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104TH CONGRESS

2D SESSION H. R. 4250

To amend title XIX of the Social Security Act to permit a State the option

of covering community-based attendant services under the Medicaid program.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 27, 1996

Mr. GUNDERSON (for himself and Mr. GINGRICH) introduced the following

bill; which was referred to the Committee on Commerce

A BILL

To amend title XIX of the Social Security Act to permit

a State the option of covering community-based attendant services 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. OPTIONAL COVERAGE OF COMMUNITY-BASED

4 ATTENDANT SERVICES UNDER THE MEDIC5 AID PROGRAM.

6 (a) COVERAGE.—

7 (1) IN GENERAL.—Section 1905 of the Social

8 Security Act (42 U.S.C. 1396d) is amended—

9 (A) in subsection (a)—
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1 (i) by striking ‘‘and’’ at the end of

2 paragraph (24),

3 (ii) by redesignating paragraph (25)

4 as paragraph (26), and

5 (iii) by inserting after paragraph (24)

6 the following new paragraph:

7 ‘‘(25) subject to subsection (t)(3), qualified

8 community-based attendant services (as defined in

9 subsection (t)(1)); and’’; and

10 (B) by adding at the end the following new

11 subsection:

12 ‘‘(t)(1) The term ‘qualified community-based attend13 ant services’ means community-based attendant services

14 furnished to individuals under a plan of care if all the fol15 lowing conditions are met:

16 ‘‘(A) The individuals to whom the services are

17 furnished select, manage, and control the attendant

18 services to be provided.

19 ‘‘(B) Attendant services would be covered only

20 if they are home or community-based and are not

21 provided in a nursing facility or other institutional

22 facility.

23 ‘‘(C) Eligibility for such coverage would be lim24 ited to those who required such services based on

25 functional need.
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1 ‘‘(D) Such services would be available in home

2 and in other locations, including school, work, recre3 ation and church.

4 ‘‘(E) Such services would be available on an as5 needed basis.

6 ‘‘(F) Backup and emergency attendant services

7 would be available.

8 ‘‘(G) Notwithstanding section 1916, a State

9 may impose copayments and cost-sharing for individ10 uals for attendant services based on the income of

11 individuals involved and in a manner so as not to be

12 a disincentive for employment.

13 ‘‘(H) Coverage of services could be effected

14 through any appropriate means, which may include

15 through provision of vouchers to eligible individuals,

16 through direct cash payment, through an individual

17 provider model, or through a consumer-directed

18 agency model.

19 ‘‘(I) Voluntary training should be available to

20 recipients on how to select, manage, and dismiss at21 tendants.

22 ‘‘(J) The particular attendant services to be

23 covered for an eligible individual would be based on

24 a service delivery plan that is agreed upon by the in25 dividual and the attendants.
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1 ‘‘(K) Health-related tasks included within such

2 services could be delegated to (or performed by) un3 licensed personal attendants.

4 ‘‘(L) The State provides for the periodic sub5 mission to the Secretary of reports on the coverage

6 of such services under this subsection.

7 ‘‘(2) Medical assistance for qualified community8 based attendant services need not be made available in all

9 geographic areas of a State or to all beneficiaries, notwith10 standing anything to the contrary in section 1902(a)(1)

11 or section 1902(a)(10)(B).

12 ‘‘(3) Medical assistance for qualified community13 based attendant services may not be made available by a

14 State under section 1905(a)(25) unless the State estab15 lishes that the provision of medical assistance with respect

16 to such services will not increase the Federal payments

17 made under this title above the level of such payments

18 if such medical assistance under such section had not been

19 provided.’’.

20 (2) CONFORMING AMENDMENTS.—(A) Section

21 1902(j) (42 U.S.C. 1396a(j)) is amended by striking

22 ‘‘(25)’’ and inserting ‘‘26)’’.

23 (B) Section 1902(a)(10)(C)(iv) (42 U.S.C.

24 1396a(a)(10)(C)(iv)) is amended by striking ‘‘(24)’’

25 and inserting ‘‘(25)’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall apply to services furnished on or after

3 the date of the enactment of this Act.

4 (c) REPORTS TO CONGRESS.—The Secretary of Sec5 retary of Health and Human Services shall submit to Con6 gress periodic reports on the impact of the amendments

7 made by this section on medicaid beneficiaries, States, and

8 the Federal Government.

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