H. R. 3590—720 
right to formulate advance directives or other written 
instructions recognized under State law, such as a living 
will or durable power of attorney for health care, in the 
case that an injury or illness causes the individual to 
be unable to make health care decisions. 
‘‘(C) ELECTRONIC MANAGEMENT OF FUNDS.—The Sec-
retary shall establish procedures for— 
‘‘(i) crediting an account established on behalf of 
a beneficiary with the beneficiary’s cash daily benefit; 
‘‘(ii) allowing the beneficiary to access such account 
through debit cards; and 
‘‘(iii) accounting for withdrawals by the beneficiary 
from such account. 
‘‘(D) PRIMARY PAYOR RULES FOR BENEFICIARIES WHO 
ARE ENROLLED IN MEDICAID.—In the case of an eligible 
beneficiary who is enrolled in Medicaid, the following pay-
ment rules shall apply: 
‘‘(i) INSTITUTIONALIZED BENEFICIARY.—If the bene-
ficiary is a patient in a hospital, nursing facility, inter-
mediate care facility for the mentally retarded, or an 
institution for mental diseases, the beneficiary shall 
retain an amount equal to 5 percent of the beneficiary’s 
daily or weekly cash benefit (as applicable) (which 
shall be in addition to the amount of the beneficiary’s 
personal needs allowance provided under Medicaid), 
and the remainder of such benefit shall be applied 
toward the facility’s cost of providing the beneficiary’s 
care, and Medicaid shall provide secondary coverage 
for such care. 
‘‘(ii) BENEFICIARIES RECEIVING HOME AND COMMU-
NITY-BASED SERVICES.— 
‘‘(I) 50 PERCENT OF BENEFIT RETAINED BY BENE-
FICIARY.—Subject to subclause (II), if a beneficiary 
is receiving medical assistance under Medicaid for 
home and community based services, the bene-
ficiary shall retain an amount equal to 50 percent 
of the beneficiary’s daily or weekly cash benefit 
(as applicable), and the remainder of the daily 
or weekly cash benefit shall be applied toward 
the cost to the State of providing such assistance 
(and shall not be used to claim Federal matching 
funds under Medicaid), and Medicaid shall provide 
secondary coverage for the remainder of any costs 
incurred in providing such assistance. 
‘‘(II) REQUIREMENT
FOR
STATE
OFFSET.—A 
State shall be paid the remainder of a beneficiary’s 
daily or weekly cash benefit under subclause (I) 
only if the State home and community-based 
waiver under section 1115 of the Social Security 
Act (42 U.S.C. 1315) or subsection (c) or (d) of 
section 1915 of such Act (42 U.S.C. 1396n), or 
the State plan amendment under subsection (i) 
of such section does not include a waiver of the 
requirements of section 1902(a)(1) of the Social 
Security Act (relating to statewideness) or of sec-
tion 1902(a)(10)(B) of such Act (relating to com-
parability) and the State offers at a minimum
H. R. 3590—721 
case management services, personal care services, 
habilitation services, and respite care under such 
a waiver or State plan amendment. 
‘‘(III) DEFINITION OF HOME AND COMMUNITY- 
BASED SERVICES.—In this clause, the term ‘home 
and community-based services’ means any services 
which may be offered under a home and commu-
nity-based waiver authorized for a State under 
section 1115 of the Social Security Act (42 U.S.C. 
1315) or subsection (c) or (d) of section 1915 of 
such Act (42 U.S.C. 1396n) or under a State plan 
amendment under subsection (i) of such section. 
‘‘(iii) BENEFICIARIES
ENROLLED
IN
PROGRAMS
OF 
ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE).— 
‘‘(I) IN
GENERAL.—Subject to subclause (II), 
if a beneficiary is receiving medical assistance 
under Medicaid for PACE program services under 
section 1934 of the Social Security Act (42 U.S.C. 
1396u–4), the beneficiary shall retain an amount 
equal to 50 percent of the beneficiary’s daily or 
weekly cash benefit (as applicable), and the 
remainder of the daily or weekly cash benefit shall 
be applied toward the cost to the State of providing 
such assistance (and shall not be used to claim 
Federal matching funds under Medicaid), and 
Medicaid shall provide secondary coverage for the 
remainder of any costs incurred in providing such 
assistance. 
‘‘(II) INSTITUTIONALIZED RECIPIENTS OF PACE 
PROGRAM
SERVICES.—If a beneficiary receiving 
assistance under Medicaid for PACE program serv-
ices is a patient in a hospital, nursing facility, 
intermediate 
care 
facility 
for 
the 
mentally 
retarded, or an institution for mental diseases, 
the beneficiary shall be treated as in institutional-
ized beneficiary under clause (i). 
‘‘(2) AUTHORIZED REPRESENTATIVES.— 
‘‘(A) IN GENERAL.—The Secretary shall establish proce-
dures to allow access to a beneficiary’s cash benefits by 
an authorized representative of the eligible beneficiary on 
whose behalf such benefits are paid. 
‘‘(B) QUALITY
ASSURANCE
AND
PROTECTION
AGAINST 
FRAUD
AND
ABUSE.—The procedures established under 
subparagraph (A) shall ensure that authorized representa-
tives of eligible beneficiaries comply with standards of con-
duct established by the Secretary, including standards 
requiring that such representatives provide quality services 
on behalf of such beneficiaries, do not have conflicts of 
interest, and do not misuse benefits paid on behalf of 
such beneficiaries or otherwise engage in fraud or abuse. 
‘‘(3) COMMENCEMENT OF BENEFITS.—Benefits shall be paid 
to, or on behalf of, an eligible beneficiary beginning with the 
first month in which an application for such benefits is 
approved. 
‘‘(4) ROLLOVER
OPTION
FOR
LUMP-SUM
PAYMENT.—An 
eligible beneficiary may elect to—
H. R. 3590—722 
‘‘(A) defer payment of their daily or weekly benefit 
and to rollover any such deferred benefits from month- 
to-month, but not from year-to-year; and 
‘‘(B) receive a lump-sum payment of such deferred 
benefits in an amount that may not exceed the lesser 
of— 
‘‘(i) the total amount of the accrued deferred bene-
fits; or 
‘‘(ii) the applicable annual benefit. 
‘‘(5) PERIOD FOR DETERMINATION OF ANNUAL BENEFITS.— 
‘‘(A) IN
GENERAL.—The applicable period for deter-
mining with respect to an eligible beneficiary the applicable 
annual benefit and the amount of any accrued deferred 
benefits is the 12-month period that commences with the 
first month in which the beneficiary began to receive such 
benefits, and each 12-month period thereafter. 
‘‘(B) INCLUSION
OF
INCREASED
BENEFITS.—The Sec-
retary shall establish procedures under which cash benefits 
paid to an eligible beneficiary that increase or decrease 
as a result of a change in the functional status of the 
beneficiary before the end of a 12-month benefit period 
shall be included in the determination of the applicable 
annual benefit paid to the eligible beneficiary. 
‘‘(C) RECOUPMENT
OF
UNPAID, ACCRUED
BENEFITS.— 
‘‘(i) IN GENERAL.—The Secretary, in coordination 
with the Secretary of the Treasury, shall recoup any 
accrued benefits in the event of— 
‘‘(I) the death of a beneficiary; or 
‘‘(II) the failure of a beneficiary to elect under 
paragraph (4)(B) to receive such benefits as a 
lump-sum payment before the end of the 12-month 
period in which such benefits accrued. 
‘‘(ii) PAYMENT INTO CLASS INDEPENDENCE FUND.— 
Any benefits recouped in accordance with clause (i) 
shall be paid into the CLASS Independence Fund and 
used in accordance with section 3206. 
‘‘(6) REQUIREMENT TO RECERTIFY ELIGIBILITY FOR RECEIPT 
OF
BENEFITS.—An eligible beneficiary shall periodically, as 
determined by the Secretary— 
‘‘(A) recertify by submission of medical evidence the 
beneficiary’s continued eligibility for receipt of benefits; 
and 
‘‘(B) submit records of expenditures attributable to the 
aggregate cash benefit received by the beneficiary during 
the preceding year. 
‘‘(7) SUPPLEMENT, NOT SUPPLANT OTHER HEALTH CARE BENE-
FITS.—Subject to the Medicaid payment rules under paragraph 
(1)(D), benefits received by an eligible beneficiary shall supple-
ment, but not supplant, other health care benefits for which 
the beneficiary is eligible under Medicaid or any other Federally 
funded program that provides health care benefits or assistance. 
‘‘(d) ADVOCACY SERVICES.—An agreement entered into under 
subsection (a)(2)(A)(ii) shall require the Protection and Advocacy 
System for the State to— 
‘‘(1) assign, as needed, an advocacy counselor to each 
eligible beneficiary that is covered by such agreement and 
who shall provide an eligible beneficiary with—
H. R. 3590—723 
‘‘(A) information regarding how to access the appeals 
process established for the program; 
‘‘(B) assistance with respect to the annual recertifi-
cation and notification required under subsection (c)(6); 
and 
‘‘(C) such other assistance with obtaining services as 
the Secretary, by regulation, shall require; and 
‘‘(2) ensure that the System and such counselors comply 
with the requirements of subsection (h). 
‘‘(e) ADVICE
AND
ASSISTANCE
COUNSELING.—An agreement 
entered into under subsection (a)(2)(A)(iii) shall require the entity 
to assign, as requested by an eligible beneficiary that is covered 
by such agreement, an advice and assistance counselor who shall 
provide an eligible beneficiary with information regarding— 
‘‘(1) accessing and coordinating long-term services and sup-
ports in the most integrated setting; 
‘‘(2) possible eligibility for other benefits and services; 
‘‘(3) development of a service and support plan; 
‘‘(4) information about programs established under the 
Assistive Technology Act of 1998 and the services offered under 
such programs; 
‘‘(5) available assistance with decision making concerning 
medical care, including the right to accept or refuse medical 
or surgical treatment and the right to formulate advance direc-
tives or other written instructions recognized under State law, 
such as a living will or durable power of attorney for health 
care, in the case that an injury or illness causes the individual 
to be unable to make health care decisions; and 
‘‘(6) such other services as the Secretary, by regulation, 
may require. 
‘‘(f) NO EFFECT ON ELIGIBILITY FOR OTHER BENEFITS.—Benefits 
paid to an eligible beneficiary under the CLASS program shall 
be disregarded for purposes of determining or continuing the bene-
ficiary’s eligibility for receipt of benefits under any other Federal, 
State, or locally funded assistance program, including benefits paid 
under titles II, XVI, XVIII, XIX, or XXI of the Social Security 
Act (42 U.S.C. 401 et seq., 1381 et seq., 1395 et seq., 1396 et 
seq., 1397aa et seq.), under the laws administered by the Secretary 
of Veterans Affairs, under low-income housing assistance programs, 
or under the supplemental nutrition assistance program established 
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.). 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this title shall be 
construed as prohibiting benefits paid under the CLASS Independ-
ence Benefit Plan from being used to compensate a family caregiver 
for providing community living assistance services and supports 
to an eligible beneficiary. 
‘‘(h) PROTECTION AGAINST CONFLICT OF INTERESTS.—The Sec-
retary shall establish procedures to ensure that the Eligibility 
Assessment System, the Protection and Advocacy System for a 
State, advocacy counselors for eligible beneficiaries, and any other 
entities that provide services to active enrollees and eligible bene-
ficiaries under the CLASS program comply with the following: 
‘‘(1) If the entity provides counseling or planning services, 
such services are provided in a manner that fosters the best 
interests of the active enrollee or beneficiary.