S 401 IS
109th CONGRESS
1st Session
S. 401
To amend title XIX of the Social Security Act to provide
individuals with disabilities and older Americans with equal access to
community-based attendant services and supports, and for other
purposes.
IN THE SENATE OF THE UNITED STATES
February 16, 2005
Mr. HARKIN (for himself, Mr. SPECTER, Mr. KENNEDY, Mr. KERRY, Mr.
BIDEN, Mr. DAYTON, Ms. LANDRIEU, Mr. SCHUMER, Mr. CORZINE, Mr.
LAUTENBERG, Mr. LIEBERMAN, and Mr. DODD) introduced the following bill;
which was read twice and referred to the Committee on Finance
A BILL
To amend title XIX of the Social Security Act to provide
individuals with disabilities and older Americans with equal access to
community-based attendant services and supports, and for other
purposes.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the `Medicaid
Community-Based Attendant Services and Supports Act of 2005'.
(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.
TITLE I--ESTABLISHMENT OF MEDICAID PLAN BENEFIT
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.
TITLE II--PROMOTION OF SYSTEMS CHANGE AND CAPACITY BUILDING
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.
SEC. 2. FINDINGS AND PURPOSES.
(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 33 percent of long
term care funds expended under the medicaid program, and only about 11
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 30 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 2003, only 7 States
spent 50 percent or more of their medicaid long term care funds under
the medicaid program on home and community-based care.
(4) 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.
TITLE I--ESTABLISHMENT OF MEDICAID PLAN
BENEFIT
SEC. 101. COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES AND
SUPPORTS UNDER THE MEDICAID PROGRAM.
(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 1936, 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) 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 1936 as section 1937;
and
(B) by inserting after section 1935 the
following:
`COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS
`SEC. 1936. (a) Required Coverage-
`(1) IN GENERAL- Not later than October 1, 2009, 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 October 1, 2005, and ends on September 30, 2009, 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 on or after the date of the approval of
such plan amendment.
`(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;
`(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
`(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.
`(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 (28)'.
(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
(27);
(B) by redesignating paragraph (28) as paragraph (29);
and
(C) by inserting after paragraph (27) the
following:
`(28) community-based attendant services and supports (to
the extent allowed and as defined in section 1936); 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 (28)' after `(24)'.
(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, 2005, and apply to medical
assistance provided for community-based attendant services and supports
described in section 1936 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, 2009.
SEC. 102. ENHANCED FMAP FOR ONGOING ACTIVITIES OF EARLY COVERAGE
STATES THAT ENHANCE AND PROMOTE THE USE OF COMMUNITY-BASED ATTENDANT
SERVICES AND SUPPORTS.
(a) In General- Section 1936 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, 2005.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR CERTAIN
EXPENDITURES.
(a) In General- Section 1936 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, 2005.
TITLE II--PROMOTION OF SYSTEMS CHANGE AND CAPACITY
BUILDING
SEC. 201. GRANTS TO PROMOTE SYSTEMS CHANGE AND CAPACITY
BUILDING.
(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 1936 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;
(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;
(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.
(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.
(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.).
(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 2006
through 2008.
(2) AVAILABILITY- Amounts appropriated to carry out this
section shall remain available without fiscal year limitation.
SEC. 202. DEMONSTRATION PROJECT TO ENHANCE COORDINATION OF CARE
UNDER THE MEDICARE AND MEDICAID PROGRAMS FOR NON-ELDERLY DUAL ELIGIBLE
INDIVIDUALS.
(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.
(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