H.R. 5454 — Long-Term Health Care Program Act of 1992

 
HR 5454 IH
102d CONGRESS
2d Session
 H. R. 5454
To amend title XVIII of the Social Security Act to provide for a Long-Term
Care Program for all Americans.
IN THE HOUSE OF REPRESENTATIVES
June 22, 1992
Mr. KENNEDY (for himself and Mr. ROYBAL) introduced the following bill;
which was referred jointly to the Committees on Energy and Commerce and Ways
and Means
A BILL
To amend title XVIII of the Social Security Act to provide for a Long-Term
Care Program for all Americans.
  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 `Long-Term Health Care
  Program Act of 1992'.
  (b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Long-Term Care Program.
`Part C--Long-Term Care Program
`Sec. 1850. Eligibility.
`Sec. 1851. Long-term care benefits.
`Sec. 1852. Long-term care agencies.
`Sec. 1853. Qualified service providers.
`Sec. 1854. Payment for home and community-based services.
`Sec. 1855. Payment for nursing facility services.
`Sec. 1856. Certification.
`Sec. 1857. Home and community-based care advisory council.
`Sec. 1858. Home and community-based care quality assurance.
`Sec. 1859. Assistance for individuals entitled to benefits.
`Sec. 1859A. Administration; Long-term Care Trust Fund.
`Sec. 1859B. Definitions.
Sec. 102. Additional provisions relating to quality assurance.
Sec. 103. Elimination of overlapping mandatory long-term care benefits under
medicaid program.
Sec. 104. Effective date.
TITLE II--FINANCING
Sec. 201. Elimination of limit on wages or self-employment income subject
to FICA and railroad retirement taxes.
Sec. 202. Increase in hospital insurance tax rate.
Sec. 203. State maintenance of effort payments.
TITLE III--GRANTS AND DEMONSTRATION PROJECTS
Sec. 301. Grants for training for home and community-based care.
Sec. 302. Grants for home health aides.
Sec. 303. Grants for model consumer training programs.
Sec. 304. Centers for long-term care planning and technical assistance.
Sec. 305. Demonstration projects for seriously mentally ill individuals.
Sec. 306. Special rules for frail elderly demonstration projects and similar
projects.
SEC. 2. ESTABLISHMENT OF LONG-TERM CARE PROGRAM.
  (a) IN GENERAL- Title XVIII of the Social Security Act is amended by
  redesignating part C as part D and by inserting after part B the following
  new part:
`Part C--Long-Term Care Program
`ELIGIBILITY
  `SEC. 1850. (a) IN GENERAL- Subject to the succeeding provisions of
  this part, an eligible individual (as defined in subsection (c)) shall
  be entitled to benefits under this part for services furnished beginning
  on or after January 1 of the second year beginning after the date of the
  enactment of the Long-Term Health Care Program Act of 1992 if--
  `(1) the individual has been determined by a Screening Agency through a
  screening process (conducted in accordance with section 1852) to be--
  `(A) completely dependent with respect to at least one age-appropriate
  activity of daily living or unable to perform two or more age-appropriate
  activities of daily living without human assistance or supervision,
  including verbal reminding or physical cueing; or
  `(B) so cognitively or mentally impaired as to require ongoing supervision
  from another individual because the impaired individual engages in
  inappropriate behavior that pose a substantial health and safety hazard
  to the impaired individual or to others; and
  `(2) with respect to nursing facility services, the Screening Agency has
  determined that providing nursing facility services in a nursing facility
  would be in the best interest of the individual.
  `(b) APPLICATION- An individual shall be eligible for benefits under this
  part only if--
  `(1) the individual has filed an application for, and is in need of,
  benefits covered under this part;
  `(2) the legal guardian of the individual has filed an application on behalf
  of an individual who is in need of benefits covered under this part; or
  `(3) the representative of an individual who is cognitively impaired,
  who has no legal guardian, and who is in need of benefits covered under
  this part, files an application on behalf of the individual.
  `(c) ELIGIBLE INDIVIDUAL DEFINED- In this section, the term `eligible
  individual' means an individual who--
  `(1) is a citizen or national of the United States, or
  `(2) is an alien lawfully admitted for permanent residence or otherwise
  permanently residing in the United States under color of law, including
  an alien lawfully admitted for temporary residence under section 210 or
  245A of the Immigration and Nationality Act.
`LONG-TERM CARE BENEFITS
  `SEC. 1851. (a) An individual who meets the eligibility criteria prescribed
  in section 1850(a) shall be eligible under the program established by this
  part for coverage for the following (if furnished on or after January 1
  of the 2nd year beginning after the date of the enactment of the Long-Term
  Health Care Program Act of 1992):
  `(1) HOME AND COMMUNITY-BASED SERVICES- Home and community-based care
  services (as defined in section 1859B(9)) that are--
  `(A) determined to be necessary by a Case Management Agency;
  `(B) described in the care plan of the individual;
  `(C) services for which the individual is eligible; and
  `(D) consistent with (i) the need for care of the individual, (ii)
  regulations issued by the Secretary, and (iii) standards established under
  this part.
  `(2) RESPITE CARE- Respite care (as defined in section 1859B(16), which may
  include home and community-based services or nursing facility services) if--
  `(A) the individual is dependent on a daily basis on a primary caregiver
  who is assisting the individual without monetary compensation in the
  performance of at least two age-appropriate activities of daily living; and
  `(B) without such assistance the individual could not perform at least
  two age-appropriate activities of daily living;
or the individual has dementia or other cognitive impairments, as determined
by a Screening Agency.
  `(3) NURSING FACILITY SERVICES- Nursing facility services (as defined in
  section 1859B(15)) provided to the individual by a nursing facility that
  are required by the individual.
  `(b) DURATION- The duration of benefits covered under this part shall
  be unlimited as long as the Case Management Agency determines, through
  its periodic review of a patient, that the patient continues to require
  services covered under this part.
  `(c) REQUIREMENT OF NEED- The determination of the need of an individual for
  covered services shall be made by the Case Management Agency. An analysis
  of that need shall be included in the care plan of the individual.
  `(d) LIMITATIONS ON COVERAGE FOR RESPITE CARE- Coverage for respite care
  under this part shall be for short periods of time not to exceed 720 hours
  during a given calendar year.
`LONG-TERM CARE AGENCIES
  `SEC. 1852. (a) Long-Term Care Screening Agency-
  `(1) ESTABLISHMENT- The Secretary shall contract with States, or in any
  case in which a State declines to contract with the Secretary, with other
  entities to act as Long-Term Care Screening Agencies (each in this part
  referred to as the `Screening Agency') for the State (or each designated
  area of a State). It shall be the responsibility of the agency to assess
  the eligibility of individuals residing in the geographic jurisdiction
  of the agency, for services provided under this part according to the
  requirements of this part and regulations prescribed by the Secretary.
  `(2) ELIGIBILITY- The Screening Agency shall determine the eligibility of
  an individual based on the results of a preliminary telephone or written
  questionnaire (completed by the applicant, by the caregiver of the applicant,
  or by the legal guardian or representative of the applicant) that shall
  be validated through the use of a screening tool administered in person
  by a physician, nurse practitioner, or registered professional nurse, to
  each applicant determined eligible through initial telephone or written
  questionnaire interviews not later than 15 days from the date on which
  the individual initially applied for services under this part.
  `(3) QUESTIONNAIRES AND SCREENING TOOLS-
  `(A) IN GENERAL- The Secretary shall establish a telephone or written
  questionnaire and a screening tool to be used by the Screening Agency to
  determine the eligibility of an individual for services under this part
  consistent with requirements of this part and standards established by
  the Secretary by regulation.
  `(B) QUESTIONNAIRES- The questionnaire shall include questions about the
  functional impairment, mental status, and living arrangement of an individual
  and other criteria that the Secretary shall prescribe by regulation.
  `(C) SCREENING TOOLS- The screening tool should measure functional impairment
  caused by physical or cognitive conditions as well as information concerning
  cognition disability, behavioral problems (such as wandering or abusive and
  aggressive behavior), the living arrangement of an individual, availability
  of caregivers, and any other criteria that the Secretary shall prescribe
  by regulation. The screening tool shall be administered in person.
  `(4) NOTIFICATION- Not later than 15 days after the date on which an
  individual initially applied for services under this part (by phone or
  written questionnaire), the Screening Agency shall notify the individual
  that the individual is not eligible for benefits, or that the individual must
  schedule an in-person screening to determine final eligibility for benefits
  under this part. The Screening Agency shall notify an individual of its
  final decision not later than 2 working days after the in-person screening.
  `(5) IN-PERSON SCREENING- An individual (or the legal guardian or
  representative of the individual) whose application for long-term care
  benefits under this part is denied on the basis of information provided
  through a telephone or written questionnaire, shall be notified of the
  individual's right to an in-person screening by a nurse or appropriate
  health care professionals.
  `(6) APPEALS- The Secretary shall establish a mechanism for hearings and
  appeals in cases in which individuals contest the eligibility findings of
  the Screening Agency.
  `(7) FUNDING LEVEL- The Screening Agency shall be responsible for determining
  the estimated funding level that shall be allotted for individuals
  eligible for home and community-based care, pursuant to section 1854(e)
  and regulations of the Secretary.
  `(b) LONG-TERM CARE CASE MANAGEMENT AGENCY-
  `(1) ESTABLISHMENT- The Secretary shall contract with a State or, in any
  case in which a State declines to contract with the Secretary, a private
  nonprofit organization, to establish and administer a Long-Term Care Case
  Management Agency (referred to in this part as a `Case Management Agency')
  for each designated area of a State. The Case Management Agency shall
  demonstrate expertise in the delivery of health and social services to
  the chronically ill and disabled pursuant to requirements established in
  this part and such standards as the Secretary may establish by regulation
  (including standards for training and qualification of personnel, financial
  responsibility, and governance).
  `(2) DUTIES- A Case Management Agency shall provide case management
  services for eligible individuals directly or through contracts with home
  care or home health agencies that meet the requirements of this part and
  standards prescribed by the Secretary by regulation for providing case
  management services.
  `(3) CARE PLAN- The Case Management Agency shall develop a care plan for each
  individual determined to be eligible by a Screening Agency. In developing a
  care plan for an individual, the Case Management Agency shall design a plan
  that meets the service needs of the individual, consistent with the resources
  available to the agency. Instead of developing a care plan, the Agency may
  approve a care plan which has been developed by a qualified service provider.
  `(4) Funding-
  `(A) IN GENERAL- The actual level of funding allotted to an eligible
  individual by the Case Management Agency to cover services included in the
  individual's care plan may fall above or below the estimated annualized
  level allotted to the individual by the Screening Agency based on the
  detailed assessment and plan of care provided by the Case Management Agency.
  `(B) LIMITATION- The Case Management Agency shall allocate the resources
  available from the Screening Agency (as described in section 1854(a)) to
  ensure that the total expenditures for home and community-based care for
  individuals eligible for services covered under this part residing within
  the geographic jurisdiction of the agency do not exceed the total amount
  available monthly to the Case Management Agency, pursuant to this section,
  for home and community-based services. The Case Management Agency shall
  establish specific financial controls (including authorizing the amount,
  scope, and duration of services to be provided to an individual) to carry
  out this subparagraph.
  `(c) REGISTRY- A Case Management Agency shall maintain a registry of
  qualified providers of home and community-based care and nursing facilities
  in the State and shall assist individuals in choosing qualified providers
  to carry out the care plan. An individual eligible for services under
  this part shall be free to choose from the registry the home care agency,
  home health agency, or other qualified provider of services to carry out
  the care plan of the individual. The Case Management Agency shall assist
  the individual in locating alternative providers if the individual becomes
  dissatisfied with the provider initially chosen.
  `(d) MONITORING- A State, in addition to the Secretary, shall monitor the
  performance of all designated Case Management Agencies and assure the
  fiscal stability of those agencies. A State shall act as the financial
  guarantor of each agency.
`QUALIFIED SERVICE PROVIDERS
  `SEC. 1853. (a) IN GENERAL- Services provided to eligible individuals
  pursuant to a plan of care under this part shall be provided by qualified
  service providers.
  `(b) QUALIFICATIONS FOR HOME AND COMMUNITY-BASED SERVICE PROVIDERS-
  `(1) IN GENERAL- A qualified service provider of home and community-based
  services shall include--
  `(A) a home care agency certified by the Secretary or by a State under a
  program approved by the Secretary;
  `(B) a home health agency certified by the Secretary;
  `(C) an adult day care center certified by the Secretary or by a State
  under a program approved by the Secretary; and
  `(D) another certified or licensed provider of specific services, including
  a registered professional nurse, qualified social worker, physician, nurse
  practitioner, physical, occupational or speech therapist, licensed dietitian,
  and other providers as the Secretary shall designate by regulation, that
  meets standards established by the Secretary.
  `(2) APPROVAL REQUIRED FOR REIMBURSEMENT- No individual or agency shall be
  eligible for reimbursement for home and community-based services provided
  to an individual under this part unless the Case Management Agency approves
  the provision of services to the individual or agency.
`PAYMENT FOR HOME AND COMMUNITY-BASED SERVICES
  `SEC. 1854. (a) CASE MANAGEMENT AGENCIES- The Secretary shall pay to each
  Case Management Agency monthly an amount that equals the sum of the amounts
  allotted by the Screening Agency for eligible individuals in the geographic
  jurisdiction of the Case Management Agency who have been determined by
  the Screening Agency to be eligible to receive services covered under this
  part with respect to home and community-based services.
  `(b) SERVICE PROVIDERS-
  `(1) DIRECT PAYMENTS- The Case Management Agency shall make direct payments
  to certified home care and home health agencies, and other qualified
  providers of home and community-based services reimbursable under this
  part, in accordance with such methods as the State may establish pursuant
  to regulations promulgated by the Secretary.
  `(2) FULL PAYMENT FOR SERVICES- All providers of home and community-based
  care services under the program established under this part shall accept
  payment rates established by the Case Management Agency as payment in full
  for services and shall not pass on additional charges to beneficiaries
  for services rendered under a plan of care.
  `(c) PROVIDERS OF CASE MANAGEMENT SERVICES- If a Case Management Agency
  contracts with a home health or home care agency to provide case management
  services, the Case Management Agency shall make direct payments to the
  agency in accordance with such methods as the State may establish pursuant
  to regulations promulgated by the Secretary.
  `(d) LIMIT ON PAYMENT FOR HOME HEALTH AND COMMUNITY-BASED SERVICES-
  `(1) INITIAL PERIOD- During the 3-year period beginning with the 2nd year
  beginning after the date of the enactment of the Long-Term Health Care
  Program Act of 1992, the maximum amount of payments that may be made to a
  Case Management Agency for home and community-based services provided to an
  individual who resides in the geographic jurisdiction of the agency and who
  is eligible for services under this part shall be, on an annualized basis,
  not more than 65 percent of the average amount payable, including the cost
  of ancillary services but not taking into account any reduction for room
  and board payment required under section 1855(c), for the same number of
  care days for care in a skilled nursing facility under this part in the
  area in which the home and community-based care is provided.
  `(2) SUBSEQUENT YEARS- In years subsequent to the period referred to in
  paragraph (1), the maximum amount referred to in such paragraph shall
  be established by the Secretary according to such prospective payment
  methods as the Secretary may establish by regulation to assure that no
  payment is made for home and community-based services that will exceed
  the cost of an alternative placement in a skilled nursing facility, less
  a reasonable estimate of the cost of room and board in nursing facilities
  or in the community.
  `(e) AMOUNT OF COVERAGE-
  `(1) IN GENERAL- Subject to subsection (d) and the succeeding provisions
  of this subsection, the amount of coverage allotted to an eligible
  individual shall be the amount necessary to carry out the service needs
  of the individual.
  `(2) MAXIMUM AVERAGE AMOUNT- In the case of an individual in a given
  geographic area, the average amount payable for the individual under this
  part for home and community-based services shall not exceed an amount
  determined by multiplying--
  `(A) the maximum amount prescribed in subsection (d), by
  `(B) a measure of the severity of the need for services of the individual.
  `(3) SEVERITY OF NEED FOR SERVICES- For purposes of paragraph (2)(B), the
  severity of the need for services of an individual shall be estimated by
  such statistical models and techniques, that shall include a measure of the
  severity of dependency in activities of daily living, cognitive impairment,
  living arrangement, age, and such other factors as the Secretary shall
  specify by regulation, except that all individuals determined to be eligible
  for services under this part shall be presumed to face a monthly need for
  services of at least 5 percent of the maximum allotment. In determining
  eligibility, the Secretary shall not use any measures of the income and
  assets of the individual. Expenditures authorized by this paragraph shall
  be made only for the home and community-based services specified in this
  part in accordance with a written care plan prepared through case management
  services provided by the Case Management Agency or a home care or home health
  agency under contract with the agency to provide case management services.
  `(f) ACCEPTANCE OF REFERRALS AND REIMBURSEMENT-
  `(1) IN GENERAL- Except as provided in paragraph (2), a home health or home
  care agency or other provider qualified to provide home and community-based
  services reimbursable under this part shall provide (directly or by another
  qualified provider under arrangements with, and the supervision of, the
  agency or provider) services to all individuals referred to the provider
  by a Case Management Agency (or by an organization under contract with the
  Agency to provide case management services) and accept as payment in full
  the reimbursement amounts provided under this part.
  `(2) EXCEPTION- The service requirement imposed under paragraph (1)
  shall not apply if the requirement would be in conflict with the operating
  policies under which the provider was certified (such as the maximum number
  of individuals an agency may care for at any time).
  `(g) Miscellaneous Provisions-
  (1) ADDITIONAL SERVICES- Nothing contained in this part shall be construed
  to preclude any individual who is eligible to receive services under
  this part from purchasing home and community-based services that are more
  generous than services provided for in the care plan of the individual. If
  an individual purchases more generous services, a provider may not charge
  the individual higher rates for those services than the rates the provider
  is authorized to charge for services reimbursed under this part.
  `(2) RELATIONSHIP TO OTHER ENTITLEMENT PROGRAMS- Notwithstanding any other
  provision of law, in the case of any service covered under this part that
  is also covered under another Federally administered entitlement program,
  the Secretary shall act as a secondary payer under this part (including
  to payment under part A or part B).
  `(3) REIMBURSEMENT- Reimbursement for services provided under this part
  shall be subject to the requirements of this part and regulations prescribed
  by the Secretary.
  `(4) PAYMENT FOR RESPITE CARE- Reimbursement rates for respite care services
  covered under this part shall be the same as rates established in this
  part for home and community-based services and nursing facility services.
`PAYMENT FOR NURSING FACILITY SERVICES
  `SEC. 1855. (a) AMOUNT- Reimbursement for nursing facility services under
  this part shall be the amount the Secretary determines to be reasonable and
  appropriate to cover the cost of nursing facility services provided under
  this part (taking into account the average cost of providing appropriate
  care in the most efficient manner) reduced by the amount of any room and
  board payment required under subsection (c). Certified nursing facilities
  shall accept payment for services rendered under this part as payment in
  full and shall not be allowed to pass on additional charges to beneficiaries
  for covered services.
  `(b) PROSPECTIVE PAYMENT- To the extent feasible, the Secretary shall
  establish a prospective payment mechanism for payment for nursing facility
  services covered under this part that takes into account the expected
  resource utilization of individual patients based on the degree of impairment
  of the patients and other factors affecting service requirements.
  `(c) PAYMENT FOR ROOM AND BOARD-
  `(1) IN GENERAL- Payment for room and board under this part shall be made by
  (or on behalf of) an individual participating in the program established
  by this part for each day spent in a nursing facility beyond 180 days in
  a spell of illness (as defined in section paragraph (4)).
  `(2) MANNER OF PAYMENT- Payments for room and board shall be made by (or
  on behalf of) an individual directly to the nursing facility and shall be
  reduced by the amount of low-income assistance provided under section 1859.
  `(3) RATES-
  `(A) INITIAL PERIOD- During the 3-year period beginning with the 2nd year
  beginning after the date of the enactment of the Long-Term Health Care
  Program Act of 1992, the amount of the payment for room and board under
  this subsection for each day shall be 35 percent of the average per diem
  rate paid by the Secretary to nursing facilities receiving reimbursement
  under this part.
  `(B) SUBSEQUENT YEARS- In years subsequent to the period referred to in
  subparagraph (A), the amount of the payment for room and board under this
  subsection for each day shall be such percent, of the average per diem rate
  paid by the Secretary to nursing facilities receiving reimbursement under
  this part, as the Secretary determines reflects a reasonable estimate of
  the cost of room and board in nursing facilities.
  `(4) SPELL OF ILLNESS DEFINED- In paragraph (1), the term `spell of illness'
  means a period of consecutive days beginning with the first day on which
  an individual is furnished nursing facility services under this part and
  ending with the close of the first 6 consecutive months thereafter during
  which the individual is not an inpatient of a hospital or a nursing facility.
  `(d) CONFORMING PROVISION- In applying the provisions of section
  1866(a)(2)(A) under this part, those provisions are superseded to the
  extent inconsistent with this section.
`CERTIFICATION
  `SEC. 1856. (a) Requirement-
  `(1) IN GENERAL- Except as provided in paragraph (3), a State shall--
  `(A) survey home care agencies, home health agencies, and adult day care
  centers to determine their eligibility to participate in the program
  established under this part; and
  `(B) certify such an agency or center as eligible to participate in the
  program if the agency meets the requirements of this part and regulations
  prescribed by the Secretary.
  `(2) FREQUENCY- A State shall conduct the survey and certification required
  under paragraph (1) not less than once during each fiscal year.
  `(3) EXCEPTION- The survey and certification requirements of paragraph
  (1) shall not apply to a home health agency that has been surveyed and is
  certified in accordance with section 1891.
  `(b) INDIVIDUAL PROVIDERS-
  `(1) IN GENERAL- To be eligible to be reimbursed for home and community-based
  services covered under this part, a qualified service provider referred
  to in section 1853(b) shall be licensed or, if applicable, certified by
  the State in which the provider practices pursuant to the requirements of
  this part and regulations prescribed by the Secretary.
  `(2) HOMEMAKERS AND HOME HEALTH AIDES- To be reimbursed for home and
  community-based services covered under this part, a homemaker or home
  health aide must be a trained employee of a certified home care or home
  health agency working under professional supervision.
  `(3) WAIVER- The Secretary may waive the certification requirement for
  providers that do not provide direct patient care.
`HOME AND COMMUNITY-BASED CARE ADVISORY COUNCIL
  `SEC. 1857. (a) ESTABLISHMENT- No later than January 1st of the first
  year beginning after the date of enactment of this part, there shall be
  established an independent body to be known as the `Home and Community-Based
  Care Advisory Council' (referred to in this section as the `Council').
  `(b) Membership-
  `(1) IN GENERAL- The Council shall be composed of 13 individuals appointed
  by the Secretary.
  `(2) EXPERTISE- To the maximum extent practicable, the Council shall
  include individuals with expertise in pediatrics, geriatrics, gerontology,
  disability, case management of home and community-based services and
  home and community-based care reimbursement, home and community-based care
  consumers and their representatives, home and community-based care providers
  and their representatives, professionals with expertise in long-term care
  including nurses, social workers, discharge planners, third party payors,
  long-term care ombudsmen, and State and local health and social service
  agency representatives.
  `(3) TERM- An appointment to the Council shall be for a term of not to
  exceed 4 years.
  `(c) PURPOSE- The purpose of the Council shall be--
  `(1) to assist the Secretary in assuring the prompt and efficient
  implementation of this part,
  `(2) to regularly review the implementation of this part, and
  `(3) to recommend to the Secretary and Congress any necessary modifications
  of this part,
with respect to home and community-based services.
  `(d) CONSULTATION- The Secretary shall regularly and closely consult with
  the Council in the implementation and administration of this part.
  `(e) MEETINGS- To carry out this section, the Secretary shall meet with
  the Council at least once every month during the 24-month period beginning
  60 days after the date of enactment of this part and at least quarterly
  after the 24-month period.
`HOME AND COMMUNITY-BASED CARE QUALITY ASSURANCE
  `SEC. 1858. (a) HOME AND COMMUNITY-BASED PROVIDER QUALITY ASSURANCE
  REQUIREMENTS-
  `(1) IN GENERAL- In addition to other requirements that may apply,
  the Secretary shall promulgate regulations that require that in
  order to receive funding under this part for the provision of home or
  community-based services (referred to in this section as `services'),
  all qualified providers shall, no later than 6 months after the date of
  the publication of those regulations--
  `(A) be duly licensed and certified by the State, pursuant to procedures
  established by the Secretary by regulation;
  `(B) comply with the long-term care consumers' bill of rights promulgated
  under section 1858(d);
  `(C)(i) implement procedures for promptly reviewing and resolving the
  grievances of consumers of services, and
  `(ii) provide an oral notification and a written copy of the procedures
  to each consumer (or the representative or guardian of the consumer)
  who receives services provided by a qualified provider;
  `(D) ensure that each provider employed by or under contract with a home
  care or home health agency receives training--
  `(i) sufficient to meet a level of proficiency established by the Secretary
  in regulations (in consultation with representatives of the elderly,
  disabled, and children, home health and home care agencies, and experts in
  the fields of geriatric nursing, pediatric nursing, geriatric social work,
  pediatric social work, mental health, rehabilitation, and other appropriate
  health care professionals) that are appropriate in content and amount as
  are consistent with the requirements of section 1891, including training
  in the care needs of the cognitively impaired, and
  `(ii) that is designed to develop separate levels of proficiency in and
  is reflective of the range of skills required of providers that provide
  different levels of services;
  `(E) make available on request to each consumer information on the amount
  of training or level of certification achieved by each provider employed
  by or under contract with a home care or home health agency;
  `(F) supervise all care providers employed by or under contract with
  a qualified provider in accordance with regulations promulgated by the
  Secretary (including regular random on-site supervisory visits by registered
  nurses or other appropriate health care professionals); and
  `(G) perform annual evaluations of the quality of services provided by
  providers employed by or under contract with a qualified provider that
  shall document consumer involvement through a process that shall include
  client interviews.
  `(2) DURABLE MEDICAL EQUIPMENT SERVICES- In addition to other requirements
  that may apply, to receive funding for the provision of durable medical
  equipment services under this part, a qualified provider shall in each
  case of a consumer to which the services are provided--
  `(A) issue written instructions for the operation of the equipment;
  `(B) provide sufficient training to the consumer, the family of the
  consumer, and the staff to permit the appropriate and safe operation of
  the equipment; and
  `(C) formulate an emergency plan that is appropriate for the services
  provided to the home care consumer.
  `(b) CASE MANAGEMENT AGENCY QUALITY ASSURANCE REQUIREMENTS- In addition
  to other requirements that may apply, the Secretary shall promulgate
  regulations requiring that an agency, to receive funding for the provision
  of case management services under this part, shall, not later than 6 months
  after the date of the publication of those regulations--
  `(1)(A) comply with the long-term care consumers' bill of rights promulgated
  under section 1858(d); and
  `(B) provide an oral notification and a written copy of the bill of rights
  to each consumer (or the representative or guardian of the consumer)
  who receives services under this part;
  `(2)(A) implement procedures for the prompt review and resolution of the
  grievances of consumers, and
  `(B) provide an oral notification and a written copy of the procedures
  to each consumer (or the representative or guardian of the consumer)
  who receives services from the agency;
  `(3) provide to each consumer (or the representative or guardian of
  the consumer) a written statement of the services to be provided to the
  consumer and the schedule for the provision of the services, as agreed on
  by the consumer;
  `(4) provide to each consumer a clear written statement as to how the
  consumer (or the representative or guardian of the consumer), may appeal
  the benefit and level decisions made by the agency;
  `(5) maintain procedures that assure prompt access by eligible consumers
  to services;
  `(6) ensure that the personnel that provide case management services to
  each consumer have received adequate training as prescribed in regulations
  promulgated by the Secretary, in consultation with the appropriate Quality
  Assurance Board; and
  `(7) establish and implement case management procedures that shall include--
  `(A) a plan of care that establishes reasonable and measurable client
  objectives and the services to be provided to meet those objectives;
  `(B) a plan of care that employs outcome measures of care insofar as they
  are appropriate and available for each consumer served;
  `(C) methods for a review of--
  `(i) the needs of the consumer; and
  `(ii) the plan of care for the consumer;
  `(D) methods for follow-up and on-going monitoring of patient and services
  delivery; and
  `(E) a statement of the criteria and procedures to be applied for the
  discharge or transfer of the consumer to another agency, program, or service.
The review under paragraph (7)(C) shall be at least once during every 6-month
period, or such shorter period as may appropriate in the case of changing
needs of the consumer or at the request of the consumer or caregiver.
  `(c) STANDARD AND EXTENDED SURVEY-
  `(1) INCORPORATION OF PROVISIONS- Section 1891(c) and (d) shall apply to
  home health agencies certified to receive payments for services provided
  under this part.
  `(2) SURVEY- The Secretary shall develop and implement a standard and
  extended survey of home care agencies certified to receive payments for
  services provided under this part.
  `(d) LONG-TERM CARE CONSUMERS' BILL OF RIGHTS- The Secretary shall
  promulgate, by regulation, a consumers' bill of rights, which shall
  recognize the following as rights of consumers of long-term care which
  may be asserted by the consumer or his or her representative or guardian:
  `(1) TREATMENT OF INDIVIDUAL- To be treated with courtesy, respect, and
  full recognition of one's dignity, individuality, and right to control
  one's own household and lifestyle.
  `(2) FULL INFORMATION- To be fully and promptly informed orally and in
  writing--
  `(A) of services to be provided and any limits regarding availability of
  services from the agency or provider;
  `(B) whether services may be provided under this title or are covered by
  other sources;
  `(C) regarding charges for services and billing procedures, including an
  itemized copy of each bill submitted;
  `(D) of changes in services or charges;
  `(E) the procedures to follow if rights are violated or services are not
  satisfactory, including the right to a hearing; and
  `(F) in the case of home and community-based services, to be fully informed
  by the individual's case management team of his or her condition.
  `(3) COMPLIANCE WITH AGREEMENTS- To receive treatment, care, and services
  consistent with agreements between the provider and the Secretary and
  between the provider and the consumer.
  `(4) PLANS OF CARE- To take an active part in creating and changing the
  plan of care.
  `(5) PARTICIPATION IN TREATMENT- To take an active part in selecting the
  provider and in selecting and evaluating treatment, care, and services.
  `(6) SERVICE BY QUALIFIED INDIVIDUALS- To be served by individuals who
  are properly trained and competent to perform their duties.
  `(7) FULL INFORMATION- To be fully informed by a provider of the provider's
  assessment of the consumer's condition.
  `(8) REFUSAL OF TREATMENT- To refuse all or part of any treatment, care,
  or service, and to be informed of the likely consequences of a refusal.
  `(9) NONDISCRIMINATION- To receive treatment, care, and services
  in compliance with all State and local laws and regulations without
  discrimination in the provision or quality of services based on race,
  religion, gender, age, or creed (except as provided under the Age
  Discrimination Act of 1975 (42 U.S.C. 6101 et seq.)) or because of a change
  in the source of payment.
  `(10) FREEDOM FROM ABUSE- To be free from mental and physical abuse, neglect,
  and exploitation, and to be free from chemical and physical restraints except
  as authorized in writing by a physician for a specified period of time.
  `(11) RESPECT AND PRIVACY- To receive respect and privacy in the
  consumer's treatment, care, and services in caring for personal needs,
  in communications, and in all daily activities.
  `(12) PROPERTY- To be assured respect for the consumer's property rights.
  `(13) CONFIDENTIALITY- To be assured confidential treatment of personal
  financial and medical records and to approve or refuse their release to
  any individuals outside the agency except as otherwise required by law or
  third-party payment contract.
  `(14) GRIEVANCE RIGHTS- To voice grievances and recommend changes in policies
  and services to staff or outside representatives of his or her choice and
  to be assisted in doing so when assistance is needed, free from restraint,
  interference, coercion, discrimination, or reprisal by the provider.
  `(15) EXERCISE OF RIGHTS- To be free to fully exercise his or her civil
  rights and to be assisted in doing so when assistance is needed.
  `(16) INFORMATION ON SERVICES- To be promptly notified of acceptance or
  denial of services and the reasons for the denial.
  `(17) INFORMATION ON CHANGES IN SERVICES- To receive promptly written
  notice if treatment, care or services are to be reduced or terminated,
  and assistance to assure a smooth transition in services consistent with
  the welfare of the homecare consumer.
  `(18) TRANSITION OF HOME AND COMMUNITY-BASED SERVICES- To receive assistance
  to assure a smooth transition in services consistent with the welfare of
  the home care consumer.
  `(e) Establishment of Quality Assurance Boards by Peer Review Organizations-
  `(1) ESTABLISHMENT- Each utilization and quality control peer review
  organization with a contract under part B of title XI shall establish and
  appoint members to a quality assurance board (each such board referred
  to in this subsection as a `QAB') that will monitor the quality of care
  provided under this part in the area served by the organization, pursuant
  to procedures established by the Secretary by regulation.
  `(2) DUTIES- Each QAB shall--
  `(A) coordinate all quality assurance activities effecting providers of
  long-term care services;
  `(B) at appropriate intervals assure that in the area served by the QAB
  licensure and certification requirements of law are enforced for all
  long-term care providers and that appropriate quality assurance and peer
  review procedures are enforced;
  `(C) utilize quality measure and cost-effective outcome guidelines consistent
  with practice guidelines developed by the Agency for Health Care Policy
  and Research; and
  `(D) perform such other quality assurance activities as the peer review
  organization specifies.
`ASSISTANCE FOR INDIVIDUALS ENTITLED TO BENEFITS
  `SEC. 1859. (a) IN GENERAL-
  `(1) INDIVIDUALS WITH INCOME BELOW THE POVERTY LINE- Except as otherwise
  provided in this section, in the case of an individual who is entitled
  to benefits under this part and whose family adjusted total income (as
  defined in subsection (d)(2)) does not exceed 100 percent of the official
  poverty line (as defined in subsection (d)(4)), the individual is entitled
  to waiver of any requirement to make payment for room and board under this
  part for the individual and the individual's family.
  `(2) Individuals with income between 100 and 200 percent of the poverty line-
  `(A) IN GENERAL- In the case of an individual who is entitled to benefits
  under this part and whose family adjusted total income exceeds 100 percent,
  but is less than 200 percent, of the official poverty line, the individual
  is entitled to a reduction in the amount of room and board payment required
  under this part by the subsidy percentage (as defined in subparagraph (B))
  multiplied by the room and board payment otherwise required.
  `(B) SUBSIDY PERCENTAGE DEFINED-
  `(i) IN GENERAL- In this paragraph, the term `subsidy percentage' means the
  number of percentage points by which the family's adjusted total income
  (expressed as a percent of the applicable official poverty line) is less
  than 200 percent.
  `(ii) ROUNDING FOR COINSURANCE- The subsidy percentage shall be rounded
  to the nearest multiple of 5 percent.
  `(b) PROTECTION AGAINST SPOUSAL IMPOVERISHMENT-
  `(1) IN GENERAL- In the case of an institutionalized spouse (as defined
  in paragraph (3)), the amount of payment for room and board required under
  this part for a month shall not exceed the difference between--
  `(A)  1/12  of the family adjusted total income, and
  `(B) the total monthly allowance permitted under paragraph (2).
  `(2) TOTAL ALLOWANCE- The total monthly allowance under this paragraph is
  the sum of the following:
  `(A) A personal needs allowance (for clothing and other personal needs of
  the institutionalized spouse) of $100 per month.
  `(B) A community spouse monthly income allowance equal to 200 percent
  of  1/12  of the official poverty line for a family unit of 2 members,
  but only to the extent income of couple is made available to (or for the
  benefit of) the community spouse.
  `(C) A family allowance, for each family member (as defined in paragraph
  (3)(C)), equal to  1/3  of the amount by which the amount described in
  subparagraph (B) exceeds the amount of the monthly income of that family
  member.
  `(D) Amounts for expenses incurred in the month for medical or remedial
  care for the institutionalized spouse that are not subject to payment by a
  third party (including health insurance premiums, deductibles, coinsurance,
  and necessary medical or remedial care, subject to reasonable limits the
  Secretary may establish on the amount of these expenses).
A revision of the official poverty line referred to in subparagraph (B)
shall apply to low-income assistance furnished under this section during and
after the second calendar quarter that begins after the date of publication
of the revision.
  `(3) DEFINITIONS- In this subsection:
  `(A) The term `institutionalized spouse' means an individual who--
  `(i) is in a nursing facility, and
  `(ii) is married to a spouse who is not in a nursing facility;
but does not include any individual who is not likely to meet the requirements
of clause (i) for at least 30 consecutive days.
  `(B) The term `community spouse' means the spouse of an institutionalized
  spouse.
  `(C) The term `family member' only includes minor or dependent children,
  dependent parents, or dependent siblings of the institutionalized or
  community spouse who are residing with the community spouse.
  `(c) APPLICATIONS FOR ASSISTANCE-
  `(1) REQUIREMENT-
  `(A) IN GENERAL- Any individual who seeks assistance under this section (with
  respect to himself or herself or a family member) shall submit a written
  application, by person or mail, to the Secretary. The application may be
  submitted with an application for benefits under this part or otherwise.
  `(B) SPECIAL TREATMENT OF CERTAIN CASH ASSISTANCE RECIPIENTS- In the case
  of a family that has been determined to be eligible for aid under part A
  or E of title IV or an individual who has been determined to be eligible
  for supplemental security income benefits under title XVI, the family or
  individual is deemed, without the need to file an application for assistance
  under subparagraph (A), to have adjusted total income below 100 percent
  of the official poverty line applicable to a family of the size involved.
  `(2) BASIS FOR DETERMINATION- Eligibility for assistance under this section
  shall be based on 12 times the family adjusted total income (as defined
  in subsection (d)(1)) during the month preceding the month in which the
  application is filed.
  `(3) FORM AND CONTENTS- An application for assistance under this section
  shall be in a form and manner specified by the Secretary and shall require
  the provision of information necessary to make the determinations described
  in paragraph (2).
  `(4) FREQUENCY OF APPLICATIONS-
  `(A) IN GENERAL- An application for assistance under this section may
  be filed at any time during the year and may be resubmitted based upon
  a change of income or family composition. However, except as provided in
  subparagraph (C), an application may not be resubmitted more frequently
  than once every 3 months.
  `(B) NEED TO REAPPLY QUARTERLY- In order to continue to remain eligible
  for assistance under this section, the individual (or a family member)
  must file with the Secretary not less often than every 3rd month a new
  application for assistance under this section.
  `(5) TIMING OF ASSISTANCE-
  `(A) IN GENERAL- If an application for assistance under this section
  is filed--
  `(i) on or before the 15th day of a month, assistance under this section
  shall be available with respect to days of nursing facility care after
  the month; or
  `(ii) after the 15th day of a month, assistance under this section shall
  be available with respect to days of nursing facility care after the
  following month.
  `(B) WELFARE RECIPIENTS- In the case of an individual or family with
  respect to whom an application for assistance is not required because
  of subsection (a)(2), in applying subparagraph (A), the date of approval
  of aid or benefits described in such subsection shall be considered the
  filing of an application for assistance under this section.
  `(6) VERIFICATION- The Secretary shall provide for verification, on a
  sample basis or other basis, of the information supplied in applications
  for assistance under this section.
  `(7) HELP IN COMPLETING APPLICATIONS- The Secretary shall provide, from
  funds appropriated to carry out this title, for grants to public or private
  nonprofit entities that will make available assistance to individuals and
  families in filing applications for assistance under this section. The
  Secretary shall make grants in a manner that provides assistance at a
  variety of sites (such as low-income housing projects and shelters for
  homeless individuals) that are readily accessible to individuals and
  families eligible for assistance under this section.
  `(8) PENALTIES FOR INACCURATE INFORMATION-
  `(A) INTEREST FOR UNDERSTATEMENTS- Each individual who knowingly understates
  income reported in an application for assistance under this section or
  otherwise makes a material misrepresentation of information in such an
  application shall be liable to the Federal Government for excess payments
  made based on the understatement or misrepresentation, and for interest
  on excess payments at a rate specified by the Secretary.
  `(B) PENALTIES FOR MISREPRESENTATION- Each individual who knowingly
  misrepresents material information in an application for assistance under
  this section shall be liable to the Federal Government for $1,000 for
  each misrepresentation or, if greater, three times the excess payments
  made based on the misrepresentation.
  `(d) COMPUTATION OF FAMILY ADJUSTED TOTAL INCOME- In this section:
  `(1) ADJUSTED TOTAL INCOME- The term `adjusted total income' means--
  `(A) adjusted gross income (as defined in section 62(a) of the Internal
  Revenue Code of 1986), determined without the application of paragraphs
  (6) and (7) of such section and without the application of section 162(l)
  of such Code, plus
  `(B) the amount of social security benefits (described in section 86(d)
  of such Code) which is not includable in gross income under section 86 of
  such Code.
  `(2) FAMILY ADJUSTED TOTAL INCOME- The term `family adjusted total income'
  means, with respect to an individual, the sum of the adjusted total income
  for the individual and all the other family members.
  `(3) FAMILY SIZE- The family size to be applied under this section, with
  respect to family adjusted total income, is the number of individuals
  included in the family (as defined by the Secretary).
  `(4) OFFICIAL POVERTY LINE- The term `official poverty line' means,
  for an individual in a family, the official poverty line (as defined by
  the Office of Management and Budget, and revised annually in accordance
  with section 673(2) of the Omnibus Budget Reconciliation Act of 1981)
  applicable to a family of the size involved.
`ADMINISTRATION; LONG-TERM CARE TRUST FUND
  `SEC. 1859A. (a) ADMINISTRATION; USE OF CARRIERS-
  `(1) IN GENERAL- Except as provided in this subsection, the provisions of
  section 1842 (insofar as they relate to the administration of the program
  under part B through the use of carriers) shall apply to this part in the
  same manner as they apply to part B.
  `(2) DIFFERENT PAYMENT RATES- In applying paragraph (1)--
  `(A) the provisions of this part, insofar as they relate to methods and
  amounts of payments under this part, shall be substituted for the methods
  and amounts of payments under part B, and
  `(B) subparagraphs (A), (B), (F), (G), and (H) of section 1842(b)(3)
  and subsections (f)(2), and (g) through (o) of section 1842 shall not apply.
  `(3) PERMITTING STATES TO BE CARRIERS- In applying paragraph (1), the term
  `carrier' also includes a State.
  `(4) APPLICATION OF OTHER PROVISIONS- Except as the Secretary may provide,
  any reference in this title or part B of title XI to a carrier or contract
  under section 1842 is deemed to include a carrier or contract under this
  subsection.
  `(b) Long-Term Care Trust Fund-
  `(1) IN GENERAL- There is hereby created on the books of the Treasury of the
  United States a trust fund to be known as the `Long-Term Care Trust Fund'
  (in this subsection referred to as the `Trust Fund'). The Trust Fund shall
  consist of such gifts and bequests as may be made as provided in section
  201(i)(1) and such amounts as may be deposited in, or appropriated to,
  the fund as provided in this part.
  `(2) AMOUNTS- There are hereby appropriated to the Trust Fund out of any
  moneys in the Treasury not otherwise appropriated, amounts equivalent to
  100 percent of--
  `(A) the aggregate increase in tax liabilities attributable to the amendments
  made by section 201 of the Long-Term Health Care Program Act of 1992,
  which are not otherwise attributable to sections 1402(b), 3101(b), and
  3111(b) of the Internal Revenue Code of 1986, and
  `(B) the contributions of States made under section 202 of the Long-Term
  Health Care Program Act of 1992.
  `(3) INCORPORATION OF PROVISIONS- Subsections (b) through (g) of section
  1842 shall apply to the Trust Fund in the same manner as they apply to
  the Federal Supplementary Medical Insurance Trust Fund.
  `(4) OFF-BUDGET TREATMENT OF TRUST FUND- The receipts and disbursements
  of the Trust Fund, and the taxes imposed under sections 1401(b), 3101(b),
  and 3111(b) of the Internal Revenue Code of 1986, shall not be included in
  the totals of the budget of the United States Government as submitted by
  the President or of the Congressional budget and shall be exempt from any
  general budget limitation imposed by statute on expenditures and net lending
  (budget outlays) of the United States Government. No provision of law may
  provide for payments from the general fund of the Treasury to the Trust Fund,
  or for payments from the Trust Fund to the general fund of the Treasury.
`DEFINITIONS
  `SEC. 1859B. As used in this part:
  `(1) ACTIVITY OF DAILY LIVING- The term `activity of daily living' includes
  each of the following:
  `(A) BATHING- Getting water and cleansing the whole body, including turning
  on the water for a bath, shower, or sponge bath, getting to, in, and out
  of a tub or shower, and washing and drying oneself.
  `(B) DRESSING- Getting clothes from closets and drawers and then getting
  dressed, including putting on braces or other devices and fastening
  buttons, zippers, snaps, or other closures, selecting appropriate attire,
  and dressing in the proper order.
  `(C) TOILETING- Going to a bathroom for bowel and bladder function,
  transferring on and off the toilet, cleaning after elimination, and
  arranging clothes.
  `(D) TRANSFERRING- Moving in and out of bed and in and out of a chair
  or wheelchair.
  `(E) EATING- Transferring food from a plate or its equivalent into the body,
  including cutting food so as to make possible safe ingestion.
  `(F) WALKING- Walking.
  `(2) ADULT DAY CARE- The term `adult day care' means a community-based
  program that provides services designed to--
  `(A) meet the need for adult day care for functionally impaired individuals
  in a structured, comprehensive program; and
  `(B) provide a variety of health and social services furnished by an adult
  day care center in an ambulatory group care setting during any part of
  a day, but on a less than 24-hour basis, to an individual eligible for
  benefits under this part.
Those services may include supervision and personal care, social, recreational,
and therapeutic services, meal and snack service, monitoring of medication and
health, nursing services (to the extent needed by participants), transportation
to and from the program, and such other services as specified in the care
plan of an individual.
  `(3) ADULT DAY CARE CENTER-
  `(A) IN GENERAL- The term `adult day care center' means a public agency
  or private organization (or a subdivision thereof), with an identifiable
  administrative unit headed by a director, that meets such standards
  for personnel, program, physical characteristics of the facility,
  recordkeeping, and such other aspects of the function of a center as
  the Secretary considers necessary or desirable for the health, safety,
  and effective treatment of patients and establishes by regulation.
  `(B) PROFESSIONAL ORGANIZATION STANDARDS- In promulgating regulations
  to carry out subparagraph (A), the Secretary shall carefully consider
  certification standards established by the National Council on Aging and
  its professional membership unit, the National Institute for Adult Day Care.
  `(C) PERSONNEL- Standards under subparagraph (A) shall include the
  participation in the provision of the services of the center of a
  multidisciplinary group of personnel that includes at least--
  `(i) one physician or nurse practitioner, which could be the individual's
  own physician or nurse practitioner;
  `(ii) one registered professional nurse;
  `(iii) one social worker;
  `(iv) individuals with skills representing physical, recreational,
  occupational, or speech therapy; and
  `(v) a licensed dietitian.
The personnel may be employed directly by the center or on a consultant basis,
as specified by the Secretary by regulation.
  `(D) STATE CERTIFICATION- To be considered an adult day care center under
  this part, a center shall be certified by a State, pursuant to regulations
  issued by the Secretary.
  `(4) CARE PLAN-
  `(A) IN GENERAL- The term `care plan' means a plan that has been developed
  by a Case Management Agency, or a home care or home health agency working
  under contract with the Case Management Agency to provide case management
  services or other qualified service provider under such a contract. A care
  plan shall be based on the results of a comprehensive needs assessment of an
  eligible individual conducted by a case management team in cooperation with
  the individual, the family of the individual, or other informal caregivers,
  and in consultation with qualified service providers furnishing covered
  services and with such other health professionals as the case management
  team considers appropriate for the needs of the individual. A care plan
  developed by a home care or home health agency or qualified service provider
  is subject to review and approval by the Case Management Agency. Any
  entity performing case management services for an individual determined
  eligible for services under this part shall not be allowed to self-refer
  for services included in the care plan of the individual.
  `(B) CONTENTS- The plan shall--
  `(i) include a definition of specific outcome goals on which improvement,
  reduced rate of decline, maintenance, or improved quality of life for the
  individual is expected; and
  `(ii) identify the specific mix of services necessary to meet the outcome
  goals allotted to the patient and reimbursable under this part as determined
  by the procedure described in section 1852.
  `(5) Case management services-
  `(A) IN GENERAL- The term `case management services' means services
  performed by a case management team that include--
  `(i) conducting a comprehensive needs assessment in cooperation with an
  individual and the family of an individual and in consultation with such
  other health professionals (including a physical therapist, occupational
  therapist, nurse practitioner, licensed dietitian, or physician) as the
  case management team considers appropriate for the needs of the individual
  to assess the physical, social, cognitive, and environmental status of
  the individual;
  `(ii) developing, implementing, and modifying (when necessary) the care
  plan of an individual;
  `(iii) coordinating the services provided under the care plan;
  `(iv) monitoring the care plan to ensure the quality, quantity, timeliness,
  and effectiveness of the services;
  `(v) monitoring the progress of an individual toward achievement of the
  goals specified in the care plan; and
  `(vi) reviewing and revising, as necessary, the care plan at least once
  every three months or earlier in the event that the condition of the
  individual changes.
  `(B) REQUIREMENT- Individuals providing case management services to children
  and the disabled under this part shall demonstrate their experience with
  the special needs of these populations.
  `(6) CASE MANAGEMENT TEAM- The term `case management team' means
  a registered professional nurse or a qualified social worker (who is
  licensed or certified, if applicable, in the State in which the individual
  is providing services), or both, working in consultation with other health
  professionals as needed, who is employed by a Case Management Agency or
  by a certified home health agency, home care agency, or other private
  nonprofit organization under contract with the agency to provide case
  management services pursuant to the requirements of this part and standards
  prescribed by the Secretary by regulation. Such a nurse or social worker
  shall meet standards of education, training, and experience established by
  the Secretary by regulation to qualify to provide case management services
  under this part. The case management team shall be available on an on-call
  basis 24-hours a day, 7 days a week (including holidays).
  `(7) COMPREHENSIVE NEEDS ASSESSMENT- The term `comprehensive needs
  assessment' means a comprehensive interdisciplinary assessment of the status
  and needs of an individual that is conducted by a case management team. The
  assessment shall address functional status (including activities of daily
  living), instrumental activities of daily living (such as housekeeping,
  shopping, transportation, meal preparation, and taking medication), medically
  defined conditions, drug regimen, nutrition status, mental status, living
  arrangement, and availability of caregiver support.
  `(8) HEAVY CHORE SERVICES- The term `heavy chore services' means heavy
  cleaning and minor home repair. Chore services may not be used to perform
  activities that are the responsibility of a housing authority or landlord,
  or both. Heavy chore services shall be provided by personnel not requiring
  special training but who work under supervision of the case management
  agency or other qualified provider. Heavy chore services include those
  services determined by a case manager to be necessary to protect the health
  and safety of an individual such as washing floors and walls, woodcutting,
  changing storm windows, replacing window panes, door and window locks,
  installing minor home adaptations, snow shoveling, weatherization, and
  such other needed heavy chore services as are specified by a case manager.
  `(9) HOME AND COMMUNITY-BASED CARE SERVICES- The term `home and
  community-based care services' means items and services provided to an
  individual--
  `(A) under a written plan of care for furnishing the items and services
  to the individual;
  `(B) except as provided in clauses (iv) and (xi) of subparagraph (C), on
  a visiting basis in a place of residence of the individual and in other
  facilities (but not including a hospital or nursing facility); and
  `(C) that include (except as provided in the last sentence of this
  paragraph)--
  `(i) homemaker services;
  `(ii) home health aide services;
  `(iii) heavy chore services;
  `(iv) adult day care provided at an adult day care center;
  `(v) respite care;
  `(vi) hospice care;
  `(vii) home mobility aids and minor adaptations to the home of the individual
  that promote independence (such as installation of an emergency alarm
  system, railings, ramps, and special toilets) that are approved by the
  case manager and included in the care plan of the individual;
  `(viii) nursing care provided by or under the supervision of a registered
  professional nurse;
  `(ix) medical social work services;
  `(x) physical, occupational, speech, or respiratory therapy or rehabilitative
  services to preserve and restore functional capability or to prevent
  functional deterioration;
  `(xi) transportation to and from health or social services;
  `(xii) nutrition and dietary counseling provided by or under the supervision
  of a licensed dietitian; and
  `(xiii) any of the items and services referred to in clauses (i) through
  (xii)--
  `(I) that are provided on an outpatient basis, under arrangements made by
  the case manager, at a hospital or nursing facility, or at a rehabilitation
  center that meets such standards as may be prescribed in regulation; and
  `(II) the furnishing of which cannot readily be made available to the
  individual in the place of residence, or can be provided more economically
  or effectively in the hospital, facility, or center.
  `(10) HOME CARE AGENCY- The term `home care agency' means an agency in any
  State that has been certified by the State to provide home care services
  (including homemaker services, heavy chore services, and respite services)
  pursuant to regulations of the Secretary.
  `(11) HOME HEALTH AGENCY- The term `home health agency' means an agency in
  any State that has been certified by the Secretary to provide home health
  services, including home health aide services, homemaker services, nursing
  services, respite services, medical social work services, and occupational,
  physical, speech therapy, and nutrition and dietary counseling.
  `(12) HOME HEALTH AIDE SERVICES-
  `(A) IN GENERAL- The term `home health aide services' means the services
  provided by a home health aide who meets such educational, training, and any
  other requirements as the Secretary shall establish by regulation and who is
  employed by a home health or home care agency or whose services are provided
  under a contract with, or subcontract on behalf of, a Case Management Agency.
  `(B) SERVICES- Such services shall include--
  `(i) providing personal care in following the instructions of the case
  management team of an individual under the supervision of a registered
  professional nurse or, if appropriate, a physical, speech, or occupational
  therapist;
  `(ii) assisting the individual with activities of daily living;
  `(iii) assisting the individual with the taking of medications ordered by
  a physician, that are ordinarily self-administered;
  `(iv) assisting and reinforcing the individual with necessary self-help
  skills; and
  `(v) reporting to the registered professional nurse supervisor any change
  in the condition or family situation of the individual.
  `(13) HOMEMAKER SERVICES-
  `(A) IN GENERAL- The term `homemaker services' means services provided by a
  homemaker who meets such educational, training, and any other requirements
  as the Secretary shall establish by regulation and who is employed by a
  home health or home care agency or who are working under contract with,
  or subcontract on behalf of, a Case Management Agency.
  `(B) SERVICES- Homemaker services may include--
  `(i) organizing the homemaking activity of the household with the active
  participation of an individual, if possible, and other responsible family
  members;
  `(ii) coordinating efforts of other family members in planning and carrying
  out the duties necessary for the normal functioning of the household;
  `(iii) performing routine housekeeping tasks, planning and preparing meals,
  doing the marketing and simple errands, and taking care of light laundry;
  `(iv) assisting the individual with personal care services including
  performing activities of daily living; and
  `(v) performing such incidental household services as are essential
  to the care of an individual at home, such as reporting to a registered
  professional nurse supervisor changes in the condition or family situation
  of the individual and following a written case plan established by a case
  management team.
  `(14) NURSING FACILITY- The term `nursing facility' means an institution
  that meets the requirements of section 1919 (as such section was in effect on
  the date of the enactment of the Long-Term Health Care Program Act of 1992).
  `(15) NURSING FACILITY SERVICES- The term `nursing facility services'
  includes--
  `(A) nursing care provided by or under the supervision of a registered
  professional nurse;
  `(B) bed and board in connection with the furnishing of nursing care;
  `(C) physical, occupational, or speech therapy and mental health services
  furnished by a facility or by others under arrangements with a facility;
  `(D) medical social services;
  `(E) drug, biological, supply, appliance, and equipment for use in the
  facility, that is ordinarily furnished by the facility for the care and
  treatment of an inpatient;
  `(F) medical services of an intern or resident-in-training under an
  approved teaching program of a hospital with which a facility has in effect
  a transfer agreement or other diagnostic or therapeutic service provided
  by a hospital with which a facility has in effect a transfer agreement; and
  `(G) such other health services necessary to the health of a patient as
  are generally provided by a nursing facility.
  `(16) RESPITE CARE- The term `respite care' means care or services
  provided to an individual for the purpose of providing temporary relief
  to a primary caregiver who is providing regular care to the individual
  without compensation. Such term includes care provided in the home or
  in the community and may include companion services, homemaker services,
  personal assistance, adult day care, temporary overnight care in accredited
  or licensed facilities, or such other services provided for the purpose
  of respite care, as specified by a Care Management Agency in the care plan
  of the individual.'.
  (b) MISCELLANEOUS CONFORMING AMENDMENTS-
  (1) Section 706 of such Act (42 U.S.C. 907) is amended--
  (A) in subsection (a), by striking `and the Federal Supplementary Medical
  Insurance Trust Fund' and `and B' inserting `the Federal Supplementary
  Medical Insurance Trust Fund, and the Long-Term Care Trust Fund' and `B,
  and C', respectively; and
  (B) in subsection (d)--
  (i) by striking `and' at the end of paragraph (2),
  (ii) by striking the period at the end of paragraph (3) and inserting `,
  and', and
  (iii) by adding at the end the following new paragraph:
  `(4) a separate report with respect to the Long-Term Care Program established
  by part C of title XVIII and of the financing thereof.'.
  (2) Section 1159 of such Act (42 U.S.C. 1320c-8) is amended--
  (A) by striking `and' at the end of paragraph (1),
  (B) by inserting `and' at the end of paragraph (2), and
  (C) by inserting after paragraph (2) the following new paragraph:
  `(3) funds in the Long-Term Care Trust Fund,'.
SEC. 102. ADDITIONAL PROVISIONS RELATING TO QUALITY ASSURANCE.
  (a) EMPHASIS BY PEER REVIEW ORGANIZATIONS ON QUALITY ASSURANCE-
  (1) MAJOR EFFORT ON QUALITY ASSURANCE- Section 1153(c) of the Social
  Security Act (42 U.S.C. 1320c-2(c)) is amended--
  (A) by striking `and' at the end of paragraph (7),
  (B) by striking the period at the end of paragraph (8) and inserting `;
  and', and
  (C) by adding at the end the following new paragraph:
  `(9) the organization must devote a major effort under the contract on
  quality assurance activities with respect to long-term care under part C
  of title XVIII.'.
  (2) REQUIRING QUALITY ASSURANCE FOR ALL TYPES OF SERVICES- The third
  sentence of section 1154(a)(4)(A) of such Act (42 U.S.C. 1320c-3(a)(4)(A))
  is amended by striking `quality of services' and inserting `quality of all
  the different types of health and long-term care (including services of all
  organized providers of long-term health care) whether payment may be made
  (in whole or in part) under part C of title XVIII or through a private
  payor, coordinate these activities with the quality assurance activities
  of other entities, and'.
  (3) REQUIRING COMPOSITION OF PRO'S TO REFLECT TYPES OF SERVICES REVIEWED-
  Section 1152 of such Act (42 U.S.C. 1320c-1) is amended--
  (A) by striking `and' at the end of paragraph (2),
  (B) by redesignating paragraph (3) as paragraph (4), and
  (C) by inserting after paragraph (2) the following new paragraph:
  `(3) includes in its composition and on its governing body representatives
  of other individuals responsible for the provision of services and items
  for which the organization is responsible for conducting quality assurance
  activities under section 1154(a)(4)(A); and'.
  (4) PROVIDING INFORMATION TO PRO'S TO CONDUCT ACTIVITIES- Section 1153 of
  such Act is amended by adding at the end the following new subsection:
  `(j) The Secretary shall provide each utilization and quality control
  peer review organization with such information as may be necessary for
  the organization to carry out subsection (c)(10).'.
  (5) FUNDING OF INCREASED ACTIVITIES- Section 1159 of such Act (42
  U.S.C. 1320c-8) is amended--
  (A) by inserting `(a)' after `1159.', and
  (B) by adding at the end the following new subsections:
  `(b)(1) In addition to any other amounts appropriated to carry out this part
  but subject to subsection (e), there are appropriated to carry out this part
  from the funds in the Long-Term Care Trust Fund (under section 1859A(b))--
  `(A) for the fiscal year beginning in the first year after the date of
  the enactment of this subsection, an amount equal to 50 percent of the
  hospital payment amounts (as defined in paragraph (3)) for that year,
  `(B) for the fiscal year beginning in the 2nd year after the date of the
  enactment of this subsection, an amount equal to 65 percent of the hospital
  payment amounts for that year,
  `(C) for the fiscal year beginning in the 3rd year after the date of the
  enactment of this subsection, an amount equal to 75 percent of the hospital
  payment amounts for that year, and
  `(D) for each subsequent fiscal year, an amount (not less than the amount
  described in subparagraph (C)) as the Secretary determines to be necessary
  to conduct the required reviews for all types of covered services and for
  all covered beneficiaries.
  `(2) The Secretary shall provide for the distribution of the amounts
  appropriated under paragraph (1) to the utilization and quality control
  peer review organizations with contracts under this part in reasonable
  proportion to each organization's expenses under this part which are not
  otherwise covered under section 1886(a)(1)(G) and which are attributable
  to activities with respect to long-term care services furnished under part
  C of title XVIII.
  `(3) In paragraph (1), the term `hospital payment amounts' means, with
  respect to a utilization and quality control peer review organization for
  a fiscal year, the aggregate amounts payable to the organization under
  section 1866(a)(1)(G) for the fiscal year.
  `(c) In the case of a State with a quality assurance and utilization
  control plan for long-term care services approved by the Secretary,
  the amounts otherwise appropriated under this section to utilization and
  quality control peer review organizations for activities in that State
  with respect to long-term care services shall be made available to that
  State for operation of its plan instead of to such organizations.'.
  (6) EFFECTIVE DATE- (A) Except as provided in subparagraph (B), the
  amendments made by this subsection shall apply to contracts entered into
  on or after January 1 of the second year beginning after the date of the
  enactment of this Act.
  (B) The Secretary of Health and Human Services shall provide for the initial
  implementation of the amendments made by paragraph (5) by January 1 of the
  second year beginning after the date of the enactment of this Act, with such
  amendments becoming fully operational on January 1 of the following year.
  (b) HOSPITAL DISCHARGE PLANNING PROCESS-
  (1) IN GENERAL- Subsection (ee) of section 1861 of the Social Security Act
  (42 U.S.C. 1395x) is amended to read as follows:
`Discharge Planning Process
  `(ee)(1) A discharge planning process of a hospital shall be considered
  sufficient if it is applicable to services furnished by the hospital to
  individuals entitled to insurance benefits under this title and if it meets
  the guidelines and standards established by the Secretary under paragraph
  (2).
  `(2) The Secretary shall develop, in conjunction with the Quality Assurance
  Boards, guidelines and standards for the discharge planning process in order
  to protect against inappropriately early hospital discharges and to ensure a
  timely and smooth transition to the most appropriate type of and setting for
  post-hospital care. The guidelines and standards shall include the following:
  `(A) Using protocols and screens to permit the early identification of
  patients likely to need post-hospital care and to permit the identification
  of patients at risk of premature discharge from a hospital.
  `(B) Patient and family education and involvement in identifying their
  options and post-hospital benefits available under this title, on their
  rights of appeal with respect to coverage under this title, and on
  appropriate techniques for self-care.
  `(C) Providing psychosocial and physical assessments and counseling of
  patients and families in determining patients' post-hospital needs.
  `(D) The development, beginning as close to the time of a patient's admission
  to the hospital as appropriate, of a discharge plan in consultation with
  the patient and family and all relevant health care professionals.
  `(E) Alerting appropriate skilled nursing facilities and home health
  agencies of a patient's anticipated need for post-hospital care at the
  earliest possible time.
  `(F) Assigning responsibility for the development and implementation of
  a discharge plan within the hospital, during the transfer of a patient to
  post-hospital care and in providing patient follow-up after discharge.'.
  (2) MONITORING BY PEER REVIEW ORGANIZATIONS OF HOSPITAL COMPLIANCE WITH
  DISCHARGE PLANNING PROCESS- Section 1154(a) of the Social Security Act
  (42 U.S.C. 1320c-3(a)) is amended by adding at the end the following
  new paragraph:
  `(17) The organization shall monitor hospitals' compliance with the
  discharge planning process requirements specified in section 1861(ee).'.
  (3) EFFECTIVE DATE- The requirements of section 1861(ee) of the Social
  Security Act, as amended by paragraph (1), shall apply to patients discharged
  on or after January 1 of the second year beginning after the date of the
  enactment of this Act.
SEC. 103. ELIMINATION OF OVERLAPPING MANDATORY LONG-TERM CARE BENEFITS UNDER
MEDICAID PROGRAM.
  (a) IN GENERAL-
  (1) LIMITING FEDERAL FINANCIAL PARTICIPATION FOR SERVICES COVERED UNDER
  LONG-TERM CARE PROGRAM- Section 1903(i) of the Social Security Act (42
  U.S.C. 1396b(i)) is amended--
  (A) in the paragraph (10) inserted by section 4401(a)(1)(B) of Omnibus
  Budget Reconciliation Act of 1990, by striking all that follows `1927(g)'
  and inserting a semicolon;
  (B) by redesignating the paragraph (10) added by section 4701(b)(2)
  as paragraph (11), by transferring and inserting it after the paragraph
  (10) inserted by section 4401(a)(1)(B) of Omnibus Budget Reconciliation
  Act of 1990, and by striking all that follows `with respect to hospitals
  or facilities' and inserting a semicolon;
  (C) by transferring and inserting the paragraph (12) inserted by section
  4752(a)(2) of Omnibus Budget Reconciliation Act of 1990 after paragraph
  (11), as redesignated by subparagraph (B), and by striking the period at
  the end and inserting a semicolon;
  (D) by redesignating the paragraph (14) inserted by section 4752(e) of
  Omnibus Budget Reconciliation Act of 1990 as paragraph (13), by transferring
  and inserting it after paragraph (12), and by striking the period at the
  end and inserting a semicolon;
  (E) by redesignating the paragraph (11) inserted by section 4801(e)(16)(A) of
  Omnibus Budget Reconciliation Act of 1990 as paragraph (14), by transferring
  and inserting it after paragraph (13), and by striking the period at the
  end and inserting `; or'; and
  (F) by inserting after paragraph (14), as so redesignated, the following
  new paragraph:
  `(15) with respect to items and services for which payment is made under
  part C of the Long-Term Care Program under part C of title XVIII.'.
  (2) CLARIFICATION OF NONDUPLICATION OF MEDICAL ASSISTANCE WITH BENEFITS
  UNDER LONG-TERM CARE PROGRAM- Title XIX of such Act is amended by adding
  at the end the following new section:
`NONDUPLICATION OF BENEFITS WITH LONG-TERM CARE PROGRAM
  `SEC. 1931. Notwithstanding any other provision of this title, a State
  is not required under its plan under section 1901(a) to provide medical
  assistance for items and services (including low-income assistance) for
  which payment is made under part C of title XVIII.'.
  (b) CONTINUATION OF OPTIONAL BENEFITS NOT COVERED UNDER PROGRAM- Nothing
  in this Act shall be construed as--
  (1) changing the eligibility of individuals for medical assistance under
  title XIX of the Social Security Act, or
  (2) subject to the amendments made by subsection (a), changing the amount,
  duration, or scope of medical assistance required (or permitted) to be
  provided under such title.
SEC. 104. EFFECTIVE DATE.
  The amendments made by this title shall apply to items and services
  furnished on or after January 1 of the second year beginning after the
  date of the enactment of this Act.
TITLE II--FINANCING
SEC. 201. ELIMINATION OF LIMIT ON WAGES OR SELF-EMPLOYMENT INCOME SUBJECT
TO FICA AND RAILROAD RETIREMENT TAXES.
  (a) IN GENERAL-
  (1) EMPLOYERS AND EMPLOYEES- Section 3121(a) of the Internal Revenue Code
  of 1986 (relating to wages) is amended by striking paragraph (1).
  (2) SELF-EMPLOYMENT INCOME- Section 1402(b) of such Code is amended by
  striking paragraph (1).
  (3) RAILROAD RETIREMENT TAXES- Section 3231(e) of such Code is amended by
  striking paragraph (2).
  (b) CONFORMING AMENDMENTS-
  (1) Section 201(a) of the Social Security Act (42 U.S.C. 401(a)) is amended
  by adding at the end the following new sentence: `Notwithstanding the
  previous provisions of this subsection or the provisions of subsection
  (b), whenever in this subsection or subsection (b) a reference is made to
  the taxes imposed by chapter 21 or chapter 2 of the Internal Revenue Code
  of 1986 with respect to wages or self-employment income, such reference
  shall not include taxes imposed as a result of the amendments made by
  section 201 of the Long-Term Health Care Program Act of 1992.'.
  (2) Section 230(c) of the Social Security Act (42 U.S.C. 430(c)) is amended
  by striking `and sections 1402, 3121, 3122, 3125, 6413, and 6654 of the
  Internal Revenue Code of 1954'.
  (3) Section 1402 of the Internal Revenue Code of 1986 is amended  by
  striking subsection (k).
  (4) Section 3231(e)(2)(B) of such Code is amended by striking clause (i).
  (5) Section 3122 of the Internal Revenue Code of 1986 is amended by striking
  the second sentence.
  (6) Section 3125 of the Internal Revenue Code of 1986 is amended by striking
  the second sentences in each of subsections (a), (b), (c), and (d).
  (d) EFFECTIVE DATE- The amendments made by this section shall apply with
  respect to remuneration paid on or after January 1 of the first year
  beginning after the date of the enactment of this Act and with respect
  to earnings from self-employment attributable to taxable years beginning
  after such date.
SEC. 202. INCREASE IN HOSPITAL INSURANCE TAX RATE.
  (a) EMPLOYER AND EMPLOYEE TAXES- Sections 3101 and 3111 of the Internal
  Revenue Code of 1986 are each amended--
  (1) by striking `and' at the end of paragraph (5),
  (2) by striking the period at the end of paragraph (6) and inserting `;
  and', and
  (3) by adding at the end the following new paragraph:
  `(7) with respect to wages received on or after January 1 of the 2nd year
  beginning after the date of the enactment of the Long-Term Health Care
  Act of 1992, the rate shall be 1.50 percent.'
  (b) SELF-EMPLOYMENT TAXES- Section 1401(b) of such Code is amended by
  striking the last line and inserting the following:
  `December 31, 1985.......January 1, 1994
2.75
  `December 31, 1993
3.00.'
  (c) EFFECTIVE DATE- The amendments made by this section shall apply with
  respect to remuneration paid on or after January 1 of the 2nd year beginning
  after the date of the enactment of this Act and with respect to earnings
  from self-employment attributable to taxable years beginning after such date.
SEC. 203. STATE MAINTENANCE OF EFFORT PAYMENTS.
  (a) CONDITION OF CONTINUED FEDERAL PAYMENTS- Notwithstanding any other
  provision of the Social Security Act, as a condition of payment to a State
  for a calendar quarter beginning on or after January 1 of the 2nd year
  beginning after the date of the enactment of this Act under title IV, V,
  XIX, or XX of the Social Security Act, the State must provide (in a manner
  and at a time specified by the Secretary) for payment to the Long-Term
  Care Trust Fund (established under section 1859A(b) of such Act) of the
  amount specified in subsection (b) for the quarter.
  (b) MAINTENANCE OF EFFORT AMOUNT-
  (1) IN GENERAL- The amount of payment specified in this subsection for a
  State for a calendar quarter is equal to the State hypothetical savings
  specified in paragraph (2) for the quarter increased by the compounded
  sum of the increase in the consumer price index for all urban consumers
  (U.S. City average, as published by the Bureau of Labor Statistics of the
  Department of Labor) for each year after 1992 and through the year before
  the year in which in which the quarter occurs.
  (2) STATE SAVINGS- A State hypothetical savings specified in this paragraph
  for a calendar quarter is  1/4  of the amount by which the payments (net
  of Federal payments) made by a State under its State plan under title XIX
  of the Social Security Act for fiscal year 1992 for medical assistance
  would have been reduced if the law (as amended by this Act and in effect
  during such quarter) has been in effect during all of fiscal year 1992.
  (c) STATE DEFINED- In this section, the term `State' includes the District
  of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and
  the Northern Mariana Islands.
TITLE III--GRANTS AND DEMONSTRATION PROJECTS
SEC. 301. GRANTS FOR TRAINING FOR HOME AND COMMUNITY-BASED CARE.
  (a) IN GENERAL- The Secretary of Health and Human Services (in this Act
  referred to as the `Secretary') shall make grants to schools of nursing,
  social work, allied health, and public health of accredited universities
  to develop and conduct programs to train individuals in the provision,
  supervision, planning, and analysis of home and community-based care and
  nursing facility services for the elderly, disabled, and chronically ill
  children and in the administration of such programs.
  (b) USE OF FUNDS- Funding made available under this section may be used for
  curriculum development, faculty support, and traineeships and fellowships.
  (c) GRANT PREFERENCES- In awarding grants under this section, the Secretary
  shall give a preference to programs that--
  (1) provide for the development or conduct of programs for continuing
  education and certification of professionals currently working in the
  field of geriatric health in the provision of services to the chronically
  impaired and working in the field of pediatric care specialization in
  the provision of care services to chronically ill, disabled, and medical
  technology dependent children;
  (2) have established or will establish affiliations with nursing facilities,
  agencies providing home and community-based care, senior citizen centers,
  adult day care centers, and other institutions and agencies providing
  health and social services to the impaired elderly, for the purpose
  of providing in-service training to individuals being trained at the
  grant-receiving institution and technical assistance to the institution
  providing services; and
  (3) have established or will establish affiliations with programs of
  geriatric training based in accredited medical schools or schools of nursing,
  or both.
  (d) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $15,000,000 for fiscal year 1993, $20,000,000
  for fiscal year 1994, and $25,000,000 for fiscal year 1995.
SEC. 302. GRANTS FOR HOME HEALTH AIDES.
  (a) IN GENERAL- The Secretary shall make grants to State approved programs
  (that meet requirements established by the Secretary relating to minimum
  course hours, curriculum content, competency evaluation, and qualifications
  of instructors) to develop and conduct programs to train individuals in
  the provision of home health aide services. Such training programs shall be
  designed and conducted according to guidelines and requirements established
  by the Secretary by regulation.
  (b) GRANT PREFERENCES- Preference shall be given to programs that have
  established or will have established affiliations with nursing facilities,
  agencies providing home and community-based care, senior citizen centers,
  adult day care centers, and other institutions providing health and social
  services to the impaired elderly, for the purpose of providing in-service
  training to individuals being trained at the grant-receiving program and
  technical assistance to the institution providing services.
  (c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $10,000,000 for each of the fiscal years 1993
  and 1994 and $25,000,000 for fiscal year 1995.
SEC. 303. GRANTS FOR MODEL CONSUMER TRAINING PROGRAMS.
  (a) IN GENERAL- The Secretary shall make grants available to accredited
  university schools of nursing to develop model consumer training
  programs. Such programs shall provide information and training about
  the delivery of home care services for caregivers as well as general
  information about the home and community-based care service system for
  consumers or potential consumers of home care or home health services,
  or both, pursuant to regulations established by the Secretary.
  (b) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $5,000,000 for fiscal year 1993, $10,000,000
  for fiscal year 1994, and $15,000,000 for fiscal year 1995.
SEC. 304. CENTERS FOR LONG-TERM CARE PLANNING AND TECHNICAL ASSISTANCE.
  (a) IN GENERAL- The Secretary shall through grants or contracts, or both,
  assist public or private nonprofit entities in meeting the costs of planning
  and developing new centers, and operating existing and new centers, for
  multidisciplinary health planning development and assistance under this
  section for the purpose of--
  (1) assisting the Secretary in carrying out part C of title XVIII of the
  Social Security Act;
  (2) providing such technical and consulting assistance as States may require;
  (3) conducting research, studies, and analysis of planning and resource
  development for the provision of long-term care services; and
  (4) developing long-term care planning approaches, methodologies, policies,
  and standards.
  (b) NUMBER OF CENTERS- The Secretary shall provide assistance under this
  section so that at least 6 such centers shall be in operation by January
  1, 1994.
  (c) CASE-MANAGEMENT AGENCIES- Agencies assisted under this section--
  (1) may enter into arrangements with Case Management Agencies for the
  provision of such services as may be appropriate and necessary in assisting
  the agencies in performing their functions under part C of title XVIII of
  the Social Security Act; and
  (2) shall develop and use methods (satisfactory to the Secretary)
  to disseminate to such agencies long-term care planning approaches,
  methodologies, policies, and standards.
  (d) Staff-
  (1) DIRECTOR- Each center shall have a full-time director who possesses
  a demonstrated capacity for substantial accomplishment and leadership in
  the field of planning and resource development in the area of long-term care.
  (2) ADDITIONAL STAFF- Each center shall employ such other additional staff
  as may be appropriate. The staff of the center shall meet such additional
  requirements as the Secretary may by regulation prescribe.
  (e) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $10,000,000 for fiscal year 1993 and $15,000,000
  for each of the fiscal years 1994 and 1995.
SEC. 305. DEMONSTRATION PROJECTS FOR SERIOUSLY MENTALLY ILL INDIVIDUALS.
  (a) IN GENERAL- The Secretary shall conduct at least 5 (but not more than
  10) demonstration projects to determine the relative effectiveness, cost,
  and impact on quality of long-term home care of using different models
  of providing and reimbursing long-term home care services for seriously
  mentally ill individuals and family caregivers.
  (b) DEFINITION- As used in section, the term `seriously mentally ill
  individual' means an individual who a licensed mental health professional
  in the individual's State of residence certifies--
  (1) has schizophrenia, bipolar or unipolar disorder or other significant
  mental illness that restrict the ability of the individual to function in
  activities of daily living, employment, and social interaction;
  (2) has been previously institutionalized or is at risk of being
  institutionalized in the absence of the services provided under this
  section; and
  (3) is not institutionalized at the time of the certification.
  (c) REQUIREMENTS- Demonstration projects conducted under this section shall--
  (1) each be conducted over a period of 3 years;
  (2) be conducted in sites that are chosen to be geographically diverse
  and include at least one rural site;
  (3) be sensitive to the needs of racial and ethnic minorities;
  (4) include outreach and case management activities;
  (5) be responsive to family needs and concerns and appropriately involve
  and consult with family members regarding the provision of services under
  this section;
  (6) specify, at the time of application, specific outcome expectations to
  be met by the project and identify appropriate mechanisms for measuring
  such outcomes; and
  (7) include testing the use of different agencies as Case Management
  Agencies and providing for the selection of such agencies in consultation
  with the Comptroller General.
  (d) OTHER SERVICES- Demonstration projects conducted under this section may--
  (1) provide services or reimbursement for nursing care, homemaker or home
  health aide services, psychosocial services, medical services, including
  the provision, monitoring, and testing of necessary medications, client
  and family education, training, and counseling, respite care, crisis
  intervention, information and referral services, and rehabilitation; and
  (2) provide services to seriously mentally ill individuals or provide
  services to home caregivers (including family members) when such services
  augment and support home caregivers in the care of seriously mentally
  ill individuals.
  (e) EVALUATION- The Secretary shall provide for the evaluation of the
  projects on a concurrent basis and shall prepare and submit to the
  appropriate Committees of Congress, not later than 18 months after the
  initiation of the projects and on the completion of the projects, a report
  on the findings of the evaluation. Such evaluation shall measure the cost
  and effectiveness of funded projects against the outcome expectations
  identified in the initial applications and include relevant data on client
  and family satisfaction and perceived benefits, together with such additional
  information as the Secretary may consider appropriate.
  (f) PAYMENTS- Payments under demonstration projects under this section may
  be made in advance or by way of reimbursement, as may be determined by the
  Secretary, and shall be made in such installments and on such conditions
  as the Secretary finds necessary to carry out the purpose of this section.
  (g) WAIVERS- The Secretary may waive such requirements of title XVIII
  of the Social Security Act as may be required to carry out demonstration
  projects under this section.
  (h) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  from the Long-Term Care Trust Fund for each of the fiscal years 1993, 1994,
  and 1995, not to exceed $10,000,000 to carry out demonstration projects
  under this section and not to exceed $1,000,000 to carry out the evaluation
  of such projects under subsection (e).
SEC. 306. SPECIAL RULES FOR FRAIL ELDERLY DEMONSTRATION PROJECTS AND SIMILAR
PROJECTS.
  Title XVIII of the Social Security Act is amended by inserting after
  section 1876 the following new section:
`TREATMENT OF FRAIL ELDERLY DEMONSTRATION PROJECTS AND SIMILAR PROJECTS
  `SEC. 1876A. (a) IN GENERAL-
  `(1) COMPREHENSIVE CAPITATION PAYMENTS- The Secretary shall establish
  special procedures under which projects described in subsection (b)
  receive payment on a capitated basis in return for the provision of care
  and services described in parts A, B, and C to special populations (such
  as frail elderly individuals) in a managed care plan.
  `(2) WAIVER OF ASSESSMENT AND CASE MANAGEMENT FUNCTIONS- In the case of such
  a project, the Secretary shall waive such requirements of part C of this
  title relating to assessment and case management functions for individuals
  served by the project as would be duplicative of functions conducted under
  the project and unnecessary in order to assure the quality of care.
  `(b) PROJECTS COVERED- The projects described in this subsection are--
  `(1) frail elderly demonstration projects identified or established under
  section 603 of the Social Security Amendments of 1983, section 9412 of
  the Omnibus Budget Reconciliation Act of 1986, or section 4744 of Omnibus
  Budget Reconciliation Act of 1990; or
  `(2) such other projects as the Secretary identifies as providing (A)
  comprehensive services (including long-term care services) to special
  populations and (B) comprehensive case management and assessment as an
  integral part of the provision of such services.'.
Long-Term Health Care Program Act of 1992

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