I 
116TH CONGRESS 
2D SESSION 
H. R. 8871 
To provide for an emergency increase in Federal funding to State Medicaid 
programs for expenditures on home and community-based services. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 4, 2020 
Mrs. DINGELL (for herself, Mr. LANGEVIN, Mr. LARSON of Connecticut, Mr. 
MICHAEL F. DOYLE of Pennsylvania, Ms. PRESSLEY, Ms. HAALAND, Ms. 
MATSUI, Ms. KUSTER of New Hampshire, Ms. SCHAKOWSKY, Mr. 
DEUTCH, Ms. BLUNT ROCHESTER, Mr. TONKO, Ms. PORTER, Miss RICE 
of New York, and Ms. DELAURO) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To provide for an emergency increase in Federal funding 
to State Medicaid programs for expenditures on home 
and community-based services. 
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 ‘‘COVID HCBS Relief 
Act of 2020’’. 
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SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 
COMMUNITY-BASED SERVICES DURING THE 
COVID–19 EMERGENCY PERIOD. 
(a) INCREASED FMAP.— 
(1) IN
GENERAL.—Notwithstanding section 
1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)), in the case of an HCBS program State, 
the Federal medical assistance percentage deter-
mined for the State under section 1905(b) of such 
Act and, if applicable, increased under subsection 
(y), (z), or (aa) of section 1905 of such Act (42 
U.S.C. 1396d), section 1915(k) of such Act (42 
U.S.C. 1396n(k)), or section 6008(a) of the Fami-
lies First Coronavirus Response Act (Public Law 
116–127), shall be increased by 10 percentage 
points with respect to expenditures of the State 
under the State Medicaid program for home and 
community-based services that are provided during 
the HCBS program improvement period. In no case 
may the application of the previous sentence result 
in the Federal medical assistance percentage deter-
mined for a State being more than 95 percent. 
(2) DEFINITIONS.—In this section: 
(A) HCBS PROGRAM
IMPROVEMENT
PE-
RIOD.—The term ‘‘HCBS program improve-
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U.S.C. 1315), and such other services specified 
by the Secretary. 
(b) CONDITION.—The condition described in this sub-
section, with respect to a State, is that the State submits 
an application to the Secretary, at such time and in such 
manner as specified by the Secretary, that includes, in ad-
dition to such other information as the Secretary shall re-
quire— 
(1) a description of which activities described in 
subsection (d) that a State plans to implement and 
a description of how it plans to implement such ac-
tivities; 
(2) assurances that the Federal funds attrib-
utable to the increase under subsection (a) will be 
used— 
(A) to implement the activities described in 
subsection (d); and 
(B) to supplement, and not supplant, the 
level of State funds expended for home and 
community-based services for eligible individ-
uals through programs in effect as of the date 
of the enactment of this section; and 
(3) assurances that the State will conduct ade-
quate oversight and ensure the validity of such data 
as may be required by the Secretary. 
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(c) APPROVAL OF APPLICATION.—Not later than 90 
days after the date of submission of an application of a 
State under subsection (b), the Secretary shall certify if 
the application is complete. Upon certification that an ap-
plication of a State is complete, the application shall be 
deemed to be approved for purposes of this section. 
(d) ACTIVITIES TO IMPROVE
THE DELIVERY
OF 
HCBS.— 
(1) IN
GENERAL.—A State shall work with 
community partners, such as Area Agencies on 
Aging, Centers for Independent Living, nonprofit 
home and community-based services providers, and 
other entities providing home and community-based 
services, to implement— 
(A) the purposes described in paragraph 
(2) during the COVID–19 public health emer-
gency period; and 
(B) the purposes described in paragraph 
(3) after the end of such emergency period. 
(2) FOCUSED
AREAS
OF
HCBS
IMPROVE-
MENT.—The purposes described in this paragraph, 
with respect to a State, are the following: 
(A) To increase rates for home health 
agencies and agencies that employ direct sup-
port professionals (including independent pro-
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viders in a self-directed or consumer-directed 
model) to provide home and community-based 
services under the State Medicaid program, 
provided that any agency or individual that re-
ceives payment under such an increased rate in-
creases the compensation it pays its home 
health workers or direct support professionals. 
(B) To provide paid sick leave, paid family 
leave, and paid medical leave for home health 
workers and direct support professionals. 
(C) To provide hazard pay, overtime pay, 
and shift differential pay for home health work-
ers and direct support professionals. 
(D) To provide home and community- 
based services to eligible individuals who are on 
waiting lists for programs approved under sec-
tions 1115 or 1915 of the Social Security Act 
(42 U.S.C. 1315, 1396n). 
(E) To expand home and community-based 
services to facilitate reducing the census of 
nursing facilities, intermediate care facilities, 
psychiatric facilities, and other institutional or 
congregate settings so that safety measures can 
be effectively implemented within these settings. 
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(F) To purchase emergency supplies and 
equipment, which may include items not typi-
cally covered under the Medicaid program, such 
as personal protective equipment, necessary to 
enhance access to services and to protect the 
health and well-being of home health workers 
and direct support professionals. 
(G) To pay for the travel of home health 
workers and direct support professionals to con-
duct home and community-based services. 
(H) To recruit new home health workers 
and direct support professionals. 
(I) To support family care providers of eli-
gible individuals with needed supplies and 
equipment, which may include items not typi-
cally covered under the Medicaid program, such 
as personal protective equipment, and pay. 
(J) To pay for training for home health 
workers and direct support professionals that is 
specific to the COVID–19 public health emer-
gency. 
(K) To pay for assistive technologies, staff-
ing, and other costs incurred during the 
COVID–19 public health emergency period in 
order to facilitate community integration and 
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ensure an individual’s person-centered service 
plan continues to be fully implemented. 
(L) To prepare information and public 
health and educational materials in accessible 
formats (including formats accessible to people 
with low literacy or intellectual disabilities) 
about prevention, treatment, recovery and other 
aspects of COVID–19 for eligible individuals, 
their families, and the general community 
served by agencies described in subparagraph 
(A). 
(M) To pay for interpreters to assist in 
providing home and community-based services 
to eligible individuals and to inform the general 
public about COVID–19. 
(N) To allow day services providers to pro-
vide home and community-based services. 
(O) To pay for other expenses deemed ap-
propriate by the Secretary to enhance, expand, 
or strengthen Home and Community-Based 
Services, including retainer payments, and ex-
penses which meet the criteria of the home and 
community-based settings rule published on 
January 16, 2014. 
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(3) PERMISSIBLE
USES
AFTER
THE
EMER-
GENCY
PERIOD.—The purpose described in this 
paragraph, with respect to a State, is to assist eligi-
ble individuals who had to relocate to a nursing fa-
cility or institutional setting from their homes dur-
ing the COVID–19 public health emergency period 
in— 
(A) moving back to their homes (including 
by paying for moving costs, first month’s rent, 
and other one-time expenses and start-up 
costs); 
(B) resuming home and community-based 
services; 
(C) receiving mental health services and 
necessary rehabilitative service to regain skills 
lost while relocated during the public health 
emergency period; and 
(D) while funds attributable to the in-
creased FMAP under this section remain avail-
able, continuing home and community-based 
services for eligible individuals who were served 
from a waiting list for such services during the 
public health emergency period. 
(e) REPORTING REQUIREMENTS.— 
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(1) STATE
REPORTING
REQUIREMENTS.—Not 
later than December 31, 2023, any State with re-
spect to which an application is approved by the Sec-
retary pursuant to subsection (c) shall submit a re-
port to the Secretary that contains the following in-
formation: 
(A) Activities and programs that were 
funded using Federal funds attributable to such 
increase. 
(B) The number of eligible individuals who 
were served by such activities and programs. 
(C) The number of eligible individuals who 
were able to resume home and community- 
based services as a result of such activities and 
programs. 
(2) HHS EVALUATION.— 
(A) IN
GENERAL.—The Secretary shall 
evaluate the implementation and outcomes of 
this section in the aggregate using an external 
evaluator with experience evaluating home and 
community-based services, disability programs, 
and older adult programs. 
(B) EVALUATION
CRITERIA.—For pur-
poses of subparagraph (A), the external eval-
uator shall— 
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(i) document and evaluate changes in 
access, availability, and quality of home 
and community-based services in each 
HCBS program State; 
(ii) document and evaluate aggregate 
changes in access, availability, and quality 
of home and community-based services 
across all such States; and 
(iii) evaluate the implementation and 
outcomes of this section based on— 
(I) the impact of this section on 
increasing funding for home and com-
munity-based services; 
(II) the impact of this section on 
achieving targeted access, availability, 
and quality of home and community- 
based services; and 
(III) promising practices identi-
fied by activities conducted pursuant 
to subsection (d) that increase access 
to, availability of, and quality of home 
and community-based services. 
(C) DISSEMINATION OF EVALUATION FIND-
INGS.—The Secretary shall— 
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(i) disseminate the findings from the 
evaluations conducted under this para-
graph to— 
(I) all State Medicaid directors; 
and 
(II) the Committee on Energy 
and Commerce of the House of Rep-
resentatives, the Committee on Fi-
nance of the Senate, and the Special 
Committee on Aging of the Senate; 
and 
(ii) make all evaluation findings pub-
licly available in an accessible electronic 
format and any other accessible format de-
termined appropriate by the Secretary. 
(D) OVERSIGHT.—Each State with respect 
to which an application is approved by the Sec-
retary pursuant to subsection (c) shall ensure 
adequate oversight of the expenditure of Fed-
eral funds pursuant to such increase in accord-
ance with the Medicaid regulations, including 
section 1115 and 1915 waiver regulations and 
special terms and conditions for any relevant 
waiver or grant program. 
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(3) NON-APPLICATION OF THE PAPERWORK RE-
DUCTION
ACT.—Chapter 35 of title 44, United 
States Code (commonly referred to as the ‘‘Paper-
work Reduction Act of 1995’’), shall not apply to the 
provisions of this subsection. 
(f) ADDITIONAL DEFINITIONS.—In this section: 
(1) COVID–19 PUBLIC
HEALTH
EMERGENCY 
PERIOD.—The term ‘‘COVID–19 public health emer-
gency period’’ means the portion of the emergency 
period described in paragraph (1)(B) of section 
1135(g) of the Social Security Act (42 U.S.C. 
1320b–5(g)) beginning on or after the date of the 
enactment of this Act. 
(2) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 
individual’’ means an individual who is eligible for or 
enrolled for medical assistance under a State Med-
icaid program. 
(3) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means, with respect to a State, the State 
program under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) (including any waiver or 
demonstration under such title or under section 
1115 of such Act (42 U.S.C. 1315) relating to such 
title). 
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(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
Æ 
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