home and community-based 

10 services, to implement the purposes described in 

11 paragraph (2). 

12 (2) FOCUSED AREAS OF HCBS IMPROVE13 MENT.—The purposes described in this paragraph, 

14 with respect to a State, are the following: 

15 (A) To increase rates for home health 

16 agencies and agencies that employ direct sup17 port professionals (including independent pro18 viders in a self-directed or consumer-directed 

19 model) to provide home and community-based 

20 services under the State Medicaid program, 

21 provided that any agency or individual that re22 ceives payment under such an increased rate in23 creases the compensation it pays its home 

24 health workers or direct support professionals. 


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

2 leave, and paid medical leave for home health 

3 workers and direct support professionals. 

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

5 and shift differential pay for home health work6 ers and direct support professionals. 

7 (D) To improve stability of home health 

8 worker and direct support professional jobs, in9 cluding consistent hours, scheduling, pay, and 

10 benefit eligibility. 

11 (E) To provide home and community-based 

12 services to eligible individuals who are on wait13 ing lists for programs approved under section 

14 1115 or 1915 of the Social Security Act (42 

15 U.S.C. 1315, 1396n). 

16 (F) To purchase emergency supplies and 

17 equipment, which may include items not typi18 cally covered under the Medicaid program, such 

19 as personal protective equipment, necessary to 

20 enhance access to services and to protect the 

21 health and well-being of home health workers 

22 and direct support professionals. 

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

24 workers and direct support professionals to con25 duct home and community-based services. 


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1 (H) To recruit new home health workers 

2 and direct support professionals. 

3 (I) To support family care providers of eli4 gible individuals with needed supplies, equip5 ment, and services, which may include items 

6 such as family caregiver pay and respite serv7 ices. 

8 (J) To pay for training for home health 

9 workers and direct support professionals. 

10 (K) To pay for assistive technologies, staff11 ing, training to facilitate an eligible individual’s 

12 communication, and other costs incurred in 

13 order to facilitate community integration and 

14 ensure an individual’s person-centered service 

15 plan continues to be fully implemented. 

16 (L) To prepare information and public 

17 health and educational materials in accessible 

18 formats (including formats accessible to people 

19 with low literacy or intellectual disabilities) 

20 about prevention, treatment, recovery and other 

21 aspects of communicable diseases and threats to 

22 the health of eligible individuals, their families, 

23 and the general community served by agencies 

24 described in subparagraph (A). 


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1 (M) To protect the health and safety of 

2 home health workers and direct support profes3 sionals during public health emergencies and 

4 natural disasters. 

5 (N) To pay for interpreters to assist in 

6 providing home and community-based services 

7 to eligible individuals and to inform the general 

8 public about communicable diseases and other 

9 public health threats. 

10 (O) To allow day services providers to pro11 vide home and community-based services. 

12 (P) To pay for other expenses deemed ap13 propriate by the Secretary to enhance, expand, 

14 or strengthen Home and Community-Based 

15 Services, including retainer payments, and ex16 penses which meet the criteria of the home and 

17 community-based settings rule published on 

18 January 16, 2014. 

19 (Q) To assist eligible individuals who had 

20 to relocate to a nursing facility or institutional 

21 setting from their homes in— 

22 (i) moving back to their homes (in23 cluding by paying for moving costs, first 

24 month’s rent, and other one-time expenses 

25 and start-up costs); 


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1 (ii) resuming home and community2 based services; 

3 (iii) receiving mental health services 

4 and necessary rehabilitative service to re5 gain skills lost while relocated; and 

6 (iv) while funds attributable to the in7 creased FMAP under this section remain 

8 available, continuing home and community9 based services for eligible individuals who 

10 were served from a waiting list for such 

11 services during the emergency period de12 scribed in section 1135(g)(1)(B) of the So13 cial Security Act (42 U.S.C. 1320b– 

14 5(g)(1)(B)). 

15 (e) REPORTING REQUIREMENTS.— 

16 (1) STATE REPORTING REQUIREMENTS.—Not 

17 later than December 31, 2027, any State with re18 spect to which an application is approved by the Sec19 retary pursuant to subsection (c) shall submit a re20 port to the Secretary that contains the following in21 formation: 

22 (A) Activities and programs that were 

23 funded using Federal funds attributable to such 

24 increase. 


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1 (B) The number of eligible individuals who 

2 were served by such activities and programs. 

3 (C) The number of eligible individuals who 

4 were able to resume home and community5 based services as a result of such activities and 

6 programs. 

7 (2) HHS EVALUATION.— 

8 (A) IN GENERAL.—The Secretary shall 

9 evaluate the implementation and outcomes of 

10 this section in the aggregate using an external 

11 evaluator with experience evaluating home and 

12 community-based services, disability programs, 

13 and older adult programs. 

14 (B) EVALUATION CRITERIA.—For pur15 poses of subparagraph (A), the external eval16 uator shall— 

17 (i) document and evaluate changes in 

18 access, availability, and quality of home 

19 and community-based services in each 

20 HCBS program State; 

21 (ii) document and evaluate aggregate 

22 changes in access, availability, and quality 

23 of home and community-based services 

24 across all such States; and 


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1 (iii) evaluate the implementation and 

2 outcomes of this section based on— 

3 (I) the impact of this section on 

4 increasing funding for home and com5 munity-based services; 

6 (II) the impact of this section on 

7 achieving targeted access, availability, 

8 and quality of home and community9 based services; and 

10 (III) promising practices identi11 fied by activities conducted pursuant 

12 to subsection (d) that increase access 

13 to, availability of, and quality of home 

14 and community-based services. 

15 (C) DISSEMINATION OF EVALUATION FIND16 INGS.—The Secretary shall— 

17 (i) disseminate the findings from the 

18 evaluations conducted under this para19 graph to— 

20 (I) all State Medicaid directors; 

21 and 

22 (II) the Committee on Energy 

23 and Commerce of the House of Rep24 resentatives, the Committee on Fi25 nance of the Senate, and the Special 


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1 Committee on Aging of the Senate; 

2 and 

3 (ii) make all evaluation findings pub4 licly available in an accessible electronic 

5 format and any other accessible format de6 termined appropriate by the Secretary. 

7 (D) OVERSIGHT.—Each State with respect 

8 to which an application is approved by the Sec9 retary pursuant to subsection (c) shall ensure 

10 adequate oversight of the expenditure of Fed11 eral funds pursuant to such increase in accord12 ance with the Medicaid regulations, including 

13 sections 1115 and 1915 waiver regulations and 

14 special terms and conditions for any relevant 

15 waiver or grant program. 

16 (3) NON-APPLICATION OF THE PAPERWORK RE17 DUCTION ACT.—Chapter 35 of title 44, United 

18 States Code (commonly referred to as the ‘‘Paper19 work Reduction Act of 1995’’), shall not apply to the 

20 provisions of this subsection. 

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

22 (1) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 

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

24 enrolled for medical assistance under a State Med25 icaid program. 


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1 (2) MEDICAID PROGRAM.—The term ‘‘Medicaid 

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

3 program under title XIX of the Social Security Act 

4 (42 U.S.C. 1396 et seq.) (including any waiver or 

5 demonstration under such title or under section 

6 1115 of such Act (42 U.S.C. 1315) relating to such 

7 title). 

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

9 the Secretary of Health and Human Services. 

10 (4) STATE.—The term ‘‘State’’ has the mean11 ing given such term for purposes of title XIX of the 

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

Æ 


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