I
105TH CONGRESS
1ST SESSION
H. R. 2020
To amend title XIX of the Social Security Act to provide for coverage
of community attendant services under the Medicaid program.
IN THE HOUSE OF REPRESENTATIVES
JUNE 24, 1997
Mr. GINGRICH introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to provide
for coverage of community attendant services under the
Medicaid 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 ‘‘Medicaid Community
Attendant Services Act of 1997’’.
SEC. 2. COVERAGE OF COMMUNITY-BASED ATTENDANT
SERVICES UNDER THE MEDICAID PROGRAM.
(a) REQUIRING COVERAGE FOR INDIVIDUALS ENTI-
TLED TO NURSING FACILITY SERVICES OR INTERMEDI-
ATE CARE FACILITY SERVICES FOR THE MENTALLY RE-
‘‘(B) voluntary training on how to select,
manage, and dismiss attendants; and
‘‘(C) health-related tasks (as defined by
the Secretary) that are assigned to, delegated
to, or performed by, unlicensed personal attend-
ants.
‘‘(3) EXCLUDED SERVICES.—Subject to para-
graph (4), such term does not include—
‘‘(A) provision of room and board, and
‘‘(B) prevocational, vocational, and sup-
ported employment.
‘‘(4) FLEXIBILITY
IN
TRANSITION
TO
HOME
SETTING.—Under regulations of the Secretary, such
term may include expenditures for transitional costs,
such as rent and utility deposits, first months’s rent
and utilities, bedding, basic kitchen supplies, and
other necessities required for an individual to make
the transition from a nursing facility or intermediate
care facility for the mentally retarded to a home set-
ting.
‘‘(b) LIMITATION ON AMOUNTS OF EXPENDITURES
AS MEDICAL ASSISTANCE.—
‘‘(1) IN
GENERAL.—In carrying out section
1902(a)(10)(D)(ii), a State shall permit an individ-
ual who is entitled to medical assistance with respect
to nursing facility services or intermediate care facil-
ity services for the mentally retarded and who quali-
fies for the receipt of such services to choose to re-
ceive medical assistance for qualified community-
based attendant services (rather than medical assist-
ance for such institutional services), in the most in-
tegrated setting appropriate to the needs of the indi-
vidual, so long as the aggregate amount of the Fed-
eral expenditures for such individuals in a fiscal year
does not exceed the total that would have been ex-
pended for such individuals to receive such institu-
tional services in the year plus, subject to subsection
(e), the transitional allotment to the State for the
fiscal year involved, as determined under paragraph
(2)(B).
‘‘(2) TRANSITIONAL ALLOTMENTS.—
‘‘(A) TOTAL AMOUNT.—The total amount
of the transitional allotments under this para-
graph for—
‘‘(i) fiscal year 1998 is $580,000,000,
‘‘(ii) fiscal year 1999 is $480,000,000,
‘‘(iii) 
fiscal 
year 
2000 
is
$380,000,000,
‘‘(iv) 
fiscal 
year 
2001 
is
$280,000,000,
‘‘(v) fiscal year 2002 is $180,000,000
and
‘‘(vi) 
fiscal 
year 
2003 
is
$100,000,000.
‘‘(B) STATE ALLOTMENTS.—The Secretary
shall provide a formula for the distribution of
the total amount of the transitional allotments
provided in each fiscal year under subparagraph
(A) among States. Such formula shall give pref-
erence to States that have a relatively higher
proportion of long-term care services furnished
to individuals in an institutional setting but
who have a plan under subsection (e) to signifi-
cantly reduce such proportion.
‘‘(C) USE OF FUNDS.—Such funds allotted
to, but not expended in, a fiscal year to a State
are available for expenditure in the succeeding
fiscal year.
‘‘(c) DELIVERY MODELS.—For purposes of this sec-
tion:
‘‘(1) AGENCY-PROVIDER
MODEL.—The term
‘agency-provider model’ means, with respect to the
provision of community-based attendant services for
an individual, a method of providing such services
under which a single entity contracts for the provi-
sion of such services.
‘‘(2) OTHER MODEL.—The term ‘other model’
means a method, other than an agency-provider
model, for provision of services. Such a model may
include the provision of vouchers, direct cash pay-
ments, or use of a fiscal agent to assist in obtaining
services.
‘‘(d) QUALITY ASSURANCE.—
‘‘(1) IN GENERAL.—No Federal financial par-
ticipation shall be available with respect to qualified
community-based attendant services furnished under
an agency-provider model or other model unless the
State establishes and maintains a quality assurance
program that is developed after public hearings, that
is based on consumer satisfaction, and that, in the
case of services furnished under the agency-provider
model, meets the following requirements:
‘‘(A) SURVEY
AND
CERTIFICATION.—The
State periodically certifies and surveys such
provider-agencies. Such surveys are conducted
on an unannounced basis and average at least
1 a year for each agency-provider.
‘‘(B) 
STANDARDS.—The 
State 
adopts
standards for survey and certification that in-
clude—
‘‘(i) minimum qualifications and train-
ing requirements for provider staff;
‘‘(ii) financial operating standards;
and
‘‘(iii) a consumer grievance process.
‘‘(C) MONITORING
BOARDS.—The State
provides a system that allows for monitoring
boards consisting of providers, family members,
consumers, and neighbors to advise and assist
the State.
‘‘(D) PUBLIC REPORTING.—The State es-
tablishes reporting procedures to make available
information to the public.
‘‘(E) ONGOING
MONITORING.—The State
provides ongoing monitoring of the delivery of
attendant services and the effect of those serv-
ices on the health and well-being of each recipi-
ent.
‘‘(2) PROTECTION OF BENEFICIARIES.—
‘‘(A) IN GENERAL.—The regulations pro-
mulgated under section 1930(h)(1) shall apply
with respect to the protection of the health,
safety, and welfare of individuals receiving
qualified community-based attendant services in
the same manner as they apply to individuals
receiving community supported living arrange-
ments services.
‘‘(B) DEVELOPMENT OF ADDITIONAL REG-
ULATIONS.—The Secretary shall develop addi-
tional regulations to protect the health, safety,
and welfare for individuals receiving qualified
community-based attendant services other than
under an agency-provider model. Such regula-
tions shall be designed to maximize the consum-
ers’ independence and control.
‘‘(C) SANCTIONS.—The provisions of sec-
tion 1930(h)(2) shall apply to violations of reg-
ulations described in subparagraph (A) or (B)
in the same manner as they apply to violations
of regulations described in section 1930(h)(1).
‘‘(e) TRANSITION PLAN.—
‘‘(1) IN GENERAL.—As a condition for receipt
of a transitional allotment under subsection (b)(2),
a State shall develop a long-term care services tran-
sition plan that establishes specific action steps and
specific timetables to increase the proportion of long-
term care services provided under the plan under
this title in home and community-based settings,
rather than institutional settings.
‘‘(2) PARTICIPATION.—The plan under para-
graph (1) shall be developed with major participa-
tion by both the State Independent Living Council
and the State Developmental Disabilities Council, as
well as input from the Councils on Aging.
‘‘(f) ELIGIBILITY.—Effective January 1, 1999, a
State may not exercise the option of coverage of individ-
uals under section 1902(a)(10)(A)(ii)(V) without provid-
ing coverage under section 1902(a)(10)(A)(ii)(VI).
‘‘(g) REPORT ON IMPACT OF SECTION.—The Sec-
retary shall submit to Congress periodic reports on the
impact of this section on beneficiaries, States, and the
Federal Government.’’.
(c) COVERAGE AS MEDICAL ASSISTANCE.—
(1) IN GENERAL.—Section 1905(a) of such Act
(42 U.S.C. 1396d) is amended—
(A) by striking ‘‘and’’ at the end of para-
graph (24),
(B) by redesignating paragraph (25) as
paragraph (26), and
(C) by inserting after paragraph (24) the
following new paragraph:
‘‘(25) qualified community-based attendant
services (to the extent allowed and as defined in sec-
tion 1932); and’’.
(2) 
ELIGIBILITY
CLASSIFICATIONS.—Section
1902(a)(10)(A)(ii)(VI) 
(42 
U.S.C.
1396a(a)(10)(A)(ii)(VI)) is amended by inserting
‘‘or qualified community-based attendant services’’
after ‘‘section 1915’’ each it appears.
(3) CONFORMING AMENDMENTS.—(A) Section
1902(j) of such Act (42 U.S.C. 1396a(j)) is amend-
ed by striking ‘‘(25)’’ and inserting ‘‘(26)’’.
(B) Section 1902(a)(10)(C)(iv) of such Act (42
U.S.C. 1396a(a)(10)(C)(iv)) is amended by striking
‘‘(24)’’ and inserting ‘‘(25)’’.
(d) REVIEW OF, AND REPORT ON, REGULATIONS.—
The Secretary of Health and Human Services shall review
existing regulations under title XIX of the Social Security
Act insofar as they regulate the provision of home health
services and other services in home and community-based
settings. The Secretary shall submit to Congress a report
on how excessive utilization of medical services can be re-
duced under such title by using qualified community-based
attendant services.
(e) DEVELOPMENT OF FUNCTIONAL NEEDS ASSESS-
MENT INSTRUMENT.—The Secretary shall develop a func-
tional needs assessment instrument that assesses an indi-
vidual’s need for qualified community-based attendant
services and that may be used in carrying out sections
1902(a)(10)(D)(ii) and 1932 of the Social Security Act.
(f) TASK FORCE
ON FINANCING
OF LONG-TERM
CARE SERVICES.—The Secretary shall establish a task
force to examine appropriate methods for financing long-
term care services. Such task force shall include signifi-
cant representation of individuals (and representatives of
individuals) who receive such services.
SEC. 3. STATE OPTION FOR ELIGIBILITY FOR INDIVIDUALS.
(a) IN GENERAL.—Section 1903(f) of the Social Se-
curity Act (42 U.S.C. 1396b(f)) is amended—
(1) in paragraph (4)(C), by inserting ‘‘subject
to paragraph (5),’’ after ‘‘does not exceed’’, and
(2) by adding at the end the following:
‘‘(5)(A) A State may waive the income limitation de-
scribed in paragraph (4)(C) in such cases as the State
finds the potential for employment opportunities would be
enhanced through the provision of such services.
‘‘(B) In the case of an individual who is made eligible
for medical assistance because of subparagraph (A), not-
withstanding section 1916(b), the State may impose a pre-
mium based on a sliding scale relating to income.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to medical assistance provided
for items and services furnished on or after January 1,
1998.
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