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‘‘(4) OTHER QUALIFIED FACILITY.—The term
‘other qualified facility’ means any facility that can
provide the services required by the enrollee con-
sistent with State and Federal law.
‘‘(5) SKILLED NURSING FACILITY.—The term
‘skilled nursing facility’ means a facility that meets
the requirements of section 1819 of the Social Secu-
rity Act (42 U.S.C. 1395i–3).’’.
(2) EFFECTIVE DATE.—The amendment made
by this section shall apply with respect to group
health plans for plan years beginning on or after
January 1, 2001.
(c) AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE INDIVIDUAL MARKET.—
(1) IN GENERAL.—The first subpart 3 of part
B of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg–51 et seq.) (relating to other re-
quirements) is amended—
(A) by redesignating such subpart as sub-
part 2; and
(B) by adding at the end the following new
section:
‘‘SEC. 2753. ENSURING CHOICE FOR CONTINUING CARE.
‘‘The provisions of section 2707 shall apply to health
maintenance organization coverage offered by a health in-
249
surance issuer in the individual market in the same man-
ner as they apply to such coverage offered by a health
insurance issuer in connection with a group health plan
in the small or large group market.’’.
(2) EFFECTIVE DATE.—The amendment made
by this section shall apply with respect to health in-
surance coverage offered, sold, issued, renewed, in
effect, or operated in the individual market on or
after January 1, 2001.
SEC. 805. GRANTS TO DEVELOP AND ESTABLISH REAL
CHOICE SYSTEMS CHANGE INITIATIVES.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the
‘‘Secretary’’) shall award grants described in sub-
section (b) to States to support real choice systems
change initiatives that establish specific action steps
and specific timetables to achieve enduring system
improvements and to provide consumer-responsive
long-term services and supports to eligible individ-
uals in the most integrated setting appropriate based
on the unique strengths and needs of the individual,
the priorities and concerns of the individual (or, as
appropriate, the individual’s representative), and the
250
individual’s desires with regard to participation in
community life.
(2) ELIGIBILITY.—To be eligible for a grant
under this section, a State shall—
(A) establish a Consumer Task Force in
accordance with subsection (d); and
(B) submit an application at such time, in
such manner, and containing such information
as the Secretary may determine. The applica-
tion shall be jointly developed and signed by the
designated State official and the chairperson of
such Task Force, acting on behalf of and at the
direction of the Task Force.
(3) DEFINITION
OF
STATE.—In this section,
the term ‘‘State’’ means each of the 50 States, the
District of Columbia, Puerto Rico, Guam, the
United States Virgin Islands, American Samoa, and
the Commonwealth of the Northern Mariana Is-
lands.
(b) GRANTS FOR REAL CHOICE SYSTEMS CHANGE
INITIATIVES.—
(1) IN
GENERAL.—From funds appropriated
under subsection (f), the Secretary shall award
grants to States to—
251
(A) support the establishment, implemen-
tation, and operation of the State real choice
systems change initiatives described in sub-
section (a); and
(B) conduct outreach campaigns regarding
the existence of such initiatives.
(2) DETERMINATION OF AWARDS; STATE AL-
LOTMENTS.—The Secretary shall develop a formula
for the distribution of funds to States for each fiscal
year under subsection (a). Such formula shall give
preference to States that have a higher need for as-
sistance, as determined by the Secretary, based on
indicators such as a relatively higher proportion of
long-term services and supports furnished to individ-
uals in an institutional setting but who have a plan
described in an application submitted under sub-
section (a)(2).
(c) AUTHORIZED ACTIVITIES.—A State that receives
a grant under this section shall use the funds made avail-
able 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
252
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 individuals within the State who are
receiving long-term services and supports in unnec-
essarily 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: REMEDIES AND PRO-
MOTION OF COMMUNITY PARTICIPATION.—The State
may use funds to identify, develop, and implement
strategies for modifying policies, practices, and pro-
cedures that unnecessarily bias the provision of long-
term services and supports toward institutional set-
tings and away from home and community-based
settings, including policies, practices, and procedures
governing statewideness, comparability in amount,
duration, and scope of services, financial eligibility,
individualized functional assessments and screenings
(including individual and family involvement), knowl-
edge about service options, and promotion of self-di-
253
rection of services and community-integrated living
and service arrangements that facilitate participa-
tion in community life to the fullest extent possible
and desired by the individual.
(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 with one-stop access for long-
term support services and the design and implemen-
tation of a coordinated screening and assessment