I 
115TH CONGRESS 
2D SESSION 
H. R. 4931 
To establish the Transition to Independence demonstration program. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 5, 2018 
Mr. LANGEVIN (for himself, Mr. HARPER, Mr. BEYER, Mr. SESSIONS, and 
Mr. FOSTER) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To establish the Transition to Independence demonstration 
program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Transition to Inde-
pendence Act of 2018’’. 
SEC. 2. TRANSITION TO INDEPENDENCE DEMONSTRATION 
PROGRAM. 
(a) ESTABLISHMENT.—The Secretary shall establish 
a demonstration program under which a State that is a 
Medicaid Buy-In State and meets certain criteria may re-
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
ceive bonus payments for meeting specific measurable 
benchmarks in expanding individual integrated employ-
ment and reducing subminimum wage work, congregate 
setting work, or facility-based day habilitation placements 
for working-age individuals with a disability receiving 
Medicaid-funded home or community-based services and 
for taking other actions conducive to expanding employ-
ment opportunities for individuals with disabilities within 
the State. 
(b) REQUIREMENTS FOR THE TRANSITION TO INDE-
PENDENCE DEMONSTRATION PROGRAM.— 
(1) 
MINIMUM
STANDARDS.—The 
Secretary 
shall establish minimum standards for Medicaid 
Buy-In States participating in the demonstration 
program to comply with in establishing eligibility re-
quirements for individual participants, benefits, and 
administrative requirements for the Transition to 
Independence Medicaid Buy-In Option offered under 
the demonstration program. 
(2) PREFERENCE GIVEN TO CERTAIN STATES 
FOR
DEMONSTRATION
PARTICIPATION.—The Sec-
retary shall give preference in selecting States to 
participate in the demonstration program to States 
that have Medicaid Buy-In programs that— 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(A) establish an assets or resources test 
for participation by an individual in the Med-
icaid Buy-In Option that is not less than 
$20,000; 
(B) establish an income requirement for 
participation by an individual in the Medicaid 
Buy-In Option that is at least up to 400 per-
cent of the poverty line; 
(C) offer home and community-based serv-
ices, including employment-based services and 
supports, in the Medicaid Buy-In Option; and 
(D) establish such other requirements for 
an individual’s participation in the Medicaid 
Buy-In Option as the Secretary shall specify. 
(3) WORK
INCENTIVES
COORDINATOR.—The 
minimum standards shall require a Medicaid Buy-In 
State participating in the demonstration program to 
provide work incentives coordinators who have been 
trained as work incentive specialists under a commu-
nity-based work incentives planning and assistance 
program established under section 1149 of the So-
cial Security Act (42 U.S.C. 1320b–20) to assist the 
individuals who elect to participate in the Medicaid 
Buy-In Option in order to ensure the individuals are 
provided with appropriate items and services. 
VerDate Sep 11 2014 
06:01 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(c) 
APPLICATION
AND
SELECTION
REQUIRE-
MENTS.— 
(1) IN
GENERAL.—Not later than June 30, 
2019, the Secretary shall solicit applications from 
Medicaid Buy-In States and select 15 Medicaid Buy- 
In States to participate in the demonstration pro-
gram. 
(2) APPLICATION REQUIREMENTS.—An applica-
tion to participate in the demonstration program 
shall include the following: 
(A) Data and information regarding the 
numbers of working-age individuals with dis-
abilities who are receiving Medicaid-funded 
home or community-based services in the Med-
icaid Buy-In State who are in individual inte-
grated employment, subminimum wage work, 
congregate setting work, or facility-based day 
habilitation or day treatment, respectively. 
(B) Data and information verifying that 
the Medicaid Buy-In State is prepared to meet 
the minimum standards established by the Sec-
retary for the Medicaid Buy-In Option. 
(C) A plan for promoting the Medicaid 
Buy-In Option to potentially eligible individuals 
that includes— 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(i) 
clear 
and 
easy-to-understand, 
multi-media information on how to enroll 
in the Medicaid Buy-In Option on the Web 
sites for the Medicaid Buy-In State’s Med-
icaid and Disability Determination Services 
Agencies; and 
(ii) a ‘‘no-wrong door’’ policy under 
which individuals who apply for a deter-
mination of eligibility for the Medicaid 
Buy-In Option are also determined if they 
are eligible for an applicable State health 
subsidy program in accordance with sec-
tion 1413 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18083) 
(including the State Medicaid program 
under another eligibility pathway), in-
formed of the results of such determina-
tions and, depending on their eligibility, 
provided with the option to voluntarily 
elect to participate in the Medicaid Buy-In 
Option or an applicable State health sub-
sidy program. 
(D)(i) An assurance that the State will es-
tablish and build capacity for an eligibility proc-
ess to make eligibility determinations for the 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(F) A description of the person-centered 
planning process that the State intends to use 
for participants in the demonstration program. 
(G) Such other information as the Sec-
retary may require relating to the demonstra-
tion program. 
(3) STAKEHOLDER ADVISORY COMMITTEE RE-
QUIREMENTS.— 
(A) MEMBERSHIP.—In establishing the 
Stakeholder Advisory Committee required for 
the demonstration program, the Medicaid Buy- 
In State shall ensure that— 
(i) at least 50 percent of the members 
of the Stakeholder Advisory Committee are 
individuals with disabilities; and 
(ii) at least 1 member of the Com-
mittee is a provider of services to individ-
uals with disabilities. 
(B) DUTIES.—The Stakeholder Advisory 
Committee shall— 
(i) analyze outcomes data and other 
information related to the conduct of the 
demonstration program; and 
(ii) regularly submit recommenda-
tions, including for specific actions by the 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
Medicaid Buy-In State participating in the 
demonstration program, that the Com-
mittee determines appropriate with respect 
to the conduct of the demonstration pro-
gram by the State. 
(d) REQUIREMENT FOR SELECTING STATES.—In se-
lecting Medicaid Buy-In States to participate in the dem-
onstration program, the Secretary shall ensure that the 
Medicaid Buy-In States selected include Medicaid Buy-In 
States with low, medium, and high numbers of working- 
age individuals with disabilities who are receiving Med-
icaid-funded home or community-based services and are 
in individual integrated employment, subminimum wage 
work, congregate setting work, or facility-based day habili-
tation or day treatment, respectively. 
(e) LENGTH OF DEMONSTRATION PROGRAM.—The 
demonstration program shall be conducted for a period of 
5 fiscal years, beginning with fiscal year 2020. 
(f) PERFORMANCE BONUS PAYMENTS.— 
(1) IN
GENERAL.—For each fiscal year in 
which the demonstration program is conducted, a 
Medicaid Buy-In State participating in the dem-
onstration program during that fiscal year may qual-
ify for a performance bonus payment. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(2) STATE-SPECIFIED CRITERIA AND PERFORM-
ANCE PLANS.—In order to participate in the dem-
onstration program, a Medicaid Buy-In State shall 
submit criteria and a plan for achieving each of the 
mandatory benchmarks described in paragraph (3) 
and a selection of the additional benchmarks de-
scribed in paragraph (4) as determined by the Sec-
retary. The Secretary shall establish a methodology 
for assessing State performance with respect to the 
State-specified criteria for the mandatory and addi-
tional benchmarks. 
(3) MANDATORY
BENCHMARKS.—The manda-
tory benchmarks described in this paragraph are the 
following: 
(A) REDUCED
PARTICIPATION
IN
SEG-
REGATED PROGRAMS AND INCREASED PARTICI-
PATION IN INDIVIDUAL INTEGRATED EMPLOY-
MENT.— 
(i) REDUCED POPULATION CENSUS OF 
SEGREGATED PROGRAMS.— 
(I) IN
GENERAL.—Achieving a 
reduction in the population in the 
State of working-age individuals with 
disabilities who are receiving Med-
icaid-funded home or community- 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
based services or who are receiving 
services through an Intermediate Care 
Facility for Persons with Develop-
mental Disabilities (ICF–DD), a nurs-
ing facility, an institution for individ-
uals with mental illness, or other con-
gregate facilities and are in submin-
imum wage work, congregate setting 
work, or facility-based day habilitation 
or day treatment. 
(II) MINIMUM PERCENT REDUC-
TIONS; BONUS
BASED
ON
ACHIEVE-
MENT
OF
DIFFERING
TIERS.—In 
order to receive a bonus payment for 
a fiscal year under this clause, a Med-
icaid Buy-In State shall achieve a re-
duction of the population described in 
subclause (I) of at least 10 percent 
below the State’s most recent prior 
fiscal year’s census of the eligible pop-
ulation in subminimum wage work, 
congregate setting work, or facility- 
based day habilitation or day treat-
ment. Subject to paragraph (5)(B), 
the Secretary shall award an in-
VerDate Sep 11 2014 
06:01 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
creased bonus payment for a fiscal 
year to a Medicaid Buy-In State that 
achieves a percentage reduction of 20, 
30, 40 or more with respect to the 
prior fiscal year’s census of such pop-
ulation. 
(III) REQUIREMENTS FOR MEET-
ING BENCHMARK.—A working-age in-
dividual with a disability shall be 
deemed as counting towards a per-
centage reduction for purposes of this 
clause if the individual is— 
(aa) employed in a competi-
tive, integrated employment set-
ting for at least 10 hours a week 
on average over a 120-day period 
during the year involved; 
(bb) receiving integrated day 
services that reach the level of 
care required in the individual’s 
person-centered plan; or 
(cc) a combination of items 
(aa) and (bb), 
enabling the individual to achieve, if 
desired, a comparable level of benefit 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
as before the change in placement. 
The State must report aggregate data 
to the Secretary on the outcome of all 
individuals transitioning out of con-
gregate settings being counted to-
wards fulfillment of this benchmark. 
(ii) INCREASED POPULATION CENSUS 
OF
INDIVIDUAL
INTEGRATED
EMPLOY-
MENT.— 
(I) IN GENERAL.—Achieving an 
increase in the population in the State 
of working-age individuals with dis-
abilities who are receiving Medicaid- 
funded home or community-based 
services and are in individual inte-
grated employment. 
(II) 
MINIMUM
PERCENT
IN-
CREASES; BONUS BASED ON ACHIEVE-
MENT OF CERTAIN TIERS.—In order 
to receive a bonus payment for a fis-
cal year under this clause, a Medicaid 
Buy-In State shall achieve an increase 
in the population described in sub-
clause (I) of at least 10 percent above 
the State’s most recent prior fiscal 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
year’s census of the eligible population 
in individual integrated employment. 
Subject to paragraph (5)(B), the Sec-
retary shall award an increased bonus 
payment for a fiscal year to a Med-
icaid Buy-In State that achieves a 
percentage increase of 20, 30, 40 or 
more with respect to the prior fiscal 
year’s census of such population. 
(III) REQUIREMENTS FOR MEET-
ING BENCHMARK.—A working-age in-
dividual with a disability shall be 
deemed as counting towards a per-
centage increase for purposes of this 
clause if the individual is employed in 
an integrated individual employment 
setting for at least 10 hours a week 
on average over a 120-day period dur-
ing the fiscal year involved. 
(B) MEETING
THE
MEDICAID
BUY-IN 
STANDARDS.—Meeting the minimum standards 
established by the Secretary for the Medicaid 
Buy-In Option. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(4) ADDITIONAL
BENCHMARKS.—The addi-
tional benchmarks described in this paragraph are 
the following: 
(A) ELIMINATION OF NEW PLACEMENT AP-
PROVALS.—Eliminating 
new 
approvals 
for 
placement in the State of working-age individ-
uals with disabilities who are receiving Med-
icaid-funded home or community-based services 
in subminimum wage work, congregate setting 
work, or facility-based day habilitation or day 
treatment, in accordance with criteria estab-
lished by the Secretary. 
(B) DEMONSTRATION
OF
INTER-AGENCY 
COLLABORATION.—Demonstrating inter-agency 
collaboration between the State agencies re-
sponsible for administering Medicaid, vocational 
rehabilitation, and education (and, if the State 
is participating the Promoting Readiness of Mi-
nors in Supplemental Security Income initiative 
(PROMISE), including coordination with that 
initiative), in determining payer of last resort 
rules and rules for providing individuals with a 
seamless transition of services provided under 
such agencies, in accordance with criteria estab-
lished by the Secretary. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(C) TERMINATION OF VOCATIONAL REHA-
BILITATION FUNDING.—Ending the use of voca-
tional rehabilitation funding for subminimum 
wage work, congregate setting work, or facility- 
based day habilitation or day treatment, in ac-
cordance with criteria established by the Sec-
retary. 
(D) WORKFORCE
DEVELOPMENT.—Dem-
onstrating in accordance with criteria estab-
lished by the Secretary satisfaction of at least 
two of the following strategies to promote work-
force development: 
(i) Increasing Medicaid payments for 
supported employment providers for indi-
viduals with disabilities by an amount nec-
essary to ensure an adequately supported 
employment network, as determined by the 
Secretary. 
(ii) Adopting employment strategies 
that result in working-age individuals with 
disabilities who are receiving Medicaid- 
funded home or community-based services 
being recruited, hired, and retained as full- 
time employees of State government or by 
contractors of State government. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(iii) Developing a State equivalent of 
section 503 of the Rehabilitation Act of 
1973 (29 U.S.C. 793) to recruit, hire, pro-
mote, and retain working-age individuals 
with disabilities who are receiving Med-
icaid-funded home or community-based 
services with a utilization goal of at least 
7 percent of the State government work-
force. 
(iv) Developing a special hiring au-
thority mechanism akin to the Schedule A 
appointing 
authority 
under 
section 
213.3102(u) of title 5 of the Code of Fed-
eral Regulations (commonly referred to as 
the ‘‘Schedule A Hiring Authority’’) to as-
sist in easing the hiring of working-age in-
dividuals with disabilities who are receiving 
Medicaid-funded home or community-based 
services within the State government with 
an accompanying plan submitted to the 
Secretary outlining targeted implementa-
tion goals for the amount of individuals 
with disabilities within State government. 
(v) Increasing the hiring of working- 
age individuals with disabilities who are re-
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
ceiving Medicaid-funded home or commu-
nity-based services in employment for 
which the individual is compensated at or 
above the minimum wage, through collabo-
ration with the State vocational rehabilita-
tion and workforce development programs 
and Federal contractors. 
(vi) Providing State tax credits to em-
ployers for hiring new workers who are 
working-age individuals with disabilities 
who are receiving Medicaid-funded home or 
community-based services. 
(5) PAYMENT TO STATES.— 
(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this paragraph, the Sec-
retary shall make a performance bonus pay-
ment to each Medicaid Buy-In State partici-
pating in the demonstration program that 
qualifies for such a payment with respect to a 
fiscal year as a single payment not later than 
the last day of the first calendar quarter of the 
fiscal year following the fiscal year to which the 
performance bonus payments applies. Payments 
to States made under this paragraph shall be 
considered to have been made under, and are 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
subject to the requirements of, section 1903 of 
the Social Security Act (42 U.S.C. 1396b). 
(B) DETERMINATION OF PAYMENT.—The 
performance bonus payment for a Medicaid 
Buy-In State shall consist of the additional 
amount that the State would have been paid for 
providing medical assistance to individuals en-
rolled in the State’s Medicaid Buy-In Option 
during the preceding fiscal year if the regular 
FMAP applicable to such assistance were in-
creased (subject to subparagraph (C)) as fol-
lows: 
(i) Two percentage points for achiev-
ing the minimum 10 percent reduction in 
the mandatory benchmark described in 
paragraph (3)(A) during the preceding fis-
cal year (or 2.4 percentage points for 
achieving a reduction of at least 20 percent 
(but not more than 30 percent), 2.6 per-
centage points for achieving a reduction of 
at least 30 percent (but not more than 40 
percent), and 2.8 percentage points for 
achieving a reduction of at least 40 per-
cent). 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
year period in which the demonstration 
project is conducted; or 
(ii) payments be made to a Medicaid 
Buy-In State under this paragraph after 
December 31, 2023. 
(D) USE OF PAYMENTS.—A Medicaid Buy- 
In State receiving a performance bonus pay-
ment under this paragraph shall use the pay-
ment only to expand individual integrated em-
ployment and community integration for work-
ing-age individuals with disabilities who are re-
ceiving Medicaid-funded home or community- 
based services. 
(g) REPORTS; RECOMMENDATIONS.— 
(1) ANNUAL STATE REPORTS.— 
(A) IN GENERAL.—Each Medicaid Buy-In 
State participating in the demonstration pro-
gram annually shall submit a detailed report to 
the Secretary regarding the State’s conduct of 
the demonstration program. 
(B) INFORMATION
TO
BE
INCLUDED.— 
Such annual reports shall include, in addition 
to data and information regarding State per-
formance with respect the mandatory and addi-
tional benchmarks described in paragraphs (3) 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
and (4) of subsection (f) and such other infor-
mation as the Secretary may require, data and 
information regarding the extent to which, since 
the start of the demonstration program— 
(i) the State has reduced the State 
population of individuals with disabilities 
who have attained age 18 but have not at-
tained age 31, are receiving Medicaid-fund-
ed home or community-based services or 
services through an Intermediate Care Fa-
cility for Persons with Developmental Dis-
abilities (ICF–DD), a nursing facility, an 
institution for individuals with mental ill-
ness, or other congregate facilities, and 
were in subminimum wage work, con-
gregate setting work, or facility-based day 
habilitation or day treatment; and 
(ii) the State has increased the State 
population of individuals with disabilities 
who have attained age 18 but have not at-
tained age 31, are receiving Medicaid-fund-
ed home or community-based services, and 
are engaged in individual integrated em-
ployment. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(C) 
ADDITIONAL
INFORMATION
ON 
TRANSITIONING INDIVIDUALS TO INTEGRATED 
EMPLOYMENT.—Each such annual report shall 
include information regarding— 
(i) the State’s efforts to transition in-
dividuals with disabilities who are partici-
pating in the demonstration program to in-
dividual integrated employment during the 
preceding fiscal year; 
(ii) the full spectrum of employment 
outcomes for such individuals; 
(iii) best practices for successfully 
achieving such transitions; and 
(iv) lessons learned. 
(D) PROMOTING PUBLIC PARTICIPATION.— 
To promote transparency with respect to such 
annual reports, each Medicaid Buy-In State 
shall— 
(i) provide, before submission of each 
such report— 
(I) for posting of a draft of the 
report for review by the public on a 
publicly accessible Web site of the 
State; 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(II) for providing a period of not 
less than 30 days for the receipt of 
public comments on the draft report; 
and 
(III) for at least two public hear-
ings regarding the draft report; and 
(ii) include in the report so submitted 
a response to public comments received 
during such period (along with a descrip-
tion of whether changes have been made in 
the report in response to such comments). 
With respect to each such State report sub-
mitted, the Secretary, at the Federal level, shall 
provide for another 30-day public comment pe-
riod to receive comments on such report. 
(E) POSTING OF REPORTS ON PUBLICLY 
ACCESSIBLE
WEB
SITE.—The Secretary shall 
post each of the annual reports submitted 
under this paragraph, with a summary of the 
comments received under subparagraph (D), on 
a publicly accessible Web site. 
(2) REPORTS AND RECOMMENDATIONS TO CON-
GRESS.— 
(A) IN GENERAL.—Not later than January 
1, 2020, and January 1 of each of the 6 years 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
thereafter, the Secretary shall submit to Con-
gress a report on the demonstration program. 
Each such report shall include data and infor-
mation regarding State performance with re-
spect to each of the mandatory and additional 
benchmarks described in paragraphs (3) and 
(4) of subsection (f) and other data and infor-
mation reported by States under paragraph (1) 
and an assessment of the extent to which the 
demonstration 
program 
is 
successful 
in 
transitioning working-age individuals with dis-
abilities to independent living and work in their 
communities. 
(B) RECOMMENDATIONS.—Not later than 
December 31, 2021, the Secretary shall submit 
to Congress recommendations regarding wheth-
er the demonstration program should be contin-
ued, expanded, modified, or terminated. 
(3) RESEARCH AND EVALUATION.— 
(A) IN GENERAL.—The Secretary, acting 
through the Administration on Community Liv-
ing, directly or through grant or contract, shall 
provide for research on, and a national evalua-
tion of, the demonstration program, including 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
assistance to the Secretary in preparing the 
final report required under subparagraph (C). 
(B) CONTENTS
OF
EVALUATION.—Such 
national evaluation shall include an analysis of 
the characteristics and outcomes of the individ-
uals participating in the demonstration program 
and the best practices developed to achieve the 
goals of the demonstration program. 
(C) FINAL REPORT.—Not later than June 
30, 2022, the Secretary shall submit to the 
President and Congress a final report that re-
flects the evaluation under subparagraph (A), 
that provides findings and conclusions on the 
conduct and effectiveness of demonstration pro-
gram, and that includes a summary of the pub-
lic comments received under paragraph (1)(D). 
(h) DEFINITIONS.—In this section: 
(1) CONGREGATE SETTING WORK.—The term 
‘‘congregate setting work’’ means a nonprofit, for- 
profit, or State agency entity that employs a major-
ity of individuals with disabilities and receives Med-
icaid or other State funds for the purpose of pro-
viding employment services, or a facility or sub-unit 
of any such agency that meets such criteria. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(2) DEMONSTRATION
PROGRAM.—The term 
‘‘demonstration program’’ means the Transition to 
Independence Demonstration Program established 
under this section. 
(3) FACILITY-BASED
DAY
HABILITATION
OR 
DAY TREATMENT.—The term ‘‘facility-based day ha-
bilitation or day treatment’’ has the meaning estab-
lished by the Secretary for that term for purposes of 
the demonstration program and shall include non- 
residential day services which take place predomi-
nantly or in large part at a single site, fixed site, or 
center-based program for individuals with disabil-
ities. In establishing the meaning of such term, the 
Secretary shall provide clear instructions distin-
guishing facility-based day habilitation or day treat-
ment from integrated day habilitation or day treat-
ment programs taking place in settings within the 
broader community and which do not isolate individ-
uals participating in such integrated day habilitation 
or day treatment programs from mainstream life. 
(4) INDIVIDUAL INTEGRATED EMPLOYMENT.— 
(A) IN GENERAL.—The term ‘‘individual 
integrated employment’’ means the ongoing 
supports to an individual who, because of the 
individual’s disabilities, needs intensive on-going 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
supports to obtain and maintain an individual 
job in competitive or customized employment, 
self-employment, or in an integrated working 
setting in the general workforce for which the 
individual is compensated at or above the min-
imum wage, but not less than the customary 
wage and level of benefits paid by the employer 
for the same or similar work performed by an 
individual without a disability. 
(B) CUSTOMIZED EMPLOYMENT SERVICES 
INCLUDED.—Such term includes customized 
employment services in which an individual re-
ceives support to craft a job description around 
their strengths and challenges. 
(C) EXCLUSIONS.—Such term does not in-
clude segregated enclaves, segregated mobile 
work crews, or other employment scenarios 
where an individual is placed solely based on 
the individual’s disability. In this subparagraph, 
the term ‘‘segregated’’ means, with respect to a 
setting or work crew, a setting or work crew in 
which individuals with disabilities are separated 
(in place or in rates of pay) from individuals 
without disabilities. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(5) INTEGRATED
DAY
HABILITATION
SERV-
ICES.—The term ‘‘integrated day habilitation serv-
ices’’ means services that are provided outside of dis-
ability specific programs or facilities, in a setting 
that supports the full access of individuals with dis-
abilities to the greater community to the same de-
gree as individuals not receiving services, and con-
sistent with the following: 
(A) Each individual receiving such services 
has an individually tailored schedule that is di-
rectly related to and reflects the individual’s 
specific interests and goals. 
(B) Activities take place on an individual 
basis or in small groups of individuals who 
choose to be served together. 
(C) The majority of time spent receiving 
such services takes place within the broader 
community rather than within a single-site, 
fixed site, or center-based program for individ-
uals with disabilities, regardless of the program 
size. 
(D) The services are provided consistent 
with the requirements of section 441.710 of 
title 42, Code of Federal Regulations. 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(6) MEDICAID.—The term ‘‘Medicaid’’ means 
the program for medical assistance established under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.). 
(7) MEDICAID BUY-IN STATE.—The term ‘‘Med-
icaid Buy-In State’’ means a State that, under sub-
clause 
(XIII), 
(XV), 
or 
(XVI) 
of 
section 
1902(a)(10)(A)(ii) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)(ii)), a waiver approved 
under section 1115 or 1915 of such Act (42 U.S.C. 
1315, 1396n), or other authority, has a program 
under which individuals with disabilities with earn-
ings and assets that would otherwise make them in-
eligible for medical assistance under the State’s 
Medicaid program are able to maintain their eligi-
bility for such assistance. 
(8) NURSING
FACILITY.—The term ‘‘nursing 
facility’’ has the meaning given that term in section 
1919(a) of the Social Security Act (42 U.S.C. 
1396r(a)). 
(9) 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)). 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(10) REGULAR
FMAP.—The term ‘‘regular 
FMAP’’ means the Federal medical assistance per-
centage applicable to the State (as determined under 
section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b))) without regard to any increases 
in that percentage applicable under subsection (y), 
(z), (aa), or (dd) of section 1905 of such Act or 
under any other provision of law. 
(11) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services. 
(12) SUBMINIMUM
WAGE
WORK.—The term 
‘‘subminimum wage work’’ means any setting in 
which individuals with disabilities are paid less than 
minimum wage under a certificate issued in accord-
ance with section 14(c) of the Fair Labor Standards 
Act of 1938 (29 U.S.C. 214(c)). 
(13) SUPPORTED
EMPLOYMENT.—The term 
‘‘supported employment’’ has the meaning given that 
term in section 7 of the Rehabilitation Act of 1973 
(29 U.S.C. 705). 
(14) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
(15) TITLE II DISABILITY BENEFICIARY.—The 
term ‘‘title II disability beneficiary’’ means an indi-
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
vidual entitled to disability insurance benefits under 
section 223 of the Social Security Act (42 U.S.C. 
423) or to monthly insurance benefits under section 
202 of such Act (42 U.S.C. 402) based on such indi-
vidual’s disability (as defined in section 223(d) of 
such Act (42 U.S.C. 423(d))). 
(16) TITLE
XVI
DISABILITY
BENEFICIARY.— 
The term ‘‘title XVI disability beneficiary’’ means an 
individual eligible for supplemental security income 
benefits under title XVI of the Social Security Act 
(42 U.S.C. 1381 et seq.) on the basis of blindness 
(within the meaning of section 1614(a)(2) of such 
Act (42 U.S.C. 1382c(a)(2))) or disability (within 
the meaning of section 1614(a)(3) of such Act (42 
U.S.C. 1382c(a)(3))). 
(17) WORKING-AGE INDIVIDUAL WITH A DIS-
ABILITY
RECEIVING
MEDICAID-FUNDED
HOME
OR 
COMMUNITY-BASED SERVICES.—The term ‘‘working- 
age individual with a disability receiving Medicaid- 
funded home or community-based services’’ means a 
title II disability beneficiary or a title XVI disability 
beneficiary who has attained age 18, but has not at-
tained age 65, and is receiving home or community- 
based services— 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS
(A) under a waiver approved under sub-
section (c) or (d) of section 1915 the Social Se-
curity Act (42 U.S.C. 1396n); 
(B) under the State Medicaid plan in ac-
cordance with subsection (i), (j), or (k) of such 
section; or 
(C) under a Medicaid waiver approved 
under section 1115 of the Social Security Act 
(42 U.S.C. 1315). 
Æ 
VerDate Sep 11 2014 
02:43 Feb 09, 2018
Jkt 079200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6301
E:\BILLS\H4931.IH
H4931
lotter on DSKBCFDHB2PROD with BILLS