SEC. 403. INDIVIDUALS WITH DISABILITIES DEFINED.
(a) IN GENERAL.—In this title, the term ‘‘individual
with disabilities’’ means any individual within one or more
of the following 4 categories of individuals:
(1) INDIVIDUALS REQUIRING HELP WITH AC-
TIVITIES OF DAILY LIVING.—An individual of any
age who—
(A) requires hands-on or standby assist-
ance, supervision, or cueing (as defined in regu-
lations) to perform three or more activities of
daily living (as defined in subsection (c)), and
(B) is expected to require such assistance,
supervision, or cueing over a period of at least
100 days.
(2) INDIVIDUALS WITH SEVERE COGNITIVE OR
MENTAL IMPAIRMENT.—An individual of any age—
(A) whose score, on a standard mental sta-
tus protocol (or protocols) appropriate for
measuring the individual’s particular condition
specified by the Secretary, indicates either se-
vere cognitive impairment or severe mental im-
pairment, or both;
(B) who—
(i) requires hands-on or standby as-
sistance, supervision, or cueing with one or
more activities of daily living,
(ii) requires hands-on or standby as-
sistance, supervision, or cueing with at
least such instrumental activity (or activi-
ties) of daily living related to cognitive or
mental impairment as the Secretary speci-
fies, or
(iii) displays symptoms of one or more
serious behavioral problems (that is on a
list of such problems specified by the Sec-
retary) which create a need for supervision
to prevent harm to self or others; and
(C) whose is expected to meet the require-
ments of subparagraphs (A) and (B) over a pe-
riod of at least 100 days.
(3) INDIVIDUALS WITH SEVERE OR PROFOUND
MENTAL RETARDATION.—An individual of any age
who has severe or profound mental retardation (as
determined according to a protocol specified by the
Secretary).
(4) SEVERELY DISABLED CHILDREN.—An indi-
vidual under 6 years of age who—
(A) has a severe disability or chronic medi-
cal condition,
(B) but for receiving personal assistance
services or any of the services described in sec-
tion 404(d)(1), would require institutionaliza-
tion in a hospital, nursing facility, or intermedi-
ate care facility for the mentally retarded, and
(C) is expected to have such disability or
condition and require such services over a pe-
riod of at least 100 days.
(b) DETERMINATION.—
(1) IN GENERAL.—The determination of wheth-
er an individual is an individual with disabilities
shall be made, by persons or entities specified under
the State plan, using a uniform protocol consisting
of an initial screening and assessment specified by
the Secretary. A State may collect additional infor-
mation, at the time of obtaining information to
make such determination, in order to provide for the
assessment and plan described in section 404(b) or
for other purposes. The State shall establish a fair
hearing process for appeals of such determinations.
(2) PERIODIC REASSESSMENT.—The determina-
tion that an individual is an individual with disabil-
ities shall be considered to be effective under the
State plan for a period of not more than 12 months
(or for such longer period in such cases as a signifi-
cant change in an individual’s condition that may af-
fect such determination is unlikely). A reassessment
shall be made if there is a significant change in an
individual’s condition that may affect such deter-
mination.
(c) ACTIVITY OF DAILY LIVING DEFINED.—In this
title, the term ‘‘activity of daily living’’ means any of the
following: eating, toileting, dressing, bathing, and trans-
ferring.
SEC. 404. HOME AND COMMUNITY-BASED SERVICES COV-
ERED UNDER STATE PLAN.
(a) SPECIFICATION.—
(1) IN
GENERAL.—Subject to the succeeding
provisions of this section, the State plan under this
title shall specify—
(A) the home and community-based serv-
ices available under the plan to individuals with
disabilities (or to such categories of such indi-
viduals), and
(B) any limits with respect to such serv-
ices.
(2) FLEXIBILITY
IN
MEETING
INDIVIDUAL
NEEDS.—The services shall be specified in a manner
that permits sufficient flexibility for providers to
meet the needs of individuals with disabilities in a
cost 
effective 
manner. 
Subject 
to 
subsection
(e)(1)(B), such services may be delivered in an indi-
vidual’s home, a range of community residential ar-
rangements, or outside the home.
(b) REQUIREMENT FOR NEEDS ASSESSMENT AND
PLAN OF CARE.—
(1) IN GENERAL.—The State plan shall provide
for home and community-based services to an indi-
vidual with disabilities only if—
(A) a comprehensive assessment of the in-
dividual’s need for home and community-based
services (regardless of whether all needed serv-
ices are available under the plan) has been
made,
(B) an individualized plan of care based on
such assessment is developed, and
(C) such services are provided consistent
with such plan of care.
(2) INVOLVEMENT OF INDIVIDUALS.—The indi-
vidualized plan of care under paragraph (1)(B) for
an individual with disabilities shall—
(A) be developed by qualified individuals
(specified under the State plan),
(B) be developed and implemented in close
consultation with the individual and the individ-
ual’s family,
(1) CONFIDENTIALITY.—The State plan shall
provide safeguards which restrict the use or disclo-
sure of information concerning applicants and bene-
ficiaries to purposes directly connected with the ad-
ministration of the plan.
(2) SAFEGUARDS AGAINST ABUSE.—The State
plans shall provide safeguards against physical, emo-
tional, or financial abuse or exploitation (specifically
including appropriate safeguards in cases where pay-
ment for program benefits is made by cash pay-
ments or vouchers given directly to individuals with
disabilities).
SEC. 407. ADVISORY GROUPS.
(a) FEDERAL ADVISORY GROUP.—
(1) ESTABLISHMENT.—The Secretary shall es-
tablish an advisory group, to advise the Secretary
and States on all aspects of the program under this
title.
(2) COMPOSITION.—The group shall be com-
posed of individuals with disabilities and their rep-
resentatives, providers, Federal and State officials,
and local community implementing agencies. A ma-
jority of its members shall be individuals with dis-
abilities and their representatives.
(b) STATE ADVISORY GROUPS.—