I 
109TH CONGRESS 
1ST SESSION 
H. R. 910 
To amend title XIX of the Social Security Act to provide individuals with 
disabilities and older Americans with equal access to community-based 
attendant services and supports, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 17, 2005 
Mr. DAVIS of Illinois (for himself and Mr. SHIMKUS) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
individuals with disabilities and older Americans with 
equal access to community-based attendant services and 
supports, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicaid Community-Based Attendant Services and 
Support Act of 2005’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings and purposes. 
TITLE I—ESTABLISHMENT OF MEDICAID PLAN BENEFIT 
Sec. 101. Coverage of community-based attendant services and supports under 
the medicaid program. 
Sec. 102. Enhanced FMAP for ongoing activities of early coverage States that 
enhance and promote the use of community-based attendant 
services and supports. 
Sec. 103. Increased Federal financial participation for certain expenditures. 
TITLE II—PROMOTION OF SYSTEMS CHANGE AND CAPACITY 
BUILDING 
Sec. 201. Grants to promote systems change and capacity building. 
Sec. 202. Demonstration project to enhance coordination of care under the 
medicare and medicaid programs for non-elderly dual eligible 
individuals. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Long-term services and supports provided 
under the medicaid program established under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) must meet the ability and life choices of indi-
viduals with disabilities and older Americans, includ-
ing the choice to live in one’s own home or with 
one’s own family and to become a productive mem-
ber of the community. 
(2) Research on the provision of long-term serv-
ices and supports under the medicaid program (con-
ducted by and on behalf of the Department of 
Health and Human Services) has revealed a signifi-
cant funding bias toward institutional care. Only 
about 27 percent of long-term care funds expended
under the medicaid program, and only about 9 per-
cent of all funds expended under that program, pay 
for services and supports in home and community- 
based settings. 
(3) In the case of medicaid beneficiaries who 
need long-term care, the only long-term care service 
currently guaranteed by Federal law in every State 
is nursing home care. Only 27 States have adopted 
the benefit option of providing personal care services 
under the medicaid program. Although every State 
has chosen to provide certain services under home 
and community-based waivers, these services are un-
evenly available within and across States, and reach 
a small percentage of eligible individuals. In fiscal 
year 2000, only 3 States spent 50 percent or more 
of their medicaid long-term care funds under the 
medicaid program on home and community-based 
care. 
(4) Despite the funding bias and the uneven 
distribution of home and community-based services, 
21⁄2 times more people are served in home and com-
munity-based settings than in institutional settings. 
(5) The goals of the Nation properly include 
providing families of children with disabilities, work-
ing-age adults with disabilities, and older Americans 
with— 
(A) a meaningful choice of receiving long- 
term services and supports in the most inte-
grated setting appropriate to their needs; 
(B) the greatest possible control over the 
services received and, therefore, their own lives 
and futures; and 
(C) quality services that maximize inde-
pendence in the home and community, including 
in the workplace. 
(b) PURPOSES.—The purposes of this Act are the fol-
lowing: 
(1) To reform the medicaid program established 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) to provide equal access to com-
munity-based attendant services and supports. 
(2) To provide financial assistance to States as 
they reform their long-term care systems to provide 
comprehensive statewide long-term services and sup-
ports, including community-based attendant services 
and supports that provide consumer choice and di-
rection, in the most integrated setting appropriate.
TITLE I—ESTABLISHMENT OF 
MEDICAID PLAN BENEFIT 
SEC. 101. COVERAGE OF COMMUNITY-BASED ATTENDANT 
SERVICES AND SUPPORTS UNDER THE MED-
ICAID PROGRAM. 
(a) 
MANDATORY
COVERAGE.—Section 
1902(a)(10)(D) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(D)) is amended— 
(1) by inserting ‘‘(i)’’ after ‘‘(D)’’; 
(2) by adding ‘‘and’’ after the semicolon; and 
(3) by adding at the end the following new 
clause: 
‘‘(ii) subject to section 1936, for the inclu-
sion of community-based attendant services and 
supports for any individual who— 
‘‘(I) is eligible for medical assistance 
under the State plan; 
‘‘(II) with respect to whom there has 
been a determination that the individual 
requires the level of care provided in a 
nursing facility or an intermediate care fa-
cility for the mentally retarded (whether or 
not coverage of such intermediate care fa-
cility is provided under the State plan); 
and
‘‘(III) who chooses to receive such 
services and supports;’’. 
(b) COMMUNITY-BASED ATTENDANT SERVICES AND 
SUPPORTS.— 
(1) IN GENERAL.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended— 
(A) by redesignating section 1936 as sec-
tion 1937; and 
(B) by inserting after section 1935 the fol-
lowing: 
‘‘COMMUNITY-BASED ATTENDANT SERVICES AND 
SUPPORTS 
‘‘SEC. 1936. (a) REQUIRED COVERAGE.— 
‘‘(1) IN GENERAL.—Not later than October 1, 
2009, a State shall provide through a plan amend-
ment for the inclusion of community-based attendant 
services and supports (as defined in subsection 
(g)(1)) 
for 
individuals 
described 
in 
section 
1902(a)(10)(D)(ii) in accordance with this section. 
‘‘(2) ENHANCED FMAP AND ADDITIONAL FED-
ERAL
FINANCIAL
SUPPORT
FOR
EARLIER
COV-
ERAGE.—Notwithstanding section 1905(b), during 
the period that begins on or after October 1, 2005, 
and ends on September 30, 2009, in the case of a 
State with an approved plan amendment under this 
section during that period that also satisfies the re-
quirements of subsection (c) the Federal medical as-
sistance percentage shall be equal to the enhanced 
FMAP described in section 2105(b) with respect to 
medical assistance in the form of community-based 
attendant services and supports provided to individ-
uals described in section 1902(a)(10)(D)(ii) in ac-
cordance with this section. 
‘‘(b) DEVELOPMENT AND IMPLEMENTATION OF BEN-
EFIT.—In order for a State plan amendment to be ap-
proved under this section, a State shall provide the Sec-
retary with the following assurances: 
‘‘(1) ASSURANCE OF DEVELOPMENT AND IM-
PLEMENTATION
COLLABORATION.—That the State 
has developed and shall implement the provision of 
community-based attendant services and supports 
under the State plan through active collaboration 
with— 
‘‘(A) individuals with disabilities; 
‘‘(B) elderly individuals; 
‘‘(C) representatives of such individuals; 
and 
‘‘(D) providers of, and advocates for, serv-
ices and supports for such individuals. 
‘‘(2) ASSURANCE OF PROVISION ON A STATE-
WIDE BASIS AND IN MOST INTEGRATED SETTING.—
That community-based attendant services and sup-
ports will be provided under the State plan to indi-
viduals described in section 1902(a)(10)(D)(ii) on a 
statewide basis and in a manner that provides such 
services and supports in the most integrated setting 
appropriate for each individual eligible for such serv-
ices and supports. 
‘‘(3) ASSURANCE
OF
NONDISCRIMINATION.— 
That the State will provide community-based attend-
ant services and supports to an individual described 
in section 1902(a)(10)(D)(ii) without regard to the 
individual’s age, type of disability, or the form of 
community-based attendant services and supports 
that the individual requires in order to lead an inde-
pendent life. 
‘‘(4) ASSURANCE
OF
MAINTENANCE
OF
EF-
FORT.—That the level of State expenditures for op-
tional medical assistance that— 
‘‘(A) is described in a paragraph other 
than paragraphs (1) through (5), (17) and (21) 
of section 1905(a) or that is provided under a 
waiver under section 1915, section 1115, or 
otherwise; and 
‘‘(B) is provided to individuals with disabil-
ities or elderly individuals for a fiscal year,
shall not be less than the level of such expenditures 
for the fiscal year preceding the fiscal year in which 
the State plan amendment to provide community- 
based attendant services and supports in accordance 
with this section is approved. 
‘‘(c) REQUIREMENTS FOR ENHANCED FMAP FOR 
EARLY COVERAGE.—In addition to satisfying the other re-
quirements for an approved plan amendment under this 
section, in order for a State to be eligible under subsection 
(a)(2) during the period described in that subsection for 
the enhanced FMAP for early coverage under subsection 
(a)(2), the State shall satisfy the following requirements: 
‘‘(1) SPECIFICATIONS.—With respect to a fiscal 
year, the State shall provide the Secretary with the 
following specifications regarding the provision of 
community-based attendant services and supports 
under the plan for that fiscal year: 
‘‘(A)(i) The number of individuals who are 
estimated to receive community-based attendant 
services and supports under the plan during the 
fiscal year. 
‘‘(ii) The number of individuals that re-
ceived such services and supports during the 
preceding fiscal year.
‘‘(B) The maximum number of individuals 
who will receive such services and supports 
under the plan during that fiscal year. 
‘‘(C) The procedures the State will imple-
ment to ensure that the models for delivery of 
such services and supports are consumer con-
trolled (as defined in subsection (g)(2)(B)). 
‘‘(D) The procedures the State will imple-
ment to inform all potentially eligible individ-
uals and relevant other individuals of the avail-
ability of such services and supports under this 
title, and of other items and services that may 
be provided to the individual under this title or 
title XVIII. 
‘‘(E) The procedures the State will imple-
ment to ensure that such services and supports 
are provided in accordance with the require-
ments of subsection (b)(1). 
‘‘(F) The procedures the State will imple-
ment to actively involve individuals with disabil-
ities, elderly individuals, and representatives of 
such individuals in the design, delivery, admin-
istration, and evaluation of the provision of 
such services and supports under this title.
‘‘(2) PARTICIPATION
IN
EVALUATIONS.—The 
State shall provide the Secretary with such sub-
stantive input into, and participation in, the design 
and conduct of data collection, analyses, and other 
qualitative or quantitative evaluations of the provi-
sion of community-based attendant services and sup-
ports under this section as the Secretary deems nec-
essary in order to determine the effectiveness of the 
provision of such services and supports in allowing 
the individuals receiving such services and supports 
to lead an independent life to the maximum extent 
possible. 
‘‘(d) QUALITY ASSURANCE PROGRAM.— 
‘‘(1) STATE RESPONSIBILITIES.—In order for a 
State plan amendment to be approved under this 
section, a State shall establish and maintain a qual-
ity assurance program with respect to community- 
based attendant services and supports that provides 
for the following: 
‘‘(A) The State shall establish require-
ments, as appropriate, for agency-based and 
other delivery models that include— 
‘‘(i) minimum qualifications and train-
ing requirements for agency-based and 
other models;