H. R. 3590—711 
individual is required to travel because of the individual’s 
employment (or in the case of an individual who is a 
member of the uniformed services, is on active duty and 
is physically able to perform the duties of the individual’s 
position); and 
‘‘(B) is able to perform all the usual and customary 
duties of the individual’s employment on the individual’s 
regular work schedule. 
‘‘(3) ACTIVITIES OF DAILY LIVING.—The term ‘activities of 
daily living’ means each of the following activities specified 
in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986: 
‘‘(A) Eating. 
‘‘(B) Toileting. 
‘‘(C) Transferring. 
‘‘(D) Bathing. 
‘‘(E) Dressing. 
‘‘(F) Continence. 
‘‘(4) CLASS PROGRAM.—The term ‘CLASS program’ means 
the program established under this title. 
‘‘(5) ELIGIBILITY ASSESSMENT SYSTEM.—The term ‘Eligibility 
Assessment System’ means the entity established by the Sec-
retary under section 3205(a)(2) to make functional eligibility 
determinations for the CLASS program. 
‘‘(6) ELIGIBLE BENEFICIARY.— 
‘‘(A) IN GENERAL.—The term ‘eligible beneficiary’ means 
any individual who is an active enrollee in the CLASS 
program and, as of the date described in subparagraph 
(B)— 
‘‘(i) has paid premiums for enrollment in such pro-
gram for at least 60 months; 
‘‘(ii) has earned, with respect to at least 3 calendar 
years that occur during the first 60 months for which 
the individual has paid premiums for enrollment in 
the program, at least an amount equal to the amount 
of wages and self-employment income which an indi-
vidual must have in order to be credited with a quarter 
of coverage under section 213(d) of the Social Security 
Act for the year; and 
‘‘(iii) has paid premiums for enrollment in such 
program for at least 24 consecutive months, if a lapse 
in premium payments of more than 3 months has 
occurred during the period that begins on the date 
of the individual’s enrollment and ends on the date 
of such determination. 
‘‘(B) DATE DESCRIBED.—For purposes of subparagraph 
(A), the date described in this subparagraph is the date 
on which the individual is determined to have a functional 
limitation described in section 3203(a)(1)(C) that is 
expected to last for a continuous period of more than 90 
days. 
‘‘(C) REGULATIONS.—The Secretary shall promulgate 
regulations specifying exceptions to the minimum earnings 
requirements under subparagraph (A)(ii) for purposes of 
being considered an eligible beneficiary for certain popu-
lations. 
‘‘(7) HOSPITAL; NURSING
FACILITY; INTERMEDIATE
CARE 
FACILITY
FOR
THE
MENTALLY
RETARDED; INSTITUTION
FOR
H. R. 3590—712 
MENTAL
DISEASES.—The terms ‘hospital’, ‘nursing facility’, 
‘intermediate care facility for the mentally retarded’, and 
‘institution for mental diseases’ have the meanings given such 
terms for purposes of Medicaid. 
‘‘(8) CLASS INDEPENDENCE ADVISORY COUNCIL.—The term 
‘CLASS Independence Advisory Council’ or ‘Council’ means the 
Advisory Council established under section 3207 to advise the 
Secretary. 
‘‘(9) CLASS INDEPENDENCE
BENEFIT
PLAN.—The term 
‘CLASS Independence Benefit Plan’ means the benefit plan 
developed and designated by the Secretary in accordance with 
section 3203. 
‘‘(10) CLASS INDEPENDENCE
FUND.—The term ‘CLASS 
Independence Fund’ or ‘Fund’ means the fund established under 
section 3206. 
‘‘(11) MEDICAID.—The term ‘Medicaid’ means the program 
established under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.). 
‘‘(12) POVERTY
LINE.—The term ‘poverty line’ has the 
meaning given that term in section 2110(c)(5) of the Social 
Security Act (42 U.S.C. 1397jj(c)(5)). 
‘‘(13) PROTECTION
AND
ADVOCACY
SYSTEM.—The term 
‘Protection and Advocacy System’ means the system for each 
State established under section 143 of the Developmental 
Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 
15043). 
‘‘SEC. 3203. CLASS INDEPENDENCE BENEFIT PLAN. 
‘‘(a) PROCESS FOR DEVELOPMENT.— 
‘‘(1) IN
GENERAL.—The Secretary, in consultation with 
appropriate actuaries and other experts, shall develop at least 
3 actuarially sound benefit plans as alternatives for consider-
ation for designation by the Secretary as the CLASS Independ-
ence Benefit Plan under which eligible beneficiaries shall 
receive benefits under this title. Each of the plan alternatives 
developed shall be designed to provide eligible beneficiaries 
with the benefits described in section 3205 consistent with 
the following requirements: 
‘‘(A) PREMIUMS.— 
‘‘(i) IN GENERAL.—Beginning with the first year 
of the CLASS program, and for each year thereafter, 
subject to clauses (ii) and (iii), the Secretary shall 
establish all premiums to be paid by enrollees for the 
year based on an actuarial analysis of the 75-year 
costs of the program that ensures solvency throughout 
such 75-year period. 
‘‘(ii) NOMINAL PREMIUM FOR POOREST INDIVIDUALS 
AND FULL-TIME STUDENTS.— 
‘‘(I) IN GENERAL.—The monthly premium for 
enrollment in the CLASS program shall not exceed 
the applicable dollar amount per month deter-
mined under subclause (II) for— 
‘‘(aa) any individual whose income does 
not exceed the poverty line; and 
‘‘(bb) any individual who has not attained 
age 22, and is actively employed during any
H. R. 3590—713 
period in which the individual is a full-time 
student (as determined by the Secretary). 
‘‘(II) 
APPLICABLE
DOLLAR
AMOUNT.—The 
applicable dollar amount described in this sub-
clause is the amount equal to $5, increased by 
the percentage increase in the consumer price 
index for all urban consumers (U.S. city average) 
for each year occurring after 2009 and before such 
year. 
‘‘(iii) CLASS
INDEPENDENCE
FUND
RESERVES.—At 
such time as the CLASS program has been in operation 
for 10 years, the Secretary shall establish all premiums 
to be paid by enrollees for the year based on an actu-
arial analysis that accumulated reserves in the CLASS 
Independence Fund would not decrease in that year. 
At such time as the Secretary determines the CLASS 
program demonstrates a sustained ability to finance 
expected yearly expenses with expected yearly pre-
miums and interest credited to the CLASS Independ-
ence Fund, the Secretary may decrease the required 
amount of CLASS Independence Fund reserves. 
‘‘(B) VESTING PERIOD.—A 5-year vesting period for eligi-
bility for benefits. 
‘‘(C) BENEFIT TRIGGERS.—A benefit trigger for provision 
of benefits that requires a determination that an individual 
has a functional limitation, as certified by a licensed health 
care practitioner, described in any of the following clauses 
that is expected to last for a continuous period of more 
than 90 days: 
‘‘(i) The individual is determined to be unable to 
perform at least the minimum number (which may 
be 2 or 3) of activities of daily living as are required 
under the plan for the provision of benefits without 
substantial assistance (as defined by the Secretary) 
from another individual. 
‘‘(ii) The individual requires substantial super-
vision to protect the individual from threats to health 
and safety due to substantial cognitive impairment. 
‘‘(iii) The individual has a level of functional limita-
tion similar (as determined under regulations pre-
scribed by the Secretary) to the level of functional 
limitation described in clause (i) or (ii). 
‘‘(D) CASH BENEFIT.—Payment of a cash benefit that 
satisfies the following requirements: 
‘‘(i) MINIMUM
REQUIRED
AMOUNT.—The benefit 
amount provides an eligible beneficiary with not less 
than an average of $50 per day (as determined based 
on the reasonably expected distribution of beneficiaries 
receiving benefits at various benefit levels). 
‘‘(ii) AMOUNT
SCALED
TO
FUNCTIONAL
ABILITY.— 
The benefit amount is varied based on a scale of func-
tional ability, with not less than 2, and not more than 
6, benefit level amounts. 
‘‘(iii) DAILY OR WEEKLY.—The benefit is paid on 
a daily or weekly basis. 
‘‘(iv) NO LIFETIME OR AGGREGATE LIMIT.—The ben-
efit is not subject to any lifetime or aggregate limit.
H. R. 3590—714 
‘‘(E) COORDINATION
WITH
SUPPLEMENTAL
COVERAGE 
OBTAINED
THROUGH
THE
EXCHANGE.—The benefits allow 
for coordination with any supplemental coverage purchased 
through an Exchange established under section 1311 of 
the Patient Protection and Affordable Care Act. 
‘‘(2) 
REVIEW
AND
RECOMMENDATION
BY
THE
CLASS 
INDEPENDENCE ADVISORY COUNCIL.—The CLASS Independence 
Advisory Council shall— 
‘‘(A) evaluate the alternative benefit plans developed 
under paragraph (1); and 
‘‘(B) recommend for designation as the CLASS 
Independence Benefit Plan for offering to the public the 
plan that the Council determines best balances price and 
benefits to meet enrollees’ needs in an actuarially sound 
manner, while optimizing the probability of the long-term 
sustainability of the CLASS program. 
‘‘(3) DESIGNATION
BY
THE
SECRETARY.—Not later than 
October 1, 2012, the Secretary, taking into consideration the 
recommendation of the CLASS Independence Advisory Council 
under paragraph (2)(B), shall designate a benefit plan as the 
CLASS Independence Benefit Plan. The Secretary shall publish 
such designation, along with details of the plan and the reasons 
for the selection by the Secretary, in a final rule that allows 
for a period of public comment. 
‘‘(b) ADDITIONAL PREMIUM REQUIREMENTS.— 
‘‘(1) ADJUSTMENT OF PREMIUMS.— 
‘‘(A) IN
GENERAL.—Except as provided in subpara-
graphs (B), (C), (D), and (E), the amount of the monthly 
premium determined for an individual upon such individ-
ual’s enrollment in the CLASS program shall remain the 
same for as long as the individual is an active enrollee 
in the program. 
‘‘(B) RECALCULATED PREMIUM IF REQUIRED FOR PRO-
GRAM SOLVENCY.— 
‘‘(i) IN GENERAL.—Subject to clause (ii), if the Sec-
retary determines, based on the most recent report 
of the Board of Trustees of the CLASS Independence 
Fund, the advice of the CLASS Independence Advisory 
Council, and the annual report of the Inspector General 
of the Department of Health and Human Services, 
and waste, fraud, and abuse, or such other information 
as the Secretary determines appropriate, that the 
monthly 
premiums 
and 
income 
to 
the 
CLASS 
Independence Fund for a year are projected to be 
insufficient with respect to the 20-year period that 
begins with that year, the Secretary shall adjust the 
monthly premiums for individuals enrolled in the 
CLASS program as necessary (but maintaining a 
nominal premium for enrollees whose income is below 
the poverty line or who are full-time students actively 
employed). 
‘‘(ii) EXEMPTION FROM INCREASE.—Any increase in 
a monthly premium imposed as result of a determina-
tion described in clause (i) shall not apply with respect 
to the monthly premium of any active enrollee who— 
‘‘(I) has attained age 65;
H. R. 3590—715 
‘‘(II) has paid premiums for enrollment in the 
program for at least 20 years; and 
‘‘(III) is not actively employed. 
‘‘(C) RECALCULATED PREMIUM IF REENROLLMENT AFTER 
MORE THAN A 3-MONTH LAPSE.— 
‘‘(i) IN
GENERAL.—The reenrollment of an indi-
vidual after a 90-day period during which the indi-
vidual failed to pay the monthly premium required 
to maintain the individual’s enrollment in the CLASS 
program shall be treated as an initial enrollment for 
purposes of age-adjusting the premium for enrollment 
in the program. 
‘‘(ii) CREDIT
FOR
PRIOR
MONTHS
IF
REENROLLED 
WITHIN 5 YEARS.—An individual who reenrolls in the 
CLASS program after such a 90-day period and before 
the end of the 5-year period that begins with the 
first month for which the individual failed to pay the 
monthly premium required to maintain the individual’s 
enrollment in the program shall be— 
‘‘(I) credited with any months of paid pre-
miums that accrued prior to the individual’s lapse 
in enrollment; and 
‘‘(II) notwithstanding the total amount of any 
such credited months, required to satisfy section 
3202(6)(A)(ii) before being eligible to receive bene-
fits. 
‘‘(D) NO LONGER STATUS AS A FULL-TIME STUDENT.— 
An individual subject to a nominal premium on the basis 
of being described in subsection (a)(1)(A)(ii)(I)(bb) who 
ceases to be described in that subsection, beginning with 
the first month following the month in which the individual 
ceases to be so described, shall be subject to the same 
monthly premium as the monthly premium that applies 
to an individual of the same age who first enrolls in the 
program under the most similar circumstances as the indi-
vidual (such as the first year of eligibility for enrollment 
in the program or in a subsequent year). 
‘‘(E) PENALTY FOR REENOLLMENT AFTER 5-YEAR LAPSE.— 
In the case of an individual who reenrolls in the CLASS 
program after the end of the 5-year period described in 
subparagraph (C)(ii), the monthly premium required for 
the individual shall be the age-adjusted premium that 
would be applicable to an initially enrolling individual who 
is the same age as the reenrolling individual, increased 
by the greater of— 
‘‘(i) an amount that the Secretary determines is 
actuarially sound for each month that occurs during 
the period that begins with the first month for which 
the individual failed to pay the monthly premium 
required to maintain the individual’s enrollment in 
the CLASS program and ends with the month pre-
ceding the month in which the reenollment is effective; 
or 
‘‘(ii) 1 percent of the applicable age-adjusted pre-
mium for each such month occurring in such period. 
‘‘(2) 
ADMINISTRATIVE
EXPENSES.—In 
determining 
the 
monthly premiums for the CLASS program the Secretary may
H. R. 3590—716 
factor in costs for administering the program, not to exceed 
for any year in which the program is in effect under this 
title, an amount equal to 3 percent of all premiums paid during 
the year. 
‘‘(3) NO UNDERWRITING REQUIREMENTS.—No underwriting 
(other than on the basis of age in accordance with subpara-
graphs (D) and (E) of paragraph (1)) shall be used to— 
‘‘(A) determine the monthly premium for enrollment 
in the CLASS program; or 
‘‘(B) prevent an individual from enrolling in the pro-
gram. 
‘‘(c) SELF-ATTESTATION AND VERIFICATION OF INCOME.—The Sec-
retary shall establish procedures to— 
‘‘(1) permit an individual who is eligible for the nominal 
premium required under subsection (a)(1)(A)(ii), as part of their 
automatic enrollment in the CLASS program, to self-attest 
that their income does not exceed the poverty line or that 
their status as a full-time student who is actively employed; 
‘‘(2) verify, using procedures similar to the procedures used 
by the Commissioner of Social Security under section 
1631(e)(1)(B)(ii) of the Social Security Act and consistent with 
the requirements applicable to the conveyance of data and 
information under section 1942 of such Act, the validity of 
such self-attestation; and 
‘‘(3) require an individual to confirm, on at least an annual 
basis, that their income does not exceed the poverty line or 
that they continue to maintain such status. 
‘‘SEC. 3204. ENROLLMENT AND DISENROLLMENT REQUIREMENTS. 
‘‘(a) AUTOMATIC ENROLLMENT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the Secretary, 
in coordination with the Secretary of the Treasury, shall estab-
lish procedures under which each individual described in sub-
section (c) may be automatically enrolled in the CLASS program 
by an employer of such individual in the same manner as 
an employer may elect to automatically enroll employees in 
a plan under section 401(k), 403(b), or 457 of the Internal 
Revenue Code of 1986. 
‘‘(2) ALTERNATIVE ENROLLMENT PROCEDURES.—The proce-
dures established under paragraph (1) shall provide for an 
alternative enrollment process for an individual described in 
subsection (c) in the case of such an individual— 
‘‘(A) who is self-employed; 
‘‘(B) who has more than 1 employer; or 
‘‘(C) whose employer does not elect to participate in 
the automatic enrollment process established by the Sec-
retary. 
‘‘(3) ADMINISTRATION.— 
‘‘(A) IN GENERAL.—The Secretary and the Secretary 
of the Treasury shall, by regulation, establish procedures 
to ensure that an individual is not automatically enrolled 
in the CLASS program by more than 1 employer. 
‘‘(B) FORM.—Enrollment in the CLASS program shall 
be made in such manner as the Secretary may prescribe 
in order to ensure ease of administration. 
‘‘(b) ELECTION TO OPT-OUT.—An individual described in sub-
section (c) may elect to waive enrollment in the CLASS program
H. R. 3590—717 
at any time in such form and manner as the Secretary and the 
Secretary of the Treasury shall prescribe. 
‘‘(c) INDIVIDUAL DESCRIBED.—For purposes of enrolling in the 
CLASS program, an individual described in this paragraph is an 
individual— 
‘‘(1) who has attained age 18; 
‘‘(2) who— 
‘‘(A) receives wages on which there is imposed a tax 
under section 3201(a) of the Internal Revenue Code of 
1986; or 
‘‘(B) derives self-employment income on which there 
is imposed a tax under section 1401(a) of the Internal 
Revenue Code of 1986; 
‘‘(3) who is actively employed; and 
‘‘(4) who is not— 
‘‘(A) a patient in a hospital or nursing facility, an 
intermediate care facility for the mentally retarded, or 
an institution for mental diseases and receiving medical 
assistance under Medicaid; or 
‘‘(B) confined in a jail, prison, other penal institution 
or correctional facility, or by court order pursuant to convic-
tion of a criminal offense or in connection with a verdict 
or finding described in section 202(x)(1)(A)(ii) of the Social 
Security Act (42 U.S.C. 402(x)(1)(A)(ii)). 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this title shall be 
construed as requiring an active enrollee to continue to satisfy 
subparagraph (B) or (C) of subsection (c)(1) in order to maintain 
enrollment in the CLASS program. 
‘‘(e) PAYMENT.— 
‘‘(1) PAYROLL DEDUCTION.—An amount equal to the monthly 
premium for the enrollment in the CLASS program of an indi-
vidual shall be deducted from the wages or self-employment 
income of such individual in accordance with such procedures 
as the Secretary, in coordination with the Secretary of the 
Treasury, shall establish for employers who elect to deduct 
and withhold such premiums on behalf of enrolled employees. 
‘‘(2) ALTERNATIVE
PAYMENT
MECHANISM.—The Secretary, 
in coordination with the Secretary of the Treasury, shall estab-
lish alternative procedures for the payment of monthly pre-
miums by an individual enrolled in the CLASS program— 
‘‘(A) who does not have an employer who elects to 
deduct and withhold premiums in accordance with subpara-
graph (A); or 
‘‘(B) who does not earn wages or derive self-employ-
ment income. 
‘‘(f) TRANSFER OF PREMIUMS COLLECTED.— 
‘‘(1) IN GENERAL.—During each calendar year the Secretary 
of the Treasury shall deposit into the CLASS Independence 
Fund a total amount equal, in the aggregate, to 100 percent 
of the premiums collected during that year. 
‘‘(2) TRANSFERS BASED ON ESTIMATES.—The amount depos-
ited pursuant to paragraph (1) shall be transferred in at least 
monthly payments to the CLASS Independence Fund on the 
basis of estimates by the Secretary and certified to the Sec-
retary of the Treasury of the amounts collected in accordance 
with subparagraphs (A) and (B) of paragraph (5). Proper adjust-
ments shall be made in amounts subsequently transferred to
H. R. 3590—718 
the Fund to the extent prior estimates were in excess of, or 
were less than, actual amounts collected. 
‘‘(g) OTHER ENROLLMENT
AND DISENROLLMENT OPPORTUNI-
TIES.—The Secretary, in coordination with the Secretary of the 
Treasury, shall establish procedures under which— 
‘‘(1) an individual who, in the year of the individual’s 
initial eligibility to enroll in the CLASS program, has elected 
to waive enrollment in the program, is eligible to elect to 
enroll in the program, in such form and manner as the Secre-
taries shall establish, only during an open enrollment period 
established by the Secretaries that is specific to the individual 
and that may not occur more frequently than biennially after 
the date on which the individual first elected to waive enroll-
ment in the program; and 
‘‘(2) an individual shall only be permitted to disenroll from 
the program (other than for nonpayment of premiums) during 
an annual disenrollment period established by the Secretaries 
and in such form and manner as the Secretaries shall establish. 
‘‘SEC. 3205. BENEFITS. 
‘‘(a) DETERMINATION OF ELIGIBILITY.— 
‘‘(1) APPLICATION FOR RECEIPT OF BENEFITS.—The Secretary 
shall establish procedures under which an active enrollee shall 
apply for receipt of benefits under the CLASS Independence 
Benefit Plan. 
‘‘(2) ELIGIBILITY ASSESSMENTS.— 
‘‘(A) IN GENERAL.—Not later than January 1, 2012, 
the Secretary shall— 
‘‘(i) establish an Eligibility Assessment System 
(other than a service with which the Commissioner 
of Social Security has entered into an agreement, with 
respect to any State, to make disability determinations 
for purposes of title II or XVI of the Social Security 
Act) to provide for eligibility assessments of active 
enrollees who apply for receipt of benefits; 
‘‘(ii) enter into an agreement with the Protection 
and Advocacy System for each State to provide 
advocacy services in accordance with subsection (d); 
and 
‘‘(iii) enter into an agreement with public and pri-
vate entities to provide advice and assistance coun-
seling in accordance with subsection (e). 
‘‘(B) REGULATIONS.—The Secretary shall promulgate 
regulations to develop an expedited nationally equitable 
eligibility determination process, as certified by a licensed 
health care practitioner, an appeals process, and a redeter-
mination process, as certified by a licensed health care 
practitioner, including whether an active enrollee is eligible 
for a cash benefit under the program and if so, the amount 
of the cash benefit (in accordance the sliding scale estab-
lished under the plan). 
‘‘(C) PRESUMPTIVE ELIGIBILITY FOR CERTAIN INSTITU-
TIONALIZED
ENROLLEES
PLANNING
TO
DISCHARGE.—An 
active enrollee shall be deemed presumptively eligible if 
the enrollee— 
‘‘(i) has applied for, and attests is eligible for, 
the maximum cash benefit available under the sliding
H. R. 3590—719 
scale established under the CLASS Independence Ben-
efit Plan; 
‘‘(ii) is a patient in a hospital (but only if the 
hospitalization is for long-term care), nursing facility, 
intermediate care facility for the mentally retarded, 
or an institution for mental diseases; and 
‘‘(iii) is in the process of, or about to begin the 
process of, planning to discharge from the hospital, 
facility, or institution, or within 60 days from the date 
of discharge from the hospital, facility, or institution. 
‘‘(D) APPEALS.—The Secretary shall establish proce-
dures under which an applicant for benefits under the 
CLASS Independence Benefit Plan shall be guaranteed 
the right to appeal an adverse determination. 
‘‘(b) BENEFITS.—An eligible beneficiary shall receive the fol-
lowing benefits under the CLASS Independence Benefit Plan: 
‘‘(1) CASH BENEFIT.—A cash benefit established by the Sec-
retary in accordance with the requirements of section 
3203(a)(1)(D) that— 
‘‘(A) the first year in which beneficiaries receive the 
benefits under the plan, is not less than the average dollar 
amount specified in clause (i) of such section; and 
‘‘(B) for any subsequent year, is not less than the 
average per day dollar limit applicable under this subpara-
graph for the preceding year, increased by the percentage 
increase in the consumer price index for all urban con-
sumers (U.S. city average) over the previous year. 
‘‘(2) ADVOCACY SERVICES.—Advocacy services in accordance 
with subsection (d). 
‘‘(3) ADVICE
AND
ASSISTANCE
COUNSELING.—Advice and 
assistance counseling in accordance with subsection (e). 
‘‘(4) ADMINISTRATIVE
EXPENSES.—Advocacy services and 
advise and assistance counseling services under paragraphs 
(2) and (3) of this subsection shall be included as administrative 
expenses under section 3203(b)(3). 
‘‘(c) PAYMENT OF BENEFITS.— 
‘‘(1) LIFE INDEPENDENCE ACCOUNT.— 
‘‘(A) IN GENERAL.—The Secretary shall establish proce-
dures for administering the provision of benefits to eligible 
beneficiaries under the CLASS Independence Benefit Plan, 
including the payment of the cash benefit for the bene-
ficiary into a Life Independence Account established by 
the Secretary on behalf of each eligible beneficiary. 
‘‘(B) USE OF CASH BENEFITS.—Cash benefits paid into 
a Life Independence Account of an eligible beneficiary shall 
be used to purchase nonmedical services and supports that 
the beneficiary needs to maintain his or her independence 
at home or in another residential setting of their choice 
in the community, including (but not limited to) home 
modifications, assistive technology, accessible transpor-
tation, homemaker services, respite care, personal assist-
ance services, home care aides, and nursing support. 
Nothing in the preceding sentence shall prevent an eligible 
beneficiary from using cash benefits paid into a Life 
Independence Account for obtaining assistance with deci-
sion making concerning medical care, including the right 
to accept or refuse medical or surgical treatment and the