I
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 attend-
ant services under the Medicaid program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. OPTIONAL COVERAGE OF COMMUNITY-BASED
ATTENDANT SERVICES UNDER THE MEDIC-
AID PROGRAM.
(a) COVERAGE.—
(1) IN GENERAL.—Section 1905 of the Social
Security Act (42 U.S.C. 1396d) is amended—
(A) in subsection (a)—
(i) by striking ‘‘and’’ at the end of
paragraph (24),
(ii) by redesignating paragraph (25)
as paragraph (26), and
(iii) by inserting after paragraph (24)
the following new paragraph:
‘‘(25) subject to subsection (t)(3), qualified
community-based attendant services (as defined in
subsection (t)(1)); and’’; and
(B) by adding at the end the following new
subsection:
‘‘(t)(1) The term ‘qualified community-based attend-
ant services’ means community-based attendant services
furnished to individuals under a plan of care if all the fol-
lowing conditions are met:
‘‘(A) The individuals to whom the services are
furnished select, manage, and control the attendant
services to be provided.
‘‘(B) Attendant services would be covered only
if they are home or community-based and are not
provided in a nursing facility or other institutional
facility.
‘‘(C) Eligibility for such coverage would be lim-
ited to those who required such services based on
functional need.
‘‘(D) Such services would be available in home
and in other locations, including school, work, recre-
ation and church.
‘‘(E) Such services would be available on an as-
needed basis.
‘‘(F) Backup and emergency attendant services
would be available.
‘‘(G) Notwithstanding section 1916, a State
may impose copayments and cost-sharing for individ-
uals for attendant services based on the income of
individuals involved and in a manner so as not to be
a disincentive for employment.
‘‘(H) Coverage of services could be effected
through any appropriate means, which may include
through provision of vouchers to eligible individuals,
through direct cash payment, through an individual
provider model, or through a consumer-directed
agency model.
‘‘(I) Voluntary training should be available to
recipients on how to select, manage, and dismiss at-
tendants.
‘‘(J) The particular attendant services to be
covered for an eligible individual would be based on
a service delivery plan that is agreed upon by the in-
dividual and the attendants.
‘‘(K) Health-related tasks included within such
services could be delegated to (or performed by) un-
licensed personal attendants.
‘‘(L) The State provides for the periodic sub-
mission to the Secretary of reports on the coverage
of such services under this subsection.
‘‘(2) Medical assistance for qualified community-
based attendant services need not be made available in all
geographic areas of a State or to all beneficiaries, notwith-
standing anything to the contrary in section 1902(a)(1)
or section 1902(a)(10)(B).
‘‘(3) Medical assistance for qualified community-
based attendant services may not be made available by a
State under section 1905(a)(25) unless the State estab-
lishes that the provision of medical assistance with respect
to such services will not increase the Federal payments
made under this title above the level of such payments
if such medical assistance under such section had not been
provided.’’.
(2) CONFORMING AMENDMENTS.—(A) Section
1902(j) (42 U.S.C. 1396a(j)) is amended by striking
‘‘(25)’’ and inserting ‘‘26)’’.
(B) Section 1902(a)(10)(C)(iv) (42 U.S.C.
1396a(a)(10)(C)(iv)) is amended by striking ‘‘(24)’’
and inserting ‘‘(25)’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to services furnished on or after
the date of the enactment of this Act.
(c) REPORTS TO CONGRESS.—The Secretary of Sec-
retary of Health and Human Services shall submit to Con-
gress periodic reports on the impact of the amendments
made by this section on medicaid beneficiaries, States, and
the Federal Government.
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