To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver.

Bill: 118-hr-8106
Sponsor: full_name: Rep. McMorris Rodgers, Cathy [R-WA-5]
Introduced: 2024-04-23
Policy area: Health
Latest action: action_date: 2024-04-26
text: Referred to the Subcommittee on Health.

Summaries:

tv_txt: I 118th CONGRESS 2d Session H. R. 8106 IN THE HOUSE OF REPRESENTATIVES April 23, 2024 Mrs. Rodgers of Washington (for herself and Mr. Pallone ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver.

1. Increasing transparency and expanding HCBS coverage options Section 1915(c) of the Social Security Act ( 42 U.S.C. 1396n(c) ) is amended— (1) in paragraph (2)— (A) in subparagraph (E)— (i) by inserting , not less frequently than before annually ; and (ii) by inserting (including, with respect to such information provided on or after January 1, 2028, the information specified in paragraph (12)) before the period at the end; and (B) by adding at the end the following flush sentence: The Secretary shall make all information provided under subparagraph (E) on or after January 1, 2028, publicly available on the website of the Centers for Medicare & Medicaid Services. ; and (2) by adding at the end the following new paragraphs: (11) (A) Notwithstanding paragraph (1), the Secretary may approve a waiver under this subsection for a State to include as medical assistance under the State plan of such State payment for part or all of the cost of home or community-based services (other than room and board (as described in such paragraph)) approved by the Secretary which are provided pursuant to a written plan of care to individuals other than individuals described in such paragraph if such State meets the requirements specified in subparagraph (B). (B) For purposes of paragraph (1), the requirements specified in this paragraph are, with respect to a State, the following: (i) As of the date that such State requests a waiver under this subsection to provide home or community-based services to individuals with respect to whom there has not been a determination described in such paragraph made, all other waivers (if any) granted under this subsection with respect to the State plan meet the requirements of this subsection. (ii) The State demonstrates to the Secretary that approval of a waiver under this subsection with respect to individuals described in clause (i) will have no material impact on the average amount of time that individuals with respect to whom a determination described in paragraph (1) has been made will need to wait to receive home or community-based services under any waiver granted under this subsection. (iii) The State provides to the Secretary— (I) an estimate of the number of individuals described in clause (i) that the State will make such services available to under a waiver under this subsection; and (II) a description of how the types and quantities of such services furnished to such individuals under such a waiver may differ from the types and quantities of such services furnished to individuals not described in clause (i) under such a waiver. (12) For purposes of paragraph (2)(E), the information specified in this paragraph is the following: (A) In the case of a State that limits the number of individuals who may be provided home or community-based services under a waiver granted under this subsection— (i) a description of how the State maintains its list of individuals who have applied to receive such services under such waiver but who, due to such limit, have not yet been approved to receive such services; (ii) information on whether the State screens individuals on such list to determine whether such individuals are eligible to receive such services under such waiver; (iii) information on whether (and, if applicable, how often) the State periodically re-screens such individuals to determine whether such individuals are so eligible; and (iv) the average amount of time that individuals approved to receive such services were on such list. (B) A description of the types of services furnished under waivers under this subsection, including the following: (i) The average amount of time from when such services are initially approved for an individual to when such individual begins receiving such services. (ii) With respect to the most recent 1-year period ending on the date that such information is provided to the Secretary for which data is available (or such other period as may be specified by the Secretary), the average percentage of hours of home or community-based services authorized under written plans of care for individuals receiving such services under a waiver granted under this subsection that are actually furnished to such individual. (C) Information regarding access to homemaker services, home health aide services, and personal care services under waivers under this subsection, including the following: (i) With respect to the most recent 1-year period ending on the date that such information is provided to the Secretary for which data is available, the average amount of time from when homemaker services, home health aide services, or personal care services are initially approved to be furnished to individuals under such a waiver to when services began. (ii) With respect to the period described in clause (i), the average percentage of hours of homemaker services, home health aide services, and personal care services authorized under written plans of care for individuals receiving such services under a waiver granted under this subsection that are actually furnished to such individual. . 2. CMS guidance to States on interim coverage under waiver Not later than January 1, 2025, the Secretary of Health and Human Services shall issue guidance to the States to clarify how a State with a waiver in effect under section 1915(c) of the Social Security Act ( 42 U.S.C. 1396n(c) ) may provide, with respect to an individual who is eligible for home and community-based services (as such term is described in such section) under such waiver, up to 60 days of coverage of such services under an interim care plan for the period beginning on the date such eligibility is determined and ending on the date that a written plan of care (as such term is described in such section) with respect to such individual is finalized.