Section 1

This section includes the title of the legislation: "Medicaid Community Attendant Services and Supports Act of 1999."

Section 2

This section includes a statement of the Findings, Purpose, and Policy. For example, the research on the provision of long-term care and services and supports under the Medicaid program has revealed a significant bias toward funding these services in institutional rather than home and community-based settings. Seventy-five percent of Medicaid funds for long-term services and supports are expended in nursing homes and intermediate care facilities for the mentally retarded (ICF-MRs). Only 25% of such funds pays for services in home and community based settings.

Federal and State Medicaid policies should facilitate, rather than impede, and individual’s choice in selecting where they receive long-term services and supports.

Section 3

This section allows individuals who are eligible for nursing home and ICF-MR services under Medicaid to choose to receive community attendant services and supports; defines the eligible services and supports and eligible persons; and contains funding and quality assurance provisions.

Right to Choose Community Attendant Services & Eligibility for Such Services

The bill amends Title XIX of the Social Security Act (Medicaid provisions) to allow individuals who are eligible for Medicaid and who qualify for nursing home and ICF-MR services, to choose community attendant services and supports in lieu of institutional care. Individuals’ eligibility is determined without regard to age or disability.

Community attendant services and supports are defined as services that assist in accomplishing activities of daily living (such as bathing, dressing, toileting), instrumental activities of daily living (such as meal preparation, shopping, household chores), and health-related functions (only those that can be delegated or assigned by a licensed health professional), through hands-on assistance, supervision, and/or cueing. The italicized activities are intended to meet the needs of persons with cognitive disabilities like traumatic brain injury, stroke and dementia, as well as developmental disabilities such as mental retardation and autism.

Services are further defined to include tasks such as hands-on assistance; the acquisition of skills so that individuals can do as many of their own personal tasks as possible; back-up systems such as substitute attendants to ensure continuity of support; and voluntary training on how to manage attendants.

Other services are explicitly excluded from coverage, including room and board, special education and related services, assistive technology devices and services, durable medical equipment, and home modifications.

Finally, there is a provision to allow for use of funds to pay for transition costs related to moving from an institutional to community based setting, such as first month’s rent and utilities, bedding and basic kitchen supplies.

If the aggregate amount of Federal expenditures on people living in the community exceeds what would have been spent on the same people had they been in a nursing home or ICF-MR, the State may limit the program. In addition, States must continue to provide community-based services and personal attendants under other Medicaid programs.

States must establish a quality assurance program that includes minimum qualifications and training for attendants, financial operating standards for agencies, an appeals process for eligibility denials and grievance procedures, an external system that allows for monitoring of services by consumers, disability organizations, family members and others, mandatory reporting, investigation, and resolution of allegations of neglect, abuse or exploitation, mechanisms to obtain consumer input through surveys, etc., and a systems of sanctions, based on guidelines developed by the Secretary.

Section 4

This section makes grants available to States to support "real choice systems change initiatives" that include action plans to provide long term community services and supports to eligible individuals based on individual needs and consumer choice.

Grants would be awarded on a formula basis, with priority going to states with high levels of institutional services that have a plan to shift resources into community–based long term care services and supports. The grants may be used to accomplish systems change activities, including assessments and other data collecting activities; strategies for modifying policies in order to deliver more community-based services and supports, interagency coordination, and training and technical assistance.

To be eligible to receive a grant under this section, a State must establish a Consumer Task Force to assist in the development, implementation, and evaluation of real choice systems change initiatives. The Task Force must include a broad range of consumers and members of the State Independent Living Councils, Commissions on Aging, Developmental Disabilities Councils and other organizations providing long term care services and supports.

Section 5

This gives States the option to waive income and resource limits to enhance employment opportunities for people with disabilities and to create a Medicaid "buy-in" program.

Section 6

This section requires the National Council on Disability to review existing Medicaid regulations as they relate to excessive utilization of medical services in the provision of home and community based services, and requires the Secretary to submit a report to Congress on the same.

Section 7

This section requires the Secretary to establish a Task Force on the financing of long-term care services.