Summary of S. 1935
Medicaid Community Attendant Services and Supports Act
Senator Tom Harkin (D-IA) and Senator Arlen Specter (R-PA)
Background
Given a real choice, most Americans who need long term services and supports would prefer to receive them in home and community settings rather than in institutions. And yet, too often decisions relating to the provision of long term services and supports are influenced by what is reimbursable under Federal and state Medicaid policy rather than by what individuals need. Research has revealed a significant bias in the Medicaid program toward reimbursing services provided in institutions over services provided in home and community settings (seventy-five percent of Medicaid funds pay for services provided in institutions).
Long term services and supports provided under the Medicaid program must meet the evolving and changing needs and preferences of individuals. No individual should be forced into an institution to receive reimbursement for services that can be effectively and efficiently delivered in the home or community. Individuals must be empowered to exercise real choice in selecting long term services and supports that meet their unique needs. Federal and state Medicaid policies should facilitate and be responsive to and not impede an individual’s choice in selecting needed long term services and supports.
Summary of Legislation
The Medicaid Community Attendant Services and Supports Act of 1999 (S. 1935) eliminates the bias in Medicaid law toward institutional care by providing that states offer community attendant services and supports as well as institutional care for eligible individuals in need of long term services and supports. The legislation also assists states develop and enhance comprehensive statewide systems of long term services and supports that provide real consumer choice consistent with the principle that service and supports should be provided in the most integrated setting appropriate to meeting the unique need of the individual.
The legislation would
–-- Amend Title XIX of the Social Security Act (Medicaid provisions) to allow individuals who are eligible for nursing home and ICF-MR services to choose to receive community attendant services and supports in lieu of institutional care.
-- Make grants available to States to support "real choice systems change initiatives" that include specific action steps and timetables for the provision of community-based long term community services and supports.
-- Require 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 report to Congress on the issue. Also requires the Secretary of HHS to establish a Task Force on the financing of long-term care services.
-- Give 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.