‘‘(G) WAGE
ENHANCEMENT
INCENTIVE 
PERCENTAGE.—The term ‘wage enhancement 
incentive percentage’ means— 
‘‘(i) the product of (I) the total direct 
support professional wage rate differential 
(as defined in subparagraph (E), and (II) 
annual rate differential percentage (as de-
fined in subparagraph (A)); divided by 
‘‘(ii) the average reference direct sup-
port professional hourly wage rate (as de-
fined in subparagraph (B)). 
‘‘(g) INSPECTOR GENERAL AUDIT.—The Secretary, 
through the Inspector General of the Department of 
Health and Human Services, shall audit a sample from 
among the States in order to assess the effectiveness of 
progress made in reducing or eliminating the wage gap 
between targeted and reference direct support profes-
sionals through funds under this section. 
‘‘(h) GAO STUDY.— 
‘‘(1) STUDY.—The Comptroller General of the 
United States shall conduct a study concerning the 
wage equalization and recruitment and retention of 
direct support professionals who are providing serv-
ices and supports to individuals with disabilities. 
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‘‘(2) REPORTS.—The Comptroller General shall 
submit to Congress reports, in the third and fifth 
years in which this section is being implemented, on 
progress made by States, and the impact of pay-
ments under this section, on providing wage equali-
zation and in improving recruitment and retention of 
direct support professionals. 
‘‘(i) DEFINITIONS.—For purposes of this section: 
‘‘(1) DIRECT
SUPPORT
PROFESSIONAL.—The 
term ‘direct support professional’ means an indi-
vidual who, whether in a supervisory or non-super-
visory capacity, provides services and supports, as 
needed, to an individual with a disability to assist in 
acquiring, maintaining or enhancing skills necessary 
to perform activities of daily living or instrumental 
activities of daily living and health-related functions 
through hands-on assistance, supervision, or cueing. 
Such term includes, among others, individuals who 
may be classified as nurses aides, home health aides, 
home care aides, personal care aides and personal 
assistants, in-home support workers, homemakers, 
behavioral specialists, habilitation specialist, mental 
health rehabilitation technicians, independent living 
skills specialists, crisis program workers, qualified 
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mental health or mental retardation professionals, 
and educational technicians. 
‘‘(2) DIRECT
SUPPORT
PROFESSIONAL
WAGE 
ENHANCEMENT
PLAN.—The term ‘direct support 
professional wage enhancement plan’ is defined in 
subsection (b)(1). 
‘‘(3) DIRECT
SUPPORT
SERVICES.—The term 
‘direct support services’ means a range of services 
and supports, provided by one or more persons, de-
signed to provide support and health-related services 
to an individual with a disability to enable them to 
perform, acquire, maintain or enhance skills nec-
essary to perform activities of daily living (ADL), in-
strumental activities of daily living (IADL) and 
health-related functions. Such term includes per-
sonal care services, consumer-directed personal as-
sistance services, rehabilitation services, habilitation 
services, and respite care. 
‘‘(4) INDIVIDUAL
WITH
A
DISABILITY.—The 
term ‘individual with a disability’ means an indi-
vidual who meets (or is regarded as meeting) the cri-
teria for being disabled under the supplemental secu-
rity income program under title XVI. Such term in-
cludes an individual who, regardless of age, is eligi-
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ble for and receiving medical assistance under this 
title for any benefits described in paragraph (i)(8). 
‘‘(5) 5-YEAR
IMPLEMENTATION
PERIOD.—The 
term ‘5-year implementation period’ means, with re-
spect to a State and a direct support professional 
wage enhancement plan under this section, the pe-
riod of 20 calendar quarters beginning with the first 
full calendar quarter in which such plan is imple-
mented in the State under this section. Each of the 
five 4-calendar-quarter periods within such period 
shall be treated as a year for purposes of this sec-
tion. 
‘‘(6) REFERENCE
DIRECT
SUPPORT
PROFES-
SIONAL.—The term ‘reference direct support profes-
sional’ means a direct support professional who— 
‘‘(A) is employed by a State or local gov-
ernment entity; and 
‘‘(B) provides direct support services to 
targeted individuals with disabilities under this 
title. 
‘‘(7) TARGETED
DIRECT
SUPPORT
PROFES-
SIONAL.—The term ‘targeted direct support profes-
sional’ means a direct support professional who— 
‘‘(A) is not employed by a State or local 
government entity; and 
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‘‘(B) provides direct support services to 
targeted individuals with disabilities under this 
title. 
‘‘(8) TARGETED
INDIVIDUAL
WITH
A
DIS-
ABILITY.—The term ‘targeted individual with a dis-
ability’ means an individual with a disability who is 
eligible for and is receiving medical assistance under 
this title for personal care services under section 
1905(a)(23), for rehabilitative services under section 
1905(a)(13), for home health care services under 
section 1905(a)(7), for intermediate care facility 
services for the mentally retarded under section 
1905(a)(15), for home and community-based serv-
ices under a State plan option under section 1915(j), 
for self-directed personal assistance services under a 
State plan amendment option under section 1915(i), 
or for home and community-based services under a 
waiver approved under section 1915(c) or section 
1115.’’. 
(b) CONFORMING AMENDMENT.—Section 1903(a)(1) 
of such Act (42 U.S.C. 1396b(a)(1)) is amended by insert-
ing ‘‘and section 1942(f)’’ after ‘‘1923(f)’’. 
(c) AUTHORIZATION OF PLANNING GRANTS.—The 
Secretary of Health and Human Services is authorized to 
award State planning grants in an amount not to exceed, 
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in the aggregate, $3,000,000, in order to assist States in 
establishing direct support professional wage enhancement 
plans under section 1942 of the Social Security Act, as 
added by subsection (a). 
Æ 
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