Title: Community Integration Act of 2018
Policy area: Health

Summary:
Community Integration Act of 2018
This bill requires a state Medicaid program to, with respect to an individual who requires a level of care provided in a nursing facility, intermediate care facility for the developmentally disabled, institution for mental disease, or other similar setting: (1) provide the individual with the choice and equal opportunity to receive such care in a home- and community-based setting; and (2) meet specified requirements relating to the provision and availability of care in such a setting, including a requirement to develop a statewide plan to increase affordable and accessible housing for individuals with disabilities.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6371 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6371

 To ensure that Medicaid beneficiaries have the opportunity to receive 
              care in a home and community-based setting.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2018

Mr. Cartwright introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To ensure that Medicaid beneficiaries have the opportunity to receive 
              care in a home and community-based setting.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community Integration Act of 2018''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Supreme Court's 1999 decision in Olmstead v. L.C., 
        527 U.S. 581 (1999), held that the unnecessary segregation of 
        individuals with disabilities is a violation of the Americans 
        with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
            (2) Under Olmstead, individuals generally have the right to 
        receive their supports and services in home and community-based 
        settings, rather than in institutional settings, if they so 
        choose.
            (3) Olmstead envisioned that States would provide 
        appropriate long-term services and supports to individuals with 
        disabilities through home and community-based services and end 
        forced segregation in nursing homes and other institutions.
            (4) While there has been progress in rebalancing State 
        spending on individuals with disabilities in institutions as 
        compared to home and community-based settings, more than 75 
        percent of States continue to spend the majority of their long-
        term care dollars on nursing homes and other institutional 
        settings, and the number of individuals with disabilities under 
        age 65 in nursing homes increased between 2008 and 2012.
            (5) As of June 2013, there were more than 200,000 
        individuals younger than age 65 in nursing homes--almost 16 
        percent of the total nursing home population.
            (6) Thirty-eight studies published from 2005 to 2012 
        concluded that providing services in home and community-based 
        settings is less costly than providing care in a nursing home 
        or other institutional setting.
            (7) No clear or centralized reporting system exists to 
        compare how effectively States are meeting the Olmstead 
        mandate.

SEC. 3. ENSURING MEDICAID BENEFICIARIES MAY ELECT TO RECEIVE CARE IN A 
              HOME AND COMMUNITY-BASED SETTING.

    (a) In General.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (1) in paragraph (82), by striking ``and'' at the end;
            (2) in paragraph (83), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (83) the following new 
        paragraph:
            ``(84) in the case of any individual with respect to whom 
        there has been a determination that the individual requires the 
        level of care provided in a nursing facility, an intermediate 
        care facility for the mentally retarded, an institution for 
        mental diseases, or any other similarly restrictive or 
        institutional setting--
                    ``(A) provide the individual with the choice and 
                opportunity to receive such care in a home and 
                community-based setting, including rehabilitative 
                services, assistance and support in accomplishing 
                activities of daily living, instrumental activities of 
                daily living, and health-related tasks, and assistance 
                in acquiring, maintaining, or enhancing skills 
                necessary to accomplish such activities, tasks, or 
                services;
                    ``(B) ensure that each such individual has an equal 
                opportunity (when compared to the receipt and 
                availability of nursing facility services) to receive 
                care in a home and community-based setting, if the 
                individual so chooses, by ensuring that the provision 
                of such care in a home and community-based setting is 
                widely available on a Statewide basis for all such 
                individuals within the State; and
                    ``(C) meet the requirements of section 1904A 
                (relating to the provision of care in a home and 
                community-based setting).''.
    (b) Requirements for Community Care Options.--Title XIX of the 
Social Security Act is amended by inserting after section 1904 (42 
U.S.C. 1396c) the following new section:

         ``provisions related to home and community-based care

    ``Sec. 1904A.  (a) Definitions.--For purposes of this section, 
section 1902(a)(84), and section 1905(a)(4)(A):
            ``(1) Activities of daily living.--The term `activities of 
        daily living' includes, but is not limited to, tasks such as 
        eating, toileting, grooming, dressing, bathing, and 
        transferring.
            ``(2) Health-related tasks.--The term `health-related 
        tasks' means specific tasks related to the needs of an 
        individual, including, but not limited to, bowel or bladder 
        care, wound care, use and care of ventilators and feeding 
        tubes, and the administration of medications and injections, 
        which, in the opinion of the individual's physician, can be 
        delegated to be performed by an attendant.
            ``(3) Home and community-based setting.--The term `home and 
        community-based setting' means, with respect to an individual 
        who requires a level of care provided in a nursing facility, an 
        intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting, a setting that--
                    ``(A) includes a house, an apartment, a townhouse, 
                a condominium, or any similar public or private housing 
                where the individual resides that--
                            ``(i) is owned or leased by the individual 
                        or a member of the individual's family;
                            ``(ii) ensures the individual's privacy, 
                        dignity, respect, and freedom from coercion; 
                        and
                            ``(iii) maximizes the individual's autonomy 
                        and independence;
                    ``(B) is integrated in, and provides access to, the 
                general community in which the setting is located so 
                that the individual has access to the community and 
                opportunities to seek employment and work in 
                competitive integrated settings, participate in 
                community life, control and utilize personal resources, 
                benefit from community services, and participate in the 
                community in an overall manner that is comparable to 
                that available to individuals who are not individuals 
                with disabilities; and
                    ``(C) has the services and supports that the 
                individual needs in order to live as independently as 
                possible.
            ``(4) Instrumental activities of daily living.--The term 
        `instrumental activities of daily living' means activities 
        related to living independently in the community and includes, 
        but is not limited to, meal planning and preparation, managing 
        finances, shopping for food, clothing, and other items, 
        performing household chores, communicating by phone or other 
        media, and traveling around and participating in the community.
            ``(5) Public entity.--The term `public entity' means a 
        public entity as defined in subparagraphs (A) and (B) of 
        section 201(1) of the Americans with Disabilities Act of 1990.
    ``(b) Requirements for Providing Services in Home and Community-
Based Settings.--With respect to the availability and provision of 
services under the State plan under this title, or under any waiver of 
State plan requirements (subject to section 3(d) of the Community 
Integration Act of 2018), in a home and community-based setting to any 
individual who requires a level of care provided in a nursing facility, 
an intermediate care facility for the mentally retarded, an institution 
for mental diseases, or any other similarly restrictive or 
institutional setting, any public entity that receives payment under 
the State plan or waiver for providing services to such an individual 
shall not--
            ``(1) impose or utilize policies, practices, or procedures, 
        such as unnecessary requirements or arbitrary service or cost 
        caps, that limit the availability of services in home and 
        community-based settings to an individual with a disability 
        (including individuals with the most significant disabilities) 
        who need such services;
            ``(2) impose or utilize policies, practices, or procedures 
        that limit the availability of services in a home and 
        community-based setting (including assistance and support in 
        accomplishing activities of daily living, instrumental 
        activities of daily living, health-related tasks, and 
        rehabilitative services) based on the specific disability of an 
        otherwise eligible individual;
            ``(3) impose or utilize policies, practices, or procedures 
        that arbitrarily restrict an individual with a disability from 
        full and meaningful participation in community life;
            ``(4) impose or utilize policies, practices, or procedures 
        that unnecessarily delay or restrict the provision of services 
        in a home and community-based setting to any individual who 
        requires such services;
            ``(5) fail to establish and utilize adequate payment 
        structures to maintain a sufficient workforce to provide 
        services in home and community-based settings to any individual 
        who requires such services;
            ``(6) fail to provide information, on an ongoing basis, to 
        help any individual who receives care in a nursing facility, an 
        intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting, understand the 
        individual's right to choose to receive such care in a home and 
        community-based setting; or
            ``(7) fail to provide information to help any individual 
        that requires the level of care provided in a nursing facility, 
        an intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting, prior to the individual's 
        placement in such a facility or an institution, understand the 
        individual's right to choose to receive such care in a home and 
        community-based setting.
    ``(c) Plan To Increase Affordable and Accessible Housing.--Not 
later than 180 days after the enactment of this section, each State 
shall develop a Statewide plan to increase the availability of 
affordable and accessible private and public housing stock for 
individuals with disabilities (including accessible housing for 
individuals with physical disabilities and those using mobility 
devices).
    ``(d) Availability of Remedies and Procedures.--
            ``(1) In general.--The remedies and procedures set forth in 
        sections 203 and 505 of the Americans with Disabilities Act of 
        1990 shall be available to any person aggrieved by the failure 
        of--
                    ``(A) a State to comply with this section or 
                section 1902(a)(84); or
                    ``(B) a public entity (including a State) to comply 
                with the requirements of subsection (b).
            ``(2) Rule of construction.--Nothing in paragraph (1) shall 
        be construed to limit any remedy or right of action that 
        otherwise is available to an aggrieved person under this title.
    ``(e) Enforcement by the Secretary.--
            ``(1) In general.--The Secretary may reduce the Federal 
        medical assistance percentage applicable to the State (as 
        determined under section 1905(b)) if the Secretary determines 
        that the State has violated the requirements of subsection (b).
            ``(2) Rule of construction.--Nothing in paragraph (1) shall 
        be construed to limit any remedy or right of action that is 
        otherwise available to the Secretary.
    ``(f) Reporting Requirements.--With respect to fiscal year 2018, 
and for each fiscal year thereafter, each State shall submit to the 
Administrator of the Administration for Community Living of the 
Department of Health and Human Services, not later than April 1 of the 
succeeding fiscal year, a report, in such form and manner as the 
Secretary shall require, that includes--
            ``(1) the total number of individuals enrolled in the State 
        plan or under a waiver of the plan during such fiscal year that 
        required the level of care provided in a nursing facility, an 
        intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting, disaggregated by the type 
        of facility or setting;
            ``(2) with respect to the total number described in 
        paragraph (1), the total number of individuals described in 
        that paragraph who received care in a nursing facility, an 
        intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting, disaggregated by the type 
        of facility or setting; and
            ``(3) with respect to the total number described in 
        paragraph (2), the total number of individuals described in 
        that paragraph who were transitioned from a nursing facility, 
        an intermediate care facility for the mentally retarded, an 
        institution for mental diseases, or any other similarly 
        restrictive or institutional setting to a home and community-
        based setting, disaggregated by the type of home and community-
        based setting.''.
    (c) Inclusion as a Mandatory Service.--Section 1905(a)(4)(A) of the 
Social Security Act (42 U.S.C. 1396d(a)(4)(A)) is amended by striking 
``other than'' and inserting ``including similar services such as 
rehabilitative services and assistance and support in accomplishing 
activities of daily living, instrumental activities of daily living, 
and health-related tasks, that are provided, at the individual's 
option, in a home and community-based setting (as defined in section 
1904A(a)(3)), but not including''.
    (d) Application to Waivers.--Notwithstanding section 1904A of the 
Social Security Act (as added by subsection (b)), such section and 
sections 1902(a)(84) and 1905(a)(4)(A) of the Social Security Act (42 
U.S.C. 1396 et seq.), as amended by subsections (a) and (c), 
respectively, shall not apply to any individuals who are eligible for 
medical assistance for home and community-based services under a waiver 
under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 
1396n) and who are receiving such services, to the extent such sections 
(as so added or amended) are inconsistent with any such waiver.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect on October 1, 
        2019.
            (2) Delay permitted if state legislation required.--In the 
        case of a State plan under section 1902 of the Social Security 
        Act (42 U.S.C. 1396a) which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirements imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such section 1902 solely on 
        the basis of the failure of the plan to meet such additional 
        requirements before the first day of the first calendar quarter 
        beginning after the close of the first regular session of the 
        State legislature that begins after the date of enactment of 
        this Act. For purposes of the previous sentence, in the case of 
        a State that has a 2-year legislative session, each year of 
        such session shall be deemed to be a separate regular session 
        of the State legislature.
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