Medicaid Community-Based Attendant Services and Supports Act of 2005 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to require State Medicaid plan coverage of community-based attendant services and supports for certain Medicaid-eligible individuals.
Outlines requirements for: (1) an enhanced Federal medical assistance percentage (FMAP) for ongoing activities of early coverage States that enhance and promote the use of community-based attendant services and supports; and (2) increased Federal financial participation for certain expenditures incurred by the State for the provision of such services and supports.
Directs the Secretary of Health and Human Services to: (1) award grants to eligible States which have established a Consumer Task Force to assist the State in its development of real choice systems change initiatives; and (2) conduct a demonstration project for the purpose of evaluating service coordination and cost-sharing approaches with respect to the provision of community-based services and supports to non-elderly dually eligible individuals.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 401 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 401
To amend title XIX of the Social Security Act to provide individuals
with disabilities and older Americans with equal access to community-
based attendant services and supports, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 16, 2005
Mr. Harkin (for himself, Mr. Specter, Mr. Kennedy, Mr. Kerry, Mr.
Biden, Mr. Dayton, Ms. Landrieu, Mr. Schumer, Mr. Corzine, Mr.
Lautenberg, Mr. Lieberman, and Mr. Dodd) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide individuals
with disabilities and older Americans with equal access to community-
based attendant services and supports, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicaid
Community-Based Attendant Services and Supports Act of 2005''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
TITLE I--ESTABLISHMENT OF MEDICAID PLAN BENEFIT
Sec. 101. Coverage of community-based attendant services and supports
under the medicaid program.
Sec. 102. Enhanced FMAP for ongoing activities of early coverage States
that enhance and promote the use of
community-based attendant services and
supports.
Sec. 103. Increased Federal financial participation for certain
expenditures.
TITLE II--PROMOTION OF SYSTEMS CHANGE AND CAPACITY BUILDING
Sec. 201. Grants to promote systems change and capacity building.
Sec. 202. Demonstration project to enhance coordination of care under
the medicare and medicaid programs for non-
elderly dual eligible individuals.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress makes the following findings:
(1) Long-term services and supports provided under the
medicaid program established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) must meet the ability and
life choices of individuals with disabilities and older
Americans, including the choice to live in one's own home or
with one's own family and to become a productive member of the
community.
(2) Research on the provision of long-term services and
supports under the medicaid program (conducted by and on behalf
of the Department of Health and Human Services) has revealed a
significant funding bias toward institutional care. Only about
33 percent of long term care funds expended under the medicaid
program, and only about 11 percent of all funds expended under
that program, pay for services and supports in home and
community-based settings.
(3) In the case of medicaid beneficiaries who need long
term care, the only long-term care service currently guaranteed
by Federal law in every State is nursing home care. Only 30
States have adopted the benefit option of providing personal
care services under the medicaid program. Although every State
has chosen to provide certain services under home and
community-based waivers, these services are unevenly available
within and across States, and reach a small percentage of
eligible individuals. In fiscal year 2003, only 7 States spent
50 percent or more of their medicaid long term care funds under
the medicaid program on home and community-based care.
(4) The goals of the Nation properly include providing
families of children with disabilities, working-age adults with
disabilities, and older Americans with--
(A) a meaningful choice of receiving long-term
services and supports in the most integrated setting
appropriate to their needs;
(B) the greatest possible control over the services
received and, therefore, their own lives and futures;
and
(C) quality services that maximize independence in
the home and community, including in the workplace.
(b) Purposes.--The purposes of this Act are the following:
(1) To reform the medicaid program established under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to
provide equal access to community-based attendant services and
supports.
(2) To provide financial assistance to States as they
reform their long-term care systems to provide comprehensive
statewide long-term services and supports, including community-
based attendant services and supports that provide consumer
choice and direction, in the most integrated setting
appropriate.
TITLE I--ESTABLISHMENT OF MEDICAID PLAN BENEFIT
SEC. 101. COVERAGE OF COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS
UNDER THE MEDICAID PROGRAM.
(a) Mandatory Coverage.--Section 1902(a)(10)(D) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(D)) is amended--
(1) by inserting ``(i)'' after ``(D)'';
(2) by adding ``and'' after the semicolon; and
(3) by adding at the end the following new clause:
``(ii) subject to section 1936, for the inclusion
of community-based attendant services and supports for
any individual who--
``(I) is eligible for medical assistance
under the State plan;
``(II) with respect to whom there has been
a determination that the individual requires
the level of care provided in a nursing
facility or an intermediate care facility for
the mentally retarded (whether or not coverage
of such intermediate care facility is provided
under the State plan); and
``(III) chooses to receive such services
and supports;''.
(b) Community-Based Attendant Services and Supports.--
(1) In general.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(A) by redesignating section 1936 as section 1937;
and
(B) by inserting after section 1935 the following:
``community-based attendant services and supports
``Sec. 1936. (a) Required Coverage.--
``(1) In general.--Not later than October 1, 2009, a State
shall provide through a plan amendment for the inclusion of
community-based attendant services and supports (as defined in
subsection (g)(1)) for individuals described in section
1902(a)(10)(D)(ii) in accordance with this section.
``(2) Enhanced fmap and additional federal financial
support for earlier coverage.--Notwithstanding section 1905(b),
during the period that begins on October 1, 2005, and ends on
September 30, 2009, in the case of a State with an approved
plan amendment under this section during that period that also
satisfies the requirements of subsection (c) the Federal
medical assistance percentage shall be equal to the enhanced
FMAP described in section 2105(b) with respect to medical
assistance in the form of community-based attendant services
and supports provided to individuals described in section
1902(a)(10)(D)(ii) in accordance with this section on or after
the date of the approval of such plan amendment.
``(b) Development and Implementation of Benefit.--In order for a
State plan amendment to be approved under this section, a State shall
provide the Secretary with the following assurances:
``(1) Assurance of development and implementation
collaboration.--That the State has developed and shall
implement the provision of community-based attendant services
and supports under the State plan through active collaboration
with--
``(A) individuals with disabilities;
``(B) elderly individuals;
``(C) representatives of such individuals; and
``(D) providers of, and advocates for, services and
supports for such individuals.
``(2) Assurance of provision on a statewide basis and in
most integrated setting.--That community-based attendant
services and supports will be provided under the State plan to
individuals described in section 1902(a)(10)(D)(ii) on a
statewide basis and in a manner that provides such services and
supports in the most integrated setting appropriate for each
individual eligible for such services and supports.
``(3) Assurance of nondiscrimination.--That the State will
provide community-based attendant services and supports to an
individual described in section 1902(a)(10)(D)(ii) without
regard to the individual's age, type of disability, or the form
of community-based attendant services and supports that the
individual requires in order to lead an independent life.
``(4) Assurance of maintenance of effort.--That the level
of State expenditures for optional medical assistance that--
``(A) is described in a paragraph other than
paragraphs (1) through (5), (17) and (21) of section
1905(a) or that is provided under a waiver under
section 1915, section 1115, or otherwise; and
``(B) is provided to individuals with disabilities
or elderly individuals for a fiscal year,
shall not be less than the level of such expenditures for the
fiscal year preceding the fiscal year in which the State plan
amendment to provide community-based attendant services and
supports in accordance with this section is approved.
``(c) Requirements for Enhanced FMAP for Early Coverage.--In
addition to satisfying the other requirements for an approved plan
amendment under this section, in order for a State to be eligible under
subsection (a)(2) during the period described in that subsection for
the enhanced FMAP for early coverage under subsection (a)(2), the State
shall satisfy the following requirements:
``(1) Specifications.--With respect to a fiscal year, the
State shall provide the Secretary with the following
specifications regarding the provision of community-based
attendant services and supports under the plan for that fiscal
year:
``(A)(i) The number of individuals who are
estimated to receive community-based attendant services
and supports under the plan during the fiscal year.
``(ii) The number of individuals that received such
services and supports during the preceding fiscal year.
``(B) The maximum number of individuals who will
receive such services and supports under the plan
during that fiscal year.
``(C) The procedures the State will implement to
ensure that the models for delivery of such services
and supports are consumer controlled (as defined in
subsection (g)(2)(B)).
``(D) The procedures the State will implement to
inform all potentially eligible individuals and
relevant other individuals of the availability of such
services and supports under this title, and of other
items and services that may be provided to the
individual under this title or title XVIII.
``(E) The procedures the State will implement to
ensure that such services and supports are provided in
accordance with the requirements of subsection (b)(1).
``(F) The procedures the State will implement to
actively involve individuals with disabilities, elderly
individuals, and representatives of such individuals in
the design, delivery, administration, and evaluation of
the provision of such services and supports under this
title.
``(2) Participation in evaluations.--The State shall
provide the Secretary with such substantive input into, and
participation in, the design and conduct of data collection,
analyses, and other qualitative or quantitative evaluations of
the provision of community-based attendant services and
supports under this section as the Secretary deems necessary in
order to determine the effectiveness of the provision of such
services and supports in allowing the individuals receiving
such services and supports to lead an independent life to the
maximum extent possible.
``(d) Quality Assurance Program.--
``(1) State responsibilities.--In order for a State plan
amendment to be approved under this section, a State shall
establish and maintain a quality assurance program with respect
to community-based attendant services and supports that
provides for the following:
``(A) The State shall establish requirements, as
appropriate, for agency-based and other delivery models
that include--
``(i) minimum qualifications and training
requirements for agency-based and other models;
``(ii) financial operating standards; and
``(iii) an appeals procedure for
eligibility denials and a procedure for
resolving disagreements over the terms of an
individualized plan.
``(B) The State shall modify the quality assurance
program, as appropriate, to maximize consumer
independence and consumer control in both agency-
provided and other delivery models.
``(C) The State shall provide a system that allows
for the external monitoring of the quality of services
and supports by entities consisting of consumers and
their representatives, disability organizations,
providers, families of disabled or elderly individuals,
members of the community, and others.
``(D) The State shall provide for ongoing
monitoring of the health and well-being of each
individual who receives community-based attendant
services and supports.
``(E) The State shall require that quality
assurance mechanisms appropriate for the individual be
included in the individual's written plan.
``(F) The State shall establish a process for the
mandatory reporting, investigation, and resolution of
allegations of neglect, abuse, or exploitation in
connection with the provision of such services and
supports.
``(G) The State shall obtain meaningful consumer
input, including consumer surveys, that measure the
extent to which an individual receives the services and
supports described in the individual's plan and the
individual's satisfaction with such services and
supports.
``(H) The State shall make available to the public
the findings of the quality assurance program.
``(I) The State shall establish an ongoing public
process for the development, implementation, and review
of the State's quality assurance program.
``(J) The State shall develop and implement a
program of sanctions for providers of community-based
services and supports that violate the terms or
conditions for the provision of such services and
supports.
``(2) Federal responsibilities.--
``(A) Periodic evaluations.--The Secretary shall
conduct a periodic sample review of outcomes for
individuals who receive community-based attendant
services and supports under this title.
``(B) Investigations.--The Secretary may conduct
targeted reviews and investigations upon receipt of an
allegation of neglect, abuse, or exploitation of an
individual receiving community-based attendant services
and supports under this section.
``(C) Development of provider sanction
guidelines.--The Secretary shall develop guidelines for
States to use in developing the sanctions required
under paragraph (1)(J).
``(e) Reports.--The Secretary shall submit to Congress periodic
reports on the provision of community-based attendant services and
supports under this section, particularly with respect to the impact of
the provision of such services and supports on--
``(1) individuals eligible for medical assistance under
this title;
``(2) States; and
``(3) the Federal Government.
``(f) No Effect on Ability to Provide Coverage Under a Waiver.--
``(1) In general.--Nothing in this section shall be
construed as affecting the ability of a State to provide
coverage under the State plan for community-based attendant
services and supports (or similar coverage) under a waiver
approved under section 1915, section 1115, or otherwise.
``(2) Eligibility for enhanced match.--In the case of a
State that provides coverage for such services and supports
under a waiver, the State shall not be eligible under
subsection (a)(2) for the enhanced FMAP for the early provision
of such coverage unless the State submits a plan amendment to
the Secretary that meets the requirements of this section.
``(g) Definitions.--In this title:
``(1) Community-based attendant services and supports.--
``(A) In general.--The term `community-based
attendant services and supports' means attendant
services and supports furnished to an individual, as
needed, to assist in accomplishing activities of daily
living, instrumental activities of daily living, and
health-related functions through hands-on assistance,
supervision, or cueing--
``(i) under a plan of services and supports
that is based on an assessment of functional
need and that is agreed to by the individual
or, as appropriate, the individual's
representative;
``(ii) in a home or community setting,
which may include a school, workplace, or
recreation or religious facility, but does not
include a nursing facility or an intermediate
care facility for the mentally retarded;
``(iii) under an agency-provider model or
other model (as defined in paragraph (2)(C));
and
``(iv) the furnishing of which is selected,
managed, and dismissed by the individual, or,
as appropriate, with assistance from the
individual's representative.
``(B) Included services and supports.--Such term
includes--
``(i) tasks necessary to assist an
individual in accomplishing activities of daily
living, instrumental activities of daily
living, and health-related functions;
``(ii) the acquisition, maintenance, and
enhancement of skills necessary for the
individual to accomplish activities of daily
living, instrumental activities of daily
living, and health-related functions;
``(iii) backup systems or mechanisms (such
as the use of beepers) to ensure continuity of
services and supports; and
``(iv) voluntary training on how to select,
manage, and dismiss attendants.
``(C) Excluded services and supports.--Subject to
subparagraph (D), such term does not include--
``(i) the provision of room and board for
the individual;
``(ii) special education and related
services provided under the Individuals with
Disabilities Education Act and vocational
rehabilitation services provided under the
Rehabilitation Act of 1973;
``(iii) assistive technology devices and
assistive technology services;
``(iv) durable medical equipment; or
``(v) home modifications.
``(D) Flexibility in transition to community-based
home setting.--Such term may include expenditures for
transitional costs, such as rent and utility deposits,
first month's rent and utilities, bedding, basic
kitchen supplies, and other necessities required for an
individual to make the transition from a nursing
facility or intermediate care facility for the mentally
retarded to a community-based home setting where the
individual resides.
``(2) Additional definitions.--
``(A) Activities of daily living.--The term
`activities of daily living' includes eating,
toileting, grooming, dressing, bathing, and
transferring.
``(B) Consumer controlled.--The term `consumer
controlled' means a method of providing services and
supports that allow the individual, or where
appropriate, the individual's representative, maximum
control of the community-based attendant services and
supports, regardless of who acts as the employer of
record.
``(C) Delivery models.--
``(i) Agency-provider model.--The term
`agency-provider model' means, with respect to
the provision of community-based attendant
services and supports for an individual, a
method of providing consumer controlled
services and supports under which entities
contract for the provision of such services and
supports.
``(ii) Other models.--The term `other
models' means methods, other than an agency-
provider model, for the provision of consumer
controlled services and supports. Such models
may include the provision of vouchers, direct
cash payments, or use of a fiscal agent to
assist in obtaining services.
``(D) Health-related functions.--The term `health-
related functions' means functions that can be
delegated or assigned by licensed health-care
professionals under State law to be performed by an
attendant.
``(E) Instrumental activities of daily living.--The
term `instrumental activities of daily living' includes
meal planning and preparation, managing finances,
shopping for food, clothing, and other essential items,
performing essential household chores, communicating by
phone and other media, and traveling around and
participating in the community.
``(F) Individual's representative.--The term
`individual's representative' means a parent, a family
member, a guardian, an advocate, or an authorized
representative of an individual.''.
(c) Conforming Amendments.--
(1) Mandatory benefit.--Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in
the matter preceding clause (i), by striking ``(17) and (21)''
and inserting ``(17), (21), and (28)''.
(2) Definition of medical assistance.--Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d) is amended--
(A) by striking ``and'' at the end of paragraph
(27);
(B) by redesignating paragraph (28) as paragraph
(29); and
(C) by inserting after paragraph (27) the
following:
``(28) community-based attendant services and supports (to
the extent allowed and as defined in section 1936); and''.
(3) IMD/ICFMR requirements.--Section 1902(a)(10)(C)(iv) of
the Social Security Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is
amended by inserting ``and (28)'' after ``(24)''.
(d) Effective Dates.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section (other than the amendment made
by subsection (c)(1)) take effect on October 1, 2005, and apply
to medical assistance provided for community-based attendant
services and supports described in section 1936 of the Social
Security Act furnished on or after that date.
(2) Mandatory benefit.--The amendment made by subsection
(c)(1) takes effect on October 1, 2009.
SEC. 102. ENHANCED FMAP FOR ONGOING ACTIVITIES OF EARLY COVERAGE STATES
THAT ENHANCE AND PROMOTE THE USE OF COMMUNITY-BASED
ATTENDANT SERVICES AND SUPPORTS.
(a) In General.--Section 1936 of the Social Security Act, as added
by section 101(b), is amended--
(1) by redesignating subsections (d) through (g) as
subsections (f) through (i), respectively;
(2) in subsection (a)(1), by striking ``subsection (g)(1)''
and inserting ``subsection (i)(1)'';
(3) in subsection (a)(2), by inserting ``, and with respect
to expenditures described in subsection (d), the Secretary
shall pay the State the amount described in subsection (d)(1)''
before the period;
(4) in subsection (c)(1)(C), by striking ``subsection
(g)(2)(B)'' and inserting ``subsection (i)(2)(B)''; and
(5) by inserting after subsection (c), the following:
``(d) Increased Federal Financial Participation for Early Coverage
States That Meet Certain Benchmarks.--
``(1) In general.--Subject to paragraph (2), for purposes
of subsection (a)(2), the amount and expenditures described in
this subsection are an amount equal to the Federal medical
assistance percentage, increased by 10 percentage points, of
the expenditures incurred by the State for the provision or
conduct of the services or activities described in paragraph
(3).
``(2) Expenditure criteria.--A State shall--
``(A) develop criteria for determining the
expenditures described in paragraph (1) in
collaboration with the individuals and representatives
described in subsection (b)(1); and
``(B) submit such criteria for approval by the
Secretary.
``(3) Services and activities described.--For purposes of
paragraph (1), the services and activities described in this
subparagraph are the following:
``(A) One-stop intake, referral, and institutional
diversion services.
``(B) Identifying and remedying gaps and inequities
in the State's current provision of long-term services,
particularly those services that are provided based on
such factors as age, disability type, ethnicity,
income, institutional bias, or other similar factors.
``(C) Establishment of consumer participation and
consumer governance mechanisms, such as cooperatives
and regional service authorities, that are managed and
controlled by individuals with significant disabilities
who use community-based services and supports or their
representatives.
``(D) Activities designed to enhance the skills,
earnings, benefits, supply, career, and future
prospects of workers who provide community-based
attendant services and supports.
``(E) Continuous improvement activities that are
designed to ensure and enhance the health and well-
being of individuals who rely on community-based
attendant services and supports, particularly
activities involving or initiated by consumers of such
services and supports or their representatives.
``(F) Family support services to augment the
efforts of families and friends to enable individuals
with disabilities of all ages to live in their own
homes and communities.
``(G) Health promotion and wellness services and
activities.
``(H) Provider recruitment and enhancement
activities, particularly such activities that encourage
the development and maintenance of consumer controlled
cooperatives or other small businesses or
microenterprises that provide community-based attendant
services and supports or related services.
``(I) Activities designed to ensure service and
systems coordination.
``(J) Any other services or activities that the
Secretary deems appropriate.''.
(b) Effective Date.--The amendments made by subsection (a) take
effect on October 1, 2005.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR CERTAIN
EXPENDITURES.
(a) In General.--Section 1936 of the Social Security Act, as added
by section 101(b) and amended by section 102, is amended by inserting
after subsection (d) the following:
``(e) Increased Federal Financial Participation for Certain
Expenditures.--
``(1) Eligibility for payment.--
``(A) In general.--In the case of a State that the
Secretary determines satisfies the requirements of
subparagraph (B), the Secretary shall pay the State the
amounts described in paragraph (2) in addition to any
other payments provided for under section 1903 or this
section for the provision of community-based attendant
services and supports.
``(B) Requirements.--The requirements of this
subparagraph are the following:
``(i) The State has an approved plan
amendment under this section.
``(ii) The State has incurred expenditures
described in paragraph (2).
``(iii) The State develops and submits to
the Secretary criteria to identify and select
such expenditures in accordance with the
requirements of paragraph (3).
``(iv) The Secretary determines that
payment of the applicable percentage of such
expenditures (as determined under paragraph
(2)(B)) would enable the State to provide a
meaningful choice of receiving community-based
services and supports to individuals with
disabilities and elderly individuals who would
otherwise only have the option of receiving
institutional care.
``(2) Amounts and expenditures described.--
``(A) Expenditures in excess of 150 percent of
baseline amount.--The amounts and expenditures
described in this paragraph are an amount equal to the
applicable percentage, as determined by the Secretary
in accordance with subparagraph (B), of the
expenditures incurred by the State for the provision of
community-based attendant services and supports to an
individual that exceed 150 percent of the average cost
of providing nursing facility services to an individual
who resides in the State and is eligible for such
services under this title, as determined in accordance
with criteria established by the Secretary.
``(B) Applicable percentage.--The Secretary shall
establish a payment scale for the expenditures
described in subparagraph (A) so that the Federal
financial participation for such expenditures gradually
increases from 70 percent to 90 percent as such
expenditures increase.
``(3) Specification of order of selection for
expenditures.--In order to receive the amounts described in
paragraph (2), a State shall--
``(A) develop, in collaboration with the
individuals and representatives described in subsection
(b)(1) and pursuant to guidelines established by the
Secretary, criteria to identify and select the
expenditures submitted under that paragraph; and
``(B) submit such criteria to the Secretary.''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on October 1, 2005.
TITLE II--PROMOTION OF SYSTEMS CHANGE AND CAPACITY BUILDING
SEC. 201. GRANTS TO PROMOTE SYSTEMS CHANGE AND CAPACITY BUILDING.
(a) Authority to Award Grants.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall award
grants to eligible States to carry out the activities described
in subsection (b).
(2) Application.--In order to be eligible for a grant under
this section, a State shall submit to the Secretary an
application in such form and manner, and that contains such
information, as the Secretary may require.
(b) Permissible Activities.--A State that receives a grant under
this section may use funds provided under the grant for any of the
following activities, focusing on areas of need identified by the State
and the Consumer Task Force established under subsection (c):
(1) The development and implementation of the provision of
community-based attendant services and supports under section
1936 of the Social Security Act (as added by section 101(b) and
amended by sections 102 and 103) through active collaboration
with--
(A) individuals with disabilities;
(B) elderly individuals;
(C) representatives of such individuals; and
(D) providers of, and advocates for, services and
supports for such individuals.
(2) Substantially involving individuals with significant
disabilities and representatives of such individuals in jointly
developing, implementing, and continually improving a mutually
acceptable comprehensive, effectively working statewide plan
for preventing and alleviating unnecessary institutionalization
of such individuals.
(3) Engaging in system change and other activities deemed
necessary to achieve any or all of the goals of such statewide
plan.
(4) Identifying and remedying disparities and gaps in
services to classes of individuals with disabilities and
elderly individuals who are currently experiencing or who face
substantial risk of unnecessary institutionalization.
(5) Building and expanding system capacity to offer quality
consumer controlled community-based services and supports to
individuals with disabilities and elderly individuals,
including by--
(A) seeding the development and effective use of
community-based attendant services and supports
cooperatives, independent living centers, small
businesses, microenterprises and similar joint ventures
owned and controlled by individuals with disabilities
or representatives of such individuals and community-
based attendant services and supports workers;
(B) enhancing the choice and control individuals
with disabilities and elderly individuals exercise,
including through their representatives, with respect
to the personal assistance and supports they rely upon
to lead independent, self-directed lives;
(C) enhancing the skills, earnings, benefits,
supply, career, and future prospects of workers who
provide community-based attendant services and
supports;
(D) engaging in a variety of needs assessment and
data gathering;
(E) developing strategies for modifying policies,
practices, and procedures that result in unnecessary
institutional bias or the overmedicalization of long-
term services and supports;
(F) engaging in interagency coordination and single
point of entry activities;
(G) providing training and technical assistance
with respect to the provision of community-based
attendant services and supports;
(H) engaging in--
(i) public awareness campaigns;
(ii) facility-to-community transitional
activities; and
(iii) demonstrations of new approaches; and
(I) engaging in other systems change activities
necessary for developing, implementing, or evaluating a
comprehensive statewide system of community-based
attendant services and supports.
(6) Ensuring that the activities funded by the grant are
coordinated with other efforts to increase personal attendant
services and supports, including--
(A) programs funded under or amended by the Ticket
to Work and Work Incentives Improvement Act of 1999
(Public Law 106-170; 113 Stat. 1860);
(B) grants funded under the Families of Children
With Disabilities Support Act of 2000 (42 U.S.C. 15091
et seq.); and
(C) other initiatives designed to enhance the
delivery of community-based services and supports to
individuals with disabilities and elderly individuals.
(7) Engaging in transition partnership activities with
nursing facilities and intermediate care facilities for the
mentally retarded that utilize and build upon items and
services provided to individuals with disabilities or elderly
individuals under the medicaid program under title XIX of the
Social Security Act, or by Federal, State, or local housing
agencies, independent living centers, and other organizations
controlled by consumers or their representatives.
(c) Consumer Task Force.--
(1) Establishment and duties.--To be eligible to receive a
grant under this section, each State shall establish a Consumer
Task Force (referred to in this subsection as the ``Task
Force'') to assist the State in the development,
implementation, and evaluation of real choice systems change
initiatives.
(2) Appointment.--Members of the Task Force shall be
appointed by the Chief Executive Officer of the State in
accordance with the requirements of paragraph (3), after the
solicitation of recommendations from representatives of
organizations representing a broad range of individuals with
disabilities, elderly individuals, representatives of such
individuals, and organizations interested in individuals with
disabilities and elderly individuals.
(3) Composition.--
(A) In general.--The Task Force shall represent a
broad range of individuals with disabilities from
diverse backgrounds and shall include representatives
from Developmental Disabilities Councils, Mental Health
Councils, State Independent Living Centers and
Councils, Commissions on Aging, organizations that
provide services to individuals with disabilities and
consumers of long-term services and supports.
(B) Individuals with disabilities.--A majority of
the members of the Task Force shall be individuals with
disabilities or representatives of such individuals.
(C) Limitation.--The Task Force shall not include
employees of any State agency providing services to
individuals with disabilities other than employees of
entities described in the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15001 et seq.).
(d) Annual Report.--
(1) States.--A State that receives a grant under this
section shall submit an annual report to the Secretary on the
use of funds provided under the grant in such form and manner
as the Secretary may require.
(2) Secretary.--The Secretary shall submit to Congress an
annual report on the grants made under this section.
(e) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section, $50,000,000 for each of fiscal years
2006 through 2008.
(2) Availability.--Amounts appropriated to carry out this
section shall remain available without fiscal year limitation.
SEC. 202. DEMONSTRATION PROJECT TO ENHANCE COORDINATION OF CARE UNDER
THE MEDICARE AND MEDICAID PROGRAMS FOR NON-ELDERLY DUAL
ELIGIBLE INDIVIDUALS.
(a) Definitions.--In this section:
(1) Non-elderly dually eligible individual.--The term
``non-elderly dually eligible individual'' means an individual
who--
(A) has not attained age 65; and
(B) is enrolled in the medicare and medicaid
programs established under titles XVIII and XIX,
respectively, of the Social Security Act (42 U.S.C.
1395 et seq., 1396 et seq.).
(2) Project.--The term ``project'' means the demonstration
project authorized to be conducted under this section.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(b) Authority to Conduct Project.--The Secretary shall conduct a
project under this section for the purpose of evaluating service
coordination and cost-sharing approaches with respect to the provision
of community-based services and supports to non-elderly dually eligible
individuals.
(c) Requirements.--
(1) Number of participants.--Not more than 5 States may
participate in the project.
(2) Application.--A State that desires to participate in
the project shall submit an application to the Secretary, at
such time and in such form and manner as the Secretary shall
specify.
(3) Duration.--The project shall be conducted for at least
5, but not more than 10 years.
(d) Evaluation and Report.--
(1) Evaluation.--Not later than 1 year prior to the
termination date of the project, the Secretary, in consultation
with States participating in the project, representatives of
non-elderly dually eligible individuals, and others, shall
evaluate the impact and effectiveness of the project.
(2) Report.--The Secretary shall submit a report to
Congress that contains the findings of the evaluation conducted
under paragraph (1) along with recommendations regarding
whether the project should be extended or expanded, and any
other legislative or administrative actions that the Secretary
considers appropriate as a result of the project.
(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1535-1536)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S1536-1539)
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