110th CONGRESS
1st Session
H. R. 1621
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 HOUSE OF REPRESENTATIVES
March 21, 2007
Mr. DAVIS of Illinois (for himself and Mr. SHIMKUS) introduced the following
bill; which was referred to the Committee on Energy and Commerce
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 `Community Choice Act of 2007'.
(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 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 and programmatic
bias toward institutional care. Only about 37 percent of long-term care
funds expended under the Medicaid program, and only about 12.5 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 are services related to 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. Individuals with the most significant disabilities are usually afforded
the least amount of choice, despite advances in medical and assistive
technologies and related areas.
(4) Despite the more limited funding for community services, the majority
of individuals who use Medicaid long-term services and supports are in
the community, indicating that community services is a more cost effective
alternative to institutional care.
(5) The goals of the Nation properly include providing families of children
with disabilities, working-age adults with disabilities, and older Americans
with--
(A) a meaningful choice of receiving long-term services and supports
in the most integrated setting appropriate to the individual's 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 services in the
most integrated setting appropriate to the individual's needs, and to
provide equal access to community-based attendant services and supports
in order to assist individuals in achieving equal opportunity, full participation,
independent living, and economic self-sufficiency.
(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.
(3) To assist States in meeting the growing demand for community-based
attendant services and supports, as the Nation's population ages and individuals
with disabilities live longer.
(4) To assist States in addressing the decision of the Supreme Court in
Olmstead v. L.C., (527 U.S. 581 (1999)) and implementing the integration
mandate of the Americans with Disabilities Act.
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 1939, 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,
institution for mental diseases, or an intermediate care facility
for the mentally retarded (whether or not coverage of such institution
or 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 1939 as section 1940; and
(B) by inserting after section 1938 the following:
`COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS
`Sec. 1939. (a) Required Coverage-
`(1) IN GENERAL- Not later than October 1, 2012, 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, 2007, and ends on September 30, 2012, 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-
`(A) IN GENERAL- That State plan amendment--
`(i) has been developed in collaboration with, and with the approval
of, a Development and Implementation Council established by the State
that satisfies the requirements of subparagraph (B); and
`(ii) will be implemented in collaboration with such Council and on
the basis of public input solicited by the State and the Council.
`(B) DEVELOPMENT AND IMPLEMENTATION COUNCIL REQUIREMENTS- For purposes
of subparagraph (A), the requirements of this subparagraph are that--
`(i) the majority of the members of the Development and Implementation
Council are individuals with disabilities, elderly individuals, and
their representatives; and
`(ii) in carrying out its responsibilities, the Council actively collaborates
with--
`(I) individuals with disabilities;
`(II) elderly individuals;
`(III) representatives of such individuals; and
`(IV) 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 consumer controlled 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
to the individual's needs.
`(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 or nature
of disability, severity 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 medical assistance that is provided under section 1905(a), section
1915, section 1115, or otherwise 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 first full fiscal year
in which the State plan amendment to provide community-based attendant
services and supports in accordance with this section is implemented.
`(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 and other Federal or State long-term service and support
programs.
`(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 in
a systematic, comprehensive, and ongoing basis, the Development and
Implementation Council established in accordance with subsection (b)(1)(A)(ii),
individuals with disabilities, elderly individuals, and representatives
of such individuals in the design, delivery, administration, implementation,
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.
`(1) STATE RESPONSIBILITIES- In order for a State plan amendment to be
approved under this section, a State shall establish and maintain a comprehensive,
continuous quality assurance system 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 system, 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 pertaining
to 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 system.
`(I) The State shall establish an ongoing public process for the development,
implementation, and review of the State's quality assurance system.
`(J) The State shall develop and implement a program of sanctions for
providers of community-based services and supports that violate the
terms or conditions for the provision of such services and supports.
`(2) FEDERAL RESPONSIBILITIES-
`(A) PERIODIC EVALUATIONS- The Secretary shall conduct a periodic sample
review of outcomes for individuals who receive community-based attendant
services and supports under this title.
`(B) INVESTIGATIONS- The Secretary may conduct targeted reviews and
investigations upon receipt of an allegation of neglect, abuse, or exploitation
of an individual receiving community-based attendant services and supports
under this section.
`(C) DEVELOPMENT OF PROVIDER SANCTION GUIDELINES- The Secretary shall
develop guidelines for States to use in developing the sanctions required
under paragraph (1)(J).
`(e) Reports- The Secretary shall submit to Congress periodic reports on
the provision of community-based attendant services and supports under this
section, particularly with respect to the impact of the provision of such
services and supports on--
`(1) individuals eligible for medical assistance under this title;
`(3) the Federal Government.
`(f) No Effect on Ability To Provide Coverage-
`(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 section 1905(a),
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 and demonstrates
that the State is able to fully comply with and implement 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 tasks 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 in writing by the individual
or, as appropriate, the individual's representative;
`(ii) in a home or community setting, which shall include but not
be limited to a school, workplace, or recreation or religious facility,
but does not include a nursing facility, institution for mental diseases,
or an intermediate care facility for the mentally retarded;
`(iii) under an agency-provider model or other model (as defined in
paragraph (2)(C));
`(iv) the furnishing of which--
`(I) is selected, managed, and dismissed by the individual, or,
as appropriate, with assistance from the individual's representative;
and
`(II) provided by an individual who is qualified to provide such
services, including family members (as defined by the Secretary).
`(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
tasks;
`(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 tasks;
`(iii) backup systems or mechanisms (such as the use of beepers) to
ensure continuity of services and supports; and
`(iv) voluntary training on how to select, manage, and dismiss attendants.
`(C) EXCLUDED SERVICES AND SUPPORTS- Subject to subparagraph (D), such
term does not include--
`(i) the provision of room and board for the individual;
`(ii) special education and related services provided under the Individuals
with Disabilities Education Act and vocational rehabilitation services
provided under the Rehabilitation Act of 1973;
`(iii) assistive technology devices and assistive technology services;
`(iv) durable medical equipment; or
`(D) FLEXIBILITY IN TRANSITION TO COMMUNITY-BASED HOME SETTING- Such
term may include expenditures for transitional costs, such as rent and
utility deposits, first month's rent and utilities, bedding, basic kitchen
supplies, and other necessities required for an individual to make the
transition from a nursing facility, institution for mental diseases,
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 selecting and providing services and supports that allow the individual,
or where appropriate, the individual's representative, maximum control
of the community-based attendant services and supports, regardless of
who acts as the employer of record.
`(i) AGENCY-PROVIDER MODEL- The term `agency-provider model' means,
with respect to the provision of community-based attendant services
and supports for an individual, subject to clause (iii), 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, subject to clause
(iii), 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.
`(iii) COMPLIANCE WITH CERTAIN LAWS- A State shall ensure that, regardless
of whether the State uses an agency-provider model or other models
to provide services and supports under a State plan amendment under
this section, such services and supports are provided in accordance
with the requirements of the Fair Labor Standards Act of 1938 and
applicable Federal and State laws regarding--
`(I) withholding and payment of Federal and State income and payroll
taxes;
`(II) the provision of unemployment and workers compensation insurance;
`(III) maintenance of general liability insurance; and
`(IV) occupational health and safety.
`(D) HEALTH-RELATED TASKS- The term `health-related tasks' means specific
tasks 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, but is not limited to, 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) INDIVIDUALS REPRESENTATIVE- The term `individual's representative'
means a parent, a family member, a guardian, an advocate, or other 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 1939); and'.
(3) IMD/ICFMR REQUIREMENTS- Section 1902(a)(10)(C)(iv) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting `and (28)'
after `(24)'.
(1) IN GENERAL- Except as provided in paragraph (2), the amendments made
by this section (other than the amendment made by subsection (c)(1)) take
effect on October 1, 2007, and apply to medical assistance provided for
community-based attendant services and supports described in section 1939
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, 2012.
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 1939 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, SUPPORTS AND ACTIVITIES DESCRIBED- For purposes of paragraph
(1), the services, supports and activities described in this subparagraph
are the following:
`(A) 1-stop intake, referral, and institutional diversion services.
`(B) Identifying and remedying gaps and inequities in the State's current
provision of long-term services and supports, particularly those services
and supports that are provided based on such factors as age, severity
of disability, type of disability, 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, comprehensive quality 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 micro-enterprises
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, 2007.
SEC. 103. INCREASED FEDERAL FINANCIAL PARTICIPATION FOR CERTAIN EXPENDITURES.
(a) In General- Section 1939 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, 2007.
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 1939 of the Social Security
Act (as added by section 101(b) and amended by sections 102 and 103) through
active collaboration with--
(A) individuals with disabilities;
(C) representatives of such individuals; and
(D) providers of, and advocates for, services and supports for such
individuals.
(2) Substantially involving individuals with significant disabilities
and representatives of such individuals in jointly developing, implementing,
and continually improving a mutually acceptable comprehensive, effectively
working statewide plan for preventing and alleviating unnecessary institutionalization
of such individuals.
(3) Engaging in system change and other activities deemed necessary to
achieve any or all of the goals of such statewide plan.
(4) Identifying and remedying disparities and gaps in services to classes
of individuals with disabilities and elderly individuals who are currently
experiencing or who face substantial risk of unnecessary institutionalization.
(5) Building and expanding system capacity to offer quality consumer controlled
community-based services and supports to individuals with disabilities
and elderly individuals, including by--
(A) seeding the development and effective use of community-based attendant
services and supports cooperatives, Independent Living Centers, small
businesses, micro-enterprises, micro-boards, 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 over-medicalization
of long-term services and supports;
(F) engaging in interagency coordination and single point of entry activities;
(G) providing training and technical assistance with respect to the
provision of community-based attendant services and supports;
(i) public awareness campaigns;
(ii) facility-to-community transitional activities; and
(iii) demonstrations of new approaches; and
(I) engaging in other systems change activities necessary for developing,
implementing, or evaluating a comprehensive statewide system of community-based
attendant services and supports.
(6) Ensuring that the activities funded by the grant are coordinated with
other efforts to increase personal attendant services and supports, including--
(A) programs funded under or amended by the Ticket to Work and Work
Incentives Improvement Act of 1999 (Public Law 106-170; 113 Stat. 1860);
(B) grants funded under the Families of Children With Disabilities Support
Act of 2000 (42 U.S.C. 15091 et seq.); and
(C) other initiatives designed to enhance the delivery of community-based
services and supports to individuals with disabilities and elderly individuals.
(7) Engaging in transition partnership activities with nursing facilities
and intermediate care facilities for the mentally retarded that utilize
and build upon items and services provided to individuals with disabilities
or elderly individuals under the Medicaid program under title XIX of the
Social Security Act, or by Federal, State, or local housing agencies,
Independent Living Centers, and other organizations controlled by consumers
or their representatives.
(1) ESTABLISHMENT AND DUTIES- To be eligible to receive a grant under
this section, each State shall establish a Consumer Task Force (referred
to in this subsection as the `Task Force') to assist the State in the
development, implementation, and evaluation of real choice systems change
initiatives.
(2) APPOINTMENT- Members of the Task Force shall be appointed by the Chief
Executive Officer of the State in accordance with the requirements of
paragraph (3), after the solicitation of recommendations from representatives
of organizations representing a broad range of individuals with disabilities,
elderly individuals, representatives of such individuals, and organizations
interested in individuals with disabilities and elderly individuals.
(A) IN GENERAL- The Task Force shall represent a broad range of individuals
with disabilities from diverse backgrounds and shall include representatives
from Developmental Disabilities Councils, Mental Health Councils, State
Independent Living Centers and Councils, Commissions on Aging, organizations
that provide services to individuals with disabilities and consumers
of long-term services and supports.
(B) INDIVIDUALS WITH DISABILITIES- A majority of the members of the
Task Force shall be individuals with disabilities or representatives
of such individuals.
(C) LIMITATION- The Task Force shall not include employees of any State
agency providing services to individuals with disabilities other than
employees of entities described in the Developmental Disabilities Assistance
and Bill of Rights Act of 2000 (42 U.S.C. 15001 et seq.).
(1) STATES- A State that receives a grant under this section shall submit
an annual report to the Secretary on the use of funds provided under the
grant in such form and manner as the Secretary may require.
(2) SECRETARY- The Secretary shall submit to Congress an annual report
on the grants made under this section.
(e) Authorization of Appropriations-
(1) IN GENERAL- There is authorized to be appropriated to carry out this
section, $50,000,000 for each of fiscal years 2008 through 2010.
(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 DUAL ELIGIBLE INDIVIDUALS.
(a) Definitions- In this section:
(1) DUALLY ELIGIBLE INDIVIDUAL- The term `dually eligible individual'
means an individual who 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 dually eligible individuals.
(1) NUMBER OF PARTICIPANTS- Not more than 5 States may participate in
the project.
(2) APPLICATION- A State that desires to participate in the project shall
submit an application to the Secretary, at such time and in such form
and manner as the Secretary shall specify.
(3) DURATION- The project shall be conducted for at least 5, but not more
than 10 years.
(d) Evaluation and Report-
(1) EVALUATION- Not later than 1 year prior to the termination date of
the project, the Secretary, in consultation with States participating
in the project, representatives of dually eligible individuals, and others,
shall evaluate the impact and effectiveness of the project.
(2) REPORT- The Secretary shall submit a report to Congress that contains
the findings of the evaluation conducted under paragraph (1) along with
recommendations regarding whether the project should be extended or expanded,
and any other legislative or administrative actions that the Secretary
considers appropriate as a result of the project.
(e) Authorization of Appropriations- There are authorized to be appropriated
such sums as are necessary to carry out this section.
END
