S 971 IS
108th CONGRESS
1st Session
S. 971
IN THE SENATE OF
THE UNITED STATES
Mr. HARKIN (for himself, Mr. SPECTER, Mr. KENNEDY, Mr. COCHRAN, Mr. BIDEN,
Ms. LANDRIEU, Mr. KERRY, Mr. CORZINE, Mr. SCHUMER, Mrs. CLINTON, and Mr.
DAYTON) introduced the following bill; which was read twice and referred to the
Committee on Finance
A BILL
Be it enacted by the Senate and
House of Representatives of the United States of America in Congress assembled,
(a) SHORT TITLE- This Act may be
cited as the `Medicaid Community-Based Attendant Services and Supports Act of
2003'.
(b) TABLE OF CONTENTS- The table of
contents for this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Findings and purposes.
Sec. 101. Coverage of
community-based attendant services and supports under the medicaid program.
Sec. 102. Enhanced FMAP for
ongoing activities of early coverage States that enhance and promote the use of
community-based attendant services and supports.
Sec. 103. Increased Federal
financial participation for certain expenditures.
Sec. 201. Grants to promote
systems change and capacity building.
Sec. 202. Demonstration project to
enhance coordination of care under the medicare and medicaid programs for
non-elderly dual eligible individuals.
(a) FINDINGS- Congress makes the
following findings:
(1) Long-term services and
supports provided under the medicaid program established under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) must meet the ability and life
choices of individuals with disabilities and older Americans, including the
choice to live in one's own home or with one's own family and to become a
productive member of the community.
(2) Research on the provision of
long-term services and supports under the medicaid program (conducted by and on
behalf of the Department of Health and Human Services) has revealed a
significant funding bias toward institutional care. Only about 27 percent of
long term care funds expended under the medicaid program, and only about 9
percent of all funds expended under that program, pay for services and supports
in home and community-based settings.
(3) In the case of medicaid
beneficiaries who need long term care, the only long-term care service
currently guaranteed by Federal law in every State is nursing home care. Only
27 States have adopted the benefit option of providing personal care services
under the medicaid program. Although every State has chosen to provide certain
services under home and community-based waivers, these services are unevenly
available within and across States, and reach a small percentage of eligible
individuals. In fiscal year 2000, only 3 States spent 50 percent or more of
their medicaid long term care funds under the medicaid program on home and
community-based care.
(4) Despite the funding bias and
the uneven distribution of home and community-based services, 2 1/2 times more
people are served in home and community-based settings than in institutional
settings.
(5) The goals of the Nation
properly include providing families of children with disabilities, working-age
adults with disabilities, and older Americans with--
(A) a meaningful choice of
receiving long-term services and supports in the most integrated setting
appropriate to their needs;
(B) the greatest possible control
over the services received and, therefore, their own lives and futures; and
(C) quality services that maximize
independence in the home and community, including in the workplace.
(b) PURPOSES- The purposes of this
Act are the following:
(1) To reform the medicaid program
established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
to provide equal access to community-based attendant services and supports.
(2) To provide financial
assistance to States as they reform their long-term care systems to provide
comprehensive statewide long-term services and supports, including
community-based attendant services and supports that provide consumer choice
and direction, in the most integrated setting appropriate.
(a) MANDATORY COVERAGE- Section
1902(a)(10)(D) of the Social Security Act (42 U.S.C. 1396a(a)(10)(D)) is
amended--
(1) by inserting `(i)' after
`(D)';
(2) by adding `and' after the
semicolon; and
(3) by adding at the end the
following new clause:
`(ii) subject to section 1935, for
the inclusion of community-based attendant services and supports for any
individual who--
`(I) is eligible for medical
assistance under the State plan;
`(II) with respect to whom there
has been a determination that the individual requires the level of care
provided in a nursing facility or an intermediate care facility for the
mentally retarded (whether or not coverage of such intermediate care facility
is provided under the State plan); and
`(III) who chooses to receive such
services and supports;'.
(b) COMMUNITY-BASED ATTENDANT
SERVICES AND SUPPORTS-
(1) IN GENERAL- Title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) is amended--
(A) by redesignating section 1935
as section 1936; and
(B) by inserting after section
1934 the following:
`SEC. 1935. (a) REQUIRED COVERAGE-
`(1) IN GENERAL- Not later than
October 1, 2007, a State shall provide through a plan amendment for the
inclusion of community-based attendant services and supports (as defined in
subsection (g)(1)) for individuals described in section 1902(a)(10)(D)(ii) in
accordance with this section.
`(2) ENHANCED FMAP AND ADDITIONAL
FEDERAL FINANCIAL SUPPORT FOR EARLIER COVERAGE- Notwithstanding section
1905(b), during the period that begins on or after October 1, 2003, and ends on
September 30, 2007, in the case of a State with an approved plan amendment
under this section during that period that also satisfies the requirements of
subsection (c) the Federal medical assistance percentage shall be equal to the
enhanced FMAP described in section 2105(b) with respect to medical assistance
in the form of community-based attendant services and supports provided to
individuals described in section 1902(a)(10)(D)(ii) in accordance with this
section.
`(b) DEVELOPMENT AND IMPLEMENTATION
OF BENEFIT- In order for a State plan amendment to be approved under this
section, a State shall provide the Secretary with the following assurances:
`(1) ASSURANCE OF DEVELOPMENT AND
IMPLEMENTATION COLLABORATION- That the State has developed and shall implement
the provision of community-based attendant services and supports under the
State plan through active collaboration with--
`(A) individuals with
disabilities;
`(B) elderly individuals;
`(C) representatives of such
individuals; and
`(D) providers of, and advocates
for, services and supports for such individuals.
`(2) ASSURANCE OF PROVISION ON A
STATEWIDE BASIS AND IN MOST INTEGRATED SETTING- That community-based attendant
services and supports will be provided under the State plan to individuals
described in section 1902(a)(10)(D)(ii) on a statewide basis and in a manner
that provides such services and supports in the most integrated setting
appropriate for each individual eligible for such services and supports.
`(3) ASSURANCE OF
NONDISCRIMINATION- That the State will provide community-based attendant
services and supports to an individual described in section 1902(a)(10)(D)(ii)
without regard to the individual's age, type of disability, or the form of
community-based attendant services and supports that the individual requires in
order to lead an independent life.
`(4) ASSURANCE OF MAINTENANCE OF
EFFORT- That the level of State expenditures for optional medical assistance
that--
`(A) is described in a paragraph
other than paragraphs (1) through (5), (17) and (21) of section 1905(a) or that
is provided under a waiver under section 1915, section 1115, or otherwise; and
`(B) is provided to individuals
with disabilities or elderly individuals for a fiscal year,
shall not be less than the level
of such expenditures for the fiscal year preceding the fiscal year in which the
State plan amendment to provide community-based attendant services and supports
in accordance with this section is approved.
`(c) REQUIREMENTS FOR ENHANCED FMAP
FOR EARLY COVERAGE- In addition to satisfying the other requirements for an
approved plan amendment under this section, in order for a State to be eligible
under subsection (a)(2) during the period described in that subsection for the
enhanced FMAP for early coverage under subsection (a)(2), the State shall
satisfy the following requirements:
`(1) SPECIFICATIONS- With respect
to a fiscal year, the State shall provide the Secretary with the following
specifications regarding the provision of community-based attendant services
and supports under the plan for that fiscal year:
`(A)(i) The number of individuals
who are estimated to receive community-based attendant services and supports
under the plan during the fiscal year.
`(ii) The number of individuals
that received such services and supports during the preceding fiscal year.
`(B) The maximum number of
individuals who will receive such services and supports under the plan during
that fiscal year.
`(C) The procedures the State will
implement to ensure that the models for delivery of such services and supports
are consumer controlled (as defined in subsection (g)(2)(B)).
`(D) The procedures the State will
implement to inform all potentially eligible individuals and relevant other individuals
of the availability of such services and supports under this title, and of
other items and services that may be provided to the individual under this
title or title XVIII.
`(E) The procedures the State will
implement to ensure that such services and supports are provided in accordance
with the requirements of subsection (b)(1).
`(F) The procedures the State will
implement to actively involve individuals with disabilities, elderly
individuals, and representatives of such individuals in the design, delivery,
administration, and evaluation of the provision of such services and supports
under this title.
`(2) PARTICIPATION IN EVALUATIONS-
The State shall provide the Secretary with such substantive input into, and
participation in, the design and conduct of data collection, analyses, and
other qualitative or quantitative evaluations of the provision of
community-based attendant services and supports under this section as the
Secretary deems necessary in order to determine the effectiveness of the provision
of such services and supports in allowing the individuals receiving such
services and supports to lead an independent life to the maximum extent
possible.
`(d) QUALITY ASSURANCE PROGRAM-
`(1) STATE RESPONSIBILITIES- In
order for a State plan amendment to be approved under this section, a State
shall establish and maintain a quality assurance program with respect to
community-based attendant services and supports that provides for the
following:
`(A) The State shall establish
requirements, as appropriate, for agency-based and other delivery models that
include--
`(i) minimum qualifications and
training requirements for agency-based and other models;
`(ii) financial operating
standards; and
`(iii) an appeals procedure for
eligibility denials and a procedure for resolving disagreements over the terms
of an individualized plan.
`(B) The State shall modify the
quality assurance program, as appropriate, to maximize consumer independence
and consumer control in both agency-provided and other delivery models.
`(C) The State shall provide a
system that allows for the external monitoring of the quality of services and
supports by entities consisting of consumers and their representatives,
disability organizations, providers, families of disabled or elderly
individuals, members of the community, and others.
`(D) The State shall provide for
ongoing monitoring of the health and well-being of each individual who receives
community-based attendant services and supports.
`(E) The State shall require that
quality assurance mechanisms appropriate for the individual be included in the
individual's written plan.
`(F) The State shall establish a
process for the mandatory reporting, investigation, and resolution of allegations
of neglect, abuse, or exploitation in connection with the provision of such
services and supports.
`(G) The State shall obtain
meaningful consumer input, including consumer surveys, that measure the extent
to which an individual receives the services and supports described in the
individual's plan and the individual's satisfaction with such services and
supports.
`(H) The State shall make
available to the public the findings of the quality assurance program.
`(I) The State shall establish an
ongoing public process for the development, implementation, and review of the
State's quality assurance program.
`(J) The State shall develop and
implement a program of sanctions for providers of community-based services and
supports that violate the terms or conditions for the provision of such
services and supports.
`(2) FEDERAL RESPONSIBILITIES-
`(A) PERIODIC EVALUATIONS- The
Secretary shall conduct a periodic sample review of outcomes for individuals
who receive community-based attendant services and supports under this title.
`(B) INVESTIGATIONS- The Secretary
may conduct targeted reviews and investigations upon receipt of an allegation
of neglect, abuse, or exploitation of an individual receiving community-based
attendant services and supports under this section.
`(C) DEVELOPMENT OF PROVIDER
SANCTION GUIDELINES- The Secretary shall develop guidelines for States to use
in developing the sanctions required under paragraph (1)(J).
`(e) REPORTS- The Secretary shall
submit to Congress periodic reports on the provision of community-based
attendant services and supports under this section, particularly with respect
to the impact of the provision of such services and supports on--
`(1) individuals eligible for
medical assistance under this title;
`(2) States; and
`(3) the Federal Government.
`(f) NO EFFECT ON ABILITY TO
PROVIDE COVERAGE UNDER A WAIVER-
`(1) IN GENERAL- Nothing in this
section shall be construed as affecting the ability of a State to provide
coverage under the State plan for community-based attendant services and
supports (or similar coverage) under a waiver approved under section 1915,
section 1115, or otherwise.
`(2) ELIGIBILITY FOR ENHANCED
MATCH- In the case of a State that provides coverage for such services and
supports under a waiver, the State shall not be eligible under subsection
(a)(2) for the enhanced FMAP for the early provision of such coverage unless
the State submits a plan amendment to the Secretary that meets the requirements
of this section.
`(g) DEFINITIONS- In this title:
`(1) COMMUNITY-BASED ATTENDANT
SERVICES AND SUPPORTS-
`(A) IN GENERAL- The term
`community-based attendant services and supports' means attendant services and
supports furnished to an individual, as needed, to assist in accomplishing
activities of daily living, instrumental activities of daily living, and
health-related functions through hands-on assistance, supervision, or cueing--
`(i) under a plan of services and
supports that is based on an assessment of functional need and that is agreed
to by the individual or, as appropriate, the individual's representative;
`(ii) in a home or community
setting, which may include a school, workplace, or recreation or religious
facility, but does not include a nursing facility or an intermediate care
facility for the mentally retarded;
`(iii) under an agency-provider
model or other model (as defined in paragraph (2)(C)); and
`(iv) the furnishing of which is
selected, managed, and dismissed by the individual, or, as appropriate, with
assistance from the individual's representative.
`(B) INCLUDED SERVICES AND
SUPPORTS- Such term includes--
`(i) tasks necessary to assist an
individual in accomplishing activities of daily living, instrumental activities
of daily living, and health-related functions;
`(ii) the acquisition,
maintenance, and enhancement of skills necessary for the individual to
accomplish activities of daily living, instrumental activities of daily living,
and health-related functions;
`(iii) backup systems or mechanisms
(such as the use of beepers) to ensure continuity of services and supports; and
`(iv) voluntary training on how to
select, manage, and dismiss attendants.
`(C) EXCLUDED SERVICES AND
SUPPORTS- Subject to subparagraph (D), such term does not include--
`(i) the provision of room and
board for the individual;
`(ii) special education and
related services provided under the Individuals with Disabilities Education Act
and vocational rehabilitation services provided under the Rehabilitation Act of
1973;
`(iii) assistive technology
devices and assistive technology services;
`(iv) durable medical equipment;
or
`(v) home modifications.
`(D) FLEXIBILITY IN TRANSITION TO
COMMUNITY-BASED HOME SETTING- Such term may include expenditures for
transitional costs, such as rent and utility deposits, first month's rent and
utilities, bedding, basic kitchen supplies, and other necessities required for
an individual to make the transition from a nursing facility or intermediate
care facility for the mentally retarded to a community-based home setting where
the individual resides.
`(2) ADDITIONAL DEFINITIONS-
`(A) ACTIVITIES OF DAILY LIVING-
The term `activities of daily living' includes eating, toileting, grooming,
dressing, bathing, and transferring.
`(B) CONSUMER CONTROLLED- The term
`consumer controlled' means a method of providing services and supports that
allow the individual, or where appropriate, the individual's representative,
maximum control of the community-based attendant services and supports,
regardless of who acts as the employer of record.
`(C) DELIVERY MODELS-
`(i) AGENCY-PROVIDER MODEL- The
term `agency-provider model' means, with respect to the provision of
community-based attendant services and supports for an individual, a method of
providing consumer controlled services and supports under which entities
contract for the provision of such services and supports.
`(ii) OTHER MODELS- The term
`other models' means methods, other than an agency-provider model, for the
provision of consumer controlled services and supports. Such models may include
the provision of vouchers, direct cash payments, or use of a fiscal agent to
assist in obtaining services.
`(D) HEALTH-RELATED FUNCTIONS- The
term `health-related functions' means functions that can be delegated or
assigned by licensed health-care professionals under State law to be performed
by an attendant.
`(E) INSTRUMENTAL ACTIVITIES OF
DAILY LIVING- The term `instrumental activities of daily living' includes meal
planning and preparation, managing finances, shopping for food, clothing, and
other essential items, performing essential household chores, communicating by
phone and other media, and traveling around and participating in the community.
`(F) INDIVIDUAL'S REPRESENTATIVE-
The term `individual's representative' means a parent, a family member, a
guardian, an advocate, or an authorized representative of an individual.'.
(c) CONFORMING AMENDMENTS-
(1) MANDATORY BENEFIT- Section
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is
amended, in the matter preceding clause (i), by striking `(17) and (21)' and
inserting `(17), (21), and (27)'.
(2) DEFINITION OF MEDICAL
ASSISTANCE- Section 1905(a) of the Social Security Act (42 U.S.C. 1396d) is
amended--
(A) by striking `and' at the end
of paragraph (26);
(B) by redesignating paragraph
(27) as paragraph (28); and
(C) by inserting after paragraph
(26) the following:
`(27) community-based attendant
services and supports (to the extent allowed and as defined in section 1935);
and'.
(3) IMD/ICFMR REQUIREMENTS-
Section 1902(a)(10)(C)(iv) of the Social Security Act (42 U.S.C.
1396a(a)(10)(C)(iv)) is amended by inserting `and (27)' after `(24)'.
(d) EFFECTIVE DATES-
(1) IN GENERAL- Except as provided
in paragraph (2), the amendments made by this section (other than the amendment
made by subsection (c)(1)) take effect on October 1, 2003, and apply to medical
assistance provided for community-based attendant services and supports
described in section 1935 of the Social Security Act furnished on or after that
date.
(2) MANDATORY BENEFIT- The
amendment made by subsection (c)(1) takes effect on October 1, 2007.
(a) IN GENERAL- Section 1935 of the
Social Security Act, as added by section 101(b), is amended--
(1) by redesignating subsections
(d) through (g) as subsections (f) through (i), respectively;
(2) in subsection (a)(1), by
striking `subsection (g)(1)' and inserting `subsection (i)(1)';
(3) in subsection (a)(2), by
inserting `, and with respect to expenditures described in subsection (d), the
Secretary shall pay the State the amount described in subsection (d)(1)' before
the period;
(4) in subsection (c)(1)(C), by
striking `subsection (g)(2)(B)' and inserting `subsection (i)(2)(B)'; and
(5) by inserting after subsection
(c), the following:
`(d) INCREASED FEDERAL FINANCIAL
PARTICIPATION FOR EARLY COVERAGE STATES THAT MEET CERTAIN BENCHMARKS-
`(1) IN GENERAL- Subject to
paragraph (2), for purposes of subsection (a)(2), the amount and expenditures
described in this subsection are an amount equal to the Federal medical
assistance percentage, increased by 10 percentage points, of the expenditures
incurred by the State for the provision or conduct of the services or
activities described in paragraph (3).
`(2) EXPENDITURE CRITERIA- A State
shall--
`(A) develop criteria for
determining the expenditures described in paragraph (1) in collaboration with
the individuals and representatives described in subsection (b)(1); and
`(B) submit such criteria for
approval by the Secretary.
`(3) SERVICES AND ACTIVITIES
DESCRIBED- For purposes of paragraph (1), the services and activities described
in this subparagraph are the following:
`(A) One-stop intake, referral,
and institutional diversion services.
`(B) Identifying and remedying
gaps and inequities in the State's current provision of long-term services,
particularly those services that are provided based on such factors as age,
disability type, ethnicity, income, institutional bias, or other similar
factors.
`(C) Establishment of consumer
participation and consumer governance mechanisms, such as cooperatives and
regional service authorities, that are managed and controlled by individuals
with significant disabilities who use community-based services and supports or
their representatives.
`(D) Activities designed to
enhance the skills, earnings, benefits, supply, career, and future prospects of
workers who provide community-based attendant services and supports.
`(E) Continuous improvement
activities that are designed to ensure and enhance the health and well-being of
individuals who rely on community-based attendant services and supports,
particularly activities involving or initiated by consumers of such services
and supports or their representatives.
`(F) Family support services to
augment the efforts of families and friends to enable individuals with disabilities
of all ages to live in their own homes and communities.
`(G) Health promotion and wellness
services and activities.
`(H) Provider recruitment and
enhancement activities, particularly such activities that encourage the
development and maintenance of consumer controlled cooperatives or other small
businesses or microenterprises that provide community-based attendant services
and supports or related services.
`(I) Activities designed to ensure
service and systems coordination.
`(J) Any other services or
activities that the Secretary deems appropriate.'.
(b) EFFECTIVE DATE- The amendments
made by subsection (a) take effect on October 1, 2003.
(a) IN GENERAL- Section 1935 of the
Social Security Act, as added by section 101(b) and amended by section 102, is
amended by inserting after subsection (d) the following:
`(e) INCREASED FEDERAL FINANCIAL
PARTICIPATION FOR CERTAIN EXPENDITURES-
`(1) ELIGIBILITY FOR PAYMENT-
`(A) IN GENERAL- In the case of a
State that the Secretary determines satisfies the requirements of subparagraph
(B), the Secretary
shall pay the State the amounts described in paragraph (2) in addition to
any other payments provided for under section 1903 or this section for the
provision of community-based attendant services and supports.
`(B) REQUIREMENTS- The
requirements of this subparagraph are the following:
`(i) The State has an approved
plan amendment under this section.
`(ii) The State has incurred
expenditures described in paragraph (2).
`(iii) The State develops and
submits to the Secretary criteria to identify and select such expenditures in
accordance with the requirements of paragraph (3).
`(iv) The Secretary determines
that payment of the applicable percentage of such expenditures (as determined
under paragraph (2)(B)) would enable the State to provide a meaningful choice
of receiving community-based services and supports to individuals with
disabilities and elderly individuals who would otherwise only have the option
of receiving institutional care.
`(2) AMOUNTS AND EXPENDITURES
DESCRIBED-
`(A) EXPENDITURES IN EXCESS OF 150
PERCENT OF BASELINE AMOUNT- The amounts and expenditures described in this
paragraph are an amount equal to the applicable percentage, as determined by
the Secretary in accordance with subparagraph (B), of the expenditures incurred
by the State for the provision of community-based attendant services and
supports to an individual that exceed 150 percent of the average cost of
providing nursing facility services to an individual who resides in the State
and is eligible for such services under this title, as determined in accordance
with criteria established by the Secretary.
`(B) APPLICABLE PERCENTAGE- The
Secretary shall establish a payment scale for the expenditures described in
subparagraph (A) so that the Federal financial participation for such
expenditures gradually increases from 70 percent to 90 percent as such
expenditures increase.
`(3) SPECIFICATION OF ORDER OF
SELECTION FOR EXPENDITURES- In order to receive the amounts described in
paragraph (2), a State shall--
`(A) develop, in collaboration
with the individuals and representatives described in subsection (b)(1) and
pursuant to guidelines established by the Secretary, criteria to identify and
select the expenditures submitted under that paragraph; and
`(B) submit such criteria to the
Secretary.'.
(b) EFFECTIVE DATE- The amendment
made by subsection (a) takes effect on October 1, 2003.
(a) AUTHORITY TO AWARD GRANTS-
(1) IN GENERAL- The Secretary of
Health and Human Services (in this section referred to as the `Secretary')
shall award grants to eligible States to carry out the activities described in
subsection (b).
(2) APPLICATION- In order to be
eligible for a grant under this section, a State shall submit to the
Secretary an application in such form and manner, and that contains such
information, as the Secretary may require.
(b) PERMISSIBLE ACTIVITIES- A State
that receives a grant under this section may use funds provided under the grant
for any of the following activities, focusing on areas of need identified by
the State and the Consumer Task Force established under subsection (c):
(1) The development and
implementation of the provision of community-based attendant services and
supports under section 1935 of the Social Security Act (as added by section
101(b) and amended by sections 102 and 103) through active collaboration with--
(A) individuals with disabilities;
(B) elderly individuals;
(C) representatives of such
individuals; and
(D) providers of, and advocates
for, services and supports for such individuals.
(2) Substantially involving
individuals with significant disabilities and representatives of such
individuals in jointly developing, implementing, and continually improving a
mutually acceptable comprehensive, effectively working statewide plan for
preventing and alleviating unnecessary institutionalization of such
individuals.
(3) Engaging in system change and
other activities deemed necessary to achieve any or all of the goals of such
statewide plan.
(4) Identifying and remedying
disparities and gaps in services to classes of individuals with disabilities
and elderly individuals who are currently experiencing or who face substantial
risk of unnecessary institutionalization.
(5) Building and expanding system
capacity to offer quality consumer controlled community-based services and
supports to individuals with disabilities and elderly individuals, including
by--
(A) seeding the development and
effective use of community-based attendant services and supports cooperatives,
independent living centers, small businesses, microenterprises and similar
joint ventures owned and controlled by individuals with disabilities or
representatives of such individuals and community-based attendant services and
supports workers;
(B) enhancing the choice and
control individuals with disabilities and elderly individuals exercise,
including through their representatives, with respect to the personal
assistance and supports they rely upon to lead independent, self-directed
lives;
(C) enhancing the skills, earnings,
benefits, supply, career, and future prospects of workers who provide
community-based attendant services and supports;
(D) engaging in a variety of needs
assessment and data gathering;
(E) developing strategies for
modifying policies, practices, and procedures that result in unnecessary
institutional bias or the overmedicalization of long-term services and
supports;
(F) engaging in interagency
coordination and single point of entry activities;
(G) providing training and
technical assistance with respect to the provision of community-based attendant
services and supports;
(H) engaging in--
(i) public awareness campaigns;
(ii) facility-to-community
transitional activities; and
(iii) demonstrations of new
approaches; and
(I) engaging in other systems
change activities necessary for developing, implementing, or evaluating a
comprehensive statewide system of community-based attendant services and
supports.
(6) Ensuring that the activities
funded by the grant are coordinated with other efforts to increase personal
attendant services and supports, including--
(A) programs funded under or
amended by the Ticket to Work and Work Incentives Improvement Act of 1999
(Public Law 106-170; 113 Stat. 1860);
(B) grants funded under the Families
of Children With Disabilities Support Act of 2000 (42 U.S.C. 15091 et seq.);
and
(C) other initiatives designed to
enhance the delivery of community-based services and supports to individuals
with disabilities and elderly individuals.
(7) Engaging in transition
partnership activities with nursing facilities and intermediate care facilities
for the mentally retarded that utilize and build upon items and services
provided to individuals with disabilities or elderly individuals under the
medicaid
program under title XIX of the Social Security Act, or by Federal, State, or
local housing agencies, independent living centers, and other organizations
controlled by consumers or their representatives.
(c) CONSUMER TASK FORCE-
(1) ESTABLISHMENT AND DUTIES- To be
eligible to receive a grant under this section, each State shall establish a
Consumer Task Force (referred to in this subsection as the `Task Force') to
assist the State in the development, implementation, and evaluation of real
choice systems change initiatives.
(2) APPOINTMENT- Members of the
Task Force shall be appointed by the Chief Executive Officer of the State in
accordance with the requirements of paragraph (3), after the solicitation of
recommendations from representatives of organizations representing a broad
range of individuals with disabilities, elderly individuals, representatives of
such individuals, and organizations interested in individuals with disabilities
and elderly individuals.
(3) COMPOSITION-
(A) IN GENERAL- The Task Force
shall represent a broad range of individuals with disabilities from diverse
backgrounds and shall include representatives from Developmental Disabilities
Councils, Mental Health Councils, State Independent Living Centers and
Councils, Commissions on Aging, organizations that provide services to
individuals with disabilities and consumers of long-term services and supports.
(B) INDIVIDUALS WITH DISABILITIES-
A majority of the members of the Task Force shall be individuals with
disabilities or representatives of such individuals.
(C) LIMITATION- The Task Force
shall not include employees of any State agency providing services to
individuals with disabilities other than employees of entities described in the
Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15001 et seq.).
(d) ANNUAL REPORT-
(1) STATES- A State that receives
a grant under this section shall submit an annual report to the Secretary on
the use of funds provided under the grant in such form and manner as the
Secretary may require.
(2) SECRETARY- The Secretary shall
submit to Congress an annual report on the grants made under this section.
(e) AUTHORIZATION OF
APPROPRIATIONS-
(1) IN GENERAL- There is
authorized to be appropriated to carry out this section, $50,000,000 for each of
fiscal years 2004 through 2006.
(2) AVAILABILITY- Amounts
appropriated to carry out this section shall remain available without fiscal
year limitation.
(a) DEFINITIONS- In this section:
(1) NON-ELDERLY DUALLY ELIGIBLE
INDIVIDUAL- The term `non-elderly dually eligible individual' means an
individual who--
(A) has not attained age 65; and
(B) is enrolled in the medicare
and medicaid programs established under titles XVIII and XIX, respectively, of
the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.).
(2) PROJECT- The term `project'
means the demonstration project authorized to be conducted under this section.
(3) SECRETARY- The term
`Secretary' means the Secretary of Health and Human Services.
(b) AUTHORITY TO CONDUCT PROJECT-
The Secretary shall conduct a project under this section for the purpose of
evaluating service coordination and cost-sharing approaches with respect to the
provision of community-based services and supports to non-elderly dually
eligible individuals.
(c) REQUIREMENTS-
(1) NUMBER OF PARTICIPANTS- Not
more than 5 States may participate in the project.
(2) APPLICATION- A State that
desires to participate in the project shall submit an application to the
Secretary, at such time and in such form and manner as the Secretary shall
specify.
(3) DURATION- The project shall be
conducted for at least 5, but not more than 10 years.
(d) EVALUATION AND REPORT-
(1) EVALUATION- Not later than 1
year prior to the termination date of the project, the Secretary, in
consultation with States participating in the project, representatives of
non-elderly dually eligible individuals, and others, shall evaluate the impact
and effectiveness of the project.
(2) REPORT- The Secretary shall
submit a report to Congress that contains the findings of the evaluation
conducted under paragraph (1) along with recommendations regarding whether the
project should be extended or expanded, and any other legislative or
administrative actions that the Secretary considers appropriate as a result of
the project.
(e) AUTHORIZATION OF
APPROPRIATIONS- There are authorized to be appropriated such sums as are
necessary to carry out this section.
END