(C) be approved by the individual (or the
individual’s representative), and
(D) be reviewed and updated not less often
than every 6 months.
(3) PLAN OF CARE.—The plan of care under
paragraph (1)(B) shall—
(A) specify which services specified under
the individual plan will be provided under the
State plan under this title,
(B) identify (to the extent possible) how
the individual will be provided any services
specified under the plan of care and not pro-
vided under the State plan, and
(C) specify how the provision of services to
the individual under the plan will be coordi-
nated with the provision of other health care
services to the individual.
The State shall make reasonable efforts to identify
and arrange for services described in subparagraph
(B). Nothing in this subsection shall be construed as
requiring a State (under the State plan or other-
wise) to provide all the services specified in such a
plan.
(c) MANDATORY COVERAGE OF PERSONAL ASSIST-
ANCE SERVICES.—The State plan shall include, in the
array of services made available to each category of indi-
viduals with disabilities, both agency-administered and
consumer-directed personal assistance services (as defined
in subsection (g)).
(d) ADDITIONAL SERVICES.—
(1) TYPES OF SERVICES.—Subject to subsection
(e), services available under a State plan under this
title shall include any (or all) of the following:
(A) Case management.
(B) Homemaker and chore assistance.
(C) Home modifications.
(D) Respite services.
(E) Assistive devices.
(F) Adult day services.
(G) Habilitation and rehabilitation.
(H) Supported employment.
(I) Home health services.
(J) Any other care or assistive services
(approved by the Secretary) that the State de-
termines will help individuals with disabilities to
remain in their homes and communities.
(2) CRITERIA FOR SELECTION OF SERVICES.—
The State plan shall specify—
(A) the methods and standards used to se-
lect the types, and the amount, duration, and
scope, of services to be covered under the plan
and to be available to each category of individ-
uals with disabilities, and
(B) how the types, and the amount, dura-
tion, and scope, of services specified meet the
needs of individuals within each of the 4 cat-
egories of individuals with disabilities.
(e) EXCLUSIONS AND LIMITATIONS.—
(1) IN GENERAL.—A State plan may not pro-
vide for coverage of—
(A) room and board,
(B) services furnished in a hospital, nurs-
ing facility, intermediate care facility for the
mentally retarded, or other institutional setting
specified by the Secretary, or
(C) items and services to the extent cov-
erage is provided for the individual under a
health plan or the medicare program.
(2) TAKING INTO ACCOUNT INFORMAL CARE.—
A State plan may take into account, in determining
the amount and array of services made available to
covered individuals with disability, the availability of
informal care.
(f) PAYMENT FOR SERVICES.—A State plan may pro-
vide for the use of—
(1) vouchers,
(2) cash payments directly to individuals with
disabilities,
(3) capitation payments to health plans, and
(4) payment to providers,
to pay for covered services.
(g) PERSONAL ASSISTANCE SERVICES.—
(1) IN
GENERAL.—In this section, the term
‘‘personal assistance services’’ means those services
specified under the State plan as personal assistance
services and shall include at least hands-on and
standby assistance, supervision, and cueing with ac-
tivities of daily living, whether agency-administered
or consumer-directed (as defined in paragraph (2)).
(2) CONSUMER-DIRECTED; 
AGENCY-ADMINIS-
TERED.—In this title:
(A) The term ‘‘consumer-directed’’ means,
with reference to personal assistance services or
the provider of such services, services that are
provided by an individual who is selected and
managed (and, at the individual’s option,
trained) by the individual receiving the services.
(B) 
The 
term 
‘‘agency-administered’’
means, with respect to such services, services
that are not consumer-directed.
SEC. 405. COST SHARING.
(a) NO OR NOMINAL COST SHARING FOR POOR-
EST.—The State plan may not impose any cost sharing
(other than nominal cost sharing) for individuals with in-
come (as determined under subsection (c)) less than 150
percent of the official poverty line (referred to in section
402(a)(1)(E)) applicable to a family of the size involved.
(b) SLIDING SCALE FOR REMAINDER.—The State
plan shall impose cost sharing in the form of coinsurance
(based on the amount paid under the State plan for a serv-
ice)—
(1) at a rate of 10 percent for individuals with
disabilities with income not less than 150 percent,
and less than 200 percent, of such official poverty
line (as so applied); and
(2) at a rate of 20 percent for such individuals
with income not less than 200 percent, and less than
250 percent, of such official poverty line (as so ap-
plied).
(c) DETERMINATION OF INCOME FOR PURPOSES OF
COST SHARING.—The State plan shall specify the process
to be used to determine the income of an individual with
disabilities for purposes of this section. Such process shall
be consistent with standards specified by the Secretary.
SEC. 406. QUALITY ASSURANCE AND SAFEGUARDS.
(a) QUALITY ASSURANCE.—The State plan shall
specify how the State will ensure and monitor the quality
of services, including—
(1) safeguarding the health and safety of indi-
viduals with disabilities,
(2) the minimum standards for agency provid-
ers and how such standards will be enforced,
(3) the minimum competency requirements for
agency provider employees who provide direct serv-
ices under this title and how the competency of such
employees will be enforced,
(4) obtaining meaningful consumer input, in-
cluding consumer surveys that measure the extent to
which participants receive the services described in
the plan of care and participant satisfaction with
such services,
(5) participation in quality assurance activities,
and
(6) specifying the role of the long-term care om-
budsman (under the Older Americans Act of 1965)
and the Protection and Advocacy Agency (under the
Developmental Disabilities Assistance and Bill of
Rights Act) in assuring quality of services and pro-
tecting the rights of individuals with disabilities.
(b) SAFEGUARDS.—