II

106TH CONGRESS

1ST SESSION S. 1935

To amend title XIX of the Social Security Act to provide for coverage

of community attendant services and supports under the medicaid program.

IN THE SENATE OF THE UNITED STATES

NOVEMBER 16, 1999

Mr. HARKIN (for himself and Mr. SPECTER) 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

for coverage of community attendant services and supports under the medicaid 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 ‘‘Medicaid Community

5 Attendant Services and Supports Act of 1999’’.

6 SEC. 2. FINDINGS, PURPOSES, AND POLICY.

7 (a) FINDINGS.—Congress makes the following find8 ings:

9 (1) Many studies have found that an over10 whelming majority of individuals with disabilities
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1 needing long-term services and supports would pre2 fer to receive them in home and community-based

3 settings rather than in institutions. However, re4 search on the provision of long-term services and

5 supports under the medicaid program (conducted by

6 and on behalf of the Department of Health and

7 Human Services) has revealed a significant bias to8 ward funding these services in institutional rather

9 than home and community-based settings. The ex10 tent of this bias is indicated by the fact that 75 per11 cent of medicaid funds for long-term services and

12 supports are expended in nursing homes and inter13 mediate care facilities for the mentally retarded

14 while approximately 25 percent of such funds pays

15 for services in home and community-based settings.

16 (2) Because of this bias, significant numbers of

17 individuals with disabilities of all ages who would

18 prefer to live in the community and could do so with

19 community attendant services and supports are

20 forced to live in unnecessarily segregated institu21 tional settings if they want to receive needed services

22 and supports. Benefit packages provided in these

23 settings are medically-oriented and constitute bar24 riers to the receipt of the types of services individ25 uals need and want. Decisions regarding the provi-
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1 sion of services and supports are too often influ2 enced by what is reimbursable rather than by what

3 individuals need and want.

4 (3) There is a growing recognition that dis5 ability is a natural part of the human experience

6 that in no way diminishes an individual’s right to—

7 (A) live independently;

8 (B) enjoy self-determination;

9 (C) make choices;

10 (D) contribute to society; and

11 (E) enjoy full inclusion and integration in

12 the mainstream of American society.

13 (4) Long-term services and supports provided

14 under the medicaid program must meet the evolving

15 and changing needs and preferences of individuals

16 with disabilities, including the preferences for living

17 within one’s own home or living with one’s own fam18 ily and becoming productive members of the commu19 nity.

20 (5) The goals of the Nation properly include

21 providing individuals with disabilities with—

22 (A) a meaningful choice of receiving long23 term services and supports in the most inte24 grated setting appropriate;
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1 (B) the greatest possible control over the

2 services received; and

3 (C) quality services that maximize social

4 functioning in the home and community.

5 (b) PURPOSES.—The purposes of this Act are as fol6 lows:

7 (1) To provide that States shall offer commu8 nity attendant services and supports for eligible indi9 viduals with disabilities.

10 (2) To provide financial assistance to States to

11 support systems change initiatives that are designed

12 to assist each State in developing and enhancing a

13 comprehensive consumer-responsive statewide system

14 of long-term services and supports that provides real

15 consumer choice and direction consistent with the

16 principle that services and supports should be pro17 vided in the most integrated setting appropriate to

18 meeting the unique needs of the individual.

19 (c) POLICY.—It is the policy of the United States

20 that all programs, projects, and activities receiving assist21 ance under this Act shall be carried out in a manner con22 sistent with the following principles:

23 (1) Individuals with disabilities, or, as appro24 priate, their representatives, must be empowered to

25 exercise real choice in selecting long-term services
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1 and supports that are of high quality, cost-effective,

2 and meet the unique needs of the individual in the

3 most integrated setting appropriate.

4 (2) No individual should be forced into an insti5 tution to receive services that can be effectively and

6 efficiently delivered in the home or community.

7 (3) Federal and State policies, practices, and

8 procedures should facilitate and be responsive to,

9 and not impede, an individual’s choice in selecting

10 long-term services and supports.

11 (4) Individuals and their families receiving

12 long-term services and supports must be involved in

13 decisionmaking about their own care and be pro14 vided with sufficient information to make informed

15 choices.

16 SEC. 3. COVERAGE OF COMMUNITY ATTENDANT SERVICES

17 AND SUPPORTS UNDER THE MEDICAID PRO18 GRAM.

19 (a) REQUIRED COVERAGE FOR INDIVIDUALS ENTI20 TLED TO NURSING FACILITY SERVICES OR ELIGIBLE FOR

21 INTERMEDIATE CARE FACILITY SERVICES FOR THE MEN22 TALLY RETARDED.—Section 1902(a)(10)(D) of the Social

23 Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended—

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

25 (2) by adding ‘‘and’’ after the semicolon; and
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1 (3) by adding at the end the following:

2 ‘‘(ii) subject to section 1935, for the inclu3 sion of community attendant services and sup4 ports for any individual who is eligible for med5 ical assistance under the State plan and with

6 respect to whom there has been a determination

7 that the individual requires the level of care

8 provided in a nursing facility or an intermediate

9 care facility for the mentally retarded (whether

10 or not coverage of such intermediate care facil11 ity is provided under the State plan) and who

12 requires such community attendant services and

13 supports based on functional need and without

14 regard to age or disability;’’.

15 (b) MEDICAID COVERAGE OF COMMUNITY ATTEND16 ANT SERVICES AND SUPPORTS.—

17 (1) IN GENERAL.—Title XIX of the Social Se18 curity Act (42 U.S.C. 1396 et seq.) is amended—

19 (A) by redesignating section 1935 as sec20 tion 1936; and

21 (B) by inserting after section 1934 the fol22 lowing:

23 ‘‘COMMUNITY ATTENDANT SERVICES AND SUPPORTS

24 ‘‘SEC. 1935. (a) DEFINITIONS.—In this title:

25 ‘‘(1) COMMUNITY ATTENDANT SERVICES AND

26 SUPPORTS.—
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1 ‘‘(A) IN GENERAL.—The term ‘community

2 attendant services and supports’ means attend3 ant services and supports furnished to an indi4 vidual, as needed, to assist in accomplishing ac5 tivities of daily living, instrumental activities of

6 daily living, and health-related functions

7 through hands-on assistance, supervision, or

8 cueing—

9 ‘‘(i) under a plan of services and sup10 ports that is based on an assessment of

11 functional need and that is agreed to by

12 the individual or, as appropriate, the indi13 vidual’s representative;

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

15 which may include a school, workplace, or

16 recreation or religious facility, but does not

17 include a nursing facility, an intermediate

18 care facility for the mentally retarded, or

19 other congregate facility;

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

21 or other model (as defined in paragraph

22 (2)(C)); and

23 ‘‘(iv) the furnishing of which is se24 lected, managed, and dismissed by the in-
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1 dividual, or, as appropriate, with assistance

2 from the individual’s representative.

3 ‘‘(B) INCLUDED SERVICES AND SUP4 PORTS.—Such term includes—

5 ‘‘(i) tasks necessary to assist an indi6 vidual in accomplishing activities of daily

7 living, instrumental activities of daily liv8 ing, and health-related functions;

9 ‘‘(ii) acquisition, maintenance, and en10 hancement of skills necessary for the indi11 vidual to accomplish activities of daily liv12 ing, instrumental activities of daily living,

13 and health-related functions;

14 ‘‘(iii) backup systems or mechanisms

15 (such as the use of beepers) to ensure con16 tinuity of services and supports; and

17 ‘‘(iv) voluntary training on how to se18 lect, manage, and dismiss attendants.

19 ‘‘(C) EXCLUDED SERVICES AND SUP20 PORTS.—Subject to subparagraph (D), such

21 term does not include—

22 ‘‘(i) provision of room and board for

23 the individual;

24 ‘‘(ii) special education and related

25 services provided under the Individuals
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1 with Disabilities Education Act and voca2 tional rehabilitation services provided

3 under the Rehabilitation Act of 1973;

4 ‘‘(iii) assistive technology devices and

5 assistive technology services;

6 ‘‘(iv) durable medical equipment; or

7 ‘‘(v) home modifications.

8 ‘‘(D) FLEXIBILITY IN TRANSITION TO

9 COMMUNITY-BASED HOME SETTING.—Such

10 term may include expenditures for transitional

11 costs, such as rent and utility deposits, first

12 months’s rent and utilities, bedding, basic

13 kitchen supplies, and other necessities required

14 for an individual to make the transition from a

15 nursing facility or intermediate care facility for

16 the mentally retarded to a community-based

17 home setting where the individual resides.

18 ‘‘(2) ADDITIONAL DEFINITIONS.—

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

20 term ‘activities of daily living’ includes eating,

21 toileting, grooming, dressing, bathing, and

22 transferring.

23 ‘‘(B) CONSUMER DIRECTED.—The term

24 ‘consumer directed’ means a method of pro25 viding services and supports that allow the indi-
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1 vidual, or where appropriate, the individual’s

2 representative, maximum control of the commu3 nity attendant services and supports, regardless

4 of who acts as the employer of record.

5 ‘‘(C) DELIVERY MODELS.—

6 ‘‘(i) AGENCY-PROVIDER MODEL.—The

7 term ‘agency-provider model’ means, with

8 respect to the provision of community at9 tendant services and supports for an indi10 vidual, a method of providing consumer-di11 rected services and supports under which

12 entities contract for the provision of such

13 services and supports.

14 ‘‘(ii) OTHER MODELS.—The term

15 ‘other models’ means methods, other than

16 an agency-provider model, for the provision

17 of consumer-directed services and supports.

18 Such models may include the provision of

19 vouchers, direct cash payments, or use of

20 a fiscal agent to assist in obtaining serv21 ices.

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

23 term ‘health-related functions’ means functions

24 that can be delegated or assigned by licensed
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1 health-care professionals under State law to be

2 performed by an attendant.

3 ‘‘(E) INSTRUMENTAL ACTIVITIES OF DAILY

4 LIVING.—The term ‘instrumental activities of

5 daily living’ includes meal planning and prepa6 ration, managing finances, shopping for food,

7 clothing and other essential items, performing

8 essential household chores, communicating by

9 phone and other media, and getting around and

10 participating in the community.

11 ‘‘(F) INDIVIDUAL’S REPRESENTATIVE.—

12 The term ‘individual’s representative’ means a

13 parent, a family member, a guardian, an advo14 cate, or an authorized representative of an indi15 vidual.

16 ‘‘(b) LIMITATION ON AMOUNTS OF EXPENDITURES

17 UNDER THIS TITLE.—In carrying out section

18 1902(a)(10)(D)(ii), a State shall permit an individual who

19 has a level of severity of physical or mental impairment

20 that entitles such individual to medical assistance with re21 spect to nursing facility services or qualifies the individual

22 for intermediate care facility services for the mentally re23 tarded to choose to receive medical assistance for commu24 nity attendant services and supports (rather than medical

25 assistance for such institutional services and supports), in
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1 the most integrated setting appropriate to the needs of

2 the individual, so long as the aggregate amount of the

3 Federal expenditures for community attendant services

4 and supports for all such individuals in a fiscal year does

5 not exceed the total that would have been expended for

6 such individuals to receive such institutional services and

7 supports in the year.

8 ‘‘(c) MAINTENANCE OF EFFORT.—With respect to a

9 fiscal year quarter, no Federal funds may be paid to a

10 State for medical assistance provided to individuals de11 scribed in section 1902(a)(10)(D)(ii) for such fiscal year

12 quarter if the Secretary determines that the total of the

13 State expenditures for programs to enable such individuals

14 with disabilities to receive community attendant services

15 and supports (or services and supports that are similar

16 to such services and supports) under other provisions of

17 this title for the preceding fiscal year quarter is less than

18 the total of such expenditures for the same fiscal year

19 quarter for the preceding fiscal year.

20 ‘‘(d) STATE QUALITY ASSURANCE PROGRAM.—In

21 order to continue to receive Federal financial participation

22 for providing community attendant services and supports

23 under this section, a State shall, at a minimum, establish

24 and maintain a quality assurance program that provides

25 for the following:
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1 ‘‘(1) The State shall establish requirements, as

2 appropriate, for agency-based and other models that

3 include—

4 ‘‘(A) minimum qualifications and training

5 requirements, as appropriate for agency-based

6 and other models;

7 ‘‘(B) financial operating standards; and

8 ‘‘(C) an appeals procedure for eligibility

9 denials and a procedure for resolving disagree10 ments over the terms of an individualized plan.

11 ‘‘(2) The State shall modify the quality assur12 ance program, where appropriate, to maximize con13 sumer independence and consumer direction in both

14 agency-provided and other models.

15 ‘‘(3) The State shall provide a system that al16 lows for the external monitoring of the quality of

17 services by entities consisting of consumers and their

18 representatives, disability organizations, providers,

19 family, members of the community, and others.

20 ‘‘(4) The State provides ongoing monitoring of

21 the health and well-being of each recipient.

22 ‘‘(5) The State shall require that quality assur23 ance mechanisms appropriate for the individual

24 should be included in the individual’s written plan.
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1 ‘‘(6) The State shall establish a process for

2 mandatory reporting, investigation, and resolution of

3 allegations of neglect, abuse, or exploitation.

4 ‘‘(7) The State shall obtain meaningful con5 sumer input, including consumer surveys, that meas6 ure the extent to which a participant receives the

7 services and supports described in the individual’s

8 plan and the participant’s satisfaction with such

9 services and supports.

10 ‘‘(8) The State shall make available to the pub11 lic the findings of the quality assurance program.

12 ‘‘(9) The State shall establish an on-going pub13 lic process for the development, implementation, and

14 review of the State’s quality assurance program.

15 ‘‘(10) The State shall develop and implement a

16 program of sanctions.

17 ‘‘(e) FEDERAL ROLE IN QUALITY ASSURANCE.—The

18 Secretary shall conduct a periodic sample review of out19 comes for individuals based upon the individual’s plan of

20 support and based upon the quality assurance program of

21 the State. The Secretary may conduct targeted reviews

22 upon receipt of allegations of neglect, abuse, or exploi23 tation. The Secretary shall develop guidelines for States

24 to use in developing sanctions.
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1 ‘‘(f) REQUIREMENT TO EXPAND ELIGIBILITY.—Ef2 fective October 1, 2000, a State may not exercise the op3 tion of coverage of individuals under section

4 1902(a)(10)(A)(ii)(V) without providing coverage under

5 section 1902(a)(10)(A)(ii)(VI).

6 ‘‘(g) REPORT ON IMPACT OF SECTION.—The Sec7 retary shall submit to Congress periodic reports on the

8 impact of this section on beneficiaries, States, and the

9 Federal Government.’’.

10 (c) INCLUSION IN OPTIONAL ELIGIBILITY CLASSI11 FICATION.—Section 1902(a)(10)(A)(ii)(VI) of the Social

12 Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) is

13 amended by inserting ‘‘or community attendant services

14 and supports described in section 1935’’ after ‘‘section

15 1915’’ each place such term appears.

16 (d) COVERAGE AS MEDICAL ASSISTANCE.—

17 (1) IN GENERAL.—Section 1905(a) of the So18 cial Security Act (42 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 attendant services and sup2 ports (to the extent allowed and as defined in section

3 1935); and’’.

4 (2) CONFORMING AMENDMENTS.—

5 (A) Section 1902(j) of the Social Security

6 Act (42 U.S.C. 1396a(j)) is amended by strik7 ing ‘‘of of’’ and inserting ‘‘of’’.

8 (B) Section 1902(a)(10)(C)(iv) of the So9 cial Security Act (42 U.S.C.

10 1396a(a)(10)(C)(iv)) is amended by inserting

11 ‘‘and (27)’’ after ‘‘(24)’’.

12 SEC. 4. GRANTS TO DEVELOP AND ESTABLISH REAL

13 CHOICE SYSTEMS CHANGE INITIATIVES.

14 (a) ESTABLISHMENT.—

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

16 Human Services (referred to in this section as the

17 ‘‘Secretary’’) shall award grants described in sub18 section (b) to States to support real choice systems

19 change initiatives that establish specific action steps

20 and specific timetables to provide consumer-respon21 sive long term services and supports to eligible indi22 viduals in the most integrated setting appropriate

23 based on the unique strengths and needs of the indi24 vidual and the priorities and concerns of the indi-
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1 vidual (or, as appropriate, the individual’s represent2 ative).

3 (2) ELIGIBILITY.—To be eligible for a grant

4 under this section, a State shall—

5 (A) establish the Consumer Task Force in

6 accordance with subsection (d); and

7 (B) submit an application at such time, in

8 such manner, and containing such information

9 as the Secretary may determine. The applica10 tion shall be jointly developed and signed by the

11 designated State official and the chairperson of

12 such Task Force, acting on behalf of and at the

13 direction of the Task Force.

14 (3) DEFINITION OF STATE.—In this section,

15 the term ‘‘State’’ means each of the 50 States, the

16 District of Columbia, Puerto Rico, Guam, the

17 United States Virgin Islands, American Samoa, and

18 the Commonwealth of the Northern Mariana Is19 lands.

20 (b) GRANTS FOR REAL CHOICE SYSTEMS CHANGE

21 INITIATIVES.—

22 (1) IN GENERAL.—From funds appropriated

23 under subsection (f), the Secretary shall award

24 grants to States to—
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1 (A) support the establishment, implemen2 tation, and operation of the State real choice

3 systems change initiatives described in sub4 section (a); and

5 (B) conduct outreach campaigns regarding

6 the existence of such initiatives.

7 (2) DETERMINATION OF AWARDS; STATE AL8 LOTMENTS.—The Secretary shall develop a formula

9 for the distribution of funds to States for each fiscal

10 year under subsection (a). Such formula shall give

11 preference to States that have a relatively higher

12 proportion of long-term services and supports fur13 nished to individuals in an institutional setting but

14 who have a plan described in an application sub15 mitted under subsection (a)(2).

16 (c) AUTHORIZED ACTIVITIES.—A State that receives

17 a grant under this section shall use the funds made avail18 able through the grant to accomplish the purposes de19 scribed in subsection (a) and, in accomplishing such pur20 poses, may carry out any of the following systems change

21 activities:

22 (1) NEEDS ASSESSMENT AND DATA GATH23 ERING.—The State may use funds to conduct a

24 statewide needs assessment that may be based on

25 data in existence on the date on which the assess-
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1 ment is initiated and may include information about

2 the number of individuals within the State who are

3 receiving long-term services and supports in unnec4 essarily segregated settings, the nature and extent to

5 which current programs respond to the preferences

6 of individuals with disabilities to receive services in

7 home and community-based settings as well as in in8 stitutional settings, and the expected change in de9 mand for services provided in home and community

10 settings as well as institutional settings.

11 (2) INSTITUTIONAL BIAS.—The State may use

12 funds to identify, develop, and implement strategies

13 for modifying policies, practices, and procedures that

14 unnecessarily bias the provision of long-term services

15 and supports toward institutional settings and away

16 from home and community-based settings, including

17 policies, practices, and procedures governing

18 statewideness, comparability in amount, duration,

19 and scope of services, financial eligibility, individual20 ized functional assessments and screenings (includ21 ing individual and family involvement), and knowl22 edge about service options.

23 (3) OVER MEDICALIZATION OF SERVICES.—The

24 State may use funds to identify, develop, and imple25 ment strategies for modifying policies, practices, and
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1 procedures that unnecessarily bias the provision of

2 long-term services and supports by health care pro3 fessionals to the extent that quality services and

4 supports can be provided by other qualified individ5 uals, including policies, practices, and procedures

6 governing service authorization, case management,

7 and service coordination, service delivery options,

8 quality controls, and supervision and training.

9 (4) INTERAGENCY COORDINATION; SINGLE

10 POINT OF ENTRY.—The State may support activities

11 to identify and coordinate Federal and State poli12 cies, resources, and services, relating to the provision

13 of long-term services and supports, including the

14 convening of interagency work groups and the enter15 ing into of interagency agreements that provide for

16 a single point of entry and the design and implemen17 tation of a coordinated screening and assessment

18 system for all persons eligible for long-term services

19 and supports.

20 (5) TRAINING AND TECHNICAL ASSISTANCE.—

21 The State may carry out directly, or may provide

22 support to a public or private entity to carry out

23 training and technical assistance activities that are

24 provided for individuals with disabilities, and, as ap25 propriate, their representatives, attendants, and
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1 other personnel (including professionals, paraprofes2 sionals, volunteers, and other members of the com3 munity).

4 (6) PUBLIC AWARENESS.—The State may sup5 port a public awareness program that is designed to

6 provide information relating to the availability of

7 choices available to individuals with disabilities for

8 receiving long-term services and support in the most

9 integrated setting appropriate.

10 (7) DOWNSIZING OF LARGE INSTITUTIONS.—

11 The State may use funds to support the per capita

12 increased fixed costs in institutional settings directly

13 related to the movement of individuals with disabil14 ities out of specific facilities and into community15 based settings.

16 (8) TRANSITIONAL COSTS.—The State may use

17 funds to provide transitional costs described in sec18 tion 1935(a)(1)(D) of the Social Security Act, as

19 added by this Act.

20 (9) TASK FORCE.—The State may use funds to

21 support the operation of the Consumer Task Force

22 established under subsection (d).

23 (10) DEMONSTRATIONS OF NEW AP24 PROACHES.—The State may use funds to conduct,

25 on a time-limited basis, the demonstration of new
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1 approaches to accomplishing the purposes described

2 in subsection (a).

3 (11) OTHER ACTIVITIES.—The State may use

4 funds for any systems change activities that are not

5 described in any of the preceding paragraphs of this

6 subsection and that are necessary for developing, im7 plementing, or evaluating the comprehensive state8 wide system of long term services and supports.

9 (d) CONSUMER TASK FORCE.—

10 (1) ESTABLISHMENT AND DUTIES.—To be eli11 gible to receive a grant under this section, each

12 State shall establish a Consumer Task Force (re13 ferred to in this section as the ‘‘Task Force’’) to as14 sist the State in the development, implementation,

15 and evaluation of real choice systems change initia16 tives.

17 (2) APPOINTMENT.—Members of the Task

18 Force shall be appointed by the Chief Executive Of19 ficer of the State in accordance with the require20 ments of paragraph (3), after the solicitation of rec21 ommendations from representatives of organizations

22 representing a broad range of individuals with dis23 abilities and organizations interested in individuals

24 with disabilities.

25 (3) COMPOSITION.—
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1 (A) IN GENERAL.—The Task Force shall

2 represent a broad range of individuals with dis3 abilities from diverse backgrounds and shall in4 clude representatives from Developmental Dis5 abilities Councils, State Independent Living

6 Councils, Commissions on Aging, organizations

7 that provide services to individuals with disabil8 ities and consumers of long-term services and

9 supports.

10 (B) INDIVIDUALS WITH DISABILITIES.—A

11 majority of the members of the Task Force

12 shall be individuals with disabilities or the rep13 resentatives of such individuals.

14 (C) LIMITATION.—The Task Force shall

15 not include employees of any State agency pro16 viding services to individuals with disabilities

17 other than employees of agencies described in

18 the Developmental Disabilities Assistance and

19 Bill of Rights Act (42 U.S.C. 6000 et seq.).

20 (e) AVAILABILITY OF FUNDS.—

21 (1) FUNDS ALLOTTED TO STATES.—Funds al22 lotted to a State under a grant made under this sec23 tion for a fiscal year shall remain available until ex24 pended.
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1 (2) FUNDS NOT ALLOTTED TO STATES.—Funds

2 not allotted to States in the fiscal year for which

3 they are appropriated shall remain available in suc4 ceeding fiscal years for allotment by the Secretary

5 using the allotment formula established by the Sec6 retary under subsection (b)(2).

7 (f) ANNUAL REPORT.—A State that receives a grant

8 under this section shall submit an annual report to the

9 Secretary on the use of funds provided under the grant.

10 Each report shall include the percentage increase in the

11 number of eligible individuals in the State who receive

12 long-term services and supports in the most integrated

13 setting appropriate, including through community attend14 ant services and supports and other community-based set15 tings.

16 (g) APPROPRIATION.—Out of any funds in the Treas17 ury not otherwise appropriated, there is authorized to be

18 appropriated and there is appropriated to make grants

19 under this section for—

20 (1) fiscal year 2001, $25,000,000; and

21 (2) for fiscal year 2002 and each fiscal year

22 thereafter, such sums as may be necessary to carry

23 out this section.
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1 SEC. 5. STATE OPTION FOR ELIGIBILITY FOR INDIVIDUALS.

2 (a) IN GENERAL.—Section 1903(f) of the Social Se3 curity Act (42 U.S.C. 1396b(f)) is amended—

4 (1) in paragraph (4)(C), by inserting ‘‘subject

5 to paragraph (5),’’ after ‘‘does not exceed’’, and

6 (2) by adding at the end the following:

7 ‘‘(5)(A) A State may waive the income, resources,

8 and deeming limitations described in paragraph (4)(C) in

9 such cases as the State finds the potential for employment

10 opportunities would be enhanced through the provision of

11 medical assistance for community attendant services and

12 supports in accordance with section 1935.

13 ‘‘(B) In the case of an individual who is eligible for

14 medical assistance described in subparagraph (A) only as

15 a result of the application of such subparagraph, the State

16 may, notwithstanding section 1916(b), impose a premium

17 based on a sliding scale related to income.’’.

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

19 subsection (a) shall apply to medical assistance provided

20 for community attendant services and supports described

21 in section 1935 of the Social Security Act furnished on

22 or after October 1, 2000.

23 SEC. 6. STUDIES AND REPORTS.

24 (a) REVIEW OF, AND REPORT ON, REGULATIONS.—

25 The National Council on Disability established under title

26 IV of the Rehabilitation Act of 1973 (29 U.S.C. 780 et
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1 seq.) shall review regulations in existence under title XIX

2 of the Social Security Act (42 U.S.C. 1396 et seq.) on

3 the date of enactment of this Act insofar as such regula4 tions regulate the provision of home health services, per5 sonal care services, and other services in home and com6 munity-based settings and, not later than 1 year after

7 such date, submit a report to Congress on the results of

8 such study, together with any recommendations for legis9 lation that the Council determines to be appropriate as

10 a result of the study.

11 (b) REPORT ON REDUCED TITLE XIX EXPENDI12 TURES.—Not later than 1 year after the date of enact13 ment of this Act, the Secretary of Health and Human

14 Services shall submit to Congress a report on how expendi15 tures under the medicaid program under title XIX of the

16 Social Security Act (42 U.S.C. 1396 et seq.) can be re17 duced by the furnishing of community attendant services

18 and supports in accordance with section 1935 of such Act

19 (as added by section 3 of this Act).

20 SEC. 7. TASK FORCE ON FINANCING OF LONG-TERM CARE

21 SERVICES.

22 The Secretary of Health and Human Services shall

23 establish a task force to examine appropriate methods for

24 financing long-term services and supports. The task force

25 shall include significant representation of individuals (and
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1 representatives of individuals) who receive such services

2 and supports.

Æ