1905(d) of the Social Security Act (as in effect be-
fore the enactment of this Act); and 
(2) the term ‘‘services in intermediate care fa-
cilities for individuals with an intellectual disability’’ 
means services described in section 1905(a)(15) of 
such Act (as so in effect) in an intermediate care fa-
cility for individuals with an intellectual disability to 
an individual determined to require such services in 
accordance 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 
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similar level of disability due to cognitive im-
pairment)— 
(i) bathing; 
(ii) eating; 
(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 
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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 
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(d), 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.— 
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(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-
ices are furnished through an organized system of 
care, as described in paragraph (2), if— 
(A) the services are provided to an indi-
vidual less than 22 years of age; 
(B) the individual has a serious emotional 
disturbance or a substance abuse disorder; and 
(C) the individual is, or is at imminent risk 
of being, subject to the authority of, or in need 
of the services of, at least 1 public agency that 
serves the needs of children, including an agen-
cy involved with child welfare, special education, 
juvenile justice, or criminal justice. 
(2) REQUIREMENTS FOR SYSTEM OF CARE.—In 
this subsection, an ‘‘organized system of care’’ is a 
community-based service delivery network, which 
may consist of public and private providers, that 
meets the following requirements: 
(A) The system has established linkages 
with existing mental health services and sub-
stance abuse treatment service delivery pro-
grams in the plan service area (or is in the 
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process of developing or operating a system 
with appropriate public agencies in the area to 
coordinate the delivery of such services to indi-
viduals in the area). 
(B) The system provides for the participa-
tion and coordination of multiple agencies and 
providers that serve the needs of children in the 
area, including agencies and providers involved 
with child welfare, education, juvenile justice, 
criminal justice, health care, mental health, and 
substance abuse prevention and treatment. 
(C) The system provides for the involve-
ment of the families of children to whom mental 
health services and substance abuse treatment 
services are provided in the planning of treat-
ment and the delivery of services. 
(D) The system provides for the develop-
ment and implementation of individualized 
treatment plans by multidisciplinary and multi-
agency teams, which are recognized and fol-
lowed by the applicable agencies and providers 
in the area. 
(E) The system ensures the delivery and 
coordination of the range of mental health serv-
ices and substance abuse treatment services re-
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(iii) statistical or other studies re-
quired for the implementation of this Act; 
and 
(iv) such other purposes as the Board 
or State may specify. 
(D) The provider agrees not to bill the pro-
gram for any services for which benefits are not 
available because of section 204(d). 
(E) In the case of a provider that is not 
an individual, the provider agrees not to employ 
or use for the provision of health services any 
individual or other provider who or which has 
had a participation agreement under this sub-
section terminated for cause. 
(F) In the case of a provider paid under a 
fee-for-service basis under section 612, the pro-
vider agrees to submit bills and any required 
supporting documentation relating to the provi-
sion of covered services within 30 days (or such 
shorter period as a State health security pro-
gram may require) after the date of providing 
such services. 
(2) TERMINATION OF PARTICIPATION AGREE-
MENTS.— 
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