means services described in section 1905(a)(15) of 
such Act (as so in effect) in an intermediate care fa-
cility for individuals with mental retardation to an 
individual determined to require such services in ac-
cordance with standards specified by the Board and 
comparable to the standards described in section 
1902(a)(31)(A) of such Act (as so in effect). 
(k) OTHER TERMS.—Except as may be provided by 
the Board, the definitions contained in section 1861 of the 
Social Security Act shall apply. 
SEC. 203. SPECIAL RULES FOR HOME AND COMMUNITY- 
BASED LONG-TERM CARE SERVICES. 
(a) QUALIFYING INDIVIDUALS.—For purposes of sec-
tion 201(a)(5)(C), individuals described in this subsection 
are the following individuals: 
(1) ADULTS.—Individuals 18 years of age or 
older determined (in a manner specified by the 
Board)— 
(A) to be unable to perform, without the 
assistance of an individual, at least 2 of the fol-
lowing 5 activities of daily living (or who has a 
similar level of disability due to cognitive im-
pairment)— 
(i) bathing; 
(ii) eating; 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
(iii) dressing; 
(iv) toileting; and 
(v) transferring in and out of a bed or 
in and out of a chair; 
(B) due to cognitive or mental impair-
ments, to require supervision because the indi-
vidual behaves in a manner that poses health or 
safety hazards to himself or herself or others; 
or 
(C) due to cognitive or mental impair-
ments, to require queuing to perform activities 
of daily living. 
(2) CHILDREN.—Individuals under 18 years of 
age determined (in a manner specified by the Board) 
to meet such alternative standard of disability for 
children as the Board develops. Such alternative 
standard shall be comparable to the standard for 
adults and appropriate for children. 
(b) LIMIT ON SERVICES.— 
(1) IN GENERAL.—The aggregate expenditures 
by a State health security program with respect to 
home and community-based long-term care services 
in a period (specified by the Board) may not exceed 
65 percent (or such alternative ratio as the Board 
establishes under paragraph (2)) of the average of 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00040
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
the amount of payment that would have been made 
under the program during the period if all the home- 
based long-term care beneficiaries had been resi-
dents of nursing facilities in the same area in which 
the services were provided. 
(2) ALTERNATIVE RATIO.—The Board may es-
tablish for purposes of paragraph (1) an alternative 
ratio (of payments for home and community-based 
long term care services to payments for nursing fa-
cility services) as the Board determines to be more 
consistent with the goal of providing cost-effective 
long-term care in the most appropriate and least re-
strictive setting. 
SEC. 204. EXCLUSIONS AND LIMITATIONS. 
(a) IN GENERAL.—Subject to section 201(e), benefits 
for service are not available under this Act unless the serv-
ices meet the standards specified in section 201(a). 
(b) SPECIAL DELIVERY REQUIREMENTS FOR MEN-
TAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERV-
ICES PROVIDED TO AT-RISK CHILDREN.— 
(1) REQUIRING
SERVICES
TO
BE
PROVIDED 
THROUGH ORGANIZED SYSTEMS OF CARE.—A State 
health security program shall ensure that mental 
health services and substance abuse treatment serv-
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS