available through the grant to accomplish the purposes de-
scribed in subsection (a) and, in accomplishing such pur-
poses, may carry out any of the following systems change
activities:
(1) NEEDS
ASSESSMENT
AND
DATA
GATH-
ERING.—The State may use funds to conduct a
statewide needs assessment that may be based on
data in existence on the date on which the assess-
ment is initiated and may include information about
the number of persons within the State who are re-
ceiving long term services and supports in unneces-
sarily segregated settings, the nature and extent to
which current programs respond to the preferences
of individuals with disabilities to receive services in
home and community-based settings as well as in in-
stitutional settings, and the expected change in de-
mand for services provided in home and community
settings as well as institutional settings.
(2) INSTITUTIONAL BIAS.—The State may use
funds to identify, develop and implement strategies
for modifying policies, practices, and procedures that
unnecessarily bias the provision of long-term services
and supports toward institutional settings and away
from home and community based setting, including
policies, 
practices 
and 
procedures 
governing
statewideness, comparability in amount, scope and
duration of services, financial eligibility, individual-
ized functional assessments and screenings (includ-
ing individual and family involvement), and knowl-
edge about service options.
(3) OVER MEDICALIZATION OF SERVICES.—The
State may use funds to identify, develop, and imple-
ment strategies for modifying policies, practices, and
procedures that unnecessarily bias the provision of
long term services and supports by health care pro-
fessionals to the extent that quality services and
supports can be provided by other qualified individ-
uals, including policies, practices, and procedures
governing service authorization, case management
and service coordination, service delivery options,
quality controls, and supervision and training.
(4) 
INTERAGENCY
COORDINATION; 
SINGLE
POINT OF ENTRY.—The State may support activities
to identify and coordinate Federal and State poli-
cies, resources, and services, relating to the provision
of long term services and supports, including the
convening of interagency work groups and the enter-
ing into of interagency agreements that provide for
a single point of entry and the design and implemen-
tation of coordinated screening and assessment sys-
tem for all persons eligible for long term services
and supports.
(5) TRAINING AND TECHNICAL ASSISTANCE.—
The State may carry out directly, or may provide
support to a public or private entity to carry out
training and technical assistance activities that are
provided for individuals with disabilities, as appro-
priate, their representatives, attendants and per-
sonnel (including professionals, paraprofessionals,
volunteers, and other members of the community).
(6) PUBLIC AWARENESS.—The State may sup-
port a public awareness program design to provide
information relating to the availability of choices in-
dividuals with disabilities may select for receiving
long term services and support in the most inte-
grated setting appropriate.
(7) DOWNSIZING
OF
LARGE
INSTITUTIONS.—
The State may use funds to support the per capita
increased fixed costs in institutional settings directly
related to the movement of individuals with disabil-
ities out of a specific facility into community-based
settings.
(8) TRANSITIONAL COSTS.—The State may use
funds to provide transitional costs described in sec-
tion 1935(a)(4) of the Social Security Act, as added
by section 3(b) of this Act.
(9) TASK FORCE.—The State may use these
funds to support the operation of the task force de-
scribed in subsection (d).
(10) 
DEMONSTRATIONS
OF
NEW
AP-
PROACHES.—The State may use funds to conduct,
on a time-limited basis, the demonstration of new
approaches to accomplishing the purposes described
in subsection (a).
(11) OTHER ACTIVITIES.—The State may uti-
lize amounts made available through grants made
under subsection (b) for any systems change activi-
ties other than the activities described in another
paragraph of this subsection, that are necessary for
developing, implementing, or evaluating the com-
prehensive statewide system of long term services
and supports.
(d) CONSUMER TASK FORCE.—
(1) ESTABLISHMENT AND DUTIES.—To be eli-
gible to receive financial assistance under this sec-
tion, each State shall establish a task force to assist
the State in the development, implementation, and
evaluation of real choice systems change initiative.
(2) APPOINTMENT.—Members of the task force
shall be appointed by the Governor. The Governor
shall select members after soliciting recommenda-
tions from representatives of organizations rep-
resenting a broad range of individuals with disabil-
ities and organizations interested in individuals with
disabilities.
(3) COMPOSITION.—
(A) The task force shall represent a broad
range of individuals with disabilities from di-
verse backgrounds and shall include representa-
tives from Developmental Disabilities Councils,
State Independent Living Councils, Commis-
sions on Aging, organizations that provide serv-
ices to individuals with disabilities and con-
sumers of long-term services and supports.
(B) A majority of task force members shall
be individuals with disabilities or their rep-
resentatives.
(C) The task force shall not include em-
ployees of any State agency providing services
to individuals with disabilities other than em-
ployees of agencies described in the Develop-
mental Disabilities Assistance and Bill of
Rights Act.
(e) AVAILABILITY OF FUNDS.—
(1) FUNDS ALLOCATED TO STATES.—Funds al-
located to a State under a grant made under this
section for a fiscal year shall remain available until
expended.
(2) FUNDS
NOT
ALLOCATED
TO
STATES.—
Funds not allocated to States in the fiscal year for
which they are appropriated shall remain available
in succeeding fiscal years for allocation by the Sec-
retary using the allocation formula established by
the Secretary under subsection (b)(2).
(f) ANNUAL REPORT.—A State that receives a grant
under this section shall submit an annual report to the
Secretary on the use of funds provided under the grant.
Each report shall include the percentage increase in the
number of eligible individuals in the State who receive long
term services and supports in the most integrated setting
appropriate, including through community attendant serv-
ices and supports and other community-based settings.
(g) APPROPRIATION.—Out of any funds in the Treas-
ury not otherwise appropriated, there is authorized to be
appropriated and there is appropriated to make grants
under this section—
(1) for fiscal year 2001, $25,000,000; and
(2) for each of fiscal years 2002 through 2010,
such amounts as may be appropriate.
SEC. 5. 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, resources,
and deeming limitations described 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,
2001.
SEC. 6. REVIEW OF, AND REPORT ON, REGULATIONS.
The National Council on Disability established under
title IV of the Rehabilitation Act of 1973 shall review ex-
isting regulations under title XIX of the Social Security
Act insofar as they regulate the provision of home health
services, personal care services, and other services in home
and community-based settings. The Secretary of Health
and Human Services shall submit to Congress a report
on how excessive utilization of medical services can be re-
duced under such title by using community attendant serv-
ices and supports.
SEC. 7. TASK FORCE ON FINANCING OF LONG-TERM CARE
SERVICES.
The Secretary of Health and Human Services shall
establish a task force to examine appropriate methods for
financing long-term services and supports. Such task force
shall include significant representation of individuals (and
representatives of individuals) who receive such services
and supports.
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