I 
114TH CONGRESS 
2D SESSION 
H. R. 5902 
To amend title XIX of the Social Security Act to provide a temporary 
higher Federal medical assistance percentage for Federal expenditures 
under the Medicaid program that are associated with the cost of compli-
ance with certain Federal regulations with respect to services furnished 
in certain intermediate care facilities or home and community-based 
services furnished to individuals with intellectual and developmental dis-
abilities. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 14, 2016 
Mr. TONKO (for himself, Mr. STIVERS, Mr. LANGEVIN, and Mr. HARPER) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
a temporary higher Federal medical assistance percent-
age for Federal expenditures under the Medicaid pro-
gram that are associated with the cost of compliance 
with certain Federal regulations with respect to services 
furnished in certain intermediate care facilities or home 
and community-based services furnished to individuals 
with intellectual and developmental disabilities. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Disability Community 
Act of 2016’’. 
SEC. 2. HIGHER FMAP FOR CERTAIN MEDICAID EXPENDI-
TURES ASSOCIATED WITH CERTAIN REGULA-
TION COMPLIANCE. 
(a) IN GENERAL.—Section 1903(a)(5) of the Social 
Security Act (42 U.S.C. 1396b(a)(5)) is amended— 
(1) by striking ‘‘an amount equal to’’ and in-
serting ‘‘(A) an amount equal to’’; 
(2) by striking ‘‘supplies;’’ and inserting ‘‘sup-
plies; and’’; and 
(3) by adding at the end the following: 
‘‘(B) an amount equal to 90 percent of the sum 
of the amounts expended during a quarter in 2017, 
2018, or 2019, for items and services furnished in 
an intermediate care facility for the mentally re-
tarded or for home and community-based services 
furnished to individuals with intellectual and devel-
opmental disabilities, as the Secretary determines 
are attributable to compliance with any of the regu-
lations specified in— 
‘‘(i) part 591 of title 29, Code of Federal 
Regulations; 
‘‘(ii) part 552 of title 29, Code of Federal 
Regulations; or 
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‘‘(iii) part 430, 431, 435, 436, 440, 441, 
or 447 of title 42, Code of Federal Regula-
tions;’’. 
(b) CONFORMING TERMINOLOGY FOR INTERMEDIATE 
CARE FACILITIES.—Title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) is amended— 
(1) by striking ‘‘intermediate care facility for 
the mentally retarded’’ each time such term appears 
(including in headings) and inserting ‘‘intermediate 
care facility for individuals with intellectual and de-
velopmental disabilities’’; 
(2) by striking ‘‘intermediate care facilities for 
the mentally retarded’’ each time such term appears 
(including in headings) and inserting ‘‘intermediate 
care facilities for individuals with intellectual and 
developmental disabilities’’; 
(3) by striking ‘‘State mental retardation or de-
velopmental disability authority’’ each time such 
term appears and inserting ‘‘State intellectual or de-
velopmental disability authority’’; 
(4) in section 1905(d)— 
(A) in the matter before paragraph (1), by 
striking ‘‘thereof) for the mentally retarded or 
persons’’ and inserting ‘‘thereof) for individuals 
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with intellectual or developmental disabilities 
or’’; 
(B) in paragraph (1), by striking ‘‘men-
tally retarded individuals’’ and inserting ‘‘indi-
viduals with intellectual or developmental dis-
abilities’’; and 
(C) in paragraph (2), by striking ‘‘the 
mentally retarded individual’’ and inserting 
‘‘the individual with an intellectual or develop-
mental disability’’; 
(5) in section 1915(c)(7)(C), by striking ‘‘men-
tal retardation’’ and inserting ‘‘intellectual or devel-
opmental disabilities’’; 
(6) in section 1919(b)— 
(A) in paragraph (3)— 
(i) in subparagraph (E), by striking 
‘‘mentally retarded’’ and inserting ‘‘has in-
tellectual or developmental disabilities’’; 
and 
(ii) in subparagraph (F)— 
(I) in the heading, by striking 
‘‘AND MENTALLY RETARDED INDIVID-
UALS’’ and inserting ‘‘INDIVIDUALS 
AND
INDIVIDUALS
WITH
INTELLEC-
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TUAL
OR
DEVELOPMENTAL
DISABIL-
ITIES’’; and 
(II) in clause (ii)— 
(aa) by striking ‘‘is mentally 
retarded’’ and inserting ‘‘has an 
intellectual or developmental dis-
ability’’; and 
(bb) by striking ‘‘for mental 
retardation’’ and inserting ‘‘for 
intellectual or developmental dis-
abilities’’; 
(B) in paragraph (4)— 
(i) in subparagraph (A)(vii), by strik-
ing ‘‘mentally ill and mentally retarded 
residents’’ and inserting ‘‘residents who 
are mentally ill or who have intellectual or 
developmental disabilities’’; and 
(ii) in subparagraph (C)(ii)(IV), by 
striking ‘‘the mentally retarded’’ and in-
serting ‘‘individuals with intellectual or de-
velopmental disabilities’’; and 
(7) in section 1919(e)— 
(A) in paragraph (7)— 
(i) in subparagraph (A)(i), by striking 
‘‘mentally ill and mentally retarded individ-
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uals’’ and inserting ‘‘individuals who are 
mentally ill or who have intellectual or de-
velopmental disabilities’’; 
(ii) in subparagraph (B)— 
(I) by striking ‘‘mental retarda-
tion’’ each place such term appears 
and inserting ‘‘intellectual or develop-
mental disability’’; 
(II) in clause (ii)— 
(aa) in the heading, by 
striking ‘‘MENTALLY
RETARDED 
RESIDENTS’’ and inserting ‘‘RESI-
DENTS WITH INTELLECTUAL OR 
DEVELOPMENTAL DISABILITIES’’; 
and 
(bb) in the matter preceding 
subclause (I), by striking ‘‘is 
mentally retarded’’ and inserting 
‘‘has an intellectual or develop-
mental disability’’; and 
(III) in clause (iii), by striking 
‘‘mentally ill or mentally retarded 
resident’’ and inserting ‘‘resident who 
is mentally ill or who has an intellec-
tual or developmental disability’’; 
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(iii) in subparagraph (C), by striking 
‘‘mental retardation’’ each place such term 
appears and inserting ‘‘intellectual or de-
velopmental disability’’; 
(iv) in subparagraph (E)— 
(I) by striking ‘‘are mentally re-
tarded or’’ and inserting ‘‘have intel-
lectual or developmental disabilities or 
are’’; and 
(II) by striking ‘‘mental retarda-
tion’’ and inserting ‘‘intellectual or de-
velopmental disability’’; and 
(v) in subparagraph (G)(ii)— 
(I) by striking ‘‘be ‘mentally re-
tarded’ ’’ and inserting ‘‘have ‘an in-
tellectual 
or 
developmental 
dis-
ability’ ’’; and 
(II) by striking ‘‘is mentally re-
tarded or a person with’’ and insert-
ing ‘‘has an intellectual or develop-
mental disability or’’. 
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SEC. 3. ELECTRONIC VISIT VERIFICATION SYSTEM RE-
QUIRED FOR PERSONAL CARE SERVICES AND 
HOME HEALTH CARE SERVICES UNDER MED-
ICAID. 
(a) IN GENERAL.—Section 1903 of the Social Secu-
rity Act (42 U.S.C. 1396b) is amended by inserting after 
subsection (k) the following new subsection: 
‘‘(l)(1) Subject to paragraphs (3) and (4), with re-
spect to any amount expended for personal care services 
or home health care services requiring an in-home visit 
by a provider that are provided under a State plan under 
this title (or under a waiver of the plan) and furnished 
in a calendar quarter beginning on or after January 1, 
2019 (or, in the case of home health care services, on or 
after January 1, 2023), unless a State requires the use 
of an electronic visit verification system for such services 
furnished in such quarter under the plan or such waiver, 
the Federal medical assistance percentage shall be re-
duced— 
‘‘(A) in the case of personal care serv-
ices— 
‘‘(i) for calendar quarters in 2019 and 
2020, by .25 percentage points; 
‘‘(ii) for calendar quarters in 2021, by 
.5 percentage points; 
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‘‘(iii) for calendar quarters in 2022, 
by .75 percentage points; and 
‘‘(iv) for calendar quarters in 2023 
and each year thereafter, by 1 percentage 
point; and 
‘‘(B) in the case of home health care serv-
ices— 
‘‘(i) for calendar quarters in 2023 and 
2024, by .25 percentage points; 
‘‘(ii) for calendar quarters in 2025, by 
.5 percentage points; 
‘‘(iii) for calendar quarters in 2026, 
by .75 percentage points; and 
‘‘(iv) for calendar quarters in 2027 
and each year thereafter, by 1 percentage 
point. 
‘‘(2) Subject to paragraphs (3) and (4), in im-
plementing the requirement for the use of an elec-
tronic visit verification system under paragraph (1), 
a State shall— 
‘‘(A) consult with agencies and entities 
that provide personal care services, home health 
care services, or both under the State plan (or 
under a waiver of the plan) to ensure that such 
system— 
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‘‘(i) is minimally burdensome; 
‘‘(ii) takes into account existing best 
practices and electronic visit verification 
systems in use in the State; and 
‘‘(iii) is conducted in accordance with 
the requirements of HIPAA privacy and 
security law (as defined in section 3009 of 
the Public Health Service Act); 
‘‘(B) take into account a stakeholder proc-
ess that includes input from beneficiaries, fam-
ily caregivers, personal care or home health care 
services workers, and other stakeholders, as de-
termined by the State in accordance with guid-
ance from the Secretary; and 
‘‘(C) ensure that individuals who furnish 
personal care services, home health care serv-
ices, or both under the State plan (or under a 
waiver of the plan) are provided the opportunity 
for training on the use of such system. 
‘‘(3) Paragraphs (1) and (2) shall not apply in 
the case of a State that, as of the date of the enact-
ment of this subsection, requires the use of any sys-
tem for the electronic verification of visits conducted 
as part of both personal care services and home 
health care services. 
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‘‘(4)(A) In the case of a State described in sub-
paragraph (B), the reduction under paragraph (1) 
shall not apply— 
‘‘(i) in the case of personal care services, 
for calendar quarters in 2019; and 
‘‘(ii) in the case of home health care serv-
ices, for calendar quarters in 2023. 
‘‘(B) For purposes of subparagraph (A), a 
State described in this subparagraph is a State that 
demonstrates to the Secretary that the State— 
‘‘(i) has made a good faith effort to comply 
with the requirements of paragraphs (1) and 
(2) (including by taking steps to adopt the tech-
nology used for an electronic visit verification 
system); or 
‘‘(ii) in implementing such a system, has 
encountered unavoidable system delays. 
‘‘(5) In this subsection: 
‘‘(A) The term ‘electronic visit verification 
system’ means, with respect to personal care 
services or home health care services, a system 
under which visits conducted as part of such 
services are electronically verified with respect 
to— 
‘‘(i) the type of service performed; 
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‘‘(ii) the individual receiving the serv-
ice; 
‘‘(iii) the date of the service; 
‘‘(iv) the location of service delivery; 
‘‘(v) the individual providing the serv-
ice; and 
‘‘(vi) the time the service begins and 
ends. 
‘‘(B) The term ‘home health care services’ 
means services described in section 1905(a)(7) 
provided under a State plan under this title (or 
under a waiver of the plan). 
‘‘(C) The term ‘personal care services’ 
means personal care services provided under a 
State plan under this title (or under a waiver 
of the plan), including services provided under 
section 1905(a)(24), 1915(c), 1915(i), 1915(j), 
or 1915(k) or under a wavier under section 
1115. 
‘‘(6)(A) In the case in which a State requires 
personal care service and home health care service 
providers to utilize an electronic visit verification 
system operated by the State or a contractor on be-
half of the State, the Secretary shall pay to the 
State, for each quarter, an amount equal to 90 per 
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centum of so much of the sums expended during 
such quarter as are attributable to the design, devel-
opment, or installation of such system, and 75 per 
centum of so much of the sums for the operation 
and maintenance of such system. 
‘‘(B) Subparagraph (A) shall not apply in the 
case in which a State requires personal care service 
and home health care service providers to utilize an 
electronic visit verification system that is not oper-
ated by the State or a contractor on behalf of the 
State.’’. 
(b) COLLECTION
AND DISSEMINATION
OF BEST 
PRACTICES.—Not later than January 1, 2018, the Sec-
retary of Health and Human Services shall, with respect 
to electronic visit verification systems (as defined in sub-
section (l)(5) of section 1903 of the Social Security Act 
(42 U.S.C. 1396b), as inserted by subsection (a)), collect 
and disseminate best practices to State Medicaid Directors 
with respect to— 
(1) training individuals who furnish personal 
care services, home health care services, or both 
under the State plan under title XIX of such Act (or 
under a waiver of the plan) on such systems and the 
operation of such systems and the prevention of 
fraud with respect to the provision of personal care 
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services or home health care services (as defined in 
such subsection (l)(5)); and 
(2) the provision of notice and educational ma-
terials to family caregivers and beneficiaries with re-
spect to the use of such electronic visit verification 
systems and other means to prevent such fraud. 
(c) RULES OF CONSTRUCTION.— 
(1) NO
EMPLOYER-EMPLOYEE
RELATIONSHIP 
ESTABLISHED.—Nothing in the amendment made by 
this section may be construed as establishing an em-
ployer-employee relationship between the agency or 
entity that provides for personal care services or 
home health care services and the individuals who, 
under a contract with such an agency or entity, fur-
nish such services for purposes of part 552 of title 
29, Code of Federal Regulations (or any successor 
regulations). 
(2) NO PARTICULAR OR UNIFORM ELECTRONIC 
VISIT
VERIFICATION
SYSTEM
REQUIRED.—Nothing 
in the amendment made by this section shall be con-
strued to require the use of a particular or uniform 
electronic visit verification system (as defined in sub-
section (l)(5) of section 1903 of the Social Security 
Act, as inserted by subsection (a)) by all agencies or 
entities that provide personal care services or home 
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health care under a State plan under title XIX of 
the Social Security Act (or under a waiver of the 
plan) (42 U.S.C. 1396 et seq.). 
(3) NO LIMITS ON PROVISION OF CARE.—Noth-
ing in the amendment made by this section may be 
construed to limit, with respect to personal care 
services or home health care services provided under 
a State plan under title XIX of the Social Security 
Act (or under a waiver of the plan) (42 U.S.C. 1396 
et seq.), provider selection, constrain beneficiaries’ 
selection of a caregiver, or impede the manner in 
which care is delivered. 
(4) NO PROHIBITION ON STATE QUALITY MEAS-
URES REQUIREMENTS.—Nothing in the amendment 
made by this section shall be construed as prohib-
iting a State, in implementing an electronic visit 
verification system (as defined in subsection (l)(5) of 
section 1903 of the Social Security Act, as inserted 
by subsection (a)), from establishing requirements 
related to quality measures for such system. 
Æ 
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