`COVERAGE OF QUALIFIED COMMUNITY-BASED ATTENDANT SERVICES

`SEC. 1932. (a) QUALIFIED COMMUNITY-BASED ATTENDANT SERVICES DEFINED-

`(1) IN GENERAL- In this title, the term `qualified community-based attendant services' means attendant services (as defined by the Secretary) furnished to an individual--

`(A) on an as-needed basis under a plan of service that is based on an assessment of functional need and that is agreed to by the individual;

`(B) in a home or community-based setting, which may include a school, workplace, or recreation or religious facility, but does not include a nursing facility, an intermediate care facility for the mentally retarded, or other institutional facility;

`(C) under either an agency-provider model or other model (as defined in subsection (c)); and

`(D) the furnishing of which is selected, managed, controlled by the individual (as defined by the Secretary).

`(2) SERVICES INCLUDED- Such term includes--

`(A) backup and emergency attendant services;

`(B) voluntary training on how to select, manage, and dismiss attendants; and

`(C) health-related tasks (as defined by the Secretary) that are assigned to, delegated to, or performed by, unlicensed personal attendants.

`(3) EXCLUDED SERVICES- Subject to paragraph (4), such term does not include--

`(A) provision of room and board, and

`(B) prevocational, vocational, and supported employment.

`(4) FLEXIBILITY IN TRANSITION TO HOME SETTING- Under regulations of the Secretary, such term may include expenditures for transitional costs, such as rent and utility deposits, first months'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 home setting.

`(b) LIMITATION ON AMOUNTS OF EXPENDITURES AS MEDICAL ASSISTANCE-

`(1) IN GENERAL- In carrying out section 1902(a)(10)(D)(ii), a State shall permit an individual who is entitled to medical assistance with respect to nursing facility services or intermediate care facility services for the mentally retarded and who qualifies for the receipt of such services to choose to receive medical assistance for qualified community-based attendant services (rather than medical assistance for such institutional services), in the most integrated setting appropriate to the needs of the individual, so long as the aggregate amount of the Federal expenditures for such individuals in a fiscal year does not exceed the total that would have been expended for such individuals to receive such institutional services in the year plus, subject to subsection (e), the transitional allotment to the State for the fiscal year involved, as determined under paragraph (2)(B).

`(2) TRANSITIONAL ALLOTMENTS-

`(A) TOTAL AMOUNT- The total amount of the transitional allotments under this paragraph for--

`(i) fiscal year 1998 is $580,000,000,

`(ii) fiscal year 1999 is $480,000,000,

`(iii) fiscal year 2000 is $380,000,000,

`(iv) fiscal year 2001 is $280,000,000,

`(v) fiscal year 2002 is $180,000,000 and

`(vi) fiscal year 2003 is $100,000,000.

`(B) STATE ALLOTMENTS- The Secretary shall provide a formula for the distribution of the total amount of the transitional allotments provided in each fiscal year under subparagraph (A) among States. Such formula shall give preference to States that have a relatively higher proportion of long-term care services furnished to individuals in an institutional setting but who have a plan under subsection (e) to significantly reduce such proportion.