‘‘(F) Advocacy services to assist the indi-
vidual in obtaining appropriate, accessible, and
cost-effective services.
‘‘(G) Assessment of the individual’s need
for and level of home care services at appro-
priate intervals during the course of the individ-
ual’s treatment under the program.
‘‘(H) Reassessment of each individual at
regular intervals of at least every 3 months to
determine the extent of each individual’s
progress and to ascertain whether the individ-
ual—
‘‘(i) is being kept too long in a given
setting,
‘‘(ii) is being provided services inap-
propriately, or
‘‘(iii) would be better served by other
services or in another setting.
‘‘(3) COORDINATION AND ADMINISTRATION OF
BENEFITS
AND
SERVICES.—A State case-manage-
ment program meets the requirements of this sub-
section only if the program assists in ensuring that
an eligible individual is referred to and applies for
other benefits (through cooperative agreements with
agencies administering benefit programs) and serv-
ices for which the individual is eligible under other
Federal, State, or local programs, including—
‘‘(A) employment services, including voca-
tional assessment, training, and placement,
sheltered employment, and supported employ-
ment;
‘‘(B) education benefits, including primary,
secondary, and higher education programs;
‘‘(C) services available under the Older
Americans Act of 1965;
‘‘(D) disability insurance under title II;
and
‘‘(E) independent living services under title
VII of the Rehabilitation Act of 1973.
‘‘(4) LICENSURE
AND
COMPLAINT
PROCE-
DURE.—A State case-management program meets
the requirements of this subsection only if the pro-
gram provides for the following:
‘‘(A) Assuring that any residential setting
or facility which provides services to individuals
under the program meets any applicable State
or local requirements regarding certification or
licensure.
‘‘(B) A complaint procedure, overseen by
the State coordinator, regarding any treatment
or service provided to an individual which pro-
vides that—
‘‘(i) the individual or any person
named by the individual may make an oral
or written complaint;
‘‘(ii) the individual or any person
named by the individual may receive the
response to the complaint;
‘‘(iii) the confidentiality of any com-
plainant is maintained;
‘‘(iv) an investigation of the complaint
is completed within—
‘‘(I) 30 days for a routine com-
plaint,
‘‘(II) 7 days for a complaint of
abuse or neglect, and
‘‘(III) 24 hours if the individual’s
life or safety is immediately threat-
ened; and
‘‘(v) if the complaint is with respect to
a publicly appointed case manager or case
worker, substitution of such manager or
worker is allowed.
‘‘(5) RIGHTS.—
‘‘(A) NOTICE.—A State case-management
program meets the requirements of this sub-
section only if the State coordinator—
‘‘(i) provides for the distribution of a
notice of the rights described in subpara-
graph (B) (including a telephone number
to call to register complaints of alleged vio-
lations of such rights) to all case managers
and residential facilities which provide
services under the program to eligible indi-
viduals; and
‘‘(ii) ensures that such managers and
facilities—
‘‘(I) distribute such notice to
each eligible individual served under
the program, and
‘‘(II) prominently post such a no-
tice in a location readily accessible to
such individuals.
‘‘(B) RIGHTS
SPECIFIED.—The following
are the rights of eligible individuals receiving
services under a State case-management pro-
gram that meets the requirements of this sub-
section:
‘‘(i) FREE
CHOICE.—The right to
choose a personal attending physician, to
be fully informed in advance about care
and treatment, to be fully informed in ad-
vance of any changes in care or treatment
that may affect the individual’s well-being,
and (except with respect to an individual
adjudged incompetent) to participate in
planning care and treatment or changes in
care and treatment.
‘‘(ii) FREE
FROM
PHYSICAL
RE-
STRAINTS.—The right to be free from
physical or mental abuse, corporal punish-
ment, involuntary seclusion, and any phys-
ical or chemicals imposed for purposes of
discipline or convenience and not required
to treat the individual’s medical symptoms.
Restraints may only be imposed—
‘‘(I) to ensure the physical safety
of the individual or other individuals,
and
‘‘(II) only upon the written order
of a physician (or other health profes-
sional so authorized under State law)
that specifies the duration and cir-
cumstances under which the restraints
are to be used (except in emergency
circumstances) until such an order
could reasonably be obtained.
‘‘(iii) FREE FROM PHARMACOLOGICAL
RESTRAINTS.—Psychopharmacologic drugs
may be administered only on the orders of
a physician (or other health professional
authorized to prescribe under State law)
and only as part of a plan designed to
eliminate or modify the symptoms for
which the drugs are prescribed and only if,
at least annually, an independent, external
consultant reviews the appropriateness of
the drug plan of each individual receiving
such drugs.
‘‘(iv) PRIVACY.—The right to privacy
with regard to accommodations, medical
treatment, written and telephonic commu-
nications, visits, and meetings of family
and of patient groups.
‘‘(v) CONFIDENTIALITY.—The right to
confidentiality of personal and clinical
records.
‘‘(vi) ACCOMMODATION OF NEEDS.—
The right—
‘‘(I) to receive services with rea-
sonable accommodation of individual
needs and preferences, except where
the health or safety of the individual
or other individuals would be endan-
gered, and
‘‘(II) in the case of a residential
facility, to receive notice before the
room or roommate of an individual
living in the facility is changed.
‘‘(vii) GRIEVANCES.—The right to
voice grievances with respect to treatment
of care that is (or fails to be) furnished,
without discrimination or reprisal for voic-
ing the grievances, and the right to prompt
efforts by the provider to resolve griev-
ances the individual may have, including
those with respect to the behavior of other
individuals.
‘‘(viii) PARTICIPATION
IN
PATIENT
AND FAMILY GROUPS.—In the case of a
residential facility, the right of the individ-
ual to organize and participate in resident
groups and the right of the individual’s
family to meet with the families of other
patients.
‘‘(ix) PARTICIPATION
IN
OTHER
AC-
TIVITIES.—In the case of a residential fa-
cility, the right of the individual to partici-
pate in social, religious, and community ac-
tivities that do not interfere with the rights
of other individuals.
‘‘(x) 
TRANSFER
AND
DISCHARGE
RIGHTS FOR RESIDENTS OF RESIDENTIAL
CARE FACILITIES.—In the case of a resi-
dential facility, the facility must permit
each eligible individual who is a resident to
remain in the facility and must not trans-
fer or discharge the resident from the facil-
ity unless—
‘‘(I) the transfer or discharge is
necessary to meet the resident’s wel-
fare and the resident’s welfare cannot
be met in the facility,
‘‘(II) the transfer or discharge is
appropriate because the resident has
improved sufficiently so the resident
no longer needs the services provided
by the facility,
‘‘(III) the safety or health of in-
dividuals in the facility would other-
wise be endangered,
‘‘(IV) the resident has failed,
after reasonable and appropriate no-
tice, to pay (or to have paid on the
resident’s behalf under this title or
under another program for which the
resident is eligible to receive benefits)
an allowable charge imposed by the
facility for an item or service re-
quested by the resident, or
‘‘(V) the facility ceases to oper-
ate.
‘‘(xi) PRE-TRANSFER
AND
PRE-DIS-
CHARGE NOTICE.—In the case of a resi-
dential facility, before effecting a transfer
or discharge of an eligible individual who is
a resident, the facility must—
‘‘(I) notify the resident (and, if
known, a family member of a resident
or legal representative) of the transfer
or discharge and the reasons there-
fore, and
‘‘(II) record the reasons in the
resident’s plan of care.
‘‘(C) RIGHTS OF INCOMPETENT INDIVID-
UALS.—In the case of an individual adjudged
incompetent under the laws of a State, the
rights of the individual under this paragraph
devolve upon, and, to the extent judged nec-
essary by a court of competent jurisdiction, be
exercised by, the person appointed under State
law to act on the individual’s behalf.
‘‘(D) CONSTRUCTION.—The rights speci-
fied in this paragraph are in addition to any
right an individual may have under the Ameri-
cans with Disabilities Act, section 504 of the
Rehabilitation Act of 1973, or under section
1919.
‘‘(c) SCOPE OF SERVICES.—
‘‘(1) IN GENERAL.—An eligible individual who
is receiving case-management services described in
subsection (b)(2) may receive the following services
under such individual’s treatment plan under the
State plan:
‘‘(A) Acute rehabilitation services, focusing
on intensive physical and cognitive restorative
services in the early months following injury.
‘‘(B) Subacute rehabilitation in either in-
patient or outpatient settings.
‘‘(C) Transitional living services to train
the individual for more independent living, with
an emphasis on compensating for the loss of
skills which may not be restored.
‘‘(D) Lifelong living services for individuals
discharged from rehabilitation who require on-
going lifetime support.
‘‘(E) Home care, including comprehensive
training for family or other informal caregivers.
‘‘(F) Day treatment and other outpatient
programs in nonresidential settings.
‘‘(G) Independent living services to allow
the individual to live at home with optimal per-
sonal control over services.
‘‘(H) Behavior disorder treatment services
to address or resolve patterns of behavior which
prevent or hinder participation in active reha-
bilitation.
‘‘(I) Respite and recreation services to aid
the individual and members of the individual’s
family in adapting psychologically and environ-
mentally to residual deficits resulting from
brain injury.
‘‘(J) Treatment for conditions related to
alcoholism and drug dependency.
‘‘(2) WAIVER OF CERTAIN LIMITATIONS ON THE
EXPENDITURE OF FUNDS.—
‘‘(A) IN
GENERAL.—In accordance with
standards established by the State coordinator,
a State case-management program may waive
restrictions on the amount, duration, and scope
of services otherwise applicable under the State
plan for medical assistance under this title to
the extent necessary to carry out a treatment
plan for an individual.
‘‘(B) HOME CARE SERVICES IN EXCESS OF
LIMITATIONS ESTABLISHED BY STATE COORDI-
NATOR.—In accordance with standards estab-
lished by the State coordinator, a State case-
management program may approve the use of
funds provided under the State plan for medical
assistance under this title to pay for home care
services when such home care services exceed
limitations established by the State coordinator.