‘‘(d) DELIVERY MODELS.—For purposes of this sec-
tion:
‘‘(1) AGENCY-PROVIDER
MODEL.—The term
‘agency-provider model’ means, with respect to the
provision of community attendant services and sup-
ports for an individual, a method of providing con-
sumer-directed services and supports under which
entities contract for the provision of such services
and supports.
‘‘(2) OTHER MODELS.—The term ‘other models’
means methods, other than an agency-provider
model, for provision of consumer-directed services
and supports. Such models may include the provi-
sion of vouchers, direct cash payments, or use of a
fiscal agent to assist in obtaining services.
‘‘(e) STATE QUALITY ASSURANCE PROGRAM.—A
State shall, in order to continue to receive Federal finan-
cial participation for providing services and supports
under this section, be required to, at a minimum, establish
and maintain a quality assurance program that provides
the following:
‘‘(1) The State shall establish requirements, as
appropriate for agency-based and other models,
including—
‘‘(A) minimum qualifications and training
requirements, as appropriate for agency-based
and other models;
‘‘(B) financial operating standards; and
‘‘(C) an appeals procedure for eligibility
denials and a procedure for resolving disagree-
ments over the terms of an individualized plan.
‘‘(2) The State shall modify its quality assur-
ance program, where appropriate, to maximize con-
sumer independence and consumer direction in both
agency-provided and other models.
‘‘(3) The State shall provide a system that pro-
vides for the external monitoring of the quality of
services by entities consisting of consumers and their
representatives, disability organizations, providers,
family, members of the community, and others.
‘‘(4) The State shall provide ongoing moni-
toring of the health and well-being of each recipient.
‘‘(5) The State shall require that quality assur-
ance mechanisms appropriate for the individual
should be included in the individual’s written plan.
‘‘(6) The State shall establish a process for re-
porting, investigation, and resolution of allegations
of neglect, abuse, or exploitation.
‘‘(7) The State shall obtain meaningful con-
sumer input, including consumer surveys, that meas-
ure the extent to which participants receive the serv-
ices and supports described in the individual plan
and participant satisfaction with such services and
supports.
‘‘(8) The State shall make available to the pub-
lic the findings of the quality assurance program.
‘‘(9) The State shall establish an on-going pub-
lic process for development, implementation, and re-
view of the State’s quality assurance program as de-
scribed in this subparagraph.
‘‘(10) The State shall develop sanctions.
‘‘(f) FEDERAL ROLE IN QUALITY ASSURANCE.—The
Secretary shall conduct a periodic sample review of out-
comes for individuals based upon the individual’s plan of
support and based upon the quality assurance program of
the state plan. The Secretary may conduct targeted re-
views upon receipt of allegations of neglect, abuse, or ex-
ploitation. The Secretary shall develop guidelines for
states to use in developing sanctions.
‘‘(g) ELIGIBILITY.—Effective January 1, 2001, a
State may not exercise the option of coverage of individ-
uals under section 1902(a)(10)(A)(ii)(V) without pro-
viding coverage under section 1902(a)(10)(A)(ii)(VI).
‘‘(h) REPORT ON IMPACT OF SECTION.—The Sec-
retary shall submit to Congress periodic reports on the
impact of this section on beneficiaries, States, and the
Federal Government.’’.
(c) COVERAGE AS MEDICAL ASSISTANCE.—
(1) IN GENERAL.—Section 1905(a) of such Act
(42 U.S.C. 1396d) is amended—
(A) by striking ‘‘and’’ at the end of para-
graph (26),
(B) by redesignating paragraph (27) as
paragraph (28), and
(C) by inserting after paragraph (26) the
following new paragraph:
‘‘(27) community attendant services and sup-
ports (to the extent allowed and as defined in section
1935); and’’.
(2) 
ELIGIBILITY
CLASSIFICATIONS.—Section
1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C.
1396a(a)(10)(A)(ii)(VI)) is amended by inserting
‘‘or community attendant services and supports’’
after ‘‘section 1915’’ each place it appears.
(3) 
CONFORMING
AMENDMENT.—Section
1902(a)(10)(C)(iv) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(10)(C)(iv)) is amended by striking ‘‘(24)’’
and inserting ‘‘(27)’’.
SEC. 4. GRANTS TO DEVELOP AND ESTABLISH REAL
CHOICE SYSTEMS CHANGE INITIATIVES.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the
‘‘Secretary’’) shall award grants described in sub-
section (b) to States to support real choice systems
change initiatives that establish specific actions steps
and specific timetables to provide consumer-respon-
sive long term services and supports to eligible indi-
viduals in the most integrated setting appropriate
based on the unique strengths and needs of the indi-
vidual and the priorities and concerns of the indi-
vidual (or, as appropriate, the individual’s represent-
ative). A State may submit an application for a
grant authorized under this section at such time, in
such manner, and containing such information as
the Secretary may determine. The application shall
be jointly developed and signed by the designated
state official and the chairperson of the task force
described in subsection (d), acting on behalf of and
at the direction of the task force.
(2) DEFINITION
OF
STATE.—In this section,
the term ‘‘State’’ means each of the 50 States, the
District of Columbia, Puerto Rico, Guam, the
United States Virgin Islands, American Samoa, and
the Commonwealth of the Northern Mariana Is-
lands.
(b) GRANTS FOR REAL CHOICE SYSTEMS CHANGE
INITIATIVES.—
(1) IN
GENERAL.—Out of the funds appro-
priated under subsection (f), the Secretary shall
award grants to States to—
(A) support the establishment, implemen-
tation, and operation of the State real choice
systems change initiatives described in sub-
section (a); and
(B) conduct outreach campaigns regarding
the existence of such initiatives.
(2) DETERMINATION OF AWARDS; STATE AL-
LOTMENTS.—The Secretary shall provide a formula
for the distribution of the total amount of the allot-
ments provided in each fiscal year under subpara-
graph (A) among States. Such formula shall give
preference to States that have a relatively higher
proportion of long-term services and supports fur-
nished to individuals in an institutional setting but
who have a plan described in an application sub-
mitted under subsection (a).
(c) AUTHORIZED ACTIVITIES.—Any State that re-
ceives a grant under this section shall use the funds made