•HR 1200 SC4
(2) Outpatient mental health services.
(3) Partial hospitalization and day and evening
treatment programs.
(4) Psychosocial rehabilitation services.
(5) Pharmacotherapeutic interventions.
(6) Other rehabilitation services, including half-
way and three-quarter-way house care.
(7) Inpatient mental health services.
(8) Care coordination services (as defined in
subsection (g)(1)).
(f) SUBSTANCE ABUSE TREATMENT SERVICES.—In
this title, the term ‘‘substance abuse treatment services’’
means services for the treatment of dependency on alcohol
or controlled substances provided through a treatment
program meeting State qualification standards and in-
cludes the following services:
(1) Crisis intervention, including assessment,
diagnosis, and referral.
(2) Detoxification services, in ambulatory and
inpatient settings.
(3) Outpatient services, including intensive day
and evening programs, continuing care, and family
services.
(4) Short-term residential services in a hospital
or free-standing program.
•HR 1200 SC4
(5) Long-term residential services, including
therapeutic communities and halfway houses.
(6) Pharmacotherapeutic interventions.
(7) Care coordination services (as defined in
subsection (g)(1)).
(g) CARE COORDINATION SERVICES.—
(1) IN GENERAL.—In this title, the term ‘‘care
coordination services’’ means services provided by
care coordinators (as defined in paragraph (2)) to
individuals described in paragraph (3) for the co-
ordination and monitoring of mental health services,
substance abuse treatment services, and home and
community-based long term care services to ensure
appropriate, cost-effective utilization of such services
in a comprehensive and continuous manner, and in-
cludes—
(A) transition management between inpa-
tient facilities and community-based services,
including assisting patients in identifying and
gaining access to appropriate ancillary services;
and
(B) evaluating and recommending appro-
priate treatment services, in cooperation with
patients and other providers and in conjunction
•HR 1200 SC4
with any quality review program or plan of care
under section 205.
(2) CARE COORDINATOR.—
(A) IN GENERAL.—In this title, the term
‘‘care coordinator’’ means an individual or non-
profit or public agency or organization which
the State health security program determines—
(i) is capable of performing directly,
efficiently, and effectively the duties of a
care coordinator described in paragraph
(1), and
(ii) demonstrates capability in estab-
lishing and periodically reviewing and re-
vising plans of care, and in arranging for
and monitoring the provision and quality
of services under any plan.
(B) INDEPENDENCE.—State health secu-
rity programs shall establish safeguards to as-
sure that care coordinators have no financial in-
terest in treatment decisions or placements.
Care coordination may not be provided through
any structure or mechanism through which
quality review is performed.
(3) ELIGIBLE INDIVIDUALS.—An individual de-
scribed in this paragraph is an individual—
•HR 1200 SC4
(A) described in section 203 (relating to
individuals qualifying for long term and chronic
care services); or
(B) determined (in a manner specified by
the Board)—
(i) to have a serious mental illness (as
defined by the Board), or
(ii) to have a history of substance
abuse displaying severe associated illness
or previous treatment failure (as defined
by the Board).
(h) DENTAL SERVICES.—In this title, the term ‘‘den-
tal services’’ means preventive and prophalactic dental
treatment consistent with a periodicity schedule estab-
lished by the Board and treatment for dental disease and
injury in children under 18 years of age, and does not
include orthodontic services.
(i) NURSING
FACILITY; NURSING
FACILITY
SERV-
ICES.—Except as may be provided by the Board, the
terms ‘‘nursing facility’’ and ‘‘nursing facility services’’
have the meanings given such terms in sections 1919(a)
and 1905(f), respectively, of the Social Security Act.
(j) OTHER TERMS.—Except as may be provided by
the Board, the definitions contained in section 1861 of the
Social Security Act shall apply.
•HR 1200 SC4
SEC. 203. SPECIAL RULES FOR HOME AND COMMUNITY-
BASED LONG-TERM CARE SERVICES.
(a) QUALIFYING INDIVIDUALS.—For purposes of sec-
tion 201(a)(5)(C), individuals described in this subsection
are the following individuals:
(1) ADULTS.—Individuals 18 years of age or
older determined (in a manner specified by the
Board)—
(A) to be unable to perform, without the
assistance of an individual, at least 2 of the fol-
lowing 5 activities of daily living (or who has a
similar level of disability due to cognitive
impairment)—
(i) bathing;
(ii) eating;
(iii) dressing;
(iv) toileting; and
(v) transferring in and out of a bed or
in and out of a chair; or
(B) due to cognitive or mental impair-
ments, requires supervision because the individ-
ual behaves in a manner that poses health or
safety hazards to himself or herself or others.
(2) CHILDREN.—Individuals under 18 years of
age determined (in a manner specified by the Board)
•HR 1200 SC4
to meet such alternative standard of disability for
children as the Board develops.
(b) LIMIT ON SERVICES.—
(1) IN GENERAL.—No individual is entitled to
receive benefits under a State health security pro-
gram with respect to home and community-based
long term care services in a period (specified by the
Board) to the extent the amount of payments for
such benefits exceeds 65 percent (or such alternative
ratio as the Board establishes under paragraph (2))
of the average of amount of payment that would
have been made under the program during the pe-
riod if the individual were a resident of a nursing fa-
cility in the same area in which the services were
provided.
(2) ALTERNATIVE RATIO.—The Board may es-
tablish for purposes of paragraph (1) an alternative
ratio (of payments for home and community-based
long term care services to payments for nursing fa-
cility services) as the Board determines to be more
consistent with the goal of providing cost-effective
long-term care in the most appropriate and least
restrictive setting.
•HR 1200 SC4
creasing the supply and expanding the scope of
practice of mid-level professionals and the use of
community health outreach workers and other non-
professional health care workers.
(2) MEMBERSHIP.—The membership of the
committee shall include individuals (in such number
as the Board may determine) from the health pro-
fessions and health services with expertise in—
(A) primary care services;
(B) the education and training of primary
care practitioners;
(C) the special health needs of medically
underserved populations;
(D) the training, educational, and financial
incentives that would encourage health practi-
tioners to serve in medically underserved areas;
(E) the delivery of health services through
community-based and public facilities; and
(F) developing alternative models of deliv-
ering primary health services to medically un-
derserved populations.
In appointing such individuals, the Board shall as-
sure significant representation of consumers of
health services and providers of health services.